Table of Content

01 March 2024, Volume 30 Issue 6

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Topic:Lung Cancer

Mechanism of radix trichosanthis in the treatment of lung cancer based on network pharmacology and molecular docking

Cui Qidi, Sun Shanshan, Lu Mei, Huang Yanying, Lyu Wenwen

2024, 30(6):  881-889.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.001

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Objective　To investigate the target and mechanism of radix trichosanthis in the treatment of lung cancer based on network pharmacology and molecular docking. Methods　The search period was up to July 2022. The active ingredients of radix trichosanthis were selected using the TCMSP and TCMID databases combined with the PubChem database. The potential targets of active ingredients were obtained using the TCMSP, TCMID, and SwissTargetPrediction databases. The GeneCards, OMIM, TTD, and DrugBank databases were searched to collect the targets of lung cancer. The drugs were intersected with disease targets and a Venn diagram was drawn using the online web site Venny 2.1. The common target protein-protein interaction network was drawn using the String database. The "drug-active ingredient-disease-target" network diagram was constructed through Cytoscape 3.8.2 software. Gene ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis of common targets were performed using Metascape database. Molecular docking verification was performed using Autodock software. Results　Through screening, 28 active ingredients and 201 action targets were obtained from radix trichosanthis. A total of 1 645 lung cancer targets were retrieved from the four major disease databases. There were 37 intersecting targets between the drug and disease. According to the Degree value, estrogen receptor 1 (ER1), signal transduction and transcriptional activator 3 (STAT3), and epidermal growth factor receptor (EGFR) were determined as the core targets. GO enrichment analysis found that radix trichosanthis might treat lung cancer by regulating gland development, cell proliferation, cell adhesion, receptors, enzymes, and activities of proteins. The KEGG pathway enrichment analysis revealed that radix trichosanthis might act on chemical oncogenic receptor activation, pathways in cancer, hypoxia-inducing factor 1 (HIF-1) signaling pathway, and microRNAs and proteoglycans in cancer. Molecular docking results showed that the binding activity of key small molecule compounds to the core target was significant. Conclusion　Radix trichosanthis plays a role in the treatment of lung cancer through multi-target and multi-pathway mechanisms, laying a foundation for subsequent experiments and clinical applications.

Effects of cognitive behavioral therapy on anxiety, depression, and quality of life in patients with lung cancer: a meta-analysis

Li Jinping, Xiao Huan

2024, 30(6):  890-896.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.002

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Objective　To investigate the effects of cognitive behavioral therapy (CBT) on anxiety, depression, and quality of life in patients with lung cancer. Methods　The databases such as Web of Science, PubMed, Embase, CINAHL, MEDLINE, CNKI, Wanfang, and VIP were searched until April 1, 2023. Literatures related to CBT intervention in lung cancer patients were screened according to the inclusion and exclusion criteria, the literature quality was evaluated, and meta-analysis was performed using RevMan 5.4 software. Results　A total of 9 studies were included, involving 800 patients with lung cancer. CBT improved the anxiety [SMD=-0.80, 95%CI (-0.97, -0.63), P<0.000 01], depression [SMD=-1.25, 95%CI (-1.99, -0.52), P=0.000 8], and quality of life [SMD=0.89, 95%CI (0.62, 1.16), P<0.000 01] in lung cancer patients. Conclusions　Existing evidences show that CBT can improve the anxiety, depression, and quality of life in lung cancer patients, but existing studies have problems of publication bias, high heterogeneity, and low quality. It is necessary to conduct high-quality, multi-center, and large-sample homogenization studies to further explore the intervention effects of CBT on anxiety, depression, and quality of life in lung cancer patients.

Meta-analysis of the safety of EGFR-TKI monotherapy versus conventional chemotherapy in patients with advanced non-small cell lung cancer

Ma Jing, Lin Tingting, Dong Ningxia, Lyu Wenwen

2024, 30(6):  897-902.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.003

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Objective　In this study, we compared the safety of the first to third generations of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) versus conventional chemotherapy in patients with advanced non-small cell lung cancer (NSCLC). Net-work meta-analysis was used to compare the safety among different generations of EGFR-TKIs. Methods　Randomized controlled trials (RCTs) of EGFR-TKI monotherapy versus platinum-based pemetrexed chemotherapy were retrieved from PubMed, Embase, Cochrane Library, CBM, CNKI, Wanfang Database, and VIP from the establishment of the databases to December 2020. Investigators screened the literatures, extracted the information, and assessed the risk of bias for RCTs using the Cochrane Systematic Evaluation Risk of Bias Assessment Tool. The meta-analysis was performed with RevMan 5.3 software and STATA 15.1 software. Results　Seven RCTs with a total of 1 315 patients were included. Meta-analysis showed that there were no statistically significant differences in the incidence of diarrhea [relative risk (RR) = 2.16, 95% confidence interval (CI) (0.742, 6.297), P>0.05] or constipation [RR=0.44, 95%CI (0.187, 1.039), P>0.05] between the experimental group (EGFR-TKI monotherapy group) and the control group (pemetrexed combined with platinum group). The incidences of leukopenia [RR=0.21, 95%CI (0.10, 0.41), P<0.001], neutropenia [RR=0.21, 95%CI (0.08, 0.55), P<0.001], anemia [RR=0.26, 95%CI (0.13, 0.51), P<0.001], thrombocytopenia [RR=0.39, 95%CI (0.24, 0.64), P<0.001], loss of appetite [RR=0.39, 95%CI (0.28, 0.55), P<0.001], and nausea [RR=0.30, 95%CI (0.24, 0.37), P<0.001] in the experimental group were lower than those in the control group, while the incidence of rash in the experimental group was higher than that in the control group [RR=9.63, 95%CI (6.30, 14.72), P<0.001]. Network meta-analysis of the adverse events showed that the incidence of leukopenia in the third generation of EGFR-TKI osimertinib was higher than those in the first and second generations of EGFR-TKIs; the incidence of anemia in the osimertinib group was similar to that in the icotinib group, but was higher than those in the gefitinib and afatinib groups (both P<0.05). Conclusions　Compared with traditional chemotherapy regimens, the incidence of adverse reactions in the blood and digestive systems is lower in the first to third generations of EGFR-TKIs. Compared with the first and second generations, the third-generation of EGFR-TKI has advantages in reducing the incidences of leukopenia and anemia.

Expression of CLCA4 in non-small cell lung cancer tissue and its correlations with pathology and prognosis

Wu Yuanyuan, Liu Ke, Qi Yanli, Tong Xiaohua

2024, 30(6):  903-907.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.004

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Objective　To investigate the expression of calcium-activated chloride channel regulator 4 (CLCA4) in non-small cell lung cancer (NSCLC) tumor tissues and its correlations with pathology and prognosis. Methods　A total of 106 patients with NSCLC admitted to Shangluo Central Hospital from April 2019 to April 2022 were prospectively selected for the study, including 64 males and 42 females, aged (56.53±7.54) years. All the patients underwent radical resection of NSCLC. The positive expression of CLCA4 in cancer tissues and adjacent normal tissues was detected by immunohistochemistry, and the relative expression of CLCA4 mRNA in cancer tissues and adjacent normal tissues was detected by real-time fluorescent quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR). The patients were divided into a progression-free survival (DFS) group and a non-DFS group according to the 1-year follow-up outcomes. t test and χ² test were used for statistical analysis. Multivariate logistic stepwise regression model, Kaplan-Meier survival curve analysis, and log-rank test were used to analyze the patients' prognostic factors. The receiver operating characteristic curve (ROC) was drawn to analyze the relationships between CLCA4 and pathology and prognosis. Results　The positive rate of CLCA4 [45.28% (48/106)] and the relative expression level of CLCA4 mRNA [(0.61±0.14)] in cancer tissues were lower than those in adjacent normal tissues [66.98% (71/106) and (1.07±0.23)] (χ²=10.134, P<0.001; t=17.589, P<0.001). The expression level of CLCA4 mRNA in stage Ⅱ patients was higher than that in stage ⅢA patients [(0.69±0.15) vs. (0.61±0.13)] (t=2.914, P=0.004). The proportion of stage ⅢA in the non-DFS group was higher than that in the DFS group [82.76% (48/58) vs. 33.33% (16/48)] (χ²=26.819, P<0.001), and the expression of CLCA4 mRNA was lower than that in the DFS group [(0.54±0.13) vs. (0.69±0.17)] (t=5.514, P<0.001). TNM stage (OR=4.031, 95%CI 1.429-11.364, P=0.003) and CLCA4 mRNA expression level (OR=0.310, 95%CI 0.109-0.873, P=0.003) were the influencing factors for DFS in NSCLC patients. The sensitivity of CLCA4 mRNA expression in predicting DFS in NSCLC patients was 0.802 (95%CI 0.715-0.893), the specificity was 0.809 (95%CI 0.721-0.904), and the area under the curve (AUC) was 0.857 (95%CI 0.782-0.935). The survival curves of the patients in different CLCA4 mRNA expression groups were significantly different (Log-rank χ²=6.006, P=0.014). Conclusion　The expression of CLCA4 in cancer tissue of NSCLC patients is suppressed, which is related to pathological progression as well as prognosis.

