Table of Content

15 May 2024, Volume 30 Issue 10

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New Medical Advances

Research progress on the relationship between obstructive sleep apnea hypopnea syndrome and gut microflora 

Lu Manlu, Zhu Jiwei, Ding Honghong, Yu Yan, Pan Lei

2024, 30(10):  1585-1589.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.001

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Obstructive sleep apnea hypopnea syndrome (OSAHS) is a respiratory disorder characterized by intermittent hypoxia and impaired reoxygenation that manifests during sleep. Researches have demonstrated a significant association between OSAHS and gut well-being, as it has the potential to disrupt the gut microbiome, modify the gut metabolites, compromise the integrity of the intestinal barrier, and trigger the systemic inflammation. This article provides a comprehensive review of the current research advancements pertaining to the relationship between OSAHS and gut microflora, and highlighting the potential role of disturbances in gut microflora in the progression of OSAHS, albeit with an incomplete understanding of the underlying mechanisms.

Research progress of perivascular adipose tissue inflammation involved in the occurrence and development of aortic dissection

Wang Ao, Zou Mingrui, Han Yuexin, Wang Yujiu

2024, 30(10):  1590-1593.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.002

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Aortic dissection (AD), also referred to as aortic dissection aneurysm, is a perilous condition associated with high mortality rate. Recent studies investigating the alterations in inflammatory markers during the disease progression suggest that inflammation plays a crucial role in determining the clinical outcomes of AD. The initial manifestation of inflammatory response occurs within the aortic adventitia and surrounding adipose tissue. Perivascular adipose tissue (PVAT) orchestrates arterial wall inflammation through proinflammatory mechanisms, which are closely linked to the occurrence and progression of various cardiovascular diseases. Consequently, detecting and intervening in PVAT inflammation holds immense significance for comprehending early pathophysiological changes in AD and implementing timely preventive measures among individuals at high risk.

Advances in the study of biologic therapy for nail psoriasis

Wang Hui, Wang Jing, Ma Lei, Gao Yu

2024, 30(10):  1594-1597.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.003

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The use of biological agents in treating psoriasis has led to a significant enhancement in the effectiveness of addressing nail psoriasis. Different biological agents have different targets and different efficacies. The application and efficacy comparison of biological agents in nail psoriasis has been increasingly studied over the past few years, and this paper reviews them to provide clinical insight.

Literature Analysis

Research hotspots and frontier analysis of fragility fracture risk prediction in the elderly

Liu Caijuan, Zeng Qingqing, Li Zhuolan, Lu Yan, Zeng Guqing

2024, 30(10):  1598-1603.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.004

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Objective　The hot spots and development trends of fragility fracture risk prediction in the elderly at home and abroad were analyzed to provide references for further research on fragility fracture risk prediction in the elderly. Methods　The bibliometric method was used to search the Chinese and English literatures on the topic of fragility fracture risk prediction in the elderly included in CNKI, VIP, Wanfang, CBM, Web of Science, PubMed, and Medline databases from 2013 to 2022. CiteSpace 6.2.R5 was used for visual analysis. Results　A total of 4 809 articles were retrieved. The number of domestic publications showed a gradual growth trend, and the number of foreign publications showed an overall growth trend. The most published journal in China was Chinese Journal of Osteoporosis, and the most published journal in English on the risk prediction of fragility fracture in the elderly was Osteoporosis International. The research hotspots were mainly focused on the occurrence of osteoporosis, measurement of bone mineral density, and assessment of fracture risk. Research frontiers in recent years were mainly focused on the advancement of machine learning methods. Conclusions　Research on the prediction of risk factors for fragility fracture in the elderly provides an important scientific basis for medical staff to carry out primary prevention. It provides an important reference for clinical diagnosis and nursing work to carry out the prediction study of the influencing factors of fragility fracture in the elderly. Machine learning is an important direction for future research on fragility fracture risk prediction in the elderly.

Treatises

Effect observation on elderly patients with non-valvular atrial fibrillation treated with dabigatran etexilate

Wang Xuewen, Li Guangping, Bi Xiaoxue, Zhang Zizhao, Xu Yanmin, Liu Tong

2024, 30(10):  1604-1608.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.005

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Objective　To investigate the effects of dabigatran etexilate treatment on the coagulation function, cardiac function, adverse reactions, and prognosis in elderly patients with non-valvular atrial fibrillation. Methods　This study was a randomized controlled trial. A total of 130 elderly patients with non-valvular atrial fibrillation admitted to the Second Hospital of Tianjin Medical University from January 2020 to September 2023 were included. The patients were divided into group A (warfarin treatment, 43 cases), group B (rivaroxaban treatment, 43 cases), and group C (dabigatran etexilate treatment, 44 cases) by the random number table method. Group A included 22 males and 21 females, aged (74.56±6.43) years; there were 23 cases of grade I and 20 cases of grade II cardiac function. Group B included 24 males and 19 females, aged (73.89±6.21) years; there were 22 cases of grade I and 21 cases of grade II cardiac function. Group C included 20 males and 24 females, aged (74.12±6.38) years; there were 23 cases of grade I and 21 cases of grade II cardiac function. Group A was treated with warfarin sodium tablets, once a day, starting at 2.5 mg and then adjusting the dose according to the international normalized ratio (INR) by 0.5 mg each time, keeping the INR between 2.0 and 3.0. Group B was treated with rivaroxaban tablets, 15 mg each time, once a day. Group C was treated with dabigatran etexilate capsules, 110 mg each time, twice a day. The course of treatment was 2 months. The levels of liver and kidney function indicators [creatinine (Cr), urea nitrogen (BUN), alanine aminotransferase (ALT), and aspartate aminotransferase (AST)], coagulation function indicators [thrombin time (TT), fibrinogen (FIB), activated partial thromboplastin time (APTT), and plasma prothrombin time (PT)], CHA2DS2-VASc scores of atrial fibrillation thromboembolic risk, HAS-BLED scores of atrial fibrillation anticoagulant bleeding risk, and adverse reactions (skin ecchymosis, nausea and vomiting, stroke, and hematuria) of the three groups were compared. The patients were followed up for 3 months to record the incidences of thromboembolic formation and bleeding. Repeated measure ANOVA, χ² test, and Fisher exact probability method were used. Results　After 2 months of treatment, the levels of Cr, BUN, ALT, and AST in group B and C were lower than those in group A, with statistically significant differences (all P<0.05). The levels of TT, APTT, and PT in group B and C were higher than those in group A, and the levels of FIB in group B and C were lower than that in group A, with statistically significant differences (all P<0.05). The CHA2DS2-VASc and HAS-BLED scores in group A, B, and C after treatment were slightly higher than those before treatment, but the differences were not statistically significant (all P>0.05). The incidences of adverse reactions in group A, B, and C were 16.28% (7/43), 4.65% (2/43), and 2.27% (1/44); the incidence of adverse reactions in group C was lower than that in group A, with a statistically significant difference (P<0.05). After 3 months of follow-up, the rates of thromboembolic formation and minor bleeding in group B and C were slightly lower than those in group A, but the differences were not statistically significant (all P>0.05). Conclusion　In treating elderly patients with non-valvular atrial fibrillation, dabigatran etexilate and rivaroxaban demonstrate better therapeutic effects and safety compared to warfarin, improving the liver and kidney functions and coagulation function, and reducing the adverse reactions and thromboembolic and bleeding events.

Expression levels of serum miR-16-5p and miR-155-5p and their relationships with prognosis in patients with infectious shock

Liu Gang, Yuan Pingli

2024, 30(10):  1609-1614.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.006

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Objective　This study aimed to assess the serum levels of miR-16-5p and miR-155-5p in patients with infectious shock, and to explore their relationships with prognosis. Methods　From June 2021 to July 2023, a total of 86 patients diagnosed with infectious shock were selected from the Emergency Department of Chang'an Hospital. There were 47 males and 39 females, 45 cases <60 years old and 41 cases ≥60 years old. These patients were categorized into three groups based on the severity of their condition: mild (30 patients), moderate (29 patients), and severe degree (27 patients). Over a one-month period, the survival status of these patients was monitored, leading to the formation of two groups: a death group (20 patients) and a survival group (66 patients). Comparative analyses of clinical data were conducted across each group. The correlations between the expression levels of miR-16-5p and miR-155-5p and the Acute Physiology and Chronic Health Evaluation (APACHEⅡ) score were analyzed. The receiver operating characteristic curve (ROC) was constructed to assess the prognostic diagnostic values of serum miR-16-5p and miR-155-5p in infectious shock. The risk factors of poor prognosis in patients with infectious shock were analyzed by logistic regression analysis. Independent sample t test, F test, χ² test, and Pearson correlation analysis were used. Results　The heart rate (HR), C-reactive protein (CRP), APACHEⅡ score, and expression levels of miR-16-5p and miR-155-5p in the severe group were higher than those in the mild and moderate groups (all P<0.05), but the mean arterial pressure (MAP), central venous pressure (CVP), and oxygenation index (OI) were lower than those in the mild and moderate groups (all P<0.05). The CRP, APACHEⅡ score, and expression levels of miR-16-5p and miR-155-5p in the death group were higher than those in the survival group (all P<0.05), but the OI was lower than that in the survival group (P<0.05). Pearson correlation analysis showed that the expression levels of miR-16-5p and miR-155-5p were positively correlated with APACHEⅡ score (r=0.509 and 0.722, both P<0.001). The area under the curve (AUC) of serum miR-16-5p combined with miR-155-5p in predicting poor prognosis in patients with infectious shock was 0.944, the 95% confidence interval (CI) was 0.894 - 0.994, the sensitivity was 90.0%, and the specificity was 84.8%, indicating high predictive efficacy. Both miR-16-5p and miR-155-5p were risk factors for poor prognosis in patients with infectious shock [OR=10.608 (2.275-49.461) and 25.410 (4.573-141.176), both P<0.05]. Conclusion　In patients with infectious shock, serum expression levels of miR-16-5p and miR-155-5p are significantly associated with the condition's severity and prognosis. Thus, these two miRNAs may serve as biomarkers for predicting poor prognosis in such patients.

