Table of Content

15 July 2024, Volume 30 Issue 14

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Special Column of Cardiovascular Diseases

Advances in METS-IR and cardiovascular diseases

Wang Xinyu, Guo Yishan, Liu Qian, Wang Dong

2024, 30(14):  2289-2293.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.001

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With the improvement of living standards, the incidence and mortality of cardiovascular diseases are increasing year by year and have become an important public health problem. Insulin resistance status is closely related to the pathophysiologic process in the occurrence and development of cardiovascular diseases. In-depth study of the intrinsic link between insulin resistance and cardiovascular diseases is essential for early prevention, treatment, and follow-up of cardiovascular diseases. Traditional insulin resistance testing methods are cumbersome, time-consuming, and expensive, making them unsuitable for hospitals, not to mention being unable to be generalized in large-scale populations. Metabolic Score for Insulin Resistance (METS-IR) is a new type of predictors of insulin resistance, and METS-IR reflects insulin resistance with high efficiency and simplicity. Moreover, elevated METS-IR is positively correlated with cardiovascular diseases and poor cardiovascular prognosis. Based on this, this article summarizes the diagnostic and clinical value of METS-IR in common cardiovascular diseases.

Research progress of Notch signal pathway in cardiovascular diseases

Liu Zhengxing, Zhao Ke, Shi Dayu, Zhao Jiahao, Shang Xue, Xu Huipu

2024, 30(14):  2293-2296.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.002

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With the increasingly prominent unhealthy lifestyle of Chinese residents, the impact of cardiovascular disease risk factors on their health is becoming more and more significant. The Annual Report on Cardiovascular Health and Diseases in China (2022) points out that the incidence of cardiovascular diseases in China is still increasing, and cardiovascular diseases are the primary cause of death for urban and rural residents in our country. The Notch signaling pathway plays an important role in the recovery of cardiac function in various cardiovascular diseases. Therefore, people are increasingly concerned about the role of Notch signaling pathway in the development of cardiovascular diseases. At the same time, the research in this area has also made certain progress. This article aims to explore the potential therapeutic targets of Notch signaling pathway and provide new pathways for the treatment of cardiovascular diseases by elucidating its mechanism of action.

Effects of YAP2 gene on rat H9c2 cardiomyocyte apoptosis and TNF-α and IL-6 levels

Huang Yi, Wang Conghan

2024, 30(14):  2297-2302.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.003

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Objective　To investigate the effect of Yes-associated protein 2 (YAP2) gene silencing on rat H9c2 cardiomyocyte viability, apoptosis rate, and inflammatory factors induced by H₂O₂. Methods　The experiment was conducted from May to December 2023. The experiment cells were divided into four groups: a normal control group, a H₂O₂ group, a si-YAP2+H₂O₂ group, and a NC+H₂O₂ group. MTT, flow cytometry, and Western blotting were used to detect the cell viability, apoptosis rate, and the expressions of YAP2, Bcl-2, Bax, and p-AKT protein in the four groups, and the contents of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in the cell culture medium of each group were detected by enzyme-linked immunosorbent assay (ELISA) kit. One-way analysis of variance and SNK-q test were used. Results　The expression levels of YAP2 in the H₂O₂ group and the si-YAP2+H₂O₂ group were (0.716±0.056) and (0.204±0.018), respectively, with a statistically significant difference (P<0.05). The viability of H9c2 cardiomyocytes in the H₂O₂ group was significantly lower than that in the si-YAP2+H₂O₂ group and the normal control group, while the apoptosis rate was significantly higher, with statistically significant differences (all P<0.05). There were no statistically significant differences in the viability or apoptosis rate of H9c2 cardiomyocytes between the H₂O₂ group and the NC+H₂O₂ group (both P>0.05). The expression levels of Bcl-2 and p-AKT in the H₂O₂ group were significantly lower than those in the si-YAP2+H₂O₂ group and the normal control group, while the expression level of Bax was significantly higher, with statistically significant differences (all P<0.05). There were no statistically significant differences in the expression levels of Bcl-2, p-AKT, and Bax between the H₂O₂ group and the NC+H₂O₂ group (all P>0.05). The contents of TNF-α and IL-6 in the H₂O₂ group were significantly higher than those in the si-YAP2+H₂O₂ group and the normal control group (all P<0.05). There were no statistically significant differences in the contents of TNF-α and IL-6 between the H₂O₂ group and the NC+H₂O₂ group (both P>0.05). Conclusion　Silencing the expression of YAP2 gene may reduce the occurrence of cardiovascular diseases by reducing the apoptosis of cardiomyocytes and the contents of inflammatory factors TNF-α and IL-6.

Relationships between NEUT, ESR, and Gal-3 levels and clinical prognosis in patients with infective endocarditis

Sun Chunxi, Zhang Junying

2024, 30(14):  2303-2307.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.004

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Objective　To explore the relationships between neutrophil count (NEUT), erythrocyte sedimentation rate (ESR), and galectin-3 (Gal-3) levels and clinical prognosis in patients with infective endocarditis (IE). Methods　Eighty-eight patients with IE were selected from Shangluo Central Hospital from February 2021 to April 2023, including 49 males and 39 females, with an average age of 46.20 years old, 54 cases of grade Ⅱ-Ⅲ and 34 cases of grade Ⅳ. They were followed up for one year. Based on the prognosis results, the patients were divided into a good prognosis group (54 cases) and a poor prognosis group (34 cases). Univariate analysis was used to analyze the patients' clinical data and laboratory indicators. Subsequently, multivariate logistic regression analysis was conducted to identify the risk factors for poor prognosis. The receiver operating characteristic curve (ROC) was used to evaluate the predictive capability of NEUT, ESR, and Gal-3 levels for the poor prognosis of IE patients. t test and χ² test were used. Results　There were statistically significant differences in the cardiac function grade, Pitt score, NEUT level before treatment, and NEUT, ESR, and Gal-3 levels after 2 weeks of treatment between the poor prognosis group and the good prognosis group (all P<0.05). Multivariate logistic regression analysis showed that cardiac function grade Ⅳ, Pitt score ≥2, and high NEUT, ESR, and Gal-3 levels after 2 weeks of treatment were independent risk factors for poor prognosis in IE patients (all P<0.05). The areas under the curves (AUC) of NEUT, ESR, and Gal-3 levels after 2 weeks of treatment and their combination in predicting poor prognosis in IE patients were 0.912, 0.949, 0.905, and 0.985, respectively. Conclusions　NEUT, ESR, and Gal-3 levels have significant clinical predictive value in IE patients. High levels of NEUT, ESR, and Gal-3 are closely related to poor prognosis in IE patients and can serve as independent risk factors for poor prognosis. These markers can provide more accurate risk assessment and decision support for clinical treatment.

Value of hs-cTnI combined with MR-proADM in the peripheral blood in predicting short-term prognosis of acute myocardial infarction patients

Dong Chunhui, Zhang Dongmei, Wang Yuan

2024, 30(14):  2308-2312.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.005

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Objective　To analyze the value of peripheral blood hypersensitive troponin I (hs-cTnI) combined with mid-regional proadrenomedullin (MR-proADM) in predicting short-term prognosis of acute myocardial infarction (AMI) patients. Methods　The clinical data of 81 AMI patients admitted to Xi'an Ninth Hospital from March 2022 to February 2023 were retrospectively analyzed. There were 47 males and 34 females, aged 26-79 (52.37±8.46) years. The major adverse cardiovascular events (MACE) within 12 months after discharge were statistically analyzed, and the patients were divided into a poor prognosis group (MACE) and a good prognosis group (non-MACE). The baseline data of the two groups were analyzed, and the factors influencing the short-term prognosis of AMI patients were analyzed by logistic regression analysis. The predictive value of serum hs-cTnI and MR-proADM for short-term prognosis of AMI patients was analyzed by receiver operating characteristic curve (ROC). χ² test and independent sample t test were used. Results　Among the 81 patients with AMI, 27 cases had poor prognosis and 54 cases had good prognosis. Compared with the good prognosis group, the rates of Killip grade Ⅲ, chest pain, and three-vessel coronary artery lesions and the levels of hs-cTnI and MR-proADM in the poor prognosis group were higher (all P<0.05). Multivariate logistic regression analysis found that Killip grade Ⅲ [OR=4.375 (1.495, 12.801)], chest pain [OR=3.769 (1.400, 10.151)], three-vessel coronary artery lesions [OR=3.950 (1.297, 12.030)], hs-cTnI [OR=4.049 (1.414, 11.591)], and MR-proADM [OR=1.161 (1.082, 1.246)] were independent risk factors for poor short-term prognosis in AMI patients (all P<0.05). According to the ROC, the area under the curve (AUC) of hs-cTnI combined with MR-proADM in predicting poor short-term prognosis of AMI patients was 0.903, which was significantly higher than that of hs-cTnI and MR-proADM (both P<0.05). Conclusion　hs-cTnI combined with MR-proADM in the peripheral blood can predict the short-term prognosis of AMI patients.

Prognostic value of C-ACS risk score for no reflow or slow flow in patients with STEMI after PCI

Xin Yaya, Ma Hong

2024, 30(14):  2312-2316.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.006

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Objective　To evaluate the prognostic value of Canada Acute Coronary Syndrome (C-ACS) risk score for no reflow or slow flow in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). Methods　One hundred and twenty-one patients diagnosed with STEMI who received PCI in No.215 Hospital of Shaanxi Nuclear Industry from January 2022 to April 2023 were included. There were 87 males and 34 females, with an average age of 67.4 years old. The patients were divided into two groups according to whether combined with no-reflow/slow flow, and the clinical data of the two groups were compared. Logistic regression analysis was used to find the influencing factors of no reflow/slow flow in STEMI patients after PCI. The receiver operating characteristic curve (ROC) was used to evaluate the predictive value of C-ACS risk score for no reflow/slow flow in STEMI patients after PCI. Independent sample t test and χ² test were used. Results　Age, male, smoking, serum creatinine level, Global Registry of Acute Coronary Events (GRACE) score, and C-ACS risk score in the no-reflow/slow flow group were significantly higher than those in the normal flow group, with statistically significant differences (all P<0.05). Logistic regression analysis showed that age, GRACE score, C-ACS risk score, male, and smoking were all risk factors for no-reflow/slow flow in STEMI patients after PCI (all P<0.05). The sensitivity, specificity, and area under the curve (AUC) of C-ACS risk score for predicting no-reflow/slow flow in STEMI patients after PCI were 72.9%, 75.3%, and 0.783; the sensitivity, specificity, and AUC of C-ACS risk score combined with GRACE score in predicting no-reflow/slow flow in STEMI patients after PCI were 70.8%, 86.3%, and 0.844. The specificity and AUC of C-ACS risk score combined with GRACE score in predicting no-reflow/slow flow in STEMI patients after PCI were higher than those of single indicator. Conclusions　C-ACS risk score has a high predictive value for no-reflow/slow flow in STEMI patients after PCI. The C-ACS risk score combined with GRACE score has a higher specificity in predicting no reflow/slow flow in STEMI patients after PCI.

