Table of Content

01 March 2024, Volume 30 Issue 5

Previous Issue   

New Medical Advances

Research progress on mechanism of ferroptosis in Alzheimer's disease

Zheng Mei, Lu Ying, Mu Dawei

2024, 30(5):  705-709.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.001

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Alzheimer's disease is a neurodegenerative disease characterized by chronic neuroinflammation, and poses a serious medical challenge and burden worldwide. As an iron-dependent form of cell death characterized by iron accumulation, lipid peroxidation, disturbance of amino acid metabolism, and irreversible disruption of the plasma membrane. Ferroptosis may be associated with neurological dysfunction in Alzheimer's disease. This article reviews the role of ferroptosis in the pathologic progression of Alzheimer's disease through iron, lipid, and amino acid metabolisms, and the potential therapeutic measures for inhibiting ferroptosis in Alzheimer's disease. It is expected that ferroptosis will provide new insights into the pathogenesis and preventive treatment of Alzheimer's disease.

Research progress on effects of smoking on rotator cuff injury and prognosis

He Hengyi, Zhang Xiaowei, Chen Ningjie

2024, 30(5):  710-712.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.002

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Smoking is one of the risk factors for rotator cuff injury, and affects the repair, healing, and postoperative complications of rotator cuff. This article reviews the existing literatures on the relationship between smoking and rotator cuff injury, the pathological changes and pathogenesis of rotator cuff tendons in smoking patients, and the impact of smoking on surgery, healing, repair, and postoperative complications in patients with rotator cuff injury, so as to provides references for the treatment of smoking patients with rotator cuff injury.

Literature Analysis

Visualized analysis on researches of posterior reversible encephalopathy syndrome based on Web of Science database

Xiang Lingli, Zhang Kai, Shao Yong

2024, 30(5):  713-720.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.003

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Objective　To investigate the status, hotspots, and frontiers of global scientific researches on posterior reversible encephalopathy syndrome (PRES) through the visualized atlas. Methods　The literatures on PRES were searched from the Web of Science database from its establishment to December 31, 2022 on May 12, 2023. The visualized software was used to perform the atlas analysis. Results　A total of 1 778 articles were retrieved. The article number increased year by year. The keyword clustering found 11 clusters, involving hypertensive encephalopathy, tacrolimus, magnetic resonance imaging, etc. The keyword burst analysis indicated that the main research frontiers were pathophysiology, risk factors, COVID-19 infection, cytokines, etc. Conclusions　It is believed that the incidence of PRES is related to damage of blood-brain barrier. In recent years, endothelial injury and brain tissue hypoperfusion mediated by vasoconstrictors after COVID-19 infection may induce PRES.

Breast Cancer

Meta-analysis on goserelin in protection of ovarian function in premenopausal patients with breast cancer

Hao Huihui, Li Zhenzhen, Ding Chuanhua, Han Xiuyuan, Guo Xichun

2024, 30(5):  721-731.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.004

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Objective　To evaluate the ability of goserelin in the protection of the ovarian function in premenopausal patients with breast cancer by meta-analysis. Methods　The China National Knowledge Infrastructure, Wanfang Database, VIP Database, PubMed, Web of Science, Scopus, and Cochrane Library were searched for the controlled trials of goserelin for premenopausal patients with breast cancer from their establishment to October 2023. Two investigators independently screened the literatures according to the inclusion and exclusion criteria, extracted the data, and evaluated the quality of the included studies using the Cochrane Collaboration risk of bias assessment tool. The data were analyzed using the RevMan 5.3 software. Results　Twenty-eight studies and 8 782 patients were included, including 4 372 in the test group and 4 410 in the control group. The meta-analysis results showed that the total effective rate of the test group was higher than that of the control group (OR=2.87, 95%CI 1.94-4.26, P<0.000 01); the basal follicle-stimulating hormone (bFSH) level of the test group was lower than that of the control group (MD=-3.81, 95%CI -4.35 to -3.27, P<0.000 01); the basal antral follicle counting (bAFC) of the test group was higher than that of the control group (MD=3.27, 95%CI 2.83-3.72, P<0.000 01); the estradiol (E2) level in the test group was not significantly different from that in the control group (SMD=0.85, 95%CI -0.69 to -2.40, P=0.28); the luteinizing hormone (LH) in the test group was higher than that in the control group (MD=8.75, 95%CI 7.84-9.67, P<0.000 01); the premature ovarian failure (POI) in the test group was lower than that in the control group (OR=0.24, 95%CI 0.08-0.73, P=0.01); the menstrual recurrence rate in the test group was higher than that in the control group (OR=3.09, 95%CI 1.01-9.46, P=0.05); the disease-free survival (DFS) in the test group was higher than that in the control group (OR=1.91, 95%CI 1.28-2.85, P=0.002); the overall survival (OS) in the test group was higher than that in the control group (OR=1.35, 95%CI 1.14-1.59, P=0.000 4); the progression-free-survival (PFS) in the test group was higher than that in the control group (MD=30.15, 95%CI 29.47-30.83, P<0.000 01); the incidence of adverse reactions in the test group was lower than that in the control group (OR=0.48, 95%CI 0.25-0.90, P=0.02). Conclusion　Goserelin for premenopausal patients with breast cancer effectively protects their ovarian function and improves their survival time, and is safe.

Research progress of PD-L1 and tumor-associated macrophages in breast cancer

Chen Miaoling, Han Yuzhen

2024, 30(5):  732-735.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.005

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Tumor microenvironment has many components that play an immunosuppressive role; among which, programmed cell death-ligand 1 (PD-L1) is closely related to tumor-associated macrophages (TAMs), and plays a vital role in the occurrence and development of breast cancer. This article reviews the significance of PD-L1 and TAMs in the occurrence and development of breast cancer and the possible interaction mechanism between them, as well as the effects of anti-programmed cell death protein-1 (PD-1)/PD-L1 combined with targeting TAMs in the treatment of breast cancer.

Flow parameters of enhanced MRI scan combined with ultrasound in diagnosis of breast cancer

Chen Jiao, Shen Rong

2024, 30(5):  736-739.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.006

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Objective　To investigate the diagnostic value of blood flow parameters of enhanced MRI scan combined with ultrasound for breast cancer. Methods　Eighty patients with suspected breast cancer treated at Huangshi Central Hospital from January 2020 to January 2023 were selected as the study objects and divided into a control group (13 cases) and a confirmed group (67 cases) according to the clinical and pathological examination results. The control group were (53.12±8.79) years old, and the confirmed group (54.35±7.96). The diagnostic results by the two methods were compared. The enhanced MRI scan parameters [volume transfer constant (Ktrans), rate constant (Kep), and vascular extracellular space volume ratio (Ve)] and ultrasound parameters [(blood beat index (PI), flow resistance index (RI), and peak flow rate (PSV)] were compared between the two groups. Comparisons of the measurement and count data were performed using the t test and χ² test, respectively. The diagnostic values of enhanced MRI scan parameters and ultrasound parameters alone and their combination for breast cancer were evaluated using the receiver operating characteristic curve (ROC). Results　In the 67 patients confirmed with breast cancer, there was no statistical difference in the accurate diagnostic rate between the MRI and ultrasound [91.04% (61/67) vs. 92.54% (62/67); P>0.05], but the MRI had a higher misdiagnosis rate than ultrasound [6.15% (4/67) vs. 0; P<0.05]. The results of the ROC showed that individual Ktrans [area under the curve (AUC)=0.711], Kep (AUC=0.739), PI (AUC=0.756), RI (AUC=0.846), and PSV (AUC=0.755) had some value in breast cancer diagnosis. The AUC of the combination of the 2 enhanced MRI scan parameters was 0.790; the AUC of the combination of the 3 ultrasound parameters was 0.928; the AUC of the combination of the 5 parameters was 0.954. Conclusion　The enhanced MRI scan parameters and ultrasound parameters of blood flow in patients with breast cancer are high. The combination of MRI and ultrasound is of some clinical value.

Value of ABUS combined with serum VEGF and CEA in diagnosis of breast cancer 

Tian Yan, Yuan Quan, Wang Huxia, Hui Jinzi, Duan Shaoxue

2024, 30(5):  740-743.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.007

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Objective　To explore the value of the automated breast ultrasound system (ABUS) combined with vascular endothelial growth factor (VEGF) and carcinoembryonic antigen (CEA) in the diagnosis of breast cancer. Methods　From April 2020 to April 2023, 210 patients with breast cancer from Shaanxi Provincial Cancer Hospital were selected as an observation group, including 113 cases on the left side and 97 cases on the right side; they were (52.01±5.16) years old. One hundred healthy individuals undergoing physical examination in the same period were selected as a control group; they (51.23±5.03) years old; both sides were examined. Based on the ABUS imaging, the ultrasound characteristics were observed. The serum levels of VEGF and CEA in both groups were detected using enzyme-linked immunosorbent assay and chemiluminescence. t and χ² tests were used. The receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of ABUS combined with serum VEGF and CEA for breast cancer. Results　The occurrence rates of worm-eaten sign, convergence sign, and stellate sign in the observation group were significantly higher than those in the control group [82.86% (174/210) vs. 23.00% (23/100), 76.19% (160/210) vs. 20.00% (20/100), and 77.62% (163/210) vs. 13.00% (13/100)], with statistical differences (χ²=104.778, 87.840, and 115.262; all P<0.001). The serum levels of VEGF and CEA in the observation group were higher than those in the control group [(141.20±17.23) ng/L vs. (112.81±14.14) ng/L and (8.76±2.92) μg/L vs. (3.51±1.17) μg/L], with statistical differences (t=14.335 and 17.312; both P<0.001). The ROC analysis showed that ABUS combined with serum VEGF and CEA had the highest diagnostic value for breast cancer (AUC=0.981), with a sensitivity of 92.4% and a specificity of 97.0%, which were higher than any single test. Conclusions　ABUS combined with serum VEGF and CEA has a high diagnostic value for breast cancer. Compared with single testing methods, its sensitivity and specificity are higher. It can effectively enhance the early detection and accurate diagnosis of breast cancer.

