Table of Content

15 April 2024, Volume 30 Issue 8

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Topic: Cardiovascular Disease

Value of LTBP-2 combined with cardiopulmonary ultrasound in predicting short-term prognosis of elderly patients with acute myocardial infarction

Guo Jianghong, Wang Huan, Wu Yan

2024, 30(8):  1233-1238.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.001

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Objective　To explore the predictive value of latent transforming growth factor-β binding protein-2 (LTBP-2) combined with cardiopulmonary ultrasound (CPUS) in short-term prognosis of elderly patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods　A retrospective analysis was performed on 116 patients with AMI who underwent PCI in Xi'an Gaoxin Hospital during May 2020 and March 2023. There were 60 males and 56 females, aged 60-80 years, Killip grade: 37 cases of grade I, 51 cases of grade II, and 28 cases of grade III. The level of LTBP-2 and CPUS were measured. The patients were followed up for 3 months after operation to observe the prognosis, and they were divided into a good prognosis group and a bad prognosis group. The clinical data, LTBP-2 levels, and CPUS parameters of the two groups were compared. The influencing factors of major adverse cardiac events (MACE) after PCI in AMI patients were analyzed by multifactor logistic regression analysis, and the predictive value of LTBP-2 combined with CPUS in short-term prognosis was analyzed by the receiver operating characteristic curve (ROC). χ² test and independent sample t test were performed. Results　The incidence of poor short-term prognosis in elderly AMI patients after PCI was 26.72% (31/116). The LTBP-2, early diastolic peak velocity of the mitral valve inflow/early diastolic peak velocity of the mitral valve annulus (E/e'), left atrial volume index (LVAI), number of B lines, time from onset to interventional treatment, and proportion of severe coronary lesions in the poor prognosis group were all higher than those in the good prognosis group, and the left ventricular ejection fraction (LVEF) was lower than that in the good prognosis group (all P<0.05). The results of multivariate analysis showed that LTBP-2 (OR=3.221, 95%CI: 1.993-5.206), number of B-lines (OR=3.182, 95%CI: 1.663-6.087), degree of coronary lesions (OR=1.487, 95%CI: 1.082-2.043) were independent risk factors for prognosis, and LVEF (OR=0.328, 95%CI: 0.157-0.681) was an independent protective factor (all P<0.05). ROC analysis results showed that the sensitivities of LTBP-2, LVEF, number of B-lines, and their combination in predicting the short-term prognosis were 71.00%, 74.20%, 67.70%, and 87.10%, the specificities were 72.90%, 76.50%, 71.80%, and 91.80%, and the areas under the curves were 0.795, 0.816, 0.769, and 0.932, respectively (all P<0.05). Conclusion　LTBP-2 combined CPUS can predict the short-term prognosis of elderly AMI patients after PCI.

Evaluation value of lipoprotein a and apolipoprotein B combined with vitamin D detection on the severity degree and short-term prognosis of coronary heart disease

Yang Xing, Wang Qiuru, Zhou Xue

2024, 30(8):  1238-1242.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.002

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Objective　To analyze the value of lipoprotein a (Lp-a) and apolipoprotein B (ApoB) combined with vitamin D (VD) in evaluating the severity degree and short-term prognosis of coronary heart disease. Methods　Between May 2020 and April 2022, 105 patients with coronary heart disease admitted to Xianyang Hospital, Yan'an University were selected as the study group, and another 102 healthy people who were examined in our hospital during the same period were selected as the control group. There were 65 males and 40 females in the study group, aged 40-71 (55.62±7.85) years, 45 cases of single-vessel disease, 39 cases of double-vessel disease, and 21 cases of three-vessel disease. There were 63 males and 39 females in the control group, aged 39-72 (55.39±8.47) years. The serum level of VD was measured by enzyme linked immunosorbent assay (ELISA), and the serum levels of Lp-a and ApoB were detected by immunoturbidimetric assay. Spearman correlation analysis was used to analyze the correlations between Lp-a, ApoB, and VD levels and the severity degree of coronary artery disease. The patients were followed up for 1 year and the death of the study group was counted. The prognostic value of Lp-a, ApoB, and VD in coronary heart disease was analyzed by the receiver operating characteristic curve (ROC). Independent sample t test and χ² test were performed. Results　The serum Lp-a and ApoB levels in the study group were higher than those in the control group, while the serum VD level was lower than that in the control group (all P<0.05). Serum Lp-a and ApoB levels in the three-vessel disease group were higher than those in the double-vessel disease group > those in the single-vessel disease group, while the VD level was lower than that in the double-vessel disease group < that in the single-vessel disease group (all P<0.05). Correlation analysis showed that Lp-a and ApoB levels were positively correlated with the severity of coronary artery disease (r=0.607 and 0.601, both P<0.05), and the VD level was negatively correlated with the severity of coronary artery disease (r=-0.461, P<0.05). The 1-year mortality of the three-vessel disease group was higher than that in the double-vessel disease group and that in the single-vessel disease group [28.57% (6/21) vs. 10.26% (4/39) vs. 6.67% (3/45)] (P<0.05). ROC analysis showed that the areas under the curves of Lp-a, ApoB, VD, and combined detection to evaluate the prognosis of coronary heart disease were 0.729, 0.737, 0.793, and 0.838, respectively, the sensitivities were 60.1%, 60.0%, 71.3%, and 79.1%, respectively, and the specificities were 77.8%, 74.8%, 62.8%, and 79.4%, respectively. Conclusion　Lp-a, ApoB, and VD are closely related to the severity of coronary heart disease, they can be used to evaluate the short-term prognosis of coronary heart disease, and the combined detection of Lp-a, ApoB, and VD is more effective.

Correlations between serum GDF-11 and TSG-6 levels and risk of heart failure in patients with dilated cardiomyopathy

Wang Wen, Gou Zhiping, Tan Gangwen, Li Huan

2024, 30(8):  1243-1248.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.003

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Objective　To explore the correlations between serum growth differentiation factor 11 (GDF-11) and tumor necrosis factor α-stimulating gene-6 (TSG-6) levels and the risk of heart failure in patients with dilated cardiomyopathy (DCM). Methods　A total of 174 patients with DCM admitted to the People's Hospital of Longhua, Shenzhen from August 2019 to May 2022 were retrospectively selected. There were 87 males and 87 females, aged 50 to 82 years. According to whether the patients were complicated with heart failure within 1 year, they were divided into a heart failure group (84 cases) and a non-heart failure group (90 cases). Serum GDF-11 and TSG-6 levels were measured in all the patients. The clinical data of the two groups were collected and were compared. Multivariate logistic regression analysis was used to analyze the influencing factors of heart failure in DCM patients. The predictive values of serum GDF-11 and TSG-6 levels for heart failure in DCM patients were analyzed by the receiver operating characteristic curve (ROC). Kaplan-Meier (KM) curve was used to analyze the correlations between GDF-11 and TSG-6 levels and heart failure. χ² test and independent sample t test were performed. Results　The levels of GDF-11 and TSG-6 in the heart failure group were higher than those in the non-heart failure group (both P<0.05). There were no statistically significant differences in the gender, body mass index (BMI), combined underlying diseases, smoking history, drinking history, systolic blood pressure, diastolic blood pressure, triglyceride (TG), or total cholesterol (TC) between the two groups (all P>0.05). The levels of age, heart rate (HR), brain natriuretic peptide (BNP), alanine aminotransferase (ALT), and serum creatinine (Scr) in the heart failure group were higher than those in the non-heart failure group, while the level of left ventricular ejection fraction (LVEF) was lower than that in the non-heart failure group (all P<0.05). Binary logistic regression analysis showed that LVEF level (OR=0.487, 95%CI: 0.289-0.818) was an independent protective factor for heart failure in DCM patients, and BNP (OR=6.437, 95%CI: 1.793-23.104), GDF-11 (OR=3.582, 95%CI: 1.825-7.029), and TSG-6 levels (OR=5.421, 95%CI: 2.329-12.617) were independent risk factors for heart failure in DCM patients (all P<0.05). ROC analysis results showed that the sensitivities of GDF-11, TSG-6, and their combination in predicting DCM heart failure were 72.60%, 73.80%, and 90.50%, the specificities were 71.10%, 75.60%, and 87.80%, and the areas under the curves were 0.794, 0.818, and 0.948, respectively (all P<0.05). There was a statistically significant difference in the KM curve between the patients with high expression of GDF-11 and the patients with low expression (P<0.05). There was a statistically significant difference in the KM curve between the patients with high expression of TSG-6 and the patients with low expression (P<0.05). Conclusions　Serum GDF-11 and TSG-6 are related to the risk of heart failure in DCM patients, and are independent risk factors affecting the occurrence of heart failure in DCM patients. The combined detection of GDF-11 and TSG-6 levels can better predict the occurrence of heart failure in DCM patients.

Factors influencing non-response to cardiac resynchronization therapy in elderly heart failure patients

Wang Lei, You Fei, Zhang Feng, Wu Guanji, Liu Shuwen, Ma Qianfeng

2024, 30(8):  1248-1252.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.004

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Objective　To analyze the factors influencing non-response to cardiac resynchronization therapy (CRT) in elderly patients with heart failure. Methods　A retrospective analysis was conducted on the clinical data of 80 elderly heart failure patients who underwent CRT between May 2020 and May 2023 at the Department of Cardiology, Xi'an Central Hospital, including 46 males and 34 females, 50 cases ≥80 years old and 30 cases <80 years old, cardiac function grade: 53 cases of grade III and 27 cases of grade IV. The patients were observed for CRT response and were categorized into the response and non-response groups. The clinical data were analyzed using univariate analysis, and variables with statistically significant differences were further analyzed using multivariate logistic regression analysis to analyze the influencing factors of non-response after CRT in elderly patients with heart failure. Independent sample t test and χ² test were used. Results　Among the 80 elderly patients who underwent CRT, 59 responded to the treatment, and 21 did not, resulting in a response rate of 73.75%. There were no statistically significant differences in the age, gender, body mass index, smoking history, drinking history, diabetes history, hypertension history, left atrial inner diameter (LAD), right ventricular inner diameter (RVD), triglyceride (TG) level, and cardiac function grade between the two groups (all P>0.05). There were statistically significant differences in the course of disease, mitral regurgitation volume, QRS wave duration, left ventricular ejection fraction (LVEF), and total cholesterol (TC) between the two groups (all P<0.05). Multivariate logistic regression analysis showed that the duration of disease ≥3 years, increased mitral regurgitation volume, reduced QRS wave duration, LVEF ≤30%, and elevated TC level were all risk factors for non-response to CRT in elderly patients with heart failure (all P<0.05). Conclusion　For elderly heart failure patients, risk assessment, electrophysiological evaluation, enhanced cardiac support, lipid management, and lifestyle interventions are essential to enhance the efficacy of CRT, reduce the non-response rate, and ultimately improve the patients' prognosis and quality of life.