Risk factors for cardiac damage in children with Kawasaki disease

Gao Yiwei, Ma Yingying, Zhang Man, Chu Weihong

2024, 30(14):  2317-2321.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.007

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Objective　To explore the risk factors for cardiac damage in children with Kawasaki disease (KD), and to identify cardiac damage as early as possible and make timely intervention measures. Methods　The clinical data of 437 children with KD in the First Affiliated Hospital of Zhengzhou University from May 2018 to November 2023 were collected for a retrospective study, including 249 boys and 188 girls, aged from 2 months to 10 years. The patients were divided into a cardiac damage group (52 cases) and a non-cardiac damage group (385 cases) according to whether cardiac damage occurred. The clinical data of the two groups were compared, the risk factors of cardiac damage were analyzed, and the predictive value of the logistic prediction model was analyzed using receiver operating characteristic curve (ROC). Independent sample t test and χ² test were used. Results　The proportions of the children with fever duration ≥10 d, intravenous immunoglobulin (IVIG) treatment delay, IVIG non-response, white blood cell count ≥10×10⁹/L, total bile acid >14 μmol/L, C-reactive protein (CRP) >46 mg/L, and hemoglobin (HGB) ≥90 g/L in the cardiac damage group were higher than those in the non-cardiac damage group (all P<0.05). The duration of fever, IVIG treatment delay, IVIG non-response, CRP, and HGB were the risk factors for cardiac damage in children with KD (all P<0.05); Logit (P) =-11.754+1.333× duration of fever +1.520×IVIG treatment delay +1.761×IVIG non-response +1.676×CRP+1.345×HGB. The logistic regression equation predicted cardiac damage with an area under the curve (AUC) of 0.905 (95%CI: 0.874-0.931), with an optimal sensitivity and specificity of 90.38% and 90.65%, respectively, when compared with each of the correlates alone. Conclusions　The occurrence of cardiac damage in children with KD is mainly related to the duration of fever, IVIG treatment delay, IVIG non-response, CRP, HGB, etc. Timely treatment and more strict monitoring and follow-up should be given to the children with the above clinical characteristics to optimize the long-term prognosis.

Impact of exercise endurance detail care on postoperative cardiac function and complications in patients with acute myocardial infarction

Li Jiaojiao, Luo Kemei

2024, 30(14):  2322-2327.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.008

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Objective　To explore the effects of exercise endurance detail care on postoperative cardiac function and complications in patients with acute myocardial infarction (AMI). Methods　A prospective study design was used, involving 98 AMI patients admitted to Xi'an First Hospital from January 2021 to July 2023. The patients were stratified and randomly assigned into an intervention group and a control group, with 49 patients in each group. In the intervention group, there were 29 males and 20 females, aged (58.34±6.25) years, 26 cases of anterior wall infarction and 23 cases of inferior wall infarction. In the control group, there were 30 males and 19 females, aged (57.89±6.51) years, 25 cases of anterior wall infarction and 24 cases of inferior wall infarction. The control group received routine care, while the intervention group received exercise endurance detail care for 3 months. The cardiac function indicators [left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF)], 6-minute walk distance (6MWD), scores from the Chinese version of Positive and Negative Affect Schedule (PANAS), Somatization Symptom Scale (SSS), and Seattle Angina Questionnaire (SAQ), and occurrence of complications (arrhythmia, heart failure, stress injury, and venous thrombosis) were compared between the two groups. t test and χ² test were used for statistical analysis. Results　After intervention, the LVEF and 6MWD in the intervention group were (53.83±5.34)% and (408.27±61.49) m, which were higher than those in the control group [(49.87±5.62)% and (375.68±54.62) m], and the LVEDD was (48.34±5.27) mm, which was lower than that in the control group [(51.23±5.24) mm], with statistically significant differences (t=3.576, 2.722, and 2.774, all P<0.05). After intervention, the positive affect (PA) score of the PANAS of the intervention group was (37.61±1.39) points, which was higher than that of the control group [(35.43±1.41) points], the negative affect (NA) score was (15.41±1.27) points, which was lower than that of the control group [(17.47±1.40) points], and the SSS score of the intervention group was (28.16±7.74) points, which was lower than that of the control group [(32.98±9.04) points], with statistically significant differences (t=7.707, 7.629, and 2.835, all P<0.05). After intervention, the scores of angina pectoris attack, angina stability, disease cognition, and efficacy satisfaction of the SAQ in the intervention group were (89.27±9.29), (82.93±9.35), (75.24±8.38), and (81.05±8.15) points, which were higher than those in the control group [(83.68±9.07), (77.67±8.86), (70.85±8.21), and (76.36±7.73) points], with statistically significant differences (t=3.014, 2.858, 2.619, and 2.923, all P<0.05). The total complication rate of the intervention group was 4.08% (2/49), which was lower than that of the control group [18.37% (9/49)], with a statistically significant difference (χ²=5.018, P=0.025). Conclusion　Exercise endurance detail care significantly improved the postoperative cardiac function indicators, reduced the somatic symptoms and angina symptoms, improved the emotional state, and effectively reduced the occurrence of complications in AMI patients, demonstrating its significant clinical value.

Effect of quantitative evaluation model of airway nursing for postoperative respiratory management in children with congenital heart disease

Hu Penghe, Pang Qiuhe, Zhang Yuanyuan

2024, 30(14):  2327-2331.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.009

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Objective　To explore the effect of quantitative evaluation model of airway nursing for postoperative respiratory management in children with congenital heart disease. Methods　In this randomized controlled trial, 96 children with congenital heart disease admitted to Fuwai Central China Cardiovascular Hospital from September 2022 to October 2023 were divided into two groups by random drawing with 48 cases in each group. The control group included 27 boys and 21 girls, with an age of (3.57±0.53) years old. The observation group included 29 boys and 19 girls, with an age of (3.64±0.54) years old. The control group was given routine airway management after surgery, and the observation group was given quantitative evaluation model of airway nursing, until the children were discharged from the hospital. The perioperative indexes, oxygenation indicators [partial pressure of arterial oxygen (PaO₂), fraction of inspired oxygen (FiO₂), and oxygenation index (PaO₂/FiO₂)] before and 14 d after intervention, and incidence of postoperative complications were compared between the two groups. χ² test and t test were performed. Results　Compared with those in the control group [(86.26±12.93) h, (7.35±1.10) d, and (8.49±1.27) d], the duration of ventilator use, monitoring, and hospitalization [(45.32±6.79) h, (4.04±0.60) d, and (5.58±0.83) d] in the observation group were shorter, with statistically significant differences (t=19.421, 18.302, and 13.288, all P<0.001). After intervention, the levels of PaO₂, FiO₂, and PaO₂/FiO₂ in the observation group were (121.63±18.24) mmHg (1 mmHg = 0.133 kPa), (48.67±7.30)%, and (439.62±65.94) mmHg, respectively, which were higher than (110.58±16.58) mmHg, (39.82±5.97)%, and (378.40±56.76) mmHg in the control group, with statistically significant differences (t=3.105, 6.501, and 4.874, all P<0.05). Compared with that in the control group [16.66% (8/48)], the incidence of postoperative complications in the observation group [4.16% (2/48)] was lower, with a statistically significant difference (χ²=4.018, P=0.045). Conclusion　The application of quantitative evaluation model of airway nursing to respiratory management in postoperative nursing for children with congenital heart disease can effectively promote the children's recovery, improve the oxygenation indicators, and has positive significance in reducing the incidence of postoperative complications.

Effect of phased rehabilitation training under multidisciplinary collaboration on cardiac function in patients after pacemaker implantation

Zhang Bo, Xu Lingping, Feng Lin, Li Xiaohua

2024, 30(14):  2332-2337.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.010

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Objective　To explore the impact of phased rehabilitation training under multidisciplinary collaboration on cardiac function in patients after pacemaker implantation. Methods　A prospective study design was used, including 98 pacemaker implantation patients treated at Xianyang Central Hospital from January 2020 to December 2022. The patients were divided into an experimental group (49 cases) and a control group (49 cases) based on the admission order. In the experimental group, there were 25 males and 24 females, aged (60.52±7.21) years, and the type of pacemaker implantation was single-chamber pacemaker in 20 cases and dual-chamber pacemaker in 29 cases. In the control group, there were 26 males and 23 females, aged (60.78±7.09) years, and the type of pacemaker implantation was single-chamber pacemaker in 21 cases and dual-chamber pacemaker in 28 cases. The control group received routine postoperative care, and the experimental group underwent phased rehabilitation training under multidisciplinary collaboration on the basis. The intervention lasted until 3 months after surgery in both groups. The intervention effect was evaluated by exercise endurance (6 min walking distance), cardiac function [N-terminal pro-B-type natriuretic peptide (NT-proBNP) and left ventricular ejection fraction (LVEF)], upper limb mobility, complications (bleeding, infection, shoulder pain, and lead dislodgment), and comfort level [General Comfort Questionnaire (GCQ) score]. Independent sample t test and χ² test were used for statistical methods. Results　After intervention, the 6-min walking distance of the experimental group was (290.14±34.16) m, which was longer than that of the control group [(138.75±14.34) m], the level of NT-proBNP was (262.11±68.12) ng/L, which was lower than that of the control group [(398.93±76.69) ng/L], and the LVEF level was (69.82±4.73)%, which was higher than that of the control group [(52.53±5.44)%], with statistically significant differences (t=28.604, 9.337, and 16.789, all P<0.05). At 3 months after surgery, the ranges of motion in adduction, abduction, flexion, and extension in the experimental group were (18.27±6.02)°, (52.67±10.33)°, (64.37±7.14)°, and (22.78±3.96)°, which were greater than those in the control group [(12.78±5.39)°, (45.34±9.33)°, (51.36±6.93)°, and (18.61±3.78)°], with statistically significant differences (t=4.756, 3.686, 9.153, and 5.332, all P<0.05). The incidence of complications in the experimental group was 4.08% (2/49), which was lower than that in the control group [16.33% (8/49)], with a statistically significant difference (χ²=4.009, P=0.045). After intervention, the GCQ scores for environmental, physiological, sociocultural, and psychological dimensions of the experimental group were (3.72±0.67), (3.24±0.53), (3.90±0.42) and (3.68±0.54) points, which were higher than those of the control group [(2.38±0.42), (2.49±0.36), (2.75±0.27), and (3.17±0.35) points], with statistically significant differences (t=11.537, 7.951, 15.276, and 5.431, all P<0.05). Conclusion　Phased rehabilitation training under multidisciplinary collaboration has a positive impact on postoperative outcomes for patients with pacemakers, improving the exercise endurance, cardiac function, and upper limb mobility, and reducing the complications, thereby enhancing their comfort and daily self-care abilities, with significant clinical value.

