Table of Content

01 July 2024, Volume 30 Issue 13

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Cerebrovascular Disease

Research progress of cerebrovascular diseases

Xie Xi, Cai Zhiyou, Wang Qizheng, Liu Ruifang, Zhao Yu

2024, 30(13):  2114-2118.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.001

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Cerebrovascular diseases are the first cause of death and disability in China, so the main goal of studying these diseases is to reduce the fatality rate, reduce the disability rate, and improve their life quality. Through the study of new imaging in the diagnosis of cerebrovascular diseases, it can improve the efficiency and accuracy of diagnosis. The researches on new drugs and treatment schemes can shorten the course of disease and promote their recovery. The researches on pre-action strategies may guide healthy lifestyles. This article summarizes and analyzes the latest cerebrovascular disease imaging, drugs and treatment methods, and lifestyle researches, so as to provide more help for the prevention and treatment of cerebrovascular diseases.

Value of serum Fibulin-5 combined with Sestrin2 in prediction of prognosis of patients with acute ischemic stroke

Bian Na, Feng Xiaowei, Liu Qian

2024, 30(13):  2118-2123.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.002

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Objective　To analyze the value of serum key protein of aging antigen 5 (Fibulin-5) combined with Sestrin2 in the prediction of prognosis of patients with acute ischemic stroke (AIS). Methods　The clinical data of patients with AIS admitted to Baoji People's Hospital from January 2019 to October 2023 were retrospectively analyzed. All the patients took alteplase intravenous thrombolytic therapy. Ninety days after intravenous thrombolysis, according to the results of the modified Rankin scale, the patients whose scores > 2 were set as a poor prognosis group, and the patients whose scores ≤2 a good prognosis group. The clinical data and serum levels of Fibulin-5 and Sestrin2 of the poor prognosis group and the good prognosis group were compared by t and χ² tests. The multivariate logistic regression analysis was used to analyze the influencing factors of poor prognosis after intravenous thrombolysis in the patients. The receiver operating characteristic curve (ROC) was used to evaluate the predictive value. Results　Ninety days after intravenous thrombolysis, among the 175 patients, 64 (36.57%) had poor prognosis, and 111 (63.43%) good prognosis. There were statistical differences in age, gender, body mass index, etc. between the two groups. The proportions of the patients with coronary heart disease and atrial fibrillation, score of National Institutes of Health Stroke Scale (NIHSS) 24 hours after thrombolysis, platelet to lymphocyte ratio (PLR) 24 hours after thrombolysis, and fasting blood glucose in the poor prognosis group were higher than those in the good prognosis group (all P<0.05); the albumin in the poor prognosis group was lower than that in the good prognosis group (P<0.05). The serum levels of Fibulin-5 and Sestrin2 in the poor prognosis group were higher than those in the good prognosis group [(95.17±10.41) μg/L vs.(78.25±8.34) μg/L and (13.84±3.61) μg/L vs.(11.02±2.38) μg/L] (both P<0.05). Serum Fibulin-5, serum Sestrin2, 24-hour post-thrombolysis NIHSS score, and 24-hour post-thrombolysis PLR were identified as the significant factors associated with poor prognosis in the patients with AIS after intravenous thrombolysis (all P<0.05). The areas under the curves (AUC) of serum Fibulin-5, Sestrin2, and their combination in predicting poor prognosis of the patients after intravenous thrombulysis were 0.752, 0.798, and 0.906, respectively, and the AUC of the combination was higher (P<0.05). Conclusion　Serum Fibulin-5 and Sestrin2 levels 24 h after thrombolysis can be used to evaluate the prognosis of AIS patients after intravenous thrombolysis with alteplase, and the combined value is higher.

Efficacy of Xiaoxuming decoction combined with conventional western medicine in treatment of patients with acute ischemic stroke of wind-fire disturbance type

Zhang Jianping, Wang Zhen, Wang Wen, Liu Zhangfeng

2024, 30(13):  2123-2129.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.003

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Objective　To analyze the efficacy and mechanism of Xiaoxuming decoction combined with conventional western medicine in the treatment of patients with acute ischemic stroke of wind-fire disturbance type. Methods　One hundred and eighty-eight patients with acute ischemic stroke of wind-fire disturbance syndrome type treated at Shangluo Hospital of Traditional Chinese Medicine from January 2020 to January 2022 were selected for the randomized controlled trial. They were divided into a control group and a study group by the random number table method, with 94 cases in each group. There were 48 males and 46 females in the control group; they were (67.50±6.23) years old; their disease course was (7.21±1.15) h; 58 cases had lesions in basal ganglia, 27 cases brains, and 9 cases cerebellums. There were 49 males and 45 females in the study group; they were (67.00±8.46) years old; their disease course was (7.14±1.04) h; 59 cases had lesions in basal ganglia, 25 cases brains, and 10 cases cerebellums. The control group were treated with conventional western medicine, and the study group with Xiaoxuming decoction and conventional western medicine, for 28 d. The traditional Chinese medicine (TCM) symptom scores, scores of National Institute of Health Stroke Scale (NIHSS), and Barthel index scores before the treatment and after 28 days' treatment and the clinical efficacies were compared between the two groups. The levels of serum glial fibrillary acidic protein (GFAP), stromal cell-derived factor (SDF-1), brain-derived neurotrophic factor (BDNF), monocyte chemoattractant protein-1 (MCP-1), homocysteine (Hcy), C-reactive protein (CRP), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), malondialdehyde (MDA), blood viscosity, fibrinogen (FIB), and D-dimer (D-D) before and after the treatment were compared. The safety during the treatment was compared. t test, χ² test, and rank sum test were used. Results　After 28 days' treatment, the TCM symptom scores [(13.00±2.64) and (9.50±1.71)], NIHSS scores [(9.50±1.76) and (6.00±1.21)] and levels of GFAP [(5.02±1.25) μg/L and (4.21±0.98) μg/L], MCP-1[(112.28±10.29) μg/L and (92.58±7.41) μg/L], Hcy [(15.25±2.67) μmol/L and (8.56±2.21) μmol/L], CRP [(10.50±2.12) mg/L and (6.89±1.24) mg/L], MDA [(7.58±1.05) mol/L and (5.42±1.12) mol/L], whole blood high shear viscosity [(4.85±1.23) mPa/s and (2.58±1.05) mPa/s], whole blood low shear viscosity [(16.45±3.56) mPa/s and (10.89±1.98) mPa/s], plasma viscosity [(1.56±0.19) mPa/s and (1.35±0.15) mPa/s], FIB [(3.25±0.47) g/L and (2.68±0.35) g/L], and D-D [(1.91±0.29) mg/L and (1.39±0.26) mg/L] in the control group and the study group were lower than those before the treatment (all P<0.001), and those in the study group were lower than those in the control group (all P<0.001). After the treatment, the Barthel index scores [(65.00±9.35) and (74.50±8.76)] and serum levels of SDF-1 [(502.94±29.32) μg/L and (550.75±30.56) μg/L], BDNF [(4.52±0.61) μg/L and (5.68±0.55) μg/L], SOD [(5.13±0.65) U/ml and (6.56±0.38) U/ml], and GSH PX [(34.32±6.87) mmol/L and (45.21±7.59) mmol/L] in the control group and the study group were higher than those before the treatment (all P<0.001), and those in the study group were higher those in the control group (all P<0.001). The total effective rate of the study group was higher than that of the control group [93.62% (88/94) vs. 75.53% (71/94); χ²=11.783, P<0.001]. There was no statistical difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion　Xiaoxuming decoction combined with conventional western medicine in the treatment of patients with acute ischemic stroke patients of wind-fire disturbance type can significantly improve their conditions and living abilities, and has significant curative effect and good safety.

Effect of tirofiban-assisted endovascular intervention on neurological function in patients with acute ischemic stroke

Bai Zhangyong, Pu Xiaolong, Yang Liying

2024, 30(13):  2130-2135.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.004

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Objective　To investigate the effect of tirofiban-assisted endovascular intervention on neurological function in patients with acute ischemic stroke (AIS). Methods　Eighty-six patients with AIS treated at Department of Intervention, Baoji City People's Hospital from January 2020 to October 2023 were selected for the randomized controlled trial. The patients were randomly divided into a control group and an observation group by the random number table method, with 43 cases in each group. There were 25 males and 18 females in the control group; they were (60.33±6.13) years old. There were 26 males and 17 females in the observation group; they were (59.48±5.29) years old. The control group took endovascular intervention; in addition, the observation group took tirofiban (treated for 2 weeks). The treatment efficacies, neurological function scores [National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS)], neurotrophic indicators [brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), and serum CNS-specific protein （S100β)], platelet function markers (platelet aggregation, adhesion rates, and maximum aggregation time), and oxidative and inflammatory markers [glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), malondialdehyde (MDA), and C-reactive protein (CRP)] were compared between the two groups by the independent sample t test and χ² test. Results　After two weeks' treatment, the total effictive rate in the observation group higher than that in the control group [81.40% (35/43) vs. 60.47% (26/43)], with a statistical difference between the two groups (χ² =4.568, P<0.05). The scores of NIHSS and mRS in the observation group were lower than those in the control group [(7.48±1.35) vs. (9.68±1.89) and (1.69±0.24) vs. (2.06±0.23)], with statistical differences (t=6.211 and 7.299; both P<0.05). The levels of S100β, BDNF, and NGF in the observation group were better than those in the control group [(0.37±0.06) μg/L vs. (0.46±0.09) μg/L, (43.97±7.92) μg/L vs. (37.14±6.87) μg/L, and (99.38±12.73) ng/L vs. (86.47±9.56) ng/L], with statistical differences (t=5.456, 4.272, and 5.318; all P<0.05). The platelet aggregation rate, adhesion rate, and maximum aggregation time in the observation group were lower than those in the control group [(26.74±4.93)% vs. (32.64±5.26)%, (32.35±4.86)% vs. (38.26±5.38)%, and (147.35±21.83) s vs. (163.67±22.67) s], with statistical differences (t=5.367, 5.345, and 3.400; all P<0.05). The levels of GSH-Px, SOD, MDA, and CRP in the observation group were better than those in the control group [(168.97±24.73) U/L vs. (140.68±20.59) U/L, (86.36±12.79) U/mL vs. (75.21±11.47) U/mL, (4.89±1.35) μmol/L vs. (6.82±1.63) μmol/L, and (9.36±3.25) mg/L vs. (12.18±4.75) mg/L], with statistical differences (t=5.765, 4.256, 5.980, and 3.213; all P<0.05). There were no statistical differences in bleeding, symptomatic intracerebral hemorrhage, recurrence, and mortality between the two groups (all P>0.05). Conclusion　Tirofiban-assisted endovascular intervention for patients with AIS can significantly increase the overall treatment efficacy, their neurological function scores, and promote their neurological function recovery, and is safe.