Risk factor analysis of coronary heart disease in elderly patients with hypertension

Song Yunhong, Liu Yanan, Zhang Zongli

2024, 30(8):  1253-1258.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.005

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Objective　This study aims to analyze the risk factors of coronary heart disease in elderly patients with hypertension. Methods　A total of 228 elderly hypertensive patients treated in the general outpatient department of Jinan Maternal and Child Health Hospital from January 2019 to January 2023 were included in this study. They were divided into two groups based on the coronary angiography results: a coronary heart disease group (125 cases) and a non-coronary heart disease group (103 cases). There were 64 males and 61 females in the coronary heart disease group, aged 67-80 (75.16±1.38) years. In the non-coronary heart disease group, there were 52 males and 51 females, aged 60-71 (64.53±1.26) years. The general data of all the patients were collected, and the severity of coronary lesions was assessed using the Gensini score. Full-day blood pressure monitoring was conducted, and the whole day blood pressure load was calculated using diastolic and systolic blood pressures. The myocardial perfusion reserve (MPR) was evaluated by cardiac magnetic resonance (CMR). The hemorheological indicators such as blood platelet parameters, blood lipids, fibrinogen, and plasma viscosity were measured. Ultrasound was used to compare the plaque detection rate, plaque index, and Coronary Artery Calcium Score (CACS) between the two groups. The differences in these indicators were compared, and multivariate logistic regression analysis was conducted to explore the risk factors of coronary heart disease in elderly patients with hypertension. Additionally, the correlations between these indicators and the Gensini score were analyzed by Pearson correlation analysis. Independent sample t test and χ² test were used. Results　Of the 228 hypertensive patients included, 125 had concurrent coronary heart disease. The Gensini score in the coronary heart disease group was significantly higher than that in the non-coronary heart disease group [(96.21±10.25) points vs. (21.03±3.36) points] (P<0.05). Multivariate logistic regression analysis showed that age, blood pressure load, MPR, mean platelet volume, hemorheological indicators, plaque index, and CACS were influencing factors for coronary heart disease in elderly hypertensive patients (all P<0.05). Additionally, the Gensini score was positively correlated with blood pressure load, plasma specific viscosity, plaque index, and CACS, and was negatively correlated with MPR (all P<0.05). Conclusion　Age, blood pressure load, MPR, platelet parameters, hemorheological indicators, plaque index, and CACS are all factors that influence elderly patients with hypertension complicated with coronary heart disease.

Curative effect of Shenfu Jiuxin Decoction combined with sacubitril/valsartan in the treatment of heart failure with ejection fraction preservation

Lyu Weikun, Suo Xinqi, Chen Minna, Zhang Wang, Kang Qi, Yao Tingting, Men Danyang, Dong Jing

2024, 30(8):  1259-1263.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.006

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Objective　To observe the clinical effect of Shenfu Jiuxin Decoction combined with sacubitril/valsartan in the treatment of heart failure with preserved ejection fraction. Methods　A total of 80 patients with heart failure with ejection fraction preservation were selected from the Second Affiliated Hospital of Shanxi University of Traditional Chinese Medicine from June 2020 to June 2023, and were divided into two groups according to the random number table method. In the control group, there were 17 males and 23 females, aged 51-83 (62.53±4.17) years, New York Heart Association (NYHA) classification: 21 cases of grade II and 19 cases of grade III. In the study group, there were 16 males and 24 females, aged 50-84 (63.14±4.65) years, NYHA classification: 22 cases of grade II and 18 cases of grade III. The control group was treated with sacubitril/valsartan tablets (the initial dose was 50 mg each time, and increased to 100 mg each time after 2 weeks, twice a day) based on the basic treatment, and the study group was treated with Shenfu Jiuxin Decoction (taking 100 ml each time, twice a day) based on the control group for 2 months. The clinical efficacies of the two groups were compared. Before and after treatment, cold limbs, facial edema, palpations, asthma/inability to sleep, foaming sputum, oliguria and abdominal distension, blue lips, accompanied by ascites, pleural fluid, face gray, irritability, and sweating were evaluated. Before and after treatment, the patients' 6-min walking distance, Minnesota Living with Heart Failure Questionnaire (MLHFQ) score, left ventricular ejection fraction, left ventricular mass index, and E peak deceleration time were evaluated. The levels of tumor necrosis factor α (TNF-α), interleukin 33 (IL-33), soluble stromal lysin 2 (sST2), and N-terminal B-type natriuretic peptide (NT-proBNP) were detected. t test and χ² test were used. Results　The total effective rate of the study group was 97.50% (39/40), which was higher than that of the control group [80.00% (32/40)] (P<0.05). After treatment, the scores of cold limbs, facial edema, palpations, asthma/inability to sleep, foaming sputum, oliguria and abdominal distension, blue lips, accompanied by ascites, pleural fluid, face gray, irritability, and sweating in the study group were lower than those in the control group (all P<0.05); the 6-min walking distance of the study group was longer than that of the control group (P<0.05); the MLHFQ score of the study group was lower than that of the control group (P<0.05); the left ventricular ejection fraction of the study group was higher than that of the control group (P<0.05); the left ventricular mass index and E peak deceleration time of the study group were lower than those of the control group (both P<0.05); the levels of TNF-α, IL-33, sST2, and NT-proBNP in the study group were lower than those in the control group (all P<0.05). Conclusion　Shenfu Jiuxin Decoction combined with sacubitril/valsartan can inhibit the inflammation, reduce the sST2 and NT-proBNP levels, improve the ventricular remodeling, cardiac function, exercise endurance, clinical efficacy, and quality of life in patients with heart failure with preserved ejection fraction.

Effect of levosimendan combined with cyclic adenosine monophosphate on elderly patients with acute left heart failure

Liu Honggang, Li Jing

2024, 30(8):  1264-1268.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.007

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Objective　To explore the impact of levosimendan combined with cyclic adenosine monophosphate (cAMP) on the ventricular remodeling and levels of serum cardiac troponin I (TnI) and transient receptor potential channel 1 (TRPC1) in elderly patients with acute left heart failure. Methods　Ninety-six elderly patients diagnosed with acute left heart failure in Hancheng People's Hospital from June 2022 to November 2023 were selected and were divided into an observation group and a control group by the envelope method with 48 patients in each group, in a prospective study. In the observation group, there were 25 males and 23 females; the age was (76.97±5.23) years old; the body mass index was (25.35±2.79) kg/m²; the cardiac function classification was grade III in 30 cases and grade IV in 18 cases. In the control group, there were 26 males and 22 females; the age was (77.41±5.16) years old; the body mass index was (25.14±2.62) kg/m²; the cardiac function classification was grade III in 31 cases and grade IV in 17 cases. Both groups received conventional interventions such as diuretics, cardiotonics, and vasodilators. The control group was treated with intravenous drip with cAMP, and the observation group received intravenous drip with levosimendan and cAMP for a treatment period of 7 days. The clinical efficacy, ventricular remodeling indexes [interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), and left ventricular mass index (LVMI)], cardiac reserve function indexes [left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), and left ventricular end-diastolic diameter (LVEDD)], serum TnI and TRPC1 levels, and incidence of adverse reactions were compared between the two groups. Independent sample t test, paired sample t test, and χ² test were used. Results　After treatment, the total effective rate of the observation group [91.67% (44/48)] was higher than that of the control group [75.00% (36/48)] (P<0.05). After treatment, the ventricular remodeling indexes in the observation group were better than those in the control group [IVST: (7.45±0.82) mm vs. (9.04±1.11) mm, LVPWT: (8.09±0.84) mm vs. (8.89±1.07) mm, LVMI: (112.67±15.12) g/m² vs. (120.21±16.83) g/m²] (all P<0.05). After treatment, the LVEF of the observation group was higher than that of the control group [(56.32±6.01)% vs. (51.78±5.90)%], but the LVESD and LVEDD were lower than those of the control group [(50.27±5.98) mm vs. (59.46±6.24) mm, (53.92±7.47) mm vs. (62.85±7.22) mm] (all P<0.05). After treatment, the serum TnI and TRPC1 levels in the observation group were lower than those in the control group [(0.34±0.06) μg/L vs. (0.46±5.90) μg/L, (8.25±1.62) ng/L vs. (13.27±2.07) ng/L] (both P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the observation group [16.67% (8/48)] and the control group [14.58% (7/48)] (P>0.05). Conclusion　Levosimendan combined with cAMP effectively improves the ventricular remodeling, enhances the cardiac function, and reduces the serum levels of TnI and TRPC1 in elderly patients with acute left heart failure, benefiting the recovery treatment of left heart failure patients.

