Table of Content

01 May 2024, Volume 30 Issue 9

Previous Issue   

Column of Digestive Tract Diseases

Research progress on treatment for patients with slow transit constipation based on interstitial cells of Cajal

Xiao Zhengping, Li Baosong, Zhang Zhirui, Jiang Hong

2024, 30(9):  1409-1414.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.001

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Slow transit constipation (STC) is a common type of functional constipation characterized by slowed colonic motility and delayed intestinal transit, and often accompanies by symptoms such as infrequent bowel movements and difficulty in defecation. Studies indicate that the development of STC is related to abnormal changes in interstitial cells of Cajal (ICCs). This article summarizes the classification, markers, and functions of ICCs, as well as their relationship with STC, highlighting that abnormalities in the quantity and function of ICCs can influence the symptoms of patients with STC. Additionally, the article reviews various treatment strategies for patients with STC, such as the use of microbiota preparations, traditional Chinese medicine, physical therapy, and molecular treatments, and their potential impacts on ICCs, providing new treatment insights for patients with STC. The authors suggest that ICCs can serve as potential therapeutic targets for STC; future research should focus on the role of ICCs in the pathogenesis of STC, develop specific therapeutic approaches, and assess the feasibility of clinical applications of emerging strategies, such as stem cell therapy and gene therapy, so as to offer new treatment options for patients with STC.

Research progress on ulcerative colitis in traditional Chinese and western medicines

Zeng Xianhu, Li Ming, Li Zilong, Xiang Xu, Tian Hui, Li Huizhu, Ma Longjie, Fang Xiaoli, Chen Li, Tang Ran

2024, 30(9):  1415-1418.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.002

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Ulcerative colitis is a non-specific intestinal inflammatory disease that mainly affects the rectum and colon, typically characterized by chronic, persistent, and recurrent symptoms. The lesion is limited to the mucosal layer or muscular layer, mainly characterized by ulcers, and may be accompanied by varying degrees of intestinal wall congestion, edema, and bleeding. The patients' clinical symptoms include intermittent diarrhea, feces with mucus and pus, abdominal pain, and urgency. This disease is difficult to cure, has a high recurrence rate, and a high cancer transformation rate, and is closely related to the incidence of colon cancer. Western medicine medication often uses mesalazine enteric coated tablets, glucocorticoids, immunosuppressants, etc. Generally, treatments, such as rest and nutritional support, are used. For patients who meet surgical indications, total colectomy and ileal pouch anal anastomosis can be used. With the continuous development of traditional Chinese medicine surgery, the internal and external treatment methods of traditional Chinese medicine have unique advantages and good therapeutic effects in the classification and treatment of ulcerative colitis. This article summarizes the clinical diagnosis, treatment, and research status of ulcerative colitis in recent years.

New progress in treatment of intestinal bacterial overgrowth

Gao Wenwen, Zhang Xiang, Wang Hong, Yin Yanhui

2024, 30(9):  1418-1421.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.003

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Small intestinal bacterial overgrowth (SIBO) is defined as an increase in the bacterial content of the small intestine above the normal value and is associated with various diseases, such as irritable bowel syndrome, inflammatory diseases, etc. The treatment for SIBO is still controversial. Therefore, this article reviews treatments for SIBO, including antibiotic, probiotics, prokinetic, herbal therapy, dietary therapies, and other treatments.

Clinical experience of professor Li Shijie in treating patients with diarrhea after colorectal cancer surgery with traditional Chinese medicine

Liu Huan, Liao Tingting, Zhang Zhengwei, Li Shijie

2024, 30(9):  1422-1425.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.004

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Colorectal cancer is one of the common malignant tumors in digestive tract, and diarrhea is one of the postoperative complications of colorectal cancer. Professor Li Shijie has engaged in the treatment of malignant tumors by combining traditional Chinese and western medicines for long, and especially has unique insight into the treatment of malignant tumors and their complications by traditional Chinese medicine. In this paper, Li's clinical experience on the treatment of postoperative diarrhea of colorectal cancer with traditional Chinese medicine is described. Starting from the general laws of cancer occurrence and development and based on the basic theory of the disease caused by the deficiency of genuine qi and excess of pathogenic factors, he summarized that the basic pathogenesis of postoperative diarrhea of colorectal cancer is the deficiency of spleen qi, and the deficiency of spleen qi with excessive dampness is the important factor of postoperative diarrhea of colorectal cancer. In addition, he also proposed that the treatment of postoperative diarrhea of colorectal cancer should follow the principles: combining the symptoms and evidences, reinforcing health qi and removing pathogenic factors, benefiting qi and strengthening spleen as the cornerstone, treating in stages, and selecting prescriptions based on evidences.

Relationship between putrescine and macrophage polarization in gastric "inflammatory carcinoma transformation"

Sun Xiao, Liu Chengxia, Wang Na, Hao Jiahui, Chu Linlin, Li Chengyu

2024, 30(9):  1426-1429.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.005

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It gradually develops from superficial gastritis to gastric cancer, and this sequential process is called Correa cascade. In the Correa cascade, the involvement of macrophages was found both in the inflammatory microenvironment at the inflammatory stage and in the tumor microenvironment where tumor cells are located. Polyamines, especially putreamine, are also closely related to the occurrence and development of gastric cancer, and the metabolism of polyamines can affect the polarization of macrophages. In recent years, the relationship between putrescine and gastric "inflammation and cancer transformation" and the intervention of the occurrence and development of cancer by regulating the polarization of macrophages have become research hotspots. This article reviews the related researches on gastric cancer, putrescine, and macrophage polarization in recent years, and discusses the relationship between putrescine and macrophage polarization in the process of gastric "inflammation and cancer transformation". Subsequent studies are expected to achieve the purpose of preventing or delaying the occurrence and development of gastric cancer by regulating putrescine metabolism and macrophage polarization.

Efficacy of pembrolizumab combined with albumin-bound paclitaxel and capecitabine in treatment of patients with advanced gastric cancer

Wang Wenbin, Guo Xiaohua, Zheng Zhaohua, Guo Man, Sun Li

2024, 30(9):  1430-1434.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.006

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Objective　To explore the efficacy of pembrolizumab combined with albumin-bound paclitaxel in the treatment of patients with advanced gastric cancer. Methods　From October 2019 to October 2022, 122 patients with advanced gastric cancer treated at Hong hui Hospital, Xi'an Jiaotong University were selected for the randomized controlled trial, and were divided into an observation group and a control group by the random number table method, with 61 cases in each group. There were 47 males and 14 females in the observation group who were (63.14±5.65) years old. There were 48 males and 13 females in the control group who were (62.45±5.47) years old. The control group were treated with the capecitabine regimen and albumin-bound paclitaxel; in addition, the observation group took pembrolizumab. The clinical efficacies, serum levels of tumor markers [carbohydrate antigen-724 (CA-724), carbohydrate antigen-199 (CA-199), vascular endothelial growth factor (VEGF), and tumor necrosis factor-α (TNF-α)] before and after the treatment, and adverse reactions were compared between the groups using t and χ² tests. Results　The total effective rate in the observation group was higher than that in the control group [68.85% (42/61) vs. 47.54% (29/61)], with a statistical difference (χ²=5.509, P=0.019). Before the treatment, there were no statistical differences in the levels of CA-724, CA-199, VEGF, and TNF-α between the two groups (all P>0.05). After the treatment, the levels of CA-724, CA-199, VEGF, and TNF-α in the observation group were lower than those in the control group [(17.56±2.22) μg/L vs. (22.53±2.49) μg/L, (21.56±3.21) U/ml vs. (27.52±3.44) U/ml, (271.64±21.22) ng/L vs. (281.33±24.15) ng/L, and (15.08±2.53) μg/L vs. (19.54±3.68) μg/L], with statistical differences (t=11.636, 9.893, 2.354, and 7.800; all P<0.05). The incidence of grade Ⅲ-Ⅳ thrombocytopenia in the observation group was lower than that in the control group [4.92% (3/61) vs. 18.03% (11/61)], with a statistical difference (χ²=5.164, P=0.023). There were no statistical differences in the incidences of neutropenia, diarrhea, and hypothyroidism between the two groups (all P>0.05). After one-year follow-up, the survival rate in the observation group was higher than that in the control group [95.08% (58/61) vs. 83.61% (51/61)] (χ²=4.218, P=0.039). Conclusion　The combination of pembrolizumab and albumin-bound paclitaxel for patients with advanced gastric cancer is effective, and can significantly reduce their levels of serum tumor markers.

Standardized nutrition therapy for patients with esophageal cancer during perioperative period 

Yu Siyan, Gao Ling, Xu Peng, Huang Yufang

2024, 30(9):  1434-1439.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.007

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Patients with esophageal cancer are at high risk of malnutrition. Nutritional therapy is of great significance in improving the surgical tolerance, clinical outcomes, and quality of life of patients undergoing surgery for esophageal cancer. Standardized nutritional therapy can benefit patients with esophageal cancer during perioperative period as early as possible. This review summarizes the status quo of perioperative nutritional therapy for patients with esophageal cancer, the importance of standardized nutritional therapy, and its contents. And we also analyze the potential causes and solutions of unreasonable application of nutritional therapy. The paper aims at improving the understanding of medical staff and clinical application of standardized nutritional therapy in patients with esophageal cancer during perioperative period, so as to promote the patients' postoperative recovery and improve their quality of life.