New exploration of pembrolizumab treatment for ALK-mutated advanced non-small cell lung cancer after resistance to targeted therapy

Cheng Lin, Wei Yalan, Tian Xia

2024, 30(6):  908-912.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.005

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Objective　To explore the efficacy of pembrolizumab treatment after resistance to targeted therapy in patients with advanced non-small cell lung cancer (NSCLC) with anaplastic lymphoma kinase (ALK) mutation. Methods　It was a prospective, controlled, single-center, randomized, single-blind clinical study. Ninety-five patients with advanced NSCLC with ALK mutation who were resistant to targeted therapy were selected from Xi'an Gaoxin Hospital from March 2020 to July 2022, and were divided into a control group and an experimental group by the random number table method. In the control group, 47 cases were enrolled, 2 cases were shed, and 45 cases were finally included in the analysis. In the experimental group, 48 cases were enrolled, 2 cases were shed, and 46 cases were finally included in the analysis. The control group included 29 males and 16 females, aged (56.85±8.67) years; there were 12 cases of stage III B and 33 cases of stage IV; there were 12 cases of squamous cell carcinoma and 33 cases of adenocarcinoma. The experimental group included 26 males and 20 females, aged (55.02±8.23) years; there were 15 cases of stage III B and 31 cases of stage IV; there were 10 cases of squamous cell carcinoma and 36 cases of adenocarcinoma.The control group received alectinib treatment, and the experimental group received pembrolizumab treatment on the basis of the control group. With 21 days as a treatment cycle, both groups were treated for 3 cycles. The levels of matrix metalloproteinase-9 (MMP-9), serum cytokeratin 19 fragment antigen 21-1 (CYFRA21-1), neuron-specific enolase (NSE), carbohydrate antigen 9 (CA9), endostatin (ES), vascular endothelial growth factor (VEGF), natural killer (NK) cells, CD8+, and CD4+ before and after treatment, clinical efficacy, and adverse drug reactions were compared between the two groups; the survival conditions of the two groups were recorded. Independent sample t test, paired t test, and χ² test were used. Results　After treatment, the levels of CYFRA21-1, NSE, CA9, MMP-9, VEGF, and CD8+ in both groups were lower than those before treatment (all P<0.05), and those in the experimental group were lower than those in the control group (all P<0.05); the levels of ES, CD4+, and NK cells in both groups were higher than those before treatment (all P<0.05), and those in the experimental group were higher than those in the control group (all P<0.05). The total effective rate of the experimental group was higher than that of the control group [78.26% (36/46) vs. 57.78% (26/45)] (χ²=4.396, P=0.036). There was no statistically significant difference in the total incidence of adverse drug reactions between the two groups (χ²=0.385, P=0.535). After 1 year of follow-up, 1 case was lost in the experimental group and 2 cases in the control group, with a follow-up rate of 97.70%. The 1-year overall survival rate of the experimental group was 55.56% (25/45), and that of the control group was 34.88% (15/43). There was a statistically significant difference in the overall survival (OS) curve between the two groups (Log-rank χ²=7.805, P=0.005). Conclusion　Pembrolizumab treatment for ALK-mutated advanced NSCLC after resistance to targeted therapy shows significant efficacy, which can improve the immune function, reduce the tumor marker levels, increases the survival rate, and improve the angiogenesis regulatory factors, without significantly increasing the incidence of adverse drug reactions.

Comparative analysis of the clinical efficacies of furmonertinib and gefitinib in the treatment of advanced EGFR-mutated non-small cell lung cancer

Fan Chengtao, Yu Fang

2024, 30(6):  913-917.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.006

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Objective　To explore the efficacies and safeties of furmonertinib and gefitinib in the treatment of advanced non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) sensitive mutations. Methods　This study was a prospective, randomized, controlled, and single-center clinical study. A total of 90 patients with advanced NSCLC admitted to Shangluo Central Hospital from April 2021 to April 2022 were selected and were divided into an experimental group and a control group according to the random number table method. In the experimental group, 45 cases were screened, 2 cases were excluded, and 43 cases were finally included in the analysis, including 29 males and 14 females, aged (51.79±6.28) years, and 43 cases of adenocarcinoma. In the control group, 45 cases were screened, 3 cases were excluded, and 42 cases were finally included in the analysis, including 26 males and 16 females, aged (52.06±5.41) years, and 42 cases of adenocarcinoma. Both groups were treated with pemetrexed 500 mg/m² intravenously, once every 21 days, on the first day of each treatment cycle. The control group was treated with gefitinib tablets, 250 mg each time, once a day, 21 days as 1 treatment cycle. The experimental group was treated with oral furmonertinib mesylate tablets, 40 mg each time, twice a day, 21 days as 1 treatment cycle. Both groups were treated for 3 cycles. The carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), cytokeratinin-19 fragment antigen 21-1 (CYFRA21-1), matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), efficacy, and safety were compared between the two groups. The patients were followed up for 18 months, and the survival prognosis was recorded. Independent sample t test, paired t test, and χ² test were used. Results　After treatment, the total effective rates of the experimental group and the control group were 69.77% (30/43) and 47.62% (20/42), respectively, with a statistically significant difference (χ²=4.303, P=0.038). After treatment, the CEA levels in the experimental group and the control group were (20.21±5.72) and (25.31±4.16) µg/L, the CA19-9 levels were (26.85±3.92) and (29.62±4.15) µg/L, the CYFRA21-1 levels were (2.61±0.76) and (3.62±0.91) µg/L, the MMP-9 levels were (102.86±20.37) and (117.41±22.06) µg/L, and the TIMP-1 levels were (608.31±60.43) and (635.93±61.15) µg/L, with statistically significant differences (all P<0.05). The total incidence of adverse drug reactions in the experimental group and the control group were 39.53% (17/43) and 30.95% (13/42), respectively (χ²=0.685, P=0.408). At the end of follow-up, 2 patients in the experimental group were lost to follow-up, the median progression-free survival (PFS) was 8 months, and 8 patients died. In the control group, 2 patients were lost to follow-up, the median PFS was 14 months, and 17 patients died. Median overall survival (OS) was not achieved in both groups, and the difference in the OS survival curve between the two groups was statistically significant (Log-rank χ²=4.939, P=0.026). Conclusion　Compared to gefitinib, furmonertinib is more helpful in improving the disease remission rate and prolonging the PFS and OS in the treatment of advanced NSCLC, with good safety.

Application effect of extended care during atezolizumab immunotherapy in non-small cell lung cancer patients

Chen Lirui, Su Zhaokun, Gao Yana

2024, 30(6):  918-922.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.007

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Objective　To explore the application effect of extended care during the immunotherapy period with atezolizumab for postoperative non-small cell lung cancer patients. Methods　This study was a randomized controlled trial. According to the random number table method, 102 non-small cell lung cancer patients who visited Henan Cancer Hospital from March 2019 to March 2022 were divided into a control group (51 cases) and an observation group (51 cases). There were 30 males and 21 females in the control group, aged (62.39±5.16) years, 3 cases in stage Ⅱ, 29 cases in stage Ⅲ, and 19 cases in stage Ⅳ. There were 31 males and 20 females in the observation group, aged (62.47±5.22) years, 2 cases in stage Ⅱ, 31 cases in stage Ⅲ, and 18 cases in stage Ⅳ. Both groups were treated with cisplatin combined with attillizumab for 4 consecutive courses of treatment with 3 weeks as 1 course. During the treatment period, routine care was given to the control group, while extended care was given to the observation group on the basis of the control group. The compliance behaviors, quality of life and psychological status before and after intervention, and nursing satisfaction were compared between the two groups. t test and χ² test were used. Results　The proportions of the patients in the control group who took medication as prescribed, persisted in exercise, had a reasonable diet, and had good emotions [70.59% (36/51), 68.63% (35/51), 64.71% (33/51), and 66.67% (34/51)] were lower than those in observation group [94.12% (48/51), 88.24% (45/51), 90.20% (46/51), and 92.16% (47/51)], with statistically significant differences (χ²=9.714, 5.795, 9.487, and 10.134, P=0.002, 0.016, 0.002, and 0.001). After intervention, the scores of physical function, sleep quality, emotional function, cognitive function, social function, and role function in both groups were higher than those before intervention, and those in the observation group [(75.69±4.13) points, (72.88±3.87) points, (71.33±4.57) points, (70.82±5.03) points, (72.77±4.66) points, and (77.17±3.89) points] were higher than those in the control group [(64.94±4.82) points, (63.72±3.96) points, (63.49±4.25) points, (62.49±5.17) points, (64.49±5.12) points, and (66.38±3.94) points], with statistically significant differences (all P<0.05). After intervention, the scores of anxiety, depression, and psychosis in both groups were lower than those before intervention, and those in the observation group [(1.36±0.32) points, (1.32±0.31) points, and (1.14±0.29) points] were lower than those in the control group [(1.73±0.38) points, (1.69±0.33) points, and (1.59±0.36) points], with statistically significant differences (all P<0.05). The overall nursing satisfaction in the observation group was higher than that in the control group [96.08% (49/51) vs. 82.35% (42/51)] (χ²=4.993, P=0.025). Conclusion　Extended care has a definite effect during the postoperative atezolizumab immunotherapy period for non-small cell lung cancer, which can effectively improve the patients' quality of life and psychological status, enhance their compliance behaviors and nursing satisfaction.