Effect of Qili Qiangxin capsules combined with rhBNP on patients with heart failure after acute myocardial infarction

Xu Xin, Wang Lanlan

2024, 30(8):  1269-1273.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.008

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 Objective　To investigate the effects of Qili Qiangxin capsules combined with recombinant human brain natriuretic peptide (rhBNP) on the cardiac function and expressions of angiotensin Ⅱ (AngⅡ), Periostin, and growth arrest-specific protein 6 (GAS6) in patients with heart failure after acute myocardial infarction. Methods　A total of 82 patients with heart failure after acute myocardial infarction admitted to Liaocheng Third People's Hospital from April 2021 to April 2023 were simply randomly divided into two groups. In the control group, there were 19 males and 22 females, aged (59.35±8.64) years, 7 cases of grade II, 18 cases of grade III, and 16 cases of grade IV. In the observation group, there were 20 males and 21 females, aged (60.27±9.12) years, 9 cases of grade Ⅱ, 19 cases of grade Ⅲ, and 13 cases of grade Ⅳ. The control group received 1.5 μg/kg of rhBNP treatment for 7 days, and the observation group received oral administration of Qili Qiangxin capsules on the basis of the control group for 21 days (1.2 g/time, 3 times/day). The therapeutic effects, cardiac function [left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), and left ventricular end-diastolic diameter (LVEDD)], AngⅡ, Periostin, and GAS6 levels before treatment and 21 days after treatment, and adverse reactions of the two groups were compared. t test and χ² test were performed. Results　The total effective rate of the observation group was higher than that of the control group [92.68% (38/41) vs. 75.61% (31/41)] (P<0.05). After treatment, the LVEF of the observation group [(54.56±5.15)%] was higher than that of the control group [(46.32±5.44)%], while the LVEDD [(42.34±6.18) mm], LVESD [(37.32±4.52) mm], AngⅡ [(112.37±9.58) ng/L], Periostin [(89.47±9.25) ng/L], and GAS6 [(13.41±3.68) μg/L] were lower than those of the control group [(51.17±5.26) mm, (40.92±4.11) mm, (118.13±9.61) ng/L, (98.54±9.72) ng/L, and (15.72±3.21) μg/L] (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the observation group [12.20% (5/41)] and the control group [17.07% (7/41)] (P>0.05). Conclusion　The combination of Qili Qiangxin capsules combined with rhBNP has a significant therapeutic effect on heart failure after acute myocardial infarction, improving the heart function and reducing the Ang Ⅱ, Periostin, and GAS6 levels, which can be widely promoted in clinical practice.

Curative effect of metoprolol tartrate combined with amiodarone on arrhythmia in acute myocardial infarction

Zhu Buquan, Li Yuliang

2024, 30(8):  1273-1278.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.009

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Objective　To explore the curative effect of metoprolol tartrate combined with amiodarone on arrhythmia in acute myocardial infarction. Methods　The data of 223 patients with acute myocardial infarction and arrhythmia who were admitted to Xianyang Rainbow Hospital from July 2020 to July 2022 were analyzed retrospectively. The patients treated with amiodarone (intravenous drip with 4 ml of amiodarone hydrochloride injection into glucose injection + oral amiodarone hydrochloride tablets 0.2 g/time, 3 times/day) and those treated with amiodarone combined with metoprolol tartrate (oral metoprolol tartrate tablets, 25 mg/time, twice a day) were included in the control group (100 cases) and the combination group (123 cases), respectively. Both groups received treatment for 1 month. In the control group, there were 48 males and 52 females, aged (52.67±13.42) years, 66 patients with cardiac function grade Ⅱ and 34 patients with grade Ⅲ. In the combination group, there were 71 males and 52 females, aged (51.92±13.56) years, 86 patients with grade Ⅱ and 37 patients with grade Ⅲ. The curative effect, the cardiac function and levels of heart rate variability indices before and after treatment, and the occurrence of arrhythmia and drug-related adverse reactions were compared between the two groups. t test and χ² test were used. Results　The total effective rate of the combination group was 95.12% (117/123), while that of the control group was only 86.00% (86/100), with a statistically significant difference between the two groups (P<0.05). After treatment, the cardiac function indexes such as left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), heart rate (HR), and B-type natriuretic peptide (BNP) were significantly improved in both groups (all P<0.05). After treatment, the LVEDD, LVESD, HR, and BNP in the combination group were lower than those in the control group, and the LVEF was higher than that in the control group, with statistically significant differences (all P<0.05). After treatment, the root-mean-square of normal continuous sinus RR interval difference (rMSSD) decreased significantly, while the standard deviation of normal sinus RR intervals (SDNN), percentage of the number of adjacent RR intervals with an interval difference greater than 50 ms (PNN50), and mean standard deviation of sinus RR interval every 5 min within 24 h (SDANN) increased significantly in both groups (all P<0.05). After treatment, the improvements of the above indexes of heart rate variability in the combination group were significantly greater than those in the control group (all P<0.05). The incidences of arrhythmia and drug-related adverse reactions in the combination group [1.63% (2/123) and 5.69% (7/123)] after treatment were lower than those in the control group [11.00% (11/100) and 12.00% (12/100)], and there was a statistically significant difference in the incidence of arrhythmia only (P<0.05). Conclusion　Applying metoprolol tartrate combined with amiodarone to treat patients with acute myocardial infarction and arrhythmia can improve the heart rate variability, alleviate the cardiac injury, and reduce the occurrence of arrhythmia, with significant curative effect.

Effect of noninvasive ventilator on severe acute left heart failure

Yang Ge, Wang Dandan

2024, 30(8):  1278-1281.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.010

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Analysis of electrocardiogram characteristics in patients with hyperacute myocardial infarction

Nie Haihua, Li Maocha, Li Yang

2024, 30(8):  1282-1285.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.011

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Objective　To explore the diagnostic value of electrocardiogram in hyperacute myocardial infarction. Methods　A total of 200 patients diagnosed as acute myocardial infarction (AMI) in the chest pain center of Huitong County People's Hospital from January 2018 to March 2023 were selected as the research objects. There were 118 males and 82 females, aged 31 to 65 (48.6±7.5) years. The electrocardiogram manifestations of AMI in hyperacute stage were analyzed, and the time difference between typical electrocardiogram (ECG) pattern of AMI and abnormal myocardial necrosis markers was compared. Paired t test and McNemar-Bowker Pearson Chi-square test were used. Results　Immediately at treatment and 30 min, 1 h, 2 h, 3 h, and 4 h after treatment, the incidences of arrhythmia were 7.0% (14/200), 11.0% (22/200), 36.5% (73/200), 64.0% (128/200), 85.5% (171/200), and 93.0% (186/200), with a statistically significant difference (P<0.001); the incidences of conduction block were 2.5% (5/200), 4.5% (9/200), 11.5% (23/200), 41.5% (83/200), 61.0% (121/200), and 75.5% (151/200), with a statistically significant difference (P<0.001); the incidences of ST segment decline were 37.0% (74/200), 90.0% (180/200), 81.5% (163/200), 77.5% (155/200), 40.0% (80/200), and 5.5% (11/200), with a statistically significant difference (P<0.001); the incidences of low and flat T wave were 40.5% (81/200), 48.5% (97/200), 60.0% (120/200), 83.5% (167/200), 42.0% (84/200), and 15.0% (30/200), with a statistically significant difference (P<0.001). The occurrence time of typical ECG pattern of AMI was longer than that of abnormal markers of myocardial necrosis [(3.86±0.34) h vs. (2.75±0.22) h], with a statistically significant difference (P<0.05). Conclusion　New and frequent arrhythmia, conduction block, ST segment decline, and low and flat T wave in patients with chest pain may be the unique ECG manifestations of hyperacute AMI patients.

Construction and application of a cluster management model for shortening FMC-to-B time in patients with acute myocardial infarction

Chen Bei, Jin Ailian

2024, 30(8):  1286-1290.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.012

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Objective　To construct a cluster management model that shortens the time from first medical contact to balloon (FMC-to-B) in patients with acute myocardial infarction (AMI), and analyze its application value. Methods　By consulting relevant literatures and summarizing clinical work experiences, a cluster management model for shortening FMC-to-B time was constructed. A prospective randomized controlled study was conducted, selecting 121 AMI patients in Shangqiu First People's Hospital from January 2020 to January 2023 as the study subjects. The patients were divided into a control group and an observation group using the random number table method + sealed letter method. During the study period, the control group did not fall off, a total of 61 cases. There were 28 males and 33 females, aged 42-56 (50.30±4.50) years, Killip cardiac function classification: 32 cases of grade I and 27 cases of grade II, and routine nursing was used. In the observation group, 1 case fell off due to delayed percutaneous coronary intervention (PCI), a total of 59 cases. There were 35 males and 24 females, aged 42-56 (50.42±4.56) years, Killip cardiac function classification: 37 cases of grade I and 24 cases of grade II. On the basis of the control group, the cluster management mode of shortening FMC-to-B time was used to intervene, the main contents were to build a medical team and establish a shortening FMC-to-B time model. The clinical indicators, treatment, complications, economic indicators and nursing satisfaction were compared between the two groups. Independent sample t test, χ² test, and rank sum test were used for statistical analysis. Results　The AMI diagnosis time, FMC-to-B time, and catheter room activation time in the observation group were shorter than those in the control group [(582.61±10.36) s vs. (602.67±10.07) s, (110.61±9.48) min vs. (125.77±11.81) min, (19.85±3.94) min vs. (28.39±5.82) min], with statistically significant differences (t=10.758, 7.737, and 9.386, all P<0.05). The revascularization rate of infarction and survival rate in the observation group were higher than those in the control group [94.92% (56/59) vs. 83.61% (51/61), 93.22% (55/59) vs. 80.33% (49/61)], with statistically significant differences (χ²=3.971 and 4.314, both P<0.05). There was no statistically significant difference in the total incidence of complications between the two groups [13.56% (8/59) vs. 18.03% (11/61)] (χ²=0.450, P>0.05). The hospitalization time of the observation group was shorter than that of the control group, and the hospitalization cost was lower than that of the control group [(8.95±1.84) d vs. (10.95±1.51) d, (39 503.25±600.36) yuan vs. (43 981.22±586.37) yuan], with statistically significant differences (t=6.519 and 41.335, both P<0.05). The nursing satisfaction of the observation group was higher than that of the control group, with a statistically significant difference (Z=2.003, P<0.05). Conclusion　The construction and application of a cluster management model for shortening the FMC-to-B time of AMI patients can effectively shorten the AMI diagnosis time, FMC-to-B time, catheter room activation time, and hospitalization time, improve the vascular recanalization and survival rates, reduce the hospitalization costs, and improve the patients' nursing satisfaction.

Research progress of Wnt signaling pathway in acute myocardial infarction

Yang Shoujuan, Zhang Haitao, Cui Mingli, Wang Jian, Li Yang, Cheng Yanli

2024, 30(8):  1291-1296.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.013

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Wnt signaling pathway is a signal transduction pathway by which ligand protein Wnt binds to membrane protein receptors to stimulate downstream signaling molecules to produce cascade reactions. Wnt signaling pathway is a key pathway to regulate cell growth, proliferation, and differentiation. After acute myocardial infarction (AMI), the regeneration capacity of cardiomyocytes is limited, the fibroblasts multiply greatly, and the scar tissue is formed. Myocardial remodeling leads to decreased left ventricular function. Therefore, promoting myocardial regeneration and reducing scar area are of great significance for improving cardiac function after myocardial infarction. Wnt signaling pathway is involved both in normal cardiomyocytes and in the formation and development of cardiovascular diseases. The study on the role of Wnt signaling pathway in AMI can provide a new basis for the treatment of AMI. In this paper, we review the research progress of Wnt signaling pathway in the development of AMI.