Literature Analysis

Visual analysis of research hotspots and trends of cirrhosis sarcopenia based on Web of Science

Wang He, Huang Haiqun, Zi Qinglan

2024, 30(9):  1440-1445.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.008

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Objective　To explore the research status, hotspots, and trends of cirrhosis sarcopenia, and to provide references for promoting the research of cirrhosis sarcopenia in China. Methods　The literatures retrieved from the Web of Science (WoS) TM core collection database from January 1, 2013 to September 2, 2023 and cited references were exported in the plain text format. The CiteSpace software was used to analyze the information of the research literatures on cirrhosis sarcopenia. Results　A total of 834 articles were included, and the number of articles on cirrhosis sarcopenia increased year by year in the past ten years. The United States and Japan were the core contributors to the literature, with not much cooperation between countries but closer cooperation between institutions. The main research hotspots on cirrhosis sarcopenia include the mechanism and treatment of sarcopenia, risk factors and effects, clinical studies on the relationship between sarcopenia and comorbidities such as liver cancer and hepatic encephalopathy, nutritional status, function, quality of life, etc. Conclusion　The research on sarcopenia in patients with cirrhosis is the developing trend in recent years, but there is still a lot of blank information. It lacks researches on sarcopenia in patients with cirrhosis in China. In the future, we can learn from foreign research experiences, pay attention to international cooperation, and strengthen in-depth researches on various aspects of sarcopenia in patients with cirrhosis.

New Medical Advances

Progress in treatment of primiparae with postpartum lactation deficiency

Li Chun, Du Qiaoting, Liu Lingling

2024, 30(9):  1446-1449.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.009

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In recent years, with the improvement of people's living standards, the change of women's social status, the increase of cesarean section rate, and other factors, postpartum lack of milk is more and more common, and the lack of milk in primiparae is more serious. If this problem is not solved in time, it will seriously affect the infants' long-term growth and development. Therefore, by referring to relevant literatures, this study summarizes the causes and pathogenesis of traditional Chinese and western medicine related to postpartum lack of milk in primiparae and related treatment of traditional Chinese and western medicine. It has certain reference value for the follow-up research on primiparae with postpartum lactation deficiency.

Research progress of traditional Chinese patent medicine related liver injury

He Xiangqin, Yang Fang, Ding Guofeng

2024, 30(9):  1450-1453.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.010

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Drug-induced liver injury refers to liver damage caused by chemicals, biological products, and traditional Chinese medicine and its preparations, and is one of the common adverse drug reactions in clinical practice. In recent years, the clinical reports of traditional Chinese patent medicine containing Polygoni Multiflori Radix, Psoralea corylifolia Linn, and Epimedium brevicornu Maxim causing liver injury have gradually increased. The researches on the causes and mechanisms of liver injury caused by them have received extensive attention and made some progress. This article mainly reviews the causes and pathogenesis of traditional Chinese patent medicine related liver injury containing such components.

Treatises

Expression and significance of miR-150-5p and miR-135b in patients with diabetes nephropathy

Ma Lijun, Liu Zhanjun, Han Jiming

2024, 30(9):  1454-1459.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.011

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Objective　To investigate the relationship of the levels of miR-150-5p and miR-135b in peripheral blood with urinary albumin excretion rate (UAER) and prognosis in patients with diabetic nephropathy (DN). Methods　The prospective research method was used. Eighty-five patients with DN admitted to Hospital Affiliated to Yan'an University from January 2019 to October 2021 were selected as a DN group, including 46 men and 39 women; they were (46.28±4.41) years old; their duration of type 2 diabetes (T2DM) was (7.24±2.31) years. Seventy-six patients with T2DM were selected as a T2DM group, including 40 men and 36 women; they were (44.95 ± 6.13) years old; their duration of T2DM was (6.98±3.28) years. Eighty healthy people were selected as a control group, including 43 men and 37 women; they were (45.74±5.68) years old. The clinical data and levels of miR-150-5p and miR-135b in peripheral blood of the 3 groups were collected. The correlation of each indicator with UAER was analyzed by the Spearman analysis. The receiver operating characteristic curves (ROC) were drawn and the areas under the curves (AUC) were calculated to analyze the predictive efficacy of each indicator for the prognosis. Relative risk (RR) and 95% confidence interval (CI) were used to analyze the impact of each indicator on prognosis. Results　The levels of peripheral blood miR-150-5p and miR-135b in the DN group were both higher than those in the T2DM group, which were higher than those in the control group [(3.36±0.68) vs. (1.03±0.62) vs. (0.78±0.21) and (3.96±0.51) vs. (1.24±0.48) vs. (0.66±0.12)], with statistical differences (F=560.11 and 1 519.26, both P<0.05). The levels of peripheral blood miR-150-5p and miR-135b in the patients with UAER>300 mg/24 h were both higher than those in the patients with UAER 30-300 mg/24 h, which were higher than those in the patients with UAER<30 mg/24 h [(4.10±0.92) vs. (3.42±0.64) vs. (2.73±0.51) and (5.40±0.87) vs. (3.87±0.61) vs. (3.02±0.49)], with statistical differences (F=23.53 and 78.25; both P<0.05).The levels of peripheral blood miR-150-5p and miR-135b in the DN patients were positively correlated with UREA (r=0.783 and 0.835; both P<0.05). After 12 months' follow-up, 15 patients developed ESRD; the levels of peripheral blood miR-150-5p and miR-135b in the patients with ESRD were higher than those in the patients without ESRD [(4.41±0.55) vs. (3.14±0.38) and (4.67±0.61) vs. (3.81±0.42)], with statistical differences (t=10.67 and 6.53; both P<0.05). The AUC's of peripheral blood miR-150-5p, miR-135b, and their combination in the prediction of ESRD in the DN patients were 0.733, 0.829, and 0.944, respectively. The RR of ESRD in the patients with high levels of peripheral blood miR-150-5p and miR-135b was 3.619 times and 10.889 times higher than that in the patients with low levels, with the 95%CI of 1.105-11.856 and 1.503-78.872, respectively. Conclusions　The levels of miR-150-5p and miR-135b in peripheral blood are positively correlated with UAER in patients with DN. The combined detection can be used as an important auxiliary means to predict ESRD in patients with DN, and provide reliable data support for clinical diagnosis and treatment.

Correlation of serum CTRP 5 level in patients with acute large artery atherosclerotic cerebral infarction 

San Dan, Li Ziru, Yuan Jun

2024, 30(9):  1459-1464.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.012

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Objective　To explore the serum level of tumor necrosis factor-associated protein 5 (CTRP 5) in the course of patients with acute large atherosclerosis (ALAA) type cerebral infarction and its potential associations. Methods　This was a prospective study. One hundred and twelve patients with ALAA cerebral infarction who were hospitalized in Inner Mongolia Autonomous Region People's Hospital from December 2022 to August 2023 were selected as an ALAA cerebral infarction group, including 69 men and 43 women who were (64.25±9.42) years old. Fifty-five control individuals who had intracranial and external intracranial large artery atherosclerosis but no symptoms of cerebral infarction were selected as an LAA non-cerebral infarction group, including 36 men and 19 women who were (66.98±9.78) years old. Forty-one patients with large intracranial artery plaque were selected as a plaque group, including 18 men and 23 women who were (65.10±7.63) years old. Thirty-seven healthy subjects were selected as a normal group, including 18 men and 19 women who were (63.03±10.85) years old. The enzyme-linked immunosorbent assay (ELISA) was used to detect the serum CTRP 5 levels in all the participants. The serum CTRP 5 levels were compared between the ALAA cerebral infarction group and the non-cerebral infarction control groups (including the plaque group and the normal group). t test, nonparametric U test, and χ² test were used. Results　The serum CTRP 5 levels between the normal group and the other 3 groups (the ALAA cerebral infarction group, the LAA non-cerebral infarction group, and the plaque group), between the plaque group and the cerebral infarction group, and between the plaque group and the non-cerebral infarction group were statistically significant (F=5 259.50, 538.00, 5 327.00, 51 466.50, and 5 441.00; all P<0.05). The logistic regression analysis showed that the CTRP 5 level was positively correlated with the disease risk (OR=0.002, 95%CI 0-0.171). The ROC analysis of CTRP 5 showed that the area under the ROC was 0.937 (95%CI 0.895-0.980), demonstrating the effectiveness and accuracy of CTRP 5 in identifying cases of ALAA cerebral infarction. Conclusions　There is some correlation between serum CTRP 5 level and ALAA cerebral infarction and major atherosclerosis. No clear association is detected between serum CTRP 5 level and severity of neurological deficit. CTRP 5 level in serum is expected to be a potential biomarker for predicting ALAA cerebral infarction and assessing the risk of major atherosclerosis.

