Table of Content

01 February 2024, Volume 30 Issue 4

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Special Column of Pediatrics

Application of WES accompanied by CNVseq in the diagnosis of pediatric genetic diseases

Zhang Hua, Liu Min, Yuan Lu, Yang Liming, Zhang Fuqing

2024, 30(4):  529-534.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.001

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Objective　To explore the significance of whole exome sequencing (WES) accompanied by copy number variation sequencing (CNVseq) in the diagnosis of pediatric genetic diseases. Methods　Children with suspected genetic diseases or unclear clinical diagnosis admitted to the departments of neonatology and pediatrics of Women & Infants Hospital of Zhengzhou from August 2019 to July 2023 were selected as the study objects. The peripheral blood of the children and their parents were collected for WES and CNVseq. The detected genetic mutations were classified according to American College of Medical Genetics and Genomics (ACMG) classification, and Sanger sequencing or qPCR was performed to verify the mutations. Results　A total of 33 children were enrolled, including 18 boys and 15 girls, aged 1 d to 8 years. The positive detection rate of WES was 36.4% (12/33), the positive detection rate of CNVseq was 9.1% (3/33), and the positive detection rate of the combination of WES and CNVseq was 45.5% (15/33). Conclusion　WES accompanied by CNVseq is a powerful tool for molecular diagnosis of pediatric genetic diseases and can be widely used as a first-line detection method in clinical practice.

Efficacy and safety of TEE guided right axillary small incision ventricular septal defect closure in children with perimembranous ventricular septal defect

Dong Xiangyang, Zhai Bo, Li Wenjing

2024, 30(4):  535-539.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.002

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Objective　To investigate the efficacy and safety of transesophageal echocardiography (TEE) guided right axillary small incision ventricular septal defect closure in the treatment of perimembranous ventricular septal defect (PmVSD). Methods　A total of 98 PmVSD children who underwent surgical treatment in Henan Children's Hospital from May 2020 to May 2021 were selected and were divided into two groups according to the operation type: a closure group (50 cases) and a repair group (48 cases). In the closure group, there were 28 boys and 22 girls, aged (3.25±0.40) years. In the repair group, there were 26 boys and 22 girls, aged (3.68±0.31) years. The closure group underwent TEE guided right axillary small incision ventricular septal defect closure, while the repair group underwent right axillary direct incision surgical repair under cardiopulmonary bypass. Both groups were followed up for 2 years. The operation conditions and the differences of myocardial injury and cardiac function were compared between the two groups. t test, χ² test, and Fisher exact probability method were used. Results　The success rates of operation in the closure group and the repair group were 98.00% (49/50) and 100.00% (48/48), respectively, and there was no statistically significant difference between the two groups (P>0.05). The operation time, ICU stay, and hospital stay in the closure group were shorter than those in the repair group [(74.25±11.58) min vs. (133.69±28.78) min, (4.60±1.00) h vs. (6.82±1.23) h, (4.05±0.69) d vs. (7.03±1.25) d] (all P<0.05), and the drainage volume within 24 h after operation was lower than that of the repair group [0 vs. (67.50±15.69) ml] (P<0.05). The levels of cardiac troponin I (cTnI) and creatine kinase isoenzyme (CK-MB) in the closure group were lower than those in the repair group 24 h after operation (both P<0.05). There were no statistically significant differences in the cardiac function indexes between the two groups before and 2 years after operation (all P>0.05). There were no statistically significant differences in the incidence of residual shunt or new tricuspid regurgitation between the two groups within 2 years after operation (all P>0.05). However, the incidences of new abnormal electrocardiogram in the closure group 3, 6, 12, and 24 months after operation were lower than those in the repair group [10.00% (5/50) vs. 27.08% (13/48), 6.00 (3/50) vs. 20.83% (10/48), 4.00% (2/50) vs. 16.67% (8/48), 2.00% (1/50) vs. 12.50% (6/48)] (all P<0.05). Conclusion　TEE-guided right axillary small incision ventricular septal defect closure and surgical repair both have good long-term follow-up results for PmVSD, but TEE guided right axillary small incision ventricular septal defect closure has the advantages of faster postoperative recovery, less myocardial damage, and more minimally invasive incision.

Effect of bacterial lysates combined with methylprednisolone on children with bronchopneumonia

Liu Hongjie, Li Xing, Cheng Xiao

2024, 30(4):  540-544.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.003

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Objective　To investigate the effect of bacterial lysates combined with methylprednisolone on the lung function, immunoglobulin (Ig), and inflammatory factors in children with bronchopneumonia. Methods　A total of 98 children with bronchopneumonia admitted to Xuchang People's Hospital from April 2021 to April 2023 were selected as the research objects, and were randomly divided into a control group (49 cases) and an observation group (49 cases) according to the two-color sphere method. The control group included 25 boys and 24 girls, aged (7.59±1.52) years. The observation group included 27 boys and 22 girls, aged (8.01±1.72) years. The control group was given methylprednisolone treatment, intravenous infusion, 1 mg/kg, qd, continuous infusion for 3 days, and on the basis the observation group was given bacterial lysate capsules, 3.5 mg/time, qd, oral fasting daily for 10 days. The clinical efficacy, recovery time of clinical symptoms, forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁), maximum expiratory flow (PEF), IgA, IgM, IgG, C-reactive protein (CRP), transforming growth factor-β1 (TGF-β1), tumor necrosis factor-α (TNF-α), and interleukin-4 (IL-4) levels before and after treatment, incidence of adverse reactions were compared between the two groups. t test and χ² test were used. Results　After treatment, the total effective rate of the observation group was 97.96% (48/49), which was higher than that of the control group [83.67% (41/49)], with a statistically significant difference (P<0.05). The recovery time of high fever, cough, shortness of breath, and rales in the observation group were shorter than those in the control group, with statistically significant differences (all P<0.05). After treatment, the PEF, FVC, and FEV₁ levels in the observation group were (3.01±0.48) L/s, (1.56±0.22) L, and (1.39±0.28) L, which were higher than those in the control group [(2.72±0.39) L/s, (1.38±0.19) L, and (1.23±0.18) L], with statistically significant differences (all P<0.05). After treatment, the levels of IgA, IgM, and IgG in the observation group were (1.35±0.12) g/L, (1.44±0.31) g/L and (10.37±1.68) g/L, which were higher than those in the control group [(1.08±0.09) g/L, (1.11±0.36) g/L, and (8.35±0.79) g/L], with statistically significant differences (all P<0.05). After treatment, the levels of TGF-β1, CRP, IL-4, and TNF-α in the observation group were decreased more 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 two groups (P>0.05). Conclusions　Bacterial lysates combined with methylprednisolone is effective in the treatment of children with bronchopneumonia, which can improve the lung function, inhibit the expressions of inflammatory factors, and improve the immunity, with good safety.

Clinical effect of lung rehabilitation training in children with severe bronchial asthma treated with salbutamol in acute stage

Zhu Yunqing, Li Fan, Qiao Xiaowu

2024, 30(4):  544-548.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.004

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Objective　To analyze the effect of lung rehabilitation training on the airway inflammatory factors and lung function in children with severe acute bronchial asthma treated with salbutamol, so as to provide therapeutic basis for clinical treatment of severe acute bronchial asthma. Methods　A prospective study was conducted on 102 children with acute attack of severe bronchial asthma who were admitted to the Third Affiliated Hospital of Zhengzhou University from September 2021 to February 2023, and the children were divided into two groups (a reference group and a treatment group) by the random number table method, with 51 cases in each group. In the reference group, there were 32 boys and 19 girls, the age was 5-12 (7.32±1.85) years old, the course of disease was 2-18 (12.30±1.28) months, and the body weight was 12-27 (21.65±2.08) kg. In the treatment group, there were 28 boys and 23 girls, the age was 6-13 (7.94±1.16) years old, the course of disease was 2-17 (11.89±2.31) months, and the body weight was 11-28 (22.32±2.17) kg. After admission, both groups were given anti-infection treatment with budesonide, the reference group was treated with salbutamol, and the treatment group was treated with salbutamol combined with pulmonary rehabilitation training. The treatment cycle of both groups was 1 month. The clinical effects, disappearance time of clinical symptoms (dyspnea, cough, wheezing, wheezing rales, and moist rales), and levels of inflammatory factors [interleukin-4 (IL-4), IL-18, IL-1β, and eosinophils (EOS)] and lung function [forced expiratory flow at 50% (FEF50%), peak expiratory flow (PEF), forced expiratory volume in the first second (FEV₁), and forced vital capacity (FVC)] before and 1 month after treatment of the two groups were compared. t and χ² tests were applied. Results　The total effective rate of the treatment group was higher than that of the reference group [96.08% (49/51) vs. 82.35% (42/51)] (χ²=4.993, P<0.05). Compared with those in the reference group [(5.23±1.03) d, (4.32±1.30) d, (2.36±0.26) d, (6.22±1.63) d, and (5.89±1.07) d], the duration of dyspnea, cough, wheezing, wheezing rales, and moist rales in the treatment group [(2.25±0.69) d, (2.03±0.85) d, (2.23±0.32) d, (5.63±1.10) d, (3.62±1.04) d] were shorter, with statistically significant differences (t=17.166, 10.529, 2.252, 2.143, and 10.864, all P<0.05). After 1 month of treatment, the levels of serum IL-4, IL-18, IL-1β, and EOS in the treatment group were lower than those in the reference group [(25.30±3.96) ng/L vs. (28.30±3.47) ng/L, (92.03±7.36) ng/L vs. (100.65±8.66) ng/L, (2.03±0.26) ng/L vs. (2.89±0.32) ng/L, (1.06±0.39)% vs. (2.84±0.52)%], with statistically significant differences (t=4.069, 5.417, 14.896, and 19.557, all P<0.05). After 1 month of treatment, the levels of FEF50%, PEF, FEV1, and FVC in the treatment group were higher than those in the reference group, with statistically significant differences (all P<0.05). Conclusion　Lung rehabilitation training can improve the clinical effect, shorten the disappearance time of clinical symptoms such as dyspnea and cough, alleviate the airway inflammation, promote the recovery of lung function, and accelerate the recovery in children with severe bronchial asthma treated with salbutamol in acute stage.