Clinical value of 3D-CTBA precise localization in patients undergoing thoracoscopic segmentectomy for early NSCLC

Zhang Qian, Chen Liang, Yang Ran

2024, 30(6):  923-927.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.008

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Objective　To investigate the effect of three-dimensional computed tomography bronchography and angiography (3D-CTBA) precise localization on the improvement of carbohydrate antigen 125 (CA125), carbohydrate antigen 724 (CA724), carcinoembryonic antigen (CEA), and lung function in patients with thoracoscopic segmentectomy. Methods　A total of 135 patients with early non-small cell lung cancer (NSCLC) who underwent thoracoscopic segmentectomy in Anyang Hospital of Traditional Chinese Medicine from August 2019 to August 2022 were prospectively selected and were divided into a control group (67 cases) and a study group (68 cases) by the random number table method. In the control group, there were 42 males and 25 females, aged (58.75±6.81) years, with a tumor diameter of (1.39±0.25) cm; in the study group, there were 41 males and 27 females, aged (58.22±6.35) years, with a tumor diameter of (1.36±0.31) cm. The control group underwent thoracoscopic segmentectomy, while the study group underwent 3D-CTBA precise localization before thoracoscopic segmentectomy. The operation-related indexes, serum tumor marker levels before and 7 days after surgery, changes in pulmonary function indexes before and 1 month after surgery, and incidence of complications were compared between the two groups. χ² test and independent sample t test were used. Results　The operation time and thoracic drainage tube removal time [(115.77±7.96) min and (3.48±0.81) d] in the study group were shorter than those in the control group [(140.05±8.77) min and (4.52±0.74) d], the intraoperative blood loss and postoperative drainage volume were less than those in the control group [(129.83±11.65) ml vs. (150.02±10.23) ml, (541.23±41.78) ml vs. (720.22±56.66) ml], and the number of lymph nodes dissected was more than that in the control group [(11.86±2.44) vs. (9.26±2.31)] (all P<0.05). Seven days after surgery, the levels of CA125, CA724, and CEA in both groups were decreased compared with those before surgery, and those in the study group [(29.88±6.15) U/ml, (11.75±7.08) U/ml, and (15.55±5.67) µg/L] were lower than those in the control group [(36.78±5.42) U/ml, (18.35±6.24) U/ml, and (21.22±6.45) µg/L] (all P<0.05). One month after surgery, the forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁), and peak expiratory flow (PEF) in both groups were decreased compared with those before surgery, and those in the study group [(2.95±0.58) L, (1.68±0.19) L, and (4.73±0.59) L/s] were higher than those in the control group [(2.72±0.65) L, (1.50±0.33) L, and (4.50±0.57) L/s] (all P<0.05). The total incidence of complications in the study group was 10.29% (7/68), which was lower than that in the control group [29.85% (20/67)], with a statistically significant difference (χ²=8.067, P=0.005). Conclusion　The precise positioning of 3D-CTBA in patients undergoing thoracoscopic segmentectomy for early NSCLC can reduce the levels of serum tumor markers, reduce the impact on lung function, and have fewer complications and high surgical safety.

A case of small cell lung cancer with Lambert-Eaton myasthenic syndrome as the first manifestation

Zhou Tianbao, Ma Hongming

2024, 30(6):  928-931.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.009

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New Medical Advances

Research progress on the relevance of HR-HPV load and cervical precancerous lesions and cervical cancer

Chen Xiaolin, Yang Zhen

2024, 30(6):  932-935.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.010

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Cervical cancer is the fourth most common cancer worldwide, and its incidence is rising. The most important risk factor for cervical cancer is persistent high risk human papilloma virus (HR-HPV) infection. Many authorities in the world have recommended that HPV DNA testing has been a method of cervical cancer preliminary screening since 2019. However, this method screens out a large number of HPV-positive women, so it is necessary to accurately identify the high-risk groups of cervical cancer and implement effective managements. Recent studies have shown that HR-HPV load may be a reference marker for the progression of cervical lesions, but the relationship between them is still not clear. The aim of this study is to investigate the relevance of HR-HPV load and cervical precancerous lesions and cervical cancer, and to improve the early diagnosis and treatment of cervical cancer.

Advances in single-cell RNA sequencing in secondary nephrosis

Zou Haozhen, Yang Jia, Xi Zhefan, Ji Rui, Dong Hua

2024, 30(6):  936-940.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.011

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Diabetic nephropathy (DN) and lupus nephritis (LN) are the major secondary nephropathy and are important causes of end-stage renal disease (ESRD). Exploring the developmental process of secondary nephrosis is conducive to reducing the renal function damage. Kidney cells have the characteristics of high degree of differentiation and complex structure. Bulk RNA sequencing can only explore the average transcription level and relationship of one type of cells. In recent years, single-cell RNA sequencing (scRNA-seq) technology has developed rapidly. Its high throughput and unprecedented resolution make it possible to analyze the renal tissue, blood, and urine cell samples, to identify the new cell types and states, to draw the cell atlas, to unravel the complex mechanisms of kidney disease from the cellular level dimension, and to discover the biomarkers and cell specificity. This reviews focuses on the latest research advances in scRNA-seq in common secondary nephrosis.

Research progress on diagnosis and prevention strategies of pregnancy associated venous thromboembolism

Wang Yuwei, Li Rui, Liu Chao, Liang Kuixiang

2024, 30(6):  940-945.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.012

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Pregnancy associated venous thromboembolism (PA-VTE) is currently one of the main causes of maternal mortality. PA-VTE is a disease in which abnormal blood clotting occurs in the venous vessels of women during pregnancy and postpartum period, causing venous blood reflux disorders. Due to the complex diagnosis and prevention of PA-VTE in pregnant and postpartum women, in order to avoid delay in the diagnosis of PA-VTE and adverse consequences of inadequate prevention and treatment strategies, this article reviews the diagnosis and prevention strategies of PA-VTE.

Research progress in pre-anesthetic evaluation of elderly patients

Wu Qiaoqiao

2024, 30(6):  946-948.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.013

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As the global population ages, the demand for surgical and perioperative care among the elderly is increasing dramatically. Therefore, it is particularly important to optimize anesthetic management strategies in elderly patients to reduce the surgical complications and improve the long-term prognosis. This article aims to comprehensively review the preoperative evaluation of elderly patients to systematically address the various challenges that this special population may face during surgery and provide a clinical basis.

Basic Research

Value of ultrasound gel pad in shear wave elastography of rabbit testes

Lin Yunyong, Lu Wenjie, Ouyang Liangyan, Li Jin, Mao Lin, Chen Fei, Qiu Shaodong

2024, 30(6):  949-952.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.014

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Objective　To evaluate the application value of ultrasound gel pad in shear wave elastography (SWE) of rabbit testes. Methods　From September 2020 to April 2021, 30 healthy male rabbits were included, aged 5 to 6 months, with a body weight of (2.52±0.18) kg. Their 60 testes were studied by SWE using ultrasound gel pad and thick ultrasound transmission gel respectively in the Second Affiliated Hospital of Guangzhou Medical University. Ten consecutive measurements of shear wave velocity (SWV) were obtained in the central zone of the largest standard transverse axis view of testicular parenchyma, and the mean, standard deviation, and interquartile range/median were calculated and recorded. Paired sample t-test, one-way ANOVA, Pearson's chi-squared test, and intraclass correlation coefficient (ICC) were applied. Results　In the ultrasound gel pad group, the mean and standard deviation of the ten SWV measurements were significantly lower than those in the thick ultrasound transmission gel group [(1.67±0.16) m/s vs. (2.46±0.20) m/s, (0.09±0.03) m/s vs. (0.22±0.08) m/s], with statistically significant differences (t=26.617 and 12.965, both P<0.001). With the interquartile range/median ≤10% as the standard, the number of cases being in conformity the standard in the ultrasound gel pad group was significantly larger than that in the thick ultrasound transmission gel group [80.0% (48/60) vs. 23.3% (14/60)], with a statistically significant difference (χ²=38.576, P<0.001). Two ultrasound physicians obtained three consecutive SWV measurements in the central zone of the largest standard transverse axis view of normal testicular parenchyma using an ultrasound gel pad, demonstrating good consistency (ICC=0.823, 95%CI 0.712-0.892, P<0.001). Conclusion　The utilization of ultrasound gel pad in SWE of normal testes yields a clear enhancement in image quality, leading to increased stability and the reproducibility of measured values.

Treatises

Risk factors for plasmapheresis or dialysis in non-diabetic patients with kidney transplantation

Wang Le, Chen Yingli, Zhang Kailu, Zhang Yinfu, Du Ruini, Gao Wei

2024, 30(6):  953-957.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.015

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Objective　To investigate the risk factors of plasmapheresis or dialysis in non-diabetic patients in kidney transplantation (KT). Methods　A retrospective study was conducted to collect the clinical data of 507 patients who received KT in the First Affiliated Hospital of Xi'an Jiaotong University from January 2019 to December 2020, including 349 males and 158 females, aged 15 to 65 years. According to the occurrence of plasmapheresis or dialysis within 1 year after KT, the patients were divided into a treated group (49 cases) and an untreated group (458 cases). The general data of the two groups were compared by non-parametric test, chi-square test, continuity correction chi-square test, or Fisher exact probability method. The independent risk factors of plasmapheresis or dialysis were analyzed by multivariate logistic regression analysis. Results　Compared with those in the untreated group, the treated group had a higher proportion of fasting plasma glucose (FPG) ≥7.8 mmol/L on the 8th day after KT, a higher proportion of delayed graft function (DGF), higher levels of cystatin C (CysC) and creatinine on the 8th day after KT, and a lower glomerular filtration rate (χ²=5.202 and 5.030, Z=-4.676, -5.002, and -4.937; all P<0.05). Multivariate logistic regression analysis found that the ratio of FPG≥7.8 mmol/L on the 8th day after KT [OR=1.216, 95% confidence interval (CI) 1.003-1.473, P<0.05] and CysC on the 8th day after KT (OR=1.610, 95%CI 1.300-1.995, P<0.05) were independent risk factors for plasmapheresis or dialysis. Conclusions　FPG ≥7.8 mmol/L and CysC on the 8th day after KT are the independent risk factors of plasmapheresis or dialysis in non-diabetic patients with KT, so as to facilitate early assessment, prevention, and treatment.