Research progress of myocardial fibrosis and AMPK-mTOR-ULK1 signaling pathway

Liu Zhiqiang, Zhang Cui, Dong Wenjing, Liu Zhen, Sun Jingwu

2024, 30(8):  1297-1300.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.014

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Myocardial fibrosis is an important pathological change in the occurrence and development of many cardiovascular diseases, and it is also the pathological basis of heart pump failure and adverse cardiovascular events, which is mainly manifested by excessive deposition of extracellular matrix (ECM) and continuous proliferation of cardiac fibroblasts (CFs). Adenylate activated protein kinase (AMPK) signaling pathway is the main system to mediate phosphorylation. AMPK activates autophagy, inhibits mammalian target of rapamycin (mTOR), and phosphorylates Unc-51-like autophagy activated kinase 1(ULK1). AMPK signaling pathway plays an important role in the occurrence and development of myocardial fibrosis. This paper analyzes the role of AMPK-mTOR-ULK1 signaling pathway in myocardial fibrosis, hoping to provide guidance for the treatment of myocardial fibrosis.

Meta Analysis

Effect of bioimpedance analysis-guided ultrafiltration on remaining renal function in hemodialysis patients: a meta-analysis

Jiang Haili, Pan Hong, Jiao Chunxiao, Cong Lina, Li Haiqiang

2024, 30(8):  1301-1306.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.015

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Objective　To investigate the effect of bioimpedance analysis (BIA) -guided ultrafiltration on remaining renal function (RRF) in hemodialysis patients compared with conventional clinical methods. Methods　PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang, VIP, and CBM were searched for randomized controlled trials (RCTs) about the effects of BIA-guided ultrafiltration on RRF in hemodialysis patients compared with conventional clinical methods from the inception to December 31, 2022. Meta-analysis was performed by RevMan 5.4. Results　A total of 6 RCTs with 406 participants were included. The results of meta-analysis showed that the RRF [P<0.05, MD=1.15, 95%CI (1.00, 1.31)] and 24 h urine output [P<0.05, MD=253.56, 95%CI (229.17, 277.96)] of the BIA guidance group were higher than those of the control group, and the ultrafiltration volume [P<0.05, MD=-0.45, 95%CI (-0.65, -0.26)] and diastolic blood pressure [P<0.05, MD=-5.52, 95%CI (-7.58, -3.47)] were lower than those of the control group, but there were no statistically significant differences in the systolic blood pressure [P>0.05, MD=-0.25, 95%CI (-7.70, 7.21)], body weight [P>0.05, MD=-0.01, 95%CI (-3.38, 3.37)], or albumin [P>0.05, MD=0.41, 95%CI (-1.61, 2.43)] between the two groups. Conclusion　Based on the existed data, compared with conventional clinical methods, BIA-guided ultrafiltration can protect the RRF in hemodialysis patients.

New Medical Advances

Advances in single-cell RNA sequencing in kidney disease

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

2024, 30(8):  1307-1311.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.016

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Single-cell RNA sequencing (scRNA-seq) technology has brought many new discoveries to biomedical research, enabling high-resolution, high-throughput, and repeatable transcriptional analysis to identify new cell types and form cell maps. However, traditional sequencing methods can only reflect the overall level of gene expression of all cells in the samples and cannot reveal the heterogeneity of gene expression between individual cells. This article elaborates on the development history of scRNA-seq technology and outlines its potential application to reveal the mechanisms of kidney diseases, which is beneficial for diagnosis and treatment of kidney disease.

Research progress of metabolomics in infectious diseases

Wang Xia, Sai Haifang

2024, 30(8):  1312-1316.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.017

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Infectious diseases are one of the serious public health problems in the world, which are very harmful to human health. In recent years, metabolomics has been gradually applied to the research of infectious diseases to understand host-pathogen interactions at the small molecular level. By screening disease specific biomarkers through metabolomics based on nuclear magnetic resonance (NMR) or mass spectrometry (MS), new opportunities have been brought for disease prevention and exploration of etiology and pathogenesis. This review discusses the application of metabolomics in screening biomarkers, finding metabolites in infectious diseases such as virus, bacteria, and parasite infections, and the application of immunometabolomics, in order to provide new evidences for the diagnosis of infectious diseases.

m⁶A and m⁵C methylation modification affects the initiation and development of cancers by regulating cellular proliferation and metastasis

Shao Shuang, Guo Jiwei, Meng Wei

2024, 30(8):  1316-1320.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.018

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So far, more than 170 chemical modifications have been found in RNA. RNA methylation modification is an important post-transcriptional regulation process. N6-methyladenosine (m⁶A) and 5-methylcytosine (m⁵C) are ubiquitous in eukaryotes and prokaryotes. Additionally, more and more attention has been paid to the exploration of RNA methylation within regulating gene expression and regulating the cellular biological activity in the tumor cells. Furthermore, some known cell signal pathways involved in cellular proliferation and metastasis are closely related to cancers immunity and metabolic regulation, and these signal pathways play an important role in regulating organ size, tissue regeneration, and stem cell self-renewal, which ultimately affects the initiation and development of tumors. In this review, we discuss that the m⁶A and m⁵C methylation regulate the occurrence and development of cancers through some popular pathways in human cancers, which provides a new theoretical basis for understanding and seeking new therapeutic disease approaches.

Treatises

Clinical efficies of different daily doses of meropenem in patients with hyperactive renal function

Yu Jingjing, Shao Chen, Qu Peng, Zhang Laozhui

2024, 30(8):  1321-1325.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.019

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Objective　To explore the clinical efficacies of different daily doses of meropenem in patients with hyperactive renal function. Methods　A retrospective analysis was conducted on 144 patients treated with meropenem at Dongying Second People's Hospital from January 2021 to December 2022. Based on the creatinine clearance rate (CCr), the patients were divided into a hyperactive renal function group (63 cases) and a normal renal function group (81 cases). In the hyperactivity group, there were 37 males and 26 females, aged 37-69 (53.55±4.47) years, with a body mass of 46-93 (71.51±6.06) kg, with a disease course of 1-6 (2.98±0.93) years. In the normal group, there were 48 males and 33 females, aged 41-73 (53.50±4.42) years, with a body weight of 49-89 (71.56±6.01) kg, with a disease course of 1-5 (2.97±0.95) years. The renal function [Ccr, serum creatinine (Scr), and blood urea nitrogen (BUN)], inflammatory indicators [white blood cell count (WBC), neutrophil percentage (NEUT%), procalcitonin (PCT), and C-reactive protein (CRP)], medication status, and clinical efficacy of different daily doses of meropenem were compared between the two groups. Independent sample t test and χ² test were used. Results　The Ccr level in the hyperactivity group was higher than that in the normal group [(126.14±11.63) ml/min vs. (116.25±10.51) ml/min], but the levels of Scr [(47.66±4.25) μmol/L] and BUN [(3.10±0.33) mmol/L] were lower than those in the normal group [(58.62±5.62) μmol/L and (4.22±0.49) mmol/L], with statistically significant differences (all P<0.05). The levels of WBC [(15.55±1.23) ×10⁹/L], NEUT% [(77.85±5.69)%], PCT [(48.60±4.12) µg/L], and CRP [(16.17±3.55) mg/L] in the hyperactivity group were higher than those in the normal group [(9.44±1.56) ×10⁹/L, (68.52±5.52)%, (48.60±4.12) µg/L, and (9.23±1.06) mg/L], with statistically significant differences (all P<0.05). The drug use of the hyperactivity group was higher than that of the normal group at 0.5 g dose (administered every 6 h and every 8 h) and 2.0 g dose (administered every 8 h), but lower than that of the normal group at 1.0 g dose (administered every 8 h and every 12 h), with statistically significant differences (all P<0.05). The clinical effective rates of the hyperactivity group at 1/2 day dose and 2/3 day dose were 0 (0/15 and 0/17), which were lower than those of the normal group [88.89% (8/9) and 92.31% (24/26)], with statistically significant differences (both P<0.05). The clinical effective rate of the hyperactivity group at 1 day dose [50.00% (10/20)] was higher than those at 1/2 day dose and 2/3 day dose, but still lower than that of the normal group [75.61% (31/41)], with statistically significant differences (all P<0.05). The clinical effective rate of the hyperactivity group at double daily dose was 81.82% (9/11), without statistically significant difference compared with 100.00% (5/5) of the normal group (P>0.05). Conclusions　Different doses of meropenem affect the clinical efficacy in patients with hyperactive renal function. The dosage should be ≥ 2.0 g (daily dose), and can be increased to 3.0 g if necessary.

Effect of drug coated balloon dilation and angioplasty on patients with in-stent restenosis of the femoral popliteal artery

Hu Kaifeng, Gao Yuan, Li Yan, Zhao Liang

2024, 30(8):  1325-1329.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.020

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Objective　To explore the clinical effect of drug coated balloon dilation and angioplasty for patients with in-stent restenosis of the femoral popliteal artery. Methods　A total of 96 patients with in-stent restenosis of the femoral popliteal artery, who were planned to undergo surgical treatment in Department of Vascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University from June 2019 to December 2022, were selected as the research subjects. They were divided into a study group and a control group with 48 cases in each group using the random number table method. In the study group, there were 28 males and 20 females, aged (64.1±6.7) years, and the length of lesion was (14.3±4.1) cm. In the control group, there were 33 males and 15 females, aged (62.5±7.2) years, and the length of lesion was (13.8±3.3) cm. The study group was treated with drug coated balloon dilation and angioplasty, while the control group was treated with conventional balloon technique. The changes in ankle-brachial index (ABI), minimum target vessel lumen diameter (MLD), long-term lumen loss (LLL), primary patency rate, Rutherford grade, intermittent claudication distance, and coagulation function were compared between the two groups before and after treatment. Statistical methods used were repeated measure ANOVA, independent sample t test, χ² test, and rank sum test. Results　The ABI values of the two groups 3 months, 6 months, and 12 months after surgery were higher than those before surgery; the ABI value of the study group 12 months after surgery was higher than that of the control group [(0.86±0.11) vs. (0.75±0.14)], with a statistically significant difference (t=4.28, P<0.05). The MLD value of the study group was higher than that of the control group 12 months after surgery [(2.85±0.46) mm vs. (2.53±0.51) mm], with a statistically significant difference (t=3.23, P<0.05). The LLL values of the study group 6 months and 12 months after surgery were lower than those of the control group [(4.56±1.80)% vs. (5.71±1.92)%, (13.37±2.60)% vs. (19.68±3.81)%], with statistically significant differences (t=-3.03 and -9.48, both P<0.05). The Rutherford grade of the study group was lower than that of the control group 12 months after surgery, with a statistically significant difference (Z=-2.19, P<0.05). Three months after surgery, the prothrombin time (PT) and thrombin time (TT) of the study group were higher than those of the control group [(13.41±0.31) s vs. (13.23±0.34) s, (16.92±0.88) s vs. (16.46±0.95) s], with statistically significant differences (t=2.71 and 2.46, both P<0.05). Conclusion　The treatment of in-stent restenosis of the femoral popliteal artery using drug coated balloon dilation and angioplasty is more beneficial than conventional stents in maintaining continuous vascular patency, alleviating the patients' blood hypercoagulable state, and better improving the treatment effect.