Application of nursing model based on management by objectives theory in neonates with hyperbilirubinemia

Feng Fuyun, Cao Jing, Shi Lanlan

2024, 30(4):  549-552.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.005

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Objective　To explore the application of nursing model based on management by objectives theory in neonates with hyperbilirubinemia. Methods　From January 2021 to January 2023, 94 neonates with hyperbilirubinemia in Children's Hospital Affiliated to Zhengzhou University were selected and were divided into a management group (47 cases) and a routine group (47 cases) according to the order of admission. There were 25 boys and 22 girls in the routine group, with a gestational age of 36-42 (39.03±1.07) weeks. In the management group, there were 21 boys and 26 girls, with a gestational age of 36-42 (38.94±1.12) weeks. Routine nursing was carried out in the routine group, while nursing model based on management by objectives theory was carried out in the management group on the basis of the routine group. Both groups were intervened until the recovery of the children's condition. The serum bilirubin levels and sleep time [Brief Infant Sleep Questionnaire (BISQ)] before and after intervention, jaundice resolution time, discomfort symptoms, and family satisfaction [Newcastle Satisfaction with Nursing Scale (NSNS)] were compared between the two groups. t test and χ² test were used. Results　After intervention, the level of serum bilirubin in the management group was lower than that in routine group [(157.49±15.82) μmol/L vs. (204.83±15.29) μmol/L] (P<0.05). The time of jaundice resolution in the management group was shorter than that in the routine group [(6.36±1.27) d vs. (7.13±1.06) d], with a statistically significant difference (t=3.191, P=0.002). After intervention, the daytime sleep time and nighttime sleep time [(8.32±1.39) h and (8.55±1.29) h] in the management group were longer than those in the routine group [(7.30±1.41) h and (7.62±1.34) h] (both P<0.05). There was no statistically significant difference in the total incidence of discomfort symptoms between the management group [8.51% (4/47)] and the routine group [21.28% (10/47)] (P>0.05). The family satisfaction in the management group [95.74% (45/47)] was higher than that in the routine group [68.09% (32/47)] (P<0.05). Conclusion　Applying the nursing model based on management by objectives theory to neonates with hyperbilirubinemia can reduce the level of serum bilirubin, shorten the regression time of jaundice, prolong the sleep time, and improve the satisfaction of family members.

Application of MEBO in the wound repair for children with large area port-wine stains treated by laser

Liu Xiaojia, Wu Jihong, Luo Tao, Luo Mingcan, Li Gaofeng, Tan Jun

2024, 30(4):  553-558.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.006

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Objective　To observe the effect of moisture exposed burn ointment (MEBO) combined with pulsed dye laser on enhancing the overall treatment effect of large area port-wine stains in children, and to guide the treatment of clinically relevant diseases. Methods　This was a randomized controlled trial. A total of 60 children with large area port-wine stains admitted to Hunan Provincial People's Hospital from January 2022 to September 2022 were selected as the research objectives, and were divided into two groups using the random number table method, with 30 cases in each group. There were 12 boys and 18 girls in the control group, with an age of (6.25±1.02) years old. There were 10 boys and 20 girls in the experimental group, with an age of (6.35±1.05) years old. The control group received 595 nm pulsed dye laser treatment combined with conventional anti-inflammatory ointment to care for the wound, while the experimental group received 595 nm pulsed dye laser combined with MEBO to care for the wound. The treatment effect, degree of red nevus scar regression [evaluated using the Vancouver Scar Scale (VSS)], degree of pain (evaluated using the International Digital Pain Rating System), and adverse reactions were compared between the two groups. t test, χ² test, and rank sum test were used. Results　The total effective rate of the experimental group was higher than that of the control group [96.67% (29/30) vs. 70.00% (21/30)], with a statistically significant difference (χ²=7.680, P<0.05). At the end of treatment, the regression degree of nevus scar (VSS score) of the experimental group was lower than that of the control group [(1.25±0.85) points vs. (4.02±1.12) points], with a statistically significant difference (t=10.791, P<0.05). At the end of treatment, the pain degree of the experimental group was lower than that of the control group [(1.02±0.25) vs. (3.02±0.52)], with a statistically significant difference (t=18.986, P<0.05). The total incidence of adverse reactions in the experimental group was lower than that in the control group [10.00% (3/30) vs. 43.33% (13/30)], with a statistically significant difference (χ²=8.523, P<0.05). Conclusion　MEBO combined with 595 nm pulsed dye laser can significantly improve the therapeutic effect of large area port-wine stains in children, which facilitates the subsidence of red nevus scar, improves the degree of pain, promotes the children's comfort in the process of treatment, and is safe and reliable.

Effect of ultrasound-guided nursing program in preventing pressure ulcers in children during the ECMO operation period

Li Dandan, Wang Huanhuan, Ji Xianghua, Kou Xiangcao, Luo Leng, Sun Yuyan

2024, 30(4):  559-563.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.007

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Objective　To assess the effects of different nursing programs, namely traditional pressure ulcer prevention interventions and ultrasound-guided nursing program combined with traditional pressure ulcer prevention interventions, on observed indicators in children during the extracorporeal membrane oxygenation (ECMO) operation period. Methods　Sixty children during the ECMO operation period admitted to Children's Hospital Affiliated to Zhengzhou University from June 2020 to June 2022 were randomly divided into a control group and an observation group, with 30 cases in each group. In the control group, there were 18 boys and 12 girls; the age was 5-14 (10.74±1.63) years old; there were 7 cases of cardiovascular diseases, 5 cases of respiratory diseases, 4 cases of gastrointestinal diseases, 8 cases of surgical diseases, and 6 cases of other diseases. In the observation group, there were 16 boys and 14 girls; the age was 5-13 (10.72±1.55) years old; there were 8 cases of cardiovascular diseases, 6 cases of respiratory diseases, 3 cases of gastrointestinal diseases, 9 cases of surgical diseases, and 4 cases of other diseases. After enrollment, the control group received traditional pressure ulcer prevention interventions, while the observation group received ultrasound-guided nursing program combined with traditional pressure ulcer prevention interventions. Nursing till discharge, the nursing effects of different nursing intervention schemes were compared by observing the data of indicators. t test and χ² test were used. Results　The incidence of pressure ulcers in the observation group [6.67% (2/30)] was lower than that in the control group [26.67% (8/30)], and the length of hospital stay [(14.71±2.59) d], the use time of vasoactive drugs [(15.34±2.38) h], and the ECMO support time [(8.91±2.51) d] were shorter than those in the control group [(20.38±3.39) d, (23.55±2.45) h, and (12.05±3.54) d], with statistically significant differences between the two groups (χ²=4.320, t=7.280, 13.165, and 3.963; all P<0.05). Nursing till discharge, the Short Form 36 (SF-36) scores (social function, physical function, psychological function, and role function) of the observation group were (86.64±5.48) points, (82.28±5.41) points, (82.54±5.51) points, and (84.17±5.48) points, which were higher than those of the control group [(74.35±5.61) points, (73.59±5.37) points, (71.41±5.48) points, and (70.21±5.53) points], with statistically significant differences between the two groups (t=5.584, 5.584, 7.845, and 9.821, all P<0.05). Nursing till discharge, the Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) scores of the control group and the observation group [(48.27±4.64) and (41.28±3.51) points, (42.10±4.79) and (33.59±3.57) points] were decreased compared with those before nursing [(52.49±4.33) and (49.35±2.61) points, (51.67±4.29) and (48.64±2.48) points], and those of the observation group were lower than those of the control group (all P<0.05). Nursing till discharge, the satisfaction scores (health education, environmental comfort, nurses' attitude, nursing operation, and treatment effect) of family members of the observation group were (16.22±2.47) points, (17.28±2.45) points, (16.48±2.72) points, (18.36±1.12) points, and (18.01±1.51) points, which were higher than those of the control group [(14.18±2.58) points, (15.66±2.51) points, (13.56±2.59) points, (12.28±2.33) points, and (13.40±2.61) points], with statistically significant differences between the two groups (t=3.128, 2.530, 4.258, 12.882, and 8.374, all P<0.05). The treatment compliance of the observation group was higher than that of the control group [90.00% (27/30) vs. 73.33% (22/30)], with a statistically significant difference (χ²=4.320, P=0.038). Conclusion　The use of ultrasound-guided nursing program in children during the ECMO operation period can shorten the recovery time, improve the psychological status, enhance the quality of life, increase the treatment compliance and family satisfaction, and prevent the pressure ulcers.

A child with lower limb osteomyelitis complicated with deep vein thrombosis

Zhang Sheng, Cai Huiqiang, Hou Chongzhi, Su Jing

2024, 30(4):  564-567.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.008

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Lower limb osteomyelitis is a common infectious disease in children's orthopedics. The common bacterium is Staphylococcus aureus, which is also easy to cause deep vein thrombosis in the lower limbs. Osteomyelitis is similar to deep vein thrombosis, including lower limb swelling, local skin redness, etc., which are not easy to be distinguished. Early blood D-dimer detection, lower limb magnetic resonance examination, and vascular B-ultrasound are the main means of diagnosis. The treatment of osteomyelitis includes anti-infective therapy of sensitive antibiotics and drilling drainage of suppurated bone marrow; the treatment of deep vein thrombosis mainly includes low molecular weight heparin anticoagulation, urokinase thrombolysis, and other treatments. This paper reports a child with right lower limb tibial osteomyelitis complicated with deep vein thrombosis admitted to Xi'an Children's Hospital in 2022, and analyzes her clinical manifestations and diagnosis and treatment process.

