Table of Content

15 June 2024, Volume 30 Issue 12

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New Medical Advances

Research progress of enhanced external counterpulsation in cardiac rehabilitation

Shen Guzhuo, Chen Yanli, Li Xiufen

2024, 30(12):  1937-1941.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.001

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Cardiac rehabilitation is a comprehensive treatment that helps to reduce the risk of myocardial ischemia and improve the patients' quality of life. In addition, cardiac rehabilitation can also relieve the patients' negative emotions, help the patients improve self-cognition and emotional regulation ability, and promote the mental health. As an important means of cardiac rehabilitation, external counterpulsation has a positive impact on patients' long-term survival and quality of life by increasing coronary artery perfusion pressure, improving the function of cardiovascular system, and reducing the risk of cardiovascular disease and the rate of re-hospitalization and other prognostic indicators. This article discusses the research progress of enhanced external counterpulsation in cardiac rehabilitation from several aspects of clinical application and mechanism.

Research progress of Claudin18.2 in solid tumors

Zheng Xiaoyi, Lin Danxia

2024, 30(12):  1941-1945.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.002

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For malignant solid tumors, we use surgery, radiotherapy, chemotherapy, and other treatments to improve the patients' survival rate, but the application of chemotherapy drugs has the disadvantages of low selectivity and toxicity and side effects. Through research, the efficacy of targeted drugs has shown good prospects. Claudin18.2 is a unique molecule for different malignant solid tumors, and targeted therapy for Claudin18.2 is the most promising research hotspot. This study reviews the research progress of Claudin18.2.

Current status of CT in evaluating the progression and prognosis of GGNs of the lung

Li Zhaohui, Huang Ranran, Huang Qiaolu, Yi Yongjie, Jiang Xingyue, Zhang Guowei

2024, 30(12):  1945-1949.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.003

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In recent years, with the continuous development of medical imaging technology, the detection rate of ground glass nodules (GGNs) has increased year by year, and has been widely concerned. GGNs are not only seen in benign diseases, but also are early manifestation of lung adenocarcinoma. Compared with solid nodules, GGNs have a variety of imaging manifestations and a different pace of development, which leads to a great controversy in clinical treatment. This paper evaluates the benign and malignant progression and prognosis of GGNs　of the lung based on different CT imaging methods, and summarizes the malignant progression prediction of GGNs of the lung in imaging aspects, which is helpful for clinicians to make accurate judgments in the screening, follow-up, and later treatment of GGNs of the lung.

Progress in endovenous treatment of thrombotic iliac vein compression syndrome 

Ye Feiting, Yan Leilei, Zhang Chengde

2024, 30(12):  1950-1954.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.004

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Thrombotic iliac vein compression syndrome (TIVCS) is caused by iliac vein compression, resulting in iliac vein return obstruction and blood stasis, followed by ipsilateral lower extremity deep venous thrombosis (LEDVT). Without effective treatment, it can lead to pulmonary embolism in the acute stage, seriously endangering the life and health, and may develop into lower extremity post thrombotic syndrome (PTS) in the later stage, which seriously affect the quality of life. At present, endovenous treatment is the main therapy, including inferior vena cava filter (IVCF) implantation, catheter directed thrombolysis (CDT), percutaneous mechanical thrombectomy (PMT), balloon angioplasty, and stent implantation. However, there is still controversy about the timing of iliac vein stenosis treatment, and there is no unified standard. Therefore, this article reviews the progress of endovenous treatment for TIVCS.

Basic Research

Study on the mechanism of T cell dysfunction alleviated by Picria felterrae extractive in burn sepsis mice model

Wang Wei, Zhang Wenqi

2024, 30(12):  1955-1960.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.005

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Objective　To explore whether the Picria felterrae extractive (PFE) can alleviate the symptoms of mice with burn sepsis by regulating the FMS like tyrosine kinase 3 ligand (Flt3L) and its regulation effect on T cell function. Methods　The study was conducted from July 2022 to April 2023 at the animal experimental center of Ankang Traditional Chinese Medicine Hospital. According to the random number table method, 72 SPF male C57 mice [body mass 21 - 25 (22±2) g, 10 weeks old] were randomly divided into 6 groups: a burn group, a model group, low, middle, and high dose of PFE groups, and a positive group. The low, middle, and high dose of PFE groups were given 0.5 g/kg, 1.0 g/kg, and 2.0 g/kg of PFE on the next day after model preparation for 1 week. In the positive group, 10 μg of Flt3L was injected subcutaneously on the next day after model preparation for 9 days. The fluorescence intensity of the back skin was detected on day 1, 3, and 5 after administration; the levels of serum interleukin (IL)-6, IL-1β, tumor necrosis factor α (TNF-α), proliferation activity of peripheral blood T lymphocytes, changes of spleen T-lymphocyte subsets, histopathological changes of subcutaneous tissue, lung, and spleen, and expression levels of IL-2, IL-4, interferon-γ (IFN-γ), and Flt3L protein were detected. Univariate analysis of variance and SNK-q test were used for statistical analysis. Results　Compared with the burn group, the fluorescence intensity of the wound bacteria in the model group was enhanced, and the levels of IL-6 [(59.44±5.41) μg/L vs. (23.47±3.29) μg/L], IL-1β [(80.47±6.83) μg/L vs. (32.74±4.36) μg/L], and TNF-α [(12.33±1.15) μg/L vs. (4.76±0.97) μg/L], pathology scores of wound tissue, lung tissue, and spleen tissue, IL-2, IL-4, and IFN-γ protein expressions, and CD8⁺T cell proportion [(65.33±5.68)% vs. (26.72±6.75)%] in the model group were all higher, but the T lymphocyte proliferation activity, CD3⁺T cell proportion [(34.55±3.29)% vs. (64.49±9.33)%], CD4⁺T cell proportion [(16.71±3.49)% vs. (48.18±7.36)%], and CD4⁺/CD8⁺ [(0.26±0.06) vs. (1.81±0.35)] were all lower (all P<0.05). Compared with the model group, the fluorescence intensities of the wound bacteria in the low, middle, and high dose of PFE groups and the positive group were weakened, and the levels of IL-6, IL-1β, and TNF-α, pathology scores of wound tissue, lung tissue, and spleen tissue, IL-2, IFN-γ, and IL-4 protein expressions, and CD8⁺T cell proportion were all lower, but the T lymphocyte proliferation activity, CD3⁺T, CD4⁺T, and CD4⁺/CD8⁺ were all higher, in dose-dependent manners (all P<0.05). Conclusion　PFE can reduce the bacterial content of infected wound, inflammation, and organ damage, and the mechanism may be related to up-regulation of Flt3L, promotion of T lymphocyte activity, and remission of immunosuppression.

Treatises

Application of Jin's three-needle combined with goal-activity-exercise environment training in infants with high-risk of cerebral palsy 

Li Xiaobing, Zhao Jianli

2024, 30(12):  1961-1965.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.006

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Objective　To observe the clinical effect of Jin's three-needle combined with early goal-activity-exercise environment training on infants with high-risk of cerebral palsy, and to provide new treatment ideas for the treatment of infants with high-risk of cerebral palsy. Methods　This study was a randomized controlled trial. A total of 80 infants with high-risk of cerebral palsy admitted to the Children's Health Department of Xi'an People's Hospital from May 2021 to January 2023 were divided into an observation group (40 cases) and a control group (40 cases) according to the random number table method. In the observation group, there were 19 boys and 21 girls, aged (4.09±0.89) months. In the control group, there were 22 boys and 18 girls, aged (4.25±0.74) months. The control group received basic rehabilitation and early goal-activity-exercise environment treatment. Basic rehabilitation was Rood therapy and Bobath therapy, which were mainly neurodevelopmental treatment, 40 min each time, once a day, 5 times a week, for 6 months. The observation group was treated with Jin's three-needle therapy on the basis of the control group, acupuncture once every 2 days, 3 times a week, 3 months as a course of treatment, and the curative effect was observed after 2 courses of treatment. The changes of scores of Gross Motor Function Measure (GMFM), Fine Motor Function Measure (FMFM), and Gesell Developmental Diagnosis Scale (GDDS) were observed before and after intervention in the two groups, and the infants' development status was observed by routine follow-up. t test and χ² test were performed. Results　Before treatment, there were no statistically significant differences in the scores of GMFM, FMFM, adaptive behavior, or language between the two groups (all P>0.05). After 3 and 6 months of treatment, the GMFM and FMFM scores in the observation group were (39.29±3.90) points, (49.79±3.16) points, (16.83±3.57) points, and (25.59±4.11) points, respectively, which were higher than those in the control group [(34.25±4.08) points, (45.69±3.17) points, (13.73±3.44) points, and (19.34±3.54) points], with statistically significant differences (t=5.648, 5.793, 3.955, and 7.287, all P<0.001). After 3 and 6 months of treatment, the scores of adaptive behavior and language in the observation group were (57.33±3.90) points, (69.72±4.76) points, (62.86±4.38) points, and (68.19±3.89) points, respectively, which were higher than those in the control group [(55.22±4.08) points, (65.21±4.17) points, (58.44±4.74) points, and (63.84±3.56) points], with statistically significant differences (t=2.364, 4.507, 4.331, and 5.217, all P<0.05). On the basis of corrected gestational age of 12 months, the proportion of normal development was 85.00% (34/40) in the observation group and 60.00% (24/40) in the control group, respectively, with a statistically significant difference between the two groups (χ²=6.270, P=0.012). Conclusion　Jin's three-needle combined with early goal-activity-exercise environment training has a significant effect on improving the motor and cognitive ability in infants with high-risk of cerebral palsy, and is of great significance for improving their growth and development.