Effect of modified Kaitianmen combined with five-tone therapy on the rehabilitation for patients with coronary heart disease after intervention surgery

Jiang Bei, Liu Xiaorong, Li Man, Shi Xin

2024, 30(14):  2337-2342.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.011

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Objective　To evaluate the impact of modified Kaitianmen therapy combined with five-tone therapy on the postoperative recovery and sleep quality in patients undergoing interventional treatment for coronary heart disease (CHD). Methods　This prospective study included 120 patients with CHD who underwent interventional treatment at Xi'an People's Hospital and Xi'an Hospital of Traditional Chinese Medicine from February to October 2023. The patients were divided into a control group and an observation group by the random number table method, with 60 patients in each group. In the control group, there were 37 males and 23 females, aged (53.11±4.98) years, and the cardiac function grade was as follows: 5 cases of grade I, 12 cases of grade II, 25 cases of grade III, and 18 cases of grade IV. In the observation group, there were 41 males and 19 females, aged (50.51±5.14) years, and the cardiac function grade was as follows: 6 cases of grade I, 14 cases of grade II, 27 cases of grade III, and 13 cases of grade IV. The control group received modified Kaitianmen therapy, and the observation group received both modified Kaitianmen and five-tone therapy for a week. The rehabilitation outcomes, traditional Chinese medicine (TCM) syndrome score, psychological state [using the Symptom Checklist-90 (SCL-90)], and sleep quality [using the Pittsburgh Sleep Quality Index (PSQI)] were compared between the two groups before and one week after intervention. Independent sample t test and χ² test were used. Results　After intervention, the 6-min walking distance of the observation group was (413.14±36.67) m, which was longer than that of the control group [(364.68±30.70) m], and the left ventricular ejection fraction (LVEF) was (59.96±6.14)%, which was higher than that of the control group [(52.79±4.57)%], with statistically significant differences (both P<0.05). After intervention, the TCM scores of fatigue, chest tightness, shortness of breath, and chest pain in the observation group were (1.96±0.63) points, (2.76±0.43) points, (1.91±0.56) points, and (1.93±0.49) points, which were lower than those in the control group [(3.52±0.79) points, (3.88±0.50) points, (2.95±0.79) points, and (3.65±0.76) points]; the scores of anxiety, depression, interpersonal sensitivity, hostility, compulsion, paranoia, phobia, somatization, and mental illness of the SCL-90 were (1.96±0.20) points, (1.87±0.16) points, (1.72±0.17) points, (1.74±0.18) points, (1.84±0.18) points, (1.98±0.24) points, (2.38±0.32) points, (1.09±0.12) points, and (0.93±0.09) points, which were lower than those in the control group [(2.67±0.33) points, (2.36±0.33) points, (2.27±0.23) points, (2.19±0.20) points, (2.33±0.30) points, (2.72±0.39) points, (3.42±0.34) points, (1.57±0.16) points, and (1.43±0.17) points]; the scores of sleep duration, latency, sleep quality, daytime dysfunction, sleep disorders, hypnotic drugs, and sleep efficiency of the PSQI were (0.76±0.08) points, (0.91±0.06) points, (0.73±0.09) points, (0.97±0.10) points, (0.60±0.07) points, (0.86±0.07) points, and (0.78±0.09) points, which were lower than those in the control group [(1.78±0.51) points, (1.95±0.61) points, (1.65±0.29) points, (2.04±0.22) points, (1.28±0.13) points, (1.84±0.39) points, and (1.82±0.26) points], with statistically significant differences (all P<0.05). Conclusion　The combination of modified Kaitianmen therapy and five-tone therapy can effectively improve the 6-min walking distance and LVEF, reduce the TCM syndrome score and negative emotions, and enhance the sleep quality in patients undergoing interventional treatment for CHD, thus promoting the postoperative recovery.

Basic Research

Experimental study of mesenchymal stem cell repair of previous cesarean scar defect in rats

Yuan Xueqing, Zhu Mei

2024, 30(14):  2343-2347.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.012

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Objective　To investigate the repair effect of mesenchymal stem cells (MSCs) on rat previous cesarean scar defect (PCSD) and to provide a potential strategy for the treatment of scar pregnancy. Methods　This research experiment was conducted from December 2023 to January 2024 at Guangdong Medical Laboratory Animal Center. A total of 120 female specific pathogen free grade Sprague-Dawley (SPF SD) rats, aged 7 to 8 weeks and weighing 300 to 350 g, were selected and were divided into 3 groups with 40 rats per group according to the random number table method. A rat uterine diverticulum model was established through two consecutive cesarean sections and verified by ultrasound and histology. The control group received 0.2 ml of local saline injection and 0.5 ml of tail vein saline injection, the local injection group (experimental group) was injected with 0.2 ml of MSCs gel locally, and the tail vein injection group (experimental group) was injected with 0.2 ml of MSCs gel through the tail vein. The repair effects on uterine scar defects were observed. The rats' diet, water intake, and mental status were systematically recorded. Four weeks post-administration, the rats were euthanized for autopsy, and their organs were macroscopically observed. Uterine tissue samples were collected for hematoxylin and eosin (H&E) staining to observe the thickness of the myometrium and endometrium, and the endometrial defect rate, the percentage of α-smooth muscle actin (α-SMA) positive area, and the percentage of transforming growth factor-β1 (TGF-β1) positive area were calculated. The statistical methods used were t test, ANOVA, and χ² test. Results　The proportions of the rats with normal diet, water intake, and mental status in the experimental group were higher than those in the control group [72.5% (58/80) vs. 52.5% (21/40), 76.3% (61/80) vs. 42.5% (17/40), 70.0% (56/80) vs. 47.5% (19/40)], with statistically significant differences (χ²=4.74, 13.35, and 6.46, all P<0.05). H&E staining revealed that in both local and tail vein injection groups, there was an increase in endometrial gland proliferation, a small amount of fibrous tissue proliferation, and inflammatory cell infiltration, with macrophages and surgical sutures observed in the muscle layer. The basal layer thickness, endometrial thickness, and percentage of α-SMA positive area in the tail vein and local injection groups were higher than those in the control group [(116.32±4.59) μm vs. (109.21±5.73) μm vs. (74.23±6.30) μm, (200.34±7.21) μm vs. (156.98±6.98) μm vs. (119.55±7.38) μm, (32.99±1.26)% vs. (25.93±1.33)% vs. (20.59±1.48)%], but the percentage of TGF-β1 positive area and endometrial defect rate were lower than those in the control group [(14.11±1.01)% vs. (17.54±1.08)% vs. (20.09±1.13)%, 35.00% (14/40) vs. 62.50% (25/40) vs. 100.00% (40/40)], with statistically significant differences (F=650.86, 1 264.19, 836.93, and 311.99, χ²=37.86, all P<0.05). Conclusions　Umbilical cord MSCs can significantly promote the repair of uterine diverticula and are safe. This provides an experimental basis for the application of MSCs in the treatment of uterine scar pregnancy and offers a new strategy for the treatment of post-cesarean scar formation.

PAX3 regulates ferroptosis in trophoblast cells under hypoxia

Gu Hao, Gu Ying, Chen Jiaying, Wu Hongqin, Feng Yaling

2024, 30(14):  2347-2354.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.013

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Objective　To investigate the mechanism of paired box gene (PAX)3 regulating ferroptosis in trophoblast cells under hypoxia. Methods　The experiment was conducted from January to December 2023 at the Institute of Eugenics Medicine, the Affiliated Women's Hospital of Jiangnan University. Human chorionic trophoblast cells (HTR-8 / SVneo) were cultured in vitro under normoxia of 20 % oxygen and hypoxia of 2 % oxygen, respectively , HTR-8a / Svneo cells were divided into 7 groups according to different treatments : normoxia group, hypoxia group, hypoxia + NC plasmid group, hypoxia + PAX3 (OE) group, hypoxia + SLC40A1 (OE) group, hypoxia + VDAC3 (OE) group, hypoxia + PAX3 (OE) + VDAC3 (KD) group. Plasmid transfection technology was used to knockdown VDAC3 and over-express PAX3, SLC40A1, and VDAC3 to verify the regulation of PAX3 on SLC40A1 and VDAC3 expressions in HTR-8/SVneo cells. The mitochondria in HTR-8/SVneo cells under normoxia, normoxia+Erastin, and hypoxia conditions were observed by electron microscopy. Cell death rate was detected with live/dead cell double staining kit. Immunofluorescence cytochemical staining was used to detect the localization and expressions of PAX3, SLC40A1, and VDAC3 in trophoblast cells of each group. The mRNA and protein levels of PAX3, SLC40A1, and VDAC3 in each group were detected by real-time quantitative PCR and Western blot. Independent sample t test was used. Results　(1)The mitochondrial morphology of cells exposed to hypoxia resembled that observed under normoxia+Erastin treatment. Notably, there was a significant reduction in mitochondrial shrinkage and volume, an increase in membrane electron density, as well as a decrease and blurring of the inner ridge. (2)Under hypoxia, the live/dead double staining kit showed that the cell death rate was increased. Immunofluorescence results showed that PAX3 was mainly expressed in the nucleus, SLC40A1 was mainly expressed in the cytoplasm, and VDAC3 was mainly expressed in the mitochondria. (3)Compared with the normoxia group, the cell death in the hypoxia group increased, and the mRNA and protein expressions of PAX3 and SLC40A1 decreased in the HTR-8a/Svneo hypoxia group, but the mRNA and protein expressions of VDAC3 increased in the HTR-8a/Svneo hypoxia group. After knocking down PAX3, the expression of SLC40A1 was decreased, and the cells died extensively. After over-expressing PAX3, the expression of SLC40A1 was increased, and the cell survival rate increased. Conclusions　Hypoxia induces ferroptosis in trophoblast cells. PAX3 affects SLC40A1 expression by regulating ferroptosis in trophoblast cells, but the knockdown or over-expression of PAX3 has no effect on the expression of VDAC3.

Treatises

Relationship and predictive value of the ratio of IVC/Ao and corrected carotid artery flow time with volumetric response in patients with septic shock

Xu Peng, Mi Ting, Li Xiaoqing, Zhang Hao, Li Qingqing, Fan Yali

2024, 30(14):  2355-2360.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.014

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Objective　To evaluate the value of the ratio of the maximum diameter of the inferior vena cava at end-expiration (IVCmax) to the maximum internal diameter of the abdominal aorta during systole (IVC/Ao) and the corrected flow time of the carotid artery (FTc) in predicting volumetric response in patients with septic shock. Methods　A total of 86 patients with septic shock were included in Xi'an Central Hospital from June 2020 to June 2023, and the stroke output (SV) before and after the volume loading test was monitored by transthoracic echocardiography, and the SV added value (ΔSV) was calculated. In the volume-responsive group (ΔSV≥15%), there were 28 males and 17 females, aged (63.21±6.95) years. In the non-responsive group (ΔSV <15%), there were 24 males and 17 females, aged (64.17±7.24) years. The IVC/Ao, mean arterial pressure (MAP), central venous pressure (CVP), heart rate, FTc, and variation in peak carotid artery flow velocity (ΔVpeak-CA) were recorded before and after the test. The correlations between IVC/Ao, FTc, ΔVpeak-CA, and ΔSV before the test were analyzed. Their predictive value for volume responsiveness in septic shock patients was analyzed by receiver operating characteristic curve (ROC). Statistical methods used were χ² test and t test. Results　The FTc in the responsive group was higher after the test than that before the test (t=4.63, P<0.001). Before the test, the inferior vena cava collapse index (IVCCI), IVC/Ao, and ΔVpeak-CA in the responsive group were higher than those in the non-responsive group [(28.77±3.36) vs. (14.20±3.87), (1.55±0.16) vs. (1.19±0.12), and (12.81±4.59)% vs. (8.04±4.29)%], with statistically significant differences (t=18.68, 11.71, and 4.97, all P<0.05). ΔSV was negatively correlated with FTc and was positively correlated with IVC/Ao, ΔVpeak-CA, and IVCCI (all P<0.001). Nomogram model results suggested a higher risk of volume non-responsiveness in patients with higher FTc level and lower IVC/Ao, ΔVpeak-CA, and IVCmax levels. ROC analysis indicated that the combined predictive value of these indicators for volume responsiveness had an area under the curve (AUC) of 0.946. Conclusion　The IVC/Ao ratio and carotid FTc are effective predictors of volume responsiveness in septic shock patients and can be utilized as valuable clinical tools for determining the need for fluid resuscitation in these patients.