New Medical Advances

Advances in endovascular treatment for intracranial aneurysms

Zhang Fuxing, Yao Xiaofeng, Fang Bo

2024, 30(13):  2136-2141.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.005

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The occurrence of craniocerebral aneurysm is mainly due to the outward cystic swelling of the intracranial artery wall under the influence of hemodynamics. Rupture of intracranial aneurysm is a main cause of subarachnoid hemorrhage, second only to ischemic cerebrovascular embolism and hemorrhagic cerebrovascular accidents caused by hypertension, and is one of the common diseases in cerebrovascular neurosurgery. The disease tends to occur in middle-aged and elderly people between 40 and 70 years old, and the onset is sudden, disabling, with a high fatality rate, often bringing serious economic burden to the society and the family. Foreign scholars have been constantly carrying out further researches on the treatment of the disease. Serbinenko first proposed the endovascular treatment of aneurysms in the 1970s, but it was limited by the high requirements and lack of interventionary materials. It was not until the 1990s that Guido Guglielmi invented the detachable spring coil, which made a breakthrough in the treatment of intracranial aneurysms. With the continuous progress of modern science and technology, endovascular intervention materials and technologies have also undergone earth-shaking changes, and people have gradually understood the superiority of minimally invasive intervention in the treatment of endovascular diseases. This article mainly reviews the development of interventional materials and techniques for intracranial aneurysms.

Research progress of sotagliflozin in treatment of cardiovascular complications of patients with type 2 diabetes mellitus

Wang Xia, Zhang Lingyun, Song Shoujun

2024, 30(13):  2141-2144.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.006

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The incidence of type 2 diabetes mellitus (T2DM) is increasing, and its development can result in several complications, including cardiac, renal, vascular, and neurological problems. Cardiovascular complications are the leading cause of death in patients with T2DM. Sotagliflozin, a dual SGLT inhibitor, may reduce cardiovascular complications, and improve cardiac outcome and patients' survival rate.

Molecular mechanism of regulation of insulin secretion

Liang Lichan, Wang Yangyang, Lin Dejian, Chen Liqiang

2024, 30(13):  2145-2147.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.007

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Insulin is secreted by pancreatic β cells, and is the key active molecule in the body to regulate metabolism. Insulin biosynthesis is regulated at the transcriptional and translational levels. The cis-acting elements and trans-acting factors included paired box 6 (PAX6), pancreatic and duodenal homeobox-1 (PDX-1), V-maf musculoaponeurotic fibrosarcoma oncogene homolog A (MafA), and B-2 / neural differentiation factor 1, and they involve in insulin biosynthesis. Insulin secretion involves the formation, transport, and fusion of insulin secretory vesicles. Insulin is not only controlled by blood sugar, but also affected by free fatty acid and amino acid. In addition, different hormones can also affect insulin secretion, such as melatonin, estrogen, leptin, growth hormone, and glucagon-like peptide-1. This review focuses on the molecular mechanism of insulin synthesis and secretion, in order to understand the pancreatic β-cell dysfunction and the occurrence of diabetes mellitus.

Meta Analysis

Meta-analysis of on efficacy and safety of acupuncture combined with Huoxue Quyu prescription in treatment of migraine

Zhang Ruihuan, Hao Tao, Chen Jun, Sun Xiaolin

2024, 30(13):  2148-2157.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.008

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Objective　To evaluate the clinical efficacy, adverse reactions, and potential mechanism of acupuncture combined with Huoxue Quyu prescription in the treatment of migraine. Methods　The China Biomedical Literature Database, CNKI, Wanfang Digital Journal Database, VIP Database, PubMed, and Cochrane Library were searched to collect clinical randomized controlled trials (RCTs) from their establishment to April 10, 2023. The control group were treated with western medicine, and the treatment group with acupuncture and Huoxue Quyu prescription. The review Manager 5.4 software was used for the meta-analysis. The evidence level of the outcome indicators was evaluated by the grading of recommendations assessment, development, and evaluation (GRADE) rating system. The TSA 0.9.5.1 Beta software was used to conduct a sequential analysis of the main outcome measures. Results　A total of 20 RCTs with 2 127 patients were included. The meta-analysis results showed that: among the main outcome indicators, the recovery rate (RR=1.93, 95%CI 1.56-2.38, P<0.000 01) and the total effective rate (RR=1.22, 95%CI 1.16-1.29, P<0.000 01) in the treatment group were higher than those in the control group; there was no statistical difference in adverse reactions between the two groups (RR=0.36, 95%CI 0.12-1.12, P=0.08). Among the secondary outcome measures, the score of Visual Analogue Scale (VAS) in the treatment group (MD=-1.55, 95%CI -2.39--0.70, P=0.000 3) was lower than that in the control group; there was no statistical difference in the anterior cerebral artery (ACA) blood flow velocity (MD=-1.51, 95%CI -3.18-0.16, P=0.08) between the two groups; the middle cerebral artery (MCA) blood flow (MD=-4.12, 95%CI -5.76--2.49, P<0.000 01) and posterior cerebral artery (PCA) blood flow (MD=-2.73, 95%CI -4.14--1.32, P<0.000 1) in the treatment group were lower than those in the control group. The GRADE evidence grading results showed that total effectiveness, recovery rate, adverse reactions, VAS score, and cerebral artery (ACA, MCA, and PCA) blood flow velocities were all low. The sequential analysis of the trials showed that among the main outcome indicators, the included sample size of recovery rate and total effective rate met the requirements of the meta-analysis. However, the adverse reactions still needed to be verified by a larger sample. Conclusion　Acupuncture combined with Huoxue Quyu prescription has definite clinical effect on migraine, and can improve cerebral artery blood flow velocity to a certain extent.

Treatises

Jiawei Zuojin pills combined with rabeprazole sodium in treatment of patients with gastroesophageal reflux disease of liver-stomach depression and heat type

Liu Nan, Wu Bo, Hao Dandan, Gao Ning

2024, 30(13):  2158-2162.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.009

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Objective　To explore the clinical efficacy and safety of Jiawei Zuojin pills combined with rabeprazole sodium in the treatment of patients with gastroesophageal reflux disease of the liver-stomach depression and heat type. Methods　One hundred and twenty patients with gastroesophageal reflux disease of the liver-stomach depression and heat type who were admitted to Department of Spleen, Stomach, and Liver Diseases, Yan'an Hospital of Traditional Chinese Medicine from June 2021 to June 2023 were selected for the randomized controlled trial, and were divided into a control group and a combined treatment group by the random number table method, with 60 cases in each group. There were 28 males and 32 females in the control group; they were (42.32±5.42) years old; their disease course was (3.51±0.87) years; their body mass index was (23.52±1.91) kg/m². There were 31 males and 29 females in the combined treatment group; they were (43.88±6.17) years old; their disease course was (3.92±1.04) years; their body mass index was (24.05±0.47) kg/m². The control group were treated with rabeprazole sodium, and the combined treatment group with Jiami Zuogin pillsand rabeprazole sodium, for 8 weeks. The clinical efficacies, endoscopic scores, scores of clinical symptoms of traditional Chinese medicine, and levels of serum gastrointestinal hormones [gastrin (Gas), motilin (MTL), vasoactive intestinal peptide (VIP), and somatostatin (SS)], and scores of Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) before and after the treatment, and incidences of adverse reactions were compared between the two groups by t and χ² tests. Results　After the treatment, the endoscopic score in the combined treatment group was lower than that in the control group [(0.87±0.23) vs. (1.31±0.58); P<0.05]. The total effective rates of the combined treatment group and the control group were 93.33% (56/60) and 78.33% (47/60), respectively, with a statistical difference (χ²=4.312, P=0.009). After the treatment, the scores of post-sternal burning pain, acid reflux, thoracic and hypochondriac pain, gastrointestinal and epigastric pain, epigastric distension, belching or regurgitation, and irritability in the combined treatment group were lower than those in the control group [(1.49±0.65) vs. (3.51±0.91), (1.34±0.27) vs. (2.64±0.87), (0.34±0.16) vs. (0.51±0.21), (0.24±0.11) vs. (0.46±0.12), (0.31±0.14) vs. (0.57±0.33), (0.19±0.17) vs. (0.32±0.11), and (0.63±0.24) vs. (1.05±0.68); all P<0.05]; there was no statistical difference in the score of being hungery easily between the two groups (P>0.05). After the treatment, the levels of GAS, MTL, VIP, and SS in the combined treatment group were (126.11±11.52) ng/L, (102.66±8.16) ng/L, (45.88±7.44) ng/L, and (9.01±2.17) ng/L, and those in the control group were (105.63±10.21) ng/L, (84.33±7.17) ng/L, (53.52±6.23) ng/L, and (15.43±3.61) ng/L, with statistical differences (all P<0.05). After the treatment, the scores of SAS and SDS in the combined treatment group were lower than those in the control group [(30.66±10.29) vs. (41.31±8.55) and (31.44±8.19) vs. (38.12±11.28); both P<0.05]. The incidence of adverse reactions in the combined treatment group was 6.67% (4/60), and that of the control group was 8.33% (5/60), with no statistical difference (χ²=0.531, P=0.637). Conclusion　Jiawei Zuojin pills combined with rabeprazole sodium in the treatment of patients with gastroesophageal reflux disease of the liver-stomach depressive heat type is effective and safe.