Value of color ultrasound in evaluating the orifice of autologous arteriovenous fistula and blood flow velocity in hemodialysis patients

Gao Hua, Wu Jiawei, Li Xin

2024, 30(6):  957-962.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.016

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Objective　To study the value of color ultrasound in evaluating autologous arteriovenous fistula (AVF) orifice and blood flow velocity in hemodialysis (HD) patients. Methods　A total of 150 HD patients admitted to Tongchuan People's Hospital from February 2019 to February 2022 were included in the study. There were 87 males and 63 females, aged 41-69 (56.82±7.12) years. CT angiography and color ultrasound were performed in all subjects. According to the results of CT angiography, the patients were divided into a stenosis group (internal fistula stenosis, 59 cases) and a non-stenosis group (normal internal fistula, 91 cases). The blood flow at the proximal brachial artery (Qb), the proximal radial artery (Qr), the proximal fistula (Qf), and the proximal cephalic vein (Qc) of the two groups were compared. The receiver operating characteristic curve (ROC) was used to determine the effectiveness of color ultrasound parameters in the evaluation of autologous arteriovenous fistula stenosis in HD patients. In addition, the incidence of internal fistula complications was compared between the two groups. t test and χ² test were used. Results　The levels of Qb, Qr, Qf, and Qc in the stenosis group were lower than those in the non-stenosis group [(377.45±103.46) ml/min vs. (491.52±136.71) ml/min, (320.58±102.99) ml/min vs. (410.89±138.46) ml/min, (476.12±112.57) ml/min vs. (566.43±129.85) ml/min, (519.04±120.87) ml/min vs. (667.36±134.53) ml/min], with statistically significant differences (t=5.47, 4.30, 4.38, and 6.86, all P<0.05). ROC analysis showed that the area under the curve of Qb in evaluating autologous arteriovenous fistula stenosis in HD patients was 0.854, and the sensitivity and specificity were 86.92% and 84.10%, respectively, which were higher than those of Qr, Qf, and Qc. The incidences of venous stenosis, thrombosis, and phletomatous dilatation in the stenosis group were higher than those in the non-stenosis group [23.73% (14/59) vs. 6.59% (6/91), 20.34% (12/59) vs. 4.40% (4/91), 37.29% (22/59) vs. 17.58% (16/91)], with statistically significant differences (χ²=9.10, 9.55, and 7.35, all P<0.05). Conclusion　Color ultrasound can effectively evaluate AVF fistula and blood flow velocity in HD patients, and Qb has a best efficacy in diagnosing AVF stenosis in HD patients, which is worthy of popularization.

Predictive efficacy of serum TG/HDLC and SPP24 for cardiovascular events in hemodialysis patients

Du Lin, Li Wenjuan, Zhu Yongmei

2024, 30(6):  963-967.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.017

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Objective　To explore the efficacy of serum triglyceride/high density lipoprotein cholesterol (TG/HDLC) and secreted phosphoprotein 24 (SPP24) in predicting cardiovascular events in hemodialysis patients. Methods　A total of 159 patients undergoing maintenance hemodialysis admitted to Chang An Hospital from June 2020 to June 2022 were prospectively selected, including 88 males and 71 females, aged >18 years, and cardiovascular events were followed up for 1 year. Forty-one patients with cardiovascular events were included in the cardiovascular event group, and 118 patients without cardiovascular events were included in the non-cardiovascular event group. Serum TG/HDLC and SPP24 levels were detected. t test, χ² test, and logistic regression analysis model were used to analyze the factors affecting the occurrence of cardiovascular events in maintenance hemodialysis patients. Receiver operating characteristic curve (ROC) was used to analyze the efficacy of serum TG/HDLC and SPP24 in predicting cardiovascular events in maintenance hemodialysis patients. Results　Multivariate logistic regression analysis showed that dialysis age (OR=4.586, 95%CI 1.887-11.145), TG/HDLC (OR=3.904, 95%CI 1.594-9.563), and SPP24 level (OR=0.308, 95%CI 0.127-0.748) were the influencing factors for cardiovascular events in maintenance hemodialysis patients (all P<0.05). ROC analysis results showed that the sensitivities of TG/HDLC, SPP24, and their combination in predicting cardiovascular events in maintenance hemodialysis patients were 70.73% (95%CI 54.26%-83.35%), 68.29% (95%CI 51.78%-81.42%), and 82.93% (95%CI 67.35%-92.30%), respectively, the specificities were 70.34% (95%CI 61.12%-78.21%), 75.42% (95%CI 66.48%-82.68%), and 89.83% (95%CI 82.56%-94.40%), respectively, and the areas under the curves were 0.733 (95%CI 0.638-0.828), 0.708 (95%CI 0.597-0.819), and 0.894 (95%CI 0.829-0.959), respectively. Conclusion　Serum TG/HDLC combined with SPP24 can improve the predictive efficacy of cardiovascular events in maintenance hemodialysis patients.

Long non-coding RNA IGF2BP2-AS1 regulates the migration and proliferation of laryngeal cancer cells through miR-375

Wang Ting, Zhang Yang, Guo Jie, Fan Chongsheng, Liu Yafang

2024, 30(6):  968-973.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.018

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Objective　To investigate the effect of long non-coding RNA (lncRNA) insulin-like growth factor 2 mRNA binding protein 2 (IGF2BP2) -AS1 on the migration and proliferation of laryngeal cancer cells by regulating the expression of microRNA-375 (miR-375). Methods　The research period was from January 2022 to November 2023, the research place was the central laboratory of Luoyang Central Hospital Affiliated to Zhengzhou University, and the research type was basic research. qPCR was used to detect the expression of IGF2BP2-AS1 in laryngeal cancer cell lines AMC-NH-8, TU159, TU138, and TU686 and bronchial epithelial cell line 16HBE. Taking TU686 cells as the research object, the TU686 cells were divided into a si-NC group and a si-IGF2BP2-AS1 group, and IGF2BP2-AS1 small interfering RNA was used to down-regulate the expression level of IGF2BP2-AS1. The scratch healing assay and CCK-8 method were used to analyze the effects of knocking down IGF2BP2-AS1 on the migration and proliferation of TU686 cells. Dual luciferase reporter gene experiment verified the targeting relationship between IGF2BP2-AS1 and miR-375. qPCR was used to detect the effect of knocking down IGF2BP2-AS1 on the expression of miR-375. Western blotting was used to detect the expressions of migration proteins (N-Cadherin and FOXC2) and proliferation proteins (CDK2 and Cyclin A) in cells. One-way ANOVA and t test were used. Results　Compared with 16HBE cells, IGF2BP2-AS1 was highly expressed in laryngeal cancer cell lines (F=37.42, P<0.01). The scratch healing rate of TU686 cells in the si-IGF2BP2-AS1 group was lower than that in the si-NC group [(28.16±6.13)% vs. (65.08±3.82)%], with a statistically significant difference (t=5.11, P<0.01). The proliferation capacity of TU686 cells in the si-IGF2BP2-AS1 group was lower than that in the si-NC group 2, 3, 4, and 5 days after planking (t=3.83, 3.17, 3.02, and 6.31, all P<0.01). In IGF2BP2-AS1-Wt, the relative luciferase activity of the miR-375 group was lower than that of the miR-NC group (t=8.95, P<0.01). The expression of miR-375 in TU686 cells in the si-IGF2BP2-AS1 group was higher than that in the si-NC group [(4.95±0.49) vs. (1.02±0.40)], with a statistically significant difference (t=6.23, P<0.01). Compared with the si-NC group, the expression levels of migration proteins (N-Cadherin and FOXC2) and proliferation proteins (CDK2 and Cyclin A) were reduced in TU686 cells after knocking down IGF2BP2-AS1. Conclusion　IGF2BP2-AS1 is highly expressed in laryngeal cancer cell lines, and knocking down IGF2BP2-AS1 inhibits the migration and proliferation of laryngeal cancer TU686 cells by regulating the expression of miR-375.

Clinical significance of MRI functional imaging combined with serology in distinguishing the nature of prostate lesions

Liu Tao, Zhang Xiaoxiao, Wang Minxuan

2024, 30(6):  973-977.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.019

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Objective　To explore the clinical significance of MRI functional imaging combined with serology in distinguishing the nature of prostate lesions. Methods　A retrospective study was conducted on 120 suspected prostate cancer (PCa) patients admitted to Yan'an People's Hospital from July 2021 to July 2023, all male. All patients underwent routine 3.0T MRI scan, diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS), and pathological examination. Based on the pathological results, the patients were divided into a PCa group (53 cases) and a benign group (67 cases). The age of the PCa group was (63.19±4.72) years old, while the age of the benign group was (61.75±4.54) years old. Serum free prostate-specific antigen (fPSA) levels, total prostate-specific antigen (tPSA) levels, MRI functional imaging results, pathological results, and diagnostic efficacies of different examination methods were compared between the two groups. Independent sample t test and χ² test were used. Results　The serum levels of fPSA and tPSA in the PCa group were higher than those in the benign group (both P<0.05). The diagnostic sensitivity of routine MRI scanning was 69.81% (37/53), the specificity was 83.58% (56/67), and the accuracy was 77.50% (93/120). The diagnostic sensitivity of DWI was 75.47% (40/53), the specificity was 88.06% (59/67), and the accuracy was 82.50% (99/120). The diagnostic sensitivity of MRS was 73.58% (39/53), the specificity was 86.57% (58/67), and the accuracy was 80.83% (97/120). The diagnostic sensitivity of serology was 71.70% (38/53), the specificity was 86.57% (58/67), and the accuracy was 80.00% (96/120). The diagnostic sensitivity of their combination was 94.34% (50/53), the specificity was 83.58% (56/67), and the accuracy was 88.33% (106/120). The sensitivity and positive predictive value of combined diagnosis were higher than those of functional MRI imaging and serology alone, and the missed diagnosis rate was lower than that of functional MRI imaging and serology alone (all P<0.05). Conclusion　MRI functional imaging combined with serology has certain diagnostic value for PCa and can serve as an effective diagnostic method for distinguishing the nature of prostate lesions in clinical practice.