Clinical value of miR-16-5p combined with plasma ZO-1 detection in prognostic prediction of infectious shock 

Wang Jian, Zhang Chunying, Huang Jiangbo

2024, 30(10):  1615-1619.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.007

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Objective　To explore the clinical value of miR-16-5p combined with plasma zonula occludens-1 (ZO-1) detection in predicting the prognosis in patients with infectious shock. Methods　A total of 137 patients with infectious shock admitted to Xi'an Union Hospital from January 2021 to August 2023 were retrospectively analyzed. There were 77 males and 60 females, aged 40 to 80 years. The levels of miR-16-5p and ZO-1 were detected. According to the 28-day survival, the patients were divided into a poor prognosis group (53 cases) and a good prognosis group (84 cases). Binary logistic regression analysis was used to analyze the risk factors affecting the patients' prognosis, and the receiver operating characteristic curve (ROC) was used to analyze the predictive value of miR-16-5p and ZO-1 for the patients' prognosis. ��² test and independent sample t test were used. Results　Univariate analysis showed that the proportion of age ≥60 years old, C-reactive protein (CRP), procalcitonin (PCT), Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, and miR-16-5p and ZO-1 levels in the poor prognosis group were higher than those in the good prognosis group (all P<0.05). Binary logistic regression analysis showed that PCT (OR=1.783, 95%CI: 1.124-2.826), APACHEⅡ score (OR=3.011, 95%CI: 1.293-7.007), miR-16-5p (OR=4.628, 95%CI: 2.223-9.632), and ZO-1 (OR=4.287, 95%CI: 1.915-9.594) were independent risk factors for poor prognosis in patients with infectious shock (all P<0.05). ROC analysis results showed that the sensitivities of miR-16-5p, ZO-1, and their combination in predicting poor prognosis of infectious shock patients were 75.50%, 71.70%, and 92.50%, the specificities were 72.60%, 70.20%, and 89.30%, and the areas under the curves (AUC) were 0.805, 0.810, and 0.921 (all P<0.05). Conclusion　miR-16-5p and ZO-1 are independent risk factors for poor prognosis in patients with infectious shock, and clinical combined detection of miR-16-5p and ZO-1 levels can better predict the patients' prognosis.

Clinical characteristics in children with refractory Mycoplasma pneumoniae pneumonia and its correlation with TLR4 inflammasome

Chen Xianping, Zhang Lisheng, Hong Yan

2024, 30(10):  1620-1625.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.008

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Objective　To analyze the clinical characteristics in children with refractory Mycoplasma pneumoniae pneumonia (RMPP) and its correlation with Toll like receptor 4 (TLR4) inflammasome. Methods　A total of 97 children with Mycoplasma pneumoniae pneumonia admitted to Ankang Hospital of Traditional Chinese Medicine from August 2021 to August 2023 were selected as the research subjects. There were 46 boys and 51 girls, aged 2 to 14 years. At admission, the incidence of RMPP was statistically analyzed and the children were divided into a RMPP group and a general Mycoplasma pneumoniae pneumonia (GMPP) group. The relative expression level (mRNA) of TLR4 mononuclear cells in all children on the next day after admission was measured, the clinical data and TLR4 mRNA of the two groups were compared, and the correlation between TLR4 mRNA and RMPP was analyzed. Independent sample t test, χ² test, logistic regression analysis, and restricted cubic spline (RCS) were used. Results　According to statistics, out of 97 children with Mycoplasma pneumoniae pneumonia, 33 had RMPP, accounting for 34.02% (33/97). The proportions of fever duration >7 days, pleural effusion, and lobar atelectasis in the RMPP group were higher than those in the GMPP group, and the length of hospital stay was longer than that in the GMPP group (all P<0.05). The percentage of neutrophils, levels of C-reactive protein (CRP), interleukin-18 (IL-18), IL-1β, IL-6, and immunoglobulin A (IgA), Mycoplasma pneumoniae-DNA, and TLR4 mRNA [(0.92±0.08) vs. (0.88±0.04)] in the RMPP group were higher than those in the GMPP group (all P<0.05). Logistic regression model was constructed, and the results showed that the percentage of neutrophils, CRP, IL-18, IL-1β, IL-6, IgA, Mycoplasma pneumoniae-DNA, and TLR4 mRNA on admission were all related to the occurrence of RMPP (all P<0.05). By RCS analysis, there was a non-linear dose-response relationship between TLR4 mRNA and RMPP. When TLR4 mRNA >0.955, the risk of RMPP increased with the increase of indicator expression level. Conclusions　The duration of fever and hospitalization in RMPP children are long, often accompanied by worsening pulmonary signs and imaging manifestations, as well as severe inflammatory reactions and immune damage. TLR4 inflammasomes and their related inflammatory factors are also associated with RMPP. The high expression of TLR4 inflammasomes induces a high inflammatory response, which is an independent risk factor for RMPP, and the correlation between the two is a non-linear dose-response relationship.

Effect of nalbuphine combined with rhomboid intercostal block on acute hyperalgesia after video-assisted thoracoscopic lobectomy

Wu Hui, Yuan Lei, Chen Jiao

2024, 30(10):  1625-1631.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.009

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Objective　To explore the effect of nalbuphine combined with rhomboid intercostal block (RIB) on acute hyperalgesia after video-assisted thoracoscopic lobectomy. Methods　A total of 96 patients with non-small cell lung cancer who underwent video-assisted thoracoscopic lobectomy in Hanzhong Central Hospital from February 2021 to March 2023 were prospectively selected and were divided into group A, B, and C with 32 cases in each group by the random number table method. Group A included 18 males and 14 females, aged (64.25±7.41) years. Group B included 20 males and 12 females, aged (64.89±7.56) years. Group C included 16 males and 16 females, aged (65.18±7.20) years. Group C received RIB under ultrasound guidance before anesthesia induction, and group B and C received intravenous injection with 2 ml of nalbuphine 3 minutes before anesthesia induction, while group A received an equal amount of normal saline intravenously. The intraoperative medication, postoperative recovery, pain, mechanical pain threshold, stress response, immune function, hemodynamics, adverse reactions, and complications were compared among the three groups. One-way ANOVA, repeated measure ANOVA, LSD-t test, and χ² test were used. Results　The dosage of propofol, dosage of remifentanil, rescue analgesia rate, and usage rate of vasoactive drugs in group C were lower than those in group A and B, and those in group B were lower than those in group A (all P<0.05). There were no statistically significant differences in the hospital stay, time of first standing, time of first food intake, or total incidence of complications and adverse reactions among the three groups (all P>0.05). The mechanical pain thresholds around the incision and inside forearm of the three groups 6 h and 48 h after surgery were lower than those before surgery, and those 48 h after surgery were higher than those 6 h after surgery (all P<0.05); those in group C were higher than those in group A and B 6 h and 48 h after surgery [(76.25±7.03) g vs. (41.31±5.22) g and (58.06±6.10) g, (81.19±8.24) g vs. (63.44±6.38) g and (76.30±7.21) g, (85.39±7.01) g vs. (72.06±5.23) g and (79.24±6.15) g, (95.07±8.36) g vs. (79.43±6.28) g and (87.31±7.12) g], those in group B were higher than those in group A 6 h and 48 h after surgery, with statistically significant differences (all P<0.05). The VAS scores of the three groups 48 h after surgery were lower than those of the same group 1 h and 6 h after surgery, and those 6 h after surgery were lower than those of the same group 1 h after surgery. The VAS scores of group C 1 h, 6 h, and 48 h after surgery were lower than those of group A and B, and those of group B were lower than those of group A (all P<0.05). Twenty-four hours after surgery, the levels of serum cortisol, adrenocorticotropic hormone, and norepinephrine in the three groups were higher than those before surgery, those in group C were lower than group A and B, and those in group B were lower than those in group A (all P<0.05). Twenty-four hours after surgery, the levels of CD3+ and CD4+ in the three groups were lower than those before surgery, the levels in group C were higher than those in group A and B, and the levels in group B were higher than those in group A (all P<0.05). At the end of anesthesia (T2), the heart rate and mean arterial pressure of the three groups were lower than those 5 min after anesthesia induction (T1), but were higher than those 5 min before anesthesia induction (T0), and those of the three groups at T1 were higher than those at T0 (all P<0.05); those of group C were lower than group A and B, and those of group B were lower than those of A group at T1 and T2 (all P<0.05). Conclusion　Nalbuphine combined with RIB can inhibit acute hyperalgesia after video-assisted thoracoscopic lobectomy, improve the immune function, reduce the anesthesia drug usage during surgery, alleviate the postoperative pain and stress response, and maintain the hemodynamic stability, which is safe and reliable.

Construction of a nomogram prediction model for delirium in patients with open and comminuted fractures of the limbs after trauma

Yu Hongjin, Yang Wenbin, Yan Yu, Liu Xingguo

2024, 30(10):  1632-1637.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.010

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Objective　To analyze the risk factors for delirium in patients with open and comminuted fractures of the limbs after trauma, and to construct and validate a risk prediction model. Methods　A retrospective analysis was conducted on the medical records of 108 patients with open and comminuted fractures of the limbs after trauma admitted to Xi'an Gaoxin Hospital from March 2021 to March 2023. Among them, there were 76 males and 32 females, aged (54.17±14.62) years. According to the 80/20 law, they were randomly divided into a training set (86 cases) and a verification set (22 cases). The occurrence of delirium within one month after surgery was recorded, and the patients were divided into a delirium group and a non-delirium group based on whether delirium occurred postoperatively. The risk factors for delirium in patients with open and comminuted fractures of the limbs after trauma were screened, and a risk prediction model was constructed and validated. t test, χ² test, logistic regression model, receiver operating characteristic curve (ROC), and Hosmer-Lemeshow test were used. Results　Among the 86 patients with open and comminuted fractures of the limbs after trauma, 18 patients developed delirium after surgery, with an incidence of 20.93% (18/86). The age, proportion of stroke history, proportion of intraoperative hypoxemia, and serum soluble tumor necrosis factor 1 (sTNFR1) level in the delirium group were higher than those in the non-delirium group (all P<0.05). Age (OR=3.187, 95%CI 1.176-8.633), stroke history (OR=3.684, 95%CI 1.359-9.979), intraoperative hypoxemia (OR=4.958, 95%CI 1.830-13.431), and serum sTNFR1 (OR=4.591, 95%CI 1.695-12.435) were identified as risk factors for postoperative delirium in patients with open and comminuted fractures of the limbs after trauma (all P<0.05). The risk prediction model showed a sensitivity of 0.825 (95%CI 0.741-0.922), specificity of 0.829 (95%CI 0.753-0.906), and area under the curve of 0.892 (95%CI 0.808-0.915) for predicting postoperative delirium in 86 patients with open and comminuted fractures of the limbs after trauma of the training set. The risk prediction model showed a sensitivity of 0.799 (95%CI 0.706-0.881), specificity of 0.732 (95%CI 0.658-0.827), and area under the curve of 0.839 (95%CI 0.791-0.915) for predicting postoperative delirium in 22 patients with open and comminuted fractures of the limbs after trauma of the verification set. Conclusions　Age, history of stroke, intraoperative hypoxemia, and serum sTNFR1 are associated with postoperative delirium in patients with open and comminuted fractures of the limbs after trauma. Constructing a risk prediction model helps to predict the risk of postoperative delirium early.

