Table of Content

01 August 2024, Volume 30 Issue 15

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Breast Cancer

Overview of multi-omics research on invasive micropapillary carcinoma in breast

Yan Chenming, Cai Yiwei, Cheng Lihao, Fan Xiaorui, Jia Zhongming, Wang Xiaohong

2024, 30(15):  2465-2469.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.001

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Invasive micropapillary carcinoma is a rare type of invasive carcinoma of the breast that is highly susceptible to missed diagnosis due to its low incidence and its usual coexistence with other histologic types such as invasive ductal carcinoma. Invasive micropapillary carcinoma has high invasive capacity and severely affects the patients' quality of life. With the advancement of multi-omics technology, the molecular mechanism of invasive micropapillary carcinoma has been further elucidated, and more and more potential targets have been revealed. The aim of this article is to review the progress of multi-omics research on invasive micropapillary carcinoma.

Important role and mechanism of lipid metabolism in breast cancer progression

Cai Yiwei, Yan Chenming, Yue Linhao, Wang Xiaohong, Jia Zhongming

2024, 30(15):  2470-2473.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.002

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Breast cancer is a malignant tumor originating from breast epithelial tissue, and its incidence rate is increasing year by year. Studies have shown that the level and regulation of lipid metabolism play an important role in the tumor cell proliferation, migration, invasion, metastasis, and development of drug resistance. This paper reviews the role and mechanism of lipid metabolism in the breast cancer progression from three aspects: lipid metabolism components (fatty acids, triglycerides and cholesterol), lipid metabolism signaling pathway, and regulatory genes of lipid metabolism, offers insights into the potential clinical value of targeted lipid metabolism therapy, and provides theoretical references for formulating effective treatment strategies and developing metabolism-targeted drugs.

Value of peripheral blood NLR combined with CD8⁺ T lymphocytes in predicting recurrence of breast cancer patients after breast-conserving surgery

Wu Qinghua, Hao Hong, Li Xuexue, Han Chenbo

2024, 30(15):  2474-2479.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.003

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Objective　To analyze the value of peripheral blood neutrophil to lymphocyte ratio (NLR) combined with CD8⁺ T lymphocytes in predicting the recurrence of breast cancer patients after breast-conserving surgery. Methods　A total of 106 patients with breast cancer who visited Baoji Maternal and Child Health Hospital from February 2016 to February 2019 were selected. They were (45.82±9.57) years old. The mean maximum tumor diameter was (2.37±0.85) cm. All the patients received breast-conserving surgery, and were followed up for 5 years. According to the recurrence situation, the patients were divided into a non-recurrence group and a recurrence group. The levels of peripheral blood CD8⁺, NLR's, and clinical data were compared between the recurrence group and the non-recurrence group. The factors influencing the recurrence of breast cancer after breast conserving surgery were analyzed. The values of peripheral blood CD8⁺, NLR, and their combination in predicting the recurrence of breast cancer after breast conserving surgery were analyzed.t test, χ² test, and Fisher exact probability method were used. The logistic regression model was used to analyzed the influencing factors. Results　After 5 years' follow-up, 3 of the 106 patients were lost to follow-up, and the follow-up rate was 97.17% (103/106). Of which, 12 patients relapsed, and the recurrence rate was 11.65% (12/103); the remaining 91 patients did not relapse, and the recurrence rate was 88.35% (91/103). The level of peripheral blood CD8⁺ in the recurrence group was lower than that in the non-recurrence group [(23.17±3.36)% vs. (29.45±4.23)%]; the peripheral blood NLR in the recurrence group was higher than that in the non-recurrence group [(2.64±0.39) vs. (1.72±0.24)]; there were statistical differences between the two groups (both P<0.05). The proportion of the patients with lymph node metastasis in the recurrence group was higher than that in the non-recurrence group [58.33% (7/12) vs. 24.18% (22/91); P<0.05]; the proportions of the patients taking postoperative full-course radiotherapy and standard chemotherapy in the recurrence group were lower than those in the non-recurrence group [25.00% (3/12) vs. 93.41% (85/91) and 33.33% (3/12) vs. 89.01% (81/91); both P<0.05]. The logistic regression analysis showed that peripheral blood CD8⁺ decrease (OR=0.285, 95%CI 0.125-0.647), peripheral blood NLR increase (OR=4.175, 95%CI 1.835-9.796), lymph node metastasis (OR=5.013, 95%CI 2.204-11.403), and postoperative full-course radiotherapy (OR=0.255, 95%CI 0.112-0.579) were the influential factors for breast cancer recurrence after breast conserving surgery (all P<0.05). The areas under the curves (AUC) of peripheral blood CD8⁺, NLR, and their combination in predicting breast cancer recurrence after breast preservation surgery were 0.799, 0.844, and 0.905, respectively, and the AUC of the combination was higher (P<0.05). Conclusion　Peripheral blood CD8⁺ T lymphocytes and NLR can be used to predict the recurrence of breast cancer patients after breast-conserving surgery, and the combined value is higher.