Jianpi Xiaowei Tang combined with Western medicine for patients with chronic atrophic gastritis and precancerous lesions

Zhang Congwei, Lyu Xiaolong, Fan Zhen, Du Xiaoquan, Wang Xuejiao

2024, 30(13):  2163-2168.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.010

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Objective　To explore the efficacy of Jianpi Xiaowei Tang combined with Western medicine for patients with chronic atrophic gastritis and precancerous lesions and its effect on the expression of protein kinase B (AKT) and spleen tyrosine kinase (SYK). Methods　From October 2020 to April 2022, 90 patients treated at Hospital Affiliated to Shaanxi University of Traditional Chinese Medicine were selected for the randomized controlled trial, and were divided into a study group and a control group by the random number table method, with 45 cases in each group. There were 24 males and 21 females in the control group; they were (53.89±5.23) years old; their disease curse was (5.54±3.01) years. There were 22 males and 23 females in the study group; they were (54.32±5.45) years old; their disease curse was (5.67±2.88) years. The control group orally took rebamipide tablets and mosapride citrate tablets; in addition, the study group took Jianpi Xiaowei Tang; both groups were treated for 12 weeks. The traditional Chinese medicine symptom scores, gastric mucosal lesion scores, gastric function indicators [gastric pepsinogen I (PGI), gastric pepsinogen Ⅱ (PGⅡ), and gastrin-17 (G-17)], oxidative stress markers [acetaldehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px)], growth factors [vascular endothelial growth factor, (VEGF), epidermal growth factor (EGF), transforming growth factor alpha (TGF-α), and transforming growth factor beta 1 (TGF-β1)], and the expressions of AKT and SYK were compared between the two groups. t and χ² tests were applied. Results　After the treatment, the traditional Chinese medicine symptom scores (t=2.948, 2.058, 2.229, 2.330, and 2.829; all P<0.05) and gastric mucosal lesion scores (t=3.673, 4.189, and 5.328; all P<0.05) in the study group were lower than those in the control group; the levels of PGI, PGⅡ, and G-17 in the study group were higher than those in the control group (t=9.399, 6.757, and 2.056; all P<0.05); the level of MDA was lower and the levels of SOD and GSH-Px were higher in the study group than in the control group (t=4.278, 5.435, and 7.557; all P<0.05); the level of VEGF was higher and the levels of EGF, TGF-α, and TGF-β1 were lower in the study group than in the control group (t=6.570, 9.306, 4.842, and 5.400; all P<0.05); the levels of AKT and SYK in the study group were (2.23±1.11) and (3.16±1.18), and those in the control group were (2.75±1.06) and (2.58±0.92), with statistical differences (t=2.273 and 2.600; both P<0.05). Conclusions　Jianpi Xiaowei Tang combined with Western medicine for patients with chronic atrophic gastritis and precancerous lesions can effectively alleviate their clinical symptoms, and improve their gastric function and anti-oxidant. Its mechanism may relate to AKT and SYK's role in the regulation of gastric mucosal epithelial cells' malignant transformation.

Incidence and risk factors of carotid artery plaque in some community in Hohhot

Zhang Zhenglu, Ning Jie, Gao Ruijiang, Liu Guojuan, Wu Yihan

2024, 30(13):  2169-2174.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.011

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Objective　To study the incidence of carotid artery plaque and its related risk factors in residents at some community in Hohhot City, and to provide scientific basis for the prevention and management of local carotid artery plaque. Methods　From January to June 2022,868 examinees who underwent carotid artery color ultrasound examination and completed questionnaires during physical examination at Haidong Road community, Xincheng District, Hohhot City were selected as the research objects. Their clinical data were collected. Their lifestyles were investigated by questionnaire.t, Welch's t, and χ² tests were used. The binary logistic regression analysis model was used to explore the related risk factors of carotid artery plaque formation. Results　This study included a total of 868 research objects; they were (56.82±9.77) years old; there were 424 males (48.8%) and 444 females (51.2%); 469 patients (54.0%) had carotid artery plaques were detected, and the rest 399 patients (46.0%) did not. There were statistical differences between the carotid artery plaque group and the non-plaque group in age, fasting blood glucose, glycated hemoglobin, high-density lipoprotein, homocysteine, smoking and exercise behaviors, and vegetable and fruit diet (all P<0.05). The binary logistic regression analysis showed that the occurrence of carotid artery plaque was related to gender (OR=0.368, 95%CI 0.230-0.588), age (OR=1.129, 95%CI 1.102-1.157), smoking behavior (OR=23.540, 95%CI 11.939-46.414), glycosylated hemoglobin (OR=1.663, 95%CI 1.188-2.329), and high-density lipoprotein (OR=0.291, 95%CI 0.117-0.729). Conclusion　Among the permanent residents at Haidong Road Community, Xincheng District, Hohhot City,increasing age, gender, smoking, poor glycemic control, and high-density lipoprotein level are the main independent risk factors of carotid artery plaque formation. Effective interventions on these risk factors, especially smoking cessation and blood sugar control, may reduce the risk of carotid artery plaques, thereby reducing the occurrence of cardiovascular and cerebrovascular events in the residents.

Expression of Cbl family in non-small cell lung cancer and its relationship with clinicopathology and prognosis

Sun Jing, Huang Jiachen

2024, 30(13):  2174-2180.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.012

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Objective　To detect the expression levels of Cbl-b, c-Cbl, and Cbl-c proteins of E3 ubiquitin ligase casitas b-lineage lymphoma (Cbl) family in non-small cell lung cancer (NSCLC), and to analyze their relationship with clinicopathological features and prognosis. Methods　This was a prospective study. A total of 102 patients with NSCLC admitted to Hanzhong People's Hospital from January 2020 to January 2023 were selected, including 78 males and 24 females. They were (67.49±8.33) years old. The cancer-adjacent tissues removed by surgery were used as controls. The immunohistochemical staining was used to detect the expressions of Cbl-b, c-Cbl, and Cbl-c proteins in the cancer tissues and cancer-adjacent tissues. The expressions of Cbl-b, c-Cbl, and Cbl-c proteins in the cancer tissues of the patients with different clinicopathological characteristics (gender, age, smoking history, lesion site, TNM stage, differentiation grade, pathological type, and pleural invasion) were compared. The Cox regression model was used to analyze the influencing factors of the patients' prognosis. Kaplan-Meier curves were drawn to analyze the relationship between the expressions of Cbl-b and Cbl-c proteins in the cancer tissues and NSCLC prognosis. t and χ² tests were applied. Results　The positive expression rates of Cbl-b, c-Cbl, and Cbl-c proteins in the cancer tissues were higher than those in the cancer-adjacent tissues [52.94% (54/102) vs. 37.25% (38/102), 63.73% (65/102) vs. 43.14% (44/102), and 67.65% (69/102) vs. 39.22% (40/102)], with statistical differences (χ²=5.068, 8.688, and 16.568; all P<0.05). The positive expression rates of Cbl-b, c-Cbl, and Cbl-c proteins in the cancer tissues of the patients with smoking history, TNM stage Ⅲ/Ⅳ, undifferentiated/low differentiation, and pleural invasion were higher than those of the patients without smoking history and with TNM stage I/Ⅱ, moderate/high differentiation, and no pleural invasion [smoking history: 62.32% (43/69) vs. 33.33% (11/33), 73.91% (51/69) vs. 42.42% (14/33),and 78.26% (54/69) vs. 45.45% (15/33); TNM stage: 76.00% (19/25) vs. 45.45% (35/77), 88.00% (22/25) vs. 55.84% (43/77), and 92.00% (23/25) vs. 59.74% (46/77); differentiation: 65.22% (30/46) vs. 42.86% (24/56), 78.26% (36/46) vs. 51.79% (29/56), and 82.61% (38/46) vs. 55.36% (31/56); pleural invasion: 80.00% (20/25) vs. 44.16% (34/77), 88.00% (22/25) vs. 55.84% (43/77), and 92.00% (23/25) vs. 59.74% (46/77)], with statistical differences (χ²=7.528, 9.575, 10.978, 7.068, 8.442, 8.974, 5.068, 7.658, 8.570, 9.733, 8.442, and 8.974; all P<0.05). The Cox regression analysis showed that smoking history, TNM stage Ⅲ, undifferentiated/low differentiation, pleural invasion, and Cbl-b protein expression and Cbl-c protein expression in the cancer tissues were the influencing factors of the patients' prognosis (all P<0.05). The progression-free survival time of the Cbl-b positive group was 27 months (95%CI 22.602-31.398 months), and that of Cbl-b negative group was 40 months (95%CI 28.810-51.190 months); the overall comparison of Kaplan-Meier survival curves showed a statistical difference (χ²=6.709, P=0.010). The progression-free survival time of the Cbl-c positive group was 28 months (95%CI 23.786-32.214 months), and that of the Cbl-c negative group was 39 months (95%CI 29.892-48.108 months); the overall comparison of Kaplan-Meier survival curves showed a statistical difference (χ²=4.605, P=0.032). Conclusions　Cbl-b, c-Cbl, and Cbl-c proteins are highly expressed in NSCLC. All the three are related to smoking history, TNM stage, differentiation degree, and pleural invasion. Among them, Cbl-b and Cbl-c are influencing factors of prognosis of patients with NSCLC.