Comparison of the efficacies of free anterolateral thigh perforator flap and descending branch tissue flap of lateral circumflex femoral artery transplantation in the treatment of diabetic foot

Hua Zhen, Jing Yinlei, Dai Wei, Zhao Zhuowei

2024, 30(10):  1638-1642.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.011

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Objective　To explore the therapeutic effects of free anterolateral thigh perforator flap and free descending branch tissue flap of lateral circumflex femoral artery transplantation combined with vacuum sealing drainage in the treatment of diabetic foot. Methods　A total of 94 diabetic foot patients treated at the Second Affiliated Hospital of Air Force Medical University from January 2018 to March 2023 were prospectively selected as the research subjects. They were divided into two groups, group A and B, using the random number table method. In group A, 47 patients received free anterolateral thigh perforator flap transplantation, including 24 males and 23 females, aged (53.26±11.52) years, the wounds ranged from 4.2 cm × 5.4 cm to 8.3 cm × 10.2 cm, and the lesions were distributed at dorsum of foot in 15 cases, ankle in 18 cases, and heel in 14 cases. In group B, 47 patients received free descending branch tissue flap of lateral circumflex femoral artery transplantation, including 26 males and 21 females, aged (51.34±10.89) years, the wounds ranged from 3.5 cm × 4.5 cm to 7.5 cm × 9.5 cm, and the lesions were distributed at dorsum of foot in 17 cases, ankle in 16 cases, and heel in 14 cases. Both groups underwent debridement with vacuum sealing drainage before surgery. The efficacy, wound healing, growth cytokines in the wound area [vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and transforming growth factor-β1 (TGF-β1)], flap sensory function, and walking ability (evaluated by Holden's Functional Ambulation Classification Scale) were compared between the two groups. t test χ² test, and rank sum test were used. Results　Six months after treatment, the total effective rate of group A was higher than that of group B [97.87% (46/47) vs. 87.23% (41/47)], with a statistically significant difference (χ²=3.859, P=0.049). The wound healing time [(28.98±4.49) d], hospital stay [(18.98±5.36) d], and granulation tissue formation time [(21.58±4.22) d] in group A were shorter than those in group B [(31.38±4.76) d, (22.38±6.42) d, and (23.65±4.59) d], with statistically significant differences (all P<0.05). The levels of VEGF [(113.13±12.82) ng/L], bFGF [(70.08±6.87) ng/L], and TGF-β1 [(9.08±0.91) µg/L] in group A 1 month after surgery were higher than those in group B [(102.35±13.11) ng/L, (65.33±6.37) ng/L, and (8.09±0.83) µg/L], with statistically significant differences (all P<0.05). There was no statistically significant difference in the good appearance rate of flaps between the two groups (χ²=0.712, P=0.399). The normal rate of flap sensory function in group A was higher than that in group B [61.7% (29/47) vs. 40.42% (19/47)], with a statistically significant difference (χ²=4.257, P=0.039). The Holden's Functional Ambulation Classification in group A was better than that in group B, with a statistically significant difference (Z=10.513, P=0.033). Conclusion　The use of free anterolateral thigh perforator flap for the treatment of diabetic foot is superior to free descending branch tissue flap of lateral circumflex femoral artery, with faster wound healing and better recovery of foot and ankle function.

Effects of invasive-noninvasive sequential mechanical ventilation on blood gas analysis and inflammatory response in patients with severe pneumonia

Liu Qiaoyan, Wang Juan, Wang Yongxing, Xu Yongni, Wang Ping, Xiao Linping

2024, 30(10):  1643-1647.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.012

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Objective　To investigate the effects of invasive-noninvasive sequential mechanical ventilation on blood gas analysis and inflammatory response in patients with severe pneumonia. Methods　A total of 96 patients with severe pneumonia admitted to Air Force 986 Hospital from March 2020 to March 2023 were prospectively selected and were divided into a control group and an observation group by the random number table method, with 48 cases in each group. The control group was treated with invasive mechanical ventilation, including 25 males and 23 females, aged (55.36±5.21) years, with a body mass index (BMI) of (23.64±1.51) kg/m². The observation group was treated with invasive-noninvasive sequential mechanical ventilation, 26 males and 22 females, aged (55.42±5.25) years, with a BMI of (23.61±1.48) kg/m². The surgery-related indicators, blood gas analysis indicators, lung function, and inflammatory response were compared between the two groups. Statistical methods used were t test and χ² test. Results　Before treatment, there were no statistically significant differences between the observation group and the control group in terms of blood gas analysis, lung function, or inflammatory response (all P>0.05). The duration of oxygen therapy [(12.32±2.21) d], invasive ventilation time [(5.22±1.03) d], and hospital stay [(18.31±2.76) d] in the observation group were shorter than those in the control group [(20.33±3.25) d, (13.49±2.68) d, and (25.46±3.87) d], with statistically significant differences (t=14.120, 19.956, and 10.421, all P<0.001). After 2 weeks of treatment, the partial pressure of arterial blood oxygen and saturation of arterial blood oxygen in the observation group were higher than those in the control group [(78.02±6.01) mmHg (1 mmHg = 0.133 kPa) vs. (71.25±5.86) mmHg, (93.72±6.45)% vs. (89.52±6.33)%], but the partial pressure of arterial blood carbon dioxide was lower than that in the control group [(43.55±4.42) mmHg vs. (48.89±4.68) mmHg], with statistically significant differences (t=5.588, 3.220, and 5.747, all P<0.001). The static lung compliance (Cst) in the observation group was higher than that in the control group [(71.66±6.35) kPa vs. (60.25±5.21) kPa], but the extra vascular lung water index (EVLWI) was lower than that in the control group [(5.39±1.02) ml/kg vs. (8.57±1.54) ml/kg], with statistically significant differences (t=9.624 and 11.927, both P<0.001). The levels of white blood cell count [(6.71±1.25) ×10⁹/L], C-reactive protein (CRP) [(41.55±4.32) mg/L], and procalcitonin (PCT) [(2.01±0.52) μg/L] in the observation group were lower than those in the control group [(9.58±1.87) ×10⁹/L, (54.59±6.69) mg/L, and (2.59±0.68) μg/L], with statistically significant differences (t=8.840, 11.345, and 4.694, all P<0.001). The total complication rate of the observation group was lower than that of the control group [4.17% (2/48) vs. 18.75% (9/48)], with a statistically significant difference (χ²=5.031, P=0.025). Conclusion　The use of invasive-noninvasive sequential mechanical ventilation in the treatment of patients with severe pneumonia, compared to solely invasive mechanical ventilation, effectively shortens the duration of oxygen therapy and hospitalization, improves the blood gas analysis and lung function, and reduces the inflammatory response, indicating that this treatment method is more beneficial for patients' recovery.

Genetic analysis on villi of spontaneous abortion in assisted reproductive technology by CNV-seq

Li Yiqian, Lao Kaixue, Ding Peihui, Diao Xinghua, Wang Yanlin

2024, 30(10):  1648-1652.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.013

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Objective　Utilizing CNV-seq analysis on chorionic villus tissue obtained from spontaneous abortion, to make a clinical diagnosis for the cause of miscarriage and to provide genetic guidance for subsequent pregnancies. Methods　CNV-seq technology was used to detect the chorionic villi of early spontaneous abortion, and the chromosomal abnormalities were counted. The age, gestational age, previous abortion times, and effect of pregnancy mode on the chromosomal results of 181 female patients who were diagnosed as spontaneous abortion by color ultrasonography in Binzhou Medical University Hospital from January 2019 to June 2023 were retrospectively analyzed. There were 108 cases of natural pregnancy abortion and 73 cases of abortion after assisted reproductive technology (ART). Among them, 42 pregnancies were assisted by in vitro fertilization and embryo transfer (IVF), 24 by intracytoplasmic sperm injection (ICSI), and 7 by artificial insemination (IUI). The age was (32.83±5.34) years old, the gestational age was (57.39±10.05) d, and the number of spontaneous abortion was 0-5 times. One-way analysis of variance and χ² test were applied. Results　Out of the 181 cases of spontaneous abortion, all the chorionic villi were successfully examined. Among them, 74 cases exhibited normal findings, while 107 cases showed abnormalities, resulting in an abnormal rate of 59.12%. There were 98 cases with abnormal chromosome numbers, including 67 cases with trisomy, 13 cases with X monomer, 17 cases with chimera (7 cases with trisomy 16 chimera), and 1 case with triploid. There were 9 cases of gene copy number variations, and the fragment variation ranged from 2.12 to 95.92 (37.32±24.57) Mb. According to different methods of conception, they were divided into a natural pregnancy group and an ART assisted pregnancy group. Out of the 73 cases in the ATR assisted pregnancy group, there were 40 abnormal cases, with an abnormal rate of 54.8%. Out of the 108 cases in the natural pregnancy group, there were 67 abnormal cases, with an abnormal rate of 62.0%. There was no statistically significant difference in the results of chorionic chromosome abnormality between the two groups (χ²=0.954, P=0.331). Conclusions　Chromosomal abnormalities are the primary factors contributing to early embryonic miscarriage, with numerical abnormalities being the major concern. It's worth noting that ART does not elevate the risk of spontaneous abortion. The application of the CNV-seq method to detect chromosomal variations in chorionic villi is of significant importance in unraveling the underlying causes of early spontaneous abortion.