Liver Cancer

Correlation of T lymphocyte subsets with expressions of CHI3H1 and DR-70 in patients with HBV related hepatocellular carcinoma

Chen Xilian, Yang Yongwei, Wang Pengyan, Liu Youde, Pan Wei

2024, 30(5):  744-747.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.008

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Objective　To investigate the changes and clinical significance of the levels of the T-cell subsets (CD3⁺, CD3⁺CD4⁺, and CD3⁺CD8⁺), fibrin degradation complex (DR-70), and chitinase 3-like protein 1 (CHI3H1) in patients with different clinical classification of hepatitis B virus (HBV) infections, and to analyze the correlation of T lymphocyte subsets with CHI3H1 and DR-70 in patients with HBV related hepatocellular carcinoma. Methods　One hundred and seventy-three patients with chronic HBV infection treated at Qishan Hospital were selected as an experimental group, including 114 males and 59 females who were (45.38±12.72) years old. According to their conditions, there were 59 HBV carriers, 51 cases of chronic hepatitis B, 31 cases of liver cirrhosis, and 32 cases of hepatocellular carcinoma. Forty healthy examinees during the same period were selected as a control group, including 22 males and 18 females who were (39.15±14.95) years old. The various T-cell subsets were measured by flow cytometry. The peripheral blood DR-70 levels were quantitatively detected using the double antibody sandwich enzyme-linked immunosorbent assay. The magnetic particle chemiluminescence method was used to detect the peripheral blood CHI3H1 level. The Welch analysis of variance was used for the comparison of normally distributed continuous data with heterogeneity of variance between the groups. The Games-Howell test was used for further the comparison between two the groups.The Kruskal-Wallis H test was used for the comparison of the non-normally distributed continuous data between the groups.The χ² test was used for the comparison of the categorical data between the groups. The Pearson correlation analysis was used to investigate the correlation. Results　The CD3⁺ level in the hepatocellular carcinoma group was the lowest [(61.43±19.26)%], and the CD3⁺CD4⁺ level in the liver cirrhosis group was the lowest, with statistical differences from those in the control group (both P<0.05). The levels of DR-70 and CHI3H1 in the chronic hepatitis B group, the liver cirrhosis group, and the hepatocellular carcinoma group increased in different degrees (all P<0.01), and those in the hepatocellular carcinoma group were the highest [(30.11±9.96) mg/L and (213.11±39.76) μg/L; both P<0.01]. The proportion of CD3⁺ T lymphocytes in the peripheral blood in the hepatocellular carcinoma group was negatively correlated with the DR-70 level (r=-0.291, P=0.037). Conclusions　The serum levels of DR-70 and CHI3L1 are high in patients with hepatocellular carcinoma. Their combination with T lymphocyte subsets can evaluate the progression of patients with chronic liver diseases and especially has some value in the early diagnosis of liver tumor.

Analysis of factors affecting poor prognosis after TACE in patients with hepatocellular carcinoma based on PSM

Zhang Guokun, Zhang Tianyou, Zhang Jingchang, Li Suxin

2024, 30(5):  747-753.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.009

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Objective　To investigate the influencing factors of poor prognosis after transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) based on propensity score matching (PSM). Methods　The clinical data of 496 patients with HCC admitted to First Hospital, Zhengzhou University from January 2017 to January 2020 were retrospectively analyzed; there were 305 males and 191 females; they were (58.19±7.24) years old; their body mass index (BMI) was (24.67±2.37) kg/m². According to the patients' survival after 3 years' follow up, they were divided into a good prognosis group (82 cases) and a poor prognosis group (414 cases). PSM was used to perform 1 : 1 matching between the two groups. The patients' general data [tumor node metastasis (TNM) stage, Child-Pugh classification, maximum tumor diameter, portal vein tumor thrombus, cirrhosis, distant metastasis, arteriovenous fistula, TACE treatment times, lipiodol deposition classification, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), alanine transaminase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), and alpha fetoprotein (AFP)] after matching were compared. The independent sample t test was used to compare the measurement data, and the χ² test was used to compare the count data. The indicators with statistical differences were included into the multivariate COX regression analysis to screen the influencing factors of the poor prognosis after TACE in the HCC patients. Results　Before matching, there were no statistical differences in gender, BMI, smoking history, diabetes history, hypertension history, and tumor distribution between the good prognosis group and the poor prognosis group (all P>0.05), while there were statistical differences in age and drinking history (both P<0.05). After PSM matching, 78 cases of HCC patients were obtained from both the good prognosis group and the poor prognosis group, and there were no statistical differences in gender, age, BMI, smoking history, drinking history, diabetes history, hypertension history, and tumor distribution between the two groups (all P>0.05). After matching, there were no statistical differences in liver cirrhosis, TACE treatment times, NLR, PLR, ALT, and AST between the poor prognosis group and the good prognosis group (all P>0.05), but there were statistical differences in the TNM stage Ⅲa [58.97% (46/78) vs. 26.92% (21/78)], Child-Pugh B [62.82% (49/78) vs. 29.49% (23/78)], maximum tumor diameter > 5 cm [47.44% (37/78) vs. 29.49 % (23/78)], multiple tumors [48.72% (38/78) vs. 32.05% (25/78)], portal vein tumor thrombus [41.03% (32/78 ) vs. 17.95%(14/78)], distant metastasis [21.79% (17/78) vs. 8.97% (7/78)], arteriovenous fistula [21.79% (17/78) vs. 5.13% (4/78)], lipiodol deposition type Ⅲ + Ⅳ [38.46% (30/78) vs. 14.10% (11/78)], GGT > 50 U/L [88.46% (69/78) vs. 73.08% (57/78)], and AFP > 400 μg/L [55.13% (43/78) vs. 28.21% (22/78)] between the poor prognosis group and the good prognosis group (χ²=16.351, 17.437, 5.308, 4.500, 9.989, 4.924, 9.299, 11.944, 5.943, and 11.631; all P < 0.05). The COX regression analysis showed that TNM stage Ⅲa (HR=3.504, 95%CI 1.548-7.935), Child-Pugh grade B (HR=4.345, 95%CI 1.889-9.994), maximum tumor diameter > 5 cm (HR=2.084, 95%CI 1.115-3.893), portal vein tumor thrombus (HR=2.547, 95%CI 1.217-5.333), distant metastasis (HR=1.900, 95%CI 1.078-3.348), arteriovenous fistula (HR=2.291, 95%CI 1.163-4.514), lipiodol deposition Ⅲ+Ⅳ type (HR=3.089, 95%CI 1.359-7.023), GGT > 50 U/L (HR=2.206, 95%CI 1.137-4.278), and AFP > 400 μg/L (HR=2.821, 95%CI 1.283-6.202) all were risk factors for the poor prognosis of the HCC patients after TACE (all P<0.05). Conclusion　After PSM balanced covariates, TNM stage Ⅲa, Child-Pugh grade B, maximum tumor diameter > 5 cm, portal vein tumor thrombus, distant metastasis, arteriovenous fistula, lipiodol deposition Ⅲ+Ⅳ type, GGT > 50 U/L, and AFP > 400 μg/L all are factors affecting the poor prognosis after TACE in HCC patients.

Contrast-enhanced CT combined with contrast-enhanced ultrasound in evaluation of efficacy of TACE for patients with hepatocellular carcinoma

Lu Xiaowen, Liu Ziyang

2024, 30(5):  754-758.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.010

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Objective　To investigate the value of contrast-enhanced computed tomography (CECT) combined with contrast-enhanced ultrasound (CEUS) in the evaluation of the efficacy of transcatheter arterial chemoembolization (TACE) for patients with hepatocellular carcinoma (HCC). Methods　The clinical data of 96 patients with HCC who underwent TACE in Liaocheng People's Hospital were analyzed retrospectively. Among the 96 patients, there were 53 males and 43 females; they were (52.69±4.08) old. The Child-pugh classification results showed that there were 49 cases of grade A and 47 cases of grade B. All the patients received CECT, CEUS, and digital subtraction angiography (DSA) examinations 1 month after surgery. The DSA results were taken as the golden standard to evaluate the diagnostic performance of CEUS, CECT, and CEUS combined with CECT for residual tumors. The Kappa test was used for consistency analysis, and the imaging findings of residual lesions were observed. Results　One month after TACE, DSA found 15 cases of residual tumors, accounting for 15.63%. CEUS diagnosed 11 cases (11.46%) of residual tumors; CECT diagnosed 10 cases (10.42%) of residual tumors; CEUS combined with CECT diagnosed 13 cases (13.54%) of residual tumors. The diagnostic sensitivity, specificity, accuracy, negative predictive value, positive predictive value, and Kappa value of CEUS combined with CECT (80.00%, 98.77%, 95.83%, 96.39%, 92.31%, and 0.833) were higher than those of CEUS and CECT. Conclusions　The combination of CECT and CEUS has significant advantages in evaluating the efficacy of TACE for patients with HCC. It can be used as an effective method for evaluating the efficacy after TACE.