Family-involved psycho-cognitive care for patients taking breast cancer mastectomy

Zhou Xichun, Li Qiaoyan

2024, 30(15):  2479-2484.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.004

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Objective　To explore the impact of family-involved psycho-cognitive care on the distress level and positive coping strategies of patients with breast cancer after mastectomy. Methods　Eighty-one patients with breast cancer taking mastectomy at Xi'an Central Hospital from February 2022 to February 2023 were selected for the randomized controlled trial, and were divided into a control group (40 cases) and an observation group (41 cases) by the random number table method. The control group were (53.28±4.51) years old; there were 22 cases of stage Ⅰ, 16 cases of stage Ⅱ, and 2 cases of stage Ⅲ. The observation group were (53.34±4.47) years old; there were 23 cases of stage Ⅰ, 14 cases of stage Ⅱ, and 4 cases of stage Ⅲ. The control group received conventional care, and the observation group family-involved psycho-cognitive care. The distress levels, positive coping strategies [using the Coping Strategies Questionnaire (CSQ)], cancer-related fatigue [using the Cancer Fatigue Scale (CFS)], and self-care ability [using the Self-Care Ability Scale (ESCA)] were compared between the two groups before and three months after the intervention by t and χ2 test. Results　Three months after the intervention, the scores of physical strength, religion, emotions, family, and practice of psychological distress in the observation group were lower than those in the control group [(3.51±0.66) vs. (4.92±0.89), (3.14±0.71) vs. (4.22±0.90), (3.97±0.65) vs. (5.38±0.95), (3.52±0.88) vs. (5.07±1.23), and (4.33±1.00) vs. (5.62±0.93)], with statistical differences between the two groups (all P<0.05). The score of DT in the observation group was lower than that in the control group [ (3.54±0.57) vs. (4.60±0.75)], with a statistical difference between the two groups (P<0.05). The scores of in self-blame, fantasy, and avoidance of CSQ in the observation group were lower than those in the control group [(0.41±0.06) vs. (0.62±0.09), (0.52±0.08) vs. (0.69±0.03), and (0.43±0.04) vs. (0.62±0.06)], with statistical differences between the two groups (all P<0.05); the scores of seeking help, problem-solving, and rationalization in the observation group were higher than those in the control group [(0.69±0.06) vs. (0.48±0.05), (0.63±0.06) vs. (0.49±0.05), and (0.69±0.07) vs. (0.56±0.05)], with statistical differences between the two groups (all P<0.05). The scores of physical fatigue, cognitive fatigue, and emotional fatigue of CFS in the observation group were lower than those in the control group [(15.37±1.84) vs. (22.61±2.41), (9.66±1.43) vs. (13.10±1.51), and (8.02±1.23) vs. (12.97±1.64)], with statistical differences between the two groups (P<0.05). The scores of health knowledge, self-care skills, self-concept, and self-responsibility of ESCA in the observation group were higher than those in the control group [(49.58±4.40) vs. (42.35±4.83), (41.85±3.80) vs. (37.06±3.11), (30.29±3.38) vs. (27.16±3.88), and (27.30±2.29) vs. (24.11±2.04)], with statistical differences between the two groups (all P<0.05). Conclusion　Family-involved psycho-cognitive care for patients taking breast cancer mastectomy can effectively reduce their pain levels, cancer-related fatigue, active coping strategies, and self-care ability.

Treatises

Effects of dydrogesterone combined with nifedipine on pregnancy outcomes and serum miRNA-141 and miRNA-518e in patients with threatened abortion 

Sun Xiuli, Gou Liangzhi, Guo Qian, Gao Yajuan, Gao Yu, Wang Yunping, Li Yabo

2024, 30(15):  2485-2489.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.005