Clinical study of combined treatment with creatine phosphate sodium for myocardial protection in endoscopic heart surgery 

Wu Liling, Zhang Wu, Li Yixia, Yang Kai, Liang Jielian, Du Chuchuan, Wen Xianjie, Hu Xudong, Zhong Zhiwen

2024, 30(10):  1652-1658.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.014

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Objective　To observe the effect of combined treatment of creatine phosphate sodium (CP) on myocardial ischemia and reperfusion injury in patients undergoing endoscopic heart surgery. Methods　A total of 36 patients who planned to undergo endoscopic heart surgery under cardiopulmonary bypass in the Second People's Hospital of Foshan and Affiliated Overseas Chinese Hospital of Jinan University from January 2022 to April 2023 were divided into a pre-treatment group, a post-treatment group, and a combined treatment group by the random number table method, with 12 case in each group. In the pre-treatment group, there were 8 males and 4 females, aged (58.33±12.35) years, cardiac function classification: grade III in 8 cases and grade IV in 4 cases. In the post-treatment group, there were 5 males and 7 females, aged (59.67±13.77) years, cardiac function classification: grade III in 7 cases and grade IV in 5 cases. In the combined treatment group, there were 7 males and 5 females, aged (59.92±11.29) years, cardiac function classification: grade III in 9 cases and grade IV in 3 cases. The patients underwent endoscopic mitral valve anaplasty or replacement under general anesthesia and cardiopulmonary bypass. In the pre-treatment group, 2.0 g of CP was injected intravenously before cardiopulmonary bypass, and 2.0 g of CP was added into the cardiopulmonary bypass solution. In the post-treatment group, 2.0 g of CP was injected into the cardiopulmonary bypass machine 5 min after aortic cross clamp release, and 2.0 g of CP was injected into the cardiopulmonary bypass machine before cease of cardiopulmonary bypass. In the combined treatment group, 1.0 g of CP was injected intravenously before cardiopulmonary bypass, 1.0 g of CP was added into the cardiopulmonary bypass solution, 1.0 g of CP was injected into the cardiopulmonary bypass machine 5 min after aortic cross clamp release, and 1.0 g of CP was injected into the cardiopulmonary bypass machine before cease of cardiopulmonary bypass. The time of cardiopulmonary bypass, time of aortic cross clamp, time of cardiopulmonary bypass assistance, automatic cardiac beat recovery, and postoperative use of dopamine and epinephrine were compared among the three groups. The levels of blood creatine kinase isoenzyme (CK-MB), cardiac troponin I (cTnI), and brain natriuretic peptide (BNP) were compared among the three groups before surgery, at the end of surgery, and 1 d and 2 d after surgery. F test, LSD test, χ² test, Fisher exact probability method, and rank sum test were used. Results　The proportion of epinephrine use within 48 h after surgery in the combined treatment group (1/12) was lower than that in the pre-treatment group (6/12) and post-treatment group (5/12), with a statistically significant difference (P<0.05). At the end of surgery, the level of CK-MB in the combined treatment group [(12.14±4.98) U/L] was lower than that in the pre-treatment group [(17.51±5.14) U/L], with a statistically significant difference (P<0.05). One d and 2 d after surgery, the levels of CK-MB in the combined treatment group [(27.17±11.25) U/L and (17.10±8.27) U/L] were lower than those in the pre-treatment group [(37.58±11.15) U/L and (26.46±8.98) U/L] and post-treatment group [(39.54±14.27) U/L and (24.28±7.07) U/L], with statistically significant differences (all P<0.05). At the end of surgery, the level of cTnI in the combined treatment group [(4.65±1.07) μg/L] was lower than that in the pre-treatment group [(5.86±0.99) μg/L], with a statistically significant difference (P<0.05). One d and 2 d after surgery, the levels of cTnI in the combined treatment group [(6.54±0.86) μg/L and (6.24±1.10) μg/L] were lower than those in the pre-treatment group [(8.02±1.04) μg/L and (7.22±1.07) μg/L] and post-treatment group [(9.01±0.87) μg/L and (7.45±1.08) μg/L], with statistically significant differences (all P<0.05). The BNP level of the combined treatment group [(168.64±20.19) ng/L] was lower than that of the pre-treatment group [(185.65±25.13) ng/L] 1 d after surgery, with a statistically significant difference (P<0.05). The BNP level of the combined treatment group [(134.77±22.14) ng/L] was lower than that of the pre-treatment group [(169.33±26.07) ng/L] and post-treatment group [(157.10±28.16) ng/L] 2 d after surgery, with statistically significant differences (both P<0.05). Conclusion　The combined treatment with CP is more effective on reducing myocardial ischemia and reperfusion injury during endoscopic heart surgery when compared to pre-treatment or post-treatment with CP.

Effect of Zigan Bushen Runmu Decoction combined with acupuncture and sodium hyaluronate eye drops in xerophthalmia

Wu Yini, Wei Wenjuan, Wu Xuemei, Han Zhihua

2024, 30(10):  1659-1663.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.015

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Objective　To analyze the effect of Zigan Bushen Runmu Decoction combined with acupuncture and sodium hyaluronate eye drops in xerophthalmia. Methods　A total of 120 patients with xerophthalmia admitted to Shaanxi Provincial Hospital of Chinese Medicine were enrolled between May 2020 and May 2023. According to the random number table method, they were divided into a control group (60 cases) and a combination group (60 cases). In the control group, there were 32 males and 28 females, aged (42.58±3.15) years, and the course of disease was (4.21±1.13) months. In the combination group, there were 34 males and 26 females, aged (43.46±3.27) years, and the course of disease was (4.09±1.09) months. The control group was treated with sodium hyaluronate eye drops, and the combination group was treated with Zigan Bushen Runmu Decoction and acupuncture on the basis of the control group for 2 weeks. The clinical curative effect and incidence of adverse reactions during treatment were compared between the two groups. The ocular symptom score, TCM syndrome score, tear film breakup time (BUT), Schirmer's I Test (SIT), and corneal fluorescein staining (FL) score were compared before and after treatment. t test and χ² test were used. Results　The total clinical response rate of the combination group was higher than that of the control group [93.33% (56/60) vs. 80.00% (48/60)], with a statistically significant difference (χ²=4.615, P=0.032). After 2 weeks of treatment, the scores of ocular symptoms (eye drying, foreign body sensation, and fatigue) and TCM syndromes (dry mouth, dizziness and tinnitus, soreness and weakness of waist and knees, and insomnia and dreaminess) in the combination group were lower than those in the control group (t=15.123, 8.527, 10.752, 14.267, 6.734, 16.780, and 8.226, all P<0.001). After treatment, the BUT of the combination group was longer than that of the control group [(11.17±1.12) s vs. (7.74±0.73) s], the SIT was higher than that of the control group [(13.71±1.38) mm vs. (9.55±1.07) mm], and the FL score was lower than that of the control group [(4.07±0.42) points vs. (4.68±0.51) points], with statistically significant differences (t=19.873, 18.453, and 7.152, all P<0.001). There was no statistically significant difference in the total incidence of adverse reactions between the two groups (χ²=1.878, P=0.171). Conclusion　The clinical effect of Zigan Bushen Runmu decoction combined with acupuncture and sodium hyaluronate eye drops is better than that of sodium hyaluronate eye drops, which can significantly improve the clinical eye symptoms, reduce the TCM syndrome scores, improve the tear film stability, and does not increase the incidence of clinical adverse reactions.

Basic Research

Mechanism of alleviating neuropathic pain in rats by inhibiting the expression of P38MAPK signaling pathway

Zhang Zhifeng, Yan Wenlu, Xia Ziwei

2024, 30(10):  1664-1667.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.016

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Objective　To explore the mechanism of alleviating neuropathic pain in rats by inhibiting the expression of P38 mitogen-activited protein kinase (P38MAPK) signaling pathway. Methods　Sixty male specific pathogen-free (SPF) grade rats were selected (body weight 200 - 220 g, about 3 months old), among them 10 rats were randomly selected as a sham operation group, and the remaining rats were used to establish a chronic compressive injury (CCI) model. The rat models [the success rate of modeling was 80% (40/50)] were randomly divided into a model group and a P38MAPK inhibitor group. On the 6th day after modeling, normal saline and P38MAPK inhibitor were injected into the sheath twice a day for consecutive 5 days. The mechanical pain threshold and motor function score of the rats in each group were measured 1, 7 and 11 days after operation. The rats were euthanized on the 11th day after operation, and the expressions of P38MAPK and cyclooxygenase-2 (COX-2) protein in the dorsal root ganglia of the rats were determined by the immunohistochemical method. The measurement data were analyzed by repeated measure ANOVA. Results　There was no significant change in the mechanical pain threshold in the sham operation group; the pain threshold level of the model group significantly decreased on the 7th day and to the lowest level on the 11th day after operation; the pain threshold level in the P38MAPK inhibitor group decreased on the 7th day and significantly increased on the 11th day after operation (P<0.05), which was higher than that in the model group (P<0.05). The model group and the P38MAPK inhibitor group showed significant motor dysfunction on the 7th day after operation; the degree of motor dysfunction in the model group increased on the 11th day, but the degree of motor dysfunction in the P38MAPK inhibitor group decreased on the 11th day (P<0.05), whose motor function score was lower than that of the model group (P<0.05). The expression of P38MAPK immune positive cells in the sham operation group was lower than that in the P38MAPK inhibitor group and lower than that in the model group [(7.35±0.63)% vs. (25.36±1.85)% vs. (60.23±2.17)%] (P<0.05); the expression of COX-2 protein-positive cells in the sham operation group was lower than that in the P38MAPK inhibitor group and lower than that in the model group [(5.21±2.23)% vs. (15.14±2.01)% vs. (33.43±3.02)%] (P<0.05). Conclusion　The P38MAPK signaling pathway is related to the occurrence of neuropathic pain, and inhibiting the expression of P38MAPK signaling pathway can alleviate neuropathic pain in rats.

Clinical Research

Analysis of the clinical efficacy of budesonide combined with reduced glutathione in the treatment of acute exacerbation of chronic obstructive pulmonary disease in the elderly

Ma Ziyue, Wang Gang, Bai Xiaorui

2024, 30(10):  1668-1672.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.017

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Objective　To analyze the clinical efficacy of budesonide combined with reduced glutathione in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the elderly. Methods　The clinical data of 85 elderly patients with AECOPD treated in the First Hospital of Yulin from May 2021 to December 2023 were retrospectively analyzed, who were divided into an observation group (42 cases) and a control group (43 cases) according to different treatment methods. In the control group, there were 22 males and 21 females, aged (72.13±4.51) years, and the duration of chronic obstructive pulmonary disease (COPD) was (6.78±1.94) years. In the observation group, there were 28 males and 14 females, aged (73.56±4.97) years, and the duration of COPD was (6.22±1.35) years. The control group was treated with intravenous drip with reduced glutathione (1.5 g), once a day; on the basis of the control group, the observation group was treated with budesonide aerosol inhalation, 1-2 in halations each time, twice a day. Both groups were treated for 14 d. The lung function, clinical efficacy, oxidative stress indexes, blood gas analysis indexes, serological indexes, and adverse reactions were compared between the two groups. χ² test and t test were used. Results　The total effective rate of the observation group was higher than that of the control group [90.48%% (38/42) vs. 72.09% (31/43)], with a statistically significant difference (χ²=4.699, P=0.030). After 14 d of treatment, the levels of forced expiratory volume in the first second (FEV₁), peak expiratory flow, FEV₁/forced vital capacity (FVC), superoxide dismutase (SOD), and arterial blood oxygen partial pressure (PaO₂) in both groups were increased (all P<0.05), and those in the observation group were higher than those in the control group (all P<0.05). The levels of malondialdehyde (MDA), arterial partial pressure of carbon dioxide (PaCO₂), serum transforming growth factor-β (TGF-β), matrix metalloproteinase-9 (MMP-9), and soluble myeloid cell trigger receptor-1 (sTREM-1) in both groups were decreased (all P<0.05), and those in the observation group were lower than those in the control group (all P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups (χ²=0.445, P=0.505). Conclusion　In elderly patients with AECOPD, reduced glutathione combined with budesonide has a significant effect, which can improve the arterial blood gas, quality of life, and lung function, regulate the serum sTREM-1 expression, and reduce the oxidative stress and inflammation, with good safety.