Study on the infection status of pediatric bacterial diarrhea and application of microbial testing techniques

Geng Baishao

2024, 30(4):  568-571.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.009

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Objective　To analyze the infection status of bacterial diarrhea in children and the application effects of different microbial testing techniques. Methods　This was a retrospective study. The cases included were 100 children with bacterial diarrhea admitted to Ruyang County Hospital of Traditional Chinese Medicine from January 2021 to April 2023, and 25 healthy volunteers were used as controls. There were 52 boys and 48 girls in the case group, aged 1-10 (5.53±1.46) years. There were 13 boys and 12 girls in the control group, aged 2-9 (5.44±1.28) years. The pathogenic microorganism infection of the cases was counted according to the results of pathogenic microbiological culture. Using the results of pathogenic microbiological culture as the gold standard, the diagnostic efficacies of latex agglutination test (LA) and enzyme-linked immunosorbent assay (ELISA) for bacterial diarrhea in children were compared. χ² test and independent sample t test were used. Results　According to statistics, bacterial diarrhea was more common in children aged 2-6 years, mostly occurring from October to February, boys more than girls. Among the 100 children with bacterial diarrhea, the infection rate of Shigella was 36.00% (36/100), that of pathogenic Escherichia coli was 25.00% (25/100), that of toxigenic Escherichia coli was 20.00% (20/100), that of fetal Campylobacter was 10.00% (10/100), and that of Salmonella was 9.00% (9/100). The diagnostic accuracy, sensitivity, and specificity of LA detection for pediatric bacterial diarrhea were 87.20% (109/125), 88.00% (88/100), and 84.00% (21/25), respectively, which were all higher than those of ELISA [71.20% (89/125), 72.00% (72/100), and 68.00% (17/25)], with statistically significant differences (all P<0.05). Conclusions　Bacterial diarrhea is more common in autumn and winter seasons, and it is more common in children aged 2-6 years. Shigella is a common type of infection. LA can achieve effective diagnosis of bacterial diarrhea in children, and its test results may serve as an important basis for guiding clinical treatment.

Investigation and analysis of eye hygiene status and related eye diseases among school-age children

Chen Gaoteng, Fu Aicun, Li Haiping, Meng Jia

2024, 30(4):  572-576.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.010

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Objective　To investigate the eye hygiene status and the prevalence of related eye diseases among school-age children. Methods　This study was a cross-sectional study. Four primary schools in Zhengzhou City were randomly selected by stratified cluster sampling based on urban and township areas from October to December 2022. Two classes of students in each grade of each school were randomly selected as the survey subjects. A total of 1 882 school-age children were selected, including 996 males and 886 females, and aged 6-14 years. The prevalence of eye diseases and the level of eye hygiene in children were investigated. Independent sample t test was used to compare the measurement data between the two groups, and univariate analysis of variance and SNK-q test were used to compare the multiple samples. χ² test or Fisher exact probability method was used to compare the count data. Results　The detection rate of eye diseases in school-age children was 25.08% (472/1 882), of which refractive error (275 cases) and conjunctivitis (164 cases) accounted for the highest proportion. The detection rates of refractive error and conjunctivitis in female were higher than those in male (both P<0.05). The detection rate of refractive error increased in grade one and two, grade three and four, and grade five and six (all P<0.05). The detection rate of refractive error in urban schools was higher than that in township schools (P<0.05). The effective recovery rate of the eye hygiene survey questionnaires was 98.25% (1 849/1 882). The scores of knowledge, attitude, and behavior of eye hygiene and total score among school-age children were (10.92±2.47) points, (4.49±1.02) points, (36.76±5.73) points, and (52.17±8.84) points, respectively. The total score of eye hygiene increased in grade one and two, grade three and four, and grade five and six (all P<0.05), and the total score of eye hygiene in urban schools was higher than that in township schools (P<0.05). The total scores of eye hygiene in children with amblyopia, strabismus, and refractive error were lower than that in children without eye diseases (all P<0.05). Conclusions　Refractive error and conjunctivitis are common eye diseases in school-age children, and there are differences in the distribution of eye diseases among different genders, grades, and school regions. The level of eye hygiene among school-age children needs to be improved, and there are differences in eye hygiene levels among different grades, school regions, and eye disease situations. It is necessary to strengthen the health education, eye disease screening and prevention and control work for school-age children.

New Medical Advances

Research progress and treatment strategies of intestinal immune factors in inflammatory bowel disease

Pan Guangtao, Chen Aiying

2024, 30(4):  577-581.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.011

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Inflammatory bowel disease (IBD) is a chronic intestinal inflammatory disease caused by a variety of causes. In recent years, with the deepening of research, intestinal immune factors have gradually been paid attention to by clinical and researchers, providing an emerging research direction for IBD. We have traced related literature researches in the domestic and foreign medical databases such as PubMed/Medline/Cochrane/SinoMed/CNKI/Wanfang/CQVIP in the past 20 years, and summarize the mechanisms of intestinal nutrition, intestinal microenvironment, intestinal oxygen supply, intestinal immune factors, and circadian rhythm involved in the pathogenesis of IBD, in order to explore new therapeutic targets and lay a foundation for further study of IBD.

Research progress on the characteristics and new diagnostic and treatment strategies of Klebsiella pneumoniae bloodstream infection in ICU patients

Chen Qiuyu, Liu Xiangtian, Ye Liping, Tian Xinghan

2024, 30(4):  581-585.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.012

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In recent years, bloodstream infection (BSI) caused by Klebsiella pneumoniae (Kp) in intensive care unit (ICU) has attracted attention in recent years due to an alarming rise in morbidity and mortality. With the increasing number of Kp-BSI patients and the development of studies, the characteristics of Kp-BSI in ICU have been further explored in clinical practice. Moreover, with the development of metagenomic Next Generation Sequencing technology, droplet digital PCR, machine learning, and other novel etiological diagnostic technologies, a new horizon has been opened for the etiological diagnosis of Kp-BSI in ICU. At the same time, the development of new antibiotics and the improvement of various therapeutic measures are expected to reduce the mortality of Kp-BSI patients in ICU. This article reviews the occurrence characteristics of ICU-Kp-BSI, its new diagnosis and treatment methods, and looks forward to the future research direction, so that we can provide some new ideas for clinical diagnosis and treatment of ICU-Kp-BSI in the future.

Research progress of puerarin in respiratory diseases

Gu Lulu, Wu Fuling

2024, 30(4):  586-589.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.013

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Puerarin has a wide range of pharmacological properties, such as anti-inflammatory, antioxidant, and anticancer effects. Recent studies have shown that puerarin has many advantages in the treatment of respiratory diseases. This paper summarizes the latest progress of puerarin in respiratory diseases, in order to provide it with promising drugs.

Meta Analysis

Meta-analysis of the effect of traditional Chinese medicine mouthwash on ventilator-associated pneumonia in patients with tracheal intubation

Wei Tingyu, Jiang Weiting, Li Zimeng, Jiang Yaxin, Chen Bizhen

2024, 30(4):  590-596.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.014

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Basic Research

Efficacy of mesenchymal stem cells mitigating VAP-induced lung injury by inhibiting PI3K/Akt signaling pathway

Zhu Jianqiu, Luo Xing, Xie Yingqiu, Zhu Youfeng

2024, 30(4):  597-601.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.015

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Objective　Ventilator-associated pneumonia (VAP) is the most common infectious disease in mechanically ventilated patients, which seriously decreases the prognosis of critically ill patients, but its pathogenesis is still unclear. This study investigated the effect of mesenchymal stem cells (MSCs) on the inflammatory response of alveolar epithelial cells during VAP development. Methods　This study was conducted from May 2020 to March 2023. In this study, VAP rat animal model was established and MSCs were extracted and identified. Fifteen rats were randomly divided into 3 groups: a control group, a VAP group, and a VAP+MSCs group. The alveolar epithelial cells of the control group and the VAP group were cultured alone in the incubator, and the alveolar epithelial cells of the VAP+MSCs group were co-cultured with the MSCs in the incubator. After 48 hours, the expressions of phosphatidylinositol 3-kinase (PI3K), serine/threonine protein kinase (Akt), and downstream inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-1α (IL-1α), and γ-interferon (IFN-γ)] were detected by real-time fluorescence quantitative nucleic acid amplification assay (qPCR) and enzyme-linked immunosorbent assay (ELISA). Independent sample t test and one-way analysis of variance were used. Results　The results of qPCR and ELISA showed that the expression levels of PI3K, Akt, and downstream inflammatory factors (TNF-α, IL-1α, and IFN-γ) were the lowest in the control group; the mRNA expression levels of PI3K, Akt, and downstream inflammatory factors (TNF-α, IL-1α, and IFN-γ) in the VAP group were higher than those in the other two groups; the levels of inflammatory factors in the VAP+MSCs group were higher than those in the control group, but were lower than those in the VAP group, with statistically significant differences (all P<0.05). Conclusion　MSCs may inhibit the inflammatory factor expression in alveolar epithelial cells by inhibiting the PI3K/Akt signaling pathway, thus achieving the inhibition or mitigation of VAP.