Clinical study of treatment of early prosthetic joint infection after total hip arthroplasty by debridement, antibiotics, and implant retention combined with local perfusion of vancomycin

Pan Xi'an, Zhang Yuanjin, Zhang Guofu, Li Jun, Sun Farui, Zhou Dingkang, Liu Bingxia

2024, 30(12):  1966-1971.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.007

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Objective　To investigate the clinical efficacy of treatment of early prosthetic joint infection (PJI) after total hip arthroplasty (THA) with debridement, antibiotics, and implant retention (DAIR) combined with local perfusion of vancomycin into hip joint. Methods　A total of 21 patients with early PJI after the initial THA who received DAIR combined with local perfusion of vancomycin into their joint cavity in Department of Orthopaedics, Huangshi Central Hospital from July 2018 to May 2022 were enrolled. Among them, there were 11 males and 10 females, aged (67.05±11.04) years, all patients with PJI within 3 weeks after the initial THA, and the follow-up time was (18.95±4.07) months. The operation was performed by a fixed medical team, all operated by the same doctor, and DIAR surgery was used for debridement. Sensitive antibiotics were given intravenously within 2 weeks after surgery. The patients with culture negative could be given vancomycin intravenously, 0.5 g of which was given intravenously every 12 hours, and vancomycin solution was injected into the joint cavity once every 2 days (the protocol was 0.5 g of vancomycin powder dissolved in 60 ml of normal saline and pushed into the joint cavity by self-irrigating tube under sterile conditions). The joint fluid was retained and drug concentration in the joint cavity was monitored. Intravenous medication for 2 weeks was followed by oral antibiotics for 4 weeks. The Visual Analogue Scale (VAS) score and Harris Hip Score (HHS) were used to evaluate the pain and hip joint function. The white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were used as infection indicators, and differences in their levels before surgery and at the last follow-up were determined by paired t-test. Results　A total of 21 patients were enrolled; their age was (67.05±11.04) years old and 11 of them were male. All the patients were followed up for over 12 months, with a follow-up period of (18.95±4.07) months. The overall infection control rate was 90.5% (19 cases were cured and 2 cases failed). At the last follow-up, the VAS score was decreased compared with that before surgery [(1.62±0.67) points vs. (5.86±1.06) points], the HHS was increased compared with that before surgery [(77.92±7.72) points vs. (41.30±7.77) points], and the WBC, ESR, and CRP levels were all decreased compared with those before surgery [(5.04±0.86) ×10⁹/L vs. (10.62±1.02) ×10⁹/L, (19.00±8.08) mm/h vs. (65.57±18.00) mm/h, (5.86±1.80) mg/L vs. (57.05±19.16) mg/L], with statistically significant differences (t=13.766, -16.159, 17.654, 12.610, and 12.570, all P<0.001). Conclusion　DAIR combined with local perfusion of vancomycin into joint cavity can effectively control the hip joint infection and relieve the hip joint pain in patients with early PJI after THA.

Clinical efficacy of asymmetrical pedicle subtraction osteotomy for thoracolumbar kyphotic deformity in ankylosing spondylitis

Gao Haicong, Ma Yan

2024, 30(12):  1972-1976.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.008

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Objective　To analyze the clinical efficacy of asymmetrical pedicle subtraction osteotomy (APSO) in patients with thoracolumbar kyphotic deformity due to ankylosing spondylitis (AS). Methods　This retrospective analysis included 96 patients who underwent APSO for thoracolumbar kyphotic deformity due to AS in the Orthopedic Department of Tongchuan People's Hospital from November 2020 to November 2022. There were 62 males and 34 females, aged 18 to 45 years, with an average age of 24.02 years old. Among them, 49 had vertebral hypoplasia, 36 had incomplete vertebral segmentation, and 11 had mixed-type deformities. The surgery time was (4.15±0.74) hours, the blood loss was (1 055.00±20.41) ml, and the number of fused segments was (7.12±0.96). The follow-up period was 1 year. Standing anteroposterior and lateral radiographs were taken before surgery, half a year after surgery, and at the last follow-up. Coronal plane parameters [coronal Cobb angle and coronal balance distance (CBD)] and sagittal plane parameters [sagittal vertical axis (SVA), global kyphosis (GK), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), osteotomy vertebral angle (OVA), and angle of fused segments (AFS)] were measured to evaluate the corrective effect of the surgery. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to assess the pain level and functional disability. Paired t-test was used for statistical analysis. Results　Half a year after surgery and at the last follow-up, the coronal plane parameters (Cobb Angle and CBD) and sagittal plane parameters (SVA, GK, PT, SS, and LL) of the patients were improved compared with those before surgery (all P<0.05), but there were no statistically significant differences between those half a year after surgery and at the last follow-up (all P>0.05). The VAS and ODI scores at the last follow-up were lower than those before surgery [(2.27±2.31) points vs. (4.42±2.97) points, (10.74±9.84) points vs. (20.06±14.11) points], with statistically significant differences (t=5.599 and 5.308, both P<0.001). Only 7 patients experienced complications (3 cases of osteotomy vertebral dislocation, 2 cases of brachial plexus paralysis, and 2 cases of intraoperative dural tears). Conclusion　APSO provides a stable and effective correction for thoracolumbar kyphotic deformity in AS patients, significantly improving quality of life, and is worthy of clinical promotion.

Influencing factors of neonatal adverse outcomes with meconium-stained amniotic fluid

Zhou Bei, Zeng Huiqian, Zheng Zheng, Wang Lele, Yan Feng, Lai Yumian

2024, 30(12):  1977-1982.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.009

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Objective　To explore the impact of meconium-stained amniotic fluid on short-term outcomes in newborns delivered vaginally by primigravid women and analyze the influencing factors associated with neonatal adverse outcomes. Methods　A total of 3 113 primiparas delivered vaginally at term in singleton cephalic position in Guangzhou Women and Children's Medical Center of Guangzhou Medical University from February 1, 2022 to January 31, 2023 were included. The subjects were classified into two groups using propensity score matching: a normal amniotic fluid group (535 cases) and a meconium-stained amniotic fluid group (535 cases). In the normal amniotic fluid group, the maternal age was (31.12±4.17) years old, the gestational week was (39.67±0.86) weeks, and the body mass index was (25.88±2.91) kg/m². In the meconium-stained amniotic fluid group, the maternal age was (29.61±3.10) years old, the gestational week was (39.60±0.84) weeks, and the body mass index was (25.69±2.77) kg/m². According to whether the adverse outcomes were present, the newborns with meconium-stained amniotic fluid were further divided into a non-adverse outcome group (423 cases) and an adverse outcome group (268 cases). Univariate analysis was performed to analyze the clinical baseline characteristics, and multivariate logistic regression analysis were used to further explore the influencing factors of neonatal adverse outcomes. Results　Compared with the normal amniotic fluid group, the meconium-stained amniotic fluid group had a higher rate of admission to neonatal intensive care unit [6.2% (33/535) vs. 1.1% (6/535)] (χ²=19.399, P<0.001). The risk of neonatal adverse outcomes with meconium-stained amniotic fluid was associated with category Ⅱ/Ⅲ cardiocography, prolonged first stage of labor, and grade Ⅲ meconium staining (OR=4.536, 95%CI 2.818-7.301, P<0.001; OR=1.001, 95%CI 1.000-1.002, P=0.014; OR=3.756, 95%CI 2.112-6.680, P<0.001). Conclusions　Meconium-stained amniotic fluid in primiparas increases the rate of admission to neonatal intensive care unit for newborns; category Ⅱ/Ⅲcardiocography, grade Ⅲ meconium staining in amniotic fluid, and prolonged first stage of labor are associated with increased risk of short-term adverse outcomes in newborns.

Risk factors of catheter-related bloodstream infection in ICU patients and construction of risk prediction nomogram model

Wang Sujuan, Hai Yunting, Lu Xuegeng, Wang Xue, Qu Lin

2024, 30(12):  1982-1987.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.010

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Objective　To analyze the risk factors of catheter-related bloodstream infection (CRBSI) in intensive care unit (ICU) patients, and construct a risk prediction nomogram model and validate it. Methods　The case data of patients who underwent central venous catheter (CVC) in ICU of Inner Mongolia People's Hospital from January 1, 2020 to April 30, 2023 were collected, and the modeling group and validation group were established according to the EPV method. In the modeling group, there were 408 males and 252 females, aged 66.5 (54.0, 76.0) years, with the duration of catheter retention of 10 (5,17) days and the ICU stay of 12 (6,22) days. In the validation group, there were 114 males and 65 females, aged 66.0 (55.0, 75.0) years, with the duration of catheter retention of 10 (5,16) days and the ICU stay of 10 (5,22) days. Multivariate logistic regression analysis was used to analyze the risk factors of CRBSI in ICU patients of the modeling group, and the risk prediction nomogram model was drawn by R4.3.0 software. The model was verified internally and externally. The receiver operating characteristic curve (ROC), Calibration curve, and Hosmer-Lemeshow goodness of fit test were used to evaluate the discrimination, calibration, and fitting degree of the model. Non-parametric Wilcoxon test and χ² test were used. Results　Diabetes mellitus, hypoproteinemia, times of intubation ≥2, duration of catheter retention, and duration of antibiotic use were independent risk factors for CRBSI in ICU patients (all P<0.05). Hosmer-Lemeshow goodness of fit test results showed that the nomogram model fit well in the modeling group (χ²=3.466, P=0.902) and the validation group (χ²=1.723, P=0.988). Calibration curve analysis showed that the incidence of CRBSI predicted by the nomogram model was basically consistent with the actual incidence of CRBSI in the modeling group and the validation group. ROC analysis results showed that the area under the curve (AUC) of the nomogram model for predicting CRBSI was 0.872 [95%CI (0.824 - 0.920)] in the modeling group and 0.937 [95%CI (0.890 - 0.984)] in the validation group, respectively. Conclusion　The established nomogram model for predicting risk of CRBSI had good prediction value and application value, and could identify the high risk group of CRBSI in ICU patients effectively.

Analysis of rpoB gene mutation characteristics in 256 Gene Xpert MTB/RIF-positive pulmonary tuberculosis patients in Xi'an area

Cui Jian, He Zhiqing

2024, 30(12):  1988-1992.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.011

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Objective　To analyze the mutation characteristics of rpoB gene in 256 cases of rifampicin-resistant real-time fluorescence quantitative nucleic acid amplification test (Gene Xpert MTB/RIF) positive pulmonary tuberculosis in Xi'an area. Methods　Two hundred and fifty-six MTB strain strains were isolated from outpatients and inpatients with Gene Xpert MTB/RIF-positive pulmonary tuberculosis who visited Shaanxi Provincial Tuberculosis Control Hospital from June 2020 to June 2022. The strains were not collected repeatedly. They were from 174 sputum samples and 82 bronchoalveolar lavage fluid samples. The patients were (45.67±8.36) years old. The PCR products of rpoB gene of 256 rifampicin-resistant strains were analyzed by DNA direct sequencing. The 256 rifampicin-resistant strains were divided into low-, medium-, and high-resistant MTB strains according to the degree of rifampicin resistance, and the mutation sites of the three kinds of strains were compared by χ² test. Three rifampicin-resistant MTB strains were artificially induced, and the PCR products of rpoB gene were analyzed by DNA direct sequencing. Results　The sequencing report showed that 253 of the 256 rifampicin-resistant strains had rpoB locus mutation, and the mutation rate was 98.83% (253/256). There were 10 mutation types including C→T, T→G, C→G, A→T, C→A, A→G, G→A, G→T, T→C, and A→C. There were 14 amino acid codons including serine, leucine, alanine, histidine, tyrosine, glutamic acid, lysine, arginine, aspartic acid, proline, methionine, valine, isoleucine, and glycine, all of which were point mutations. The mutations of rifampicin-resistant strains were mainly concentrated at locus 531 [53.75% (136/253)] and 526 [23.32% (59/253)]. Other sites included locus 513, 516, 533, 515, 513, 532, 522, 511, 519, 518, and 533. Compared with those of low- [37.88% (25/66)] and medium-resistant MTB strains [37.04% (20/54)], the incidence of amino acid mutation at locus 531 of high-resistant MTB strains [66.91% (91/136)] was increased (χ²=22.154,P<0.001). There was no statistically significant difference in the incidence of amino acid mutation at locus 531 in low- and medium-resistant MTB strains (P>0.05). There was no statistically significant difference in the incidence of amino acid mutation at locus 526 among the low-, medium-, and high-resistant MTB strains [22.73% (15/66) vs. 25.93% (14/54) vs. 22.06% (30/136)] (χ²=0.331, P=0.847). Three artificially induced rifampicin-resistant MTB strains all had rpoB gene locus mutation. The mutation of low- and medium-resistant MTB strains were located at locus 526, and the mutation of high-resistant MTB strain was located at locus 531. Conclusions　The mutation rate of rpoB gene in Gene Xpert MTB/RIF-positive pulmonary tuberculosis patients in Xi'an area was high, mainly point mutations, mainly concentrated at locus 531 and 526. The 531 TCG→TTG mutation had the highest mutation frequency among the rpoB gene mutation types. The mutation of low- and medium-resistant MTB strains were located at locus 526, which was associated with high drug resistance.