Construction and validation of a risk model for initial weaning failure in patients with sepsis and respiratory failure 

Zhao Zhuli, Hua Ailing, Gao Huimei

2024, 30(14):  2361-2366.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.015

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Objective　To construct and validate a risk model for initial weaning failure in patients with sepsis and respiratory failure. Methods　This study included 120 patients with sepsis and respiratory failure admitted to the Emergency Center, East Hospital, the First Affiliated Hospital of Xi'an Jiaotong University from January 2019 to January 2024. According to the outcome of weaning, they were divided into a successful weaning group (102 cases) and a failed weaning group (18 cases). There were 53 males and 49 females in the successful weaning group, aged (61.77±7.15) years. In the failed weaning group, there were 11 males and 7 females, aged (62.12±7.21) years. The general data were compared between the two groups. A risk model for initial weaning failure was constructed based on the results of logistic regression analysis and a nomogram was developed. The receiver operating characteristic curve (ROC) was established with initial weaning failure as the positive sample, and the fit of the risk model was verified by Hosmer-Lemeshow. Statistical methods used were t test and χ² test. Results　The smoking ratio, duration of mechanical ventilation, sepsis related Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, and rapid shallow breathing index (RSBI) in the failed weaning group were higher than those in the successful weaning group [72.2% (13/18) vs. 46.5% (47/102), (9.04±1.14) d vs. (6.58±0.96) d, (7.47±1.09) min vs. (5.14±0.84) min, (19.71±1.80) min vs. (17.39±1.64) min, (79.31±8.42) breaths/min/L vs. (58.38±6.45) breaths/min/L], with statistically significant differences (χ²=4.18, t=9.74, 10.35, 5.11, and 10.04, all P<0.05). Logistic regression analysis showed that smoking [P=0.011, 95% confidence interval (CI) 1.679-55.648], duration of mechanical ventilation (P=0.024, 95%CI 1.087-3.189), SOFA score (P=0.009, 95%CI 1.281-5.874), APACHEⅡ score (P<0.001, 95%CI 1.890-7.384), and RSBI (P=0.003, 95%CI 1.041-1.215) were the influential factors for initial weaning failure in patients with sepsis and respiratory failure. The ROC results showed that the combined prediction of smoking, duration of mechanical ventilation, SOFA score, APACHEⅡ score, and RSBI [area under the curve (AUC) = 0.980, sensitivity=94.7%, and specificity=92.1%] was significantly better than that of smoking (AUC=0.609, sensitivity=68.4%, and specificity=53.5%), duration of mechanical ventilation (AUC=0.868, sensitivity=57.9%, and specificity=99.0%), SOFA score (AUC=0.876, sensitivity=89.5%, and specificity=68.3%), APACHEⅡ score (AUC=0.811, sensitivity=73.7%, and specificity=78.2%), and RSBI alone (AUC=0.927, sensitivity=94.7%, and specificity=79.2%), and the risk model showed good fit through Hosmer-Lemeshow test. Conclusions　Smoking, duration of mechanical ventilation, SOFA score, APACHEⅡ score, and RSBI are significantly associated with initial weaning failure in patients with sepsis and respiratory failure. The constructed risk model has a good fit.

Analysis on the clinical characteristics and process of diagnosis and treatment of patients with pulmonary tuberculosis after liver transplantation

Fu Hongmei, Yu Zhaoxian, Li Chunyan, Tan Yigang, Cen Ying, Li Cuiping, Liu Zhihui

2024, 30(14):  2366-2370.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.016

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Objective　To explore the clinical principles of diagnosis and treatment for patients with pulmonary tuberculosis after liver transplantation. Methods　The inpatients treated in Guangzhou Chest Hospital from January 2014 to December 2023 were collected, and the data or information related to the clinical symptoms, lesion location involved, duration of diagnosis, number of hospitalizations, length of hospital stay each time, and clinical therapeutic effect of 25 inpatients with pulmonary tuberculosis after liver transplantation (study group) and 31 inpatients with pulmonary tuberculosis but non-organ transplantation (control group) were comparatively analyzed. Among them, there were 55 males and 1 female, ranging in age from 1 to 75 years old, with an average age of 66 years old. χ² test and rank sum test were used for statistical methods. Results　The rates of fever and fatigue and emaciation in the study group were higher than those in the control group [68.0% (17/25) vs. 22.6% (7/31), 56.0% (14/25) vs. 29.0% (9/31)], with statistically significant differences (χ²=11.66 and 4.16, both P<0.05). There were no statistically significant differences between the two groups in the incidences of tuberculosis lesions in thorax and lung (including lung lobes, bronchus, and pleura) and cavity lesions under CT images, but the incidence of extra-pulmonary tuberculosis (lower extremities, abdominal cavity, neck, brain, lumbar vertebra, testis, etc.) in the study group was higher than that in the control group [44.0% (11/25) vs. 3.2% (1/31)], with a statistically significant difference (χ²=13.67, P<0.05). The onset time of tuberculosis in the study group ranged from 3 to 240 months after liver transplantation (P₂₅, P₅₀, and P₇₅ were 24, 40, and 75 months, respectively), and there was no statistically significant difference in the duration of tuberculosis diagnosis or length of hospital stay each time between the two groups (both P>0.05). In the study group, 4 patients died due to advanced tumor, 1 patient had not yet completed the course of treatment by December 2023,but the condition was significantly improved, and the other 20 patients were cured after anti-tuberculosis treatment for 12 to 36 months (P₂₅, P₅₀, and P₇₅ were 14, 15, and 18 months, respectively). In the control group, 1 patient died due to advanced lung cancer, and the other 30 patients were cured after anti-tuberculosis treatment for 6 to 18 months (P₂₅, P₅₀, and P₇₅ were 12, 12, and 14 months, respectively). The length of anti-tuberculosis therapy course of the study group was longer than that of the control group (Z=3.54, P<0.05). The percent of above 3 times hospitalizations were 20.00% (5/25) in the study group, which was higher than 6.45% (2/31) in the control group (χ²=42.83, P<0.05). Conclusions　It is essential to pay close attention to extrapulmonary tuberculosis, complicated disease changes, and long anti-tuberculosis therapy course in patients with pulmonary tuberculosis after liver transplantation.

Relationships between peripheral blood miR-233-3p, miR-145, and NLRP3 inflammasome and coronary artery lesions in children with Kawasaki disease

Jia Lijuan, He Kun, Wang Fangjie, Yan Xiaochen, Fu Dapeng, Li Yingying, Sun Qiqing

2024, 30(14):  2371-2375.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.017

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Objective　 To investigate the relationships between peripheral blood miR-233-3p, miR-145, and NLRP3 inflammasome and coronary artery lesions (CAL) in children with Kawasaki disease (KD). Methods　The general data of 96 children with KD treated in Children's Hospital Affiliated to Zhengzhou University from November 2021 to December 2022 were retrospectively analyzed. All the children underwent cardiac color ultrasound examination after admission. According to the KD related diagnostic criteria proposed by the American Heart Association in 2017, 96 children with KD were divided into a CAL group (32 cases) and a non-CAL group (64 cases). The general data [gender, age, body mass index (BMI), fever time, etc.] and peripheral blood miR-233-3p, miR-145, and NLRP3 inflammasome levels were compared between the two groups. The multivariate logistic regression analysis was used to analyze the independent factors affecting the occurrence of CAL in KD children, and the assessment model of risk was established. The receiver operating characteristic curve (ROC) was used to evaluate the diagnostic efficiency of the model. Independent sample t test and χ² test were used. Results　In the CAL group, there were 18 boys and 14 girls, aged (3.63±0.54) years, with body mass index of (13.77±2.06) kg/m² and duration of fever of (5.41±0.81) d. In the non-CAL group, there were 35 boys and 29 girls, aged (3.58±0.53) years, with body mass index of (13.82±2.07) kg/m² and duration of fever of (5.36±0.80) d, with no statistically significant difference (all P>0.05). The levels of miR-233-3p and NLRP3 in the CAL group were higher than those in the non-CAL group [(1.28±0.19) vs. (0.93±0.13), (5.44±0.81) vs. (3.63±0.54)], but the level of miR-145 was lower than that in the non-CAL group [(1.07±0.16) vs. (1.98±0.29)], with statistically significant differences (t=10.606, 13.027, and 16.510, all P<0.001). Multivariate analysis by logistic regression model showed that miR-233-3p (OR=7.338, P=0.023), miR-145 (OR=0.590, P=0.001), and NLRP3 inflammasome (OR=3.111, P=0.012) levels were independent influencing factors for the occurrence of CAL in KD children. According to the ROC analysis, the area under the curve (AUC) value of miR-233-3p, miR-145, and NLRP3 combined detection mode was the highest, which was 0.899, and the sensitivity and specificity were 93.75% and 90.62%, respectively. Conclusions　miR-233-3p, miR-145, and NLRP3 inflammasome in peripheral blood of children with KD are closely related to the occurrence of CAL. Among them, the levels of miR-233-3p, miR-145, and NLRP3 inflammasome play an important role in the occurrence of CAL in KD children, and the combined detection of miR-233-3p, miR-145, and NLRP3 inflammasome has high clinical application value in evaluating the occurrence of CAL in KD children.