Construction of vancomycin-related nephrotoxicity prediction model in patients with MRSA bloodstream infection

Xie Dong, Yu Jie, Li Zhengxiang

2024, 30(6):  978-983.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.020

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Objective　To construct a prediction model of vancomycin-related nephrotoxicity in patients with methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection. Methods　The clinical data of 128 patients with MRSA bloodstream infection treated with vancomycin from January 2019 to January 2023 in Tianjin Medical University General Hospital were retrospectively analyzed. There were 66 males and 62 females, aged (61.47±10.25) years. According to whether the patients developed vancomycin-related acute kidney injury (AKI), they were divided into an AKI group (32 cases) and a non-AKI group (96 cases). The gender, age, body mass index (BMI), shock, white blood cell count (WBC), procalcitonin, hypersensitive C-reactive protein (hs-CRP), Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, combined underlying diseases (diabetes mellitus, hypertension, and coronary heart disease), serum creatinine, use of nonsteroidal anti-inflammatory drugs, use of aminoglycosides, use of vasoactive drugs, types of nephrotoxic drugs used, glomerular filtration rate (GFR), treatment dose, administration interval, duration of treatment, cumulative dose, area under the curve (AUC) of vancomycin, and other data were compared between the two groups. Logistic regression equation was used to analyze the risk factors of vancomycin-related nephrotoxicity in patients with MRSA bloodstream infection. A risk nomogram model of vancomycin-related nephrotoxicity was constructed based on the risk factors, and the constructed model was validated and its predictive efficacy was evaluated. Independent sample t test, Mann-Whitney U test, χ² test, and Hosmer-Lemeshow test were used. Results　The age, serum creatinine level, vancomycin AUC, and proportions of number of nephrotoxic drugs ≥2 and GFR ≤60 ml/min in the AKI group were higher than those in the non-AKI group (all P<0.05). Logistic regression analysis showed that age ≥60 years old, serum creatinine ≥95.42 μmol/L, number of nephrotoxic drugs ≥2, GFR ≤60 ml/min, and vancomycin AUC ≥30 g/L were all independent risk factors for AKI in patients with MRSA bloodstream infection treated with vancomycin (all P<0.05). Hosmer-Lemeshow goodness of fit test showed that the nomogram model had a good agreement in predicting the risk of AKI in patients with MRSA bloodstream infection treated with vancomycin (χ²=3.571, P=0.672). The internal verification results of Bootstrap method showed that the C-index of the nomogram prediction model was 0.785 (95%CI 0.678-0.889), indicating that the model had good differentiation. The receiver operating characteristic curve (ROC) results showed that the AUC (95%CI), sensitivity, and specificity of the nomogram risk model for predicting AKI in patients with MRSA bloodstream infection treated with vancomycin were 0.859 (0.618-0.979), 94.50%, and 78.30%, respectively (all P<0.001). Conclusions　Age ≥60 years old, serum creatinine ≥95.42 μmol/L, number of nephrotoxic drugs ≥2, GFR ≤60 ml/min, and vancomycin AUC ≥30 g/L are all independent risk factors for AKI in patients with MRSA bloodstream infection treated with vancomycin. The risk nomogram model based on the above risk factors has a high predictive value for AKI in patients with MRSA bloodstream infection treated with vancomycin.

Clinicopathological characteristics analysis of 114 cases with multiple primary tumors

Bai Yinmiao, Liu Zhihui, Li Yize, Wang Xiangxu, Zhang Hongmei

2024, 30(6):  984-988.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.021

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Objective　To explore the clinicopathological characteristics of multiple primary malignant tumors (MPMT). Method　A retrospective analysis was conducted on the clinicopathological data of MPMT patients who visited Xijing Hospital, Air Force Military Medical University from January 2021 to July 2023. Results　Among the 114 patients, there were 42 (36.8%) cases with synchronous MPMT and 72 (63.2%) cases with metachronous MPMT; there were 58 males (50.9%) and 56 females (49.1%); there were 101 cases with dual primary malignant tumors (88.6%), 10 cases with triple primary malignant tumors (8.8%), and 3 cases with quadruple primary malignant tumors (2.6%). The median age was 54 (10, 78) years old at diagnosis with the first primary malignant tumor. We found that the top three types of the first primary malignant tumor were malignant tumors of digestive tract [39.5% (45/114)], head and neck [15.8% (18/114)], and female reproductive system [14.9% (17/114)]; the top three types of the second primary malignant tumor were malignant tumors of digestive tract [36.0% (41/114)], malignant tumors of respiratory system [22.8% (26/114)], and hepatobiliary and pancreatic malignant tumors [17.5% (20/114)]. Eighty-eight patients (77.2%) received surgery, 44 patients (38.6%) received chemotherapy, and 18 patients (15.8%) received radiotherapy for the first primary malignant tumor, respectively. Conclusions　Through clinical feature analysis, we aim to improve our understanding of MPMT. In this paper, the incidence of MPMT in digestive tract is high, and clinical differentiation should be noted.

Value of serum NSE, S-100β, and CRP/PA in predicting short-term in-hospital death in patients with severe cerebral contusion complicated with cerebral hernia 

Ning Bo, Bao Yanxiang

2024, 30(6):  989-993.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.022

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Objective　To analyze the value of serum neuron specific enolase (NSE), S-100β, and C-reactive protein (CRP)/prealbumin (PA) in predicting short-term in-hospital death in patients with severe cerebral contusion complicated with cerebral hernia. Methods　The clinical data of 130 patients with severe cerebral contusion complicated with cerebral hernia who received decompressive craniectomy in Xi'an Gaoxin Hospital from May 2020 to May 2023 were retrospectively analyzed, including 85 males and 45 females, with an age of (55.13±10.33) years old. The Glasgow Coma Scale (GCS) score was 3-8 points in 56 cases, and >8 points in 74 cases. There were 79 cases of single brain contusion and 51 cases of multiple brain contusions. The patients' survival 30 days after operation was recorded. Twenty-six cases (20.00%) died in hospital and 104 cases (80.00%) were discharged successfully after treatment. Baseline data such as age and gender were collected in the two groups. Serum levels of NSE, S-100β, CRP, and PA were detected by enzyme linked immunosorbent assay (ELISA) and electrochemiluminescence method upon admission. The data were analyzed by t and χ² tests. Multivariate logistic regression analysis was used to analyze the risk factors of short-term in-hospital death in patients with severe cerebral contusion complicated with cerebral hernia, and the values of serum NSE, S-100β, and CRP/PA levels in predicting short-term in-hospital death in patients with severe cerebral contusion complicated with cerebral hernia were observed by the receiver operating characteristic curve (ROC). Results　The proportions of the patients with GCS score of 3-8, multiple cerebral contusion, and use of anticoagulants 1 week before admission and serum levels of NSE, S-100β, and CRP/PA in the death group were higher than those in the survival group (all P<0.05). Multivariate logistic regression analysis showed that GCS score at admission, site of cerebral contusion, use of anticoagulant drugs 1 week before admission, and serum NSE, S-100β, and CRP/PA levels were all risk factors for short-term in-hospital death in patients with severe cerebral contusion complicated with cerebral hernia (all P<0.05). ROC analysis confirmed that serum NSE, S-100β, and CRP/PA levels could be used to predict short-term in-hospital death in patients with severe cerebral contusion complicated with cerebral hernia, with the area under the curve of 0.795, 0.753, and 0.801, respectively (all P<0.05). Conclusions　GCS score at admission, site of cerebral contusion, use of anticoagulant drugs 1 week before admission, and serum NSE, S-100β, and CRP/PA levels are all risk factors for short-term in-hospital death in patients with severe cerebral contusion complicated with cerebral hernia. Clinical screening should be focused on high-risk patients with the above indicators, and timely interventions should be taken.

Experiences of single-hooked needle downward-type hooking-line core hernia sac high-ligation for pediatric inguinal hernia

Bian Jun, Shi Weidong, Zhang Xiangning, Ding Wenze, Yao Yuan, Wang Xingcheng

2024, 30(6):  994-997.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.023

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Objective　To explore the experiences of high ligation of hernia sac in pediatric inguinal hernia using the downward-type hooking-line core with a single-hooked needle in a totally extraperitoneal approach. Methods　A retrospective analysis was performed on 419 children with oblique inguinal hernia admitted to Xi'an Children's Hospital from May 2018 to May 2019. There were 370 boys and 49 girls. The age ranged from 8 months old to 15 years old, with an average age of 3 years and 6 months old. There were 160 cases located on the left side, 220 cases on the right side, and 39 cases on both sides. In the surgical procedure, we employed the single-hooked needle downward-type hooking-line core technique for totally extraperitoneal hernia sac high ligation in pediatric inguinal hernia cases. We also recorded the operation time and assessed the integrity of the posterior peritoneum. Results　For the girls, the operation time was (4.0±1.0) min in the cases with unilateral inguinal hernia and (6.0±1.2) min in the cases with bilateral inguinal hernia. For the boys, the operation time was (6.0±1.0) min in the cases with unilateral inguinal hernia and (9.0±1.5) min in the cases with bilateral inguinal hernia. Notably, no complications such as secondary hook line or retroperitoneal tears occurred during the operation. Conclusion　The single-hooked needle downward-type hooking-line core technique for totally extraperitoneal hernia sac high ligation in pediatric inguinal hernia cases allows for repeated hooks without causing retroperitoneal tears during the operation. This approach holds significant value for clinical reference and wider adoption.