Effects of different ball holding methods for patients with hepatocellular carcinoma who are treated by chemotherapy and take PICC

Li Ruyue, Zhai Jingming, Qiu Lishuai

2024, 30(5):  759-762.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.011

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Objective　To explore the effects of different ball holding methods on axillary vein blood flow velocity, catheter-related thrombosis (CRT) prevention, and exercise fatigue in patients with hepatocellular carcinoma who are treated by chemotherapy and take peripherally inserted central catheter (PICC). Methods　One hundred and five patients with hepatocellular carcinoma who were treated by chemotherapy and took PICC at First Hospital, Henan University of Science and Technology from October 2020 to November 2022 were retrospectively selected as the study objects, and were divided into a routine group (52 cases) and a regular group (53 cases) according to the ball holding methods. There were 27 males and 25 females in the routine group; they were (51.77±11.71) years old. There were 29 males and 24 females in the regular group; they were (52.13±12.28) years old. The routine group held the ball for about 500 times in three times every day. The regular group held the ball 25-30 times after the meals every day, and gripped it tightly for 10 s and released it 10 s each time; the grip strength was determined by squeezing the grip ball to 1/2. The axillary vein blood flow velocities, incidences of CRT, mechanical phlebitis, and catheter displacement, and exercise fatigue were compared between the two groups. t test, Fisher's exact test, and rank sum test were used. Results　Four weeks after catheter insertion, the maximum velocity of axillary vein and the velocity of axillary vein per unit time in the regular group were higher than those in the conventional group [(14.61±2.03) cm/s vs. (11.56±1.32) cm/s and (9.13±1.67) cm/s vs. (6.57±0.92) cm/s; t=9.1083 and 9.7030; both P<0.05]. There were no statistical differences in the incidences of CRT, mechanical phlebitis, and catheter displacement between the regular group and the routine group [1.89% (1/53) vs. 5.77% (3/52), 0 vs. 3.85% (2/52), and 0 vs. 1.92% (1/52); P=0.362 9, 0.242 9, and 0.495 2]. The exercise fatigue level during 12 days' catheter insertion in the regular group was better than that in the routine group (Z=2.574 7, P=0.005 0). Conclusion　Regular ball holding can improve the exercise fatigue of patients with hepatocellular carcinoma who are treated by chemotherapy and take PICC, adjust the axillary vein blood flow velocity, and reduce the incidences of CRT, mechanical phlebitis, and catheter displacement.

Type 2 Diabetes Mellitus

Imaging research on relationship between brain structure and glycosylated hemoglobin in patients with type 2 diabetes

Sun Chunyan, Lin Xiaoqing, Xia Xinjian, Yang Yingliang

2024, 30(5):  763-766.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.012

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Type 2 diabetes is a common metabolic disease, and can cause complications of multiple organ systems, including the impact on brain structure. With the development of imaging technology, researchers can intuitively assess the brain structure and function of patients with type 2 diabetes through structural magnetic resonance imaging (sMRI), functional magnetic resonance imaging (fMRI), electroencephalogram (EEG), and other methods. This article reviews the recent research progress based on imaging technology, focuses on the relationship between the brain structure and glycosylated hemoglobin of patients with type 2 diabetes, and discusses the future research directions.

Effect and clinical significance detecting acute phase protein and cytokines in patients with type 2 diabetes mellitus

Dong Bo, Ding Tian

2024, 30(5):  767-770.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.013

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Application of blood glucose spectrum and insulin secretion curve in rational selection of insulin secretagogues for type 2 diabetes

Shao Chen, Geng Lijuan, Yu Jingjing

2024, 30(5):  771-775.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.014.

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Objective　To explore the value of insulin secretion curve and blood glucose spectrum in the selection of insulin secretagogues for type 2 diabetes, and to provide a basis for clinical selection of insulin secretagogues. Methods　One hundred and twenty patients with type 2 diabetes who selected insulin secretagogues according to the need of hypoglycemic treatment at Dongying Second People's Hospital were selected for the randomized controlled trial. They were divided into an observation group and a control group by the random number table method, with 60 cases in each group. There were 38 males and 22 females in the observation group; they were (58.27±6.34) years old, with a course of disease of (3.62±1.28) years. There were 33 males and 27 females in the control group; they were (59.04±7.82) years old, with a course of disease of (3.55±1.17) years. The observation group carried out the Mantou meal test and selected the insulin secretagogues sulfonylurea (glimepiride and gliclazide) and glinide (repaglinide) according to the insulin secretion curve. The control group selected the insulin secretagogues according to the blood glucose spectrum. Both groups were treated for 24 weeks. The average days of blood glucose control reaching the standard, the rate of blood glucose reaching the standard, the days of hospitalization, and the incidences of hypoglycemia in the two groups were recorded. The insulin β cell function [fasting insulin (FINS), insulin resistance index (HOMA-IR), and C-peptide (CP)] and blood glucose levels [fasting blood glucose (FPG), 2 h postprandial blood glucose (2 h PBG), and glycosylated hemoglobin (HbA1c)] before and after the treatment were compared between the two groups. t and χ² tests were applied. Results　The average days of blood glucose control reaching the standard and hospitalization days in the observation group were shorter than those in the control group [(7.05±1.42) d vs. (8.39±1.86) d and (10.29±2.08) d vs. (11.35±2.17) d]; the rate of blood glucose reaching the standard in the observation group was higher than that in the control group [86.67% (52/60) vs. 71.67% (43/60)]; there were statistical differences (t=4.436, 2.732, χ²=4.093; all P<0.05). After the treatment, the levels of FINS and CP in the observation group were higher than those in the control group [9.32±1.55) IU/L vs. (8.46±1.38) IU/L and (1.49±0.39) μg/L vs. (1.35±0.32) μg/L]; the HOMA-IR in the observation group was lower than that in the control group [(1.92±0.43) vs. (2.37±0.84)]; there were statistical differences (t=3.210, 2.150, and 3.694; all P<0.05). After the treatment, the levels of FPG, 2 h PBG, and HbA1c in the observation group were lower than those in the control group [(6.47±1.12) mmol/L vs. (7.35±0.94) mmol/L, (10.52±1.17) mmol/L vs. (11.83±1.59) mmol/L, and (6.12±1.09)% vs. (6.79±1.35)%], with statistical differences (t=4.662, 5.140, and 2.991; all P<0.05). There was no statistical difference in the incidence of adverse reactions between the observation group and the control group [15.00 (9/60) vs. 18.33 (11/60); χ²=0.240; P=0.624]. Conclusion　Compared with by the blood glucose spectrum, the insulin secretagogue selected by the insulin secretion curve has better insulin secretion promoting and hypoglycemic effects, and is conducive to shortening the time of blood glucose control reaching the standard and hospitalization and improving the rate of blood glucose reaching the standard.

Current status and influencing factors of resourcefulness in young and middle-aged adults with type 2 diabetes mellitus

Wu Chenghui, Gao Hong, Chen Huiyuan, Xie Chenxi, Tan Lingling

2024, 30(5):  776-781.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.015

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Objective　To investigate the current status and influencing factors of resourcefulness in young and middle-aged patients with type 2 diabetes mellitus, and to provide references for the formulation of resourcefulness intervention program. Methods　The convenience sampling method was used to select 272 young and middle-aged adults with type 2 diabetes mellitus treated in the endocrinology departments of two grade A hospitals in Hunan Province from November 2022 to April 2023, including 198 males and 74 females who were (49.36±8.89) years old. They were surveyed using the general information questionnaire, Resourcefulness Scale (RS), and Type 2 Diabetes Stigma Assessment Scale (DSAS-2). t test, ANOVA, correlation analysis, and multiple linear regression analysis were applied. Results　The overall score of RS in the patients was (75.53±11.42), which was at a medium level; the score of personal resourcefulness was (45.26±7.51); the score of social resourcefulness was (30.26±5.60). Except between the patients with different courses of disease, numbers of comorbidities, treatment methods, and body mass indexes (BMI), there were statistical differences in the resourcefulness level between the patients with different ages, genders, educational levels, occupations, personal monthly incomes, medical insurance types, and numbers of complications (t=3.890 and 2.099; F=45.556, 18.883, 40.970, 21.060, and 3.306; all P<0.05). The Pearson correlation analysis showed that resourcefulness was negatively correlated with stigma (r=-0.396, P<0.001). The multiple linear regression analysis showed that gender (t=-2.915, P=0.004), age (t=-3.004, P=0.003), education level (t=4.714, P<0.001), personal monthly income (t=5.066, P<0.001), and stigma(t=-6.270, P<0.001) were important factors influencing the resourcefulness of the patients, accounting for 45.8% of the total resourcefulness variation in the patients. Conclusions　The resourcefulness of young and middle-aged patients with type 2 diabetes mellitus is at a medium level. Clinicians should pay more attention to female, older, less educated, low income, and stigma-existed middle-aged and young people with type 2 diabetes mellitus, and carry out specific interventions according to their conditions to further improve their resourcefulness.