Clinical significance of MASP-2 and complement factor H in patients with autoimmune hepatitis

He Xuexue, Yang Ning, Zhe Hui

2024, 30(14):  2375-2379.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.018

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Objective　To analyze the relationships between the levels of mannose associated serine protease 2 (MASP-2) and complement factor H and the severity and recurrence of autoimmune hepatitis. Methods　A retrospective analysis was conducted on the clinical data of 60 patients with autoimmune hepatitis treated in Yan'an People's Hospital from February 2020 to February 2021. They were selected as the observation group, consisting of 17 males and 43 females, with an age of (52.71±3.58) years old. According to the Child-Pugh grading system, they were divided into grade A group (26 cases), grade B group (22 cases), and grade C group (12 cases). Additionally, based on the 1-year follow-up results, they were divided into a recurrent group (15 cases) and a non-recurrent group (45 cases). A total of 60 healthy individuals who underwent physical examinations in Yan'an People's Hospital during the same period were selected as the control group, with 13 males and 47 females, with an age of (52.64±3.62) years old. t test or repeated measure analysis of variance was used to compare the MASP-2 and complement factor H levels among different groups. Spearman correlation analysis was used to analyze the correlations between MASP-2 and complement factor H levels and Child-Pugh grading. The value of MASP-2 and complement factor H levels in predicting recurrence in patients with autoimmune hepatitis was analyzed by receiver operating characteristic curve (ROC). Results　The levels of MASP-2 and complement factor H in the observation group were (91.89±15.74) µg/L and (66.28±12.58) mg/L, which were lower than those in the control group [(262.93±35.63) µg/L and (145.31±25.71) mg/L], with statistically significant differences (t=31.013 and 21.387, both P<0.001). The levels of MASP-2 and complement factor H in grade A and B groups were (106.72±16.52) µg/L, (84.94±14.73) µg/L, (76.87±12.46) mg/L, and (61.66±9.38) mg/L, which were higher than those in group C [(72.80±12.59) µg/L and (52.12±8.89) mg/L], and those in group A were higher than those in group B, with statistically significant differences (all P<0.05). The levels of MASP-2 and complement factor H in the recurrent group were (78.30±13.66) µg/L and (56.20±8.53) mg/L, which were lower than those in the non-recurrent group [(96.48±15.57) µg/L and (69.61±7.36) mg/L], with statistically significant differences (t=4.030 and 5.893, both P<0.001). Spearman correlation analysis showed that the MASP-2 and complement factor H levels were negatively correlated with Child-Pugh grading (r=-0.721 and -0.748, both P<0.05). ROC analysis showed that the MASP-2 and complement factor H levels had high value in predicting recurrence in autoimmune hepatitis patients, and the area under the curve (AUC) was 0.823 and 0.877, respectively. Conclusion　With the exacerbation of the disease, the levels of MASP-2 and complement factor H decrease in patients with autoimmune hepatitis, and these two indicators have high value in predicting the recurrence of autoimmune hepatitis patients, which can be used to assess the severity and prognosis of the disease.

Application of entropy weight method to construct a diagnostic model of atypical scrub typhus suitable for primary healthcare organizations

Su Zhengjun, Chen Wanjin, Huang Shanshan, Liang Aijun, Chen Feiyan

2024, 30(14):  2379-2385.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.019

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Objective　To improve the early diagnosis and treatment ability of atypical scrub typhus without scotoma in primary healthcare organizations in Yulin City, to effectively control the epidemic of scrub typhus, and to construct a diagnostic model for atypical scrub typhus applicable to the subtropical regions of Southern China and Southwest China. Methods　Patients with fever who were first diagnosed in the respiratory department of Yulin Red Cross Hospital from June 2016 to December 2022 were selected as the study objects. A total of 546 patients were included, including 335 males and 211 females, aged 14-100 years. Based on the characteristics of scrub typhus in three aspects: epidemiology, clinical manifestations, and physicochemical examination, the entropy weight method was applied to analyze the fever cases diagnosed as scrub typhus, atypical scrub typhus, and non-scrub typhus. The diagnostic model for atypical scrub typhus was determined after evaluation of the receiver operating characteristic curve (ROC), validation and optimization of the small samples. The diagnostic efficacy of the atypical scrub typhus diagnostic model and the Weil-Felix reaction OXK was evaluated in 77 suspected cases of scrub typhus using indirect immunofluorescent antibody test (IFAT) as the gold standard for diagnosing scrub typhus. χ² test was used. Results　Based on the percentage of each diagnostic element of scrub typhus, the prototype diagnostic model for scrub typhus/atypical scrub typhus was determined, and the optimal cut-off value for ROC curve analysis was 2.95 points, with the corresponding area under the curve (AUC) of 0.962 8, and the sensitivity and specificity were 90.0% and 100.0%, respectively. The sensitivity and specificity of the secondary evaluation of the prototype diagnostic model in a small sample (25 cases) were 90.0% and 86.7%, respectively. There was no statistically significant difference in diagnostic efficacy between the diagnostic model of atypical scrub typhus and the IFAT in scrub typhus (P>0.05), and the former's diagnosis of suspected scrub typhus cases had the following sensitivity, specificity, Youden index, compliance rate, and Kappa value of 96.7%, 70.6%, 0.67, 90.9%, and 0.72, while there was a statistically significant difference in diagnostic efficacy between the Weil-Felix reaction OXK and the IFAT (P<0.05), with corresponding diagnostic sensitivity, specificity, Youden index, compliance rate, and Kappa value of 5.0%, 100.0%, 0.05, 26.0%, and 0.02, respectively. Conclusion　The diagnostic model of atypical scrub typhus helps clinicians to objectively analyze non-specific clinical information, and provides an important reference for early diagnosis and treatment of scrub typhus, which is expected to be widely applied in primary medical institutions with limited diagnostic technology and equipment in Southern China and Southwest subtropical regions.

Efficacy of fibrobronchoscopy in the treatment of children with plastic bronchitis

Guo Lili, Xie Yong, Tian Yufeng

2024, 30(14):  2386-2389.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.020

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Objective　To investigate the efficacy of fiberbronchoscopy in the treatment of plastic bronchitis in children and its impact on the neutrophil percentage and D-dimer content, so as to provide more evidences on fiberbronchoscopy for plastic bronchitis in children, and provide guidance and reference for clinical treatment. Methods　Ninety-eight children with plastic bronchitis hospitalized in the First Hospital of Yulin between March 2020 and March 2023 were enrolled and were assigned into two groups according to different treatment approaches. In the control group, there were 21 females and 27 males, the age was (6.27±2.54) years old, and the course of disease was (2.57±0.74) d. There were 24 females and 26 males in the study group, the age was (6.34±2.48) years old, and the course of disease was (2.61±0.46) d. The control group was given conventional therapy, and the study group received fiberbronchoscopy on the basis of the control group. After 2 weeks of treatment, the disappearance time of clinical symptoms (cough, fever, shortness of breath, and lung moist rales) and clinical efficacies of the two groups were compared, and the changes in percentage of neutrophils, D-dimer content, and levels of inflammatory factors [tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), and interferon-γ (IFN-γ)] were compared between the two groups before and after treatment. Independent sample t test and χ² test were used. Results　The disappearance time of cough, fever, shortness of breath, and lung moist rales in the study group were shorter than those in the control group (all P<0.05). The total effective rate of the control group was 81.25% (39/48), which was lower than that of the study group [96.00% (48/50)] (P<0.05). After treatment, the percentage of neutrophils [(53.12±7.81)%] and D-dimer content [(223.46±63.29) μg/L] in the study group were lower than those in the control group [(61.53±8.29)% and (287.65±76.58) μg/L] (both P<0.05); the levels of TNF-α, IL-6, and IFN-γ in the study group were lower than those in the control group (all P<0.05). Conclusion　Application of fiberbronchoscopy in the treatment of plastic bronchitis in children can effectively ameliorate the clinical symptoms, attenuate the inflammation response, reduce the percentage of neutrophils and D-dimer content, and facilitate the recovery of ventilatory function in children.

Observation on the therapeutic effect of fast filiform needling method on improving upper limb dysfunction in patients with cervical spondylotic radiculopathy

Li Zhiwei, He Lei, Zhang Lei, Liu Baolin, Huang Qian

2024, 30(14):  2390-2394.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.021

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Objective　To observe the therapeutic effect of fast filiform needling method to improve the upper limb dysfunction in patients with cervical spondylotic radiculopathy. Methods　This study was a randomized controlled trial. A total of 72 patients with cervical spondylotic radiculopathy admitted to Lianyungang Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from January 2021 to December 2022 were divided into two groups according to the block randomization method. In the experimental group, there were 20 males and 16 females, aged (47.94±6.16) years, with the course of disease of (27.25±9.49) months. In the control group, there were 18 males and 18 females, aged (46.73±5.14) years, with the course of disease of (26.02±7.58) months. The experimental group was treated with fast filiform needling method, and the penetrating release stimulation was given to the neck soft tissue injury site, once every other day, and alternately with massage treatment, 6 times in each group. The control group was treated with traditional acupuncture, once a day, 6 times as a course of treatment, and rested for 1 day every other course of treatment, for a total of 2 courses of treatment. The Tanaka Jingjiu cervical symptom score and cervical dysfunction index (NDI) were compared between the two groups 1 day before treatment and 1 day after treatment, and the clinical efficacies of the two groups were evaluated. t test and χ² test were used. Results　Compared with those 1 day before treatment, the Tanaka Jingjiu cervical symptom scores in both groups were increased on the 1st day after treatment [(14.93±2.74) points vs. (9.70±2.45) points in the experimental group and (12.70±2.93) points vs. (9.40±2.01) points in the control group], but the NDI scores were decreased [(15.92±4.21) points vs. (38.19±5.86) points in the experimental group and (25.46±3.84) points vs. (36.76±7.25) points in the control group], with statistically significant differences (all P<0.05). The improvement of scores of the experimental group was better than that of the control group [Tanaka Jingjiu cervical symptom score: (5.23±1.89) points vs. (3.30±1.25) points, NDI score: (22.27±4.67) points vs. (11.30±3.97) points, both P<0.05]. The total effective rate of the experimental group was higher than that of the control group [91.7% (33/36) vs. 72.2% (26/36)], with a statistically significant difference (χ²=4.560, P=0.032). Conclusions　The fast filiform needling method can relieve the clinical symptoms in patients with cervical spondylotic radiculopathy, relieve the patients' pain, achieve the benign regulation of upper limb function, and reduce the impact of disease on living ability. It has certain advantages over traditional acupuncture treatment, and is worthy of further popularization and application in clinic.