Distribution and modification of Khorana score in hospitalized patients with malignant tumors

Gao Keqin, Qin Xiaochun, Liu Pengchuan

2024, 30(12):  1993-1998.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.012

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Objective　To investigate the distribution of Khorana score and risk factors of venous thromboembolism (VTE) in hospitalized patients with malignant tumors, and to explore the value of modified Khorana score model in predicting the risk of VTE in hospitalized patients with malignant tumors. Methods　The clinical data of 389 hospitalized patients with malignant tumors admitted to Weifang People's Hospital from November 2019 to October 2022 were retrospectively analyzed, including 233 males and 156 females, aged (57.95±11.71) years. The Khorana score was used to assess the risk of VTE, and the incidence of VTE was calculated. Independent sample t test, χ² test, logistic regression analysis, and receiver operating characteristic curve (ROC) were used for analysis. Results　Among the 389 patients, 19 occurred VTE, with an overall incidence of 4.88%. The proportions of the patients with Khorana score of 0, 1, 2, and ≥3 points were 36.25% (141/389), 37.79% (147/389), 19.54% (76/389), and 6.43% (25/389), respectively. The corresponding incidences of VTE were 2.84% (4/141), 4.08% (6/147), 7.89% (6/76), and 12.00% (3/25). The higher the Khorana score was, the higher the incidence of VTE was, but the difference was not statistically significant (χ²=4.936, P=0.177). The rates of Khorana score ≤2 points in the patients with or without drinking history were 95.16% (118/124) and 92.83% (246/265) (P<0.05). Coronary heart disease, high-risk VTE cancer, and high D-dimer were the risk factors for VTE in hospitalized patients with malignant tumors (OR=3.844, 2.010, and 1.102, all P<0.05), among which coronary heart disease was an independent risk factor (OR=4.048, P=0.023). The sensitivity, specificity, and Youden index of modified Khorana score for predicting the risk of VTE in hospitalized patients with malignant tumors were 68.421%, 68.378%, and 0.368 (P<0.01), respectively, and the area under the curve (AUC) was increased by 0.135 compared with the original score, with higher predicted value (Z=2.251, P=0.018). Conclusions　The higher the Khorana score, the higher the incidence of VTE, but its predictive value is not high. Coronary heart disease is an independent risk factor for VTE in hospitalized patients with malignant tumors. Modified Khorana score combined with D-dimer has a higher predictive value for the risk of VTE in in hospitalized patients with malignant tumors than the original score.

Observation of the sedative effects of different doses of dexmedetomidine combined with midazolam on children with mental disorders undergoing cranial magnetic resonance imaging 

Lei Yangang, Zhao Ningxia, Qiao Cheng, Li Yu

2024, 30(12):  1999-2003.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.013

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Objective　To evaluate the sedative effects of different doses of dexmedetomidine combined with midazolam on children with mental disorders undergoing cranial magnetic resonance imaging (MRI). Methods　This study was a randomized controlled trial. From January 2021 to October 2023, 84 children with mental disorders requiring cranial MRI at Xi'an Traditional Chinese Medicine Brain Disease Hospital were enrolled in this study, and were divided into two groups according to the random number table method. In the low-dose group, there were 23 boys and 19 girls, aged (5.95±0.93) years, 9 cases of autism, 7 cases of hyperactivity disorders, 7 cases of depression, 5 cases of anxiety disorders, and 14 other cases. In the high-dose group, there were 25 boys and 17 girls, aged (5.84±0.97) years, 8 cases of autism, 7 cases of hyperactivity disorders, 11 cases of depression, 6 cases of anxiety disorders, and 10 other cases. At 30 min before MRI examination, the low-dose group was given 2 μg/kg of dexmedetomidine via nasal drip and 0.1 mg/kg of midazolam via intravenous injection, and the high-dose group was given 3 μg/kg of dexmedetomidine via nasal drip and 0.1 mg/kg of midazolam via intravenous injection. The coordination (completion rate and incidence of agitation), vital signs at different time points (heart rate, blood pressure, and pulse oxygen saturation), sedation effects (modified Ramsay sedation scale scores 10, 20, 30, 40, and 50 min after administration), and adverse events were observed in the two groups. χ² test and t test were used. Results　There were no statistically significant differences in the examination completion rate or incidence of agitation between the low dose group and the high dose group [85.71% (36/42) vs. 90.48% (38/42), 21.43% (9/42) vs. 19.05% (8/42)] (χ²=0.045, P=0.500; χ²=0.074, P=0.786). There were no statistically significant differences in the heart rate, mean arterial pressure, or pulse oxygen saturation between the two groups before administration (all P>0.05). The heart rate and mean arterial pressure of the low-dose group were higher than those of the high-dose group 10 to 50 min after sedation (all P<0.05). The pulse oxygen saturation of the low-dose group was higher than that of the high-dose group 10 to 40 min after sedation (all P<0.05), and there was no statistically significant difference between the two groups 50 min after sedation (P>0.05). There was no statistically significant difference in the Ramsay score between the two groups 10 to 50 min after sedation (all P>0.05). The incidence of adverse events in the low dose group was lower than that in the high dose group [4.76% (2/42) vs. 19.05% (8/42)], with a statistically significant difference (χ²=4.086, P=0.043). Conclusion　Low-dose dexmedetomidine combined with midazolam administered nasally is safe and effective, suitable for children with mental disorders undergoing cranial MRI.

Effect of standardized follow-up monitoring mechanism on the growth and development of high-risk infants

Wang Li, Li Chen, Lyu Panpan, Cui Chuanying

2024, 30(12):  2004-2008.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.014

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Objective　By establishing the standardized follow-up monitoring mechanism for high-risk infants, the influence on the growth and development of high-risk infants was analyzed, and the basis for formulating reasonable nutrition support and early intervention strategies was provided. Methods　From January 2021 to January 2023, 260 high-risk infants were hospitalized in Binzhou Central Hospital. According to whether the high-risk infants returned to hospital regularly for follow-up, they were divided into a standardized follow-up group and a non-standardized follow-up group. In the standardized follow-up group, there were 170 high-risk infants, 78 boys and 92 girls, aged 12 (7,14) days, 112 cases with 1 high-risk factor and 58 cases with 2 high-risk factors. In the non-standardized follow-up group, there were 90 high-risk infants, 41 boys and 49 girls, aged 13 (7,15) days, 59 cases with 1 high-risk factor and 31 cases with 2 high-risk factors. The standardized follow-up group referred to regular return to the hospital after discharge according to the discharge follow-up schedule, and timely assessment and intervention measures were given according to the results of various examinations. In the non-standardized follow-up group, the infants did not return to the hospital regularly after discharge for follow-up and the number of lost visits was >3 times, but there were developmental assessment data at 4 time points of 2 weeks, 3 months, 6 months, and 12 months old. The physical development of high-risk infants at 6 months and 12 months old were compared between the two groups. The Neonatal Behavioral Neurological Assessment (NBNA) scores at 2 weeks and 4 weeks old were compared between the two groups. The Gesell development scale of 3-month old and 12-month old of high-risk infants were compared. The incidences of complications were compared between the two groups. t test, χ² test, and U test were used. Results　The body length, body weight, and head circumference of the high-risk infants in the standardized follow-up group were (70.4±7.8) cm, (8.7±1.6) kg, and (43.4±1.5) cm at 6 months old, and (78.3±6.4) cm, (11.4±1.5) kg, and (45.3±1.5) cm at 12 months old, respectively, which were higher than (62.8±8.7) cm, (7.6±2.3) kg, (41.4±1.1) cm, (76.6±7.6) cm, (10.7±1.9) kg, and (44.8±1.6) cm in the non-standardized follow-up group, with statistically significant differences (t=7.178, P<0.001; t=4.509, P<0.001; t=12.830, P<0.001; t=1.907, P=0.058; t=3.256, P=0.001; t=2.498, P=0.013). The NBNA scores of the high-risk infants in the standardized follow-up group were (36.67±2.18) and (38.59±1.61) points at 2 weeks and 4 weeks old, respectively, and those in the non-standardized follow-up group were (36.62±2.21) and (37.73±1.34) points, respectively. The NBNA scores of the two groups at 4 weeks old were higher than those at 2 weeks old, and the NBNA score of the standardized follow-up group at 4 weeks old was higher than that of the non-standardized follow-up group, with statistically significant differences (all P<0.05). At 3 months old, there were no statistically significant differences in the developmental retardation rates of gross motor, fine motor, adaptive behavior, language, or personal social between the two groups (all P>0.05). At 12 months old, the developmental retardation rates of the high-risk infants in both groups were significantly decreased, and the retardation rates of the high-risk infants in the non-standardized follow-up group were higher than those in the standardized follow-up group, with statistically significant differences (all P<0.05). The overall incidence of malnutrition and anemia in the standardized follow-up group was lower than that in the non-standardized follow-up group [5.8% (10/170) vs. 25.4% (23/90)], with a statistically significant difference (χ²=20.553, P<0.001). Conclusion　The establishment of standardized follow-up monitoring mechanism, sequential management of the growth and development of high-risk infants, and timely early intervention can promote their physical and neuropsychological development, which has important clinical significance in the growth and development of high-risk infants.