Treatises

Correlation between serum KL-6 level and PD-1 associated immune pneumonia in patients with NSCLC

Hu Shaobo, Zhang Nali, Cheng Jingmei

2024, 30(4):  602-605.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.016

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Objective　To analyze the relationship between serum Krebs Von den Lungen-6 (KL-6) level and programmed death receptor-1 (PD-1) associated immune pneumonia in patients with non-small cell lung cancer (NSCLC). Methods　A total of 72 patients with NSCLC admitted to Luoyang Central Hospital from January 2021 to December 2022 were selected, who were treated with PD-1 inhibitor for 1 month. There were 43 males and 29 females, aged 63-75 (68.54±3.83) years. Serum KL-6 level was detected before and after 1 month of treatment. The occurrence of PD-1 associated immune pneumonia was observed within 3 months after treatment, and the relationship between the occurrence of PD-1 associated immune pneumonia and serum KL-6 level before and after treatment was compared. t test, χ² test, and point two-column correlation analysis were used. Results　After the patients were treated with PD-1 inhibitor, 5 cases developed associated immune pneumonia, with an incidence of 6.94%. The serum KL-6 level in the occurrence group was (1 518.72±263.67) U/ml before treatment and (1 185.36±207.15) U/ml after treatment, which were higher than those in the non-occurrence group [(1 064.01±185.09) U/ml and (879.44±112.06) U/ml], with statistically significant differences (both P<0.05). By point two-column correlation analysis, the occurrence of PD-1 associated immune pneumonia was positively correlated with serum KL-6 level before and after treatment (r=0.524 and 0.551, both P<0.001). Conclusion　During PD-1 inhibitor therapy, the occurrence of PD-1 associated immune pneumonia is positively correlated with pre- and post-treatment serum KL-6 levels, and patients with higher serum KL-6 level before treatment are more likely to develop associated immune pneumonia after treatment.

Effect of oral high-glucose solution before laparoscopy on patients with colorectal cancer

Du Shengwang, Shi Chunqiang, Wu Xinjun, Zhang Tingting

2024, 30(4):  606-609.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.017

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Objective　To investigate the effects of oral high-glucose solution before laparoscopy on postoperative gastrointestinal function, inflammation response, and insulin resistance in patients with colorectal cancer. Methods　A total of 78 patients with colorectal cancer admitted to Lianyungang Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from May 2020 to July 2022 were selected as the study objects. They were divided into 2 groups by the random number table method: an observation group (39 cases) and a control group (39 cases). In the observation group, there were 20 males and 19 females, aged 38-75 (56.65±8.43) years, Dukes stage: 21 cases of stage Ⅰ and 18 cases of stage Ⅱ. In the control group, there were 19 males and 20 females, aged 39-74 (55.79±8.39) years, Dukes stage: 22 cases of stage Ⅰ and 17 cases of stage Ⅱ. The control group received conventional treatment, and the observation group received oral high-glucose solution. Postoperative gastrointestinal function, inflammatory response, insulin resistance index, and complications were compared between the two groups. Independent sample t test, paired t test, and χ² test were used. Results　After treatment, the postoperative anal exhaust time, the first postoperative defecation time, and the hospital stay in the observation group were (23.97±2.85) h, (14.35±5.43) h, and (5.69±0.87) d, respectively, which were shorter than those in the control group [(34.68±3.94) h, (21.06±7.47) h, and (9.52±1.14) d], with statistically significant differences (all P<0.05). After treatment, the levels of tumor necrosis factor α (TNF-α), C-reactive protein (CRP), and interleukin-6 (IL-6) in the observation group were (141.85±30.29) ng/L, (8.69±2.05) mg/L, and (7.34±0.93) ng/L, respectively, which were lower than those in the control group [(182.46±33.37) ng/L, (15.33±2.78) mg/L, and (9.97±1.54) ng/L], with statistically significant differences (all P<0.05). After treatment, the insulin resistance index of the observation group was lower than that of the control group [(5.14±0.31) vs. (7.75±0.96)], with a statistically significant difference (P<0.05). After treatment, the total incidence of complications in the observation group was 10.25% (4/39), which was lower than that in the control group [28.21% (11/39)], with a statistically significant difference (P<0.05). Conclusion　The oral administration of high-glucose solution before laparoscopy can effectively improve the postoperative gastrointestinal function in patients with colorectal cancer, reduce the level of inflammation, improve their insulin resistance, and reduce the incidence of complications, which is worthy of promotion.

Effect of Simo decoction on gastrointestinal hormone level in patients with cholelithiasis after operation

Zhang Tingting, Du Shengwang, Wu Xinjun, Zhu Maoshan

2024, 30(4):  610-614.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.018

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Objective　To investigate the effect of Simo decoction on gastrointestinal hormone level in patients with cholelithiasis after operation. Methods　A total of 102 patients with cholelithiasis admitted to Lianyungang Traditional Chinese Medicine Hospital from January 2019 to January 2022 were selected for this study, who all underwent laparoscopic cholecystectomy (LC). After operation, the patients were divided into an observation group and a control group according to the random number table method, with 51 cases in each group. In the observation group, there were 20 males and 31 females; the patients were aged 22-64 years, with an age of (43.17±3.74) years old; they were treated with conventional anti-infection and liver protection therapy plus Simo decoction. In the control group, there were 21 males and 30 females; the patients were aged 21-63 years, with an age of (42.62±3.49) years old; they were given routine anti-infection and liver protection treatment. The treatment effects of the two groups were compared, and the traditional Chinese medicine (TCM) symptom scores of abdominal distension, loss of appetite, pulse string, chest tightness and nausea, frequent belching, and red tongue and white fur were compared between the two groups before and after treatment. The anal exhaust time, bowel call relief time, defecation time, and feeding time of the two groups were compared. The levels of gastrin (GAS), motilin (MTL), and somatostatin (SS) before and after treatment were compared between the two groups, and the adverse reactions were compared between the two groups. Independent sample t test and paired t test were used for the measurement data, and χ² test was used for the count data. Results　The total effective rate of the observation group was significantly higher than that of the control group [92.16% (47/51) vs. 70.59% (36/51)], with a statistically significant difference (χ²=7.826, P=0.005). After treatment, the TCM symptom scores of abdominal distension, loss of appetite, pulse string, chest tightness and nausea, frequent belching, and red tongue and white fur in the observation group were lower than those in the control group (all P<0.05). Compared with those in the control group, the duration of anal exhaust [(33.56±5.44) h], bowel sound relief time [(18.76±3.28) h], defecation time [(40.56±6.67) h], and feeding time [(37.27±6.24) h] were shorter in the observation group (all P<0.05). After treatment, the level of GAS [(112.87±18.25) ng/L] and MTL [(203.81±22.13) ng/L] in the observation group were lower than those in the control group, and the level of SS [(48.96±8.09) ng/L] was higher than that in the control group (all P<0.05). The total incidence of adverse reactions in the observation group was lower than that in the control group [3.92% (2/51) vs. 17.64% (9/51)], with a statistically significant difference (χ²=4.993, P=0.025). Conclusion　Simo decoction can effectively relieve the clinical symptoms in cholelithiasis patients after operation, shorten the recovery time of various indexes of gastrointestinal function, regulate the gastrointestinal hormone level, and have high safety and less adverse reactions.

Clinical effect of supersmooth coated tracheal catheter for nasal tracheal intubation

Jiang Jianfeng, Sun Yanyuan, Yan Yunfei, Li Tingting, Kuang Xin

2024, 30(4):  614-618.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.019

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Objective　To compare the difficulty and complications of nasal tracheal intubation guided by visual laryngoscope between supersmooth coated tracheal catheter and ordinary reinforced catheter. Methods　This study was a randomized controlled trial. A total of 120 patients were prospectively selected from Shenzhen University General Hospital from June 2023 to August 2023 for elective surgery under general anesthesia through nasal tracheal intubation, including patients in stomatology and spinal orthopedics, with American Society of Anesthesiologists (ASA) grade Ⅰ to Ⅲ, aged 18 to 65 years, regardless of gender. The patients were divided into two groups by the random number table method: a supersmooth coated tracheal catheter group (group C) and an ordinary reinforced tracheal catheter group (group P), with 60 cases in each group. The time of catheter passing through the nasal cavity, catheter tip bloodstain score (B₁), cuff bloodstain score (B₂), and total injury score (B=B₁+B₂) were recorded. The mean arterial pressure (MAP), heart rate (HR), and pulse oxygen saturation (SpO₂) were recorded before intubation (t₁), after the catheter passing through the nasal cavity (t₂), and 1 min after passing through the glottis (t₃). t test, analysis of variance for repeated measurements, and χ² test were used. Results　During the process of nasal tracheal intubation, the time of catheter passing through the nasal cavity [(8.43±4.85) s] in group C was shorter than that in group P [(17.00±8.91) s], with a statistically significant difference (P<0.05). The incidence of catheter tip bloodstain in group C [9.4% (5/53)] was lower than that in group P [27.6% (16/58)], with a statistically significant difference (P<0.05). Comparison of HR at 3 time points in group P showed statistically significant differences (all P<0.05). Conclusion　Supersmooth coated tracheal catheter is a safe and effective tool for nasal tracheal intubation, which can shorten the time of catheter passing through the nasal cavity, reduce the damage of the catheter tip to the nasal cavity, and is beneficial for the stability of hemodynamics.