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Objective　To study the effects of dydrogesterone combined with nifedipine on the improvement of pregnancy outcomes and serum miRNA-141 and miRNA-518e in patients with threatened abortion. Methods　One hundred and seventeen patients with threatened abortion admitted to Shaanxi Provincial Tuberculosis Prevention and Control Hospital from May 2020 to May 2023 were selected, and were divided into a combination group (58 cases) and a reference group (59 cases) by the computer random odd-even number method. The reference group was treated with nifedipine 10 mg/time, 3 times/day, for 3 days, and the dosage was adjusted to 20 mg/time, 3 times/day; they took the medicine until their symptoms completely disappeared. The combination group were treated with dydrogesterone on the basis of the reference group; the first dose was 40 mg, then the dosage was 10 mg/time every other 12 h; they took the medicine until their symptoms completely disappeared. The pregnancy outcomes, reproductive hormone levels, uterine artery blood flow parameters, and serum levels of miRNA-141 and miRNA-518e were compared between the two groups. t and χ² tests were applied. Results　The abortion rate of the combination group was lower than that of the reference group, but the full-term pregnancy rate was higher than that of the reference group [3.45% (2/58) vs. 15.25% (9/59) and 86.21% (50/58) vs. 64.41% (38/59)], with statistical differences between the two groups (both P<0.05). After 30 days' treatment, the levels of reproductive hormones in both groups were significantly higher than those 1 day before the treatment, and the increases in combination group were better than those in the reference group (all P<0.05). After 30 days' treatment, all the uterine artery blood flow parameters in both groups were lower than those 1 day before the treatment, and the down-regulation amplitudes in combination group were better than those in the reference group (all P<0.05). After 30 days' treatment, the serum levels of miRNA-141 and miRNA-518e in both groups were lower than those 1 day before the treatment, and the levels in combination group were lower than those in the reference group [(20.73±1.82) vs. (24.81±2.09) and (15.97±1.45) vs. (22.50±2.03)], with statistical differences between the two groups (both P<0.05). Conclusion　Dydrogesterone combined with nifedipine for patients with threatened abortion can improve their pregnancy outcomes, reproductive hormones, and uterine artery blood flow, and negatively regulate the expression of miRNA-141 and miRNA-518e.

Value of preoperative WLR and p16 protein expression in prediction of survival outcomes of patients with penile cancer

Shi Liang, Ren Lei, Chen Hanxuan

2024, 30(15):  2489-2494.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.006

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Objective　To assess the value of preoperative white blood cell to lymphocyte ratio (WLR) and p16 protein expression in the prediction of the survival outcomes of patients with penile cancer. Methods　This study is a retrospective cohort study. Ninety-one patients with penile cancer admitted to Xianyang First People's Hospital from January 2018 to January 2020 were selected as the study objects. All the patients took partial penectomy, and were followed up for 3 years after the surgery. According to their prognosis, they were divided into a survival group (58 cases) and a death group (33 cases). The survival group were (61.12±7.13) years old. The death group were (60.88±7.22) years old. The basic information and preoperative imaging results (tumor location, biggest tumor diameter, nerve invasion, lymph node metastasis, and cell differentiation) were compared between the two groups. The levels of vascular endothelial growth factor (VEGF) and tumor necrosis factor receptor-associated protein 1 (TRAP1) were detected. The p16 protein expression was assessed. The preoperative white blood cell to lymphocyte ratio (WLR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR) were calculated. The logistic regression analysis was employed to assess the determinants influencing patient survival. The predictive value of WLR and p16 for postoperative death in the patients was assessed by the receiver operating characteristic curve (ROC). t and χ² tests were applied. Results　There were no statistical differences in the basic information, tumor location, biggest tumor diameter, and cell differentiation between the two groups (all P>0.05). The proportions of the patients with nerve invasion, lymph node metastasis, and positive p16 protein expression in the death group were higher than those in the survival group [63.64% (21/33) vs. 32.76% (19/58), 57.58% (19/33) vs. 31.03% (18/58), and 66.67% (22/33) vs. 32.76% (19/58)], with statistical differences (χ²=8.140, 6.141, and 9.769; all P<0.05). The WLR, NLR, PLR, MLR, and levels of VEGF and TRAPl in the death group were higher than those in the survival group [(5.62±0.91) vs. (4.11±0.75), (5.27±0.88) vs. (3.91±0.71), (181.06±25.13) vs. (145.32±20.64), (0.58±0.20) vs. (0.32±0.12), (539.03±52.48) ng/L vs. (442.18±47.36) ng/L, and (58.01±6.63) ng/L vs. (45.25±5.82) ng/L], with statistical differences (t=8.537, 8.044, 7.331, 7.761, 9.016, and 9.556; all P<0.05). The logistic regression analysis indicated that preoperative nerve invasion, lymph node metastasis, p16 protein, VEGF, TRAPl, WLR, NLR, PLR, and MLR were important factors affecting the patients' prognosis (all P<0.05). The ROC demonstrated that the combination of WLR and p16 protein expression had a predictive accuracy of 0.943 (0.896-0.990) for patient death. Conclusion　Preoperative measurement of WLR and p16 can help assess the postoperative survival outcomes of patients with penile cancer.