Value of serum indicators combined with transvaginal and transabdominal ultrasound in diagnosis of early ectopic pregnancy

Zhao Yan, Zhang Tianmei, Jiang Shuyan, Wang Yunqin, Song Xiuqin

2024, 30(13):  2181-2185.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.013

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Objective　To analyze the value of the levels of β-human chorionic gonadotropin (β-HCG), cancer antigen 199 (CA199), and progesterone (P) combined with transvaginal and transabdominal ultrasound in the prediction of early ectopic pregnancy. Methods　From October 2020 to October 2023, a total of 93 patients suspected with early ectopic pregnancy treated in Yantai Yantaishan Hospital were selected as the study objects; among which, 82 patients who were (31.35±3.16) years were confirmed with early ectopic pregnancy by postoperative pathological diagnosis and were set as an observation group. Another 105 women with normal intrauterine pregnancy during the same period were selected as a control group; they were (31.57±3.22) years old. The objects' clinical data were retrospectively collected. The serum levels of β-HCG, CA199, and P, transvaginal and transabdominal ultrasound signs, and diagnostic results of early ectopic pregnancy in the two groups were analyzed and compared by t test and χ² test. The receiver operating characteristic curves (ROC) were drawn. Results　The serum levels of β-HCG, CA199, and P in the observation group were lower than those in the control group (all P<0.05). All the 93 patients took pathological examination, and 82 were positive. The transvaginal ultrasound results showed that 72 cases had early ectopic pregnancy. The transabdominal ultrasound results showed that 69 cases had early ectopic pregnancy. The proportions of the patients with uterine and rectal effusion, original cardiac tube pulsation, adnexal mass, and no pregnancy sac in utero by abdominal ultra sound were lower than those by transvaginal ultrasound (all P<0.05). The areas under the ROC's of transvaginal ultrasound, transabdominal ultrasound, β-HCG, CA199, P, and their combination were 0.716, 0.657, 0.630, 0.605, 0.691, and 0.910; the sensitivities were 65.85%, 63.41%, 70.73%, 58.54%, 68.29%, and 86.59%; the specificities were 72.73%, 72.73%, 63.64%, 72.68%, 63.64%, and 81.82%. Conclusion　Abnormal expressions of levels of serum β-HCG, CA199, and P and transvaginal and transabdominal ultrasound are found in patients with early ectopic pregnancy, and their combined detection has high diagnostic value for patients with early ectopic pregnancy, and may be used as a target for clinical diagnosis and treatment of early ectopic pregnancy.

Application of thromboelastography in patients taking antiplatelet therapy after vertebrobasilar artery stenting

Zhang Sheng, Gao Lili, Liao Yuansheng

2024, 30(13):  2186-2190.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.014

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Objective　To compare the clinical efficacies of using the results of thromboelastography (TEG) to guide the selection of antiplatelet aggregation drugs after vertebrobasilar artery stenting and the conventional use of antiplatelet aggregation drugs. Methods　This was retrospective analysis. Sixty-nine patients taking vertebral-basilar artery stenting at Department of Neurology, Second Hospital Affiliated to Fujian University of Traditional Chinese Medicine from July 2018 to June 2023 were selected as the study objects. They orally took aspirin enteric-coated tablets, 100 mg/d, qd, and clopidogrel tablets, 75 mg/d, qd. The patients whose antiplatelet therapy was adjusted according to the results of thrombologram parameters were set as an adjusted group (53 cases), and the patients whose therapy was not adjusted were set as a control group (16 cases). There were 43 males and 10 females in the adjusted group; they were (68.53±11.4) years old. There were 12 males and 4 females in the control group; they were (68.50±9.28) years old. The adjusted group's therapy was adjusted as below: if the controlled rate of arachidonic acid (AA) was not qualified, the patients took indobufen tablets (100 mg, bid) or cilostazol tablets (100 mg, bid) instead of aspirin enteric-coated tablets; if the controlled rate of adenosine diphosphate (ADP) was not qualified, the patients took ticagrelor tablets (90 mg, bid) instead of clopidogrel tablets, for 6 months. The control group continued to orally take aspirin enteric-coated tablets (100 mg, qd) and clopidogrel tablets (75 mg, qd) for 6 months. The levels of total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triacylglycerol (TG), creatinine (Cr), uric acid (UA), and fibrinogen (FIB) and the incidences of ischemic events, bleeding events, stent restenosis, and death within 6 months after operation were compared between the two groups. The independent sample t test, Mann-Whitney U test, χ² test, and Fisher's precision probability test were applied. Results　There were no statistical differences in the levels of CHOL, HDL-C, LDL-C, TG, Cr, UA, and FIB before and 6 months after the operation between the two groups (all P>0.05). Within 6 months after operation, the incidences of ischemic events and stent restenosis in the adjusted group were lower than those in the control group [18.87% (10/53) vs. 68.75% (11/16) and 7.55% (4/53) vs. 31.25% (5/16)], with statistical differences between the two groups (χ²=12.184, P<0.001; χ²=4.177, P=0.041). One case (1.89%) had brain bleeding in the adjusted group, and none in the control group, with no statistical difference between the two groups (P=1.000). Conclusion The use of thromboelastography to guide the individualized antiplatelet therapy for patients after vertebrobasilar artery stenting has better clinical prognosis than the traditional standard therapy.

Analysis of genetic mutation types in 121 cases of rare thalassemia

Chen Fang, Chen Mingfa

2024, 30(13):  2190-2197.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.015

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Relationship of fibrinogen and peripheral blood leukocytes with degree of renal function impairment in patients with diabetic kidney disease

Wang Limin, Dong Hengli

2024, 30(13):  2198-2203.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.016

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Objective　To explore the relationship of fibrinogen (FIB) and peripheral blood leukocytes with the degree of renal function impairment in patients with diabetic kidney disease (DKD). Methods　One hundred and sixty-four patients with DKD treated at Shaanxi Hospital of Traditional Chinese Medicine from March 2022 to February 2024 were selected for as the study objects. According to the 24-hour urinary albumin excretion, the patients were divided into a microalbuminuria group [96 patients; 30 mg≤24-hour urinary albumin excretion <300 mg; 50 males and 46 females; (55.79±7.27) years old] and a macroalbuminuria group [68 patients; 24-hour urinary albumin excretion≥300 mg; 36 males and 32 females; (56.50±7.01) years old]. The general data, levels of FIB and fibrinogen degradation products (FDP), FIB to albumin ratios (FAR), lymphocyte counts, monocyte counts, neutrophil counts, eosinophil counts, and basophil counts were compared between the two groups. The multifactorial logistic regression was used to analyze the risk factors affecting renal function impairment in the patients with DKD. t and χ² tests were applied. Results　The levels of blood urea nitrogen (BUN), serum creatinine (Scr), FIB, FDP, and FAR in the macroalbuminuria group were higher than those in the microalbuminuria group [(10.04±3.38) mmol/L vs. (5.83±1.52) mmol/L, (191.59±35.79) mmol/L vs. (81.54±16.10) mmol/L, (3 645.15±725.13) mg/L vs. (2 864.94±759.73) mg/L, (2.05±0.46) mg/L vs. (1.42±0.39) mg/L, and (92.93±33.86) mg/g vs. (73.40±20.40) mg/g], with statistical differences (t=10.772, 26.591, 6.602, 9.455, and 4.598; all P<0.05). The estimated glomerular filtration rate (eGFR) in the macroalbuminuria group was lower than that in the microalbuminuria group [(42.62±12.40) ml/(min·1.732 m²) vs. (82.43±20.43) ml/(min·1.732 m²)], with a statistical difference (t=14.303; P<0.05). The monocyte and neutrophil counts in the macroalbuminuria group were higher than those in the microalbuminuria group [(0.48±0.16) ×10⁹/L vs. (0.35±0.10) ×10⁹/L and (4.21±1.19) ×10⁹/L vs. (3.58±0.88) ×10⁹/L], with statistical differences (t=6.394 and 3.898; both P<0.05). There were no statistical differences in the lymphocyte, eosinophil, and basophil counts between the two groups (all P>0.05). The multifactorial logistic regression analysis revealed that high BUN, Scr, FIB, FDP, FAR, and counts of monocytes and neutrophils, as well as low eGFR were independent risk factors for the severity of renal function impairment in the patients with DKD (all P<0.05). The Pearson correlation analysis indicated that the levels of FIB, FDP, and FAR and monocyte and neutrophil counts were positively correlated with BUN and Scr, and negatively with eGFR (all P<0.05). Conclusions　In patients with DKD, the levels of FIB, FDP, and FAR and counts of monocytes and neutrophils increase, and are positively correlated with the degree of renal function impairment. These indicators are identified as the independent risk factors affecting the degree of renal function impairment in patients with DKD and can serve as indicators for assessing the progression of DKD.