Hematological phenotype and genotype analysis of hemoglobin E

Chai Huiying, Liang Lihua, Guo Hao, Liu Pan, Tang Yuan, He Tianwen

2024, 30(9):  1465-1468.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.013

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Objective　To analyze the correlation between hematological phenotype characteristics and genotype distribution in patients with hemoglobin E (HbE), and to provide clinical references for the screening, prevention, and control of thalassemia. Methods　Two hundred and seventy-five patients with HbE detected by the Thalassemia Screening Laboratory of Guangdong Women and Children Hospital from January 2016 to December 2022 were retrospectively analyzed, including 108 males and 167 females. They were 2-46 years old. According to the genotypes, the patients were divided into HbE heterozygous(226 cases), HbE homozygous(1 case), HbE/α-thalassemia (40 cases), and HbE/β-thalassemia (8  cases) groups. The blood cell analyzer was used to analyze the red blood cell parameters of hemoglobin (Hb), mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH). The capillary electrophoresis was used to analyze the hemoglobin components of HbE, HbA2,and HbF. The red blood cell parameters (Hb, MCV, and MCH) and hemoglobin components (HbE, HbA2, and HbF) of the four groups were analyzed statistically by one-way analysis of variance. Results　There were statistical differences in red blood cell parameters (Hb, MCV, and MCH) and hemoglobin components (HbE, HbA2, and HbF) between the 4 groups (F=24.19,39.24,48.28,592.69,33.34 and 980.25; all P<0.05). The HbE heterozygous group [Hb (129.2±17.4) g/L, MCV (77.8±3.3) fl, and MCH (25.8±1.3) pg] and the HbE heterozygous/α-thalassemia group [Hb (125.3±13.0) g/L, MCV (74.4±7.2) fl, and MCH (24.1±3.0) pg] had the lightest hematological phenotype, while the HbE/β-thalassemia group [Hb (78.0±15.9) g/L, MCV (61.9±8.2) fl, and MCH (18.7±2.5) pg] had the heaviest hematological phenotype. Conclusions　Different genotypes of patients with HbE have differences in hematological phenotype; prenatal screening only based on the results of blood cell analysis will lead to a certain proportion of missed diagnosis.

Value of automated breast ultrasound in diagnosis of BI-RADS 4A breast nodules

Liu Xiaolin, Chen Ling, Chen Xinxin, Liang Weixiang

2024, 30(9):  1469-1473.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.014

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Objective　To investigate the value of automated breast ultrasound (ABUS) in the diagnosis of 4A benign and malignant breast nodules in the breast imaging reporting and data system (BI-RADS). Methods　Two hundred and two female patients with a total of 216 BI-RADS 4A breast nodules [the longest diameter was (17.92±11.60) mm] found by ABUS in Guangdong Provincial Hospital of Chinese Medicine from January 2018 to September 2022 were retrospectively analyzed; they were 23-72 years old. All the patients were examined by ABUS, conventional ultrasound, and mammography. The BI-RADS classification was conducted according to the classification standard of Breast Imaging Report and Data System established by the American College of Radiology (ACR) in 2013. The postoperative pathological results were used as the gold standard to analyze the diagnostic efficacies of the three methods. The χ² test or Fisher's exact probability method were used to compare the count data. Results　It was confirmed by surgery and pathology that 178 nodules were benign, and 38 malignant. The malignant composition ratios of B-RADS 4A breast nodules by ABUS, routine ultrasound, and mammography were 17.59% (38/216), 12.94% (22/170), and 19.61% (10/51), respectively. There were no statistical differences between the three groups in the malignant composition ratio of BI-RADS 4A nodules between by ABUS and by conventional ultrasound, between by ABUS and by mammography, and between by conventional ultrasound and by mammography (χ²=1.568, 0.114, and 1.408; all P>0.05). Conclusions　The diagnostic efficacy of ABUS for BI-RADS 4A breast nodules is similar to those of conventional ultrasound and mammography. ABUS has certain clinical value in early breast cancer screening, and is conducive to breast disease screening and disease grading management in grass-root units.

Clinical outcomes between long-acting long protocol in follicular phase versus short-acting long protocol in luteal phase

Sun Xueyan, Zhang Aiyu, Wang Hui

2024, 30(9):  1473-1477.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.015

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Objective　To compare the clinical outcomes of fresh transfer cycles of in vitro fertilization-embryo transfer (IVF-ET) between follicular phase long-acting long protocol and luteal phase short-acting long protocol. Methods　The data of 313 patients taking IVF-ET (313 cycles) at Reproductive Medicine Center, Yantaishan Hospital from January 2018 to December 2022 were retrospectively analyzed. The cycles were divided into a folicular phase long-acting long protocol group (group A; 141 cycles) and a luteal phase short-acting long protocol group (group B; 172 cycles) according to the controlled ovarian stimulation protocols. Group A were (31.59±3.00) years old, with (3.48±2.38) years of infertility. Group B were (31.42±3.03) years old, with (3.38±2.38) years of infertility. The clinical outcomes were compared between the two groups by t and χ² tests. Results　The total dosage of gonadotropin (Gn), Gn days, and endometrial thickness on the human chorionic gonadotropin (HCG) administration day in group A were more than those in group B [(29.53±11.18) ones vs. (23.83±7.03) ones, (9.61±1.80) d vs. (8.44±1.26) d, and (1.13±0.23) cm vs. (1.06±0.26) cm], with statistical differences (t=5.49, 6.75, and 2.44; all P<0.05). The levels of estrogen and luteinizing hormone (LH) on the HCG administration day, oocyte retrieved rate, and high-quality embryo rate in group A were lower than those in group B [(2 255.00±1 417.75) ng/L vs. (2 787.01±1 285.11) ng/L, (1.56±1.34) mIU/ml vs. (2.12±1.02) mIU/ml, 81.00% (1 522/1 879) vs. 84.74% (2 043/2 411), and 38.31% (344/898) vs. 48.22% (597/1 238)], with statistical differences (t=3.44 and 4.14; χ²=10.50 and 20.76; all P<0.05). The clinical pregnancy rate and embryo implantation rate in group A were higher than those in group B [59.65% (68/114) vs. 43.88% (43/98) and 44.39% (87/196) vs. 31.82% (56/176)], with statistical differences (χ²=5.26 and 6.19; all P<0.05). Conclusion　The clinical pregnancy rate and embryo implantation rate of fresh transfer cycles are higher by the follicular phase long-acting long protocol than by the luteal phase short-acting long protocol.

Effects of HSYA on biological characteristics of human lens epithelial cell line SRA01/04

Li Shiyi, Wang Kang, Huang Ju, Zhang Ao, Zhang Peipei, Xie Yingbin

2024, 30(9):  1478-1485.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.016

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Objective　To explore the effects of hydroxysafflor yellow A (HSYA) on the proliferation, migration, and epithelial-mesenchymal transition (EMT) of human lens epithelial cell line SRA01/04 (HLEC-SRA01/04) induced by recombinant human epidermal growth factor (rhEGF). Methods　This study was from June 2022 to September 2023. The HLEC-SRA01/04 induced by rhEGF were treated with different concentrations of HSYA solution for different durations. The proliferation status of the cells of each group was detected by the MTT assay, and the IC50 value was calculated. The cell scratch test and Transwell chamber were used to measure the migration ability of the cells in different concentration groups. Reverse transcription quantitative polymerase chain reaction (RT-qPCR) and Western Blot were adopted to determine the mRNA and protein expression levels of proliferating cell nuclear antigen (PCNA) and vimentin involved in EMT in the cells of different concentration groups. The measurement data were compared by the t test. Results　The MTT assay results showed that the proliferation inhibition rates were (12.1±0.6)%, (19.0±3.8)%, (31.5±2.2)%, (53.7±0.4)%, and (70.8±0.3)%, respectively, and the IC50 value was (76.520±0.954) μmol/L after treating HLECs induced by 5 μg/L rhEGF with the HSYA solution of 20, 40, 60, 80, and 100 μmol/L for 24 h; the proliferation inhibition rates were (14.3±3.7)%, (27.4±3.1)%, (42.6±2.7)%, (59.2±2.2)%, and (81.0±1.0)% , respectively, and the IC50 value was (66.094±2.508) μmol/L after treating HLECs induced by 5 μg/L rhEGF with the HSYA solution of 20, 40, 60, 80, and 100 μmol/L for 48 h, indicating significant dose-dependent effects. The cell scratch test results showed that the 24 h cell migration rates of the blank group and the 0, 20, 40, 70, and 100 μmol/L groups were (46.9±1.8)%, (90.0±1.5)%, (88.4±2.1)%, (43.3±6.6)%, (31.5±16.2)%, and (5.82±5.2)%, and the 48 h cell migration rates were (81.1±2.3)%, 100%, (95.5±0.1)%, (72.6±3.5)%, (58.5±6.1)%, and (37.4±7.1)%, respectively. The Transwell chamber results showed that the numbers of cells in the blank group and the 0, 20, 40, 70, and 100 μmol/L groups were (171.667±20.407), (290.222±24.135), (198.667±16.826), (161.222±5.981), (134.111±6.850), and (67.444±7.351), respectively; HSYA inhibited the migration of HLECs induced by rhEGF in a concentration-dependent manner. The RT-qPCR and Western Blot results proved that HSYA significantly down-regulated the mRNA and protein expressions of PCNA and Vimentin in HLECs induced by rhEGF in a dose-dependent manner. Conclusion　HSYA remarkably inhibits the proliferation, migration, and EMT of HLEC-SRA01/04 induced by rhEGF, serving as a promising drug for preventing posterior capsular opacification.