Clinical Research

Effect of percutaneous low-frequency neuromuscular electrical stimulation on refractory overactive bladder

Xu Jinfeng, Chen Zekai, Yao Yongqiang, Xu Beixun, Chen Jie

2024, 30(6):  998-1005.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.024

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Objective　To explore the practicability, safety, and efficacy of appropriate electrophysiological techniques in the treatment of refractory overactive bladder (OAB) by percutaneous low-frequency neuromuscular electrical stimulation. Methods　From September 2019 to July 2022, 36 patients with refractory OAB were enrolled in the department of urology and lower urinary tract and male outpatient clinic of the First Affiliated Hospital of Jinan University. There were 28 females and 8 males, aged from 29 to 83 (43.94±2.68) years, with a disease duration of (4.19±2.43) years. Among the female patients, there were 8 cases of pelvic organ prolapse, 1 case with history of pelvic surgery combined with pelvic organ prolapse, 1 case with sleep disorders combined with history of pelvic surgery, 1 case with major depressive disorder, 2 cases with hypertension, 1 case with diabetes, 1 case with hypertension combined with diabetes, 3 cases with urge incontinence, and 10 cases with simple refractory OAB. Among the male patients, there were 2 cases with chronic prostatitis, 1 case with urgent incontinence, and 5 cases with simple refractory OAB. All patients received percutaneous low-frequency neuromuscular electrical stimulation. The scores of quality of life (QOL) scale, scores of Overactive Bladder Symptom Scale (OABSS), and urination diary were collected before and after treatment. The above indicators were statistically analyzed and the efficacy was evaluated. Follow-up data of 1 month and 3 months after treatment were analyzed to analyze the persistence of short-term clinical effect and recurrence rate in patients with OAB treated by percutaneous low-frequency neuromuscular electrical stimulation. Paired t test and Cox regression analysis were used. Results　After treatment, the QOL score of the refractory OAB patients was higher than that before treatment, and the OABSS score was lower than that before treatment, with statistically significant differences (t=1.327 and 102.244, both P<0.05); the frequency of urination was decreased after treatment compared with that before treatment, with a statistically significant difference (t=10.246, P<0.05); the single urine volume and single maximum urine volume were higher than those before treatment, with statistically significant differences (t=45.467 and 103.344, both P<0.05). The clinical symptoms of 29 patients with refractory OAB were improved after treatment, and the clinical effective rate reached 80.55% (29/36). In the 1-month and 3-month follow-up OABSS score data, the regression coefficients showed level significance results (P=0.033 and 0.002), indicating the short-term clinical efficacy of percutaneous low-frequency neuromuscular electrical stimulation for refractory OAB patients. The results of Cox regression analysis showed that the lower the OABSS score after 1 month and 3 months of treatment, the longer the validity period, the less likely to relapse. All patients had no discomfort during or after treatment. Conclusions　Percutaneous low-frequency neuromuscular electrical stimulation in the treatment of refractory OAB can significantly improve the patients' quality of life, reduce the score of OABSS, reduce the frequency of urination, increase the single urine volume and the single maximum urine volume. The treatment is safe and has significant short-term clinical efficacy. However, the long-term efficacy should be followed up with the increase of the number of cases.

Comparison of the effectiveness of sandwich cup centrifuge smear method and direct smear method in detecting acid-fast bacteria

Luo Shaozhen, Liu Xin, Zhang Zhijian, Huang Yelun, Liu Zhihui

2024, 30(6):  1005-1008.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.025

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Objective　To investigate the clinical value of sandwich cup centrifuge smear method for detecting acid-fast bacteria. Methods　The test results of sputum and bronchial lavage fluid by smear staining and mycobacterium isolation were collated from the LIS system of the Department of Clinical Laboratory of Guangzhou Chest Hospital from January to July 2021. The results of direct smear method and sandwich cup centrifuge smear method for acid-fast bacteria of multiple sputum and bronchial lavage fluid samples which were collected within one week interval from the same patient were analyzed retrospectively. Results　Of the 241 sputum samples, 178 bronchial lavage fluid samples, and all 419 samples tested, the positive rates of direct smear method and sandwich cup centrifuge smear method were 15.35% (37/241) and 13.69% (33/241), 15.17% (27/178) and 12.92% (23/178), 15.27% (64/419) and 13.37% (56/419), respectively. Of the 65 positive sputum samples, 50 positive bronchial lavage fluid samples, and all 115 positive samples detected by mycobacterium isolation during the same period, the positive rates of direct smear method and sandwich cup centrifuge smear method were 56.52% (65/115) and 50.78% (65/128), 54.34% (50/92) and 45.88% (50/109), 55.56% (115/207) and 48.73% (115/236), respectively. In the 241 sputum samples, the proportions of samples with direct smear (+) and sandwich cup centrifuge smear (+), direct smear (+) and sandwich cup centrifuge smear (-), direct smear (-) and sandwich cup centrifuge smear (+), and direct smear (-) and sandwich cup centrifuge smear (-) were 12.03% (29/241), 3.32% (8/241), 1.66% (4/241), and 82.99% (200/241), respectively, and those in the 178 bronchial lavage fluid samples were 8.99% (16/178), 6.18% (11/178), 3.93% (7/178), and 80.90% (144/178), respectively. Conclusion　The overall positive rate of sandwich cup centrifuge smear method is slightly lower than that of direct smear method, but it has positive clinical application value because it can find a considerable proportion of etiologically positive tuberculosis patients that can not be found by direct smear method, especially in bronchial lavage fluid samples.

Efficacy of compound hydrochloride articaine in the treatment of dental pulp diseases in children

Song Jie, Zhang Guangwei, Lu Jian

2024, 30(6):  1009-1012.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.026

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Objective　To explore the impact of compound hydrochloride articaine on pain level and anesthetic effect in the treatment of dental pulp diseases in children. Methods　This study was a randomized controlled trial. A total of 80 children with dental pulp diseases who were admitted to Liaocheng Third People's Hospital from January 2020 to January 2023 were selected as the research subjects. They were divided into a control group and an observation group using the random number table method with 40 cases in each group. In the control group, there were 22 boys and 18 girls, aged 5 to 11 (7.72±1.13) years. In the observation group, there were 21 boys and 19 girls, aged 5 to 12 (7.58±1.05) years. The control group underwent anesthesia treatment with lidocaine, while the observation group underwent anesthesia treatment with compound hydrochloride articaine. The anesthesia effect (onset time of anesthesia, duration of anesthesia, and recovery time after anesthesia), anesthesia efficiency, pain degree [Visual Analog Scale (VAS) scores during surgery and during anesthesia], and incidence of adverse reactions (gingival pain, nausea and vomiting, dizziness and headache, and tachycardia) were compared between the two groups. Independent sample t test and χ² test were used. Results　The onset time of anesthesia in the observation group was (2.19±0.33) min and the recovery time after anesthesia was (155.71±26.17) min, which were shorter than those in the control group [(5.56±1.10) min and (172.15±27.69) min]; the duration of anesthesia was longer than that in the control group [(156.78±25.26) min vs. (141.57±19.82) min], with statistically significant differences (all P<0.05). The total effective rate of anesthesia in the observation group [97.5% (39/40)] was higher than that in the control group [62.5% (25/40)], with a statistically significant difference (P<0.05). The VAS scores during surgery [(1.16±0.25)] and during anesthesia [(1.69±0.37)] in the observation group were lower than those in the control group [(2.36±0.53) and (2.48±0.57)], with statistically significant differences (both P<0.05). The total incidence of adverse reactions in the observation group [12.5% (5/40)] was lower than that in the control group [45.0% (18/40)], with a statistically significant difference (P=0.001). Conclusion　Compound hydrochloride articaine can reduce the pain level and enhance the anesthetic effect in the treatment of dental pulp diseases in children.

Effect analysis of autologous platelet-rich plasma in the treatment of chronic refractory wounds

Ouyang Yuexian, Wu Hairong, Peng Jiao, Zhou Lide

2024, 30(6):  1013-1017.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.027

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Objective　To explore the effect of autologous platelet-rich plasma in the treatment of chronic refractory wounds. Methods　From July 2022 to June 2023, 64 patients with chronic refractory wounds in the People's Hospital of Xiangxiang City were divided into two groups by drawing lots with two-color balls. The patients with red balls were selected as the control group, and the patients with green balls as the observation group. In the control group, there were 18 males and 14 females; the age was 23-77 (46.48±3.34) years old; the course of disease was 2-22 (13.45±2.12) months; the wound area was 2-35 (16.23±3.12) cm². In the observation group, there were 19 males and 13 females; the age was 23-78 (46.12±3.12) years old; the course of disease was 2-24 (14.67±2.08) months; the wound area was 2-33 (16.12±3.07) cm². The control group was treated with traditional therapy, while the observation group was treated with autologous platelet-rich plasma. The recovery conditions (wound healing time, infection control time, hospital stay, and granulation tissue growth thickness), pain scores [Visual Analogue Scale (VAS) score], scar hyperplasia scores [Vancouver Scar Scale (VSS) score], wound recovery scores [Bates-Jensen Wound Assessment Tool (BWAT) score], wound healing levels [Pressure Ulcer Scale for Healing (PUSH) score], levels of inflammatory factors [C-reactive protein (CRP), interleukin-1β (IL-1β), and procalcitonin (PCT)], and qualities of life [36-item Short Form (SF-36) score] of the two groups were compared. Independent sample t test and χ² test were used. Results　The wound healing time, infection control time, hospital stay, and granulation tissue growth thickness in the observation group were (29.25±2.68) d, (10.12±2.48) d, (30.24±2.48) d, and (3.48±0.78) mm, respectively, which were superior to those in the control group [(35.26±2.74) d, (12.15±2.78) d, (36.59±3.12) d, and (1.57±0.45) mm] (t=8.870, 11.998, 3.082, and 9.013, all P<0.05). After treatment, the VAS and VSS scores of the observation group were (3.12±0.56) points and (2.41±0.63) points, which were lower than those of the control group [(4.45±0.78) points and (4.15±1.05) points] (t=7.835 and 8.038, both P<0.05). After treatment, the BWAT and PUSH scores of the observation group were (21.12±0.56) points and (8.35±2.04) points, which were lower than those of the control group [(27.45±0.78) points and (10.29±2.08) points] (t=37.292 and 3.763, both P<0.05). After treatment, the levels of CRP [(15.65±6.21) mg/L], IL-1β [(26.58±7.89) μg/L], and PCT [(1.89±0.48) ng/L] in the observation group were lower than those in the control group [(23.26±6.78) mg/L, (33.48±8.14) μg/L, and (3.15±0.78) μg/L] (t=4.682, 3.443, and 7.782, all P<0.05). After treatment, the general health status of life quality in the observation group was better than that in the control group [(79.46±8.45) points vs. (72.78±8.26) points] (t=3.198, P<0.05). Conclusion　Autologous platelet-rich plasma is effective in the treatment of chronic refractory wounds, which is helpful for wound healing, can effectively relieve the patients' pain, reduce the inflammatory reaction, promote the appearance improvement, and comprehensively improve their quality of life, with significant clinical value.