Basic Research

Research on apigenin regulating miR-152/BRD4 axis and inhibiting HMGB1 in treatment of carbon monoxide induced brain injury

Zhou Xiaochun, Qiu Dongdong, Yuan Sisi, Luo Xurui, Huang Shaofang

2024, 30(13):  2204-2209.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.017

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Objective　To explore the effect of apigenin on regulating the miR-152/bromodomain protein 4 (BRD4) axis and inhibiting high mobility group protein B1 (HMGB1) in the treatment of carbon monoxide (CO) induced brain injury. Methods　The mouse models of CO induced brain injury were established in February 2024, and were divided into a control group, a CO treatment group, an apigenin 25 mg/kg intervention group, and an apigenin 50 mg/kg intervention group by the random number table method, with 10 in each group. The control group was intraperitoneally given air, 170 ml/kg; the CO treatment group was given intraperitoneal injection of CO, 170 ml/kg; the apigenin 25 mg/kg intervention group established the CO models 24 h, and were intraperitoneally injected apigenin, 25 mg/kg, once per day; and the 50 mg/kg apigenin intervention group established the CO models 24 h, and were intraperitoneally injected apigenin, 50 mg/kg , once per day. The mice were euthanized by 3% isoflurane anesthesia after 90 minutes, 7 days, and 14 days, respectively. The brain tissue and peripheral blood were collected. The pathological and physiological conditions of the cortical and hippocampal regions of the brain tissue were compared between the two groups, and HE staining was used for morphological observation. Immunohistochemical detection of glial fibrillary acidic protein in the brain tissue was did; the serum concentrations of HMGB1, tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, and IL-6 in the mouse serum were detected by ELISA; Western blot/real time polymerase chain reaction was used to detect the expressions of BRD4 and HMGB1/mRNA in the cells; the flow cytometry was used to detect cell apoptosis. Analysis of variance was used. Results　The expressions of GFAP protein in the control group, the CO treatment group, the apigenin 25 mg/kg intervention group, and the apigenin 50 mg/kg intervention group were (1.11±0.06), (1.93±0.18), (1.32±0.09), and (1.09±0.05), respectively, with statistical differences between the groups (all P<0.05). The concentrations of TNF-α, IL-1β, and IL-6 in the CO treatment group were higher than those in the control group and the apigenin 50 mg/kg intervention group [(1.24±0.08) pg/L vs. (0.45±0.03) pg/L vs. (0.59±0.04) pg/L, (13.56±2.30) mg/L vs. (6.30±1.23) mg/L vs. (7.69±2.10)mg/L, and (3.86±0.22) pg/L vs. (0.14±0.01) pg/L vs. (1.35±0.06) pg/L], with statistical differences (all P<0.05). The levels of HMGB1/β-actin, TNF-α/β-actin, IL-1β/β-actin, and IL-6/β-actin in the CO treatment group were higher than those in the control group and the apigenin 50 mg/kg intervention group [(1.23±0.10) vs. (0.50±0.04) vs. (0.78±0.08), (0.61±0.06) vs. (0.24±0.02) vs. (0.37±0.02), (0.85±0.14) vs. (0.42±0.05) vs. (0.52±0.02), and (1.23±0.10) vs. (0.50±0.04) vs. (0.78±0.08)], with statistical differences (all P<0.05). The apoptosis rates of hippocampal neurons in the CO treatment group, the apigenin 25 mg/kg intervention group, and the apigenin 50 mg/kg intervention group were higher than that in the control group [(19.92±3.25)%, (15.63±2.25)%, and (11.23±3.55)% vs. (4.98±1.26)%], with statistical differences (all P<0.05). Conclusion　Apigenin inhibits the expression of HMGB1 by regulating the miR-152/BRD4 axis, and alleviates brain damage caused by carbon monoxide poisoning.

Clinical Research

Distribution of traditional Chinese medicine syndromes in patients with diabetic gastroparesis based on cluster analysis

Wang Mi, Wang Yan, Chen Chao

2024, 30(13):  2210-2213.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.018

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Objective　 To study the distribution of traditional Chinese medicine syndromes in patients with diabetic gastroparesis (DGP), to analyze the characteristics of traditional Chinese medicine syndromes in patients with DGP, and to provide references for the clinical differentiation and treatment.Methods　A total of 153 patients with DGP treated at Ankang Hospital of Traditional Chinese Medicine from May 2021 to November 2023 were investigated by the general data investigation table and traditional Chinese medicine syndrome collection table, including 66 males and 87 females who were (51.30±10.28) years old. The descriptive frequency analysis and cluster analysis were applied. The χ² test was used. Results　The syndrome analysis showed that spleen and stomach weakness syndrome accounted for the highest proportion (56 cases, 36.60%), followed by liver depression and spleen deficiency syndrome (31 cases, 20.26%), phlegm-dampness syndrome (28 cases, 18.30%), cold and heat syndrome (21 cases, 13.73%), and Yin deficiency and internal heat syndrome (17 cases, 11.11%). The analysis of the relationship between the syndromes and diabetes course showed that the patients with diabetes course within 5 years mainly had cold and heat syndrome (16 cases, 28.07%) and phlegm-dampness syndrome (15 cases, 26.32%); the patients with diabetes course >5-10 years mainly had spleen and stomach weakness syndrome (17 cases, 41.46%) and liver depression and spleen deficiency syndrome (10 cases, 24.39%); the patients with diabetes course over 10 years mainly had spleen and stomach weakness syndrome (29, 52.73%) and Yin deficiency and internal heat syndrome (10 cases, 18.18%). Conclusions　The main traditional Chinese medicine syndrome of patients with DGP is spleen and stomach weakness, which runs through the whole process of DGP development. With the extension of diabetes course, the patients' pathogenesis is the evolution process from deficiency to deficiency syndrome. 

Risk factors of cognitive dysfunction in patients taking peritoneal dialysis and establishment of a predictive model

Shao Shuqin, Liu Xiaoming

2024, 30(13):  2214-2219.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.019

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Objective　To construct and validate a predictive model for the occurrence of cognitive impairment in patients taking peritoneal dialysis by nomograms. Methods　This was a prospective study. One hundred and twenty patients taking peritoneal dialysis at Department of Nephrology, Yantai Laiyang Central Hospital from January 2020 to January 2024 were selected as the study objects. According to the Montreal Cognitive Assessment (MoCA) scores, the patients were divided into a cognitively normal group (52 cases) whose MoCA score ≥26 and a cognitive impairment group (68 cases) whose MoCA score < 26. There were 28 males and 24 females in the cognitively normal group; they were (50.19±12.79) years old. There were 36 males and 32 females in the cognitive impairment group; they were (53.87±10.84) years old. The general data and clinical indicators in both groups were collected. Multivariate logistic regression analysis was used to identify the risk factors of cognitive impairment in the patients. Based on the results, a nomogram prediction model was established and validated by a calibration curve. t and χ² tests were utilized. Results　The proportion of the patients with diabetes and the levels of glycosylated hemoglobin (HbA1c), parathyroid hormone (PTH), and serum ferritin (SF) in the cognitively normal group were lower than those in the cognitive impairment group [3.85% (2/52) vs. 25.00% (17/68), (5.06±0.31)% vs. (5.52±0.36)%, (304.91±87.79) μg/L vs. (395.69±108.71) μg/L, and (342.83±85.76) μg/L vs. (433.71±134.93) μg/L], with statistical differences (χ²=9.895; t=7.359, 4.918, and 4.243; all P<0.05). The multivariate logistic regression analysis showed that having diabetes and high levels of HbA1c, PTH, and SF were independent risk factors for the occurrence of cognitive impairment in the patients (all P<0.05). Based on these findings, a nomogram prediction model was developed, and it could effectively predict the occurrence of cognitive impairment in the patients. The calibration curve confirmed that the model had good predictive accuracy. Conclusion　Patients with diabetes and high HbA1c, PTH, and SF levels have higher risk of cognitive impairment. These factors should be given special attention in treatment, and appropriate preventive measures should be taken.