Clinical Research

Study on improving effect of methylprednisolone on serum Periostin, Gal-3, and SDF-1 in children with severe pneumonia and influencing factors of therapeutic effect

Zhang Juan, Lu Xu, He Rong

2024, 30(14):  2395-2399.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.022

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Objective　To study the improvement effect of methylprednisolone on serum Periostin, galectin-3 (Gal-3), and stromal cell derived factor-1 (SDF-1) in children with severe pneumonia (SP) and the influencing factors of therapeutic effect. Methods　A total of 103 children with SP who were admitted to Ankang Central Hospital from May 2020 to May 2023 were selected, and were randomly divided into a coordination group (51 cases) and a azithromycin group (52 cases) according to the order of admission. In the azithromycin group, there were 37 boys and 15 girls, the age was (6.84±1.56) years old, the course of disease was (5.15±1.27) d, and the species of pathogenic bacteria were (1.50±0.42). In the coordination group, there were 35 boys and 16 girls, the age was (6.78±1.55) years old, the course of disease was (5.11±1.24) d, and the species of pathogenic bacteria were (1.48±0.41). The azithromycin group was treated with intravenous drip with 10 mg/kg of azithromycin once a day, and the coordination group was treated with intravenous drip with 1-2 mg/kg of methylprednisolone once a day on the basis of azithromycin. Both groups received continuous administration for 7 days. The efficacy, symptom disappearance time, and serum Periostin, Gal-3, and SDF-1 levels were compared between the two groups. Univariate analysis (t test and χ² test) and multivariate logistic regression analysis were used to identify the influencing factors of treatment ineffectiveness in SP children. Results　The total effective rate of the coordination group was higher than that of the azithromycin group [88.24% (45/51) vs. 63.46% (33/52)] (χ²=8.597, P=0.003). The disappearance time of cough, fever, and lung rales in the coordination group were shorter than those in the azithromycin group [(4.61±0.82) d vs. (7.08±1.24) d, (3.20±0.56) d vs. (5.19±0.87) d, (5.09±1.34) d vs. (7.12±1.80) d] (t=11.900, 13.774, and 6.482, all P<0.001). After treatment, the levels of serum Periostin, Gal-3, and SDF-1 in both groups were lower than those before treatment, and those in the coordination group were lower than those in the azithromycin group [(71.34±10.40) ng/L vs. (92.51±18.56) ng/L, (12.35±2.71) ng/L vs. (20.84±3.49) ng/L, (132.58±21.77) ng/L vs. (170.49±30.61) ng/L] (t=7.122, 13.771, and 7.231, all P<0.001). Multivariate logistic regression analysis confirmed that the lesion involving multiple lung lobes, pathogen species >1, and no methylprednisolone treatment were all risk factors for treatment failure in SP children (all P<0.05). Conclusions　Methylprednisolone is effective in the treatment of SP children, and can down-regulate the levels of serum Periostin, Gal-3, and SDF-1. The influencing factors of its curative effect include lesion involving multiple lung lobes, pathogen species >1, and no methylprednisolone treatment.

Efficacy of sequential treatment with methylprednisolone combined with azithromycin on paediatric refractory mycoplasma pneumoniae pneumonia

Yang Xiangling, Xu Wudan, Ming Shan, Zhang Liming

2024, 30(14):  2399-2403.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.023

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Objective　To investigate the efficacy of methylprednisolone combined with azithromycin sequential therapy on pediatric refractory mycoplasma pneumoniae pneumonia (RMPP) and the effects on serum chitinase-like protein (YKL-40), amyloid A (SAA), and lung surface-active substance-associated protein-A (SP-A). Methods　A total of 126 children with RMPP recruited by Zhengzhou Ninth People's Hospital during June 2022 and June 2023 were included in the study, and were divided into a control group (azithromycin) and an observation group (methylprednisolone + azithromycin) by the random number table method, with 63 cases in each group. In the observation group, there were 33 boys and 30 girls, aged 4 to 11 (8.34±3.61) years, and the time from onset to admission was 8 to 49 (34.59±10.13) h. In the control group, there were 36 boys and 27 girls, aged 5 to 10 (8.06±3.34) years, and the time from onset to admission was 11 to 50 (34.26±10.24) h. The control group was given intravenous drip with azithromycin aspartate at a dose of 10 mg/kg once a day; after 3 days of treatment, it was changed to oral azithromycin, at a dose of 10 mg/kg, once a day, with 7 days as a course of treatment. The observation group was given methylprednisolone sodium succinate intravenous drip on the basis of the control group, the initial dose was 2 mg/kg, once a day, and the dose was adjusted to 1 mg/kg after 5 days of continuous treatment, and continued for 2 days, with 7 days as a course of treatment. Both groups were treated for 2 consecutive courses. The two groups were compared in terms of therapeutic effects, differences in serum factor levels and lung function indexes before and after treatment, and the safety was analyzed. t test and χ² test were used. Results　The total effective rate of the observation group was higher than that of the control group [95.24% (60/63) vs. 79.37% (50/63)], with a statistically significant difference (χ²=7.159, P=0.008). In the observation group, the disappearance time of cough and sputum sound, dry and wet rales, and wheezing and hospital stay were (3.24±0.78) d, (3.47±0.71) d, (5.06±1.37) d, and (3.47±0.83) d, which were shorter than (6.04±1.31) d, (5.87±1.52) d, (7.58±1.21) d, and (6.11±1.12) d in the control group, with statistically significant differences (t=14.577, 11.355, 10.943, and 15.032, all P<0.001). After treatment, the levels of forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), high-sensitivity C-reactive protein (hs-CRP), SAA, YKL-40, and SP-A in the observation group were (2.96±0.54) L, (2.56±0.42) L, (63.47±2.11) ng/L, (1.34±0.18) ng/L, (7.02±1.13) mg/L, (26.34±6.61) mg/L, (30.64±5.41) µg/L, and (36.07±6.58) µg/L, those in the control group were (2.02±0.51) L, (1.53±0.31) L, (123.36±2.14) ng/L, (2.69±0.22) ng/L, (9.63±1.51) mg/L, (112.35±19.54) mg/L, (36.17±5.87) µg/L, and (45.62±7.03) µg/L, with statistically significant differences (all P<0.001). Conclusion　Methylprednisolone combined with azithromycin can effectively improve the lung function and downregulate serum SAA, YKL-40, and SP-A levels in children with RMPP, which is safe and worthy of promotion.

Changes in cellular classification levels in bronchoalveolar lavage fluid of children with Mycoplasma pneumoniae pneumonia

Ma Kun, Li Kaili, Wang Daobin, Li Shujun

2024, 30(14):  2404-2408.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.024

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Objective　To investigate the changes in cell classification levels in bronchoalveolar lavage fluid (BALF) of children diagnosed with Mycoplasma pneumoniae pneumonia (MPP). Methods　This study was a prospective cohort study. During the period spanning January to June 2022, a cohort of 30 children diagnosed with acute MPP who were admitted to the Department of Pediatrics and Pediatric Intensive Care Unit (PICU) at the First Affiliated Hospital of Xinxiang Medical University and underwent bronchoalveolar lavage were enrolled as the study group. Concurrently, 9 children presenting with uncomplicated bronchial foreign bodies were recruited as the control group. In the study group, there were 15 boys and 15 girls, aged (6.6±2.5) years. In the control group, there were 6 boys and 3 girls, aged (5.7±5.4) years. Wright-Giemsa stain coupled with microscopic examination served as the analytical tools to scrutinize alterations in the proportion of BALF cell classifications in children and their potential association with extrapulmonary manifestations. χ² test, independent sample t test, and rank sum test were used. Results　The levels of neutrophil percentage, C-reactive protein, D-dimer, and lactate dehydrogenase in blood routine of the study group were higher than those of the control group [71.05 (56.40, 79.83)% vs. 46.50 (34.50, 62.45)%, 17.47 (4.86, 37.65) mg/L vs. 1.00 (0.17, 1.64) mg/L, 1.75 (0.80, 4.23) mg/L vs. 0.60 (0.55, 0.75) mg/L, 342 (269, 482) U/L vs. 245 (181, 284) U/L], while the percentage of lymphocytes in blood routine was lower than that of the control group [23.45 (13.55, 34.95)% vs. 43.20 (33.10, 58.55)%], with statistically significant differences (all P<0.05). The percentage of BALF neutrophils in the study group was higher than that in the control group [46.00 (38.00, 55.00)% vs. 1.00 (0.01, 1.75)%], while the percentage of macrophages was lower than that in the control group [43.00 (33.87, 51.00)% vs. 87.50 (85.00, 90.00)%], with statistically significant differences (both P<0.05). According to the presence or absence of extrapulmonary manifestations, the study group was divided into 23 cases without extrapulmonary manifestations and 7 cases with extrapulmonary manifestations (2 cases with kidney damage, liver damage, and myocardial damage, 3 cases with kidney damage and myocardial damage, 1 case with kidney damage, and 1 case with myocardial damage). The levels of calcitonin, serum amyloid A, lactate dehydrogenase and aspartate aminotransferase in the group with extrapulmonary manifestations were higher than those in the group without extrapulmonary manifestations [0.74 (0.42, 3.59) µg/L vs. 0.35 (0.19, 0.68) µg/L, 464.9 (172.8, 655.6) mg/L vs. 134.9 (41.0, 431.0) mg/L, 697.0 (469.0, 1 177.0) U/L vs. 296.0 (255.0, 417.0) U/L, 54.0 (42.0, 109.0) U/L vs. 30.0 (22.0, 37.0) U/L], the length of hospital stay was longer than that in the group without extrapulmonary manifestations [19.00 (18.00, 22.00) d vs. 11.00 (7.00, 16.00) d], and the percentage of BALF lymphocytes and albumin level were lower than those in the group without extrapulmonary manifestations [10.50 (9.50, 11.00)% vs. 13.00 (10.00, 14.50)%, 33.9 (27.3, 40.2) g/L vs. 40.3 (37.1, 42.3) g/L], with statistically significant differences (all P<0.05). Spearman correlation analysis showed that the percentage of BALF lymphocytes was negatively correlated with extrapulmonary manifestations (r=-0.334, P=0.038). Conclusion　BALF composition in children experiencing acute MPP predominantly consists of neutrophils. Moreover, there exists a correlation wherein a decrease in the percentage of BALF lymphocytes corresponds with an elevated occurrence of extrapulmonary manifestations.

Effect of electroacupuncture combined with rehabilitation robots on upper limb function and daily living activities of post-stroke hemiplegic patients

Wang Futao, Lyu Yunliang, Wang Fei, Wu Shuhui

2024, 30(14):  2409-2412.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.025

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Objective　To explore the rehabilitation effect of the combination of electroacupuncture and rehabilitation robots on upper limb function and daily living activities in patients with post-stroke hemiplegia. Methods　Ninety patients with post-stroke hemiplegia who received treatment in Liaocheng Third People's Hospital from January to December 2023 were selected and were divided into a combined treatment group and an electroacupuncture group by the random number table method with 45 cases in each group. In the combined treatment group, there were 25 males and 20 females, the age was (58.13±9.90) years old, and the course of disease was (23.10±3.41) days. In the electroacupuncture group, there were 23 males and 22 females, the age was (59.47±7.29) years old, and the course of disease was (23.27±3.65) days. Both groups received clinical routine drug treatment and daily rehabilitation training. The combined treatment group received electroacupuncture and rehabilitation robot therapy, 30 min/time, once a day, 5 days every week. The electroacupuncture group received electroacupuncture treatment, 30 min/d, 5 days every week. After 4 weeks of treatment, the simplified Fugl-Meyer Upper Extremity Motor Function Scale (FMA-UE) was used to assess the functional recovery of the upper extremities, the modified Barthel index (MBI) was used to assess the ability to perform activities of daily living, and the surface electromyography was used to assess the muscle recovery, in order to evaluate the treatment effect. Statistical methods were χ² test and t test. Results　Before treatment, there were no statistically significant differences in the iEMG values of deltoid, biceps, and triceps and FMA-UE and MBI scores between the two groups (all P>0.05). After 4 weeks of treatment, the iEMG values of deltoid, biceps, and triceps and FMA-UE and MBI scores in both groups were higher than those before treatment, and those in the combined treatment group were all higher than those in the electroacupuncture group [(177.10±34.80) mV/s vs. (147.60±50.02) mV/s, (260.74±46.79) mV/s vs. (235.40±48.06) mV/s, (98.36±17.30) mV/s vs. (88.33±17.04) mV/s, (33.47± 5.51) points vs. (27.23±5.64) points, (47.83±8.48) points vs. (39.00±10.70) points], with statistically significant differences (t=2.652, P=0.010; t=2.069, P=0.043; t=2.264, P=0.027; t=4.330, P<0.001; t=3.544, P=0.001). Conclusion　The comprehensive application of electroacupuncture and rehabilitation robots has significant therapeutic effects on improving upper limb function and daily living activities in post-stroke hemiplegic patients.