Correlation analysis between serum uric acid and carotid intima-media thickness in patients with hypertension 

Qu Wentao, Huang Xun, Wang Lin

2024, 30(8):  1330-1333.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.021

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Objective　To analyze the relationship between serum uric acid (SUA) and carotid intima-media thickness (CIMT) in patients with hypertension. Methods　A retrospective study was conducted to select 110 patients diagnosed with hypertension in Xi'an Hospital of Traditional Chinese Medicine from March to October 2020. Among them, there were 60 patients with simple hypertension [HT group, 31 males and 29 females, aged (51.59±10.84) years] and 50 patients with hypertension combined with hyperuricemia [HT+HU group, 23 males and 27 females, aged (52.27±10.12) years]. In addition, 40 healthy adults were selected [healthy control group, 20 males and 20 females, aged (51.23±9.43) years]. The differences of blood pressure, body mass index (BMI), triglyceride, total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), SUA, and CIMT among all the groups were compared, and the correlation between SUA and CIMT was analyzed. The statistical methods were one-way ANOVA, χ² test, partial correlation analysis, and multiple linear regression analysis. Results　There were no statistically significant differences in the gender, age, heart rate, smoking, total cholesterol, triglyceride, HDL-C, and LDL-C among the 3 groups (all P>0.05). The SUA level in the HU+HT group was higher than that in the control group and the HT group [(496.52±74.82) μmol/L vs. (253.42±80.46) μmol/L vs. (267.78±75.72) μmol/L], with a statistically significant difference (F=156.14, P<0.05). The systolic blood pressure and diastolic blood pressure in the HT group and the HU+HT group were higher than those in the control group [(164.72±12.86) mmHg (1 mmHg=0.133 kPa) vs. (165.87±12.96) mmHg vs. (106.75±7.46) mmHg, (98.82±6.56) mmHg vs. (98.78±6.85) mmHg vs. (73.68±4.66) mmHg], with statistically significant differences (F=366.07 and 239.34, both P<0.05). The CIMT of the HU+HT group and the HT group were higher than that of the control group, and the CIMT of the HU+HT group was higher than those of the HT group and the control group [(1.02±0.18) mm vs.(0.85±0.19) mm vs. (0.60±0.11) mm], with a statistically significant difference (F=68.95, P<0.05). Partial correlation analysis showed that SUA level was positively correlated with CIMT level in the HU+HT group (r=0.42, P<0.05). Multiple linear regression analysis showed that SUA level was an independent risk factor for CIMT in hypertensive patients (P<0.05). Conclusions　The thickening of CIMT is significant in patients with hypertension combined with hyperuricemia, and the SUA level in patients with hypertension is closely related to CIMT. When patients with hypertension are combined with hyperuricemia, the course of cardiovascular diseases such as atherosclerosis is further aggravated.

Analysis of the reasons for the inconsistency between carotid vascular ultrasound and computed tomography angiography in the diagnosis of carotid artery stenosis

Hong Xiaofang, Hu Yujuan, Yang Pengfeng, Zhou Qiongjuan, Shen Hongyuan, Song Siyi, Song Chujun, Liang Weixiang, Liu Tao

2024, 30(8):  1334-1338.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.022

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Objective　To analyze and explore the reasons for the inconsistency between carotid vascular ultrasound and computed tomography angiography (CTA) in the diagnosis of carotid artery stenosis. Methods　A retrospective analysis was performed on 53 patients who underwent carotid vascular ultrasound and CTA in the Third Affiliated Hospital of Guangzhou Medical University from January 2018 to October 2022. There were 39 males and 14 females, aged (74.70±9.31) years. The internal carotid artery (ICA) and common carotid artery (CCA) blood vessels were recorded under carotid vascular ultrasound and CTA, with a total of 212 blood vessels. Whether the diagnosis results of carotid vascular ultrasound and CTA were consistent, and whether there were differences in the detection rate of stenosis and the degree of stenosis detected between the two test methods were analyzed. Statistical methods used were χ² test and Kappa consistency test. Results　There was a statistically significant difference in the detection rate of carotid artery stenosis between carotid vascular ultrasound and CTA (χ²=33.71, P<0.001). There was no statistically significant difference in the detection of CCA stenosis between the two detection methods (χ²=2.80, P>0.05), but there was a statistically significant difference in the detection of ICA stenosis between the two detection methods (χ²=11.98, P<0.05). There was no statistically significant difference in the detection of severe stenosis and occlusion of CCA between the two detection methods (χ²=0.70, P>0.05), but there was a statistically significant difference in the detection of severe stenosis and occlusion of ICA between the two detection methods (χ²=43.19, P<0.05). Taking CTA as the gold standard, the sensitivity, specificity, misdiagnosis rate, and missed diagnosis rate of carotid artery ultrasound for detecting moderate and severe carotid artery stenosis were 78.79%, 90.50%, 9.50%, and 21.21%, respectively. The accuracy rates of carotid artery ultrasound in the diagnosis of mild stenosis, moderate stenosis, severe stenosis, complete occlusion, and no stenosis of the carotid artery were 1.5%, 46.9%, 78.6%, 80.0%, and 87.5%, respectively. Carotid vascular ultrasound was consistent with CTA in the diagnosis of degree of carotid artery stenosis (Kappa=0.335, P<0.05). Conclusions　As the preferred test for clinical screening of carotid artery stenosis, the degree of carotid artery stenosis diagnosed by carotid vascular ultrasound is consistent with CTA. Ultrasound and CTA are consistent in detecting severe stenosis and occlusion of CCA. In the detection of mild carotid artery stenosis, there is a difference between ultrasound and CTA, mainly reflecting in a lower detection rate of ultrasound for mild stenosis lesions. Therefore, sonographers should strengthen the study of vascular ultrasound guidelines, skillfully adjust the relevant parameters of used instruments, further improve the accuracy of clinical diagnosis, and provide a stronger basis for the diagnosis and treatment for patients with carotid artery stenosis.

Correlations between macular sensitivity and fixation stability in anisometropic amblyopia  children and best corrected visual acuity 

Wang Yaming, Zhao Wen, Tang Kai

2024, 30(8):  1339-1343.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.023

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Objective　To explore the correlations between macular sensitivity, fixation stability, and best corrected visual acuity (BCVA) in children with anisometropic amblyopia. Methods　A total of 184 children with anisometropic amblyopia who were treated in Huangdao District Traditional Chinese Medicine Hospital from January 2022 to February 2023 were selected, including 184 amblyopic eyes and 184 contralateral eyes, as the research subjects. Among them, there were 94 boys and 90 girls, aged 4-12 (8.10±1.72) years. The BCVA, macular sensitivity, and fixation stability parameters, as well as differences in the thickness of the nerve fiber layer around the optic disc and the thickness of the macular area were measured for the amblyopic and contralateral eyes. The light sensitivity and fixation stability parameters in the macular area of the amblyopia and contralateral eyes were compared by rank sum test, as well as the BCVA, the average light sensitivity within 10° of the macular area, and the percentage of fixation point within 2° diameter before and after treatment. The thickness of the nerve fiber layer around the optic disc and the thickness of the macular area in the amblyopic and contralateral eyes were compared by t test. The correlation was analyzed using Spearman rank correlation analysis. Results　The BCVA of the amblyopic eyes was higher than that of the contralateral eyes [0.5 (0.4, 0.6) LogMAR vs. 0.1 (0, 0.2) LogMAR], with a statistically significant difference (Z=-4.454, P<0.05). The average light sensitivity within 10° of the macular area and the percentage of fixation point within 2° diameter of the amblyopic eyes were 25.40 (23.10, 28.00) dB and 49.98 (42.30, 61.10)%, respectively, which were lower than that of the contralateral eyes [28.40 (26.10, 29.60) dB and 70.40 (58.29, 77.50)%], with statistically significant differences (Z=-4.463 and -3.182, both P<0.05). The parameters of light sensitivity and fixation stability in the macular area of amblyopia, the thickness of the nerve fiber layer around the optic disc, and the thickness of the macular area were not correlated with BCVA (all P>0.05). The thickness of the lower macular area was positively correlated with the thickness of the nerve fiber layer around the lower optic disc (r=0.443, P<0.05), and the thickness of the nasal macular area was positively correlated with the thickness of the nerve fiber layer around the nasal optic disc (r=0.401, P<0.05). After treatment, the BCVA, the average light sensitivity within 10° of the macular area, and the percentage of fixation point within 2° diameter of the amblyopic eyes were 0.3 (0.1, 0.5) LogMAR, 27.65 (25.51, 28.93) dB, and 62.50 (51.54, 70.02)%, respectively, which were better than those before treatment [0.5 (0.4, 0.6) LogMAR, 25.40 (23.10, 28.00) dB, and 49.98 (42.30, 61.10)%], with statistically significant differences (Z=-2.932, -3.332, and -2.993, all P<0.05). Conclusion　Children with anisometropic amblyopia have a decrease in macular sensitivity and fixation stability within the 2° range, there is a correlation between the thickness of the macular area and the thickness of the nerve fiber layer around the optic disc, which deserves further research.