Effect of intravenous immunoglobulin combined with blue-purle light therapy on newborns with hemolytic jaundice

Zhai Meng, Jia Yang

2024, 30(10):  1673-1676.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.018

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Objective　To investigate the efficacy of intravenous immunoglobulin combined with blue-purle light therapy in the treatment of neonatal hemolytic jaundice and its effects on serum bilirubin level and cardiac and cerebral function. Methods　A total of 78 newborns with hemolytic jaundice admitted to Xianyang Hospital of Yan'an University from August 2018 to March 2023 were prospectively selected and were divided into an observation group and a control group by the random number table method, with 39 newborns in each group. In the control group, 21 boys and 18 girls, with a gestational age of (39.45±1.55) weeks, received blue-purle light therapy. In the observation group, 22 boys and 17 girls, with a gestational age of (39.52±1.60) weeks, received intravenous immunoglobulin (1 g/kg) combined with blue-purle light therapy. Both groups were treated for 7 days until the total bilirubin dropped to a safe level. The clinical efficacy, serum bilirubin (total bilirubin, direct bilirubin, and indirect bilirubin) levels, levels of neurological and myocardial injury markers [S100 calcium-binding protein B (S100B), neuron-specific enolase (NSE), creatine kinase (CK), and creatine kinase isoenzyme (CK-MB)], Bilirubin-Induced Neurological Dysfunction (BIND) score, and Neonatal Behavioral Neurological Assessment (NBNA) score were compared between groups. t test and χ² test were used. Results　After treatment, the total effective rate of the observation group was 94.87% (37/39), which was higher than that of the control group [79.48% (31/39)], with a statistically significant difference (χ²=4.129, P=0.042). The levels of total bilirubin, direct bilirubin, indirect bilirubin, S100B, NSE, CK, and CK-MB in the observation group were lower than those in the control group, with statistically significant differences (all P<0.05). The BIND score in the observation group was lower than that in the control group [(0.25±0.05) points vs. (0.38±0.09) points], but the NBNA score was higher than that in the control group [(38.78±1.53) points vs. (37.12±1.17) points], with statistically significant differences (t=8.564 and 5.845, both P<0.001). Conclusion　Intravenous immunoglobulin combined with blue-purle light therapy is significantly effective in the treatment of neonatal hemolytic jaundice, capable of reducing the bilirubin level and protecting the cardiac function in infants.

Curative effect of sacubitril valsartan combined with Qili Qiangxin capsules on dilated cardiomyopathy

Zhao Yun, Xing Xue, Dong Jing, Kang Qi

2024, 30(10):  1677-1681.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.019

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Objective　To explore the curative effect of sacubitril valsartan combined with Qili Qiangxin capsules on dilated cardiomyopathy (DCM) and its influences on myocardial fibrosis and ventricular remodeling (VR). Methods　A total of 62 patients with DCM admitted to Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine were enrolled as the research objects between January 2019 and January 2023. According to the random number table method, they were divided into a study group and a control group with 31 cases in each group. In the control group, there were 20 males and 11 females, aged (45.72±4.89) years, New York Heart Association (NYHA) cardiac function classification: 15 cases of grade II and 16 cases of grade III. There were 14 males and 17 females in the study group, aged (46.91±5.36) years, NYHA cardiac function classification: 12 cases of grade II and 19 cases of grade III. The control group was treated with cardiotonic, diuretic, β-blocker, aldosterone inhibitor, and sacubitril valsartan sodium, and the study group was treated with Qili Qiangxin capsules on the basis of the control group for 3 months. The clinical efficacy, left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-diastolic inner diameter (LVEDD), serum N-terminal pro-brain nitric peptide (NT-proBNP), laminin (LN), hyaluronic acid (HA), transforming growth factor-β1 (TGF-β1), 6 min walking distance (6MWD), and Generic Quality of Life Inventory-74 (GQOLI-74) score before and after treatment, and incidence of adverse reactions during treatment were compared between the two groups. Independent sample t test, paired sample t test, and χ² test were used. Results　The total effective rate of the study group was 93.55% (29/31), higher than that of the control group [74.19% (23/31)] (P<0.05). After treatment, the LVEF of the study group was higher than that of the control group [(47.11±5.68)% vs. (43.92±4.35)%], but the LVEDV and LVEDD were lower than those of the control group [(145.38±16.37) ml vs. (163.09±20.42) ml, (45.90±4.26) mm vs. (49.21±5.12) mm] (all P<0.05). After treatment, the levels of LN, HA, and TGF-β1 in the study group were lower than those in the control group [(153.82±11.24) µg/L vs. (186.31±14.73) µg/L, (165.48±16.75) µg/L vs. (197.06±19.62) µg/L, (36.91±3.77) µg/L vs. (40.52±2.63) µg/L] (all P<0.05). After treatment, the serum NT-proBNP level in the study group was lower than that in the control group [(827.95±76.13) ng/L vs. (932.74±59.25) ng/L], the GQOLI-74 score was higher than that in the control group [(89.61±3.17) points vs. (81.83±4.92) points], and the 6MWD was longer than that in the control group [(346.75±32.45) m vs. (308.26±29.71) m] (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions during treatment between the study group and the control group [19.35% (6/31) vs. 12.90% (4/31)] (P>0.05). Conclusion　Sacubitril valsartan combined with Qili Qiangxin capsules can improve the clinical curative effect on DCM, and effectively inhibit the VR and myocardial fibrosis.

Application of Jiawei Taohong Siwu Decoction combined with rivaroxaban in postoperative management of hip replacement surgery

Li Xiangyang, Yu Hongchao, Ma Hongsheng

2024, 30(10):  1682-1686.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.020

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Objective　To investigate the application effect of Jiawei Taohong Siwu Decoction combined with rivaroxaban after hip replacement surgery, and to evaluate its impact on postoperative thrombosis prevention, inflammation factor level, and complications. Methods　This study was a randomized controlled trial. A total of 120 patients undergoing hip replacement surgery in Baoji Hospital of Traditional Chinese Medicine from November 2019 to November 2023 were prospectively selected and were divided into an observation group (60 cases) and a control group (60 cases) by the random number table method. In the observation group, there were 30 males and 30 females, aged (65.25±10.33) years, and the course of disease was (4.72±1.15) years. In the control group, there were 28 males and 32 females, aged (63.96±10.87) years, and the course of disease was (4.68±1.13) years. The control group received rivaroxaban treatment, and the observation group was treated with a combination of Jiawei Taohong Siwu Decoction and rivaroxaban. The differences in coagulation function indexes [plasma prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), fibrinogen (FIB), and D-dimer (D-D)], hemorheological indexes (whole blood viscosity, plasma viscosity, hematocrit, erythrocyte rigidity index, and erythrocyte deformability index), pro-inflammatory cytokine [C-reactive protein (CRP)], complications, and deep vein thrombosis (DVT) were compared between the two groups before and 14 days after treatment. Independent sample t test, paired sample t test, and χ² test were used. Results　Before treatment, there were no statistically significant differences in various indexes between the two groups (all P>0.05). After 14 days of treatment, the PT [(15.79±2.33) s], TT [(19.05±3.12) s], and APTT [(30.21±4.07) s] in the observation group were all longer than those in the control group [(14.01±2.67) s, (15.52±2.79) s, and (27.33±3.49) s] (all P<0.05); the levels of FIB [(3.52±1.08) g/L] and D-D [(0.22±0.04) mg/L] in the observation group were lower than those in the control group [(4.09±1.06) g/L and (0.33±0.06) mg/L] (both P<0.05). After 14 days of treatment, the whole blood viscosity [(4.07±1.28) mPa·S], plasma viscosity [(1.48±0.43) mPa·S], hematocrit [(37.56±2.79)%], and erythrocyte rigidity index [(5.47±0.77)] in the observation group were lower than those in the control group [(4.65±0.27) mPa·S, (2.02±0.39) mPa·S, (42.06±2.17)%, and (6.23±0.84)] (all P<0.05); the erythrocyte deformability index in the observation group was higher than that in the control group [(0.84±0.03) vs. (0.74±0.07)] (P<0.05). After 14 days of treatment, the CRP level in the observation group [(4.25±1.09) mg/L] was lower than that in the control group [(7.97±2.14) mg/L] (P<0.05). Within 14 days after treatment, the total complication rate [13.33% (8/60)] and the positive rate of DVT [6.67% (4/60)] in the observation group were lower than those in the control group [25.00% (15/60) and 20.00% (12/60)] (both P<0.05). Conclusion　The combined application of Jiawei Taohong Siwu Decoction and rivaroxaban significantly prevents DVT after hip or knee replacement surgery, effectively improves the hemorheological parameters, inhibits the blood coagulation, and reduces the incidence of complications.

Clinical observation on the treatment of tubal infertility with warming kidney and promoting blood circulation method combined with uterine laparoscopy 

Liu Na, Jing Rui, Guo Jiayi

2024, 30(10):  1687-1692.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.021

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Objective　To investigate the effect of tubal infertility (TI) treated with warming kidney and promoting blood circulation method combined with uterine laparoscopy. Methods　A total of 112 TI patients admitted to Yan'an Traditional Chinese Medicine Hospital from February 2021 to August 2022 were selected for a prospective study and were divided into two groups with 56 cases in each group by the random number table method. In the control group, the age was (28.18±3.13) years old, the course of disease was (3.11±0.52) months, and there were 28 cases of unilateral obstruction, 9 cases of bilateral obstruction, and 19 cases of partial obstruction. In the study group, the age was (28.54±3.27) years old, the course of disease was (3.16±0.56) months, and there were 26 cases of unilateral obstruction, 10 cases of bilateral obstruction, and 20 cases of partial obstruction. The control group was treated with uterine laparoscopy, and the study group was treated with warming kidney and promoting blood circulation method on the basis of the control group. The total effective rate, TCM syndrome score, fallopian tube patency, inflammatory factor level [interleukin-4 (IL-4) and IL-6], ovarian function indexes [luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol (E₂)], pregnancy rate, and adverse reactions were compared between the two groups. Paired sample t test, independent sample t test, and χ² test were used. Results　The total effective rate of the study group [96.43% (54/56)] was higher than that of the control group [80.36% (45/56)] (P<0.05). After treatment, the TCM syndrome score of the study group was (10.01±1.28) points, which was lower than that of the control group [(14.15±1.96) points] (P<0.05). After treatment, the patency rate of fallopian tube in the study group was 96.43% (54/56), which was higher than that in the control group [82.14% (46/56)], with a statistically significant difference (P<0.05). After treatment, the levels of IL-4 and IL-6 in the study group were (5.09±0.72) ng/L and (4.62±0.63) ng/L, which were lower than those in the control group [(6.66±0.95) ng/L and (6.25±0.86) ng/L] (both P<0.05). After treatment, the LH and FSH levels in the study group were (7.42±1.21) IU/L and (5.33±0.82) IU/L, which were lower than those in the control group [(13.38±2.15) IU/L and (11.06±2.11) IU/L], but the E₂ level [(230.38±25.19) IU/L] was higher than that in the control group [(185.57±20.23) IU/L] (all P<0.05). After treatment, the pregnancy rate of the study group was higher than that of the control group [62.50% (35/56) vs. 42.86% (24/56)], with a statistically significant difference (P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups [5.36% (3/56) vs. 8.93% (5/56)] (P>0.05). Conclusion　The treatment of TI patients undergoing uterine laparoscopy by warming kidney and promoting blood circulation method can effectively improve their tubal function and regulate the levels of sex hormones, with ideal effect and high clinical application value.