Effects of finerenone versus SGLT2 inhibitors on cardiovascular events in patients with type 2 diabetes mellitus and/or chronic kidney disease

Wang Xia, Zhang Lingyun, Song Shoujun, Xu Hongxin

2024, 30(5):  781-788.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.016

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Objective　To compare the effects of finerenone versus sodium-glucose cotransporter protein-2 (SGLT2) inhibitors on cardiovascular events in patients with type 2 diabetes mellitus and/or chronic kidney disease. Methods　The PubMed, Cochrane Library, Web of Science, and Embase databases were searched for the randomized controlled trials on patients with type 2 diabetes mellitus and/or chronic kidney disease from their establishment to July 3,2023. This network meta-analysis (NMA) was performed using the STATA 17.0 software based on the frequency models. Results　A total of 7 randomized controlled trials were included, including 33 206 patients. The treatments included finerenone and SGLT2 inhibitors; the SGLT2 inhibitors included empagliflozin, canagliflozin, dapagliflozin, and sotagliflozin (a dual SGLT inhibitor). In terms of cardiovascular composite events, sotagliflozin was the most effective according to the surface under the cumulative ranking area (SUCRA) ranking. In terms of cardiovascular deaths, empagliflozin was the most effective according to the SUCRA ranking. In terms of hospitalization for heart failure, canagliflozin was the most effective according to the SUCRA ranking. In terms of all-cause mortality, dapagliflozin was the most effective according to the SUCRA ranking. There were no statistical differences between finerenone and SGLT2 inhibitors in terms of safety of adverse events, serious adverse events, and acute kidney damage. For patients with hyperkalemia, SGLT2 inhibitors had a lower incidence than finerenone (RR=0.41, 95%CI 0.32～0.52). Conclusion　SGLT2 inhibitors reduce the incidence of cardiovascular events better than finerenone and can be used as basic treatment for patients with type 2 diabetes mellitus and/or chronic kidney disease and help prevent or reduce cardiovascular events.

Dulaglutide combined with alfacalcitol for patients with type 2 diabetes mellitus complicated with osteoporosis

Zhang Jihua, Zhang Guohui, Liu Yuguang

2024, 30(5):  789-792.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.017

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Objective　To explore the curative effect of dulaglutide combined with alfacalcitol for patients with type 2 diabetes mellitus complicated with osteoporosis. Methods　A total of 107 patients with type 2 diabetes mellitus complicated with osteoporosis admitted to Department of Endocrinology, Shanxian Central Hospital from January 2022 to June 2023 were selected for the randomized controlled trial, and were divided into an observation group (54 cases) and a control group (53 cases) by the random number table method. In the control group, there were 26 males and 27 females; they were (66.57±8.91) years old; the diabetes course was (8.87±1.56) years; their body mass index was (22.34±1.59) kg/m². In the observation group, there 25 males and 29 females; they were (65.23±8.81) years old; the diabetes course was (8.53±1.21) years; their body index was (22.52±1.68) kg/m². Both groups were given metformin for routine hypoglycemia; in addition, the control group orally took alfacalcitol, and the observation group took dulaglutide and alfacalcitol. The clinical efficacies, changes of blood glucose [fasting plasma glucose (FPG), 2 hours plasma glucose (2hPG), and glycosylated hemoglobin(HbA1c)] and bone metabolism indicators, and incidences of adverse reactions in both groups were observed. t and χ² tests were observed. Results　The total effective rate of the observation group was higher than that of the control group [96.30% (52/54) vs. 84.91% (45/53)], with a statistical difference (χ²=4.096, P=0.043). After the treatment, the levels of FPG, 2 h PBG, and HbA1c in the observation group were lower than those in the control group [(6.41±1.36) mmol/L vs. (7.27±1.18) mmol/L, (9.63±2.21) mmol/L vs. (11.57±2.43) mmol/L, and (5.58±1.29)% vs. (7.21±1.67)%], with statistical differences (t= -3.491, -4.322, and -5.656; all P<0.05). After the treatment, the serum calcium (Ca) concentration and bone specific alkaline phosphatase (BALP) level in the observation group were higher than those in the control group [(2.67±0.45) mmol/L vs. (2.43±0.48) mmol/L and (19.38±3.31) U/L vs. (17.27±3.19) U/L]; the alkaline phosphatase (ALP) level in the observation group was lower than that in the control group [(32.75±9.34) U/L vs. (36.82±9.49) U/L]; there were statistical differences (t=2.669, 3.357, and -2.225; all P<0.05). There was no statistical differences in the incidence of adverse reactions between the observation group and the control group [5.56% (3/54) vs. 9.43% (5/53); χ²=0.582; P=0.446]. Conclusion　Duloglucoptide combined with alfacalcitol is effective in the treatment of patients with type 2 diabetes mellitus complicated with osteoporosis, and can effectively control their blood glucose and improve their osteoporosis, and is safe.

Effect of five "E" nursing mode for patients with diabetic nephropathy

Wen Junping, Zhou Yanyan, Peng Xiaohui

2024, 30(5):  793-796.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.018

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Objective　To explore the effect of five "E" nursing mode on quality of life of patients with diabetic nephropathy. Methods　Fifty-four patients with diabetic nephropathy treated at Department of Nephrology, Guangzhou First People's Hospital from January to December 2020 were selected as a control group, and 55 patients with diabetic nephropathy treated at Department of Nephrology, Guangzhou First People's Hospital from January to December 2021 were selected as a research group. There were 30 males and 24 females in the control group; they were (56.54±10.15) years old. There were 33 males and 22 females in the research group; they were (58.85±10.04) years old. The control group used the conventional nursing methods, and the research group used the five "E" nursing mode (encouragement, education, exercise, work, and evaluation). Twelve months later, the scores of Short Form 36 (SF-36), Physical Component Summary (PCS), and Mental Component Summary (MCS) were compared between the two groups. t test was applied. Results　There were no statistical differenes in the scores of physical function, physical role, and body pain between the two groups (P>0.05). The scores of general health status, energy, social function, emotional function and mental health in the research group were higher than those in the control group [(59.86±18.05) vs. (50.48±22.70), (66.91±19.21) vs. (54.17±21.30), (70.46±32.40) vs. (51.85±36.38), (61.21±26.15) vs. (45.98±15.19), and (61.31±15.51) vs. (48.96±18.63)], with statistical differences (t=2.390, 3.280, 2.822, 2.948, and 3.764; all P<0.05). There was no statistical difference in the score of PCS between the two groups (P>0.05). The score of MCS in the research group was higher than that in the control group [(43.15±7.23) vs. (33.82±13.06)], with a statistical difference (t=4.625; P<0.05). Conclusion　The five "E" nursing mode can improve the quality of life of patients through five aspects of skills: encouragement, education, movement, work, and evaluation.

Treatises

Effect of PTBP3 on proliferation and migration of esophageal squamous cell carcinoma and its mechanism

Lyu Ying, Hao Mingshuo, Qian Yang, Wang Rui, Xiang Longquan

2024, 30(5):  797-802.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.019

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Objective　To explore the role and potential mechanism of polypyrimidine tract binding protein 3 (PTBP3) in esophageal squamous cell carcinoma. Methods　Six specimens of esophageal squamous cell carcinoma and six specimens of its adjacent normal tissue were collected from Jining First People's Hospital from January 2021 to May 2023. The expressions of PTBP3 in the tissue and the cells were determined by real-time quantitative polymerase chain reaction (qRT-PCR) and Western blotting; the CCK8 assay kit was used to determine the ESCC cells' viability; the scratch experiment was used to determine the ESCC cells' migration ability. The UALCAN and TCGA databases were searched to analyze the expression difference of PTBP3 between the esophageal cancer tissue and the normal esophageal tissue, and the relationship between PTBP3 and miR29 family. t test was used. Results　The expression of PTBP3 in the ESCC tissue was higher than that in the normal esophageal tissue, with a statistical difference (P<0.05). The results of qRT-PCR showed that the expressions of miR-29a-3p and miR-29c-3p in the PTBP3 knocked down group were lower than those in the control virus group in the 3 ESCC cells (KYSE30, ECA109, and KYSE150)(t=29.007, 7.057, 4.844, 12.625, 15.612, and 18.861; all P<0.05). In the ESCC tissue, the expressions of miR-29a-3p and miR-29c-3p were correlated with the expression of PTBP3. Conclusion　PTBP3 may be an important molecular marker and potential therapeutic target for ESCC. It can provide new ideas and a method for the early diagnosis and a treatment of ESCC.