Efficacy of ceramide cream in adjuvant treatment of patients with facial sensitive skin

Xu Jieru, Lyu Pingping, Tai Meiling, Jiang Ling, Li Wanzhao, Li Huarun, Qin Si, Wen Ju

2024, 30(15):  2495-2500.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.007

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Objective To investigate the efficacy and safety of ceramide cream in the adjuvant treatment of patients with facial sensitive skin, and to analyze its effect on skin barrier function. Methods　A total of 60 patients with facial sensitive skin who were treated in Department of Dermatology, Guangdong Second Provincial General Hospital from June 2022 to April 2023 were selected for the randomized controlled trial, and were divided into a control group and an observation group by the random number table method, with 30 cases in each group. There were 3 males and 27 females in the control group; they were 22-39 (27.97±4.80) years old; their disease course was 1 week to 5 months. There were 3 males and 27 females in the observation group; they were 19-42 (31.33±6.42) years old; their disease course was 1 week to 5 months. The control group were treated with cetirizine hydrochloride tablets and took anti-sensitivity treatment; in addition, the observation group were treated with ceramide cream. The clinical efficacies, skin cuticle water contents, transepidermal water loss (TEWL), skin oil contents, skin erythema volumes, and incidences of adverse reactions were compared between the two groups by t and χ² tests. Results　The total effective rate in the observation group was higher than that in the control group [96.67% (29/30) vs. 76.67% (23/30)], with a statistical difference (χ²=5.192; P=0.022). Before the treatment and the first week of the treatment, there were no statistical differences in the skin cuticle water content and TEWL between the two groups (all P>0.05). The second and forth week of the treatment, the skin cuticle water contents in the observation group were higher than those in the control group [(159.4±30.38) μs vs. (144.9±24.50) μs and (172.5±27.70) μs vs. (152.8±20.56) μs]; the TEWL's in the observation group were lower than those in the control group [(21.00±3.05) g/m²/h vs. (22.87±2.87) g/m²/h and (18.93±2.98)g/m²/h vs. (21.93±2.73) g/m²/h]; there were statistical differences (t=2.035, 3.128, 2.440, and 4.071; all P<0.05). Before the treatment and the first and second week of the treatment, there were no statistical differences in the skin oil contents and skin erythema volumes between the two groups (all P>0.05). The forth week of the treatment, the skin oil content in the observation group was higher than that in the control group [(5.60±2.39)% vs. (4.13±2.16)%]; the skin erythema volume in the observation group was lower than that in the control group [(12.43±1.76) mm² vs. (14.12±1.79) mm²]; there were statistical differences (t=2.495 and 3.679; both P<0.05). No significant adverse reactions occurred in both groups during the treatment. Conclusion　Ceramide cream has a good auxiliary repair effect on facial sensitive skin, can help reduce the patients' clinical symptoms, has certain application value in promoting the recovery of skin barrier function, and has few adverse reactions and better safety.

Value of serum Hcy and FGF-23 in prediction of cardiovascular and cerebrovascular events in patients with uremia and hypertension treated with hemodialysis 

Ke Tingwen, Ye Zhao, Du Yaqin, Zheng Yeyan

2024, 30(15):  2500-2506.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.008

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Objective　To analyze the value of serum homocysteine (Hcy) and fibroblast growth factor-23 (FGF-23) in the prediction of cardiovascular and cerebrovascular events in patients with uremia and hypertension treated with hemodialysis. Methods　A total of 98 patients with uremia and hypertension who underwent hemodialysis in Huangshi Hospital of Traditional Chinese Medicine from February 2019 to December 2022 were selected as the research objects, including 58 males and 40 females who were 53-76 (64.18±5.39) years old. The clinical data, such as serum Hcy and FGF-23, were collected. The patients were followed up for 1 year. The incidence of cardiovascular and cerebrovascular events in the patients during the follow-up period was statistically analyzed. The factors affecting the occurrence of cardiovascular and cerebrovascular events in the patients were analyzed by t and χ² tests and logistic regression analysis. The values of Hcy and FGF-23 in the prediction of the occurrence of cardiovascular and cerebrovascular events in the patients was analyzed by the receiver operating characteristic curves (ROC). Results　Among the 98 patients, 37 cases (37.76%) had cardiovascular and cerebrovascular events, and the remaining 61 cases (62.24%) did not have cardiovascular and cerebrovascular events. There were no statistical differences in gender, age, body mass index, smoking history, drinking history, heart rate, hypertension course, systolic and diastolic pressures, antihypertensive drugs, fasting blood glucose, triacylglycerol, total cholesterol, high-density lipoprotein cholesterol, prealbumin, transferrin, urea nitrogen, creatinine, uric acid, alanine transaminase, gamma-glutamyltransferase, blood Ca and P, blood urea clearance index, parathyroid hormone, and left ventricular ejection fraction between the two groups (all P>0.05). The dialysis age, albumin, low density lipoprotein cholesterol, urinary albumin excretion rate, red blood cell distribution width, Hcy, and FGF-23 in the patients with cardiovascular and cerebrovascular events were higher than those in the patients with no cardiovascular and cerebrovascular events [(4.83±0.81) years vs. (4.39±0.58) years, (36.33±5.08) g/L vs. (32.66±5.39) g/L, (3.59±0.75) mmol/L vs. (3.25±0.35) mmol/L, (38.77±4.43) mg/24 h vs. (35.54±4.41) mg/24 h, (15.59±2.19)% vs. (13.21±1.16)%, (18.82±2.31) μmol/L vs. (14.46±2.20) μmol/L, and (189.71±32.69) ng/L vs. (154.59±27.68) ng/L]; the estimated glomerular filtration rate (eGFR) in the patients with cardiovascular and cerebrovascular events was lower than that in the patients with no cardiovascular and cerebrovascular events [(40.56±7.12) ml/min/1.73 m² vs. (46.37±6.23) ml/min/1.73 m²]; there were statistical differences (t=3.126, 3.388, 3.043, 3.509, 7.303, 9.333, 5.683, and 4.239; all P<0.05). The logistic multivariate regression analysis showed that dialysis age, Hcy, FGF-23, and eGFR were the factors affecting the occurrence of cardiovascular and cerebrovascular events in the patients (all P<0.05). The ROC analysis showed that the sensitivities of Hcy, FGF-23, and their combination in the prediction of cardiovascular and cerebrovascular events in the patients were 71.68%, 76.57%, and 78.04%; the specificities were 78.59%, 74.31%, and 89.36%; the areas under the curves were 0.768, 0.745, and 0.886. Conclusions　Serum Hcy and FGF-23 levels are related to cardiovascular and cerebrovascular events in patients with uremia and hypertension taking hemodialysis. The risk of cardiovascular and cerebrovascular events is higher when Hcy and FGF-23 are at high levels. The combination of the two has higher efficacy in predicting cardiovascular and cerebrovascular events in patients with uremia and hypertension taking hemodialysis.