Efficacy of Sanyinjiao warm acupuncture combined with exercise therapy on post-stroke depression patients

Li Xiaoxia, Qiang Xiaxia, Gao Xiangxiang

2024, 30(10):  1693-1697.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.022

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Objective　To explore the efficacy of Sanyinjiao warm acupuncture combined with exercise therapy in patients with post-stroke depression. Methods　A prospective study design was used. Eighty patients with post-stroke depression admitted to Xingyuan Hospital of Yulin from January 2020 to October 2023 were included. The patients were divided into two groups using the balloting method, with odd numbers assigned to the control group (40 cases) and even numbers to the experimental group (40 cases). There were 20 males and 20 females in the experimental group; the age was 48-72 (61.87±8.74) years old; the depression degree was mild in 20 cases and moderate in 20 cases; the type of stroke was cerebral infarction in 30 cases and cerebral hemorrhage in 10 cases. There were 21 males and 19 females in the control group; the age was 47-71 (60.13±8.49) years old; the degree of depression was mild in 19 cases and moderate in 21 cases; the type of stroke was cerebral infarction in 31 cases and cerebral hemorrhage in 9 cases. The control group received exercise therapy, and the experimental group received Sanyinjiao warm acupuncture in addition to exercise therapy, over a treatment course of 6 weeks. The changes in traditional Chinese medicine (TCM) symptom score, Montgomery-Asberg Depression Rating Scale (MADRS) score, levels of monoamine neurotransmitters [dopamine (DA), 5-serotonin (5-HT), and norepinephrine (NE)], Carroll Upper Extremity Functional Test (UEFT) score, Burke Lateropulsion Scale (BLS) score, Trunk Control Test (TCT) score, score of Borg scale for perceived exertion, Athens Insomnia Scale (AIS) score, and Hamilton Depression Rating Scale (HAMD) insomnia subsection score were compared between the two groups. Independent sample t test, paired sample t test, and χ² test were used. Results　After 6 weeks of treatment, the TCM symptom score [(7.39±2.13) points] and MADRS score [(11.58±1.53) points] of the experimental group were lower than those of the control group [(9.65±3.34) points and (13.34±1.60) points] (both P<0.05). The levels of DA [(74.08±7.60) ng/L], 5-HT [(280.96±34.85) μg/L], and NE [(45.44±6.51) μg/L] in the experimental groups were higher than those in the control group [(65.19±7.01) ng/L, (248.09±30.21) μg/L, and (37.21±5.48) μg/L] (all P<0.05). The UEFT score [(35.81±6.17) points] and TCT score [(75.34±16.55) points] in the experimental groups were higher than those in the control group [(23.42±3.63) points and (36.32±13.06) points] (both P<0.05). The BLS score [(4.85±1.86) points], AIS score [(4.64±1.36) points], and HAMD insomnia subsection score [(1.77±0.85) points] in the experimental groups were lower than those in the control group [(9.18±1.74) points, (6.52±1.63) points, and (2.62±0.83) points] (all P<0.05). The Borg scale score of the experimental group [(3.77±0.90) points] after walking was lower than that of the control group [(5.34±1.27) points] (P<0.05). Conclusion　Sanyinjiao warm acupuncture combined with exercise therapy significantly improves the TCM syndromes, emotional state, neurotransmitter level, upper limb function, trunk control ability, fatigue level, and sleep quality in patients with post-stroke depression, making it a valuable treatment option.

Study on early morning hypertension, cerebrovascular reserve function, and their correlation in 24 h ambulatory blood pressure monitoring in elderly population

Li Yun, Song Yunhong, Liang Yulian

2024, 30(10):  1698-1702.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.023

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Objective　To investigate the correlation between early morning hypertension and cerebrovascular reserve function (CVR) in elderly population during 24 h ambulatory blood pressure monitoring. Methods　A total of 300 elderly subjects who came to Jinan Maternal and Child Health Care Hospital for 24 h ambulatory blood pressure monitoring from January to December 2021 were retrospectively selected and were divided into group A, group B, and group C according to the monitoring results. There were 158 hypertensive patients with elevated blood pressure in the morning in group A, 88 males and 70 females, aged (66.02±4.35) years. There were 74 hypertensive patients with normal blood pressure in the morning in group B, including 41 males and 33 females, aged (65.42±4.42) years. There were 68 patients with normal blood pressure in group C, including 37 males and 31 females, aged (65.77±4.38) years. With the mean of breath holding index of bilateral middle cerebral artery <0.69% as reduced CVR, and the mean of breath holding index ≥0.69% as normal CVR, 300 subjects were divided into a CVR reduced group (52 cases) and a CVR normal group (248 cases). The clinical data and CVR indexes among group A, B, and C were compared, the general data of the CVR reduced group and the CVR normal group were compared, and unifactor analysis, multi-factor analysis, and correlation analysis were performed. F test, independent sample t test, χ² test, logistic regression analysis, and Pearson correlation analysis were used. Results　Among the 300 elderly subjects monitored for 24 h ambulatory blood pressure, there were 158 (52.67%) hypertensive patients with elevated blood pressure in the morning, 74 (24.67%) hypertensive patients with normal blood pressure in the morning, and 68 (22.67%) patients with normal blood pressure. The systolic blood pressure (24 h mean, daytime mean, and nighttime mean) and morning peak index of the 3 groups were as follow: group A > group B > group C (all P<0.05). The diastolic blood pressure (24 h mean, daytime mean, and nighttime mean) of the 3 groups were as follow: group A > group B and group C (all P<0.05), there were no statistically significant differences between group B and group C (all P>0.05). CVR: group A [(21.37±7.89)%] < group B [(25.58±8.14)%] < group C [(28.56±8.10)%] (all P<0.05). Breath holding index: group A [(0.89±0.23) %] < group B [(1.13±0.21) %] and group C [(1.20±0.24) %] (both P<0.05); there was no statistically significant difference in the breath holding index between group B and group C (P>0.05). Pulsation index: group A [(1.49±0.36)] > group B [(1.15±0.31)] and group C [(1.06±0.29)] (both P<0.05); there was no statistically significant difference in the pulsation index between group B and group C (P>0.05). In the CVR reduced group, the age [(73.14±3.21) years old], morning systolic blood pressure [(132.42±9.64) mmHg (1 mmHg=0.133 kPa)], and morning diastolic blood pressure [(68.85±6.59) mmHg] were higher than those in the CVR normal group [(64.28±4.36) years old, (121.58±7.26) mmHg, and (65.36±7.23) mmHg] (all P<0.05). Logistic regression analysis showed that age, morning systolic blood pressure, and morning diastolic blood pressure were all influencing factors for the decrease of CVR (all P<0.05). The morning systolic blood pressure was negatively correlated with breath holding index (P<0.05), and positively correlated with pulsation index (P<0.05). The morning diastolic blood pressure was negatively correlated with breath holding index (P<0.05), and positively correlated with pulsation index (P<0.05). Conclusions　In 24 h ambulatory blood pressure monitoring in elderly population, early morning hypertension patients had lower CVR and breath-holding index and higher pulsation index. Early morning systolic blood pressure and early morning diastolic blood pressure are negatively correlated with breath-holding index and positively correlated with pulsation index.

Analysis of findings of DCE-MRI combined with high B-value DWI in ovarian cancer patients

Tang Minli, Zhang Tao, Cai Lei, Liu Lianfeng, Bai Jiangtao, Ren Zhao, Yang Ningli, Ma Xuyang, Tang Haili

2024, 30(10):  1703-1707.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.024

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Objective　To investigate the findings of dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) combined with high B-value diffusion-weighted imaging (DWI) in patients with ovarian cancer. Methods　Clinical data of 50 patients diagnosed with ovarian cancer (observation group) admitted to Xianyang Hospital, Yan'an University from June 2020 to June 2023 were retrospectively analyzed, and 50 healthy controls during the same period were selected as the control group. The control group was (33.58±5.47) years old; the observation group was (33.37±5.53) years old, with 8 cases in stage Ⅰ, 25 cases in stage Ⅱ, 12 cases in stage Ⅲ, and 5 cases in stage Ⅳ according to the International Federation of Gynecology and Obstetrics (FIGO) stage. Both groups underwent DCE-MRI and high B-value DWI examination. The quantitative parameters of DCE-MRI, including volume transfer constant (Ktrans), rate constant (Kep), and extracellular volume fraction (Ve), were compared between the two groups. The apparent diffusion coefficient (ADC) of DWI was observed and compared between the two groups. The receiver operating characteristic curve (ROC) was plotted and the area under the curve (AUC) was calculated to evaluate the diagnostic efficacy of DCE-MRI combined with high B-value DWI in ovarian cancer patients. F test was used. Results　The values of Ktrans, Kep, and Ve in the observation group were (0.43±0.05) min, (0.85±0.13) min, and (0.75±0.25), which were higher than those in the control group [(0.07±0.06) min, (0.27±0.12) min, and (0.26±0.16)], and the ADC value of the observation group was (0.93±0.13) ×10^-3 mm²/s, which was significantly lower than that of the control group [(1.53±0.23) ×10^-3 mm²/s], with statistically significant differences (all P<0.05). The values of Ktrans, Kep, and Ve ranked as follow: stage Ⅳ > stage Ⅲ > stage Ⅱ > stage Ⅰ, and the ADC value ranked as follow: stage Ⅳ < stage Ⅲ < stage Ⅱ < stage Ⅰ, with statistically significant differences (all P<0.05). According to ROC analysis, the diagnostic sensitivity and specificity of DCE-MRI for different stages of ovarian cancer were 85.35% and 90.14%, the diagnostic sensitivity and specificity of high B-value DWI for different stages of ovarian cancer were 82.45% and 87.14%, and the diagnostic sensitivity and specificity of DCE-MRI combined with high B-value DWI for different stages of ovarian cancer were 94.14% and 95.85%. Conclusions　DCE-MRI combined with high B-value DWI examination has higher efficacy in ovarian cancer patients, which is significantly superior to single detection. When B-value is 1 600 s•mm^-2, combined DCE-MRI has higher sensitivity and specificity for clinical staging diagnosis of ovarian cancer. As an auxiliary means of clinical non-invasive diagnosis, the two examination methods can complement each other, avoiding misdiagnosis of ovarian cancer, have important clinical value for the patients' treatment and prognosis.