Clinical Research

Effect of heat-clearing and dampness-drying traditional Chinese medicine on the efficacy, gut microbiota, and immune function in patients with coronary heart disease and blood stasis syndrome

Zhang Yuanbo, Huang Jiaxin

2024, 30(12):  2009-2014.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.015

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Objective　This study aims to explore the effect of heat-clearing and dampness-drying traditional Chinese medicine (TCM) on improving coronary heart disease with blood stasis syndrome, as well as its influence on patients' gut microbiota and immune function regulation. Methods　This randomized controlled trial divided 106 patients with coronary heart disease and blood stasis syndrome, who were admitted to Affiliated Hospital of Shaanxi University of Chinese Medicine from February 2020 to July 2022, into an experimental group and a control group with the random number table method, with 53 patients in each group. The control group consisted of 31 males and 22 females, aged (58.84±7.16) years; the duration of coronary heart disease was (2.04±0.87) years; the cardiac function classification was grade Ⅱ in 32 cases and grade Ⅲ in 21 cases. The experimental group consisted of 28 males and 25 females, aged (59.23±8.82) years; the duration of coronary heart disease was (2.21±0.91) years; the cardiac function classification was grade Ⅱ in 29 cases and grade Ⅲ in 24 cases. All the patients were treated with conventional western medicine (basic treatment: betaloc 12.5 mg/time, twice a day; aspirin enteric-coated tablets 100 mg/time, once a day), and the experimental group was added with heat-clearing and dampness-drying TCM on this basis, for 4 weeks continuously. The clinical efficacy, TCM syndrome score, gut microbiota level, plasma endothelin-1 (ET-1), immune function, serum oxidative stress indicators, and incidence of adverse reactions were observed and compared between the two groups. Statistical methods included t test and χ² test. Results　After 4 weeks of treatment, the clinical effective rate of the experimental group was 92.45% (49/53), which was higher than that of the control group [77.36% (41/53)], with a statistically significant difference (χ²=4.711, P=0.030). The TCM syndrome score of the experimental group was lower than that of the control group [(16.54±2.56) points vs. (19.88±3.07) points], with a statistically significant difference (t=6.083, P<0.001). The levels of trimethylamine oxide (TMAO) and ET-1 in the experimental group were lower than those in the control group [(5.21±0.84) µmol/L vs. (6.04±1.01) µmol/L, (43.76±4.17) ng/L vs. (51.94±4.82) ng/L], but the total content of short-chain fatty acids (acetate, propionate, and butyrate) was higher than that in the control group [(24.97±2.46) µmol/g vs. (23.61±2.67) µmol/g], with statistically significant differences (t=4.600, P<0.001; t=9.344, P<0.001; t=2.727, P=0.008). After 4 weeks of treatment, the CD4⁺ and CD4⁺/CD8⁺ in the experimental group were higher than those in the control group [(44.79±4.17)% vs. (43.12±4.22)%, (1.82±0.32) vs. (1.56±0.29)], with statistically significant differences (t=2.049, P=0.043; t=4.383, P<0.001), but there was no statistically significant difference in the CD8⁺ between the two groups (P>0.05). After 4 weeks of treatment, the levels of superoxide dismutase (SOD) and total antioxidant capacity (T-AOC) in the experimental group were higher than those in the control group [(91.83±10.13) U/L vs. (84.72±9.67) U/L, (1.96±0.19) U/mg vs. (1.53±0.21) U/mg], but the MDA level was lower than that in the control group [(5.13±1.01) µmol/L vs. (7.27±1.06) µmol/L], with statistically significant differences (t=3.696, 11.054, and 10.641, all P<0.001). There was no statistically significant difference in the incidence of adverse drug reactions between the two groups during treatment (χ²=0.210, P=0.647). Conclusion　Heat-clearing and dampness-drying TCM can significantly improve the recovery effect in patients with coronary heart disease with blood stasis syndrome, regulate the balance of gut microbiota, enhance the immune function, and optimize the serum oxidative stress indicators, demonstrating good clinical application value.

Effect of warm needle acupuncture and fluticasone propionate nasal spray on allergic rhinitis

Sun Dunpo, Wang Yisong

2024, 30(12):  2015-2020.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.016

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Objective　To investigate the impact of integrating warm needle acupuncture with fluticasone propionate nasal spray on the immune function and sleep quality in individuals experiencing allergic rhinitis. Methods　A total of 462 patients with allergic rhinitis who received treatment in the outpatient department of acupuncture and moxibustion and the outpatient department of otolaryngology in Lianyungang Affiliated Hospital of Nanjing University of Chinese Medicine from May 2021 to October 2023 were selected as the study objects, and were divided into 3 groups with 154 cases in each group by the random number table method. There were 85 males and 69 females in the heated needle group, the age was (33.56±4.15) years old, and the course of disease was (2.35±0.73) years. There were 87 males and 67 females in the medication group, the age was (34.02±4.34) years old, and the course of disease was (2.37±0.54) years. There were 80 males and 74 females in the combined therapy group, the age was (33.89±4.26) years old, and the course of disease was (2.41±0.76) years. The heated needle group received warm needle acupuncture treatment, the medication group was given fluticasone propionate nasal spray, and the combined therapy group received both warm needle acupuncture and fluticasone propionate nasal spray treatment for one month. The clinical efficacies of the three groups were compared, along with inflammation markers and immune function before and after treatment. The nasal resistance, nasal ventilation area, and ciliary movement rate were measured before and after treatment. The sleep status and quality of life were assessed by the Pittsburgh Sleep Quality Index (PSQI) and Rhinitis Quality of Life Questionnaire (RQLQ). The occurrence of adverse reactions in patients was recorded. Analysis of variance, paired t test, and χ² test were used. Results　After treatment, the total effective rate of the combined therapy group [96.10% (148/154)] was higher than those of the heated needle group [83.77% (129/154)] and the medication group [81.82% (126/154)] (all P<0.05). The inflammatory indexes and nasal resistance of the combined therapy group were lower than those of the heated needle group and the medication group, but the immune function indexes, nasal ventilation area, and ciliary movement rate were better than those of the heated needle group and the medication group (all P<0.05). The PSQI score [(6.42±1.02) points] and RQLQ score [(39.52±5.03) points] of the combined therapy group were lower than those of the heated needle group [(9.30±1.52) points and (53.48±6.35) points] and the medication group [(9.35±1.48) points and (54.36±6.42) points] (all P<0.05). The total incidence of adverse reactions in the medication group [14.29% (22/154)] was higher than those in the heated needle group [2.60% (4/154)] and the combined therapy group [4.55% (7/154)] (all P<0.05). Conclusion　The combination of warm needle acupuncture and fluticasone propionate nasal spray has been shown to improve the clinical outcomes of allergic rhinitis patients, along with boosting their immune system performance and sleep quality.

Analysis of the therapeutic effect of Yuxue Bi tablets combined with warm needle acupuncture on patients with periarthritis of shoulder

Guo Ruixin, Gao Haozhe, Gao Xiangxiang

2024, 30(12):  2021-2025.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.017

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Objective　This study aimed to evaluate the effectiveness of Yuxue Bi tablets combined with warm needle acupuncture in improving shoulder function recovery and pain relief in patients with periarthritis of shoulder. Methods　This randomized controlled trial included 83 patients with periarthritis of shoulder treated at the Department of physiotherapy, Yulin Hospital of the First Affiliated Hospital of Xi'an Jiaotong University, from April 2020 to April 2023. The patients were randomly divided into a control group (41 cases) receiving warm needle acupuncture and an observation group (42 cases) receiving Yuxue Bi tablets combined with warm needle acupuncture, using envelope drawing method. The control group included 27 males and 14 females, the age was (55.84±5.21) years old, the course of disease was (7.91±0.91) months, and the position of shoulder periarthritis was on the left side in 17 cases and right side in 24 cases. The observation group included 31 males and 11 females, the age was (55.88±5.15) years old, the course of disease was (7.94±0.93) months, and the position of shoulder periarthritis was on the left side in 15 cases and right side in 27 cases. The clinical efficacy, shoulder joint function [Range of Motion (ROM) score], levels of pain mediators [serum 5-hydroxytryptamine (5-HT), prostaglandin E2 (PGE2), and substance P (SP)], and Traditional Chinese Medicine (TCM) syndrome scores (joint swelling, joint pain, joint aversion to cold, and joint heaviness) were compared between the two groups after 3 courses of treatment. Independent sample t test and χ² test were used. Results　After 3 courses of treatment, the total effective rate of the observation group [92.86% (39/42)] was higher than that of the control group [75.61% (31/41)], with a statistically significant difference (P<0.05). The anterior flexion [(127.97±13.54)°], abduction [(101.60±10.43)°], posterior extension [(36.26±3.67)°], internal rotation [(52.78±4.99)°], and external rotation range [(54.78±5.06)°] in the observation group were higher than those in the control group [(118.14±12.52)°, (90.18±9.58)°, (28.84±3.59)°, (43.82±4.76)°, and (45.82±4.58)°], with statistically significant differences (all P<0.05). The levels of 5-HT [(5.96±0.63) ng/L], PGE2 [(148.06±15.43) ng/L], and SP [(232.91±23.66) mg/L] in the observation group were lower than those in the control group [(9.52±0.94) ng/L, (184.18±18.50) ng/L, and (280.95±28.50) mg/L], with statistically significant differences (all P<0.05). The scores of joint swelling [(0.51±0.05) points], joint pain [(0.65±0.07) points], joint aversion to cold [(0.49±0.05) points], and joint heaviness [(0.89±0.08) points] in the observation group were all lower than those in the control group [(1.33±0.16) points, (1.72±0.14) points, (1.08±0.10) points, and (1.79±0.18) points], with statistically significant differences (all P<0.05). Conclusions　Yuxue Bi tablets combined with warm needle acupuncture can effectively improve the shoulder joint function and TCM symptom scores in patients with periarthritis of shoulder, and lower their pain mediator levels, thereby enhancing the clinical efficacy. This approach shows promising application prospects.