Prognostic factors of anterior circulation ruptured aneurysms treated by microsurgical clamping

Chen Zexin, Wang Yusheng, Lin Chuchun, Cai Yuehao, Yuan Jun

2024, 30(15):  2506-2510.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.009

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Objective　To explore the factors affecting the prognosis of patients with anterior circulation ruptured aneurysms treated by microsurgical clamping. Methods　Eighty patients with anterior circulation ruptured aneurysms admitted to Jieyang People^,s Hospital from January 2018 to June 2023 were selected, including 38 males and 42 females. They were (53.28±2.81) years old. The time from admission to surgery was (1.96±0.52) days. Clinical manifestations: 48 cases had severe headache, 31 cases mild headache, and 26 cases consciousness disorders. All the patients were treated by microsurgical clamping. They were followed up for 6 months after the surgery. The patients were divided to a good prognosis group and a poor prognosis group according to their prognosis. Their clinical data were analyzed. The Glasgow Outcome Scale (GOS) was used to evaluate their prognosis. The logistic regression equations were used to analyze the relevant factors affecting their prognosis. Results　All the 80 patients were successfully followed up, including 59 cases (73.75%) with good prognosis and 21 cases (26.25%) with poor prognosis. There were no statistical differences between the two groups in age, gender, aneurysm diameter, operation time, number of bleedings, and time from admission to operation (all P>0.05); there were statistical differences in the rest factors between the two groups (all P<0.05). The logistic analysis results showed that preoperative Hunt-Hess classification, Glasgow Coma Scale (GCS) score, postoperative cerebrovascular complications, postoperative intracranial infection, and Fisher classification were risk factors affecting the patients' prognosis (all P<0.05). Conclusion　There are many factors affecting the prognosis of patients with anterior circulation ruptured aneurysms. Their prognosis is mainly closely related to preoperative Hunt-Hess grading, GCS score, postoperative intracranial infection, etc.

New Medical Advances

Research progress on diagnosis and treatment of pharyngeal reflux disease

Yang Yang, Yang Pei, Jing Nan

2024, 30(15):  2511-2518.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.010

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Laryngeal reflux disease is caused by the reflux of gastroduodenal contents, the inflammatory state of the upper digestive tract and respiratory tract caused by direct or indirect behaviors. In the occurrence and development of many common diseases in children, laryngeal reflux plays a non-negligible role. Adenoidal hypertrophy, chronic sinusitis, chronic rhinitis, secretory otitis media, asthma, laryngeal disorders, etc. are closely related to pharyngeal reflux. The main diagnostic methods for pharyngeal reflux are multi-channel intracranial impedance (MII), 24-hour dynamic dual probe pH measurement, biopsy, scales, etc. Treatment for pharyngeal reflux is mainly a combination of drug, diet, and lifestyle adjustment.