Clinical Research

Effect of hysteroscopic endometrial resection on endometrial thickness and sex hormones in patients with abnormal uterine bleeding

Jia Mingxia, Wei Mingming, Lu Yunhui

2024, 30(9):  1486-1489.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.017

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Objective　To explore the impact of hysteroscopic endometrial resection on endometrial thickness and sex hormones in patients with abnormal uterine bleeding. Methods　One hundred and thirty patients with abnormal uterine bleeding treated at First Hospital, Northwest University from March 2020 to March 2023 were selected for the randomized controlled trial, and were divided into a control group and an observation group by the random number table method, with 65 cases in each group. The control group were (41.18±4.00) years old; their disease course was (15.00±3.58) months. The observation group were (41.55±4.44) years old; their disease course was (14.38±3.82) months. The control group underwent traditional curettage surgery, and the observation group hysteroscopic endometrial electrosurgical resection. The surgical indicators, the endometrial thicknesses, menstrual volumes, and sex hormone levels before and 6 months after the surgery, and the incidences of adverse reactions were compared between the two groups by χ² and t tests. Results　The time to first flatus, time to off bed activity, and hospital stay in the observation group were shorter than those in the control group [(4.35±0.85) h vs. (7.43±1.82) h, (8.73±1.52) h vs. (28.93±3.45) h, and (4.15±1.15) d vs. (7.43±1.96) d], with statistical differences between the two groups (t=12.362, 43.198, and 11.637; all P<0.001). Before the treatment, there were no statistical differences in endometrial thickness, menstrual volume, and sex hormone levels between the two groups (all P>0.05). Six months after the treatment, endometrial thickness, menstrual volume, and levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol (E2) in the observation group were better than those in the control group [(6.63±1.33) mm vs. (7.65±1.35) mm, (91.20±6.83) ml vs. (101.45±9.82) ml, (9.28±2.45) IU/L vs. (17.89±3.35) IU/L, (6.30±1.40) IU/L vs. (16.09±4.16) IU/L, and (69.03±6.13) pmol/L vs. (59.30±5.85) pmol/L], with statistical differences (t=4.339, 6.909, 16.726, 17.982, and 9.258; all P<0.009). The incidence of adverse reactions in the observation group was lower than that in the control group [3.08% (2/65) vs. 16.92% (11/65)], with a statistical difference (t=6.923; P=0.009). Conclusion　Hysteroscopic endometrial resection for patients with abnormal uterine bleeding can effectively reduce their endometrial thickness and menstrual volume and adverse reactions, and does not affect their sex hormone levels, so it is a safe and effective treatment option.

Effect of Jintiange capsules and alfacalcitol for elderly patients with OVCF after PKP

Liu Rifu, Zou Qi, Feng Xiaobing, Liu Wencheng, Yang Guanghua, Yang Yue, Huang Xiangjie, Wang Xueshan

2024, 30(9):  1490-1494.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.018

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Objective　To investigate the effect of Jintiange capsules combined with alfacalcitol for elderly patients with osteoporotic vertebral compression fracture (OVCF) after percutaneous kyphoplasty of vertebral body (PKP). Methods　Ninety-eight elderly patients with OVCF treated at Shandong Wendeng Osteopaths Yantai Hospital from February 2020 to May 2023 were selected for the randomized controlled trial, and were divided into a control group and an observation group by the coin toss method, with 49 cases in each group. The control group included 26 males and 23 females, with an age of (72.63±2.54) years; their disease course was (5.56±1.31) years. In the observation group, there were 29 males and 20 females; they were (72.89±2.60) years old; their disease course was (5.37±1.23) years. The patients in both groups took PKP; after PKP, the control group took alfacalcitol, and the observation group took alfacalcitol and Jintiange capsules, for 3 months. After the treatment, the treatment effects, symptom scores of traditional Chinese medicine, pain degrees, bone metabolism indicators, and adverse reactions were compared between the two groups. χ² and t tests were applied. Results　The effective rate of the observation group was higher than that of the control group [97.96% (48/49) vs. (81.63% (40/49); χ²=7.127; P=0.008]. After 3 months' treatment, the scores of main symptoms, secondary symptoms, and pain degree in the in the observation group were lower than those in the control group [(3.20±0.28) vs. (4.58±0.30), (1.20±0.16) vs. (1.96±0.21), and (1.58±0.27) vs. (3.29±0.41); t=23.540, 20.151, and 24.383; all P<0.001]. After 3 months' treatment, the levels of osteocalcin (BGP) and bone alkaline phosphatase (BALP) in the observation group were higher than those in the control group [(10.26±1.57) μg/L vs. (8.26±1.02) μg/L and (18.26±1.63) μg/L vs. (16.84±1.29) μg/L; t=7.478 and 4.782; both P<0.001]. The incidence of adverse reactions in the observation group was lower than that in the control group [6.12% (3/49) vs. (10.20% (5/49)], with no statistical difference (χ²=0.136; P=0.712). Conclusion　Jintiange capsules combined with alfacalcitol for elderly patients with OVCF after PKP can significantly improve their clinical symptoms and bone metabolism and reduce their pain degree and scores of traditional Chinese medicine symptoms, and is safe, so it is worth being generalized.

Microwave ablation guided by real-time contrast-enhanced ultrasound and fusion image in treatment of patients with small liver cancer

Wang Junfang, Chen Jiao

2024, 30(9):  1494-1497.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.019

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Objective　To study the value of microwave ablation guided by real-time contrast-enhanced ultrasound and fusion image in the treatment of patients with small liver cancer. Methods　A total of 84 patients with small liver cancer admitted to Huangshi Central Hospital from May 2019 to November 2020 were selected as the study samples. According to the treatment methods, they were divided into an observation group, taking microwave ablation guided by real-time contrast ultrasound and fusion image, and a control group, taking surgical treatment, with 42 cases each group. There were 23 males and 19 females in the observation group; they were (44.86±3.46) years old; there were 58 lesions; the longest lesion diameter was (1.56±1.07) cm. There were 25 males and 17 females in the control group; they were (43.60±3.50) years old; there were 61 lesions; the longest lesion diameter was (1.62±1.02) cm. The operation times, hospitalization times, and incidences of complications were compared between the two groups. The patients were followed up until November 2022. The disease progress and survival and death within 2 years were compared between the two groups. t, χ², and Log-rank tests were applied. Results　The operation time and hospitalization time in the observation group were shorter than those in the control group [(92.37±19.43) min vs. (142.16±21.83) min and (4.37±2.26) d vs. (9.42±2.81) d], with statistical differences between the two groups (t=11.041 and 9.076; both P<0.001). The total incidence of complications in the observation group was lower than that in the control group [9.52% (4/42) vs. 26.19% (11/42); χ²=3.977; P=0.046]. The local progression rate, mortality rate, and 2-year cumulative survival rate of the observation group were 35.71% (15/42), 28.57% (12/42), and 70.00% (28/40), respectively; and those of the control group were 33.33% (14/42), 30.95% (13/42), and 68.29% (28/41), respectively; there were no statistical differences (χ²=0.054 and 0.067; Log-rank=0.084; all P>0.05). Conclusion　Microwave ablation guided by real-time contrast-enhanced ultrasound and fusion image in the treatment of patients with small liver cancer is of great clinical value, minimally invasive, and safe.

Low-dose leflunomide combined with methotrexate for elderly patients with rheumatoid arthritis

Gai Nannan, Guo Hua, Zhang Jie, Bao Yunqi

2024, 30(9):  1498-1502.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.020

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Objective　To investigate the effect of low-dose leflumide combined with methotrexate for elderly patients with first-episode rheumatoid arthritis (RA). Methods　One hundred and twenty elderly patients with first-episode RA admitted to Xi'an Fifth Hospital from February 2020 to February 2023 were selected for the randomized controlled trial. They were divided into a combination group and a reference group by the random number table method, with 60 cases in each group. There were 37 males and 23 females in the combination group; they were (70.22±5.29) years old; their body mass index (BMI) was (22.87±1.55) kg/m²; their disease course was (4.76±0.85) years. There were 38 males and 22 females in the reference group; they were (70.31±5.34) years old; their BMI was (22.94±1.58); their disease course was (4.82±0.87) years. The reference group were treated with methotrexate, and the combination group with low-dose leflunomide and methotrexate, for 90 d. The clinical efficacies, improvement of clinical symptoms, levels of bone metabolism indicators and serum levels of chitinase 3-like protein1 (CHI3L1), soluble suppression of tumorigenicity 2 (sST2), and interleukin-32 (IL-32) before and after the treatment, and adverse reactions were compared between the two groups. χ² and t tests were applied. Results　The total effective rate of the combination group was higher than that of the reference group [96.67% (58/60) vs. 83.33% (50/60); χ²=5.926, P=0.015]. The joint number with tenderness, joint number with swelling, duration of morning stiffness, and grip strength of both hands in the combination group were better than those in the control group [(5.23±1.05) vs. (7.45±1.36), (4.18±0.66) vs. (6.39±0.82), (34.58±4.68) min vs. (50.40±8.21) min, and (14.03±2.55) kPa vs. (11.28±2.09) kPa; t=10.008, 16.263, 12.967, and 6.461; P<0.001]. After the treatment, the levels of bone gla protein (BGP), osteoprotectin (OPG), and total type Ⅰ collagen amino terminal extension peptide (T-PⅠNP) in the combination group were higher than those in the reference group [(27.48±5.02) ng/L vs. (24.16±4.19) ng/L, (5.02±0.74) ng/L vs. (4.45±0.66) ng/L, and (43.17±8.59) μg/L vs. (36.92±7.33) μg/L; t=3.933, 4.453, and 4.287; all P<0.001]. After the treatment, the serum levels of CHI3L1, sST2, and IL-32 in the combination group were lower than those in the reference group [(50.82±6.12) μg/L vs. (78.45±8.39) μg/L, (28.45±4.11) μg/L vs. (33.05±5.24) μg/L, and (14.32±2.01) ng/L vs. (16.85±2.77) ng/L; t=20.609, 5.350, 5.726; all P<0.001]. There was no statistical difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion　Low-dose leflunomide combined with methotrexate for elderly patients with first-episode RA is effective, and can significantly improve their bone metabolism indicators and serum levels of CHI3L1, sST2, and IL-32.