Effects of propofol versus etomidate on laryngoscopic tracheal intubation conditions and stress response in elderly patients taking general anesthesia

He Huali, Zhu Mingxia, Zhao Yifan, Shan Zhaoya

2024, 30(5):  802-808.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.020

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Objective To explore the effects of propofol versus etomidate on laryngoscopic tracheal intubation conditions and stress response in elderly patients taking general anesthesia. Methods　One hundred and thirty elderly patients who underwent elective orthopedic surgery under general anesthesia at Hospital Affiliated to Shaanxi University of Chinese Medicine from June 2022 to August 2023 were selected for the randomized controlled trial. They were divided into a propofol group (group P) and an etomidate group (group E) by the random number table method, with 65 cases in each group. Group P took anesthesia induction by 2.0 mg/kg propofol, and group E by 0.3 mg/kg etomidate; both groups combined with 0.50 µg/kg sufentanil and 0.15 mg/kg cisatracurium. The intubation conditions were evaluated by the Viby-Mogensen Intubation Conditions Scale immediately after intubation. The meal artery pressure (MAP), heart rate (HR), and rate pressure product (RPP) were recorded before anesthesia induction (T₀), immediately after propofol/etomidate injection (T₁), after laryngoscope insertion (T₂), 1 min after tracheal intubation (T₃), and 3 min after successful tracheal intubation (T₄). The levels of norepinephrine (NE), cortisol (Cor), and blood glucose were compared at T₀, T₂, and T₄. The incidences and severities of injection pain within 30 s after propofol or etomidate injection were compared between the two groups. The tracheal intubation times were compared between the two groups. The χ² test, Mann-Whitney U test, tepeated measurement ANOVA, and t test were used. Results　There were no statistical differences in the basal line data, such as age, gender, body mass index, American Society of Anesthesiology (ASA) grading, etc., between the two groups (all P>0.05). There were no statistical differences in the laryngoscope insertion, vocal cord position, vocal cord movement, airway response, and limb response of the Viby-Mogensen Intubation Conditions Scale between the two groups (all P>0.05). The MAP's at T₂, T₃, and T₄ in group E were higher than those in group P; the HR's at T₂, T₃, and T₄ in group E were lower than those in group P; there were statistical differences (all P<0.05). The levels of NE [(135.32±30.47) μg/L vs. (147.54±32.16) μg/L], Cor [(68.39±14.12) ng/L vs. (76.17±14.65) ng/L], and blood glucose [(5.46±0.64) mmol/L vs. (6.04±0.76) mmol/L] at T₂ in group E were lower than in group P, with statistical differences (all P<0.05). The levels of NE [(154.69±33.42) μg/L vs. (170.35±36.30) μg/L], Cor [(73.42±14.59) ng/L vs. (82.64±16.73) ng/L], and blood glucose [(6.72±0.95) mmol/L vs. (8.29±1.03) mmol/L] T₃ in group E were lower than those in group P, with statistical differences (all P<0.05). There was no statistical difference in tracheal intubation time between the two groups (P>0.05). The incidence of injection pain and injection pain score in group E were lower than those in group P [17.46% (11/63) vs. 56.67% (34/60) and 0 (0, 1) vs. 1 (0, 1)], with statistical differences (both P<0.05). Conclusions　Application of 2.0 mg/kg propofol and 0.3 mg/kg etomidate combined with 0.50 µg/kg sufentanil and 0.15 mg/kg cisatracurium in laryngoscopic tracheal intubation of elderly patients taking general anesthesia both have comparable conditions for tracheal intubation, but the induction by etomidate has more stable hemodynamics, milder stress response, and less severe injection pain.

Soft channel hematoma puncture and drainage for patients with hypertensive intracerebral hemorrhage

Wang Kun, Zhang Chunhua, Luo Changwen, Li Hai

2024, 30(5):  808-813.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.021

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Objective　To explore the effects of soft channel hematoma puncture and drainage on microRNA-21 (miR-21), microRNA-124 (miR-124), soluble myeloid cell trigger receptor-1 (sTREM-1), procalcitonin (PCT), and neurological function in patients with hypertensive intracerebral hemorrhage (HICH). Methods　Sixty-one patients with HICH who were treated at Ankang Central Hospital from February 2020 to February 2023 were selected for the randomized controlled trial, and were divided into group A (31 cases) and group B (30 cases) by the random number table method. There were 19 males and 12 females in group A; they were (58.98±10.65) years old; 3 cases had hemorrhage on thalamus, 2 cases on cerebellum, 23 cases on basal ganglia area, 1 case on parietal lobe, 1 case on frontal lobe, and 1 case on temporal lobe. There were 17 males and 13 females in group B; they were (59.20±10.71) years old; 3 cases had hemorrhage on thalamus, 3 cases on cerebellum, 20 cases on basal ganglia area, 1 case on parietal lobe, 2 case on frontal lobe, and 1 case on temporal lobe. Group A took the endoscopic intracranial hematoma removal surgery (NEIHE), while group B soft channel hematoma puncture and drainage surgery. All the patients were followed up for 6 months after the surgery. The surgery related indicators, including treatment efficacy 1 month after the surgery, neurological function [National Institute of Health Stroke Scale (NIHSS)] before and 7 d and 1 month after the surgery, the levels of miR-21, miR-124, sTREM-1, and PCT before and 1 month after the surgery, and complications during follow-up were compared between the two groups. t and χ² tests were applied. Results　The intraoperative bleeding volume, hospitalization cost, and 72 h hematoma clearance rate in group B were lower than those in group A [(46.65±42.43) ml vs. (71.67±44.76) ml, (65 543.54±23 521.06) yuan vs. (96 574.76±50 234.54) yuan, and (73.65±12.87)% vs. (88.09±17.65)%]; the operation time in group B was shorter than that in group A [(0.65±0.32) h vs. (2.03±0.41) h]; the time of hospitalization in the intensive care unit (ICU) in group B was longer than that in group A [(9.65±5.54) d vs. (2.65±1.76) d]; there were statistical differences (t=2.239, 3.073, 3.641, 14.622, and 6.696; all P<0.05). One month after the surgery, the total effective rate in group B was higher than that in group A [93.33% (28/30) vs. 70.97% (22/31)], with a statistical difference (χ²=5.160; P=0.023). Before the surgery, there was no statistical difference in the neurological function between the two groups (P>0.05). Seven days and 1 month after the surgery, the scores of neurological function in group B were lower than those in group A [(16.65±3.65) vs. (19.87±3.87) and (6.54±0.65) vs. (13.76±1.76)], with statistical differences (t=3.341 and 21.114; both P<0.05). Before the surgery, there were no statistical differences in the levels of miR-21, miR-124, sTREM-1, and PCT between the two groups (all P>0.05). One month after the surgery, the levels of miR-21, miR-124, sTREM-1, and PCT in group B were better than those in group A [(3.02±0.45) vs. (2.37±0.41), (5.43±0.45) vs. (6.98±0.67), (6.87±0.23) ng/L vs. (16.87±1.65) ng/L, and (2.76±0.18) μg/L vs. (5.87±0.79) μg/L], with statistical differences (t=5.901, 10.571, 32.879, and 21.035; all P<0.05). There was no statistical difference in the incidence of complications during follow up between group B and group A [46.67% (14/30) vs. 25.81% (8/31); χ²=2.877; P=0.090]. Conclusions　In the treatment of patients with HICH, NEIHE is more effective in hematoma removal, and helps shorten ICU hospitalization. However, soft channel hematoma puncture and drainage can significantly shorten operation time, reduce intraoperative bleeding and hospitalization cost, improve their neurological function and treatment efficacy, and regulate the expression levels of miR-21, miR-124, sTREM-1, and PCT.

Distribution and antibiotic resistance analysis of pathogens in alveolar lavage fluid from 2013 to 2022 in some hospital

Xu Chao, Wang Xiaochen, Tian Lei

2024, 30(5):  814-820.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.022

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Objective　To explore the distribution of pathogens and the resistance of common pathogens in alveolar lavage fluid samples from Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from 2013 to 2022. Method　Using a retrospective survey research method, 36 233 alveolar lavage fluid samples in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from 2013 to 2022 were collected, and 11 801 strains of pathogenic bacteria were isolated from the samples. The results of their cultivation and in vitro drug sensitivity tests were analyzed and studied using the WHONET5.6 software. Results　A total of 11 801 strains of non-duplicative isolated pathogens were detected in the alveolar lavage fluid samples; of which, 69.15% (8 321/11 801) were gram-negative bacteria, 2.28% (1 378/11 801) gram-positive bacteria, and 18.57% (2 192/11 801) fungi. Klebsiella pneumoniae (KPN) had a sensitivity of more than 70.00% to amikacin, carbapenems, and tigecycline; Pseudomonas aeruginosa (PAE) had a sensitivity of more than 40.00% to most antibiotics except cotrimoxazole and minocycline; Acinetobacter baumannii (ABA) had a resistance rate more than 75.00% to most antibiotics except minocycline. Among the most important pathogens in KPN, the proportion of Carbapenem-resistant to Klebsiella pneumoniae (CRKPN) increased, and the drug resistance increased. Methicillin-resistant Staphylococcus aureus (MRSA) accounted for a relatively high proportion, and the drug resistance rate was significantly higher than that of Methicillin-susceptible to Staphylococcus aureus (MSSA). The vast majority of Streptococcus pneumoniae (SPN) was Penicillin-susceptible to Streptococcus pneumoniae (PSSP). Conclusion　From 2013 to 2022, the pathogenic bacteria isolated from the alveolar lavage fluid specimens in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology mainly included KPN, PAE, ABA and Staphylococcus aureus (SAU); the drug resistance rate of CRKPN was on the rise. Therefore, we should rationally use the drugs to decrease its drug resistance.