Value of combined Graf and Harcke methods in early diagnosis of DDH 

Chen Meng, Huo Yaling, Zheng Bin, Zuo Bianjing, Wang Dan

2024, 30(8):  1344-1347.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.024

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Objective　To evaluate the clinical value of combined Graf and Harcke ultrasonography in early diagnosis and therapeutic effect evaluation of infant developmental dysplasia of the hip (DDH). Methods　The clinical data of 120 children (240 hips) with high risk of DDH within 6 month-old of age in Children's Hospital Affiliated to Zhengzhou University from January 2017 to February 2023 were collected. There were 54 boys and 66 girls, aged 1 to 6 (2.53±0.68) months. Graf and Harcke methods were used to evaluate the development and stability of hip joint. X-ray reexamination was performed for the treated children after 1 year-old of age, and the DDH treatment effect was evaluated by the International Hip Dysplasia Institute (IHDI) classification. Results　A total of 24 hip joints (10.00%, 24/240) were found to be suspicious abnormal in the first ultrasound examination, and all of them returned to normal after 4 - 6 weeks. There were 76 abnormal hips [31.67% (76/240)], among which 12 hips were "unstable" with Graf Ⅰ type and 4 hips with Graf Ⅱa type. After 4 - 6 weeks, 14 cases returned to normal but 2 cases turned to Graf Ⅱb type and received surgical treatment. There were 43 hip joints with dysplasia and 17 hip joints with dislocation, which were treated with surgical intervention. All the treated 62 hips after 1 year-old of age turned to IHDI Ⅰ type by X-ray review, with a acetabular index of (25±2)°. Conclusion　The combined application of Graf and Harcke techniques to observe hip joint from static and dynamic angles, respectively, has high clinical value in screening DDH and evaluating the therapeutic effect.

Relationship between increased D-dimer level and secondary persistent pulmonary hypertension of the newborn

Bai Bo, Chen Bo, Li Guanghong, Luo Huiling, Huang Xueliang, Li Fei

2024, 30(8):  1348-1352.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.025

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Objective　To explore the relationship between increased plasma D-dimer level and secondary persistent pulmonary hypertension of the newborn (PPHN). Methods　A total of 100 newborns diagnosed with pulmonary hypertension (PH) who were hospitalized in the neonatal intensive care unit of Huadu District People's Hospital of Guangzhou from June 1, 2020 to May 31, 2023 were selected as the study objects. They were divided into a PPHN group (33 cases) and a PH group (67 cases) based on presence of patent ductus arteriosus (PDA) or atrial septal defect (ASD) or patent foramen ovale (PFO) with right-to-left or bidirectional shunt, or based on whether the ventricular septum was protruded to the left. The plasma D-dimer concentration of all subjects were determined by enzyme-linked immunofluorescence assay. The difference of plasma D-dimer level between the two groups was compared, the relationship between D-dimer level and pulmonary artery systolic blood pressure (PASP) was analyzed, the value of D-dimer level in predicting PPHN was analyzed by receiver operating characteristic curve (ROC), and the related risk factors of PPHN were analyzed by multivariate logistic regression analysis. Independent sample t test, Mann-Whitney U test, χ² test, rank sum test, and Pearson correlation analysis were used. Results　The level of plasma D-dimer in the PPHN group was higher than that in the PH group [5 421.25 (3 311.23, 8 079.45) µg/L vs. 2 799.14 (2 253.28, 3 589.12) µg/L], with a statistically significant difference (Z=4.667, P<0.001). The D-dimer level was positively correlated with PASP (r=0.671, P<0.001). The area under the curve for predicting PPHN with D-dimer level was 0.788 (P<0.001). When the maximum Youden index was 0.518, the cut-off value of D-dimer level was 3 770.265 µg/L, and the sensitivity and specificity for predicting PPHN occurrence were 0.727 and 0.791. Multivariate logistic regression analysis showed that plasma D-dimer level >3 770 µg/L, acidosis (pH <7.2), HCO₃^- ≤18 mmol/L, and blood lactic acid >3 mmol/L were independent risk factors for PPHN (all P<0.05). Conclusion　The abnormal increase of D-dimer level may be an important factor that causes or promotes secondary PPHN.

Analysis of factors influencing the efficacy of subcutaneous immunotherapy for children with mite-driven allergic asthma

Wu Yao, Lyu Xiang

2024, 30(8):  1353-1357.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.026

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Objective　To analyze the factors influencing the efficacy of subcutaneous immunotherapy (SCIT) for children with mite-driven allergic asthma.Methods　The clinical data of 42 children with mite-driven allergic asthma who received standardized SCIT for more than 1 year in the pediatric respiratory specialist clinic of Affiliated Hospital of Yangzhou University from July 2018 to May 2022 were retrospectively analyzed. According to the daily dose of inhaled corticosteroids (ICS) 12 months after treatment, they were divided into a ICS discontinuation group [fluticasone propionate (FP) =0 µg] and a ICS maintenance group (FP >0 µg). In the ICS discontinuation group, there were 14 boys and 1 girl, aged (8.7±2.9) years. In the ICS maintenance group, there were 20 girls and 7 girls, aged (9.7±2.2) years. The changes of ICS daily dose and therapeutic effect before and after standardized SCIT were compared between the two groups at the beginning of treatment and 6 months and 12 months after treatment, and the related factors affecting the efficacy of SCIT were discussed. Independent sample t test, Z test, χ² test, and multiple logistic regression analysis were used. Results　After 12 months of treatment, 15 (35.7%) of the 42 children were able to withdraw from ICS use (ICS discontinuation group) and the remaining 27 (64.3%) children needed only a low dose of FP to maintain the asthma symptom control (ICS maintenance group). Six and 12 months after treatment, the daily doses of FP in the ICS discontinuation group and the ICS maintenance group decreased compared with those at the initial treatment (all P<0.05), and there were statistically significant differences between the ICS discontinuation group and the ICS maintenance group at the same treatment time point [50 (0, 100) µg vs. 100 (75, 100) µg, 0 (0, 0) µg vs. 50 (50, 100) µg] (Z=-3.54 and -5.51, both P<0.001). The proportions of overweight, allergic rhinitis, living with smoking members, and multiple allergies in the ICS maintenance group were higher than those in the ICS discontinuation group (all P<0.05). Logistic regression analysis showed that living with smoking members (OR=6.179, 95%CI 1.029-37.118, P=0.047) and multiple allergies (OR=7.772, 95%CI 1.077-56.085, P=0.042) were independent risk factors for non-complete withdrawal of ICS after 12 months of treatment. Conclusions　SCIT can significantly reduce the daily dose of glucocorticoids in children with allergic asthma while ensuring the control of asthma symptoms. Children living with smoking members and children with multiple allergies are at higher risk of continuing glucocorticoids.

Clinical Research

Association between lipoprotein-associated phospholipase A2 gene polymorphism and the risk of hypertensive large artery atherosclerotic stroke

Dou Feng, Li Dandan, Zhang Qiuyan

2024, 30(8):  1358-1362.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.027

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Objective　To explore the relationship between lipoprotein-associated phospholipase A2 (Lp-PLA2) gene polymorphism and the risk of hypertensive large artery atherosclerotic stroke (LAAS), in order to identify the genetic susceptibilities and new therapeutic targets. Methods　A prospective study was conducted on 106 hypertensive patients hospitalized for LAAS at the Department of Neurology, Yulin Xingyuan Hospital from January 2020 to January 2023, forming the case group. A control group of 160 hypertensive patients, matching in the general data, was selected from the physical examination center. The control group included 80 males and 80 females, with an age of (74.72±6.60) years old, and the case group included 53 males and 53 females, with an age of (75.07±7.13) years old. The gene polymorphism of Lp-PLA2 was examined, and its association with the risk of hypertensive LAAS was analyzed using logistic regression analysis. Independent sample t test and χ² test were used. Results　There was a statistically significant difference in the frequency of R92H site RR, RH, and HH genotype between the case group and the control group [66.04% (70/106) vs. 10.00% (16/160), 16.98% (18/106) vs. 45.00% (72/160), 16.98% (18/106) vs. 45.00% (72/160)] (χ²=91.516, P<0.001). There was a statistically significant difference in the frequency of R and H alleles between the case group and the control group [74.53% (158/212) vs. 32.50% (104/320), 25.47% (54/212) vs. 67.50% (216/320)] (χ²=90.119, P<0.001). Logistic regression analysis showed that R92H (RR) genotype was a risk factor for hypertensive LAAS (OR=38.212, 95%CI 9.959-146.616, P<0.001). Conclusion　The R92H site mutation in the Lp-PLA2 gene is an important genetic risk factor for hypertensive patients developing LAAS, playing a key role in the progression of the disease.

Application of balloon dilatation-guided placement difficult Y-style silicone stent in the treatment of malignant complex tracheal stenosis 

Zhou Jinhua, Liu Huan, Ma Huiping, Miao Jianlong, Yuan Luna, Bian Cuixia

2024, 30(8):  1362-1365.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.028

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Objective　To investigate the efficacy and safety of balloon dilatation-guided placement difficult Y-style silicone stent in the treatment of malignant complex tracheal stenosis. Methods　This was an observational study. A retrospective study was conducted on 6 patients diagnosed with severe tracheal stenosis who failed to undergo conventional silicone stent implantation in the Respiratory Intervention Diagnosis and Treatment Center of Jining No.1 People's Hospital from August 2021 to March 2022. There were 4 males and 2 females, aged (62±7) years. There were 3 cases of unilateral bronchial stenosis with protrusion widening, and 3 cases of bilateral main bronchial stenosis with protrusion widening. Four patients had pulmonary malignancies and two patients had esophageal cancer invading the airway. In the process of Y-style silicone stent implantation for malignant complex airway stenosis, 6 patients with difficult stent implantation were treated with balloon dilatation-guided technique. The indicators of successful Y-style silicone stent placement and intraoperative and postoperative complications were observed. Results　The Y-style silicone stents were successfully placed in all 6 patients, and there were no intraoperative or postoperative complications. There were no operation-related deaths. After operation, the patients' tracheal stenosis was relieved, the dyspnea was significantly relieved, and the grade of dyspnea was improved from grade Ⅲ - Ⅳ to grade 0 - Ⅱ. Conclusion　Balloon dilatation-guided placement difficult Y-style silicone stent in the treatment of malignant complex tracheal stenosis is effective and safe.