Clinical significance of CA19-9 and NLR in prognosis of patients with gallbladder cancer after radical surgery

Wang Jiang, Cui Shichang, Chen Xiaoqian, Zhu Huiyun, Zhao Boyan

2024, 30(9):  1502-1507.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.021

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Objective　To explore the clinical significance of carbohydrate antigen 19-9 (CA19-9) and neutrophil to lymphocyte ratio (NLR) in the prognosis of patients with gallbladder cancer after radical surgery. Methods　Seventy-two patients with gallbladder cancer who underwent radical resection in Linyi Central Hospital from January 2015 to December 2021 and completed one-year follow-up were selected as a gallbladder cancer group, including 39 cases and 33 cases who were (63.19±3.85) years old. According to the 1:1 matching principle, another 72 patients with gallbladder polyps during the same period were selected as a control group, including 37 males and 35 females who were (62.54±3.52) years old. The serum levels of CA19-9 and NLR's were compared between the two groups at admission. The levels of CA19-9 and NLR's were compared between the patients with different outcomes at admission and 1 week after the surgery and between the patients with different pathological parameters. Spearman analysis was used to investigate the correlations of CA19-9 and NLR with pathological parameters and disease outcomes at admission. The receiver operating characteristic curve (ROC) was used to investigate the predictive values of the combined detection at admission and 1 week after surgery for poor outcomes in the patients with gallbladder cancer. Results　The serum level of CA19-9 and NLR at admission in the gallbladder cancer group were higher than those in the control group [(237.14±38.41) U/ml vs. (31.87±6.43) U/ml and (4.02±1.25) vs. (1.84±0.43); both P<0.05]. The serum levels of CA19-9 and NLR's at admission and 1 week after the surgery in the patients with poor prognosis were higher than those in the patients with good prognosis [(261.71±25.33) U/ml vs. (218.56±24.52) U/ml, (4.73±1.02) vs. (3.48±0.75), (181.64±28.58) U/ml vs. (85.43±12.19) U/ml, and (3.37±0.48) vs. (2.24±0.53); all P<0.05]. Comparison of serum level of CA19-9 and NLR between the patients with different pathological parameters: those in the moderately and highly differentiated patients were lower than those in the poorly differentiated patients [(208.41±22.83) U/ml vs. (294.60±23.18) U/ml and (3.14±0.47) vs. (5.78±0.69)]; those in the stage Ⅰ-Ⅱ patients were lower than those in the stage Ⅲ-Ⅳpatients [(188.43±25.63) U/ml vs. (276.11±23.08) U/ml and (2.95±0.57) vs. (4.88±0.64)]; those in the patients with no lymph node metastasis were lower than those in the patients with lymph node metastasis [(206.93±24.25) U/ml vs. (287.49±16.64) U/ml and (3.38±0.49) vs. (5.09±0.73)]; both indicators were negatively correlated with tissue differentiation (r=-0.698 and -0.533), and positively correlated with clinical stage (r=0.742 and 0.659), lymph node metastasis (r=0.701 and 0.634), and disease outcome (r=0.588 and 0.719) (all P<0.05). The areas under the curves (AUC) of serum CA19-9 and NLR for predicting poor prognosis in the patients at admission and 1 week after the surgery were 0.776 (95%CI 0.718-0.839) and 0.834 (95%CI 0.768-0.906), respectively. The optimal predictive sensitivities were 87.10% and 93.55%, respectively; the optimal predictive specificities were 68.29% and 73.17%, respectively. Conclusion　CA19-9 and NLR are upregulated in the serum of patients with poor prognosis after radical cholecystectomy for gallbladder cancer. These two indicators are correlated with clinical pathological parameters and disease outcomes. The combined detection has certain predictive value for prognosis and can be used as auxiliary indicators for clinical prediction of the patients' postoperative prognosis.

"Yuntong acupuncture" combined with vestibular rehabilitation training for patients with persistent postural-perceptual dizziness

Du Qing, Gu Baodong, Xu Dong, Wang Yingchao , Zhao Xiaohui

2024, 30(9):  1508-1512.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.022

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Objective　To observe the efficacy of "Yuntong acupuncture" combined with vestibular rehabilitation training in the treatment of patients with persistent postural-perceptual dizziness and its effect on emotional disorders. Methods　Ninety patients with persistent postural-perceptual dizziness admitted to Lianyungang Hospital Affiliated to Nanjing University of Chinese Medicine from January 2022 to September 2023 were selected for the randomized controlled trial. The patients were divided into a control group and an observation group by the random number table method, with 45 cases in each group. There were 12 males and 33 females in the observation group; they were (62.64±9.40) years old. There were 17 males and 28 females in the control group; they were (62.82±9.86) years old. The control group took vestibular rehabilitation training; in addition, the observation group took "Yuntong acupuncture". Seven days was a treatment course. Both groups were treated for 4 courses. The scores of Dizziness handicap inventory (DHI), physical P, emotional E, functional F, Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and Pittsburgh Sleep Quality Index (PSQI) before and after the treatment, the efficacies, and the incidences of adverse reactions during the treatment were compared between the two groups. t and χ² tests were used for the statistical analysis. Results　Before the treatment, there were no statistical differences in the total score and scores of body, emotion, and function of DHI between the two groups (all P>0.05). After the treatment, the total score and scores of body, emotion, and function of DHI in the observation group were lower than those in the control group [(24.22±11.08) vs. (33.02±10.54), (6.98±3.32) vs. (8.67±3.19), (8.27±4.08) vs. (11.51±3.22), and (8.71±4.07) vs. (12.40±4.42)], with statistical differences (t=3.860, 2.462, 4.182, and 4.120; all P<0.05). There was a statistical difference in the clinical efficacy between the two groups (Z=2.873; P=0.005). Before the treatment, there were no statistical differences in the scores of HAMA, HAMD, and PSQI between the two groups (all P>0.05). After the treatment, the scores of HAMA, HAMD, and PSQI in the observation group were lower than those in the control group [(10.00±5.59) vs. (15.24±4.35), (10.20±6.33) vs. (15.96±4.92), and (6.31±2.98) vs. (10.11±2.70)], with statistical differences (t=4.963, 4.820, and 6.339; all P<0.05). There was no statistical difference in the incidence of adverse reactions between the observation group and the control group [11.11% (5/45) vs. 8.89% (4/45); χ²=0.137, P=0.711]. Conclusion　"Yuntong acupuncture" combined with vestibular rehabilitation training for patients with persistent postural-perceptual dizziness can improve their clinical symptoms, emotional and sleep disorders, and life quality.

Mesomeric effect of depression and loneliness on post-traumatic stress disorder and disability in patients with acute cerebral infarction 

Sun Qian, Zhao Licheng, Zhang Xiaoman, Shao Li, Shi Jin, Chen Wenji, Wang Yuanyuan

2024, 30(9):  1513-1518.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.023

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Objective　To explore the mesomeric effect of affective disorders (depression and loneliness) on post-traumatic stress disorder (PTSD) and disability in patients with acute cerebral infarction. Methods　Three hundred and twenty patients with acute cerebral infarction who were treated in Department of General Medicine, Xuzhou First People's Hospital between January 2020 and December 2022 were selected for the cross sectional study, including 273 males and 47 females. They were 46-85 (64.8±15.9) years old. The data were collected from the patients using questionnaires, including general information, World Health Organization Disability Assessment Scale (WHO DAS 2.0), Post-Traumatic Stress Disorder Self-rating Scale (PTSD-SS), Self-rating Depression Scale (SDS), and University of California Los Angeles Loneliness Scale (UCLA). t and χ² tests were applied. Results　The scores of WHO-DAS 2.0, PTSD-SS, SDS, and UCLA were (98.62±32.25), (83.15±24.01), (62.46±23.52), and (48.59±19.27) in the patients. Depression, loneliness, PTSD, and disability were correlated each other (all P<0.05). The mediation model validation showed indirect effects of depression and loneliness on disability, with effect values of 0.196 and 0.110 and effect sizes of 14.75% and 20.48%. There was a chain mediation effect of the PTSD-loneliness-depression-disability, with the effect value of 0.061 and the effect size of 46.37%. PTSD did not show any significant direct effect on disability, with an effect value of PTSD and disability of 0.079. Conclusion　Patients with acute cerebral infarction have PTSD psychological state, but PTSD does not directly affect disability, and it exerts its influence on disability through depression and loneliness by the pathway of mediated effects, and improve the patients' life quality.