Clinical Research

Endoscopic thyroidectomy via oral vestibular approach versus via areola approach for patients with thyroid nodules

Zheng Weigang

2024, 30(5):  821-824.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.023

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Objective　To explore the effects of endoscopic thyroidectomy via the oral vestibular approach versus via the areola approach in the treatment of patients with thyroid nodules. Methods　A total of 86 patients with thyroid nodules admitted to Dezhou Municipal Hospital from March 2021 to March 2022 were selected for the randomized controlled trial. They were divided into a conventional group and a study group by the random number table method, with 43 cases in each group. There were 22 males and 21 females in the conventional group; they were 48-82 (59.85±10.25) years old. There were 20 males and 23 females in the study group; they were 47-81 (59.52±10.01) years. The conventional group underwent endoscopic thyroidectomy via the areola approach, while the study group underwent endoscopic thyroidectomy via the oral vestibular approach. The surgery-related indicators (intraoperative bleeding volume and operation time), scores of Standardized Swallowing Assessment (SSA), and incidences of complications within 1 month after the surgery were compared between the two groups. t and χ² tests were applied. Results　The operation time and intraoperative bleeding volume in the study group were less than those in the conventional group [(52.14±10.02) min vs. (56.87±10.14) min and (12.14±2.85) ml vs. (15.74±3.01) ml], with statistical differences (t=2.176 and 5.695; P=0.032 and <0.001). Before the surgery, there was no statistical difference in the score of SSA between the two groups (P>0.05). After the surgery, the scores of SSA in both groups were lower than those before the surgery; the score in the study group was lower than that in the conventional group [(18.12±1.11) vs. (21.58±1.25)]; there were statistical differences (all P<0.05). The incidence of complications within 1 month after the surgery in the study group was lower than that in the conventional group [4.65% (2/43) vs. 18.60% (8/43); P<0.05]. Conclusion　Compared with endoscopic thyroidectomy through the areolar approach, endoscopic thyroidectomy through the oral vestibular approach is more effective for patients with thyroid nodules, and can reduce surgical trauma, improve their swallowing function, and reduce the incidence of complications.

Epidemiological investigation of Mycoplasma Pneumoniae and Chlamydia Pneumoniae infection in patients with acute respiratory tract infection 

Huang Youfang, Lan Huihua, Lin Yi, Zhang Ling

2024, 30(5):  825-828.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.024

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Objective　To investigate the epidemiological characteristics of Mycoplasma Pneumoniae (MP) and Chlamydia Pneumoniae (CP) infection in patients with acute respiratory tract infection in this area. Methods　The results of serum MP and CP immunoglobulin M (IgM) antibodies in 4 896 patients with acute respiratory tract infection who were 1 day to 102 years old and treated in Chenggong Hospital Affiliated to Xiamen University from February 2021 to August 2023 were retrospectively analyzed. There were 2 886 males and 2 010 females. The results were analyzed by the χ² test to compare the infection types, populations, and seasonal distribution characteristics of MP and CP. Results　The positive rate of MP-IgM and CP-IgM antibodies in the patients with acute respiratory infection from 2021 to 2023 was 14.48% (709/4 896); the positive rate of MP was 12.58% (616/4 896); the positive rate of CP was 1.63% (80/4 896); the positive rate of MP+CP was 0.27% (13/4 896); MP infection was the main infection. The positive rate of MP in the females was higher than that in the males [17.31% (348/2 010) vs. 9.74% (281/2 886)], with a statistical difference (χ²=60.748, P<0.001). There was no statistical difference in the positive rate of CP between the females and the males (χ²=0.360, P>0.05). There were statistical differences in the infection rates of MP and CP between the different age groups (χ²=237.938 and 55.070, both P<0.05). MP mainly infected the 0～14 years old children, and CP the 6-40 years old. The total positive rates of MP [15.30% (268/1 752)] and CP [2.40% (42/1 752)] in summer were higher than those in other seasons. There was a statistical difference in the total positive rate of MP between different seasons (χ²=16.747, P<0.001),with a high incidence in summer and autumn. There was no statistical difference in the total positive rate of CP between different seasons (χ²=4.114, P=0.249). Conclusions　MP and CP are important pathogens of acute respiratory diseases; among which, MP is the main infection, showing seasonal, gender, and age differences.

Effect of spinal-epidural anesthesia for parturients taking painless delivery

Meng Yajing, Ren Junyi

2024, 30(5):  829-833.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.025

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Objective　To analyze the effect of spinal-epidural anesthesia for parturients taking painless delivery. Methods　A prospective study was conducted on 302 parturients who were admitted to Baoji Maternal and Child Health Hospital for painless delivery from June 2021 to June 2023. They were divided into a control group and a research group by the random number table method, with 151 cases in each group. The control group were (28.69±3.77) years old and (39.14±1.15) weeks pregnant, and took epidural anesthesia. The research group were (28.72±3.81) years old and (39.16±1.10) weeks pregnant, and took spinal-epidural anesthesia. The delivery-related indicators, stress indicators, and delivery outcomes were compared between the two groups. t and χ² tests were applied. Results　Compared with those in the control group, the first and second stages of labor, the total stage of labor, the onset time of anesthesia, the recovery time of intestinal peristalsis, and the hospitalization time in the research group were shorter, the bleeding volume 2 hours after delivery in the research group was lower, and the duration of anesthesia in the research group was longer; there were statistical differences (all P<0.05). The scores of the Visual Analogue Scale (VAS) in the second and third stages of labor and when the cervix was fully open and the Bro-mage score of the parturient after successful delivery in the research group were lower than those in the control group; the score of milk yield 24 h after delivery in the research group was higher than that in the control group; there were statistical differences (all P<0.05). Twenty-four hours after delivery, the serum levels of cortisol (COR) [(33.66±4.53) mg/L and (18.44±3.61) mg/L], norepinephrine (NE) [(158.16±16.54) ng/L and (142.35±15.48) ng/L], prostaglandin E2 (PGE2) [(99.36±8.62) ng/L and (90.12±8.47) ng/L], substance P (SP) [(4.12±0.58) mg/L and (3.47±0.45) mg/L], and prolactin (PRL) [(245.63±24.12) μg/L and (276.30±25.78) μg/L] in the control group and the research group were higher than those before delivery, the changes of serum COR, NE, PGE2, SP, and PRL of the research group were more obvious (t=32.288, 20.106, 9.395, 10.880, and 10.675; all P<0.001). There were no statistical differences in the delivery outcomes between the two groups (all P>0.05). Conclusion　The application of spinal-epidural anesthesia in parturients taking painless delivery can shorten the labor stages, reduce the expression of stress indicators and pain-causing factors, relieve their pain, and improve their lactation function, and have good delivery outcomes.

Clinical characteristics and prognosis of patients with staphylococcal-associated pyogenic spondylitis

Wang Haifeng, Wu Zhaofeng, Hou Zhongyu, Li Liang

2024, 30(5):  834-838.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.026

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Objective　To explore the pathological changes of staphylococcal-associated pyogenic spondylitis (PS) based on laboratory examination, clinical characteristics, and prognosis, and to provide references for its clinical diagnosis and treatment. Methods　Eighty patients with staphylococcus-associated PS admitted to Jinan Eighth People's Hospital from January 2012 to October 2022 were selected. Their basic information, lesion segment distribution, laboratory indicators, CT and MRI imaging features and prognosis were statistically analyzed. Results　Among the 80 patients were statistically analyzed, there were 36 males and 44 females; 63 cases ≥50 years old; all of them had low back pain in some degree; their score of Visual Analogue Scale (VAS) was (7.38±0.23). The lesion segments were mainly distributed in T8-T9 (15 cases, 18.75%), L3-L4 (12 cases, 15.00%), and L2-L3 (10 cases, 12.50%). Platelets, erythrocyte sedimentation rate, white blood cell count, neutrophils, ferritin, and C-reactive protein increased, while serum hemoglobin and albumin decreased. The CT examination showed that PS lesions damaged the vertebral bone and surrounding soft tissue swelled. The CT enhanced scan showed no enhancement in the central liquefaction necrosis area, and the edge of the paraspinal soft tissue was enhanced. The MRI examination showed abnormal signal foci in the lesion vertebral body, swelling in the paraspinal soft tissue, abnormal signal foci in the disc destruction area, which showed low signal on T1WI and high signal on T2WI with fat compression. The MRI enhanced scan showed significant enhancement, and T2WI showed high signal with fat compression. After systematic treatment, all the patients showed a significant decrease in VAS score [(2.41±0.17)], and had good prognosis. Conclusion　PS caused by staphylococcus is accompanied by varying degrees of low back pain, with the main affected segments being T8, T9, L3, and L4. CT, MRI, C-reactive protein, and erythrocyte sedimentation rate elevation can be used as effective auxiliary tests for the diagnosis of PS. Timely relevant treatments can effectively alleviate the patients' pain and achieve cured effect.