Medication Research

Quality study of fresh fruit of Solanum nigrum Linn. formula granules based on standard decoction

Yang Na, Gong Chang, Li Nan, Zhang Sixi

2024, 30(8):  1366-1372.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.029

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Objective　To establish the quality evaluation method of fresh fruit of Solanum nigrum Linn. formula granules based on the quality indexes of standard decoction. Methods　Ten batches of standard decoction and 3 batches of formula granules of fresh fruit of Solanum nigrum Linn. were prepared and the paste rate was calculated. Thin layer chromatography (TLC) was used to identify the specific properties of the formula granules. The contents of solasonine and solamargine in the formula granules were determined by ultra-high performance liquid chromatography (HPLC). The fingerprint of formula granules was established, and 4 characteristic peaks and their relative retention time were determined. Results　The paste rate of standard decoction was (18.21±1.87)%, the paste rate of formula granules ranged from 12.75% to 23.67%, and the paste rates of the three batches of formula granules were 15.90%, 21.26%, and 18.01%, respectively. In the standard decoction, the content of solasonine was (24.54±1.24) mg·g^-1, the content of solamargine was (31.34±1.65) mg·g^-1. In the three batches of formula granules, the contents of solasonine were 19.3 mg·g^-1, 18.5 mg·g^-1, and 20.4 mg·g^-1, and the contents of solamargine were 23.9 mg·g^-1, 22.9 mg·g^-1, and 25.8 mg·g^-1. Four common characteristic peaks were identified, and the relative retention time values of the other three peaks were 1.13, 1.70, and 1.85 with solasonine as the reference peak. Conclusion　This study proved that the quality of formula granules of fresh fruit of Solanum nigrum Linn. was consistent with standard decoction, and provided data support for the formulation of quality standards for the formula granules.

Determination of Phellodendrine and Berberine in different processed products of Cortex Phellodendri by HPLC

Yang Yongle, Hu Zhenyu, ALIYA·Abulaiti , Ye Xide

2024, 30(8):  1372-1377.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.030

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Objective　To determine the content difference between the main components of Phellodendrine and Berberine in different processing methods, and to discuss the effect of processing on the quality of Cortex Phellodendri. Methods　The contents of Phellodendrine and Berberine in different processing methods were determined by high performance liquid chromatography (HPLC). Using Diamonsil C₁₈ (250.0 mm×4.6 mm, 5 µm) as column, acetonitrile-0.1% formic acid as gradient elution, the flow rate was 1.0 ml·min^-1, the column temperature was 25 ℃, and the detection wavelength was 284 nm. Results　Phellodendrine and Berberine were well related linearly within the mass concentration of 0.354-0.760, 3.865-7.530 g·L^-1 (R²>0.999 0). The contents of Phellodendrine and Berberine in different processed products of Cortex Phellodendri were different. The contents of Phellodendrine and Berberine in wine Phellodendri were the highest, which were 1.360 mg·g^-1 and 10.200 mg·g^-1. The order from low to high of Phellodendrine content was as follows: Phellodendri charcoal < raw Phellodendri < salt Phellodendri < wine Phellodendri; the order from low to high of Berberine content was as follows: Phellodendri charcoal < salt Phellodendri < raw Phellodendri < wine Phellodendri. Conclusions　Different processing methods affect the main active components of Phellodendrine and Berberine, and then its pharmacodynamics. The method is simple, scientific, and reasonable, which could be used for further study of Cortex Phellodendri.

Nursing Research

Application of childlike care in postoperative nursing for children with appendicitis

Kou Xiangcao, Li Dandan, Tian Jianjian, Zhao Ran, Luo Leng

2024, 30(8):  1378-1382.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.031

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Objective　To explore the nursing effect of childlike care in children with appendicitis after operation, so as to provide reference for clinical optimization of nursing program. Methods　This study was a randomized controlled trial. A total of 91 children with appendicitis admitted to Henan Children's Hospital from January 2020 to January 2023 were prospectively selected as the research objects and were divided into an observation group and a control group by the random number table method. In the control group, 15 boys and 30 girls, aged (8.56±2.06) years, received routine nursing. In the observation group, 18 boys and 28 girls, aged (9.15±2.22) years, were given childlike care based on the control group; both groups continued to be intervened until the children were discharged from hospital. The clinical indicators (exhaust time, bowel sound recovery time, defecation time, and hospitalization time), emergence agitation and postoperative behavior changes, medical compliance, pain degrees 2 h, 6 h, and 24 h after operation, and incidence of complications were compared between the two groups. χ² test, rank sum test, t test, and Mann-Whitney U test were used. Results　The exhaust time, bowel sound recovery time, defecation time, and hospitalization time in the observation group were shorter than those in the control group [(26.61±3.51) h vs. (28.51±4.21) h, (20.35±5.18) h vs. (22.40±4.25) h, (48.52±3.46) h vs. (51.24±5.10) h, 5.00 (4.00, 6.00) d vs. 6.00 (5.00, 7.00) d], with statistically significant differences (t=2.343, P=0.021; t=2.064, P=0.042; t=2.984, P=0.004; Z=5.121, P<0.001). The Pediatric Anesthesia Emergence Delirium Scale (PAED) score and the incidence of postoperative behavioral changes in the observation group were 13.00 (12.00, 14.00) points and 47.83% (22/46), which were lower than those in the control group [14.00 (13.00, 16.00) points and 73.33% (33/45)], with statistically significant differences (Z=5.341, P<0.001; χ²=6.122, P=0.013). The medical compliance of the observation group was significantly better than that of the control group, with a statistically significant difference (Z=2.038, P=0.042). The pain scores of the observation group 2 h, 6 h, and 24 h after operation were 3.50 (3.00, 5.00) points, 3.00 (2.00, 4.00) points, and 2.00 (1.00, 3.00) points, those of the control group were 5.00 (4.00, 5.00) points, 3.00 (3.00, 4.00) points, and 3.00 (2.00, 4.00) points, and the intergroup, time point, and intergroup and time point interaction tests showed statistically significant differences (χ²=204.912, P<0.001; χ²=6.801, P=0.033; χ²=46.483, P<0.001). There was no statistically significant difference in the incidence of complications between the observation group and the control group [4.35% (2/46) vs. 8.89% (4/45), χ²=0.775, P=0.379]. Conclusion　The implementation of childlike care is helpful to improve the postoperative medical compliance in children with appendicitis, shorten the time of hospitalization and gastrointestinal function recovery, alleviate the restlessness in the recovery period, reduce the postoperative behavior changes, and reduce the pain in children.

Effect of handheld induction electrical stimulation on swallowing function in patients with hypertensive intracerebral hemorrhage

Zhang Aoxue, Bai Xiaofang, Zhao Hehua, Xing Huanmin

2024, 30(8):  1383-1386.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.032

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Objective　To analyze the effect of handheld induction electrical stimulation on swallowing function in patients with hypertensive intracerebral hemorrhage. Methods　This study was a randomized controlled trial. A total of 118 patients with hypertensive cerebral hemorrhage admitted to Zhengzhou Ninth People's Hospital from January 2021 to January 2023 were selected as the study subjects. They were divided into an observation group and a control group using the random number table method, with 59 cases in each group. In the control group, there were 35 males and 24 females, aged (52.13±6.34) years, and the time from onset to treatment was (11.32±1.30) h. In the observation group, there were 33 males and 26 females, aged (51.65±6.20) years, and the time from onset to treatment was (11.44±1.13) h. Both groups were treated with neurotrophic drugs after surgery, the control group was combined with routine rehabilitation training, and the observation group was combined with hand-held induction electrical stimulation. Both groups were treated for 6 weeks. The tongue muscle pressure, Functional Oral Intake Scale (FOIS) score, and Rosenbek Leakage/Aspiration Scale score were compared between the two groups 3 days before treatment and 3 days after treatment. The clinical efficacy within 3 days after treatment and complications during treatment were compared between the two groups. t test and χ² test were used. Results　Three days after treatment, the average and peak tongue pressure of the observation group were higher than those of the control group [(49.85±7.65) kPa vs. (38.95±6.77) kPa, (56.98±5.69) kPa vs. (46.58±4.77) kPa], and the duration of tongue pressure was longer than that of the control group [(18.49±4.23) s vs. (13.56±4.11) s], with statistically significant differences (t=2.549, P=0.016; t=2.292, P=0.036; t=3.376, P=0.001). The FOIS score of the observation group was higher than that of the control group [(5.16±1.72) points vs. (3.54±1.45) points], the Rosenbek Leakage/Aspiration Scale score was lower than that of the control group [(2.34±0.84) points vs. (3.61±0.92) points], the total clinical effective rate was higher than that of the control group [91.53% (54/59) vs. 64.40% (38/59)], and the total incidence of complications was lower than that of the control group [6.78% (4/59) vs. 27.12% (16/59)], with statistically significant differences (t=2.858, P=0.004; t=2.186, P=0.039; χ²=7.355, P=0.019; χ²=11.265, P=0.007). Conclusion　Handheld induction electrical stimulation therapy can improve the tongue muscle pressure and swallowing function in patients with hypertensive intracerebral hemorrhage, reduce the aspiration related complications, and improve the clinical efficacy.