Value of serum miR-599 combined with VEGF in predicting recurrence of patients with differentiated thyroid cancer after subtotal resection

Yang Kai, Wang Binfeng, Ren Yanshun, Hui Peng

2024, 30(13):  2219-2224.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.020

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Objective　To investigate the efficacy of serum microRNA-599 (miR-599) and vascular endothelial growth factor (VEGF) levels in the prediction of recurrence of patients with differentiated thyroid cancer (DTC) after totally endoscopic subtotal thyroidectomy. Methods　A total of 135 patients with DTC who underwent totally endoscopic subtotal thyroidectomy at Tongchuan People's Hospital from January 2017 to March 2022 were selected. The serum levels of miR-599 and VEGF in all the patients were detected before the operation. Their preoperative clinical data were collected. The patients were followed up for 2 years after the operation. According to the postoperative recurrence, they were divided into a recurrence group (31 cases) and a non-recurrence group (104 cases). There were 12 men and 19 women in the recurrence group; they were (51.26±7.32) years old. There were 48 men and 56 women in the non-recurrence group; they were (49.57±7.08) years old. The count data were analyzed by χ² test or Fisher's exact probability test. The measurement data were analyzed by the independent-sample t test. The influencing factors of postoperative recurrence were analyzed by the multivariate stepwise logistic regression model. The predictive efficacies of serum miR-599 and VEGF levels in predicting postoperative recurrence were analyzed by the areas (AUC) under the receiver operating characteristic curves (ROC). Results　The level of miR-599 in the recurrence group was lower than that in the non-recurrence group [(0.81±0.09) vs. (1.05±0.12)], and the level of VEGF in the recurrence group was higher than that in the non-recurrence group [(32.55±5.26) ng/L vs. (24.83±4.07) ng/L] (t=10.295 and 8.639; both P<0.001). The proportion of the patients of Ⅲ-Ⅳstage [67.74% (21/31) vs. 28.85% (30/104)] and anti-thyroglobulin antibody (TgAb) level [(251.86±27.98) IU/ml vs. (211.43±23.49) IU/ml] in the recurrence group were higher than those in the non-recurrence groupm, and the proportions of the patients taking intraoperative lymph node dissection [22.58% (7/31) vs. 44.23% (46/104)] and postoperative radioactive iodine therapy [32.26% (10/31) vs. 53.85% (56/104)] in the recurrence group were lower than those in the non-recurrence group (t=8.040; χ²=4.694 and 4.454; all P<0.05). The multivariate stepwise logistic regression analysis showed that the level of miR-599 (OR=0.251, 95%CI 0.109-0.576) was an independent protective factor for postoperative recurrence, and the level of VEGF (OR=2.163, 95%CI 1.256-3.722), clinical stage (OR=4.287, 95%CI 1.908-9.631), and TgAb level (OR=4.612, 95%CI 2.172-9.789) were independent risk factors for postoperative recurrence (all P<0.05). The ROC showed that the sensitivities of miR-599, VEGF, and their combination in the prediction of postoperative recurrence were 71.00%, 74.20%, and 90.30%, respectively; the specificities were 76.90%, 72.10%, and 88.50%, respectively; the AUC's were 0.824, 0.794, and 0.931, respectively (all P<0.05). Conclusions　Serum VEGF level is an independent risk factor for recurrence, and serum miR-599 level is an independent protective factor for recurrence in DTC patients after total endoscopic subtotal thyroidectomy. The combined detection of the two markers can better predict the risk of postoperative recurrence.

Effect of heart regulating and mind calming acupuncture combined with cognitive behavioral therapy on patients with chronic insomnia

Zhang Lintao, Wang Jin, Chen Jie, Yuan Jie

2024, 30(13):  2225-2229.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.021

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Objective　To analyze the effect of heart regulating and mind calming acupuncture combined with cognitive behavioral therapy on patients with chronic insomnia (CID). Methods　One hundred and two patients with CID treated at Hospital Affiliated to Shaanxi University of Chinese Medicine from September 2021 to August 2023 were selected, and divided into a control group and an observation group by lottery, with 51 cases in each group. There were 29 males and 22 females in the control group; they were (40.26±8.54) years old. There were 27 males and 24 females in the observation group; they were (42.73±8.15) years old. The control group received cognitive-behavioral therapy, while the observation group received heart regulating and mind calming acupuncture and cognitive-behavioral therapy. Both groups were intervened once a week for 4 weeks. The treatment effects and scores of Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) and serum neurotransmitter levels before the treatment and after 4 weeks' treatment were compared between the two groups. Independent-sample t test and χ² test were applied. Results　The total effective rate of the observation group was higher than that of the control group [96.08% (49/51) vs. 84.31% (43/51)], with a statistical difference (χ²=3.991,P=0.046). After 4 weeks' treatment, the scores of ISI and PSQI in the observation group were lower than those in the control group [(9.53±2.74) vs. (11.23±2.58) and (6.17±2.45) vs. (10.32±2.62)], with statistical differences (both P<0.05). After 4 weeks' treatment, the levels of γ-aminobutyric acid and glutamic acid in the observation group were higher those in the control group [(10.42±1.32) ng/L vs. (8.61±0.95) ng/L and (17.42±0.92) μmol/L vs. (15.62±5.52) μmol/L], with statistical differences (both P<0.05). After 4 weeks' treatment, the scores of SAS and SDS in the observation group were lower than those in the control group [(31.42±5.52) vs. (39.63±5.47) and (36.15±6.43) vs. (41.62±5.79)], with statistical differences (both P<0.05). Conclusion　Heart regulating and mind calming acupuncture combined with cognitive behavioral therapy for patients with CID can improve the treatment effect, alleviate their insomnia, improve their sleep quality and serum neurotransmitter levels, and alleviate their adverse emotions.

Value of nomogram based on ultrasound in prediction of papilla-areola complex involvement in patients with breast cancer

Zhu Limin, Cheng Rong, Ji Li, Wang Jingjing

2024, 30(13):  2229-2235.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.022

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Objective　To investigate the detection rate of nipple-areola complex (NAC) involvement in patients with breast cancer, and to construct a nomogram predictive model based on conventional ultrasound and contrast-enhanced ultrasound (CEUS) signs to guide preoperative evaluation. Methods　A total of 108 patients with breast cancer who were pathologically diagnosed and eligible for mastectomy in Shaanxi Nuclear Industry 215 Hospital from October 2022 to October 2023 were retrospectively summarized. They were (44.8±10.4) years old. They were divided into an NAC positive group (35 cases) and an NAC negative group (73 cases) according to the postoperative routine pathological results. Before the operation, conventional two-dimensional color Doppler ultrasound was used to measure the tumor maximum diameter, tumor to nipple distance (TND), tumor location, type, shape, direction, edge, boundary, echo pattern, internal uniformity, blood vessels, microcalcification, and echo pattern extending from lesion to catheter. CEUS was used to measure the maximum tumor diameter, TND, catheter enhancement extension to nipple (DEEN), focal nipple enhancement, enhanced uniformity, edge enhancement, contour enhancement, sequence of enhancement, perfusion defect, and extent of enhancement. The independent-sample t test and χ² were used to compared tha data between the groups. Multivariate logistic regression was used to screen the risk factors of NAC involvement and establish a nomogram model. The predictive performance was verified by the receiver operating characteristic curves (ROC), calibration, and decision analysis (DCA). Results　Compared with the negative group, the positive group showed increases of peripheral tumors, microcalcifications, ductal echo extending from lesion, as well as CEUS measurements of DEEN and focal nipple enhancement, while the TND measured by two-dimensional ultrasound and CEUS were significantly shorter (all P<0.05). The regression analysis showed that ductal echo extending from lesion (full course: OR=2.452, 95%CI 1.590-3.782, P<0.001; segmental: OR=1.992, 95%CI 1.252-3.169, P<0.001), DEEN (OR=1.385, 95% CI 1.018-1.885, P=0.003), and focal nipple enhancement (OR=3.435, 95%CI 1.654-7.135, P<0.001) were the main risk factors of NAC involvement. After establishing the nomogram using the R software, the AUC calculated by ROC was 0.876 (95%CI 0.811-0.935, P<0.001), indicating good predictive accuracy of the model. The calibration and DCA curves showed good agreement and clinical net benefit ratio of the model. Conclusion　The nomogram model developed by conventional ultrasound and CEUS typical signs has important potential for predicting the risk of NAC involvement in patients with breast cancer taking breast conserving resection.

Research on infrared thermal imaging characteristics of patients with breast fetish of liver stagnation and qi stagnation type

Yu Xijing, Chen Bozhen, Huang Hui, Guo Rong, Fang Xiaoyi, Wan Zhangjing

2024, 30(13):  2236-2239.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.023

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Objective　To analyze the infrared thermal imaging characteristics of patients with breast fetish of liver stagnation and qi stagnation type. Methods　Thirty patients with breast fetish of liver stagnation and qi stagnation type admitted to Nanchang Hongdu Traditional Chinese Medicine Hospital from December 2021 to December 2022 were selected as an observation group, and 30 healthy women who underwent routine health examination as a control group. The observation group were (38.26±7.54) years old, and the control group (37.48±7.85) years old. The infrared thermal images of the two groups were obtained by the infrared thermal imaging detection system. The relative temperatures (ΔT value) of the breast area, Qimen acupoint, and Taichong acupoint areas of the two groups were collected. The general information, physical fitness scores, and physical fitness classifications of the two groups were collected. The independent sample t test and χ² test were used. Results　The observation group was mainly characterized by qi deficiency and qi depression [20.00% (6/30) and 26.67% (8/30)], while the control group by calmness and yang deficiency [23.33% (7/30) and 20.00% (6/30)]; there was a statistical difference between the two groups (χ²=16.785, P=0.013). The ΔT1 value of the breast area and ΔT2 value of the Qimen acupoint area in the observation group were higher than those in the control group [(0.82±0.26) ℃ vs. (0.45±0.18) ℃ and (0.78±0.15) ℃ vs. (0.51±0.16) ℃], and the ΔT3 value of the Taichong area in the observation group was lower than that in the control group [(-4.15±1.24) ℃ vs. (-3.09±1.02) ℃], with statistical differences (t=6.409, 6.743, and 3.616; all P<0.05). Conclusion　This study has preliminarily constructed the infrared thermal imaging characteristics of patients with breast fetish of liver depression and qi stagnation type: compared with that of healthy women, the infrared temperatures of the breast, Qimen acupoint, and Taichong acupoint areas of patients with breast fetish of liver depression and qi stagnation type have changed, which can be clinically used to assist the diagnosis of patients with breast fetish of liver depression and qi stagnation type.