Etiology analysis of 183 patients with fever of unknown origin

Xin Ningbo, Zhao Qingxia, Hou Mingjie, Luo Xia, Han Yifan, Xu Xiaoyuan

2024, 30(9):  1518-1522.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.024

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Objective　To understand the characteristics of etiological distribution in 183 patients with fever of unknown origin (FUO), to compare the etiological composition of patients from different hospitals and age groups and with different genders and durations of fever, and to provide references for clinical diagnosis and treatment. Methods　The clinical data of 183 inpatients with FUO admitted to the departments of infectious diseases in Zhengzhou Sixth People's Hospital and First Hospital, Peking University from August 2022 to October 2023 were retrospectively analyzed. Based on the etiology, the patients were classified into infectious diseases (93 cases), non-infectious inflammatory diseases (NIID, 42 cases), neoplastic diseases (14 cases), other diseases (21 cases), and undiagnosed cases (13 cases). The differences in etiological distribution were compared between the patients from different hospitals and age groups and with different genders and durations of fever. χ² test was applied. Results　Among the patients, 61.20% (112/183) were male. They were (49.70±19.09) years old. The common confirmed causes in each group were bacterial infections, adult Still's disease, lymphoma, and necrotizing lymphadenitis. The proportions of infectious diseases in the patients in the two hospitals were 64.29% (27/42) and 46.81% (66/141), respectively, with a statistical difference (χ²=3.96; P<0.05). The proportion of infectious diseases in the patients who were 31-45 years old was higher than in that the patients who were 15-30 years old [63.89% (23/36) vs. 34.15% (14/41); χ²=6.79; P<0.05]. The proportion of other diseases in the patients who were 15-30 years old [29.27% (12/41)] was higher than those in the other groups (χ²=4.10, 6.35, and 9.51; all P<0.05). The proportion of NIID in the females was higher than that in the males [33.80% (24/71) vs. 16.07% (18/112); χ²=7.73; P<0.05]. The proportion of the infectious disease cases with a fever duration >3 months [12.50% (3/24)] was lower than those in the patients with fever durations <1 month and 1-3 months [61.33% (46/75) and 52.38% (44/84)] (χ²=15.45 and 10.51; both P<0.05). The proportion of the neoplastic diseases cases with a fever duration >3 months was higher than that in the patients with a fever duration <1 month [20.83% (5/24) vs. 4.00% (3/75); χ²=4.86; P<0.05]. The proportion of the undiagnosed cases with a fever duration >3 months was higher than that in the patients with a fever duration <1 month [16.67% (4/24) vs. 2.67% (2/75); χ²=4.04; P<0.05]. Conclusions　Clinicians should first consider infectious diseases when facing patients with FUO. The etiological composition of FUO may vary in different hospitals, age groups, and patients with different genders and fever durations. Therefore, precise and rapid relevant tests and examinations should be conducted based on the patients' clinical characteristics to clarify the causes as soon as possible.

Drug treatment of Pingle orthopedics for cervical spondylosis

Li Wenxia, Li Jie, Zhang Xiaohui, Wang Xiuzhen

2024, 30(9):  1523-1525.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.025

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The drug treatment methods of Pingle orthopedics based on "warming and invigorating" include external treatment and internal treatment. The internal treatment mainly focuses on activating blood and dredging meridians, expelling wind and dredging arthralgia, and nourishing meridian and relaxing tendons; the external treatment mainly focuses on relaxing muscles and tendons, activating collaterals, and dredging arthralgia. It can achieve ideal treatment effect when you pay equal attention to internal and external treatments and use multiple methods based on the "Three Principles and Four Methods". This article summarizes the drugs and treatment principles of these treatment methods, so as to provide references for clinical medication.

Value of serum sTREM-1 and sCD163 in evaluation of postoperative urinary infection in patients with benign prostatic hyperplasia

Tuo Pengfei, Wang Shuaishuai, Zou Tao, Zong Youlong

2024, 30(9):  1526-1531.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.026

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Objective　To explore the value of serum levels of soluble myeloid trigger receptor 1 (sTREM-1) and soluble hemoglobin sCD163 (sCD163) in the evaluation of postoperative urinary infection in patients with benign prostatic hyperplasia (BHP). Methods　A total of 102 patients with BHP who underwent transurethral resection of prostate in Yan'an Hospital of Traditional Chinese Medicine from July 2020 to July 2023 were selected, and divided into an infected group (23 cases) and uninfected group (79 cases) according to whether they had postoperative urinary infection. The serum levels of sTREM-1 and sCD163 were compared between the two groups 7 days after the operation. The value of serum sTREM-1 and sCD163 in the evaluation of postoperative urinary infection in the patients was analyzed. The influencing factors of postoperative urinary infection in the patients were explored by the univariate analysis and multivariate logistic regression analysis. t and χ² tests were applied. Results　The levels of sTREM-1 and sCD163 in the infected group were higher than those in the uninfected group [(76.47±8.29) ng/L vs. (52.65±6.91) ng/L and (71.25±6.64) μg/L vs. (49.26±5.37) μg/L], with statistical differences (t=13.893 and 16.358; both P<0.05). The areas under the curves (AUC) of sTREM-1, sCD163, and the combination of the two for postoperative urinary infection in the patients were 0.734 (95%CI 0.684-0.779), 0.842 (95%CI 0.798～0.887), and 0.904 (95%CI 0.854-0.956), respectively. There were no statistical differences in age, body mass index, complication with hypertension, complication with diabetes mellitus, smoking history, drinking history, uric acid, triacylglycerol, and total cholesterol between the two groups (P>0.05). The operation time, postoperative hospitalization time, and catheter indwelling time in the infected group were longer than those in the uninfected group [(73.21±6.14) min vs. (69.39±6.93) min, (7.29±1.29) d vs. (6.46±1.67) d, and (4.24±0.92) d vs. (3.75±0.84) d], and the levels of procalcitonin (PCT) and C-reactive protein (CRP) in the infected group were higher than those in the uninfected group [(2.37±0.45) μg/L vs. (1.43±0.57) μg/L and (36.06±6.54) mg/L vs. (26.23±5.34) mg/L], with statistical differences (t=2.384, 2.197, 2.410, 7.268, and 7.374; all P<0.05). The results of logistic regression analysis showed that PCT (OR=2.088, 95%CI 1.436-3.035), CRP (OR=2.309, 95%CI 1.536-3.472), serum sTREM-1 (OR=3.047, 95%CI 1.859-4.992), and serum sCD163 (OR=2.617, 95%CI 1.690-4.051) were risk factors for postoperative urinary infection in the patients (P<0.05). Conclusion　Serum sTREM-1 and sCD163 are highly expressed in patients with postoperative urinary infection after BPH surgery, and are risk factors for postoperative urinary infection. The combined detection of STREM-1 and SCD163 is of higher value in the evaluation of postoperative urinary infection.

Effects of ureaplasma urealyticum infection on semen quality and serum sex hormone levels in infertile males

Liu Anna, Zhang Ling

2024, 30(9):  1532-1534.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.027

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Objective　To explore the effects of ureaplasma urealyticum (UU) infection on semen quality and serum sex hormone levels in infertile males. Methods　A total of 102 male infertile patients who were treated at Reproductive Center, Chenggong Hospital Affiliated to Xiamen University from August 2021 to November 2022 and had positive UU tested by real-time fluorescence quantitative polymerase chain reaction were selected as an UU infection group; they were 21-50 years old. One hundred and forty-five males with normal fertility who underwent physical examination in Chenggong Hospital Affiliated to Xiamen University during the same period were selected as a healthy control group; they were 23-48 years old. The semen volumes, pH values, sperm concentrations, sperm motilities, sperm forward movement rates, sperm morphology, and serum sex hormone levels of the two groups were examined and compared. The independent-sample t test was used for the statistical analysis. Results　The sperm concentration, sperm motility, sperm forward movement rate, and percentage of sperm with normal morphology in the UU infection group were lower than those in the healthy control group [(40.38±16.04)×10⁶/ml vs. (51.12±13.39)×10⁶/ml, (36.31±13.75)% vs. (48.15±12.21)%, (29.23±11.54)% vs. (36.21±10.98)%, and (10.86±6.71)% vs. (15.92±10.65)%], with statistical differences (all P<0.05). There were no statistical differences in semen volume, pH, and serum levels of estradiol (E₂), follicle- stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), and testosterone (T) between the two groups (all P>0.05). Conclusion　UU infection can decrease the semen quality, and affect the males' fertility.

Clinical Teaching

Application of case teaching method in clinical pharmacotherapy

Tang Linlin, Wu Haiyan, Ding Chuanhua, Duan Xiaoju

2024, 30(9):  1535-1538.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.028

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Clinical drug therapy is a bridge discipline between pharmacology and clinical medicine. This article explores the teaching effect of the case teaching method applied to the course of clinical drug therapy. Teachers accumulate classic cases in clinical practice, present them through demonstrations, raise questions, drive students to search for information, and integrate the guide with the cases. Through the implementation of the case teaching method, students have been mobilized to self-examine and self-study clinical guidelines, solve problems in real cases, learn and apply, get close to clinical practice, stimulate students' learning enthusiasm, improve the teaching level of clinical drug therapy in our school, and lay a foundation for cultivating clinical pharmacists with qualified pharmaceutical service capabilities.