Basic Research

Expressions of NF-κB, PD-1, and PD-L1 in gastric cancer and their clinical significance

Zhang Like, Xu Quanxiao, Li Yuanyuan, Yang Wei

2024, 30(15):  2519-2523.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.011

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Objective　To explore the expressions of nuclear factor kappa B (NF-κB), programmed cell death protein-1 (PD-1), and programmed cell death protein ligand 1 (PD-L1) in gastric cancer and their clinical significance. Methods　The specimens of the cancer tissue and paracancer tissue of 62 patients with gastric cancer treated in Nanyang First People's Hospital from January 2021 to December 2023 were selected as a gastric cancer group and a paracancer group. Among the 62 patients, there were 39 males and 23 females; they were (61.86±2.31) years old; the biggest tumor diameter was (4.92±0.53) cm. The expressions of NF-κB, PD-1, and PD-L1 were detected by immunohistochemical staining; their positive expression rates were compared between the two groups; their relationship with clinicopathological features was analyzed. χ² test was used. Results　The positive expression rates of NF-κB, PD-1, and PD-L1 in the gastric cancer group were higher than those in the paracancer group [83.87% (52/62) vs. 33.87% (21/62), 75.81% (47/62) vs. 30.65% (19/62), and 80.65% (50/62) vs. 40.32% (25/62)], with statistical differences (χ²=32.008, 25.396, and 21.088; all P<0.05). The positive expression rates of NF-κB in the patients with muscle and serosal infiltration, lymph node metastasis, and stage Ⅲ+Ⅳ were higher than those in the patients with mucosa and submucosa infiltration, no lymph node metastasis, and stage Ⅰ+Ⅱ [92.68% (38/41) vs. 66.67% (14/21), 94.74 (36/38) vs. 66.67% (16/24), and 92.31% (36/39) vs. 69.57% (16/23)], with statistical differences (χ²=5.158, 6.619, and 3.978; all P<0.05). The positive expression rates of PD-1 in the patients with muscle and serosal infiltration, lymph node metastasis, and stage Ⅲ+Ⅳ were higher than those in the patients with mucosa and submucosa infiltration, no lymph node metastasis, and stage Ⅰ+Ⅱ [85.37% (35/41) vs. 57.14% (14/21), 89.47% (34/38) vs. 54.17% (13/24), and 89.74% (35/39) vs. 52.17% (12/23)], with statistical differences (χ²=6.031, 9.998, and 11.135; all P<0.05). The positive expression rates of PD-L1 in the patients with low differentiation, muscle and serosal infiltration, lymph node metastasis, and stage Ⅲ+Ⅳ were higher than those in the patients with high differentiation, mucosa and submucosa infiltration, no lymph node metastasis, and stage Ⅰ+Ⅱ [96.00% (24/25) vs. 70.27% (26/37), 90.24% (37/41) vs. 61.90% (13/21), 92.11% (35/38) vs. 62.50% (15/24), and 94.87% (37/39) vs. 56.52% (13/23)], with statistical differences (χ²=4.787, 5.445, 6.472, and 11.286; all P<0.05). Conclusions　The positive expressions of NF-κB, PD-1, and PD-L1 in gastric cancer are increased. The expressions of NF-κB and PD-1 are related to the depth of gastric cancer invasion, lymph node metastasis, and TNM stage. The expression of PD-L1 is related to the degree of differentiation, depth of invasion, lymph node metastasis, and TNM stage of gastric cancer.

Clinical Research

Clinical efficacy of Xiaozhong decoction in treatment of postoperative complications of patients with mixed hemorrhoids

Yuan Wenbei, Zhang Leihong

2024, 30(15):  2524-2528.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.012

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Objective　To observe the clinical effect of Xiaozhong decoction in the treatment of postoperative complications of patients with mixed hemorrhoids. Methods　One hundred and twenty patients with mixed hemorrhoids treated at Minxian Hospital of Traditional Chinese Medicine from February 2023 to January 2024 were selected for the randomized controlled trial. The patients were divided into a control group and an observation group by the random number table method, with 60 cases in each group. There were 31 males and 29 females in the control group; they were (43.15±13.19) years old; their disease course was (3.70±1.95) years; their body mass index was (22.70±2.25) kg/m². There were 28 males and 32 females in the observation group; they were (42.68±14.80) years old; their disease course was (3.90±2.36) years; their body mass index was (22.91±2.13) kg/m². Both groups received routine postoperative treatment. The control group were treated with potassium permanganate fumigation, and the observation group with Xiaozhong decoction fumigation. Five days were one treatment course; both groups were treated two courses. After the treatment, the total effective rates were compared between the two groups. The scores of clinical symptoms day 1, 3, 7, and 11 after the operation and the levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6) before and after the treatment in both groups were recorded. t and χ² tests were applied. Results　The total effective rate in the control group was 75.0% (45/60), and that in the observation group was 91.7% (55/60), with a statistical difference (P<0.05). The scores of pain, wound exudate, and anal prolapse day 3, 7, and 11 after the operation in the observation group were lower than those in the control group [day 3 after the operation: (4.93±1.07) vs. (6.13±1.28), (1.85±0.40) vs. (2.07±0.68), and (2.02±0.75) vs. (2.35±0.71); day 7 after the operation: (3.53±1.11) vs. (4.13±0.93), (1.47±0.54) vs. (1.87±0.85), and (1.53±0.50) vs. (1.87±0.72); day 11 after the operation: (1.62±1.11) vs. (2.28±1.51), (0.75±0.79) vs. (1.21±0.72), and (0.63±0.58) vs. (0.98±0.83)], with statistical differences (all P<0.05). After the treatment, the levels of TNF-α, IL-1β, and IL-6 in the observation group were lower than those in the control group [(2.75±1.01) ng/L vs. (5.25±1.87) ng/L, (5.75±2.00) ng/L vs. (9.78±2.82) ng/L, and (8.14±2.14) ng/L vs. (12.68±4.13) ng/L], with statistical differences (all P<0.05). Conclusion　Xiaozhong decoction in the treatment of postoperative complications of patients with mixed hemorrhoids is effective, so it is worthy of promotion.