Application of TTPVI based on CT and MRI imaging to display microvascular invasion in patients with liver cancer

Shi Sanli, Zhang Jianping, Li Fen, Yang Lijuan, Guo Wanliang

2024, 30(13):  2240-2244.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.024

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Objective　To explore the value of two-trait predictor of venous invasion (TTPVI) of CT and MRI in the diagnosis of microvascular invasion in patients with primary liver cancer. Methods　One hundred and twelve patients with primary liver cancer admitted to Xi'an Eighth Hospital between June 2022 and September 2023 were selected as the study objects. They were divided into an invasive group and a non-invasive group based on microvascular invasion. The marginal fuzzy signs, TTPVI, and portal vein tumor thrombus (PVTT) of CT or MRI before the operation were compared between the two groups. The diagnostic efficacies of the above indicators for microvascular invasion in the patients with primary liver cancer were analyzed by the receiver operating characteristic curves (ROC). t test, χ² test, and rank sum test were used. Results　Among the 112 patients, 25 cases (22.32%) experienced microvascular invasion. The proportions of borderline fuzzy signs, TTPVI, and PVTT in the invasive group were 60.00% (15/25), 72.00% (18/25), and 16.00% (4/25), respectively, which were significantly higher than those in the non-invasive group (χ²=38.968, 40.349, and 14.436, all P<0.05). The incidence rates of edge blurry signs such as multiple sign overlap, multiple nodule fusion, incomplete local capsule, and local protruding nodules in the invasive group were 12.00% (3/25), 16.00% (4/25), 12.00% (3/25), and 12.00% (3/25), respectively, which were significantly higher than those in the non-invasive group (χ²=6.639, 10.042, 6.639, and 4.285; all P<0.05). The areas under the ROC's (AUC) of edge blurred signs, TTPVI, and PVTT of CT and MRI for microvascular invasion in the patients were 0.771 (95%CI 0.648-0.894), 0.828 (95%CI 0.723-0.934), and 0.580 (95%CI 0.443-0.717), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of preoperative TTPVI in diagnosing microvascular invasion in the patients were 72.00%, 89.66%, 66.67%, and 91.76%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of preoperative blurred signs in diagnosing microvascular invasion in the patients were 60.00%, 94.25%, 75.00%, and 89.13%, respectively. The AUC of TTPVI combined with edge blurred signs for microvascular invasion in the patients was 0.821 (95%CI 0.703～0.938); the sensitivity, specificity, positive predictive value, and negative predictive value were 76.00%, 89.66%, 67.86%, and 92.86%, respectively. Conclusion　Preoperative blurred edges and TTPVI of CT and MRI have certain diagnostic value for microvascular invasion in patients with primary liver cancer, and their combined efficacy is better.

Case Report

One case of alveolar soft part sarcoma of tongue and literature review

Xu Lei, Wu Han, Wang Miaomiao, Zhang Ruizhe, Wu Shuhua

2024, 30(13):  2245-2248.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.025

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Alveolar soft part sarcoma (ASPS) is a rare malignant soft tissue tumor, and is more common in adolescents, and occurs in the limbs and trunk. The ASPS primarily occurring in the tongue is even rarer. The article reports one patient with tongue ASPS who admitted to the Binzhou Medical University Hospital on November 23, 2022. The patient had dysphonia as the main symptom, and the imaging diagnosis tended to hemangioma. After surgical resection, the pathological manifestation was ASPS, and no recurrence was found after 6 months' follow-up after the operation. Tongue ASPS is often misdiagnosed as benign tumors such as hemangioma due to its non-specific clinical manifestations and rare location, thus delaying treatment. Therefore, clinicians should strengthen their understanding of the clinical manifestations and pathological diagnosis of tongue ASPA patients to avoid misdiagnosis and missed diagnosis.

Nursing Research

Finger exercises combined with gripping in reducing limb swelling in patients taking transradial coronary intervention

Huang Libin

2024, 30(13):  2249-2252.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.026

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桡动脉；经皮冠状动脉介入治疗；改良手指操；握力；疼痛程度；肿胀程度

Influence of dependence between patients with prostate cancer and their primary caregivers on positive feeling

Zhang Yan, Mi Yuanyuan, Sun Liya, Xu Yuan

2024, 30(13):  2253-2259.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.027

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Objective　To explore the influence of the dependence between patients with prostate cancer and their primary caregivers on positive feelings based on the actor-partner interdependence model (APIM). Methods　This study was a prospective and single-center trial. One hundred and thirty-three patients with prostate cancer treated at Hospital Affiliated to Jiangnan University from May 2021 to May 2023 and their main caregivers were selected as the research objects; the patients were 49-90 (70.52±12.65) years old; among the caregivers, there were 42 males and 91 females who were 22-79 (62.56±10.45) years old. The dependence and positive feelings of the patients and their main caregivers were investigated by the Dependence Scale (MS) and Positive Feeling Scale (PAC). t test was used to statistically analyze the differences of dependency score and positive feeling score between the patients and their main caregivers. Pearson analysis was used to analyze the dependence and positive feelings of the patients and their main caregivers. The linear mixed model APIM was used to analyze the influence of dependence between the prostate cancer patients and their main caregivers on positive feelings. Results　The scores of love and affection dimensions and total score in the dependent relationship of the prostate cancer patients were higher than those of the primary caregivers [(4.45±0.77) vs. (2.62±0.55) and (15.75±2.88) vs. (13.60±2.25)]; the scores of self-affirmation and life outlook and total score in positive feelings of the patients were lower than those of their primary caregivers [(12.34±2.11) vs. (13.28±2.59), (13.46±2.53) vs. (15.30±2.95), and (25.80±4.25) vs. (28.58±3.43)]; there were statistical differences (t=22.30, 6.78, 3.25, 5.46 and 5.87; all P<0.05). The patients' dependence was positively correlated with the caregivers' dependence and positive feelings (r=0.887 and 0.718; both P<0.001); the patients' positive feelings was positively correlated with the caregivers' dependence and positive feelings (r=0.590 and 0.527; both P<0.001). On the subjective effect, the dependence between the patients and their caregivers could affect their positive feelings (β=0.474 and 0.485; both P<0.05). On the object effect, the dependence between the patients and their caregivers could affect each other's positive feelings (β=0.356, 0.265, 0.344, and 0.315; all P<0.05). Conclusion　The score of dependence between patients with prostate cancer and their main caregivers is positively correlated with the score of their own and each other's positive feelings, and it is verified by the APIM that their dependence can positively affect their positive feelings.

Effect of preoperative video education combined with psychological nursing on postoperative patients with lung cancer during perioperative period

Qiu Xueling, Chen Jingxin, Chen Lihua, Sheng Qingqing

2024, 30(13):  2259-2263.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.028

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Objective　To analyze the impact of preoperative video education combined with psychological care on postoperative patients with lung cancer during the perioperative period. Methods　One hundred and fifty-five patients who underwent lung surgery at Department of Thoracic Surgery, First Hospital, Guangzhou Medical University from July 2022 to July 2023 were selected for the randomized controlled trial, and were divided into a control group (78 cases) and an observation group (77 cases) by computer lottery. There were 35 males and 43 females in the control group; they were (52.37±4.61) years old. There were 32 males and 45 females in the control group; they were (53.24±5.32) years old. The control group took routine care, including preoperative preparation, condition observation, etc. The observation group took preoperative video education and psychological care. The scores of Activity of Daily Living (ADL), Visual Analogue Scale (VAS), and pressure sore 24 h after the surgery, catheter-indwelled times, chest tube indwelled times, hospitalization times after the surgery, total hospitalization costs, and chest X-ray examination on the second day after surgery were compared between the two groups. t and χ² tests were applied. Results　The VAS score, catheter indwelled time, chest tube indwelled time, postoperative hospitalization time, and total hospitalization cost in the observation group were lower than those in the control group [(2.15±0.23) vs. (2.47±0.35), (10.27±1.62) h vs. (13.82±2.14) h, (2.03±0.24) d vs. (2.15±0.17) d, (2.15±0.23) d vs. (2.47±0.35) d, and (63 148.68±2 041.31) yuan vs. (65 362.51±1 869.87) yuan]; the scores of pressure sore and ADL in the observation group were higher than those in the control group [(18.67±1.35) vs. (17.54±1.22) and (30.65±2.14) vs. (27.87±3.26)]; there were statistical differences (t=6.72, 11.63, 3.60, 6.72, 7.04, 5.47, and 6.27; all P<0.05). Conclusions　Preoperative video education combined with psychological care can significantly improve the perioperative state of lung cancer surgery, increase the patients' awareness of surgery, pain, and other related knowledge, strengthen their cooperation and compliance, alleviate their anxiety and tension, and reduce their pain, analgesics dosage, and postoperative hospital stay. Under the concept of rapid recovery surgery, the combination of preoperative video education and psychological care in thoracic surgery has advantages for the patients' perioperative recovery, so it is worthy of clinical promotion and application.