Clinical significance of DWI scanning combined with conventional MRI sequence examination in the diagnosis of neonatal hypoxic-ischemic encephalopathy

Ji Xiaoxiao, Wu Xia, Jia Rongrong

2024, 30(12):  2025-2029.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.018

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Objective　To explore the clinical significance of diffusion-weighted imaging (DWI) scanning combined with conventional magnetic resonance imaging (MRI) sequence examination in the diagnosis of neonatal hypoxic-ischemic encephalopathy (HIE). Methods　A total of 85 newborns with HIE who visited the Affiliated Hospital of Northwest University, Xi'an No.3 Hospital, from January 2020 to October 2023 were selected as the HIE group, and 85 healthy newborns were selected as the control group during the same period. There were 48 boys and 37 girls in the HIE group, with gestational age of 38-40 (39.23±0.65) weeks and birth weight of 2.21-4.13 (3.24±0.41) kg. There were 43 boys and 42 girls in the control group, with gestational age of 37-41 (39.03±0.84) weeks and birth weight of 2.19-4.06 (3.11±0.45) kg. The results of DWI scanning combined with conventional MRI sequence examination in the HIE group were analyzed, and the DWI parameters [the values of apparent diffusion coefficient (ADC) of brain tissue in the thalamus, centrum ovale majus, parietal white matter, lenticular nucleus, and posterior limb of the internal capsule] of the two groups were compared. The results of lesion detection in each sequence of conventional MRI were analyzed. The diagnostic efficacy of DWI scanning, conventional MRI sequence alone and in combination were compared. Independent sample t test and χ² test were used. Results　The ADC values of brain tissue in the thalamus [(0.84±0.05) mm²/s], centrum ovale majus [(1.04±0.12) mm²/s], parietal white matter [(1.14±0.04) mm²/s], lenticular nucleus [(0.76±0.04) mm²/s], and posterior limb of the internal capsule [(0.73±0.03) mm²/s] in the HIE group were lower than those in the control group [(1.16±0.08) mm²/s, (1.83±0.17) mm²/s, (1.68±0.16) mm²/s, (1.23±0.09) mm²/s, and (1.26±0.10) mm²/s] (all P<0.05). The diagnostic sensitivity of DWI scanning combined with conventional MRI sequence examination was 97.65% (83/85), which was higher than those of DWI scanning and conventional MRI sequence examination alone, and the missed diagnosis rate was 2.35% (2/85), which was lower than those of DWI scanning and conventional MRI sequence examination alone (all P<0.05). Conclusion　The combination of DWI scanning and conventional MRI sequence examination has a high sensitivity in the diagnosis of neonatal HIE and a low missed diagnosis rate, which can provide reliable basis for clinical diagnosis of HIE.

Efficacy of rituximab in the treatment of refractory primary IgA nephropathy

Yan Li, Wang Lizhen

2024, 30(12):  2030-2034.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.019

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Objective　To investigate the efficacy and safety of rituximab in the treatment of refractory primary immunoglobulin A (IgA) nephropathy. Methods　Seventy-three cases of refractory primary IgA nephropathy treated at Tongchuan People's Hospital and Xi'an International Medical Center Hospital from September 2021 to September 2023 were selected, and were divided into an experimental group of 38 cases and a control group of 35 cases based on the treatment methods. There were 19 males and 16 females in the control group, the age was (52.03±14.90) years old, the body mass index (BMI) was (23.17±1.25) kg/m², and the course of disease was (3.19±0.83) years. There were 23 males and 15 females in the experimental group, the age was (50.78±13.22) years old, the BMI was (23.52±1.17) kg/m², and the course of disease was (3.50±1.02) years. The control group was treated with oral methylprednisolone tablets combined with Tacrolimus capsules, and the experimental group received rituximab via intravenous infusion in addition to the treatment in the control group. After 3 cycles of treatment, the efficacy, adverse reactions, renal function [serum creatinine, 24 h urinary protein quantification, and estimated glomerular filtration rate (eGFR)], and immunological factors [IgA, IgG, and galactose-deficiency (Gd)-IgA1] were compared between the two groups. Independent sample t test, paired t test, and χ² test were used. Results　After 3 cycles of treatment, the levels of serum creatinine [(79.31±6.52) µmol/L] and 24 h urinary protein [(0.73±0.21) g] in the experimental group were lower than those in the control group [(83.06±7.14) µmol/L and (0.87±0.23) g], but the eGFR [(82.16±5.39) ml/(min·1.73 m²)] was higher than that in the control group [(79.04±5.51) ml/(min·1.73 m²)], with statistically significant differences (all P<0.05). After 3 cycles of treatment, the levels of IgA [(1.84±0.41) g/L] and IgG [(9.53±1.37) g/L] in the experimental group were higher than those in the control group [(1.53±0.38) g/L and (8.86±1.17) g/L], but the level of Gd-IgA1 [(6.23±0.95) mg/L] was lower than that in the control group [(7.01±1.59) mg/L], with statistically significant differences (all P<0.05). The total effective rate of the experimental group [89.47% (34/38)] was higher than that of the control group [65.71% (23/35)], with a statistically significant difference (P<0.05). There was no statistically significant difference in the total incidence of adverse drug reactions between the two groups (P>0.05). Conclusion　The combination of rituximab and Tacrolimus in the treatment of refractory primary IgA nephropathy has shown good efficacy and safety.

Diagnostic value of 3D-TOF-MRA combined with MRI detection for primary trigeminal neuralgia

Yi Huiyang, Wang Tongming

2024, 30(12):  2035-2039.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.020

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Objective　To explore the diagnostic value of three dimensional time of flight magnetic resonance angiography (3D-TOF-MRA) combined with magnetic resonance imaging (MRI) for primary trigeminal neuralgia (PTN). Methods　A total of 78 PTN patients who visited Henan Provincial Hospital of Traditional Chinese Medicine from March 2022 to January 2024 were collected. There were 36 males and 42 females, the age was 27-76 (50.84±10.47) years old, and there were 31 left side lesions and 47 right side lesions. The 3D-TOF-MRA imaging features were analyzed, and MRI parameters of the affected and healthy sides of the PTN patients were compared. The diagnostic results of different examination methods were statistically compared, and the diagnostic efficacy was further analyzed. Paired t test and χ² test were used. Results　The trigeminal root (TR) area and nerve pontine angle [(23.86±3.86) mm² and (39.62±6.75)°] on the affected side were smaller than those on the healthy side [(28.11±3.19) mm² and (44.13±7.31)°] (both P<0.05). There were no statistically significant differences in the TR length or the angle across the apex of the rock between the affected side and the healthy side (both P>0.05). The diagnostic sensitivity of 3D-TOF-MRA combined with MRI was 96.15% (75/78), which was higher than those of 3D-TOF-MRA [82.05% (64/78)] and MRI [78.21% (61/78)], and the missed diagnosis rate of 3D-TOF-MRA combined with MRI was 3.85% (3/78), which was lower than those of 3D-TOF-MRA [17.95% (14/78)] and MRI [21.79% (17/78)] (P<0.05). The Kappa values of 3D-TOF-MRA, MRI, and 3D-TOF-MRA combined with MRI in the diagnosis of PTN of different grades were all >0.6, but the Kappa value of 3D-TOF-MRA combined with MRI was the highest, which was 0.826 (all P<0.05). Conclusion　The combined diagnosis of 3D-TOF-MRA and MRI can significantly improve the diagnostic sensitivity of PTN, reduce the missed diagnosis rate, and has high consistency, which is beneficial for clinical selection of treatment plans and improvement of quality of life.

Effectiveness and safety of Levosimendan treatment in patients with acute heart failure

Guo Zhen, Wang Taoli, Li Naijie

2024, 30(12):  2039-2043.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.021

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Objective　This study aimed to evaluate the clinical application effect of Levosimendan in patients with acute heart failure (AHF). Methods　A total of 98 patients with AHF admitted to Tongchuan People's Hospital from January 2021 to October 2023 were included in this study and were randomly divided into two groups, with 49 patients in each group. There were 27 males and 22 females in the control group, the age was (67.14±6.65) years old, and the New York Heart Association (NYHA) grading was grade Ⅱ in 20 cases, grade Ⅲ in 15 cases, and grade Ⅳ in 14 cases. There were 28 males and 21 females in the observation group, the age was (66.57±6.64) years old, and the NYHA grading was grade Ⅱ in 19 cases, grade Ⅲ in 16 cases, and grade Ⅳ in 14 cases. The control group received standard treatment, and the observation group received standard treatment plus Levosimendan (intravenous injection), with a treatment period of 4 weeks. The duration of clinical symptoms (chest tightness and shortness of breath), myocardial enzyme levels [myeloperoxidase (MPO), N-terminal pro B-type natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), and matrix metalloproteinase 9 (MMP-9)], and cardiac function indicators [left ventricular diameter (LVD), left atrial diameter (LAD), Left ventricular short axis shortening fraction (LVFS), tricuspid annular plane systolic excursion (TAPSE), and heart rate (HR)] before and after treatment, as well as the occurrence of adverse reactions during treatment were compared between the two groups. Independent sample t test and χ² test were used. Results　After treatment, the duration of chest tightness [(1.82±0.37) min/time] and dyspnea [(1.68±0.39) min/time] in the observation group were shorter than those in the control group [(2.49±0.42) min/time and (2.59±0.41) min/time], with statistically significant differences (both P<0.05). The levels of MPO [(2.89±0.61) pg/L], NT-proBNP [(2.05±0.67) g/L], cTnI [(2.58±0.56) μg/L], and MMP-9 [(58.58±7.41) μg/L] in the observation group were lower than those in the control group [(4.36±0.83) pg/L, (4.69±1.54) g/L, (2.97±0.63) μg/L, and (90.64±8.84) μg/L], with statistically significant differences (all P<0.05). The levels of LVD [(40.44±4.84) mm] and LVFS [(31.41±2.54)%] in the observation group were higher than those in the control group [(32.65±4.64) mm and (22.63±3.68)%], while the levels of LAD [(29.89±3.38) mm], TAPSE [(15.85±3.03) mm], and HR [(69.85±8.23) beats/min] were lower than those in the control group [(37.65±4.65) mm, (17.59±3.13) mm, and (86.52±8.51) beats/min], with statistically significant differences (all P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups (P>0.05). Conclusion　Levosimendan shows good efficacy and safety in patients with AHF and can be considered an effective treatment option for this condition.