Effects of zirconia all-ceramic crown and cobalt-chromium alloy porcelain crown in repairing anterior teeth defect and detection of pathogens

Cao Li, Li Baokun, Cao Jianqi

2024, 30(5):  838-843.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.027

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Objective　To analyze the effects of zirconia all-ceramic crown and cobalt(Co)-chromium(Cr) alloy porcelain crown in repairing anterior teeth defect, the patients' gingival health, and the detection of pathogenic bacteria in subgingival plaque. Methods　A prospective study was conducted on 153 patients (226 teeth) with anterior teeth defect treated at Department of Stomatology, Sun Simmiao Hospital, Beijing University of Chinese Medicine from August 2021 to August 2022. The patients were divided into a control group (76 cases, 112 teeth) and a research group (77 cases, 114 teeth) by the random number table method. There were 42 males and 34 females in the control group; they were (33.65±4.72) years old; their disease course was (5.14±1.23) months. There were 44 males and 33 females in the research group; they were (33.74±4.53) years old; their disease course was (5.15±1.22) months. The control group received Co-Cr alloy porcelain crown restoration, and the research group received zirconia all-ceramic crown restoration. Both groups were followed up for 1 year. The restoration effects, detection of subgingival plaque pathogens 1 year after restoration, chewing function, gingival crevicular fluid inflammatory factors before and 1 month after restoration, periodontal statusbefore and 6 months after restoration, and adverse reactions within 1 year after restoration were compared between the two groups. t test and χ² test were used. Results　The total excellent rate 1 year after restoration in the research group was higher than that in the control group [93.51% (72/77) vs. 82.89% (63/76)], with a statistical difference (χ²=4.149, P=0.042). One month after restoration, the bite forces and masticatory efficiencies of the two groups were higher than those before restoration, while the SDHue counts of the two groups were lower than those before restoration, and those in the research group changed more obviously, with statistical differences (all P<0.05). Six months after restoration, the scores of teeth mobility, plaque index (PLI), and gingival index (GI) [(3.54±0.63) and (1.67±0.35); (1.11±0.14) and (0.78±0.12); (0.98±0.14) and (0.79±0.13)] of the control group and the research group were lower than those before restoration [(20.75±3.31) and (20.77±3.24); (1.82±0.23) and (1.85±0.24); (1.47±0.22) and (1.44±0.25)], and those in the research group changed more obviously, with statistical differences (t=22.734, 15.661, and 8.700; all P<0.05). One year after restoration, the detection rates of Porphyromonas gingivalis (Pg), Fusobacterium nucleatum (Fn), Tannerella forsythia (Tf), and Actinobacteria actinomycetemcomitans (Aa) in the research group were lower than those in the control group [2.60% (2/77) vs. 11.84% (9/76), 3.90% (3/77) vs. 14.47% (11/76), 3.90% (3/77) vs. 14.47% (11/76), and 2.60% (2/77) vs. 13.16% (10/76)], with statistical differences (χ²=4.899, 5.148, 5.148, and 5.902; all P<0.05). One month after restoration, the levels of matrix metalloproteinase-8 (MMP-8), tumor necrosis factor-α (TNF-α), aspartate aminotransferase (AST), and C-reactive protein (CRP) in the gingival crevicular fluid of the two groups were higher than those before restoration, and those in the research group changed more obviously, with statistical differences (all P<0.05). There was no difference in the total incidence of adverse reactions within 1 year after restoration between the two groups (P>0.05). Conclusion　Compared with Co-Cr alloy porcelain crown, zirconia all-ceramic crown can improve the restoration effect, chewing function, and periodontal condition, reduce the pathogenic bacteria of subgingival plaque, and inhibit the expression of inflammatory factors in gingival crevicular fluid, and has fewer adverse reactions.

Case Report

One case of olfactory sulcus meningioma complicated with frontal raphe and literature review

Zhang Hao, Tian Zhihua

2024, 30(5):  844-847.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.028

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Meningioma is a kind of intracranial benign neoplastic disease with a high incidence in clinical practice. According to survey data, meningioma accounts for about 30% of all intracranial tumors; of which, olfactory sulci meningioma account for 8.8%. This patient had blurred vision in both eyes for 3 months. The examination of the nervous system showed that her visual acuity of both eyes decreased, and her olfactory sensation in both nasal cavities was normal. The CT examination revealed that the patient had a frontal midline suture. The magnetic resonance imaging revealed a meningioma in the olfactory sulcus of the anterior skull base. Surgical treatment was performed and there was no recurrence after six months of follow-up. The diagnosis was meningioma. The coronal incision, subfrontal and longitudinal fissure approach were selected for the surgery; the tumor was removed in blocks; the brain tissue was protected. After the tumor was completely removed, the Dura mater attached to the tumor was burned. Simpson grade Ⅱ resection was performed. After the surgery, the patient was followed up by phone; the patient could take care of herself; no sequelae were found.

A case of severe subclavian artery stenosis complicated with digital artery embolism and literature review

Wang Zhihao, Xing Guofei, Zou Xiulan, Hou Hongjun, Sui Haiming

2024, 30(5):  848-852.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.029

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This paper mainly analyzes the diagnosis and treatment process of a case of subclavian artery stenosis combined with digital artery embolism at Weihai Central Hospital in November 2022. The treatment timing and methods of subclavian artery stenosis and digital artery embolism and the treatment of vascular crisis were explored. This article reviews the etiology and treatment of subclavian artery stenosis, as well as drug therapy and surgical treatment of digital artery embolism. It is believed that when subclavian artery occlusion combined with digital artery embolism occurs, stent implantation should be performed as soon as possible for the cause of subclavian artery occlusion or stenosis. If limb ischemia still exists, early vascular exploration is recommended. For patients with smoking history and long ischemia time, autologous vein bridging should be used as early as possible to improve the survival rate of finger bodies

One rare severely obese adolescent girl with endometrial atypical hyperplasia and literature review

Shang Dandan, Li Li, Cao Zhang, Zhang Lili, Zhou Chao

2024, 30(5):  853-856.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.030

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 Endometrial atypical hyperplasia is a common endometrial disease and a precancerous lesion of endometrial cancer. This article reports a rare case of a 16-year-old severely obese girl admitted to Binzhou Medical University Hospital because of heavy vaginal bleeding. The pathological results after hysteroscopic surgery indicated endometrial atypical hyperplasia.

Nursing Research

Effect of relaxation therapy on patients with primary liver cancer complicated with portal hypertension after jugular intrahepatic portal shunt

Jia Yanbing, Wang Chaoyang, Zhang Yuzhu

2024, 30(5):  857-861.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.031

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Objective　To analyze the effects of relaxation therapy on pain stress response and adverse mood in patients with primary liver cancer complicated with portal hypertension after jugular intrahepatic portal shunt (TIPS). Methods　A total of 92 patients with primary liver cancer complicated with portal hypertension after TIPS at First Hospital, Henan University of Science and Technology from June 2020 to June 2022 were selected for the randomized controlled trial, and were divided into a control group and an experimental group by the random number table method, with 46 cases in each group. In the control group, there were 25 males and 21 females; there were 8 cases of stage A, 20 cases of stage B, and 18 of stage C; they were 40- 76 (55.16±5.80) years old. In the experimental group, there were 27 males and 19 females; there were 10 cases of stage A, 21 cases of stage B, and 15 cases of stage C; they were 42-75 (54.61±5.63) years old. Both groups were given routine intervention after the operation. The control group did postoperative music relaxation training; in addition, the experimental group did abdominal breathing training after the surgery. The degrees of postoperative pain, the levels of stress response, and the negative emotions were compared between the two groups. t test was applied. Results　After the intervention, the scores of Visual Analogue Scale (VAS) and Brief Pain Assessment Scale (BPI) and level of neuropeptide Y (NPY) in the experimental group were significantly lower than those in the control group [(2.53±0.55) vs. (3.61±0.89), (10.35±1.90) vs. (13.26±2.24), and (135.58±15.21) ng/L vs. (159.15±19.08) ng/L], while the level of calcitonin gene-related peptide (CGRP) in the experimental group was higher than that in the control group [(34.13±5.48) ng/L vs. (29.73±4.86) ng/L], with statistical differences (t=7.00, 6.72, 6.55, and 4.07; all P<0.05). After the intervention, the levels of prostaglandin E2 (PGE2), 5-hydroxytryptamine (5-HT), substance P (SP), and cortisol (Cor) in the experimental group were lower than those in the control group [(95.38±9.27) μg/L vs. (106.12±12.37) μg/L, (242.16±30.79) mmol/L vs. (282.13±36.67) mmol/L, (40.13±5.91) pg/L vs. (46.89±6.75) pg/L, and (532.12±50.79) nmol/L vs. (603.60±57.21) nmol/L], with statistical differences (t=4.71, 5.66, 5.04, and 6.43; all P<0.05). After the intervention, the scores of Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) in the experimental group were lower than those in the control group [(13.02±2.08) vs. (15.13±2.26) and (9.83±1.37) vs. (12.95±2.08)], while the level of dopamine (DA) in the experimental group was higher than that in the control group [(75.59±7.25)ng/L vs. (67.39±6.78)ng/L], with statistical differences (t=4.66, 8.50, and 5.60; all P<0.05). Conclusion　Relaxation therapy for patients with primary liver cancer complicated with portal hypertension after TIPS can relieve their pain, reduce their stress response level, and improve their bad mood.