Clinical Research

Diagnostic value of treadmill exercise test combined with resting electrocardiogram in coronary heart disease

Yan Rong, Hu Guangcui, Pang Hongfeng, Yu Jie

2024, 30(4):  619-622.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.020

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Objective　To explore the diagnostic value of treadmill exercise test (TET) combined with resting electrocardiogram (ECG) in the assessment of coronary heart disease (CHD). Methods　A total of 100 suspected CHD patients admitted to Yantai Mountain Hospital from January 2020 to January 2023 were included in the study, with an age of 32-75 (52.43±2.18) years old and a body mass index of (23.55±1.87) kg/m². Using the diagnosis result of coronary angiography (CAG) as the "gold standard", all patients underwent resting ECG and TET. The diagnostic efficacies of ECG, TET, and ECG combined with TET in CHD were compared. χ² test was used. Results　The ECG results showed 65 positive cases, 35 negative cases, and 6 misdiagnoses. The TET results showed 72 positive cases, 28 negative cases, and 4 misdiagnoses. TET was found to be more accurate than ECG and be closer to the CAG diagnostic results. When combining ECG and TET, the results showed 76 positive cases, 24 negative cases, and 2 misdiagnoses. The combination of ECG and TET was more accurate than ECG or TET alone, and had better consistency with the CAG diagnostic results. The area under the curve (AUC) for the combination of ECG and TET was 0.913, with a sensitivity of 92.50% and a specificity of 90.00%, both of which were higher than the results for ECG and TET individually. Conclusion　The combination of resting ECG and TET offers good diagnostic value in the assessment of CHD.

Pathogenic bacteria, drug resistance, and antibiotic use in elderly patients with cerebral infarction and pulmonary infection

Liu Hui, Li Zhuomin

2024, 30(4):  623-627.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.021

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Objective　To investigate the pathogenic bacteria, drug resistance, and antibiotic use in elderly patients with cerebral infarction and pulmonary infection. Methods　A total of 222 elderly patients with cerebral infarction admitted to the Third People's Hospital of Liaocheng from January to June 2023 were selected as the study subjects, including 137 males and 85 females, aged 60-85 (71.39±5.47) years. Their morning sputum from deep respiratory tract was collected to identify the pathogenic bacteria by the VITEK^®2 Compact system, and the drug resistance was tested by the K-B method. The use of antibiotics was analyzed. Results　Among the 222 elderly patients with cerebral infarction, 60 patients developed pulmonary infection, with an incidence of 27.03%. A total of 136 strains of pathogenic bacteria were isolated from the 60 patients, including 27 (19.85%) strains of Gram-positive bacteria, 104 (76.47%) strains of Gram-negative bacteria, and 5 (3.68%) strains of fungi. The main Gram-positive bacteria had high resistance to erythromycin, penicillin, and ampicillin, but low resistance to linezolid, vancomycin, nitrofurantoin, tigecycline, and tetracycline. Among the main Gram-negative bacteria, Klebsiella pneumoniae had low resistance to cefepime, cefotetan, tobramycin, ceftazidime, cefazolin, and piperacillin; E. coli had high resistance to amikacin, ceftazidime, levofloxacin, piperacillin, ciprofloxacin, gentamicin, and cefazolin, but low resistance to cefuroxime, cefotetan, and piperacillin/tazobactam; Pseudomonas aeruginosa had high resistance to piperacillin/tazobactam and cefazolin, but low resistance to amikacin, cefepime, tobramycin, imipenem, levofloxacin, and cefotetan. Among the 60 patients, 55 were treated with antibiotics alone, accounting for 91.67%. Among the antibiotics used, cephalosporins, compound preparations, and quinolones were used most frequently, and the main drugs were piperacillin/tazobactam, levofloxacin, and ceftizoxime. Conclusions　Gram-negative bacteria such as Klebsiella pneumoniae, E. coli, and Pseudomonas aeruginosa are main pathogenic bacteria in the sputum of elderly patients with cerebral infarction and pulmonary infection, which are highly resistant to some commonly used drugs. Identification of pathogenic bacteria and drug sensitivity test can help effectively prevent and treat pulmonary infection in elderly patients with cerebral infarction in clinical practice.

Discussion on the dialectical thinking of chronic atrophic gastritis based on "dredging collaterals and guiding stagnation"

Zhang Yuanrong, Ban Jiangwen, Chen Wenwen, Wang Shaomin, Sun Xuran, Tan Bao

2024, 30(4):  628-631.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.022

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Chronic atrophic gastritis (CAG) is a refractory disease of the digestive system, and its incidence is increasing year by year. At present, there is a lack of clear and effective treatment for CAG in western medicine. Professor Tan Bao has been committed to the clinical and basic research of traditional Chinese medicine for the prevention and treatment of CAG for a long time, constantly promoting the innovation. Under the idea of syndrome differentiation combined with disease differentiation and macroscopic combined with microcosmic, and combined with modern pharmacological research, he has formed the dialectical thinking of "dredging collaterals and guiding stagnation". The dialectical thinking is mainly based on invigorating the spleen, and flexibly uses the methods of soothing the liver, promoting the blood circulation, and detoxification. He has achieved satisfactory results in clinic, and most patients are highly dependent. Not only the patients' symptoms have been obviously relieved, the pathology has been reversed. This paper describes in detail Professor Tan Bao's ideas and methods of clinical treatment of CAG in recent years, which can be used for reference for clinical diagnosis and treatment of CAG. A clinical case is attached and shared with colleagues.

Case Report

A case report of tumor heterogeneity after neoadjuvant chemotherapy for refractory locally advanced triple-negative breast cancer

Gao Yongchang, Yao Qingjuan

2024, 30(4):  632-634.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.023

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The clinical manifestations, pathological characteristics, neoadjuvant treatment plan, heterogeneity changes in tumor genes, Miller-Payne (MP) classification, and surgery and other treatment plans of a patient with refractory locally advanced triple-negative breast cancer admitted to General Surgery, Tianjin Medical University General Hospital were analyzed. A specific subgroup of refractory locally advanced triple-negative breast cancer patients experiences molecular subtype conversion and molecular gene heterogeneity changes after neoadjuvant chemotherapy, which enhances the sensitivity of triple-negative breast cancer patients to conventional resistant chemotherapy regimens and improves their final comprehensive treatment decision-making. This kind of disease is relatively rare in actual clinical treatment, and it is easy for certain groups of people to be misdiagnosed and delayed in treatment. It helps to gradually form a consensus on treatment to summarize this kind of cases.

One case of acquired cystic kidney disease-associated renal cell carcinoma with ruptured bleeding and urinary leakage

Tang Yan, Wang Lijuan, Hou Guoqi, Li Yingming

2024, 30(4):  634-637.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.024

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Acquired cystic kidney disease-associated renal cell carcinoma (ACKD-RCC) is the most common type of renal cell carcinoma that occurs in patients with acquired cystic kidney disease. Due to the unique histopathology of this tumor, it is listed as one of the newly added renal cell carcinoma subtypes in the 2016 edition of the WHO Classification of Renal Tumors. At present, there are few reports on this tumor and most of them are case reports. This paper reports a case of ACKD-RCC, and summarizes its clinicopathological features by referring to relevant literatures, in order to improve the understanding on this rare subtype of renal cell carcinoma.

Stem cell therapy for a patient with cirrhosis and psoriasis: a case report and literature review

Wang Fengmei, Zhang Wenhua, Chen Duozhao, Bai Zhaojuan

2024, 30(4):  638-640.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.025

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Psoriasis is a chronic, recurrent disease characterized by squamous erythema or plaques, which are localized or widely distributed. The condition is recurrent and seriously affects patients' quality of life. During the decompensated phase of hepatitis B cirrhosis, various complications may occur, such as ascites and gastrointestinal bleeding. Mesenchymal stem cells (MSCs) are pluripotent non hematopoietic stromal cells that exist in different body tissues. In recent years, they have been attempted to be applied in patients with decompensated liver cirrhosis and psoriasis, and some patients have achieved good results. In this paper, a patient with decompensated liver cirrhosis and psoriasis was treated by stem cell therapy, and he achieved good results, which provided a certain reference value for the treatment of such patients.

Nursing Research

Application of outcome guided bicardiac service in patients with unstable angina pectoris of coronary heart disease during the perioperative period of PCI 

Zhang Zhan, Li Xing, Mo Linqin, Su Yanlin, Sun Yanbin

2024, 30(4):  641-646.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.026

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Objective　To investigate the application effect of outcome guided bicardiac service in the perioperative period of percutaneous coronary intervention (PCI) for patients with unstable angina pectoris (UAP). Methods　It was a randomized controlled trial. A total of 100 patients with UAP undergoing PCI in Wuxi Second People's Hospital from October 2020 to February 2022 were randomly divided into a control group and a study group, with 50 cases in each group. The age of the study group was (53.68±7.22) years old; there were 31 males and 19 females; the body mass index (BMI) was (24.28±3.12) kg/m²; the course of disease was (3.02±0.61) years; the New York Heart Association (NYHA) classification was grade Ⅰ in 21 cases, grade Ⅱ in 15 cases, and grade Ⅲ in 14 cases; the number of coronary artery lesions was single vessel in 17 cases, double vessels in 20 cases, and three or more vessels in 13 cases. The control group was (55.32±5.76) years old; there were 28 males and 22 females; the BMI was (23.89±3.18) kg/m²; the course of disease was (2.89±0.57) years; the NYHA classification was grade Ⅰ in 23 cases, grade Ⅱ in 15 cases, and grade Ⅲ in 12 cases; the number of coronary artery lesions was single vessel in 15 cases, double vessels in 23 cases, and three or more vessels in 12 cases. The control group received the routine nursing mode during the perioperative period, and the study group received the outcome guided bicardiac service mode on the basis of the control group. Both groups were intervened till discharge. The anxiety and depression, cardiac function indexes [left ventricular ejection fraction (LVEF) and B-type natriuretic peptide (BNP)], complications, and Seattle Angina Questionnaire (SAQ) scores of the two groups were compared before and after intervention. t test was used for the measurement data, χ² test or Fisher exact probability method for the count data, and rank sum test for the rank data. Results　After intervention, the scores of Self-rating Anxiety Scale (SAS) [(38.74±7.13) points] and Self-rating Depression Scale (SDS) [(42.26±8.03) points] of the study group were lower than those of the control group [(42.38±7.54) and (47.78±8.12) points] (t=2.480 and 3.418, P=0.015 and 0.001). After intervention, the LVEF of the study group was (69.33±6.89) %, which was higher than that of the control group [(58.93±6.42) %] (t=7.809, P<0.001); the BNP in the study group was (116.82±14.25) ng/L, which was lower than that in the control group [(138.75±12.46) ng/L] (t=8.192, P<0.001). The incidence of complications in the study group was lower than that in the control group [6.00% (3/50) vs. 22.00% (11/50)] (χ²=4.070, P=0.044). After intervention, the scores of physical activity restriction [(79.63±8.76) points], angina stable state [(57.76±9.32) points], angina pectoris attack [(70.37±7.11) points], treatment satisfaction [(82.23±8.04) points], and disease cognition [(70.12±9.07) points] of the SAQ in the study group were higher than those in the control group [(67.12±8.07) points, (53.35±8.22) points, (63.18±8.02) points, (69.35±9.33) points, and (54.62±8.74) points] (t=7.427, 2.509, 4.744, 7.395, and 8.701; all P<0.05). Conclusion　The implementation of outcome guided bicardiac service in the perioperative period of PCI for UAP patients can reduce the patients' anxiety and depression, improve their cardiac function, reduce the occurrence of complications, alleviate the clinical symptoms, improve the quality of life, and promote the prognosis.