Effects of Levosimendan on myocardial ischemia and disease progression in patients with chronic heart failure

Tang Guangyao

2024, 30(12):  2044-2048.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.022

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Objective　To observe the effect of Levosimendan on myocardial function and disease progression in patients with chronic heart failure (CHF). Methods　This study was a randomized controlled trial. A total of 125 CHF patients admitted to Zhengzhou Seventh People's Hospital from May 2020 to March 2023 were selected and were divided into a conventional group (62 cases) and a combined group (63 cases) by the computer grouping method. In the conventional group, there were 30 males and 32 females, the age was 52-78 (65.44±5.18) years old, the course of CHF was 3-7 (5.25±1.33) years, the cardiac function classification was grade II in 33 cases and grade III in 29 cases, and the complications included hypertension in 35 cases and diabetes in 27 cases. There were 33 males and 30 females in the combined group, the age was 50-80 (65.75±5.33) years old, the course of CHF was 4-6 (5.31±1.28) years, the cardiac function classification was grade II in 32 cases and grade III in 31 cases, and the complications included hypertension in 38 cases and diabetes in 25 cases. The conventional group was treated with conventional medicine, and the combined group was treated with Levosimendan via intravenous injection combined with conventional medicine for 15 d. The changes in myocardial function [soluble growth stimulator expression gene 2 protein (sST2) and growth differentiation factor 15 (GDF-15)], myocardial fibrosis indicators [connective tissue growth factor (CTGF), laminin (LN), and hyaluronic acid (HA)], and cardiac function indexes [left ventricular ejection fraction (LVEF), stroke output (SV), and cardiac output (CO)] before and after treatment, as well as occurrence of adverse cardiovascular events within 3 months after treatment and medication safety were compared between the two groups. Independent sample t test, paired t test, and χ² test were used. Results　After treatment, the levels of sST2 [(86.24±10.35) μg/L] and GDF-15 [(814.36±50.25) ng/L] in the combined group were lower than those in the conventional group [(92.37±10.41) μg/L and (841.72±50.47) ng/L](both P<0.05), the levels of CTGF [(1.04±0.52) μg/L], LN [(103.52±10.32) μg/L], and HA [(95.15±10.36) μg/L] in the combined group were lower than those in the conventional group [(1.77±0.36) μg/L, (110.75±10.25) μg/L, and (102.77±10.65) μg/L](all P<0.05), and the levels of LVEF [(55.41±10.28)%], SV [(58.72±10.45) ml], and CO [(4.52±1.36) L/min] in the combined group were higher than those in the conventional group [(49.14±10.33)%, (52.33±10.06) ml, and (3.77±0.82) L/min] (all P<0.05). The total incidence of adverse cardiovascular events in the combined group [4.76% (3/63)] was lower than that in the conventional group [16.13% (10/62)] (P<0.05). There was no statistically significant difference in the total incidence of drug-related adverse reactions between the two groups (P>0.05). Conclusions　Levosimendan can effectively improve the myocardial function of CHF patients and delay the course of myocardial fibrosis. It has positive significance in promoting the patients' cardiac function recovery and reducing the risk of cardiovascular adverse events. Moreover, this drug has high safety and does not significantly increase the risk of drug-related adverse reactions.

Impact of enteral nutrition combined with continuous blood purification on patients with severe acute pancreatitis

Liu Jie, Huo Qianwen, Wang Yong

2024, 30(12):  2049-2052.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.023

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Objective　To investigate the effect of enteral nutrition combined with continuous blood purification on abdominal pain relief, infection rate, and inflammatory indexes in patients with severe acute pancreatitis. Methods　Eighty cases of severe acute pancreatitis admitted to Xi'an No.9 Hospital from April 2020 to March 2023 were selected as the study subjects, and they were divided into an observation group (40 cases) and a control group (40 cases) according to the order of the time of diagnosis and treatment. There were 22 males and 18 females in the control group, the age was 20-67 (48.42±12.84) years old, and the course of disease was 3-28 (6.84±1.28) h. There were 23 males and 17 females in the observation group, the age was 21-66 (48.34±12.93) years old, and the course of disease was 3-29 (6.91±1.34) h. The control group was treated with continuous blood purification, and the observation group was treated with enteral nutrition combined with continuous blood purification. Symptom relief, changes in inflammatory factors levels [interleukin-6 (IL-6), IL-8, and serum tumor necrosis factor-alpha (TNF-α)] and gastrointestinal function indexes [plasma D-lactic acid and urinary lactulose/mannitol (L/M) values] before and after treatment, and occurrence of infection during the treatment period were recorded and compared between the two groups. Independent sample t test, paired sample t test, and χ² test were used. Results　After treatment, the abdominal pain relief time [(2.14±0.44) d], abdominal distension relief time [(3.63±0.96) d], and anal exhaust time [(3.39±1.03) d] in the observation group were shorter than those in the control group, with statistically significant differences (all P<0.05). After 72 h of treatment, the levels of inflammatory factors in both groups were lower than those before treatment, and the levels of IL-6 [(68.67±12.04) ng/L], IL-8 [(72.63±14.13) ng/L], and TNF-α [(10.07±1.59) ng/L] in the observation group were lower than those in the control group, with statistically significant differences (all P<0.05). After 72 h of treatment, the gastrointestinal function indexes in both groups were lower than those before treatment, and the levels of D-lactic acid [(6.37±1.06) μg/L] and urinary L/M [(0.05±0.01) g/g] in the observation group were lower than those in the control group, with statistically significant differences (all P<0.05). During the treatment period, there was no statistically significant difference in the total occurrence of infection between the two groups (P>0.05). Conclusion　Enteral nutrition combined with continuous blood purification therapy not only improves the gastrointestinal function and reduces the inflammatory response in patients with severe acute pancreatitis, but also has a good safety profile.

Case Report

A case of congenital heart disease with Tetralogy of Fallot combined with pulmonary atresia and literature analysis

Zou Mingrui, Dong Shengjun, Liu Baohui, Wang Yujiu

2024, 30(12):  2053-2055.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.024

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Tetralogy of Fallot (TOF) is the most prevalent cyanotic congenital heart disease, and pulmonary atresia (PA) is a relatively complex congenital heart malformation. This paper presented a case of TOF combined with PA admitted to Binzhou Medical University Hospital, where surgical biological mesh was utilized to reconstruct the pulmonary valve and sewed into the original pulmonary valve to prevent pulmonary regurgitation in the right ventricular incision. Finally, this paper summarized the clinical manifestations, imaging diagnosis, surgical plans, and treatment prospect associated with TOF/PA.

A case report of bronchiectasis complicated by Nocardia infection

Li Dan, Bi Yanni, Ma Shuqing, Xue Ming

2024, 30(12):  2056-2058.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.025

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This article reported a patient with bronchiectasis who developed a Nocardia infection in Shandong University Affiliated Weihai Municipal Hospital, accompanied by a relevant literature review. The patient, a 68-year-old female diagnosed with bronchiectasis, had Nocardia identified in respiratory samples through bacterial culture. The diagnosis of Nocardia infection was confirmed by detailed clinical and laboratory assessments. During the treatment process, the patient received a regimen involving third-generation cephalosporins combined with sulfamethoxazole/trimethoprim, resulting in a positive therapeutic outcome. This case underscores the importance of recognizing Nocardia infections in patients with bronchiectasis. Clinicians need to deepen their understanding on the epidemiology, clinical characteristics, treatment approaches, and prognosis of Nocardia infections in bronchiectasis patients. Additionally, laboratory professionals should enhance the pathogen detection capabilities to increase the positivity rate of Nocardia testing.

A case report on acute pancreatitis complicated by influenza A infection of IgA nephropathy and literature review

Xu Ximei, Zhu Huimin, Wu Tingbai, Zhu Bolyu

2024, 30(12):  2059-2062.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.026

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Immunoglobulin A (IgA) nephropathy is a common glomerular disease characterized by the deposition of IgA immune complexes in the glomerular mesangial regions. Its primary clinical manifestations are episodic gross hematuria and persistent microscopic hematuria, often accompanied by varying degrees of proteinuria. Some patients may present with nephrotic syndrome, acute nephritic syndrome, or rapidly progressive glomerulonephritis, and may also develop hypertension and renal function impairment. Acute pancreatitis is a condition marked by acute inflammation of the pancreas, primarily involving edema, hemorrhage, and necrosis of the pancreas, with severe abdominal pain, peritonitis, and shock as its main clinical features. Influenza A, an acute respiratory infectious disease caused by infection with the influenza A virus, is primarily airborne. Its subtypes are classified based on changes in hemagglutinin and neuraminidase surface proteins (i.e., antigenic shift and drift), with the subsequent spread, duration, and severity of influenza outbreaks depending on the susceptibility of the population, primarily manifesting as respiratory symptoms. While these three conditions are not uncommon clinically, their concurrent occurrence in the same patient is quite rare. This article reported an 11-year-old boy with IgA nephropathy who developed acute pancreatitis following an influenza A infection in Zhongshan People's Hospital, aiming to further explore the potential connections among the three diseases.

Nursing Research

Effects of prone position ventilation at different angles on patients with acute respiratory distress syndrome

Liang Yandong, He Weifeng, Liu Qiujiang, Li Yanhong, Yu Jiayan

2024, 30(12):  2063-2067.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.027

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Objective　To evaluate the effects of prone position ventilation at different angles on patients with acute respiratory distress syndrome (ARDS). Methods　This prospective, randomized, controlled clinical trial included 96 patients with ARDS admitted to the Intensive Care Unit (ICU) of Guangdong Second Hospital of Traditional Chinese Medicine from July 2021 to June 2023. The patients were randomly divided into group A (0° prone position ventilation), group B (30° prone position ventilation), and group C (45° prone position ventilation), with 32 cases in each group. There were 19 males and 13 females in group A, aged (50.25±11.31) years, with a body mass index (BMI) of (23.42±3.16) kg/m². There were 17 males and 15 females in group B, aged (51.93±12.48) years, with a BMI of (22.72±4.15) kg/m². There were 20 males and 12 females in group C, aged (52.39±12.82) years, with a BMI of (24.76±4.31) kg/m². The observation time was 5 days. The patients in group A were continuously ventilated in the prone position at 0° for 16 h every day and lifted up every 2 h to prevent stress injury. In group B, after maintaining 0° prone position for 2 h, the patients' body was tilted to the left for 30° with the 30° turning pad for 2 h, then it was tilted to the right for 30° for 2 h, finally returned to 0° prone position. This was repeated until 16 h of prone ventilation was completed. In group C, after maintaining 0° prone position for 2 h, the patients' body was tilted to the left for 45° with the 45° turning pad for 2 h, then it was tilted to the right for 45° for 2 h, finally returned to 0° prone position. This was repeated until 16 h of prone ventilation was completed. The changes in oxygenation indicators [oxygenation index (PaO₂/FiO₂), arterial oxygen saturation (SaO₂), arterial partial pressure of oxygen (PaO₂), and arterial partial pressure of carbon dioxide (PaCO₂)], hemodynamic indexes [heart rate (HR), mean arterial pressure (MAP), and central venous pressure (CVP)], Murray Lung Injury Score (MLIS), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, and multiple organ dysfunction syndrome (MODS) score were compared among the three groups. The incidence of pressure injury was also observed. One-way analysis of variance, LSD method, paired t test, and χ² test were used. Results　After 5 days of prone position ventilation, the PaO₂/FiO₂, SaO₂, PaO₂, and PaCO₂ in the three groups were improved compared with those before ventilation, and the improvement ranges of group A and group B were better than those of group C (all P<0.05). There were no statistically significant differences in the HR, MAP, or CVP among the three groups before and after 5 days of prone position ventilation (all P>0.05). After 5 days of prone position ventilation, the MLIS, APACHEⅡ, and MODS scores of the three groups were lower than those before ventilation; those of group A and group B were lower than those of group C [(1.72±0.37) points vs. (1.54±0.16) points vs. (1.89±0.26) points, (11.02±2.69) points vs. (11.01±2.01) points vs. (12.87±2.06) points, (5.64±0.37) points vs. (5.34±0.67) points vs. (6.19±0.43) points] (all P<0.05). The incidences of pressure injury in group B and group C were lower than that in group A [15.63% (5/32) vs. 18.75% (6/32) vs. 40.63% (13/32)] (P<0.05). Conclusions　Prone position ventilation at different angles can improve the oxygenation and alleviate the condition in patients with ARDS. Among the studied angles, 30° prone position ventilation shows the most significant improvement and reduces the incidence of pressure injury.