Investigation and research on the clinical medical graduate education under integration of standardized residency training and clinical practice

Lao Kaixue, Ai Dingding, Ding Peihui, Su Zhe, Li Xiaoran, Wang Yanlin

2024, 30(9):  1538-1542.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.029

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Objective　To investigate the current problems in graduate education in clinical medicine under the integration of standardized residency training and clinical practice. Methods　One hundred and thirty-one clinical postgraduate students who studied at Binzhou Medical University, Shandong University, Shihezi University, and Shandong First Medical University from May 2018 to April 2020 were investigated in terms of the teaching mode, the influence of tutors, and the demand for ability improvement under the combined training mode of standardized resident training and clinical practice through questionnaire survey. The original data were exported from the questionnaire survey platform. WPS was used to transform the data. The data were expressed as single item support rate. Results　In the teaching for clinical medical graduate students, the teachers often used actual operation (79.4%, 104/131), case teaching (77.1%, 101/131), special lectures and discussion (72.5%,95/131), teaching theories through multimedia (67.9%,89/131), etc. The teaching methods the students liked were as below: case teaching (89.3%, 117/131), actual operation (82.4%, 108/131), special lectures and discussion (66.4%, 87/131), and teaching theories through multimedia (40.5%, 53/131). Under the integration of standardized residency training and clinical practice, the tutors influenced the students in knowledge improvement and eye opening (82.4%, 108/131), increasing practice ability (80.2%, 105/131), theoretical knowledge improvement (77.1%, 101/131), innovation cultivation (64.9%, 85/131), and knowledge systemization and education idea update (51.1%, 67/131). In the theory combining with practice process, 84.7% (111/131) thought that they could applied the theories in practice well, and 15.3% (20/131) did not think so; 92.4% (121/131) thought that the knowledge and abilities they got were enough for their future positions, and 7.6% (10/131) did not think so. Most topics of the students' theses were from their tutors' programs and projects. Lack of problem awareness, lack of source of topic selection, and difficulty in determining the topic were the main difficulties in the design of graduate dissertations. In order to adapt to the future post, the ability to analyze and solve problems, the expansion of comprehensive knowledge, basic skills, and practical ability should be strengthened during the postgraduate period under the integration of standardized residency training and clinical practice. Conclusion　The combination of multiple teaching modes and the establishment of a tutor team can not only fully mobilize the learning enthusiasm and solve the existing difficulties of clinical medical graduate students, but also help them meet the needs of future post ability.

Palliative care cognition and hospice care attitude among undergraduate nursing interns and correlation analysis

Gai Na, Lei Qingmei, Shi Shengwen, Yan Hongbo, Ou Lishan, He Yuxi, Guan Yuxian

2024, 30(9):  1543-1547.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.030

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Objective　To investigate the current situation of palliative nursing cognition and hospice care attitude of undergraduate nursing interns in Guangzhou, and to provide references for the teaching and training of undergraduate nursing students. Methods　Two hundred and five undergraduate nursing interns from Second Hospital, Guangzhou Medical University, First Hospital, Guangzhou Medical University, and First Hospital, Guangdong Pharmaceutical University in Guangzhou were selected by the convenient sampling for the investigation, including 82 males and 123 females. There were 75 ones <22 years old, 117 ones 22-23 years old, and 13 ones >23 years old. The questionnaire included general demographic data (gender, age, student origin, feeling for patients taking hospice care, understanding of palliative care and hospice care, understanding of nursing for patients taking hospice care, and attitude to the patients' family members), The Chinese version of Palliative Care Knowledge Questionnaire (PCQN), and Chinese version of Fromelt End-of-Life Care Attitude Scale (FATCOD-B). t test, analysis of variance, and Pearson correlation analysis were used. Results　Among the 205 collected questionnaires, 62.0% (127/205) interns were from urban areas, and 38.0% (78/205) from countryside; 53.2% (109/205) were not from one-child families, and 46.8% (96/205) from one-child families; 60.5% (124/205) did not choose nursing by their own will; 55.1% (113/205) did not know palliative care, and only 44.9% (92/205) knew; 63.4% (130/205) did not know the differences between palliative care and hospice care; 43.4% (89/205) knew the connotation of palliative care; 42.0% (86/205) took care of end-of-life patients or their family members in practice or life ever; 52.7% (108/205) did not take care of end-of-life patients in their internship; only 39.5% (81/205) talked about death with the patients or their family members. The scores of palliative care cognition and hospice care attitude in the 205 interns were (36.62±3.98) and (99.38±8.93), respectively. There was a positive correlation between palliative care cognition and hospice care attitude (r=0.282, P<0.01). Conclusions　Undergraduate nursing interns' knowledge about palliative care and clinical care should be improved. College teachers should pay attention to the cultivation and training of nursing students' professional knowledge and skills in these two aspects, and carry out the theoretical study and curriculum practice of relevant knowledge in undergraduate study.

Application of MDT and first aid imitation training in teaching interns at department of obstetrics

Zhang Yuan, Chen Xinjuan, Wang Qingqing, Wu Lingling

2024, 30(9):  1547-1551.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.031

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Objective　To explore the effect of the application of multi-disciplinary team (MDT) and first aid imitation training in teaching interns at department of obstetrics. Methods　Ninety-nine interns majoring in clinical medicine at Sun Yat-sen University and practicing at Department of Obstetrics, Third Hospital, Sun Yat-sen University from May 2022 to April 2023 were selected for the randomized controlled trial, and were divided into an experimental group (49 interns) and a control group (50 interns) by the envelope random method. There were 23 males and 26 females in the experimental group; they were (22.59±0.53) years old. There were 29 males and 21 females in the control group; they were (22.44±0.50) years old. Both groups took practice at Department of Obstetrics, Third Hospital, Sun Yat-sen University; in addition, the experimental group took MDT and first aid imitation training for postpartum hemorrhage. By sending questionnaires to the experimental group and the control group for self-assessment of various abilities, the teaching effects of the two groups were compared. t test was used for the measurement data, and χ² test or paired χ² test for the enumeration data. Results　All the questionnaires in both groups were recovered, and the recovered rates both were 100.0%. In the experimental group, 73.5% (36/49) interns believed that participating in the MDT and first aid imitation training for postpartum hemorrhage helped them understand MDT in-depth. The questionnaire investigation after the training for the experimental group and before the obstetric pactice in the control group showed that. The rates lacking clinical obstetric diagnosis ability, single-item obstetric operation ability, diagnosis ability in other disciplines, single-item operation ability in other disciplines, multi-disciplinary diagnosis and treatment thinking, and comprehensive first aid operation ability in the experimental group were lower than those in the control group [0 vs. 44.0% (22/40), 6.1% (3/49) vs. 52.0% (26/50), 8.2% (4/49) vs. 38.0% (19/50), 6.1% (3/49) vs. 44.0% (22/50), 2.0% (1/49) vs. 58.0% (29/50), and 8.2% (4/49) vs. 82.0% (41/50)], with statistical differences (all P<0.001). Conclusion　MDT and first aid imitation training for postpartum hemorrhage can enhance the interns' understanding of MDT, and improve their multidisciplinary diagnosis and treatment thinking and comprehensive emergency operation ability.

Case Report

A case of renal light chain deposition disease complicated with multiple plasma chamber effusion

Xu Tiantian

2024, 30(9):  1552-1555.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.032

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Light chain deposition disease (LCDD) is the most common form of monoclonal immunoglobulin deposition disease, in which plasma cells or B-lymphocytes secrete excessive amounts of monoclonal immunoglobulin light chains, which are deposited in tissues and cause organ dysfunction. LCDD is a systemic disease with multiple organ involvement, mainly in the kidney. Renal involvement is common in almost all patients with LCDD, while extra-renal involvement is less common, with cardiac, hepatic, gastrointestinal, peripheral, and autonomic nerve involvement being more common, and pulmonary involvement being very rare. Most of the organ impairment in LCDD is progressive, and spontaneous remission is rare. Extra-renal light chain deposition has clear independent effect on the patients' survival and prognosis. 

One case of Wilson's disease with first manifestation of liver failure and literature review

Zheng Yanan, Ding Guofeng, Liu Xianxian

2024, 30(9):  1556-1558.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.033

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Wilson's disease (WD), also known as hepatomegaly, is an autosomal recessive genetic disease. It develops mostly in children and adolescents, with various clinical manifestations and lack of specificity. Lack of awareness of the disease among primary care physicians leads to high rates of missed diagnosis and misdiagnosis. It is rare to see patients with acute liver failure as the first manifestation of the disease. In this paper, we report a case of Wilson's disease diagnosed as slow-onset acute hepatic failure due to fever at Binzhou Medical University Hospital, who had adverse reactions during the maintenance treatment with penicillamine, and review the relevant literatures to improve clinicians' understanding of Wilson's disease and diagnosis and treatment levels.

Nursing Research

Construction of sensitive indicators for quality of nursing care in internal medicine treatment for liver failure

Zhang Sisi, Jiang Shuxian, Fan Chenmeng, Chen Miaoxia, Li Lili

2024, 30(9):  1559-1564.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.034

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Objective　To construct a sensitive indicator system for the quality of nursing care in internal medicine treatment for liver failure. Methods　The researchers reviewed the literatures in March 2022. By combining evidence-based literatures with expert interviews, and based on the structure-process-outcome model, a preliminary construction of nursing quality sensitive indicators of internal medicine treatment for liver failure was carried out. Two rounds of expert inquiries using the Delphi method were conducted; the indicators were revised and evaluated based on the experts' opinions; the best quality evaluation index system was constructed. The SPSS 26.0 software was used for the statistical analysis. The experts' general data were statistically described by frequency, proportion, and (). The experts' positive coefficient was expressed by the questionnaire recover rate. The experts' authority coefficient and degree were expressed as authority coefficient. The importance degree was weighed by importance scoring. Results　The response rates for expert consultations were all 100%, with the expert authority coefficients for the first round being 0.958 and the second round 0.943, both over 0.700. The Kendall coordination coefficient ranged from 0.089 to 0.237 (P<0.05). Finally, the sensitive indicators for the quality of nursing in internal medicine treatment for liver failure were constructed, including 3 primary indicators, 13 secondary indicators, and 29 tertiary indicators. Conclusion　The sensitive indicators for the quality of nursing in internal medicine treatment for liver failure constructed in this study have good reliability, scientificity, and a certain degree of specialized sensitivity, which can provide certain basis for the evaluation of the quality of medical treatment and nursing for liver failure.