Electrophysiological subtypes and prognosis of patients with Guillain-Barré syndrome

Guo Yuanyuan, Bai Ya, Li Wen, Guan Zhaorui, Wang Bo , Liu Xuedong

2024, 30(15):  2528-2533.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.013

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Objective　To study the relation between electrophysiological subtypes and prognosis of patients with Guillain-Barré syndrome (GBS). Methods　One hundred and sixty-eight patients with GBS treated at Department of Neurology, Xijing Hospital from September 2020 to October 2023 were selected. According to the Hadden neurophysiological classification criteria, the patients were divided into 5 types. The follow-up score of Hughes was used as the prognosis evaluation indicator. The patients whose Hughes score was 3-6 were set as a poor prognosis group, and the patients whose score was 1-2 a good prognosis group. The observation indicators included gender, age, peak Hughes score, peak mRC score, time from onset to follow-up, cerebrospinal fluid immunoglobulin (IgG), serum anti-GM antibody, prodromal gastrointestinal infections, mechanical ventilation, significant blood pressure fluctuation, and immunoglobulin therapy. Blind follow-up was conducted on the patients through telephone, outpatient daprtment, and hospitalization. χ² test was used. Univariate and multivariate COX regressions and survival curve analysis were used to analyze the risk ratio (RR) that electrophysiological typing affected the patients' prognosis. Results　A total of 168 cases were enrolled, including 100 males and 68 females. Twenty-nine cases had poor prognosis including 8 cases who died (6 men and 2 women); 139 cases had good prognosis. There were, cases (40.48%) of axonal type, 61 cases (36.31%) of demyelinating type, 20 cases (11.90%) of unclear type, 10 cases (5.95%) of normal type, and 9 cases (5.36%) of neural denervation type. The multivariate COX proportional hazards model suggested the axonal subtype (RR=4.871, 95%CI 1.397-16.983, P=0.013), male (RR=3.295, 95%CI 1.117-9.718, P=0.031), and 40-65 years old (RR=2.565, 95%CI 1.011-6.512, P=0.047) were associated with poor outcomes. Conclusion　Axonal type is the main risk factor of poor prognosis of patients with GBS.

Intense pulsed light combined with recombinant human type Ⅲ collagen dressing for patients with rosacea

Ma Tao, Lu Yanna, Bai Xue, Liu Bo

2024, 30(15):  2533-2538.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.014

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Objective　To evaluate the clinical effect of intense pulsed light (IPL) combined with recombinant human type Ⅲ collagen dressing in the treatment of patients with rosacea. Methods　One hundred and twenty-two patients with rosacea treated at Department of Dermatology, Yan'an People's Hospital from April 2020 to April 2023 were selected for the randomized controlled trial, and were divided into an IPL group and a treatment group by the random number table method, with 61 cases in each group. There were 31 males and 30 females in the IPL group; they were (31.63±5.57) years old; their disease course was (3.49±1.31) years; they were treated by IPL. There were 34 males and 27 females in the treatment group; they were (30.18±5.14) years old; their disease course was (3.36±1.27) years; they were treated by IPL and recombinant human type Ⅲ collagen dressing. The clinical efficacies, rosacea researchers' general assessment (IGA) scores, VISIA red zone measurements, skin physiological indicators, physicians' global assessment (PGA), Acne-specific quality of life (Acne-QOL), and treatment-related adverse events were compared between the two groups. t and χ² tests were applied. Results　Four weeks after the treatment, the total effective rate in the treatment group was higher than that in the IPL group [91.80% (56/61) vs. 73.77% (45/61)], with a statistical difference (χ²=6.960; P=0.008). Before the treatment, there were no statistical differences in the score of IGA, facial VISIA red zone measurement value, transepidermal water loss (TEWL), skin grease, water in cuticle, skin injury degree, and life quality score between the two groups (all P>0.05). Four weeks after the treatment, the score of IGA, TEWL, and skin grease in the treatment group were lower than those in the IPL group [(2.27±0.83) vs. (3.83±0.86), (12.29±2.91)% vs. (16.45±2.17)%, and (70.31±11.92) μg/cm² vs. (83.64±13.83) μg/cm²]; the facial VISIA red zone measurement value, water in cuticle, and scores of PGA, self-perception, emotion function, rosacea symptoms, and social function in the treatment group were higher than those in the IPL group [(56.82±12.56) vs. (42.31±10.97), (67.91±11.24)% vs. (56.26±10.39)%, (2.82±0.87) vs. (2.25±0.81), (22.52±2.71) vs. (18.73±2.52), (16.83±2.74) vs. (14.32±2.18), (20.52±2.46) vs. (17.93±2.38), and (19.74±2.85) vs. (15.83±2.14)], with statistical differences (t=10.194, 8.951, 5.702, 6.796, 5.944, 3.745, 7.999, 5.599, 5.910, and 8.568; all P<0.05). There was no statistical difference in the incidence of adverse events between the treatment group and the IPL group [6.56% (4/61) vs. 11.48% (7/61); χ²=0.899; P=0.343]. Conclusion　IPL combined with recombinant human type Ⅲ collagen dressing for patients with rosacea is effective and safe, and can improve their overall skin conditions and quality of life, so it is worth being clinically generalized.