Application of Internet + multidisciplinary collaboration model in puerperal continuous nursing 

Tian Dan, Lin Siya, Huang Yacui, Sun Fengjiao, Wu Minyan, Zhu Jianmin, Huang Yuxin

2024, 30(12):  2068-2072.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.028

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Objective　To explore the application effect of the Internet + multidisciplinary collaboration model in puerperal continuous nursing. Methods　This study was a randomized controlled trial. A total of 78 women who gave birth in the Department of Obstetrics, Zhujiang Hospital, Southern Medical University from May 2022 to May 2023 were selected as the study objects, and were divided into a control group and an observation group according to the random number table method with 39 cases in each group. The women in the observation group were (22.67±4.65) years old, and their gestational age was (37.67±2.65) weeks, including 29 cases of vaginal delivery and 10 cases of cesarean section. The women in the control group were (22.64±4.84) years old, and their gestational age was (37.75±2.17) weeks, including 30 cases of vaginal delivery and 9 cases of cesarean section. The control group received routine nursing, and the observation group received continuous nursing intervention based on the Internet + multidisciplinary collaboration model. The continuous nursing in both groups lasted until 28 days after delivery, and they were followed up until 42 days after delivery. The changes of mood state and self-care ability before and after intervention, as well as the adverse reactions of mothers and infants and satisfaction with the nursing intervention were compared between the two groups. t test, χ² test, and Fisher exact probability method were used. Results　Before intervention, the mood scores of the observation group and the control group were (22.56±2.38) points and (22.51±2.38) points, respectively, with no statistically significant difference (P>0.05). After intervention, the mood scores of the two groups were (13.95±1.56) points and (17.41±2.35) points, respectively, which were significantly decreased compared with those before intervention (both P<0.001), and there was a statistically significant difference between the two groups after intervention (P<0.001). Before intervention, the self-care ability scores of the observation group and the control group were (122.67±6.43) points and (122.62±6.33) points, respectively, with no statistically significant difference (P>0.05). After intervention, the scores of self-care ability of the two groups were (141.44±7.74) points and (131.44±6.85) points, respectively, which were significantly higher than those before intervention (both P<0.001), and there was a statistically significant difference between the two groups after intervention (P<0.001). The incidences of maternal and neonatal complications in the observation group [7.69% (3/39) and 5.13% (2/39)] were significantly lower than those in the control group [28.21% (11/39) and 33.33% (13/39)], with statistically significant differences (both P<0.05). Conclusion　The continuous nursing intervention based on the Internet + multidisciplinary cooperation model is contribute to improve the maternal mood, improve the maternal self-care ability, and reduce the maternal and neonatal complications during the puerperal period, which is worthy of clinical promotion and use.

Application effect of wechat public platform intervention in the rehabilitation of cardiovascular diseases under the background of Internet

Yu Wangdi, Yuan Lihua, Yuan Yuan, Chen Zhenhuan, Liu Yun, Xu Qing, Yan Rui

2024, 30(12):  2073-2077.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.029

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Objective　Combined with clinical practice experience, to explore the application effect of wechat public platform intervention in the rehabilitation of cardiovascular diseases under the background of Internet. Methods　This study was a randomized controlled trial. A total of 300 patients with cardiovascular diseases admitted to Jiangxi Provincial People's Hospital from October 2021 to June 2023 were prospectively selected as the study objects, and were divided into an observation group and a control group according to the random number table method with 150 cases in each group. In the observation group, there were 86 males and 74 females, aged 56 - 78 (62.38±6.15) years, including 46 cases of atrial fibrillation, 35 cases of chronic heart failure, 29 cases of hypertension, 26 cases of coronary heart disease, and 14 cases of acute myocardial infarction. In the control group, there were 89 males and 71 females, aged 52 - 75 (63.05±6.27) years, including 48 cases of atrial fibrillation, 32 cases of chronic heart failure, 31 cases of hypertension, 27 cases of coronary heart disease, and 12 cases of acute myocardial infarction. The control group received routine cardiovascular disease health education; the observation group added wechat public account publicity and intervention, established a public platform, and guided and supervised patients. The intervention lasted for three months. The scores of self-management ability, anxiety, and depression were compared between the two groups before and after intervention, the scores of quality of life and compliance were compared between the two groups after intervention, the incidence of adverse cardiovascular events were compared between the two groups, and the patient satisfaction was analyzed. χ² test and t test were used. Results　After 3 months of intervention, the scores of compliance with medical drugs, diet management, disease monitoring, exercise management, and complication prevention in the observation group were higher than those in the control group (all P<0.05). After 3 months of intervention, the quality of life scores in the observation group were higher than those in the control group (all P<0.05). After 3 months of intervention, the compliance scores of medication, diet, and exercise in the observation group were higher than those in the control group (all P<0.05). After 3 months of intervention, 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 [(47.39±4.04) points vs. (53.67±5.89) points, (42.16±4.12) points vs. (56.59±5.27) points] (both P<0.05). The incidence of adverse cardiovascular events in the observation group [1.33% (2/150)] was lower than that in the control group [6.00% (9/150)] (χ²=4.624, P=0.032). The total satisfaction of the observation group [94.00% (141/150)] was higher than that of the control group [84.67% (127/150)] (χ²=6.856, P=0.009). Conclusion　In the era of Internet media convergence, wechat public platform intervention can improve the self-management ability in patients with cardiovascular diseases, improve the quality of life, reduce the adverse cardiovascular events, and improve the patient satisfaction.

Effect of multidisciplinary collaborative intervention on wound healing and quality of life in patients with chronic wounds

Tan Shaomei, Yao Jingbin, Mo Huixin

2024, 30(12):  2078-2082.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.030

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Objective　To explore multidisciplinary collaborative intervention strategies for patients with chronic wounds, in order to improve their wound healing effect and quality of life. Methods　A prospective study method was used to select 72 patients with chronic wounds admitted to Wound Repair Department, The Fourth People's Hospital of Nanhai District, Foshan City from April 2022 to March 2023, and they were divided into a control group and an observation group with 36 cases in each group by the random number table method. There were 19 males and 17 females in the control group, aged (61.14±8.69) years, with the duration of ulcer of (51.69±14.89) d, and they received routine intervention for chronic wounds. There were 21 males and 15 females in the observation group, aged (60.53±7.28) years, with the duration of ulcer of (52.94±13.39) d, and they adopted multidisciplinary collaborative intervention model on the basis of the control group.  Both groups were intervened until wound healing or 4 weeks after discharge.The Bates-Jensen Wound Assessment Tool (BWAT) and Chinese version of Wound Quality of Life Scale (Wound QoL) were used to evaluate the patients' wound healing status and quality of life, and the patients' wound healing rate and healing time were recorded. Independent sample t test was used for the measurement data and χ² test was used for the count data. Results　The wound healing rate of the observation group was higher than that of the control group [94.4% (34/36) vs. 77.8% (28/36)], and the wound healing time was shorter than that of the control group [(43.39±12.86) d vs. (52.94±15.07) d], with statistically significant differences (χ²=4.181, t=2.894, both P<0.05). At the 4th week of intervention and after wound healing or 8 weeks after discharge, the BWAT scores of the observation group were lower than those of the control group [(17.53±5.68) points vs. (23.64±7.74) points, (13.33±1.41) points vs. (15.42±4.98) points], with statistically significant differences (t=3.818 and 2.414, both P<0.05). After wound healing or 8 weeks after discharge, the total score of Wound QoL of the observation group was lower than that of the control group [(29.44±4.69) points vs. (39.28±5.64) points], with a statistically significant difference (t=8.046, P<0.05). Conclusion　The multidisciplinary collaborative intervention model can improve the wound healing in patients with chronic wounds, shorten the wound healing time, and improve the quality of life.

Clinical Teaching

Application of PBL combined with flipped classroom blended teaching in the teaching of nephrology nursing interns

Liu Chuang, Wang Lingzhen, Lin Mian, Li Hucai

2024, 30(12):  2083-2087.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.031

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Objective　To explore the application effect of problem-based learning (PBL) combined with flipped classroom blended learning in the teaching of nephrology nursing interns. Methods　A total of 76 nursing interns who interned in the Department of Nephrology at Fangcun Hospital of Guangdong Provincial Hospital of Chinese Medicine from June 2020 to March 2022 were retrospectively selected as the research subjects. According to the time of internship, 40 nursing interns who entered the department from June 2020 to April 2021 were selected as a control group, including 35 females and 5 males, aged (20.40±0.78) years, and they were implemented routine nursing teaching; 36 nursing interns who entered the department from July 2021 to March 2022 were selected as an observation group, including 33 females and 3 males, aged (20.42±0.73) years, and they were implemented PBL combined with flipped classroom blended teaching. Both groups interned for 4 weeks. The theoretical assessment scores, skill assessment scores, self-learning ability scores, and satisfaction with nursing teaching were compared between two groups. Independent-sample t test was used for the measurement data and χ² test was used for the count data. Results　The scores of theoretical assessment, skill assessment, and satisfaction with nursing teaching in the observation group were higher than those in the control group [(88.39±6.86) points vs. (80.58±8.64) points, (92.58±5.52) points vs. (84.78±6.94) points, 97.2% (35/36) vs. 82.5% (33/40)], with statistically significant differences (t=4.333 and 5.387, χ²=4.360, all P<0.05). At the time of admission, there was no statistically significant difference in the score of self-learning ability between the two groups [(91.03±14.45) points vs. (90.58±12.13) points] (t=0.148, P>0.05). At the time of graduation, the score of self-learning ability of nursing students in the observation group was higher than that in the control group [(116.31±10.93) points vs. (106.98±14.22) points], with a statistically significant difference (t=3.180, P<0.05). Conclusion　PBL combined with flipped classroom blended teaching can improve the theoretical knowledge mastery and practical skills level of nephrology nursing interns, and promote the improvement of self-learning ability, thereby enhancing the satisfaction of nursing interns with nursing teaching.