Medication Research

Preparation and quality evaluation of sustained-release microspheres loaded with vancomycin

Song Yuanzheng, Ye Yan, Gong Shouchao, Zhang Yudong, Liu Zhi, Sun Hongwu, Zeng Hao

2024, 30(14):  2413-2418.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.026

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Objective　To prepare stable, safe, and effective vancomycin sustained-release microspheres and evaluate their quality characteristics. Methods　Vancomycin microspheres were prepared by mixing polylactic acid (PLA) and poly (lactic-co-glycolic acid) (PLGA) in three different proportions by solvent volatilization method. The effects of different concentrations of polyvinyl alcohol (PVA), the ratio of internal water phase to external water phase on size, encapsulation rate, and drug loading of the microspheres were studied by single factor experiment, and the optimal PLA/PLGA sustained-release microspheres loaded with vancomycin were prepared. The pharmacodynamics of methicillin-resistant Staphylococcus aureus (MRSA) were studied in vivo and in vitro. One-way analysis of variance was used. Results　The concentration of PVA and ratio of internal water phase to external water phase had little effect on the encapsulation rate and drug loading of vancomycin (P>0.05), but the mass ratio of PLA and PLGA in microspheres had significant effects on the encapsulation rate and drug loading of vancomycin (P<0.000 1). The microsphere size (41.95 μm), encapsulation rate [(28.87±0.32)%], and drug loading [(17.80±0.21)%] were the largest when PLA was pure. The antibacterial activity of vancomycin microspheres against MRSA 252 was higher than that of aqueous solution (0.391 ng/L vs. 0.781 ng/L) (P<0.000 1). Vancomycin microspheres showed more satisfactory bactericidal activity in the treatment of MRSA 252 than vancomycin aqueous solution with the same concentration (P<0.05). The wound healing effect of vancomycin microspheres on MRSA 252 infected mice was better than that of vancomycin aqueous solution. Conclusions　The prepared PLA/PLGA sustained release microspheres can achieve local controlled release of vancomycin drug by adjusting the proportion of PLA and PLGA in the blend to improve drug encapsulation rate and drug loading, tailor degradation rate and change drug release, which is an effective preparation against Staphylococcus aureus infection.

Nursing Research

Effect of Chinese medicine hot compress therapy combined with intradermal needling on patients with lumbar disc herniation of the qi stagnation-blood stasis type 

Liu Qiyu, Li Sha, Yi Jianjun, Chen Meng

2024, 30(14):  2419-2422.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.027

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Objective　To observe the short-term and long-term effects of Chinese medicine hot compress therapy combined with intradermal needling on patients with lumbar disc herniation (LDH) of the qi stagnation-blood stasis type. Methods　A total of 70 patients with LDH of the qi stagnation-blood stasis type admitted to the department of orthopedics, Guangdong Second Hospital of Traditional Chinese Medicine from March 2021 to March 2023 were selected and were divided into an observation group and a control group by the random number table method, with 35 cases in each group. There were 17 males and 18 females in the control group, aged 45-60 (68.20±11.54) years, and the course of disease was 1-3 (2.51±0.94) years. There were 19 males and 16 females in the observation group, aged 45-60 (69.69±3.54) years, and the course of disease was 1-3 (2.54±1.06) years. Both groups were given orthopedic nursing care, the control group was given celecoxib, and the observation group was treated with Chinese medicine hot compress therapy combined with intradermal needling on the basis of the control group. Both groups were treated continuously for 14 days, and a telephone follow-up was conducted 3 months after treatment. The Visual Analogue Scale (VAS) scores and Japanese Orthopedic Association Lumbar Function Scale (JOA) scores were compared before treatment, after 3 days of treatment, after 14 days of treatment, and 3 months after treatment. The improvement of clinical performance before and after treatment was observed and the curative effect was evaluated. Independent sample t test, paired t test, and χ² test were used. Results　The VAS scores of the observation group after 3 days of treatment, after 14 days of treatment, and 3 months after treatment [(3.97±0.95) points, (3.91±0.89) points, and (3.74±0.74) points] were lower than those of the control group [(6.46±1.15) points, (6.23±0.94) points, and (6.29±1.15) points], with statistically significant differences (all P<0.05). The JOA scores of the observation group after 3 days of treatment, after 14 days of treatment, and 3 months after treatment were (21.74±1.52) points, (22.03±1.38) points, (22.51±1.20) points, respectively, which were higher than those of the control group [(18.83±1.51) points, (19.49±1.34) points, and (20.26±1.07) points], with statistically significant differences (all P<0.05). The total effective rate of the observation group was 94.29% (33/35), which was higher than that of the control group [65.71% (23/35)], with a statistically significant difference (P<0.05). Conclusion　Combination of Chinese medicine hot compress therapy and intradermal needling for LDH patients with the qi stagnation-blood stasis type not only can relieve the pain and improve the lumbar spine function in the short term, but also has better overall efficacy than using celecoxib alone.

Study on the application of mild and moderate simple myopia in teenagers treated by acupoint pressing along the meridian combined with Qijiao moxibustion

Zeng Weijiao, Guo Xiangui, Zeng Wantao, Lin Shaofen, Wu Ru, Lin Qiaomei, Xu Lin

2024, 30(14):  2423-2426.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.028

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Objective　To explore the application effect of acupoint pressing along the meridian combined with Qijiao moxibustion in preventing and treating mild to moderate simple myopia in teenagers. Methods　A total of 30 teenagers aged 10 to 19 years were treated in the Eye Care Department of Traditional Chinese Medicine of the First Affiliated Hospital of Guangdong Pharmaceutical University from January to June 2023, among whom there were 16 males aged (14.31±3.14) years and 14 females aged (13.00±2.86) years. They all received acupoint pressing along the meridian combined with Qijiao moxibustion. Acupoints of face, ear, bladder meridian, and governor meridian were selected for point-pressing. In addition, Qijiao moxibustion treatment was performed at Shenque point, 3 times a week, every 2 times at an interval of 1 d, for a total of 12 weeks. The uncorrected visual acuity (UCVA) and local ocular symptoms were observed before and after treatment. Paired t test was used. Results　Before treatment, the visual acuity of left eye was (4.410±0.220), and that of right eye was (4.373±0.160); after treatment, the visual acuity of left eye was (4.707±0.187), and that of right eye was (4.700±0.137); after treatment, the visual acuity of both eyes increased compared with those before treatment, with statistically significant differences (t=137.549 and 188.652, both P<0.001). After treatment, the scores of nonpersistence, dryness, foreign body sensation, eye acid distension, and photophobia of local ocular symptoms were lower than those before treatment [(1.367±0.490) points vs. (2.300±0.466) points, (1.367±0.490) points vs. (2.333±0.479) points, (1.400±0.498) points vs. (2.267±0.450) points, (1.167±0.379) points vs. (2.200±0.407) points, (1.333±0.479) points vs. (2.333±0.479) points], with statistically significant differences (t=27.028, 26.655, 27.603, 29.618, and 26.655, all P<0.001). Conclusion　Acupoint pressing along the meridian combined with Qijiao moxibustion can improve the vision of both eyes in teenagers with mild and moderate simple myopia, and alleviate the local ocular symptoms, with significant clinical effect, which is worth promoting.

Effect of family social support system management on the psychological development in children with microtia

Zhang Ying, Luo Mingcan, Li Gaofeng, Tan Jun, Liu Xiaojia

2024, 30(14):  2427-2431.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.029

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Objective　To investigate the effect of family social support system management on the psychological development in children with microtia. Methods　A total of 80 children with microtia who underwent surgical treatment in Hunan Provincial People's Hospital from July 2021 to December 2022 were selected as the subjects of this study, and they were divided into a control group (40 cases) and an observation group (40 cases) with the random number table method. The control group included 24 boys and 16 girls, aged (9.8±2.1) years, the types of deformity included structural deformity in 9 cases, ear ring deformity in 6 cases, cryptotia in 5 cases, cup ear in 7 cases, protruding ear in 6 cases, and mixed type deformity in 7 cases. The observation group included 26 boys and 14 girls, aged (9.6±2.3) years, the types of deformity included structural deformity in 8 cases, ear ring deformity in 7 cases, cryptotia in 6 cases, cup ear in 6 cases, protruding ear in 5 cases, and mixed type deformity in 8 cases. The control group was given routine follow-up financial support management, and the observation group was given management of family social support system for 4 weeks. The autism behavior (Autism Behavior Scale), self-confidence (Children's Self-confidence Rating Scale), and parental satisfaction (self-developed satisfaction scale) were compared between the two groups before and after intervention. Independent sample t test, paired t test, and χ² test were used. Results　After intervention, the scores of sensation [(12.4±3.3) points], physical movement [(18.4±4.1) points], self-care [(13.4±3.5) points], social interaction [(15.3±4.6) points], and language [(15.5±4.4) points] in the observation group were lower than those in the control group [(15.7±3.4) points, (21.4±4.4) points, (16.3±3.9) points, (18.4±4.9) points, and (18.1±4.8) points], with statistically significant differences (all P<0.05). After intervention, the Self-confidence Rating Scale score of the observation group [(97.2±12.1) points] was higher than that of the control group [(86.6±14.5) points], with a statistically significant difference (P<0.05). The total parental satisfaction in the observation group [97.50% (39/40)] was higher than that in the control group [85.00% (34/40)], with a statistically significant difference (P<0.05). Conclusion　The management of family social support system has a good application effect on the psychological development in children with microtia, which can effectively improve their behavioral abnormalities, promote the psychological development, improve the self-confidence and the parental satisfaction.