Ultrasonographic characteristics of testicular adrenal rest tumors

Cao Zhe, Huo Yaling, Wang Dan

2024, 30(6):  1018-1020.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.028

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Objective　To analyze the ultrasonic image characteristics of testicular adrenal rest tumors (TART), in order to improve the diagnostic value of ultrasonography. Methods　The clinical data of 10 male patients aged 6 to 26 years who were diagnosed as TART with a history of congenital adrenal hyperplasia (CAH) for many years in the Children's Hospital Affiliated to Zhengzhou University from January 2018 to August 2022 were collected. The characteristics of ultrasound images were summarized. Results　All the 10 cases involved bilateral testis. Ultrasonography showed 23 focal lesions, 16 of which were located in the testis hilum and 7 were located next to the mediastinum of the testis. Testicular volume was normal in 6 cases (60.0%) and enlarged in 4 cases (40.0%). The testis mediastinum was clearly displayed in 9 cases (90.0%). All the 23 lesions (100.0%) had clear boundary without envelope, of which 20 were hypoechoic (87.0%) and 3 were isoechoic (13.0%); there were 16 lesions with irregular shape (69.6%) and 7 lesions with quasi-circular shape (30.4%); there were 14 lesions with abundant blood supply (60.9%) and 9 lesions with scarce blood supply (39.1%). Conclusions　TART is mainly characterized by bilateral testicular involvement. The low echo area of porta testicle or mediastinum of testicle is the characteristic ultrasonography of TART. The diagnosis of TART can be made in combination with history of CAH.

Clinical study on Chinese medicine Cangyi Yin in the treatment of hypertensive patients with phlegm-dampness constitution type

Liang Zhile, Chen Guocheng, Pan Linping, Wang Xiaoyan, Tang Canhong, Lai Manliu, Wang Yuanyuan

2024, 30(6):  1020-1024.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.029

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Objective　To explore the effect of Chinese medicine Cangyi Yin in the treatment of hypertensive patients with phlegm-dampness constitution type. Methods　A total of 96 hypertensive patients with phlegm-dampness constitution type treated in Guangzhou Yuexiu District Traditional Chinese Medicine Hospital from January to September 2023 were collected as the research objects, and were divided into two groups by the random number table method, with 48 patients in each group. There were 25 males and 23 females in the control group, aged (57.91±10.78) years, and the course of disease was (5.62±1.25) years. There were 28 males and 20 females in the TCM group, aged (58.37±11.09) years, and the course of disease was (5.59±1.21) years. The control group was given routine clinical treatment, and the TCM group was given Chinese medicine Cangyi Yin on the basis of routine treatment for 12 weeks. The symptoms of phlegm-dampness constitution, levels of blood pressure, blood lipids, and inflammatory factors, and qualities of life of the two groups were compared and analyzed. Independent sample t test was used for inter-group comparison of the measurement data, paired t test was used for intra-group comparison of the measurement data, and χ² test was used for the count data. Results　After treatment, the total effective rate of the TCM group [89.58% (43/48)] was higher than that of the control group [72.92% (35/48)], with a statistically significant difference (χ²=4.376, P=0.036). After treatment, the symptom scores of chest tightness and abdominal distension, heavy body, mucus and phlegm at the mouth, and thick and greasy tongue coating in the TCM group were lower than those in the control group [(0.64±0.17) points vs. (2.37±0.41) points, (0.51±0.12) points vs. (2.29±0.15) points, (0.66±0.15) points vs. (2.18±0.49) points, (0.67±0.25) points vs. (2.33±0.47) points] (all P<0.05). After treatment, the levels of systolic blood pressure (SBP), diastolic blood pressure (DBP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) in the TCM group were lower than those in the control group [(114.65±13.49) mmHg vs. (123.58±14.25) mmHg (1 mmHg = 0.133 kPa), (79.54±9.21) mmHg vs. (85.09±10.38) mmHg, (37.19±4.87) ng/L vs. (45.18±5.33) ng/L, (21.95±3.28) ng/L vs. (27.38±3.70) ng/L] (all P<0.05). After treatment, the levels of total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) in the TCM group were lower than those in the control group [(4.27±1.08) mmol/L vs. (6.18±1.15) mmol/L, (1.28±0.29) mmol/L vs. (2.05±0.34) mmol/L, (2.51±0.59) mmol/L vs. (3.71±0.73) mmol/L], while the level of high-density lipoprotein cholesterol (HDL-C) was higher than that in the control group [(1.97±0.35) mmol/L vs. (1.61±0.38) mmol/L] (all P<0.05). After treatment, the scores of physiological, psychological, environmental, and social dimensions of the WHOQOL-BREF in the TCM group were higher than those in the control group [(86.93±8.17) points vs. (58.34±8.32) points, (83.27±5.19) points vs. (59.52±5.34) points, (79.84±5.47) points vs. (55.87±5.29) points, (78.65±5.41) points vs. (60.41±5.82) points] (all P<0.05). Conclusion　The traditional Chinese medicine Cangyi Yin can improve the physical symptoms of hypertensive patients with phlegm-dampness constitution type, regulate the levels of blood pressure, blood lipids, and inflammatory factors, and improve their quality of life, which is worth promoting and applying.

Case Report

A case of metastatic malignant melanoma treated with toripalimab

Xu Lan, Ye Gang

2024, 30(6):  1025-1027.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.030

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The incidence of malignant melanoma is low, the mortality is high, and the survival time is short. In the early stage, surgery is the main treatment; in the late stage, chemical drugs are mostly used, but the effective rate is not high. Immunotherapy has achieved advanced and breakthrough development in the treatment of a variety of malignant tumors, and has also been proved to prolong the survival time of malignant melanoma patients in clinical practice. This article is to share a case of metastatic malignant melanoma treated with toripalimab who has achieved good efficacy in the First Affiliated Hospital of Jinan University.

Nursing Research

Clinical efficacy of treatment to plantar wart by Paiteling

Liu Yuanling, Chen Wenyi, Wu Xuelin, Hu Yanqing, Yaqoob Muhammad Danish, Liu Kangxing

2024, 30(6):  1028-1031.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.031

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Objective　To observe the clinical effect of Pateling to cure plantar wart. Methods　A total of 150 patients with plantar wart in the 3rd Affiliated Hospital of Southern Medical University from January 2019 to December 2022 were selected and were randomly assigned into three groups. Fifty patients were treated with Paiteling, 50 patients were treated with CO₂ laser, and 50 patients were treated with liquid nitrogen cryotherapy. Follow-up was performed 4 weeks and 12 weeks after the end of treatment to observe the clinical efficacy and recurrence of the 3 groups. χ² test and F test were used. Results　In the Paiteling group, 50 patients were (30.25±10.52) years old, including 27 males and 23 females, 15 cases of single lesion and 35 cases of two or more lesions. In the CO₂ laser group, 50 patients were (28.65±11.25) years old, including 30 males and 20 females, 20 cases of single lesion and 30 cases of two or more lesions. In the liquid nitrogen cryotherapy group, 50 patients were (25.15±9.65) years old, including 25 males and 25 females, 20 cases of single lesion and 30 cases of two or more lesions. Four weeks after treatment, the clinical effective rate was 94.0% (47/50) in the Paiteling group, 84.0% (42/50) in the CO₂ laser group, and 80.0% (40/50) in the liquid nitrogen cryotherapy group, and the difference was statistically significant among the three groups (χ²=6.258, P=0.025), but there was no statistically significant difference between the CO₂ laser group and the liquid nitrogen cryotherapy group (χ²=0.619, P=0.532). Twelfth weeks after treatment, the clinical effective rate was 88.0% (44/50) in the Paiteling group, 78.0% (39/50) in the CO₂ laser group, and 72.0% (36/50) in the liquid nitrogen cryotherapy group, and the difference was statistically significant among the three groups (χ²=5.893, P=0.031), but there was no statistically significant difference between the CO₂ laser group and the liquid nitrogen cryotherapy group (χ²=2.021, P=0.328). Conclusion　Paiteling can cure plantar wart effectively, which can reduce recurrence rate and can be used for clinic as a new therapy to treat plantar wart.

Lived experiences and needs in patients with glioma: a qualitative study

Zhang Tong, Gao Min, Li Xiang, Meng Xiaojing, Zhou Limin, Fan Jingli, Mei Jie

2024, 30(6):  1032-1037.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.032

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Objective　To explore the disease experiences in patients with glioma, identify the patients' illness experiences and care needs, and provide the basis for supporting patients to accept the disease and formulating targeted nursing interventions. Methods　A descriptive qualitative research approach was used. Using purposive sampling, 12 patients with glioma were selected from Henan Provincial People's Hospital for semi-structured interviews from June 2022 to April 2023. There were 7 males and 5 females, aged 31 to 69 years. The Colaizzi's 7-step analysis method was employed to identify and extract the themes. Results　Five main themes were identified from the illness experiences and needs: the urgent need for related health education, health education content (treatment measures, recurrence knowledge, postoperative rehabilitation content, healthy behaviors and daily lifestyle, and postoperative time and intensity of return to work), favoring of "Internet +" follow-up mode, desire for professional and continuous treatment and follow-up services, and importance of family or caregivers' support. Conclusions　Patients with glioma have diverse disease experiences and needs due to different disease cognition, different medical conditions, and insufficient social support. Physicians should strengthen the population's health education, improve the disease cognition, strengthen the family support, build an "Internet +" medical platform, and promote the construction of professional, personalized, and accurate treatment and follow-up systems.