Application effect of flipped classroom teaching method based on micro-lecture in surgical internship nursing students

Zou Yanhong, Xu Xiaoyan, Wu Xuelian, Liu Yuanyuan, Peng Miao

2024, 30(12):  2088-2092.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.032

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Objective　To explore the application effect of flipped classroom teaching method based on micro-lecture in surgical internship nursing students. Methods　A total of 150 nursing students who interned in department of surgery at the Second Affiliated Hospital of Guangzhou Medical University from June 2019 to May 2021 were selected as the research subjects. According to the duration of surgical internships, 71 nursing students who interned in department of surgery from June 2019 to May 2020 were divided into a control group, consisted of 5 males and 66 females, aged (21.65±1.24) years, using a conventional clinical nursing teaching model; 79 nursing students who interned in department of surgery from June 2020 to May 2021 were divided into an experimental group, consisted of 5 males and 74 females, aged (21.84±1.26) years, using a flipped classroom teaching method based on micro-lecture. The internship lasted for 8 weeks. The relevant indicators of online learning in the experimental group were evaluated, and the scores of admission assessment and satisfaction with clinical teaching were compared between the two groups. Independent sample t test was used for the measurement data and χ² test was used for the count data. Results　In the experimental group, 49 (62.03%) nursing students achieved an online learning completion rate ≥50%, 71 (89.87%) nursing students had a learning chapter count ≥10 chapters, and 43 (54.43%) nursing students had an online learning duration ≥100 min. The theoretical assessment score and comprehensive skill assessment score in the experimental group were higher than those in the control group [(87.73±6.14) points vs. (85.56±5.00) points, (88.96±2.89) points vs. (83.49±8.67) points], with statistically significant differences (t=2.362 and 5.403, both P<0.05). The nursing students' satisfaction rates in the experimental group were higher than those in the control group in 8 dimensions: teacher literacy, teaching implementation process, stimulating learning interest, enhancing self-learning ability, improving clinical operation level, improving knowledge understanding ability, inducing and cultivating independent thinking ability, and cultivating clinical thinking and working ability, with statistically significant differences (all P<0.05). Conclusion　The flipped classroom teaching method based on micro-lecture can effectively improve the clinical internship effect of surgical internship nursing students, enhance their self-learning ability, and nursing students have high satisfaction with this teaching method, which is worth further promoting in clinical teaching.

Research on the application of integrated teaching model of doctors, nurses, and therapists combined with case-based learning in teaching of nursing interns in traumatic orthopedics 

Wen Guixiang, Zhu Xiaodan, Xu Xiaolin

2024, 30(12):  2093-2096.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.033

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Objective　To explore the application effect of integrated teaching model of doctors, nurses, and therapists combined with case-based learning in teaching of nursing interns in traumatic orthopedics. Methods　A total of 47 nursing interns from Department of Orthopedics and Traumatology, Huangpu Campus, Guangdong Second Traditional Chinese Medicine Hospital from July 2021 to June 2022 were selected as a control group, and 50 nursing interns from July 2022 to June 2023 as a research group. There were 35 females and 12 males in the control group, aged 19 to 22 (20.34±1.07) years; there were 36 females and 14 males in the research group, aged 19 to 23 (20.92±1.34) years. The control group adopted the traditional clinical teaching method with nurses as the main teachers; the research group adopted the integrated teaching model of doctors, nurses, and therapists combined with case-based learning for 4 weeks. The results of theoretical assessment, operational assessment, and case analysis assessment and the satisfaction with teaching quality were compared between the two groups. Independent sample t test, χ² test, and Ridit analysis were used. Results　The results of theoretical assessment, operational assessment, and case analysis assessment of the research group were (85.01±4.21) points, (88.95±3.44) points, and (87.12±3.85) points, while those of the control group were (83.24±3.25) points, (87.25±4.12) points, and (85.26±3.45) points, with statistically significant differences (t=2.307, 2.211, and 2.500, all P<0.05). The satisfaction of nursing interns in the research group was higher than that in the control group, with a statistically significant difference (Z=2.165, P=0.030). Conclusion　Integrated teaching model of doctors, nurses, and therapists combined with case-based learning can effectively improve the comprehensive ability of nursing interns in traumatic orthopedics and improve the teaching satisfaction, which is worthy of clinical application and promotion.

Application of double tutor teaching mode based on the group standards of the Chinese Nursing Association in new nurses

Zhao Fang, Sun Yanqi, Tian Qinju

2024, 30(12):  2097-2101.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.034

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Objective　To explore the application effect of double tutor teaching mode based on the group standards of the Chinese Nursing Association in new nurses. Methods　A total of 85 newly enrolled nurses from Tengzhou Central People's Hospital Affiliated to Jining Medical College from January 2022 to September 2023 were selected by convenience sampling method, and were simply randomly divided into a routine group (43 cases) and a standard group (42 cases). In the routine group, there were 12 males and 31 females, aged (23.27±4.16) years. In the standard group, there were 15 males and 27 females, aged (22.98±3.09) years. The routine group was managed by the training strategies in the Trial Measures for Standardized Training of Clinical Nurses, while the standard group implemented the double-tutor teaching mode based on the group standards of the Chinese Nursing Association. The double tutors included a nursing department tutor and clinical tutors, respectively. The tutor of nursing department was a fixed supervisor who was responsible for the whole training process of new nurses; the clinical tutors were handed over with departments, and each department was in charge of one-to-one teaching by a clinical teacher.  Both groups were taught for 40 weeks.The theoretical and operational achievements, clinical comprehensive ability, self-efficacy, and satisfaction of the nurses in the routine group and the standard group were recorded and compared. t test and χ² test were used. Results　The theoretical and operational scores of the standard group were higher than those of the routine group [(95.33±6.25) points vs. (80.27±5.03) points, (90.17±5.43) points vs. (82.06±6.26) points] (both P<0.05). The scores of each item of clinical comprehensive ability of the standard group were higher than those of the routine group, with statistically significant differences (all P<0.05). Before training, there was no statistically significant difference in the score of General Self-Efficacy Scale (GSES) between the standard group and the routine group [(20.12±10.11) points vs. (20.67±10.36) points] (P>0.05). After training, the GSES scores of the standard group and the routine group were higher than those before training, and the GSES score of the standard group was higher than that of the routine group [(33.28±10.27) points vs. (26.71±8.31) points], with statistically significant differences (all P<0.05). The satisfaction scores of new nurses in the standard group on teaching content, teaching method, and teaching arrangement were higher than those in the routine group [(29.06±4.79) points vs. (23.08±4.17) points, (32.68±4.02) points vs. (27.02±4.79) points, (36.41±6.17) points vs. (31.68±6.22) points], with statistically significant differences (all P<0.05). Conclusion　The double tutor teaching mode based on the group standards of the Chinese Nursing Association can improve the theoretical and group standard operation performance of new nurses, improve their clinical comprehensive ability, and increase their self-efficacy, with high satisfaction.

Application of CDIO teaching mode combined with mini-CEX in obstetric intern nurses

Zhang Lin, Lyu Xixi, Sun Yanqi

2024, 30(12):  2102-2106.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.035

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Objective　To explore the application effect of Conceive-Design-Implement- Operate (CDIO) teaching mode combined with Mini-Clinical Evaluation Exercise (mini-CEX) in obstetric intern nurses. Methods　A total of 84 intern nurses who practiced in the obstetric ward of Zaozhuang Maternal and Child Health Care Hospital from July 2021 to June 2023 were selected as the research objects by convenient sampling method. According to the admission time, they were divided into an observation group [35 females and 7 males, aged (19.51±2.2) years] and a control group [36 females and 6 males, aged (19.53±2.3) years] with 42 subjects in each group. The control group adopted the routine clinical nursing teaching mode, and the observation group adopted the flipped classroom based on the CDIO model combined with Mini-CEX teaching mode for 4 weeks. After the transfer of the two groups, the subjective and objective evaluation of the teaching effect was carried out through the form of performance assessment, and the clinical practice ability score of the intern nurses and the evaluation score of clinical teaching effect of the intern nurses were compared and analyzed. Independent sample t test and χ² test were used. Results　At the time of admission, there were no statistically significant differences in the assessment results, clinical nursing practice ability scores, or clinical training effect scores between the two groups (all P>0.05). At the time of leaving the department, the scores of specialized theory, operation examination, and clinical nursing practice ability of the intern nurses in the observation group were higher than those in the control group [(93.58±2.45) points vs. (87.11±3.62) points, (89.91±5.49) points vs. (79.70±5.65) points, (52.06±4.37) points vs. (42.85±5.48) points], with statistically significant differences (all P<0.001). The scores of training methods, learning effect, professional ability, and professional identity in the evaluation of training effect in the observation group were higher than those in the control group [(2.72±0.45) points vs. (1.33±0.76) points, (2.65±0.62) points vs. (1.58±0.51) points, (2.67±0.56) points vs. (2.11±0.55) points, (2.49±0.55) points vs. (1.39±0.66) points], with statistically significant differences (all P<0.001). Conclusions　CDIO teaching mode combined with mini-CEX is helpful to improve the assessment results and clinical nursing comprehensive ability of obstetric intern nurses. Obstetric intern nurses are satisfied with the training effect, which is worthy of popularization and application in obstetric clinical teaching.

Investigation Report

Survey on the cognitive status among pediatricians in Yunnan Province on CCAAP and guidelines for the diagnosis and treatment of childhood asthma

Zhao Jiawei, Duan Jing, Peng Likun, Hao Rui, Duan Jingyuan, Ma Xiaolin

2024, 30(12):  2107-2110.  DOI: 10.3760/cma.j.issn.1007-1245.2024.12.036

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Objective　To understand the cognitive status of pediatricians from hospitals of different levels in Yunnan Province on China Children Asthma Action Plan (CCAAP) and guidelines for the diagnosis and treatment of childhood asthma. Methods　From July to December 2022, a total of 395 pediatricians (132 males and 263 females, aged over 20 years) from 41 hospitals of different levels in 11 cities of Baoshan, Kunming, Dali, Dehong, Honghe, Yuxi, Xishuangbanna, Chuxiong, Qujing, Lincang, and Wenshan in Yunnan Province were effectively investigated. The questionnaire survey was conducted online and offline. χ² test and variance analysis were used. Results　A total of 395 valid questionnaires were collected from 41 hospitals. The accuracy of answers to questions on basic knowledge of childhood asthma of the pediatricians from surveyed hospitals of different levels were 32.78% (59/180) - 97.50% (39/40), those on treatment during the acute phase were 24.44% (44/180) - 92.50% (37/40), and those on subsequent treatment were 35.56% (64/180) - 100.00% (40/40). The cognitive status on childhood asthma of the pediatricians in provincial and municipal Grade III hospitals was overall better than that in Grade II and Grade I hospitals (all P<0.05). Conclusion　Pediatricians from hospitals of different levels in Yunnan Province generally lack knowledge about CCAAP and guidelines for the diagnosis and treatment of childhood asthma, particularly pediatricians from Grade I hospitals.