Nursing cooperation of intravascular imaging combined with shockwave balloon intravascular lithotripsy in the treatment of coronary artery calcification

Yu Lei, Jia Xiaohui

2024, 30(4):  646-650.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.027

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Objective　To summarize the nursing cooperation points of intravascular imaging combined with shockwave balloon intravascular lithotripsy in the treatment of coronary artery calcification. Methods　A retrospective analysis was made on 6 patients with severe coronary artery calcification (7 vascular lesions) treated by shockwave balloon intravascular lithotripsy in Fuwai Central China Cardiovascular Hospital from June 2022 to October 2022, including 4 males and 2 females, aged (60.0±6.2) years. The process of interventional treatment and doctor-nurse cooperation were retrospectively analyzed. Results　The 6 patients underwent the interventional operation smoothly, the endovascular stent was fully expanded and adhered well to the arterial wall, without flow restricted, with grade 3 TIMI blood flow. None of the 6 patients had serious complications, and all of them were discharged from hospital after surgery. The length of hospital stay was 5-7 days. Conclusions　The combination of intravascular imaging and shockwave balloon intravascular lithotripsy can accurately evaluate and effectively deal with calcification lesions. The nursing staff should skillfully master the basic principles of intravascular imaging and shockwave balloon intravascular lithotripsy and the key points of operation cooperation, make full preoperative preparations, closely observe the changes of patients' vital signs during the operation, and take timely and effective nursing measures for possible complications, which is an important guarantee for successful operation.

Study on the curative effect of traditional Chinese medicine Qigong prescription on vascular mild cognitive impairment

Wang Jing, Cai Chunqian, Chen Xiaona, Wang Xue, Xue Mina, Niu Yali

2024, 30(4):  651-656.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.028

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Objective　To investigate the therapeutic effect of traditional Chinese medicine (TCM) Qigong prescription on vascular mild cognitive impairment (VaMCI). Methods　This was a cross-sectional study.Fifty VaMCI patients treated in Department of Rehabilitation Medicine, General Hospital of Tianjin Medical University from January 2017 to January 2019 were selected as the study objects, and were divided into a Qigong therapy group [25 cases, 12 males and 13 females, aged (67.20±5.37) years] and a conventional treatment group [25 cases, 13 males and 12 females, aged (67.36±5.38) years] according to the random number table method. Another 25 persons without diseases were selected as a normal group [11 males and 14 females, aged (67.04±4.36) years]. The conventional treatment group was given basic treatment and routine motor function rehabilitation training, and the Qigong therapy group was given Qigong prescription training on the basis of the conventional treatment group under the guidance of professionals. The overall course of treatment was 12 weeks. The systolic blood pressure (SBP), diastolic blood pressure (DBP), and scores of Mini-Mental State Examination (MMSE),Montreal Cognitive Assessment (MoCA), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), and modified Barthel index (MBI) were measured before and after treatment in the three groups. χ² test, t test, and variance analysis were used. Results　After 12 weeks of treatment, the MMSE score, MoCA score, MBI score, attention score, visual motor organization score, thinking operation score, and total LOTCA score of the Qigong therapy group were higher than those of the conventional treatment group [(23.64±2.90) points vs. (21.56±1.90) points, (23.72±2.42) points vs. (20.64±2.40) points, (75.80±7.31) points vs. (71.20±7.94) points, (3.12±0.73) points vs. (2.56±0.58) points, (21.96±1.90) points vs. (19.56±1.98) points, (26.16±1.89) points vs. (24.44±2.58) points, (96.20±4.25) points vs. (90.44±6.58) points]; the SBP and DBP of the Qigong therapy group were lower than those of the conventional treatment group [(137.00±10.70) mmHg (1 mmHg = 0.133 kPa) vs. (147.60±8.91) mmHg, (73.80±10.23) mmHg vs. (85.40±10.60) mmHg], with statistically significant differences (all P<0.05). After 12 weeks of treatment, there were no statistically significant differences in the MMSE score, SBP, and DBP between the Qigong therapy group and the normal group [(23.64±2.90) points vs. (23.52±2.20) points, (137.00±10.70) mmHg vs. (138.80±7.94) mmHg, (73.80±10.23) mmHg vs. (73.40±10.08) mmHg] (all P>0.05). The differences of MMSE, MoCA, MBI, attention, orientation, visual motor organization, and thinking operation scores and LOTCA total score and SBP before and after treatment in the Qigong therapy group were higher than those in the conventional treatment group and the normal group (all P<0.05). Conclusions　The TCM Qigong prescription can improve the cognitive function and the ability of daily living in VaMCI patients. It is an effective treatment of VaMCI and worthy of further promotion in clinical work.

Investigation on oncology nurses' knowledge, attitude, and practice toward chemotherapy-induced nausea and vomiting

Huang Minqing, Zhuang Wenxing, Wang Ying, Qiu Lihuan, Wang Fang

2024, 30(4):  657-661.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.029

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Objective　To explore oncology nurses' knowledge, attitude, and practice (KAP) toward chemotherapy-induced nausea and vomiting (CINV). Methods　Using a convenience sampling method, from July 21, 2021 to August 31, 2021, a questionnaire survey was conducted on 218 oncology nurses from 3 third-class A hospitals in Guangdong Province (Sun Yat-sen University Cancer Center, Guangdong Provincial People's Hospital, and Guangdong Second Provincial General Hospital). The questionnaire included general demographic data (hospital nature, gender, age, educational background, professional title, and working years) and scores of knowledge, attitude, and practice toward CINV. Independent sample t test and F test were used. Results　The results of oncology nurses' knowledge, attitude, and practice toward CINV showed that working years were related to nurses' CINV knowledge score, whether they had received CINV-related education was related to nurses' CINV knowledge and practice scores, and age and professional title were related to nurses' CINV attitude score, with statistically significant differences (all P<0.05). The knowledge score of oncology nurses toward CINV was (7.75±3.11), the attitude score was (34.40±4.07), and the practice score was (36.11±8.73). Conclusions　Nurses' knowledge and practice toward CINV need to be improved. We should encourage and promote nurses to use international guidelines to guide CINV assessment and nursing practice to provide a favorable basis for the construction of scientific CINV curriculum and practice training system.

Effect of traditional Chinese medicine hot compress combined with mucopolysaccharide polysulfate cream on arteriovenous fistula hematoma

Shi Kuanfan, Wen Yongshuang, Wei Yaqiong

2024, 30(4):  662-665.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.030

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Objective　To investigate the nursing effect of traditional Chinese medicine hot compress combined with mucopolysaccharide polysulfate cream on arteriovenous fistula hematoma. Methods　This study was a randomized controlled trial. Sixty patients with arteriovenous fistula hematoma admitted to Lianyungang Hospital of TCM from February 2021 to February 2023 were selected and were randomly divided into two groups: a combination group of 30 cases and a reference group of 30 cases. In the reference group, 21 males and 9 females, aged (47.58±7.15) years, were treated with mucopolysaccharide polysulfate cream combined with routine care. In the combination group, 20 males and 10 females, aged (46.45±6.14) years, were treated with traditional Chinese medicine hot compress on the basis of the reference group. The subcutaneous hematoma resolution time, pain duration, incidences of complications, and nursing satisfaction of the two groups were recorded and compared. t test and χ² test were used. Results　The subcutaneous hematoma resolution time and pain duration in the combination group were shorter than those in the reference group [(7.54±2.25) d vs. (10.85±3.14) d, (4.25±0.48) d vs. (6.50±0.51) d], with statistically significant differences (t=6.934 and 9.072, both P<0.001). The incidence of complications in the combination group was lower than that in the reference group [6.67% (2/30) vs. 26.67% (8/30)], and the overall satisfaction with nursing of the combination group was higher than that of the reference group [90.00% (27/30) vs. 66.67% (20/30)], with statistically significant differences (χ²=4.320 and 4.812, P=0.038 and 0.028). Conclusion　The combination of traditional Chinese medicine hot compress and mucopolysaccharide polysulfate cream can save the subcutaneous hematoma resolution time and pain duration for patients with arteriovenous fistula hematoma, improve the nursing satisfaction, reduce the complications, and alleviate the inflammation, which is worthy of clinical promotion.