Role of empathy technology based on bio-psycho-social system in the perioperative period of intracranial aneurysm

Zhang Huiyan, Jiang Lei, Zhou Nan

2024, 30(6):  1038-1043.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.033

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Objective　To explore the role of empathy technology based on bio-psycho-social system in the perioperative period of intracranial aneurysm. Methods　This study was a randomized controlled study. A total of 105 patients with intracranial aneurysm treated by interventional embolization in Wuxi Second People's Hospital from February 2020 to February 2022 were prospectively selected as the research objects, and they were divided into an observation group [52 cases, 27 males and 25 females, aged (63.72±8.98) years, with the diameter of the aneurysm of (6.02±1.23) mm] and a control group [53 cases, 30 males and 23 females, aged (62.36±8.75) years, with the diameter of the aneurysm of (5.86±1.17) mm] by the random number table method. The patients in the control group were given conventional nursing mode, and the patients in the observation group were given empathy technology based on bio-psycho-social system on the basis of the control group. The adverse emotions and treatment compliance before and after nursing, postoperative rehabilitation indexes, complications, and satisfaction of patients and their families were compared between the two groups. t test was used for the measurement data, χ² test and Fisher exact probability method were used for the count data. Results　The scores of Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) [(39.16±7.96) points, (48.13±9.75) points, (42.58±8.63) points, and (49.62±9.96) points] in the two groups 7 d after surgery were lower than those before surgery [(58.12±11.89) points, (59.56±12.31) points, (57.78±11.69) points, and (56.52±11.45) points] (all P<0.05). Moreover, those in the observation group [(39.16±7.96) points and (42.58±8.63) points] were lower than those in the control group [(48.13±9.75) points and (49.62±9.96) points] (both P<0.05). The hospitalization time in the observation group [(9.13±1.95) d] was shorter than that in the control group [(11.26±2.32) d] (P<0.05). There were no statistically significant differences in the Glasgow Outcome Scale (GOS) score [(4.36±0.86) points vs. (4.62±0.92) points] and complication rate [9.62% (5/52) vs. 22.64% (12/53)] between the two groups (both P>0.05). Before discharge, the scores of medication adherence [(92.23±20.50) points and (83.46±18.55) points], daily exercise [(89.58±19.91) points and (80.62±17.92) points], diet management [(90.69±14.14) points and (81.45±18.10) points], and adverse management [(87.69±19.49) points and (78.45±17.43) points] in the two groups were higher than those before nursing [(58.32±12.96) points, (56.16±12.48) points, (62.78±13.95) points, (61.82±13.74) points, (60.68±13.48) points, (59.21±13.16) points, (49.68±11.04) points, and (50.21±11.16) points] (all P<0.05). Moreover, those in the observation group [(92.23±20.50) points, (89.58±19.91) points, (90.69±14.14) points, and (87.69±19.49) points] were higher than those in the control group [(83.46±18.55) points, (80.62±17.92) points, (81.45±18.10) points, and (78.45±17.43) points] (all P<0.05). The satisfaction scores of patients and their families in the observation group [(96.25±19.25) points and (95.26±19.05) points] were higher than those in the control group [(88.05±17.61) points and (87.45±17.49) points] (both P<0.05). Conclusion　Empathy technology based on the bio-psycho-social system can effectively improve the clinical efficacy in patients with intracranial aneurysm in the perioperative period, improve their anxiety and depression, improve the treatment compliance and the satisfaction of patients and their families, and reduce the incidence of postoperative complications.

Effect of continuous quality improvement on reducing the incidence of urinary retention after natural childbirth

Zeng Liling, Zhuang Youqing, Rao Jin, Li Xueran

2024, 30(6):  1043-1046.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.034

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Objective　To explore the effect of continuous quality improvement on reducing the incidence of urinary retention after natural childbirth. Methods　This study was a clinical observation study. We selected the parturients who gave birth naturally in Guangdong Women's and Children's Hospital from January to December 2021 as the research objects. Among them, 3 062 parturients in the first delivery area were taken as the experimental group, 3 112 parturients in the second delivery area were taken as the control group. The maternal age of the experimental group was (29.52±4.25) years old; perineal wound: there were 266 cases of no wound, 2 152 cases of grade I laceration, and 644 cases of grade II laceration and lateral incision. The maternal age of the control group was (29.68±4.09) years old; perineal wound: there were 244 cases of no wound, 2 179 cases of grade I laceration, and 689 cases of grade II laceration and lateral incision. The control group was given routine urine retention nursing measures, and the observation group was given continuous quality improvement management measures on the basis of routine nursing. The incidence of urinary retention, the rate of indwelling catheter, and the standardized use rate of nursing sheet in parturients with urinary retention were observed in the experimental group and the control group, and the incidence of urinary retention, the rate of indwelling catheter, and the standardized use rate of nursing sheet in parturients with urinary retention were compared before and after improvement. χ² test, rank sum test, and independent sample t test were used. Results　There were statistically significant differences in the incidence of urinary retention, the rate of indwelling catheter, and the standardized use rate of nursing sheet in parturients with urinary retention between the experimental group and the control group [3.20% (98/3 062) vs. 4.45% (139/3 112), 1.40% (43/3 062) vs. 2.80% (87/3 112), 88.78% (87/98) vs. 56.12% (78/139)] (χ²=6.702, 14.354, and 29.988, all P<0.05). The comparison before and after improvement showed that there were statistically significant differences in the incidence of urinary retention, the rate of indwelling catheter, and the standardized use rate of nursing sheet in parturients with urinary retention (all P<0.05). Conclusion　Continuous quality improvement can effectively reduce the incidence of urinary retention after natural childbirth and improve the level of nursing quality.

Application value of fast track surgery in the perioperative period of minimally invasive transforaminal interbody fusion

Li Xiaomeng, Tong Xiaojuan, Li Meng

2024, 30(6):  1047-1051.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.035

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Objective　To analyze the clinical value of fast track surgery in perioperative nursing of minimally invasive transforaminal interbody fusion. Methods　This was a randomized controlled trial. Ninety six patients treated with minimally invasive transforaminal interbody fusion in Puyang Traditional Chinese Medicine Hospital from March 2021 to October 2022 were divided into a control group and an observation group by the random number table method. The control group received routine nursing, and the observation group received fast track surgery combined with routine nursing. In the control group, there were 28 males and 20 females, aged (50.44±6.52) years. There were 25 males and 23 females in the observation group, aged (49.95±6.73) years. The differences of Japanese Orthopaedic Association (JOA) score, lumbar Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ) score, intervertebral space height, and coronal and sagittal Cobb angles of the two groups were observed and analyzed. Independent sample t test and χ² test were used. Results　Before surgery, there were no statistically significant differences in the JOA score, ODI score, or RMDQ score between the two groups (all P>0.05). The JOA scores of the observation group 72 h, 3 months, and 6 months after surgery [(20.44±1.39), (23.68±1.40) and (24.22±1.49)] were higher than those of the control group [(19.81±1.26), (22.75±1.35) and (23.49±1.42)] (t=2.327, 3.313, and 2.457; P=0.022, 0.001, and 0.016); the ODI scores of the observation group [(40.59±3.52), (34.37±4.25), and (31.67±4.83)] were lower than those of the control group [(42.23±3.20), (36.45±4.33), and (34.69±4.95)] (t=2.388, 2.375, and 3.028; P=0.019, 0.020, and 0.003); the RMDQ scores of the observation group [(16.68±1.67), (11.75±1.38), and (5.42±1.35)] were lower than those of the control group [(17.85±1.75), (12.42±1.39), and (6.12±41.38)] (t=3.351, 2.370, and 2.512; P=0.001, 0.020, and 0.014). Before and after surgery, there were no statistically significant differences in the intervertebral space height or coronal or sagittal Cobb angle between the observation group and the control group (all P>0.05). Conclusion　The integration of fast track surgery into the perioperative nursing of minimally invasive transforaminal interbody fusion can effectively improve the lumbar function, improve the quality of life, and promote patients to recover as soon as possible.

Application of diet diary nutrition management in the perioperative period of spinal tuberculosis patients

Fan Yuyun, Zhou Mengwen, Lu Chunli, Xiao Hua

2024, 30(6):  1052-1056.  DOI: 10.3760/cma.j.issn.1007-1245.2024.06.036

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Objective　To explore the application of diet diary nutrition management in the perioperative period of spinal tuberculosis patients. Methods　Ninety-nine spinal tuberculosis patients in orthopedics department of Guangzhou Chest Hospital from August 2021 to June 2022 were selected in the current study, who were treated with standard anti-tuberculosis drugs. A total of 48 patients with spinal tuberculosis admitted from August to December 2021 were included as a control group; 51 patients with spinal tuberculosis admitted from January to June 2022 were included as an observation group. In the observation group, there were 40 males and 11 females, aged (57.94±20.98) years, with a course of disease of (8.84±3.54) months. In the control group, there were 35 males and 13 females, aged (53.00±20.07) years, with a course of disease of (8.77±3.78) months. The control group was given perioperative routine nutrition care, and the observation group was given diet diary nutrition management on the basis of routine care: empowering education was given to patients, including explaining the importance of nutrition management, conducting nutritional risk assessment, formulating nutrition plans, conducting nutrition intervention, and nutrition education. The Nutritional Risk Screening 2002 (NRS2002) score and levels of total protein (TP), serum albumin (ALB), transferrin (TRF), and prealbumin (PAB) were observed within 24 h after admission and 2 weeks after surgery in both groups. χ² test and independent sample t test were used. Results　Two weeks after surgery, 33.33% (17/51) of the patients in the observation group had a nutritional risk score <3, which was significantly higher than 12.50% (6/48) in the control group, χ² test showed that there was a statistically significant difference (P<0.05). Two weeks after surgery, the levels of ALB and TRF in the control group decreased, but the level of PAB increased, and the levels of ALB, TRF, and PAB in the observation group increased; there were statistically significant differences between the two groups (all P<0.05). Conclusion　Diet diary nutritional management can reduce the nutritional risk and improve the nutritional status in patients with spinal tuberculosis.