Application of health education based on symptom management strategies in patients with hypertensive cerebral hemorrhage 

Ma Rui, Zhang Yan, Chen Xiaoxiao, Wang Chaogang

2024, 30(8):  1387-1391.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.033

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Objective　To analyze the application effect of health education based on symptom management strategies in patients with hypertensive cerebral hemorrhage. Methods　This study was a randomized controlled trial. A total of 116 patients with hypertensive cerebral hemorrhage in Shangqiu Central Hospital from January 2021 to January 2022 were divided into two groups by the random number table method with 58 cases in each group. In the control group, there were 34 males and 24 females, aged 33-64 (47.13±6.34) years, and the time from onset to treatment was 1-18 (11.32±1.30) h. In the observation group, there were 32 males and 26 females, aged 31-65 (46.65±6.20) years, and the time from onset to treatment was 1-19 (11.44±1.13) h. The control group was given routine clinical intervention, and the observation group was given health education intervention based on symptom management strategies for a total of 6 months. The negative emotion scores, psychological resilience scores, health-related behavior scores, and hope level scores 3 days before intervention and within 3 days after intervention and symptom distress level within 3 days after intervention were compared between the two groups. Independent sample t test, χ² test, and rank sum test were used. Results　After intervention, the scores of Self-rating Anxiety Scale (SAS) [(36.45±4.41) points] and Self-rating Depression Scale (SDS) [(35.78±3.98) points] of the observation group were lower than those of the control group [(46.38±5.12) points and (49.38±1.69) points] (both P<0.05). After intervention, the scores of toughness [(44.16±5.56) points], self-reliance [(26.85±4.23) points], and optimism [(13.64±1.31) points] and total score of psychological resilience [(84.65±10.21) points] of the observation group were higher than those of the control group [(39.25±5.32) points, (23.52±4.16) points, (11.05±1.24) points, and (73.82±9.45) points] (all P<0.05). After intervention, the scores of emotional control [(8.45±0.94) points], medication adherence [(12.65±1.34) points], dietary management [(16.32±2.45) points], exercise management [(16.06±2.41) points], and self-monitoring [(9.55±0.75) points] and total score of health-related behaviors of the observation group [(63.03±7.12) points] were higher than those of the control group [(7.21±1.12) points, (9.34±1.52) points, (13.74±1.56) points, (14.49±2.12) points, (7.36±1.25) points, and (52.14±7.25) points] (all P<0.05). After intervention, the scores of positive attitudes [(11.89±2.15) points], positive actions [(11.74±2.46) points], and intimate relationships [(12.47±2.42) points] and total score of hope level of the observation group [(35.71±4.14) points] were higher than those of the control group [(9.45±3.07) points, (10.08±2.54) points, (10.84±3.26) points, and (32.65±4.28) points] (all P<0.05). Conclusion　Health education intervention based on symptom management strategies can improve the negative emotions of hypertensive intracerebral hemorrhage patients, enhance their psychological resilience, improve the health related behaviors and hope level, and alleviate the symptoms.

Analysis of the mesomeric effect of resilience between self-management ability and quality of life in patients with cervical spondylosis

Yin Xia, Meng Dongfang, Yuan Dong, Li Qian, Wang Zhe

2024, 30(8):  1392-1397.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.034

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Objective　To analyze the mesomeric effect of resilience between self-management ability and quality of life in patients with cervical spondylosis. Methods　A prospective controll and cohort study was conducted. A total of 202 patients with cervical spondylosis (observation group) and 202 healthy individuals (control group) were selected from the First Affiliated Hospital of Henan University of Chinese Medicine from January 2022 to July 2023. There were 105 males and 97 females in the observation group, aged 22-78 (40.50±8.52) years. There were 103 males and 99 females in the control group, aged 27-79 (40.24±5.88) years. The self-management abilities, psychological resilience, and qualities of life of the two groups were evaluated and compared by the Adult Health Self-Management Skill Rating Scale III (AHSMSRS III), Connor-Davidson Resilience Scale (CD-RISC), and 36-item Short-Form (SF-36). The correlations between psychological resilience and self-management ability and quality of life, and the correlation between self-management ability and quality of life in the observation group were analyzed. Mplus 8.3 software was used to analyze the mesomeric effect of resilience between self-management ability and quality of life in the observation group, which was verified by Bootstrap method. Independent sample t test, χ² test, and Pearson correlation analysis were used. Results　In the observation group, there were 7 cases of invalid questionnaires and 3 cases of poor compliance, and there were 9 cases of invalid questionnaires and 2 cases of poor compliance in the control group, all of whom fell off. The scores of self-management behaviors, self-management cognition, self-management environment, self-management ability, strength, resilience, optimism, psychological resilience, physical health, mental health, and quality of life in the observation were (33.48±5.12) points, (30.52±4.89) points, (20.76±3.73) points, (84.76±7.36) points, (11.07±2.05) points, (32.25±4.88) points, (22.18±3.75) points, (65.50±6.59) points, (54.36±6.48) points, (43.74±5.75) points, and (98.10±8.57) points, respectively, which were lower than those in the control group [(50.25±6.27) points, (51.09±6.73) points, (38.27±5.18) points, (139.61±10.35) points, (15.48±4.10) points, (48.09±5.92) points, (33.12±4.38) points, (96.69±8.75) points, (71.69±8.69) points, (58.40±7.24) points, and (130.09±11.89) points], with statistically significant differences (t=22.532, 24.867, 28.259, 43.406, 9.478, 21.675, 18.192, 28.357, 15.626, 16.024, and 22.148, all P<0.001). There were positive correlations between each two scores mentioned above in the observation group (all P<0.05). According to the linear regression analysis, the self-management ability in the observation group could affect psychological resilience and quality of life (P<0.05), and psychological resilience had a partial mesomeric effect between self-management ability and quality of life in the observation group (P<0.05). The mesomeric effect structural equation model constructed and Bootstrap method both confirmed that resilience played a mesomeric effect between self-management ability and quality of life in the observation group (P<0.05), the direct effect of self-management ability on quality of life was 0.66, and the indirect effect of psychological resilience on quality of life was 0.24, with a total effect of 0.90. The indirect effect accounted for 26.67% of the total effect. Conclusions　Patients with cervical spondylosis have low self-management ability, resilience, and quality of life. Self-management ability is directly related to quality of life, and resilience plays a mesomeric effect between the two.

Influence of micro-customary pulmonary rehabilitation nursing on rehabilitation compliance and therapeutic effect in patients with chronic obstructive pulmonary disease

Huang Ping, Chen Wenli, Zeng Qiuxuan, He Wei

2024, 30(8):  1398-1402.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.035

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Objective　To explore the effect of micro-customary pulmonary rehabilitation nursing on the rehabilitation compliance and therapeutic effect in patients with chronic obstructive pulmonary disease (COPD). Methods　This study was a randomized controlled trial. A total of 86 patients with COPD treated in the Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University from March 2021 to July 2022 were selected and were divided into a control group and an experimental group according to the random number table method, with 43 cases in each group. In the control group, there were 16 males and 27 females, aged (62.02±11.80) years. There were 18 males and 25 females in the experimental group, aged (65.79±9.82) years. The control group adopted the pulmonary rehabilitation nursing mode, which was led by the pulmonary rehabilitation nurses, centered on airway clearance, assisted by breathing and exercise training, and accompanied by full health education. On this basis, the experimental group established and applied micro-customary pulmonary rehabilitation nursing. The compliance and effect of rehabilitation were compared between the two groups. χ² test and independent sample t test were used. Results　The compliance of the control group was (68.4±23.0)%, and that of the experimental group was (94.8±5.4)%, with a statistically significant difference between the two groups (t=7.195, P<0.005). After 3 months of intervention, the 6-min walking distance of the experimental group was (468.2±102.0) m, the peak expiratory flow accounted for (67.5±20.5)% of the predicted value, and the forced expiratory volume in the first second accounted for (66.6±15.0)% of the predicted value, which were higher than (414.9±107.2) m, (51.8±19.8)%, and (56.3±17.4)% of the control group, with statistically significant differences (t=2.860, P=0.007; t=4.758, P<0.001; t=3.871, P<0.001). Conclusion　Micro-customary pulmonary rehabilitation nursing can improve the compliance and effect of COPD patients, which is worthy of clinical recommendation.

Study on the application of five-animal exercises combined with respiratory muscle exercise in stable COPD patients

Chen Lihua, Bai Hefang, Bai Li

2024, 30(8):  1403-1407.  DOI: 10.3760/cma.j.issn.1007-1245.2024.08.036

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Objective　To investigate the effects of five-animal exercises combined with respiratory muscle exercise on the degree of dyspnea and lung function in patients with stable chronic obstructive pulmonary disease (COPD). Methods　A prospective analysis was conducted on 86 stable COPD patients admitted to Zhumadian Hospital of Traditional Chinese Medicine from October 2020 to October 2022. They were divided into two groups by the random number table method, with 43 patients in each group. The control group included 23 males and 20 females, aged (70.31±3.54) years. The observation group included 25 males and 18 females, aged (70.25±3.61) years. The control group underwent respiratory muscle exercise, and on the basis, the observation group was trained in combination with five-animal exercises for 3 months. The degree of dyspnea, lung function, blood gas indicators, exercise endurance, and quality of life were compared between the two groups. χ² test, t test, and rank sum test were used. Results　There were no statistically significant differences in the degree of dyspnea, lung function, blood gas indicators, exercise endurance, and quality of life between the two groups before intervention (all P>0.05). After intervention, there was a statistically significant differences in the classification of the modified British Medical Research Council Dyspnea Scale (mMRC) between the two groups (Z=2.131, P=0.033). The forced expiratory volume in the first second (FEV₁), forced vital capacity (FVC), and FEV₁/FVC in the observation group were (3.11±0.17) L, (3.33±0.36) L, and (93.39±5.86)%, which were higher than (2.04±0.15) L, (2.26±0.24) L, and (90.27±5.11)% in the control group, with statistically significant differences (t=30.948, P<0.001; t=16.217, P<0.001; t=2.631, P=0.010). The pulse oxygen saturation and arterial partial pressure of oxygen of the observation group were (91.93±5.73)% and (82.83±7.14) mmHg (1 mmHg= 0.133 kPa), which were higher than those of the control group [(86.84±5.09) % and (70.74±6.77) mmHg]; the arterial partial pressure of carbon dioxide was lower than that of the control group [(44.15±4.03) mmHg vs. (47.44±4.31) mmHg], with statistically significant differences (t=4.355, P<0.001; t=8.057, P<0.001; t=3.656, P<0.001). There was a statistically significant difference in the 6-min walking distance between the observation group and the control group [(438.69±26.73) m vs. (422.86±25.26) m] (t=2.823, P=0.006). The symptom, activity, and disease impact scores of the St. George's Respiratory Questionnaire (SGRQ) in the observation group were (43.76±3.60) points, (42.52±3.72) points, and (41.06±3.17) points, which were lower than those in the control group [(52.07±4.19) points, (53.08±4.13) points, and (50.15±3.73) points], with statistically significant differences (t=9.864, P<0.001; t=12.458, P<0.001; t=12.177, P<0.001). Conclusion　The combination of five-animal exercises and respiratory muscle exercise can alleviate the degree of dyspnea in stable COPD patients, regulate the blood gas indicators, and improve the exercise endurance, lung function, and quality of life.