Effect analysis of gonadotropin-releasing hormone analogue in the treatment of idiopathic central precocious puberty in girls

Yu Yanmei, Yu Shujuan, Chen Qingfeng, Chen Xuebing

2024, 30(10):  1707-1711.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.025

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Objective　To investigate the effect of gonadotropin-releasing hormone analogue (GnRHa) in the treatment of idiopathic central precocious puberty (ICPP) in girls and its effects on body mass index and gonadal axis hormone levels. Methods　A total of 42 girls with ICPP diagnosed and treated in the growth and development department of Kaiping Central Hospital from March 2021 to May 2023, were selected as the study subjects. The age was (7.5±2.3) years old, and the duration of disease was (10.98±2.75) months. All children were treated with GnRHa, with triptorelin acetate for injection as the main therapeutic drug, intramuscular injection, every 28 to 32 days. The first, second, and third doses were 3.75 mg (the maximum dose was not more than 180 µg/kg), and children with higher body mass could be strengthened with 1 injection at an interval of 21 days. The GnRH simple stimulation test was performed on the 14th day after the third injection, and the dose was adjusted to 80 to 100 µg/kg according to the results of  luteinizing hormone (LH) peak (the maximum dose was not more than 3.75 mg). Their growth and development-related indicators such as height, body mass, bone age, and final adult height (FAH) were measured before treatment and 6 months after treatment. The changes in body mass index (BMI) and hormone levels such as follicle stimulating hormone (FSH), LH, and estradiol (E2) before and after treatment were compared. The changes in uterine volume, ovarian volume, and follicle diameter before and after treatment were observed, and the occurrence of adverse reactions was recorded. Wilcoxon signed rank sum test was used. Results　After 6 months of treatment, the secondary sexual characteristics of the children were significantly suppressed, including 8 children with menstrual withdrawal and 34 children with staged breast withdrawal. After 6 months of treatment, the height, body mass, bone age, and FAH of the children were all higher than those before treatment [131.1 (8.7) cm vs. 127.8 (8.2) cm, 29.5 (6.9) kg vs. 27.0 (5.5) kg, 9.4 (1.7) years vs. 9.0 (1.6) years, 157.4 (3.7) cm vs. 154.9 (2.8) cm] (Z=-5.648, -5.600, -5.713, and -5.125, all P<0.001); the standard deviation score of body mass index (BMISDS) had no significant change [16.7 (1.6) kg/m² vs. 16.5 (1.4) kg/m²] (Z=-0.356, P=0.682). After 6 months of treatment, both uterine volume and ovarian volume decreased [2.1 (1.6) ml vs. 3.1 (2.1) ml, 1.2 (0.9) ml vs. 2.0 (2.8) ml], and the follicle diameter decreased [3.0 (1.3) mm vs. 8.0 (2.3) mm] compared with those before treatment, with statistically significant differences (Z=-5.646, -5.579, and -5.622, all P<0.001). After three injections, the levels of E2, the peak of FSH activation, and the peak of LH activation were all lower than those before treatment [36.5 (10.0) pmol/L vs. 80.0 (44.8) pmol/L, 2.6 (3.6) U/L vs. 13.3 (9.3) U/L, 0.7 (0.3) U/L vs. 12.9 (11.6) U/L] (all P<0.001). One child developed fat streaks on the buttocks, and the other children did not complain of discomfort during the treatment; there were no abnormalities in blood routine, liver and kidney function, or other related indicators. Conclusion　The treatment of GnRHa in girls with ICPP can improve the FAH, has no significant effect on body mass index, and can inhibit the levels of gonadal axis hormones, which has good clinical efficacy and high safety.

Case Report

A case of systemic multiple metastatic malignant melanoma with obstructive jaundice as the first symptom and literature review

Guo Ningjie, Li Yangyang, He Shuang, Wen Feifei, Xu Xiaoyang, Wu Shuhua

2024, 30(10):  1712-1715.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.026

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Malignant melanoma is one of the most common and aggressive malignant tumors in clinical practice. It usually occurs in the skin and mucosa, and is prone to early metastasis. The common metastatic sites are liver, lung, lymph nodes, etc. Primary or metastatic gastrointestinal mucosal malignant melanoma is relatively rare. A case of Vater ampulla malignant melanoma with systemic multiple metastases in Binzhou Medical University Hospital is presented in this paper.

Pharmaceutical care for a child with severe pneumonia infected by MP combined with hMPV and SP

Duan Xiaoju, Bi Wenchao, Hou Jingjing, Wang Yan, Gu Yu, Liu Xianyong, Zheng Junqing

2024, 30(10):  1716-1719.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.027

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The clinical pharmacists participated in the pharmaceutical care of a child with severe pneumonia infected by Myocoplasima pneumonia (MP) combined with human metapneumovirus (hMPV) and streptococcus pneumonia (SP) throughout the entire process. In cases where the physicians ignored MP, used off-label drug, and violated traditional theory of drug combination with the complex disease, the clinical pharmacists timely provided safe and effective analyses and suggestions of the treatment plan, monitored the efficacies and adverse reactions, and provided medication guidance through searching for information and in-depth analyses of the disease situation. It ensured the safety and effectiveness of medication for the child effectively, provided the effective pharmaceutical services for clinical practice, and provided reference for drug treatment and care of such patients at the same time.

A case of primary liposarcoma of orbit and clinicopathological analysis

Liu Susu, Wang Nana, Chang Wenli, Si Hang, Shi Wenya, Zhang Qian

2024, 30(10):  1720-1725.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.028

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The paper reported a case of primary well-differentiated liposarcoma of orbit in Binzhou Medical University Hospital. The patient was a 52-year-old man with a 4-year history of mass growth in the left eye. Ocular examination revealed a sense of no light, orbital protrusion, inability to close the eyelids, displacement of the eyeball fixed above the temporal, and obvious conjunctival hyperemia and edema in the left eye. Imaging showed a large ellipselike mixed density shadow in the left orbit with clear boundary. Thus, an orbital tumorectomy was performed, and the diagnosis of well-differentiated liposarcoma was confirmed by histopathological examination.

A case of clear cell papillary renal cell tumor and literature analysis

Huang Yuhua, Liang Yinying, Huang Jun

2024, 30(10):  1726-1729.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.029

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Clear cell papillary renal cell tumor (CCPRCT) is a renal tumor with low malignant potential. This article retrospectively analyzed the clinical and radiographic data of middle-aged male patient with CCPRCT in the First Affiliated Hospital of Jinan University in August 2021 and reviewed the relevant literature.. Ultrasound showed a hypoechoic nodule at the upper pole of the left kidney, measuring about 3.8 cm × 2.6 cm × 3.0 cm, with clear borders, and a small patchy echogenic area within the nodule, part of the nodule protruding outside the kidney. Color Doppler flow imaging (CDFI) showed a little blood flow signal around the nodule. Contrast-enhanced ultrasound (CEUS) showed fast-forward and slow-retreat, inhomogeneous hyperenhancement. Magnetic resonance imaging (MRI) showed a lobulated mass at the upper pole of the left kidney, measuring about 4.0 mm × 2.9 mm × 2.7 mm, with clear borders and smooth edges, predominantly hyposignal on T1WI and equal-high signal on T2WI, with a honeycomb-shaped hypersignal foci and a low-signal component on T2WI within the mass. Enhancement scan showed obvious enhancement of the solid component in the arterial phase, slightly reduced enhancement in the equilibrium phase, and delayed enhancement slightly lower than normal renal parenchyma; the T2 low-signal strips within the mass were delayed enhancement, and the mass was unevenly high-signal on diffusion weighted imaging (DWI). MRI showed occupying lesions in the upper pole of the left kidney, which were considered to be a high probability of renal cancer.

Nursing Research

Summary of best evidence for thirst management in ICU adult patients receiving mechanical ventilation

Bian Hong, Yu Ping, Zhou Zhiyin, He Ping, Sun Qin

2024, 30(10):  1730-1734.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.030

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Objective　To summarize the evidence related to thirst management in ICU adult patients with mechanical ventilation, and to identify the best evidence. Methods　A systematic search was conducted on domestic and foreign databases for relevant literatures on thirst management in ICU adult patients with mechanical ventilation, including guidelines, clinical decisions, systematic reviews, evidence summaries, original studies, recommended practices, and best clinical practice information books. The search period was from the establishment of the databases to June 30, 2023. Two researchers were responsible for evaluating the quality of the included medical literature databases, PubMed, International Guide Library, China Guide Network, and the British National Institute for Health and Care Excellence (NICE) clinical research literatures, and were responsible for extracting evidence consistent with quality standards. Results　Finally, 10 pieces of evidences were included, including 4 systematic reviews, 3 randomized controlled trials (RCTs), 1 expert consensus, and 2 evidence summaries. A total of 16 best evidences were formed from six aspects: influencing factors, evaluation content, evaluation tools, intervention measures, effect evaluation, and personnel management of thirst in ICU adult patients with mechanical ventilation. Conclusions　In terms of clinical application evidences, it is necessary to evaluate the clinical conditions/environment of the hospitals, the positive and negative factors of doctors and nurses in applying evidences, and patients' preferences to carry out targeted evidence selection. In addition, as the best evidence continues to be updated over time, users should also continuously update the evidences and effectively respond to the thirst management issues of adult critically ill patients through scientific nursing methods, thereby promoting the improvement of nursing quality.