Nursing care of three children with grade Ⅳ graft-versus-host disease after hematopoietic stem cell transplantation

Feng Minxian, Cen Xiuxian

2024, 30(13):  2264-2267.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.029

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The nursing experience of three children with grade Ⅳ graft-versus-host disease after hematopoietic stem cell transplantation was summarized. The nursing points were as below: making a nursing plan for the medical team and providing full process management; paying attention to environmental management and ensuring protective isolation; taking good care of the skin wound, fixing the central venous catheter, and providing nutritional support and psychological care. After effective treatment and careful care, the affected areas of the children's skin lesions basically healed.

Application value of quantitative health education in perioperative period of subgingival scaling for patients with periodontitis

Yang E, Zhong Liangyan, Liang Shan

2024, 30(13):  2268-2272.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.030

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Objective　To study the effect of quantitative health education on the mastery of health knowledge, oral health, and occurrence of postoperative complications in patients with periodontitis treated by subgingival scaling. Methods　A total of 70 patients with periodontitis who received subgingival scaling in Xi'an International Medical Center Hospital from May 2020 to December 2021 were selected for the randomized controlled trial. They were divided into a control group and an observation group by the random number expression method, with 35 cases in each group. There were 17 males and 18 females in the control group; they were (47.35±12.32) years old. There were 19 males and 16 females in the observation group; they were (47.29±12.29) years old. The control group received routine health education, and the observation group received quantitative health education. The mastery of health knowledge, the impact of oral health, and the occurrences of postoperative complications in both groups were observed when the two groups were enrolled and after 4 weeks' intervention. t and χ² tests were applied. Results　At the time of enrollment, there were no statistical differences in the scores of oral health knowledge questionnaire between the two groups (all P>0.05). After 4 weeks' intervention, the scores of health knowledge questionnaire were higher than those at the time of enrollment in both groups, and the score in the observation group was higher than that in the control group [(14.21±2.12) vs. (12.36±2.13)] , with a statistical difference (t=3.64, P<0.05). There were no statistical differences in the scores of the items and total score of Oral Health Impact Profile (OHIP-14) between the two groups at the time of enrollment (all P>0.05); after 4 weeks' intervention, the scores of the items and total score of OHIP-14 were lower than those at the time of enrollment, and the scores in the observation group were lower than those in the control group (all P<0.05). After the operation, the total incidence of complications in the observation group was lower than that in the control group [2.86% (1/35) vs. 28.57% (10/35)], with a statistical difference (χ²=6.90, P<0.05). Conclusion　The application of quantitative health education in patients with periodontitis undergoing subgingival scaling is effective, and can improve the patients' mastery of oral health knowledge, reduce the risk of postoperative complications, and reduce the impact of the disease on their oral health.

Nursing effect in application of mental mapping health education in patients undergoing laparoscopic cholecystectomy during perioperative period

Wang Ying, Sun Yaping, Chen Qifeng, Lin Deyan, Xu Fengmei

2024, 30(13):  2273-2278.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.031

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Objective　To explore the nursing effect of mental mapping health education for patients undergoing laparoscopic cholecystectomy during perioperative period. Methods　Ninety-six patients who underwent laparoscopic cholecystectomy in Tai'erzhuang District People's Hospital from January 2020 to December 2022 were selected as the study objects, and were divided into a control group and an experimental group by the random number table method, with 48 cases in each group. There were 14 males and 34 females in the control group; they were (45.75±10.26) years old. There were 14 males and 34 females in the experimental group; they were (45.91±9.27) years old. The control group received routine nursing, and the experimental group received mental mapping health education. The health knowledge, self-management ability, and clinical indicators before (on the hospitalization day) and after (1 d before disecharge) the nursing were compared between the two groups. t and χ² tests were applied. Results　Before the nursing, there were no statistical differences in the scores of knowledge cognition and self-management and rehabilitation indicators between the two groups (all P>0.05). After the nursing, the scores of preoperative preparation knowledge, laparoscopy operation methods, points for attention, postoperative rehabilitation knowledge, self-management cognition, self-management behaviors, self-management negative emotion control, and self-management environment in the experimental group were higher than those in the control group [(21.01±3.46) vs. (18.97±2.67), (21.34±3.21) vs. (19.67±2.48), (19.24±4.62) vs. (17.48±3.69), (20.48±3.49) vs. (18.67±2.61), (60.72±14.16) vs. (54.97±12.08), (61.34±15.84) vs. (53.57±13.04), (43.24±10.04) vs. (38.48±9.57), and (41.18±9.06) vs. (36.88±8.51)], with statistical differences (t=3.234, 2.852, 3.082, 2.877, 2.140, 2.624, 2.378, and 2.397; all P<0.05). The anal exhaustion time, normal diet recovery time, time to get out of bed, and hospitalization time in the experimental group were shorter than those in the control group [(6.83±1.09) h vs. (7.69±1.25) h, (3.98±1.20) h vs. (4.65±1.26) h, (6.49±1.28) h vs. (7.11±1.36) h, and (6.87±1.77) d vs. (7.96±1.61) d], with statistical differences (t=3.593, 2.668, 2.300, and 3.156; all P<0.05). Conclusion　Mind-mapping health education for patients undergoing laparoscopic cholecystectomy during perioperative period can improve their health knowledge and self-management ability, shorten the times for the indicators to recover, and improve their prognosis.

Current status of pulmonary rehabilitation nursing training

Deng Ying, Luo Guanxiang, Li Pingdong, Zeng Qiuxuan, Li Huafen, Gong Yucui

2024, 30(13):  2278-2283.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.032

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Objective　To understand the current situation of lung rehabilitation nursing training in hospitals, and to provide references for further development of lung rehabilitation nurse training and management. Methods　The convenient sampling method was used to select 206 hospitals from 29 provinces, autonomous regions, or municipalities from July to August 2021 as the survey objects. A self-designed survey questionnaire was used to conduct the survey through Questionnaire Star. Among the 206 investigators, there were 8 males and 198 females; they were (41.28±7.91) years old. The hospitals' basic information was analyzed. The nurses' general information, general data of the lung rehabilitation nurse teams, and status of pulmonary rehabilitation nursing training were investigated. Results　Among the 206 hospitals, 88 ones (42.7%) have established teams of pulmonary rehabilitation nursing staff; 73 (35.4%) have carried out systematic teaching and training on pulmonary rehabilitation nursing; 39 (53.4%) have pulmonary rehabilitation teaching management system; 51 (69.9%) have standard procedures for specialized nursing operations; 47 (64.4%) have dedicated persons responsible for the training management; 58 (79.5%) use electronic and book materials related to lung rehabilitation training; the training content includes theoretical knowledge (73 hospitals, 100.0%), operational skills (72 hospitals, 98.6%), evidence-based and scientific research knowledge (48 hospitals, 65.8%), etc.the training forms include operational demonstrations (71 hospitals, 97.3%), theoretical lectures (68 hospitals, 93.2%), etc. The training assessment methods are mainly theoretical and knowledge assessments (61 hospitals, 83.6%); the training time is mainly concentrated in 1-4 weeks (44 hospitals, 60.3%). Among the 206 hospitals, 146 ones (70.9%) organize nurses to participate in lung rehabilitation nursing training courses and/or further education classes for training. Conclusions　The development rate of pulmonary rehabilitation nursing training in China is low. The systematic and planned construction of pulmonary rehabilitation nursing training still needs further improvement. It is recommended that hospitals strengthen pulmonary rehabilitation nursing training and promote the cultivation of pulmonary rehabilitation nurses.

Effect of modified electrocardiogram guided localization on PICC in HIV patients

Yue Yi, Luo Ying, Wang Xiaying, Wang Wenling

2024, 30(13):  2283-2287.  DOI: 10.3760/cma.j.issn.1007-1245.2024.13.033

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Objective　To investigate the effect of modified electrocardiogram guided localization on peripherally inserted central catheter (PICC) in patients infected with human immunodeficiency virus (HIV). Methods　One hundred HIV patients admitted to Changzhou Third People's Hospital from January 2022 to February 2023 were selected for the randomized controlled trial, and were divided into an experimental group and a control group by the random number table method, with 50 cases in each group. There were 42 males and 8 females in the control group; they were (46.60±14.63) years old. There were 46 males and 4 females in the experimental group; they were (46.24±15.71) years old. The control group were manually injected saline; the experimental group received modified electrocardiogram guided localization. After catheter placement, the catheter in position rates, ectopic rates during placement, the positioning times, incidences of complications, and patient satisfaction were compared between the two groups. t and χ² tests were applied. Results　The PICC in position rate and patient satisfaction in the experimental group were higher than those in the control group [98.0% (49/50) vs. 82.0% (41/50) and 98.0% (49/50) vs. 80.0% (40/50)]; the incidence of complications in the experimental group was lower than that in the control group [10.0% (5/50) vs. 30.0% (15/50)]; the positioning time in the experimental group was shorter than that in the control group [(17.56±1.64) s vs. (33.22±2.75) s]; there were statistical differences (χ²=7.111, 8.274, and 6.250; t=32.604; all P<0.05). There was no statistical difference in the ectopic rate during placement between the experimental group and the control group [2.0%(1/50) vs. 6.0%(3/50)], with no statistical difference (χ²=1.042,P=0.307). Conclusion　Application of modified electrocardiogram guided localization in HIV patients is safe, accurate, economical, and practical to improve patient satisfaction and reduce the incidence of complications after catheterization.