Effect of surgical risk self-examination nursing for patients taking trabeculectomy for glaucoma

Xin Tian , Du Tingting, Wu Peng, Li Ning

2024, 30(5):  862-866.  DOI: 2023-03199

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Objective　To explore the clinical effect of surgical risk self-examination nursing for patients taking trabeculectomy for glaucoma. Methods　One hundred and twenty-six patients taking trabeculectomy for glaucoma at Jinan Second People's Hospital from November 2022 to February 2023 were selected as the nursing study objects. According to the different nursing methods, they were divided into a control group, taking routine nursing, and an observation group, taking surgical risk self-examination nursing, with 63 cases in each group. The control group included 38 males and 25 females who were (66.48±3.44) years old; according to the core hardness, there were 36 cases of grade Ⅱ and 27 cases of grade Ⅲ. The observation group had 36 males and 27 females who were (66.51±3.58) years old; according to the core hardness, there were 33 cases of grade Ⅱ and 30 cases of grade Ⅲ. The surgery related indicators, mood status, and complications in both groups were analyzed. t and χ² tests were applied. Results　The intraoperative systolic and diastolic blood pressures, heart rate, operation time, and length of hospital stay in the observation group were better than those in the control group [(119.56±9.38) mmHg (1 mmHg=0.133 kPa) vs. (126.36±12.41) mmHg, (70.57±5.44) mmHg vs. (68.39±3.34) mmHg, (74.53±13.38) beats/min vs. (80.39±9.44) beats/min, (48.61±8.49) min vs. (54.47±11.35) min, and (2.44±0.33) d vs. (3.32±1.45) d], with statistical differences (t=3.47, 2.71, 2.84, 3.28, and 4.70; all P<0.05). The scores of depression, tension, anger, panic, fatigue, energy, and self-related emotion in the observation group were better than those in the control group [(11.57±2.49) vs. (13.33±4.43), (12.61±3.42) vs. (14.36±5.28), (13.55±5.27) vs. (15.38±4.40), (11.66±2.29) vs. (13.37±3.35), (8.54±3.53) vs. (10.41±1.42), (18.56±4.27) vs. (16.39±3.55), and (15.58±3.22) vs. (13.44±2.45)], with statistical differences (t=2.75, 2.21, 2.12, 3.35, 3.90, 3.10, and 4.20; all P<0.05). The incidence of complications in the observation group was lower than that in the control group [1.59% (1/63) vs. 11.11% (7/63)], with a statistical difference (χ²=4.81, P<0.05). Conclusion　Surgical risk self-examination nursing is helpful to improve surgical indicators of patients taking trabeculectomy for glaucoma, relieve their panic and resistance during surgery, and reduce the incidence of complications.

Effect of dietary support at night on TIPS for patients with chronic acute liver failure

Xu Xiaomeng, Zhang Panpan, Song Jia, Yuan Xiang

2024, 30(5):  867-871.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.033

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Objective　To investigate the effects of dietary support at night on liver reserve function, anthropometric indicators, and protein levels in patients with chronic acute liver failure treated by transjugular intrahepatic portal vein shunt (TIPS). Methods　A total of 107 patients with chronic acute liver failure who received TIPS in First Hospital, Henan University of Science and Technology from September 2020 to September 2022 were selected for the prospective study, and were divided into a control group (53 cases) and a study group (54 cases) by the simple randomization method. There were 42 males and 11 females in the control group; they were 27-69 (53.15±4.79) years old. There were 45 males and 9 females in the study group; they were 24-67 (52.48±5.02) years old. The control group received daily dietary support treatment; in addition, the study group took night meal nutritional support. Both groups were treated for 2 months. t test was used. Results　The scores of the nutrition risk screening (NRS-2002) and Child-Pugh 1 month after the treatment in the study group were lower than those in the control group [(2.43±0.47) vs. (3.68±0.91) and (7.12±1.41) vs. (8.64±1.63)], with statistical differences (t=8.90 and 5.16; both P<0.05). One month after the treatment, the body mass index (BMI), upper arm muscle circumference (MAMC), and triceps skin fold thickness (TSF) in the study group were higher than those in the control group [(22.11±1.83) kg/m² vs. (21.09±2.05) kg/m², (24.18±2.35) cm vs. (22.48±3.02) cm, and (13.06±3.31) cm vs. (11.26±2.78) cm], with statistical differences (t=2.71, 3.25, and 3.05; all P<0.05). One month after the treatment, the levels of albumin (ALB), prealbumin (PA), and transferrin (TRF) in the study group were higher than those in the control group [(34.06±7.24) g/L vs. (31.26±6.71) g/L, (138.26±33.49) mg/L vs. (103.18±24.36) mg/L, and (1 887.14±241.59) mg/L vs. (1 695.26±216.31) mg/L], with statistical differences (t=2.08, 6.21, and 4.33; all P<0.05). Conclusion　Adding nutritional support therapy with night meal can reduce the risk of malnutrition in patients with chronic acute liver failure after TIPS, enhance their liver reserve function, and improve their physical and nutritional status.

Application of follow-up empowerment education in patients with colorectal cancer undergoing chemotherapy

Zhou Jing, Ruan Liping, Gao Meng, Cui Fei

2024, 30(5):  871-875.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.034

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Objective　To analyze the impact of follow-up empowerment education on health belief, self-care ability, and quality of life of patients with colorectal cancer undergoing chemotherapy. Methods　A total of 80 patients with colorectal cancer undergoing chemotherapy at Department of Oncology, Anyang Cancer Hospital from January 2021 to January 2023 were selected for the randomized controlled trial, and were divided into a control group (40 cases) and an experimental group (40 cases) according to the admission order. In the control group, there were 20 males and 20 females; they were 34-79 (56.74±8.96) years old. In the experimental group, there were 21 males and 19 females; they were 32-81 (56.15±8.84) years old. The control group took routine health education. The experimental group took follow-up health education with the support of the concept of empowerment education. The scores of the Chinese version of the Champion Colorectal Cancer Health Belief Scale (CHBMS), Revised Self Care Ability Scale (ASAS-R-C), and McGill Quality of Life Scale (MQOL-C) before and after the intervention were compared between two groups. t test was applied. Results　After the intervention, the scores of Chinese version CHBMS and ASAS-R-C in the experimental group were higher than those in the control group [(146.15±20.48) vs. (126.65±22.47) and (60.45±10.33) vs. (52.36±8.77)], with statistical differences (t=4.06 and 3.78; both P<0.05). After the intervention, the scores of physiology, psychology, personal presence, and social support of MQOL-C in the experimental group were higher than those in the control group [(24.15±3.06) vs. (21.22±2.87), (41.26±3.74) vs. (37.59±3.58), (42.22±3.69) vs. (38.48±3.97), and (24.36±3.18) vs. (22.55±2.87)], with statistical differences (t=4.42, 4.48, 4.36, and 2.67; all P<0.05). Conclusion　Follow-up empowerment education can enhance the health belief of patients with colorectal cancer undergoing chemotherapy, and improve their self-care ability and quality of life.

Preventive Medicine

Investigation on postmenopausal women's cognition and behaviors of osteoporosis prevention and the influencing factors

Chen Jingsong, Liu Ran, Li Qi, Wang Xiangyu

2024, 30(5):  876-880.  DOI: 10.3760/cma.j.issn.1007-1245.2024.05.035

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Objective　To investigate the current status of cognition and behaviors of preventive osteoporosis in postmenopausal women, and to explore the influencing factors. Methods　Two hundred and eighty-six postmenopausal women who underwent physical examination in Zhengzhou Orthopedic Hospital from March 2020 to March 2023 were selected for the cross-sectional study. They were (59.41±10.82) years old. Their menopausal time was (9.44±1.70) years. The cognition and behaviors of preventive osteoporosis in the postmenopausal women were investigated by the osteoporosis knowledge questionnaire and osteoporosis behavior questionnaire, and the influencing factors of cognition and behaviors of preventive osteoporosis in the postmenopausal women were analyzed. t test and multiple linear regression analysis were applied. Results　Among the 286 postmenopausal women, 267 completed the study questionnaires, with a completion rate of 93.36%. The total scores of the osteoporosis knowledge questionnaire and osteoporosis behavior questionnaire for the postmenopausal women were (13.24±2.58) and (16.81±3.02), respectively. The multiple linear regression analysis showed that >60-80 years old, education level of junior high school or below, and residence in township were the risk factors for the postmenopausal women's cognition of osteoporosis prevention (t=-7.177, -10.479 and -7.672; all P<0.001); the education level of junior high school or below, non-retired individuals, and income < 1 600 yuan/month were the risk factors for the postmenopausal women's behaviors of osteoporosis prevention (t=-7.144, -8.568, and -6.773; all P<0.001). Conclusions　Postmenopausal women's cognitive and behavioral levels of osteoporosis prevention need to be improved. Age, educational level, and place of residence can affect the cognitive level of osteoporosis prevention, while education level, work status, and income can affect the behavior level of osteoporosis prevention.