Nursing cooperation management for associating liver partition and portal vein ligation for staged hepatectomy in the treatment of giant hepatocellular carcinoma

Tong Zhilan, Liao Yuan, Luo Jinghe, Zhang Jin, Zhang Qimei

2024, 30(4):  666-669.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.031

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Objective　To summarize the experiences of nursing cooperation for laparoscopic associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in the treatment of giant hepatocellular carcinoma. Methods　This was a retrospective study. A total of 11 patients with giant hepatocellular carcinoma from Guangdong Provincial Hospital of Chinese Medicine from January 2018 to January 2023 were selected for the study, all male, aged (54.00±11.38) years, and all of them underwent laparoscopic ALPPS. Nursing cooperation during surgery focused on preoperative assessment, materials preparation, precise cooperation for intraoperative bleeding control, and implementation of tumor-free principle. Results　The 11 patients had good postoperative recovery without complications such as hepatic trauma bleeding, bile leakage, or secondary surgery. The length of hospital stay was (10.27±2.87) d after the first stage operation and (12.36±3.50) d after the second stage operation. Conclusions　ALPPS is difficult, especially under laparoscope. Good preoperative visit and assessment, materials preparation, and precise nursing cooperation for controlling bleeding and hemostasis are important guarantees to improve the surgical effect and ensure the patients' surgical safety.

Application of health education intervention based on biphasic communication in perioperative nursing of ERCP patients

Gan Zhe, Li Guixian, Dong Hanxing

2024, 30(4):  670-673.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.032

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Objective　To explore the application of health education intervention based on biphasic communication in perioperative nursing of endoscopic retrograde cholangiopancreatography (ERCP) patients. Methods　A randomized controlled trial of 460 ERCP patients admitted to Peking University Shenzhen Hospital from May 2021 to May 2023 was conducted. The patients were divided into a control group and an observation group by the random number table method with 230 cases in each group. In the control group, 110 males and 120 females, aged (52.49±6.27) years, were treated with routine intervention. In the observation group, 115 males and 115 females, aged (51.53±6.29) years, were treated with health education intervention based on biphasic communication. The negative emotion score, disease knowledge mastery, and postoperative complications were compared between the two groups. Statistical methods used were t test and χ² test. Results　The scores of Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) in the observation group after intervention were lower than those in the control group [(6.74±1.04) points vs. (8.37±1.03) points, (6.37±1.04) points vs. (8.69±1.18) points], with statistically significant differences (t=16.889 and 22.369, both P<0.05). After intervention, the mastery degrees of disease knowledge, psychological counseling, drug guidance, and diet and exercise of the observation group were higher than those of the control group [95.22% (219/230) vs. 67.39% (155/230), 90.00% (207/230) vs. 70.43% (162/230), 85.22% (196/230) vs. 63.91% (147/230), 90.00% (207/230) vs. 72.17% (166/230)], with statistically significant differences (χ²=58.579, 27.741, 27.521, and 23.829, all P<0.05). The total complication rate of the observation group was lower than that of the control group [3.04% (7/230) vs. 12.17% (28/230)], with a statistically significant difference (χ²=13.638, P<0.05). Conclusion　The application of health education based on biphasic communication in ERCP patients has the advantages of alleviating the negative emotions, improving the mastery of disease knowledge, and reducing the incidence of complications, which is worth promoting.

Intervention effect of precision nursing model on patients with fever with thrombocytopenia syndrome

He Junning, Sun Xiuxiang, Wang Pengyan

2024, 30(4):  674-677.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.033

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Objective　To investigate the intervention effect of precision nursing model on patients with fever with thrombocytopenia syndrome. Methods　A total of 97 patients with fever with thrombocytopenia syndrome admitted to Yantai Qishan Hospital from February 2016 to December 2020 were selected and were divided into an observation group (48 patients) and a control group (49 patients) with the random number table method. The control group included 30 males and 19 females, aged (48.12±6.04) years. The observation group included 30 males and 18 females, aged (48.52±6.35) years. The control group carried out cognitive and behavioral nursing, and the observation group carried out precise nursing model on the basis of the control group for 2 months. The cognitive levels of knowledge-attitude-practice, the scores of General Self-Efficacy Scale (GSES), and the qualities of life before and after nursing and the times of platelet transfusion during nursing were compared between the two groups. Independent sample t test, paired t test, and χ² test were used. Results　After nursing, the cognitive score of knowledge-attitude-practice, GSES score, and score of quality of life in the observation group were higher than those in the control group [(22.71±1.35) points vs. (21.15±1.21) points, (28.61±1.48) points vs. (22.60±2.64) points, (87.37±11.55) points vs. (75.09±10.85) points], with statistically significant differences (t=5.996, 13.791, and 5.398, all P<0.001). The times of platelet transfusion was (2.63±0.24) times in the observation group and (3.68±0.52) times in the control group, with a statistically significant difference (t=12.724, P<0.001). Conclusion　In patients with fever with thrombocytopenia syndrome, precision nursing model is beneficial to improve the cognitive level of knowledge-attitude-practice, improve the patients' self-efficacy, reduce the times of platelet infusion, and improve the patients' quality of life, which is worthy of clinical promotion and application.

Effect of day ward care model on patients undergoing laparoscopic inguinal hernia repair

Li Pei, Niu Yating, Liu Yan

2024, 30(4):  677-681.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.034

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Objective　To analyze the effect of day ward care model on patients undergoing laparoscopic inguinal hernia repair. Methods　It was a retrospective study. A total of 60 patients with laparoscopic inguinal hernia repair who received routine inpatient care in Henan Provincial People's Hospital from June to December 2021 were selected as the control group, including 33 males and 27 females, aged 19-58 (39.20±2.01) years. A total of 60 patients with laparoscopic inguinal hernia repair who received day ward care model from January to June 2022 were selected as the observation group, including 31 males and 29 females, aged 18 to 60 (39.46±2.33) years. The hospitalization time and hospitalization cost of the two groups were compared. Through in-hospital investigation and follow-up visit, the Symptom Check-List-90 (SCL-90), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) were used to evaluate the psychological status of the two groups on the day of admission and 7 days after discharge. The Newcastle Satisfaction with Nursing Scale (NSNS) was used to evaluate the nursing satisfaction of the two groups 7 days after discharge. The incidence of complications within 7 days after surgery was compared between the two groups. Statistical methods used were t test and χ² test. Results　The hospitalization time of the observation group was shorter than that of the control group [(1.00±0.00) days vs. (7.26±1.23) days], and the hospitalization cost was lower than that of the control group [(4 210.36±349.86) yuan vs. (6 836.58±233.25) yuan], with statistically significant differences (t=39.42 and 48.38, both P<0.05). Seven days after discharge, the scores of SCL-90, SAS, and SDS in the observation group were lower than those in the control group [(94.38±5.17) points vs. (96.35±2.06) points, (29.41±2.35) points vs. (30.32±1.36) points, (27.18±1.11) points vs. (28.20±2.35) points], with statistically significant differences (t=2.74, 2.60, and 3.04, all P<0.05). Seven days after discharge, the total satisfaction rate of the observation group was higher than that of the control group [98.33% (59/60) vs. 88.33% (53/60)], with a statistically significant difference (χ²=4.82, P<0.05). Conclusion　The day ward care model can significantly shorten the hospital stay in patients with laparoscopic inguinal hernia repair, reduce the hospitalization cost, significantly improve their psychological status, and comprehensively improve their nursing satisfaction.

Application effect of 5A nursing model based on Internet platform in patients with gestational diabetes mellitus

Liu Yuqin, Li Ning, Shi Fanying, Kou Mingjie, Fan Xueying

2024, 30(4):  682-687.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.035

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Objective　To explore the application effect of 5A nursing model based on Internet platform in patients with gestational diabetes mellitus (GDM). Methods　A total of one hundred and fifteen pregnant women with GDM who underwent birth examination in Binzhou Central Hospital between July 2019 and February 2022 were prospectively selected as subjects in this study, and were divided into control and study groups by the random number table method. Fifty-eight patients in the control group, aged 22-33 years, were given clinical routine care intervention, and 57 patients in the study group, aged 22-35 years, were given 5A nursing model based on Internet platform based on routine care. The control of blood glucose [fasting blood glucose (FBG) and glycated hemoglobin (HbA1c)], self-efficacy [Diabetes Management Self-Efficacy Scale (DMSES) and General Self-Efficacy Scale (GSES)], psychological status [Pregnancy-Specific Anxiety Questionnaire (PAQ), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS)], self-management ability [modified version of Summary of Diabetes Self Care Activities (SDSCA)], and pregnancy outcomes of the two groups were compared. Statistical methods used were t test and χ² test. Results　After nursing, the levels of FBG and HbA1c in the study group were lower than those in the control group [(5.11±1.02) mmol/L vs. (5.62±1.12) mmol/L, (5.21±1.04)% vs. (5.74±1.15)%], with statistically significant differences (t=2.55 and 2.59, both P<0.05). The DMSES and GSES scores of the study group were higher than those of the control group [(168.47±18.72) points vs. (154.32±17.15) points, (35.27±3.92) points vs. (31.48±3.51) points], with statistically significant differences (t=4.23 and 5.46, both P<0.05). The scores of PAQ, SAS, and SDS in the study group were lower than those in the control group [(18.51±3.70) points vs. (21.42±4.28) points, (41.32±6.88) points vs. (45.51±7.58) points, (42.33±7.05) points vs. (45.62±7.61) points], with statistically significant differences (t=3.90, 3.10, and 2.40, all P<0.05). The scores of diet, exercise, blood glucose monitoring, and foot care of the SDSCA in the study group were higher than those in the control group [(22.15±3.69) points vs. (20.41±3.40) points, (10.87±2.17) points vs. (9.43±1.89) points, (11.12±2.22) points vs. (10.21±2.04) points, (11.45±2.29) points vs. (10.31±2.06) points], with statistically significant differences (t=2.63, 3.80, 2.29, and 2.81, all P<0.05). The incidences of polyhydramnios and macrosomia in the study group were lower than those in the control group [5.26% (3/57) vs. 18.97% (11/58), 7.02% (4/57) vs. 24.13% (14/58)], with statistically significant differences (χ²=5.05 and 6.38, both P<0.05). Conclusion　The 5A nursing model intervention based on Internet platform was applied to GDM patients, the blood glucose level during pregnancy was obviously controlled, and the self-efficacy, psychological status, and self-management ability were significantly improved, with good pregnancy outcomes.