Effect of empowerment motivation intervention mode for patients undergoing daytime oral and maxillofacial surgery 

Ren Saihong, An Xiaoyan, Ai Miaomiao, Feng Fan

2024, 30(9):  1564-1569.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.035

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Objective　To analyze the effect of the empowerment incentive intervention mode for patients undergoing oral and maxillofacial day surgery. Methods　A total of 128 patients who were admitted to the day ward for oral and maxillofacial day surgery at Hospital Affiliated to Yan'an University from January 2021 to October 2023 were selected for the randomized controlled trial. The patients were divided into a control group and an observation group by the random number table method, with 64 cases in each group. There were 32 males and 32 females in the control group; they were (42.44±8.04) years old; 15 cases underwent complex tooth extraction, 16 cases oral and maxillofacial hemangioma excision, 16 cases mucous cyst excision, and 17 cases frenulotomy. There were 33 males and 31 females in the observation group; they were (43.16±7.97) years old; 16 cases underwent complex tooth extractions, 15 cases hemangioma excisions, 18 cases mucous cyst excisions, and 15 cases frenulotomy. The control group took routine nursing intervention; in addition, the observation group took empowerment incentive intervention. The perioperative systolic blood pressures (SBP) and diastolic blood pressures (DBP), levels of anxiety and fear [the Modified Corah's Dental Anxiety Scale (MDAS) and the Stouthard Dental Fear Scale (DFI)] 3 months after the intervention, cooperation during surgery, quality of nursing service [the Service Quality Scale (SERVQUAL)], and readiness for discharge [the Readiness for Hospital Discharge Scale (RHDS)] were compared between the two groups. The data were analyzed by the SPSS 26.0 software. t and χ² tests were applied. Results　The SBP's and DBP's before the surgery, minute 10 in the surgery, and after the surgery in the observation group were (114.55±7.31) mmHg (1 mmHg=0.133 kPa), (129.28±9.31) mmHg, and (122.57±8.34) mmHg and (76.93±5.12) mmHg, (92.03±6.27) mmHg, and (82.94±6.10) mmHg; those in the control group were (116.41±6.58) mmHg, (136.93±8.98) mmHg, and (128.72±7.63) mmHg and (78.08±4.71) mmHg, (96.36±5.85) mmHg, and (86.38±5.48) mmHg; the SBP's of both groups: F_time=161.218, F_{between groups}=36.518, F_interaction=4.649; P_time<0.001, P_{between groups}<0.001, P_interaction=0.010; the DBP's of both groups: F_time=300.236, F_{between groups}=24.392, F_interaction=2.878; P_time<0.001, P_{between groups}<0.001, P_interaction=0.058. After the intervention, the scores of MDAS and DFI were lower than those before the intervention in both groups, and the scores in the observation group were lower than those in the control group [(6.19±1.19) vs. (9.59±1.71) and (62.49±6.19) vs. (75.09±7.89)] (all P<0.001). The surgical cooperation rate in the observation group was higher than that in the control group [89.06% (57/64) vs. 68.75% (44/64); P<0.001]. The scores of empathy transfer, responsiveness, reliability, assurance, tangibility, and total readiness for discharge of nursing service quality in the observation group were higher than those in the control group were all significantly higher than those in the control group [(4.14±0.34) vs. (3.78±0.40), (4.41±0.19) vs. (4.01±0.30), (4.21±0.29) vs. (3.73±0.37), (4.18±0.34) vs. (3.57±0.38), (4.10±0.36) vs. (3.67±0.39), and (105.94±7.82) vs. (100.08±8.55)], with statistical differences (all P<0.001). Conclusion　The empowerment incentive intervention mode for patients undergoing daytime oral and maxillofacial surgery can effectively improve the perioperative management effect and reduce their anxiety and fear, and has clinical application value.

Efficiency-oriented comprehensive nursing mode for patients undergoing radical prostatectomy

Jin Helian, Feng Ninghan, Guo Yuehong

2024, 30(9):  1570-1574.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.036

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Objective　To explore the effects of an efficiency-oriented comprehensive nursing mode on the complication rate and physiological function in patients undergoing radical prostatectomy. Methods　From March 2021 to March 2022, 126 patients who underwent radical prostatectomy for prostate cancer at Wuxi Second People's Hospital were selected for the randomized controlled trial. They were divided into a control group and an observation group by the random number table method, with 63 cases in each group. The control group were (52.34±4.47) years old; their disease course was (8.56±3.46) months. The observation group were (50.78±5.25) years old; their disease course was (8.14±3.62) months. The control group used the conventional care model, and the observation group adopted efficiency-oriented comprehensive nursing mode. The recovery indicators, incidences of complications, physiological functions [the International Index of Erectile Function-5 (IIEF-5) was used to evaluated their erectile function before and 1 and 3 months after the surgery], and quality of life, evaluated by the MOS Item Short from Health Survey (SF-36), were compared the two groups. t and χ² tests were used. Results　After the nursing, the time for first flatus, time for first meal, time for the first time to get off bed, and hospitalization time in the observation group were significantly shorter than those in the control group [(22.87±4.62) d vs. (37.58±4.24) d, (4.65±1.68) d vs. (6.88±1.03) d, (2.53±1.09) d vs. (5.36±1.23) d, and (8.65±2.15) d vs. (15.78±2.68) d], with statistical differences (t=18.619, 8.982, 13.668, and 16.471; all P<0.05). The incidence of complications in the observation group was lower than that in the control group [6.35% (4/63) vs. 25.40% (16/63)], with a statistical difference (χ²=8.558; P=0.003). One and three months after the surgery, the scores of IIEF-5 in the observation group were higher than those in the control group [(13.14±3.68) vs. (9.98±4.25) and (18.22±4.31) vs. (11.54±3.93)], with statistical differences (t=4.461 and 9.090; both P<0.05). Before the nursing, there were no statistical differences in the scores of physical function, emotional role, social function, psychological health, body role, general health, body pain, and activity between the two groups (all P>0.05). After the nursing, the scores of physical function, emotional role, social function, psychological health, body role, general health, body pain, and activity in the observation group were higher than those in the control group [(61.67±10.36) vs. (55.98±11.68), (73.24±12.38) vs. (66.20±14.36), (67.29±16.46) vs. (61.01±12.23), (79.13±9.41) vs. (72.01±9.10), (66.85±13.15) vs. (59.42±15.48), (63.78±11.42) vs. (57.21±9.16), (73.45±11.40) vs. (63.21±15.46), and (81.97±12.46) vs. (74.43±14.14)], with statistical differences (t=2.639, 2.947, 2.431, 4.317, 2.903, 3.562, 4.231, and 3.100; all P<0.05). Conclusion　Efficiency-oriented comprehensive nursing mode for patients undergoing radical prostatectomy can shorten their recovery period, decrease the incidence of complications, and improve their postoperative erectile function and quality of life.

Music therapy combined with accompanying by medical staff during MRI examination for patients with claustrophobia

Zhang Aili

2024, 30(9):  1574-1578.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.037

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Influence of specialized games on negative emotions and self-efficacy in school-age children with type 1 diabetes mellitus

Xie Liyue, Zheng Zhihui, Yang Yinjin, Ye Xiuyu, Lu Yacong

2024, 30(9):  1579-1584.  DOI: 10.3760/cma.j.issn.1007-1245.2024.09.038

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Objective　To investigate the effects of specialized games on negative emotions and self-efficacy in school-age children with type 1 diabetes mellitus. Methods　A total of 66 school-age children with type 1 diabetes mellitus who were followed up in pediatric endocrine clinics of Jinjiang Municipal Hospital and Jinjiang Maternal and Child Health Hospital from March 2021 to June 2022 were selected for the randomized controlled trial. The children were divided into a control group and an intervention group by the random number table method, with 33 cases in each group. During the intervention period, 31 cases finished the followed up in the control group, and 2 did not; 30 cases finished the follow up in the intervention group, and 3 did not. There were 14 males and 17 females in the control group who were (9.74±1.90) years old. There were 17 males and 13 females in the intervention group who were (9.60±1.71) years old. The control group received outpatient follow-up and routine health education; in addition, the intervention group took specialized game intervention. Both groups were intervened once every other week for 6 times 12 weeks. The scores of diabetes knowledge, social anxiety, depression, and self-efficacy were compared between the two groups before and after the intervention. t test and rank sum test were applied. Results　After the intervention, the scores of diabetes knowledge, social anxiety, and depression in the intervention group were better than those in the control group [(17.83±2.23) vs. (14.23±3.19), 7.00 (5.00, 10.00) vs. 9.00 (7.00, 11.00), and 9.00 (7.00, 12.25) vs. 13.00 (10.00, 15.00)], with statistical differences (t=5.103, P<0.001; Z=2.884, P=0.004; Z=2.560,P=0.010). The score of self-efficacy in the intervention group was higher than that in the control group [(100.80±21.96) vs. (86.77±24.24)], with a statistical difference (t=2.370, P=0.021). Conclusion　Specialized games for school-age children with type 1 diabetes mellitus can improve their knowledge of diabetes and sense of self-efficacy, and reduce their social anxiety and depression.