Application of Pilates exercise combined with pain nursing in patients with nonspecific low back pain

Li Haihua, Zhang Xian

2024, 30(14):  2432-2436.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.030

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Objective　To investigate the efficacy of Pilates exercise combined with pain care in patients with nonspecific lower back pain (NLBP). Methods　A total of 100 patients with NLBP admitted to the First Affiliated Hospital of Henan University from February 2021 to March 2023 were selected as the research subjects for a randomized controlled trial and were divided into a control group (50 cases) and an observation group (50 cases) using the random envelope method. In the control group, there were 18 males and 32 females, the age was 28-69 (51.35±8.29) years old, the course of disease was 4-36 (20.26±3.08) months, and the Visual Analog Scale (VAS) score was 4-6 points in 35 cases and ≥7 points in 15 cases. In the observation group, there were 20 males and 30 females, the age was 30-72 (52.06±8.84) years old, the course of disease was 5-36 (19.83±3.14) months, and the VAS score was 4-6 points in 32 cases and ≥7 points in 18 cases. The control group received routine nursing + pain nursing, and the observation group received Pilates exercise on the basis of the control group for 4 weeks. The pain degree (VAS score), Oswestry Disability Index (ODI) score, motivation to participate in exercise [Scale of Situational Motivation (SIMS) score], lumbar electromyographic (EMG) signals [median frequency value (MF) and root mean square value (RMS) of erector spinae and multifidus] were compared between the two groups before and after intervention. Independent sample t test, paired t test, ANOVA, and χ² test were used. Results　After 2 and 4 weeks of intervention, the VAS scores of the observation group [(5.56±0.87) points and (3.25±0.38) points] were lower than those of the control group [(6.13±1.02) points and (4.38±0.59) points] (both P<0.05); the ODI scores of the observation group [(20.38±3.70) points and (17.76±3.09) points] were lower than those of the control group [(24.65±3.64) points and (20.46±3.35) points] (both P<0.05). After 4 weeks of intervention, the scores of identification principle [(16.76±1.75) points], external motivation [(13.26±2.02) points], internal motivation [(15.62±2.12) points], and lack of motivation of the SIMS [(9.35±1.78) points] in the observation group were higher than those in the control group [(15.03±2.03) points, (11.82±2.19) points, (13.08±1.96) points, and (8.02±1.83) points] (all P<0.05). The MF of erector spinae and multifidus [(91.05±8.94) Hz and (89.16±11.03) Hz] in the observation group were lower than those in the control group [(95.16±10.36) Hz and (94.08±12.64) Hz], but the RMS of erector spinae and multifidus [(13.82±2.36) μV and (16.52±3.04) μV] were higher than those in the control group [(12.14±2.29) μV and (13.74±2.68) μV] (all P<0.05). Conclusion　Pain care combined with Pilates exercise can change the motivation of NLBP patients to participate in exercise, reduce their pain, and promote the recovery of muscle function and lumbar spine function.

Effect of path feedforward control nursing mode on patients with severe hepatitis

Ding Xueli, Jia Lixia, Li Cuncun

2024, 30(14):  2437-2441.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.031

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Objective　To explore the effect of path feedforward control nursing mode on treatment compliance, self-care ability, and quality of life in patients with severe hepatitis. Methods　A prospective study method was used to select 134 patients with severe hepatitis admitted to the Department of Hepatology of Xi'an Eighth Hospital from July 2022 to October 2023, including 71 males and 53 females, aged 25-68 years, with an age of (45.16±8.16) years old. The disease classification was acute in 32 cases, subacute in 27 cases, and chronic in 71 cases. The disease type was viral in 68 cases, alcoholic in 32 cases, fatty in 21 cases, and drug-induced in 13 cases. The patients were divided into two groups by the random number table method, with 67 cases in each group. During the research process, 2 cases were lost in each group. The control group implemented routine nursing mode, while the observation group implemented path feedforward control nursing mode. The nursing in both groups began on the next day after admission and ended 2 weeks after discharge. The scores of the 8-item Morisky Medication Adherence Scale (MMAS-8), the Chinese version of the Revised Self-Care Ability Assessment Scale (ASAS-R-C), and the Chinese version of the Liver Disease Quality of Life Scale 1.0 (LDQOL1.0) were compared between the two groups on the next day after admission and 2 weeks after discharge. Independent sample t test, paired t test, and χ² test were used. Results　Two weeks after discharge, the MMAS-8 score of the observation group [(6.03±1.34) points] was higher than that of the control group [(5.17±1.54) points] (P<0.05). The scores of general self-care needs [(19.78±4.88) points], developmental self-care needs [(16.80±3.93) points], and self-care needs when in poor health status [(14.00±2.90) points] and total score of the ASAS-R-C [(50.58±7.48) points] in the observation group were higher than those in the control group [(17.89±4.39) points, (14.69±3.59) points, (12.06±3.17) points, and (44.65±6.66) points] (all P<0.05). The scores of liver disease symptoms [(82.46±6.27) points], attention [(79.32±7.93) points], memory [(82.12±8.08) points], social quality [(80.40±7.14) points], sleep [(72.97±7.47) points], loneliness [(81.82±6.86) points], feeling of hopelessness [(79.31±10.58) points], feeling of shame [(74.29±10.95) points], sexual function [(80.62±11.46) points], and sexual life [(86.20±9.72) points] and total score [(79.54±2.39) points] of the LDQOL1.0 in the observation group were higher than those in the control group [(79.89±7.68) points, (73.78±8.22) points, (78.86±8.80) points, (75.14±7.60) points, (70.03±8.45) points, (78.88±8.44) points, (74.18±9.02) points, (69.80±12.40) points, (75.08±11.68) points, (80.55±10.02) points, and (75.55±2.83) points] (all P<0.05). Conclusion　The path feedforward control nursing mode is helpful to improve the treatment compliance and self-care ability in patients with severe hepatitis, and plays an important role in improving the patients' quality of life.

Coping ability to children's death among nurses in pediatric ICU and its influencing factors

Ye Liyan, Ma Jingxiang, Chun Xiao, Wen Xiulan, Chen Xiuchun

2024, 30(14):  2442-2446.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.032

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Establishment and practice exploration of artificial liver nurse post

He Na, Wang Juan, Li Lili, Zheng Lihua, Zheng Zimei, Jiang Shuxian

2024, 30(14):  2447-2451.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.033

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Objective　To analyze the role and effect of setting up special post of nurses in charge of artificial liver blood purification technology (artificial liver), and to provide reference for post setting and scientific management of artificial liver. Methods　Since November 2020, the post of artificial liver specialist nurse was set up in Infectious Disease Department, the Third Affiliated Hospital of Sun Yat-sen University, 12 specialized nurses for artificial liver post were selected and trained, consisting of 11 females and 1 male, with an age of (32.92±4.57) years old, with work experience of (9.51±5.12) years. The corresponding management norms were established to select and train the artificial liver specialist nurses. The artificial liver specialist nurse conducted the whole process management before, during, and after the artificial liver treatment and during the interval period. The management of artificial liver specialized post nurses and the ability of artificial liver specialized post nurses were compared before and after the establishment of post. Paired t test was used. Results　From November 2020 to December 2021, a total of 12 artificial liver specialized nurses were trained, and they participated in the formulation of 15 artificial liver treatment workflows, the revision of 5 norms, and the improvement of 3 projects. In 2021, a total of 1 050 patients were treated with artificial liver, an increase of 2.88 times compared with 2020 (365 patients). After the establishment of artificial liver nurse post, the quality of nursing care in artificial liver treatment increased from 77.0 to 92.5 points. After the artificial liver training, the scores of clinical nursing ability [self-evaluation (35.36±3.57) points and other-report (38.64±7.24) points], professional development ability [self-evaluation (42.29±6.44) points and other-report (49.60±11.03) points], and leadership and management ability [self-evaluation (38.86±4.66) points and other-report (43.47±8.99) points] of artificial liver specialized post nurses were significantly improved (all P<0.05). Conclusion　The establishment, management, and implementation of the nurses in the special post of artificial liver play a great role in the treatment of artificial liver, improve the management standard of artificial liver treatment, improve the quality of artificial liver treatment, and promote the development of the specialty.

Research progress on work practice and training of brain and heart health managers

Zhang Chun, Fu Jingjing, Jin Huayang, Feng Juanjuan, Lin Shuanghong, Li Zhiying, Gan Lu, Liu Jie, Chen Min, Zhao Chang

2024, 30(14):  2452-2456.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.034

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Brain and heart health managers are full-time managers of stroke patients, high-risk patients, and healthy people. Their responsibility is to reduce the incidence and recurrence rate of stroke through comprehensive management, and improve the level of stroke prevention and control in China. This paper reviews the origin and development, admission conditions and training status, work connotation and service mode, and shortcomings and prospects of brain and heart health managers. The current problems and deficiencies in brain and heart health management are pointed out. Through continuous improvement, the talent construction and team stability of brain and heart health managers are ensured, in order to provide reference for the research and management practice of brain and heart health management, chronic diseases in China.

Preventive Medicine

Analysis of depressive and anxious symptoms, as well as social support levels, among individuals living with HIV/AIDS in Haizhu District, Guangzhou City

Xu Meizhen, Peng Jinju, Song Ye, Liang Lejing, Zhu Kaixing, Wu Tianshi, Huang Tinghuan, Liu Li, Zheng Huijie

2024, 30(14):  2457-2461.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.035

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Objective　To understand the current situation of depression, anxiety, and social support and related factors among human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients in Haizhu District, Guangzhou City, and to provide reference for the prevention and treatment of group AIDS. Methods　Using cross-sectional study, 363 HIV/AIDS patients in Haizhu District, Guangzhou City, from October 2019 to June 2022 were selected as the study subjects for questionnaire survey. A self-designed questionnaire was used to collect information on their demographics, depression, anxiety, social support, and sexual behaviors. The status of depression, anxiety, and social support among the HIV/AIDS patients were analyzed. Independent sample t test, one-way ANOVA, and rank sum tese were used. Results　A total of 363 HIV/AIDS patients were surveyed in this study, aged (39.38±11.94) years, mainly were male [70.25% (255/363)], married [46.83% (170/363)], middle school education [36.91% (134/363)], and workers [30.03% (109/363)]. The total self-rating score of depression of the HIV/AIDS patients was (52.67±7.84) points, and 45.07% (160/355) of the patients had depression, among which 37.18% (132/355) were mild. The total self-rating score of anxiety was (51.84±6.64) points, mainly were mild anxiety [47.92% (173/361)]. The total score of social support of the HIV/AIDS patients was (22.87±7.79) points, of which the objective support score was (6.45±3.00) points, the subjective support score was (16.42±4.79) points, and the score of support utilization was (5.74±1.84) points. Conclusion　HIV/AIDS patients in Haizhu District, Guangzhou City have some mental health problems and generally low social support, mental health counseling should be strengthened, and social support, especially objective and subjective support, should be increased for this population.

Medical Education

Exploration of WebQuest combined with Sandwich teaching method guided by job competency in the undergraduate education system of ultrasound medicine major

Liu Tao, Li Jiahong, Shen Hongyuan, Zhou Qiongjuan, Song Siyi, Li Ruolan, Chen Tingwei, Liang Weixiang

2024, 30(14):  2462-2464.  DOI: 10.3760/cma.j.issn.1007-1245.2024.14.036

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Ultrasound medicine is a comprehensive subject with strong theory and practice, which has high requirements for practitioners' professional knowledge and operational skills. The problems of traditional undergraduate education of ultrasound medicine are the inability of unilateral teaching by teachers to stimulate students' learning interest and serious shortage of students' practice time, which makes it difficult to cultivate the post competence of ultrasound medical professionals. Based on the actual situation of undergraduate ultrasound medicine teaching, this paper discusses the application prospect of WebQuest combined Sandwich teaching method, which is oriented by post competence, in the undergraduate ultrasound medicine education system.