Effect of continuous quality improvement on standardizing insulin pen injection in diabetic liaison nurses

Lu Yacong, Li Yanhong, Mao Yanling

2024, 30(4):  687-690.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.036

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Objective　To investigate the effect of continuous quality improvement on standardizing insulin pen injection in diabetic liaison nurses. Methods　This was a self-controlled study. The diabetic specialist group of Quanzhou Women and Children's Hospital set up an insulin pen injection continuous improvement group in June 2022, including 1 deputy chief nurse and 9 supervisor nurses. The compliance rate of insulin pen injection of 36 diabetic liaison nurses [aged (35.17±4.07) years, working years of (12.61±5.41) years] from June 2022 to December 2022 was continuously improved. The scores and qualified rates of theoretical knowledge and operation and standard attainment rate of insulin pen injection among the diabetic liaison nurses were compared before and after improvement. Paired t test and χ² test were used. Results　After improvement, the qualified rate of theoretical knowledge of the diabetic liaison nurses was higher than that before improvement [100.00% (36/36) vs. 77.78% (28/36)], and the qualified rate of operation was higher than that before improvement [100.00% (36/36) vs. 61.11% (22/36)], with statistically significant differences (χ²=9.00 and 17.38, both P<0.05). After improvement, the compliance rate of insulin pen injection of the diabetic liaison nurses was higher than that before improvement [100.00% (36/36) vs. 55.56% (20/36)], with a statistically significant difference (χ²=20.57, P<0.05). Conclusion　Continuous quality improvement can improve the qualified rates of theoretical knowledge and operation of insulin pen injection of diabetic liaison nurses, and improve the standard rate of insulin pen injection.

Application effect of medical conjunctive hierarchical diagnosis and treatment in hospital-community management for diabetic foot patients

Bai Lifang, Zhao Haiyan, Liu Yang

2024, 30(4):  691-694.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.037

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Objective　To explore the application effect of medical conjunctive hierarchical diagnosis and treatment in the hospital-community management for diabetic foot patients. Methods　A total of 100 diabetic foot patients from Xinxiang Central Hospital from January 2020 to January 2023 were selected as the study objects for the prospective study, and were divided into a control group and an observation group according to the random number table method, with 50 cases in each group. In the control group, 34 males and 16 females, aged 55-74 (64.05±3.41) years, were given routine nursing. In the observation group, 33 males and 17 females, aged 54-73 (64.01±3.06) years, were given medical conjunctive hierarchical diagnosis and treatment nursing model. The Wagner grade, diabetic foot risk factors, and Diabetic Foot Self-Care Questionnaire of the University of Malaga (DFSQ-UMA) score were compared between the two groups. Statistical methods used were t test and χ² test. Results　After intervention, the proportion of Wagner grade 0, 1, and 2 in the observation group was higher than that in the control group [96% (48/50) vs. 86.00% (43/50)], but the proportion of Wagner grade 3, 4, and 5 was lower than that in the control group [4.00% (2/50) vs. 14.00% (7/50)], with a statistically significant difference (χ²=5.13, P<0.05). The scores of diabetic foot risk factor scale in both groups after intervention were higher than those before intervention, and that in the control group was higher than that in the observation group [(38.52±6.17) points vs. (35.41±5.23) points], with a statistically significant difference (t=2.28, P<0.05). After intervention, the scores of personal care, foot care, and wearing shoes and socks of the DFAQ-UMA in both groups were higher than those before intervention, and those in the observation group were higher than those in the control group [(4.65±1.03) points vs. (3.82±1.09) points, (3.09±0.85) points vs. (2.56±0.90) points, (1.65±0.61) points vs. (1.29±0.64) points], with statistically significant differences (t=3.91, 3.03, and 2.88, all P<0.05). Conclusion　The use of medical conjunctive hierarchical diagnosis and treatment management for diabetic foot patients can reduce the high risk factors and enhance their level of prognostic self-care, which is worthy of promotion and reference in every clinic.

Influence of core muscle strength training based on the ERAS concept on the postoperative rehabilitation in patients with lumbar vertebral fracture

Li Lu, Wang Nan, Xie Suli

2024, 30(4):  695-699.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.038

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Objective　To observe the impact of core muscle strength training based on the ERAS concept on improving the postoperative rehabilitation outcomes in patients with lumbar vertebral fracture. Methods　This was a prospective cohort study. From March 2020 to February 2022, 100 patients with lumbar vertebral fracture in 988 Hospital of People's Liberation Army Joint Service Support Force were divided into a combined group [50 cases, 30 males and 20 females, aged 42-78 (60.26±5.41) years] and a conventional group [50 cases, 25 males and 25 females, aged 40-80 (61.35±5.25) years] by the random number table method. All patients received surgery. The conventional group received conventional rehabilitation treatment after surgery, and the combined group received core muscle strength training based on the ERAS concept to assist conventional rehabilitation treatment. Both groups were followed up for one year to compare the recovery of lumbar structure, lower back pain, balance ability, and long-term improvement of lumbar function before and after treatment. χ² test and t test were used. Results　After 3 months of treatment, the posterior convex angle and the Cobb angle of the injured vertebrae in the combined group were (13.25±3.11)° and (10.45±2.28)°, which were both lower than those in the conventional group [(15.17±3.02)° and (12.23±2.06)°], and the anterior edge height of the injured vertebrae was (75.36±10.24)%, which was higher than that in the conventional group [(69.77±10.21)%] (all P<0.05). The Visual Analogue Scale (VAS) score of the combined group was (5.15±1.24) points after 1 month and (3.28±0.25) points after 3 months, which were both lower than those of the conventional group [(6.65±2.13) points and (4.49±1.25) points]; the Berg Balance Scale (BBS) score of the combined group was (42.14±10.36) points after 1 month and (54.11±10.37) points after 3 months, which were both higher than those of the conventional group [(36.62±10.33) points and (48.24±10.28) points] (all P<0.05). Under different treatment regiments, the Oswestry Disability Index (ODI) scores of the combined group were (35.25±5.41) points and (23.49±5.11) points at the 3rd month and the 9th month of follow up, which were both lower than those of the conventional group [(38.77±5.24) points and (27.12±5.44) points]; the Japanese Orthopaedic Association (JOA) scores of the combined group were (18.33±5.15) points and (26.15±5.14) points at the 3rd month and the 9th month of follow up, which were both higher than those of the conventional group [(15.44±5.33) points and (22.41±5.15) points] (all P<0.05). Conclusion　The core muscle strength training based on the ERAS concept can effectively improve the postoperative vertebral structure in patients with lumbar vertebral fracture, and has positive significance in alleviating the postoperative lumbar pain, enhancing the body balance ability, and promoting the long-term recovery of vertebral function.

Clinical Teaching

Application of batch CBL combined with PBL teaching method in clinical practice course of laboratory medicine

Deng Jiankai, Chen Dubo, Li Laisheng, Chen Yaoming, Huang Bin, Yu Xuegao

2024, 30(4):  700-703.  DOI: 10.3760/cma.j.issn.1007-1245.2024.04.039

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Objective　To explore the feasibility and effect of applying batch problem-based learning (PBL) combined with case-based learning (CBL) to practice teaching for laboratory medical undergraduates. Methods　The subjects of the study were 24 undergraduates, including 8 males and 16 females, aged 22-23 years, who practiced in the clinical laboratory of the First Affiliated Hospital, Sun Yat-sen University from June 2022 to April 2023. According to the setting of professional groups in the clinical laboratory, the teaching method of batch CBL and PBL was adopted in the teaching of microbiology inspection major, and the traditional teaching method was adopted in the teaching of other majors. Through the questionnaire survey, the students' learning effect and teaching satisfaction were compared under the two teaching modes. Wilcoxon signed rank test for two paired samples was used. Results　Compared with the traditional teaching method, the batch CBL combined with PBL teaching method improved the learning interest (Z=3.015, P=0.003), self-learning ability (Z=3.908, P<0.001), problem solving ability (Z=3.033, P=0.002), practical operation ability (Z=2.213, P=0.027), comprehensive analysis ability (Z=3.245, P=0.001), teamwork ability (Z=2.054, P=0.040), and clinical communication ability (Z=2.565, P=0.010) and inspire the clinical thinking (Z=3.014, P=0.003), with statistically significant differences. The students had a high degree of recognition for the teaching method of batch CBL combined with PBL, and 100.0% (24/24) of the students were very satisfied with "teaching contents adhering closely to the syllabus" and "teaching content related to clinical diagnosis and treatment". Conclusion　The application of batch CBL and PBL teaching method has a good teaching effectiveness in clinical practice course of laboratory medicine, which is helpful to enlighten the students' clinical thinking and can be adopted as an adjunct to traditional teaching method.