Effect analysis of functional training based on fragmentation time on patients with ankylosing spondylitis during the rehabilitation period

Gao Huan, Han Danying, Zhao Yan

2024, 30(10):  1735-1739.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.031

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Objective　To explore the effects of functional training based on fragmentation time on spinal joint motion and inflammatory cytokines in patients with ankylosing spondylitis. Methods　A randomized controlled trial was conducted on 109 patients with ankylosing spondylitis in the First Affiliated Hospital of Henan University of Science and Technology from April 2021 to September 2022. They were divided into two groups by the random number table method. In the control group, there were 37 males and 17 females, the age was (53.51±6.83) years old, the course of disease was (3.21±1.12) years, and the pain sites were peripheral joints in 18 cases, lumbar spine in 14 cases, and sacroiliac joint in 22 cases. In the observation group, there were 36 males and 19 females, the age was (54.13±6.62) years old, the course of disease was (3.33±1.21) years, and the pain sites were peripheral joint in 19 cases, lumbar spine in 15 cases, and sacroiliac joint in 21 cases. The control group was given routine functional training program, and the observation group was given functional training based on fragmentation time. The improvement of symptoms [Bath Ankylosing Spondylitis Functional index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), total joint Pain (Pain-VAS), and total joint Stiffness (Stiffness-VAS)], spinal joint mobility [scoliosis, modified Schober index (degree of lumbar flexion dysfunction), chest expansion degree, and cervical spine rotation], and inflammatory factors [C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and erythrocyte sedimentation rate (ESR)] were compared between the two groups. Independent sample t test, paired sample t test, and χ² test were used. Results　After intervention, the BASFI score, BASDAI score, Pain-VAS score, and Stiffness-VAS score in the observation group were lower than those in the control group [(3.87±0.58) points vs. (5.27±0.62) points, (3.17±0.46) points vs. (4.23±0.63) points, (1.27±0.56) points vs. (2.57±0.46) points, (1.73±0.43) points vs. (3.17±0.51) points], with statistically significant differences (t=12.177, 10.017, 13.254, and 15.948, all P<0.05). The scoliosis, modified Schober index, chest expansion degree, and cervical spine rotation in the observation group were higher than those in the control group [(17.36±0.77) cm vs. (13.28±0.65) cm, (4.85±0.18) cm vs. (3.91±0.17) cm, (4.55±0.17) cm vs. (3.61±0.15) cm, (58.73±1.96)° vs. (53.37±1.84)°], with statistically significant differences (t=29.866, 28.020, 30.590, and 14.714, all P<0.05). The levels of CRP, TNF-α, and ESR in the observation group were lower than those in the control group [(11.74±2.17) mg/L vs. (14.01±2.45) mg/L, (29.72±4.16) ng/L vs. (43.15±5.52) ng/L, (19.85±3.22) mm/h vs. (25.72±3.53) mm/h], with statistically significant differences (t=5.123, 14.325, and 9.073, all P<0.05). Conclusion　Functional training based on fragmentation time can effectively improve the clinical symptoms and spinal function in patients with ankylosing spondylitis, and reduce the levels of inflammatory factors.

Application of quality control circle in improving the awareness rate of closed drainage of thoracic cavity related knowledge in patients after cardiovascular surgery

Zhou Yingshan, Yang Yuanyuan, Li Wenhui, Li Shan, Ou Shuizhen, Cheng Yunqing

2024, 30(10):  1740-1745.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.032

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Objective　To investigate the application effect of quality control circle in improving the awareness rate of closed drainage of thoracic cavity related knowledge in patients after cardiovascular surgery. Methods　The quasi-experimental research method was adopted. A total of 60 patients after cardiovascular surgery, including 32 males and 28 females, who were hospitalized in the Department of Cardiac Surgery of Guangdong Provincial People's Hospital, Southern Medical University from June to July 2022 were selected as a control group. In order to address the status quo, the problems which urgently need to be improved were put forward, then the causes were analyzed, and the corresponding measures were took. A total of 60 patients after cardiovascular surgery, including 40 males and 20 females, who were hospitalized from February to April 2023, were selected as an observation group, and the quality control circle activities were carried out for them. After continuous strengthening of management in detail, we standardized implementation of each link, improved the status quo, then made a pre- and post-evaluation, and summarized the experiences of this activity. χ² test was used. Results　In the control group, 3 cases had excellent knowledge, 3 cases had good knowledge, 2 cases had fair knowledge, and 52 cases had poor knowledge. In the observation group, 37 cases had excellent knowledge, 11 cases had good knowledge, 7 cases had fair knowledge, and 5 cases had poor knowledge. The awareness rate of closed drainage of thoracic cavity related knowledge in the observation group was higher than that in the control group [91.67% (55/60) vs. 13.33% (8/60)], with a statistically significant difference (χ²=70.61, P<0.001). The nurses' mastery of closed drainage of thoracic cavity related knowledge in the observation group was higher than that in the control group (100.00% vs. 95.45%). Circle members' sense of responsibility, team spirit, communication skills, thoracic closed drainage and quality control circle related knowledge, problem-solving ability, and self-expression value had been improved. Conclusions　Quality control circle activities can improve the awareness rate of closed drainage of thoracic cavity related knowledge in patients after cardiovascular surgery, promote their recovery, and shorten their hospitalization period. For nurses, quality control circle can improve their relevant knowledge, thus provide patients with comprehensive, high quality, and safe nursing services. For hospitals and departments, it enhances the team cohesion, reduces the consumption of medical resources, lowers the medical costs, and improves the overall image of departments and hospitals.

Analysis of the effect of quality control circle activities on reducing the incidence of local pain of peripheral intravenous potassium supplementation

Zhong Lei, Ye Xiaorong, Liu Fangyun, Su Lishan

2024, 30(10):  1746-1751.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.033

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Objective　To explore the effect of quality control circle activities on reducing the incidence of local pain of peripheral intravenous potassium supplementation. Methods　A quality control circle activity group was established in December 2021 in the Second Affiliated Hospital of Guangzhou Medical University, and 124 patients undergoing peripheral intravenous potassium supplementation in our department from January to July 2022 were selected as the control group. There were 52 males and 72 females, aged (48.03±17.96) years, with a body mass of (52.81±8.72) kg. The current situation of pain incidence was investigated and the causes were analyzed by using a single dimension pain scale (oral 5-point scoring method), and the key points for improvement were determined. The target value was set and the countermeasures were formulated. Ninety-four patients undergoing peripheral intravenous potassium supplementation in our department from January to June 2023 were selected as the observation group. There were 32 males and 62 females, aged (51.39±18.98) years, with a body mass of (54.17±6.99) kg. The quality control circle activities were carried out and continuous quality improvement was made. The incidences of pain in the two groups were compared and the causes were analyzed. Statistical methods used were χ² test and t test. Result　The incidence of local pain in the observation group was lower than that in the control group [17.02% (16/94) vs. 48.39% (60/124)], with a statistically significant difference (χ²=23.16, P<0.05). Conclusion　Quality control circle activities can effectively reduce the incidence of local pain in patients undergoing peripheral intravenous potassium supplementation, and improve the patients' medical experience and satisfaction.

Evaluation of the application of comprehensive high quality nursing intervention in intraperitoneal hyperthermic perfusion chemotherapy for colon cancer

Chen Yanyan, He Jiali, Huang Yuhua

2024, 30(10):  1752-1756.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.034

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Objective　To study the clinical value of comprehensive high quality care intervention in colon cancer patients during intraperitoneal hyperthermic perfusion chemotherapy. Methods　A prospective study was conducted. A total of 100 colon cancer patients who underwent intraperitoneal hyperthermic perfusion chemotherapy in Guangzhou First People's Hospital from August 2022 to July 2023 were divided into two groups using the random number table method. In the control group, there were 28 males and 22 females, and the age was 42-76 (58.36±2.71) years old. In the observation group, there were 29 males and 21 females, and the age was 40-73 (58.15±2.58) years old. The control group received routine chemotherapy care, and the observation group received comprehensive high-quality nursing intervention. The cancer-related fatigue, pain degree, sleep qualities, psychological state scores, immune function, inflammatory response related indicators, incidences of adverse reactions, and nursing satisfaction were compared between the two groups before and after 7 days of nursing. Statistical methods used were t test and χ² test. Results　After nursing, the scores of Visual Analogue Scale (VAS), Pittsburgh Sleep Quality Index (PSQI), and Cancer-Related Fatigue Assessment Scale of the observation group were lower than those of the control group [(2.43±0.18) points vs. (4.16±0.25) points, (2.43±0.18) points vs. (7.16±1.25) points, (2.42±0.06) points vs. (5.16±0.17) points], with statistically significant differences (t=39.71, 26.48, and 107.47, all P<0.05). After nursing, the scores of Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) in the observation group were lower than those in the control group [(17.19±1.08) points vs. (33.52±1.64) points, (18.43±1.68) points vs. (32.16±2.05) points], with statistically significant differences (t=58.80 and 36.63, both P<0.05). The related indicators of immune function and inflammatory response in the observation group after nursing were better than those in the control group, with statistically significant differences (all P<0.05). The incidences of adverse reactions (immunosuppression, phlebitis, and gastrointestinal reactions) in the observation group were lower than those in the control group, with statistically significant differences (χ²=10.19, 7.11, and 13.56, all P<0.05). The nursing satisfaction of the observation group was higher than that of the control group [94.00% (47/50) vs. 80.00% (40/50)], with a statistically significant difference (χ²=4.33, P<0.05). Conclusion　Colon cancer patients receive comprehensive high quality nursing intervention during intraperitoneal hyperthermic perfusion chemotherapy, which helps to improve the immune function and sleep quality, control the pain, cancer-related fatigue, and inflammation, reduce the adverse reactions, and keep a good attitude, so as to improve the nursing satisfaction.

Study on the effect of voice training on postoperative voice recovery in patients with vocal cord polyps

Zhang Yarong, Wang Jin

2024, 30(10):  1757-1760.  DOI: 10.3760/cma.j.issn.1007-1245.2024.10.035

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Objective　To study the impacts of voice training on vocal function and hospital satisfaction degree after vocal cord polyp surgery, in order to analyze the overall treatment effect. Methods　This study was a randomized controlled trial. A total of 96 patients with vocal cord polyps admitted to Dongguan Houjie Hospital from June 2020 to December 2023 were divided into an observation group (48 cases) and a control group (48 cases) according to the random number table method. The control group, 25 males and 23 females, aged 35-68 (41.23±5.24) years, received routine nursing intervention after vocal cord polyp surgery. The observation group,22 males and 26 females, aged 33-66 (42.15±5.32) years, received voice training after vocal cord polyp surgery. The normalized noise energy (NNE), fundamental frequency perturbations (Jitter), amplitude perturbations (Shimmer), and overall patient satisfaction were recorded and analyzed before intervention and 1 week after intervention. Statistical methods used were χ² test and t test. Results　After intervention, the scores of five items of voice disorder index of the observation group ("It is difficult for others to hear my voice", "hoarse vocal cords limit my social life", "I feel that I can't keep up in conversation", "my voice sounds hoarse and dry", and "I feel that I am less outgoing than before") were all lower than those of the control group, with statistically significant differences (t=3.57, 4.90, 4.35, 7.70, and 2.24, all P<0.05). The NNE, Jitter, and Shimmer of the observation group were lower than those of the control group [(-9.62±4.28) points vs. (-11.45±3.18) points, (0.23±0.06) points vs. (0.33±0.08) points, (1.25±0.44) points vs. (1.78±0.65) points], with statistically significant differences (t=2.18, 6.37, and 3.12, all P<0.05). The overall patient satisfaction in the observation group was higher than that in the control group [85.42% (41/48) vs. 58.33% (28/48)], with a statistically significant difference (χ²=3.49, P<0.05). Conclusion　Voice training can effectively improve the laryngeal function in patients with vocal cord polyps, alleviate the voice disorders, and restore the voice function, with high overall patient satisfaction, which has high promotion and application value.