Relationship between preconception BMI and weight gain during pregnancy and risk of emergency cesarean section

Li Xiaohong, Min Ai, Wang Shiying

2024, 30(15):  2539-2543.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.015

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Objective　To investigate the relationship between pre-pregnancy body mass index (BMI) and pregnancy weight gain and the risk of emergency cesarean section during labor. Methods　Eighty primary monoparous women hospitalized at Ankang Maternal and Child Health Hospital from December 2020 to December 2023 were selected as the study objects. Their pregnancy period was (38.95±1.45) weeks. They were (33.28±1.34) years old. Their pre-pregnancy body weight was (57.22±10.17) kg. These women were divided into a vaginal delivery group (47 cases) and an emergency cesarean section group (33 cases) according to their delivery methods. The ages, pre-pregnancy BMI, body weights, weight gain, fasting insulin levels, fasting blood glucose levels, total cholesterol levels, glycated hemoglobin levels, pre-pregnancy weights, high-density lipoprotein levels, low-density lipoprotein levels, triglyceride levels, and educational levels were compared between the groups. Binary logistic regression was employed to analyze the risk factors of emergency cesarean section. Spearman's correlation analysis was conducted to evaluate the relationship of pregnancy BMI and gestational weight gain with the risk of emergency cesarean section during labor. t and χ² tests were applied. Results　The vaginal delivery group was (31.28±1.22) years old, and the emergency cesarean section group (33.78±1.44) (P<0.05). The pre-pregnancy BMI in the vaginal delivery group was (22.21 ±2.48) kg/m², and that in the emergency cesarean section group (23.39±2.33) kg/m²; the proportion of high BMI in the emergency cesarean section group was higher than that in the vaginal delivery group (P<0.05). The gestational weight gain in the vaginal delivery group was (15.11±5.18) kg, and that in the emergency cesarean section group (26.59±6.33) kg (P<0.05). The logistic regression analysis showed that older age, lower education level, higher pre-pregnancy BMI, and greater body weight increase during pregnancy were the risk factors of emergency cesarean section. The correlation analysis indicated positive correlation between BMI and emergency cesarean section (r=0.236, P<0.05), and between body weight gain and emergency cesarean section (r=0.710, P<0.05). Conclusions　Preconception BMI and weight during pregnancy were associated with emergency cesarean section. Overweight and obesity before pregnancy are risk factors for emergency cesarean section during pregnancy. Adequate weight management and health education may aid in reducing the risk of emergency cesarean section.

Correlation of TXB2 and S100B in cerebrospinal fluid with prognosis of patients with hypertensive intracerebral hemorrhage

Jia Yuheng, Ai Wenjun

2024, 30(15):  2544-2548.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.016

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Objective　To explore the correlation of thromboxane B2 (TXB2) and S100 calcium binding protein B (S100B) in cerebrospinal fluid with the prognosis of patients with hypertensive intracerebral hemorrhage. Methods　Ninety-six patients with hypertensive intracerebral hemorrhage admitted to Emergency Department, Chang'an Hospital between May 2020 and May 2023 were selected. All the patients underwent minimally invasive hematoma removal surgery. Their medical records were collected. Their levels of TXB2 and S100B in the cerebrospinal fluid were measured 24 hours after surgery. According to their prognosis 28 d after the surgery, they were divided into a good prognosis group and a poor prognosis group. The factors influencing their prognosis were analyzed. The efficacies of TXB2 and S100B in cerebrospinal fluid in the prediction of the patients' prognosis were evaluated. χ² and independent-sample t tests were used. The multivariate logistic stepwise regression model was used to analyze the influencing factors. Results　Twenty-eight days after the surgery, among the 96 patients, 68 (70.83%) had good prognosis, while the remaining 28 (29.17%) had poor prognosis. There were no statistical differences in gender, age, and body mass index between the two groups (all P>0.05). The score of National Institute of Health Stroke Scale (NIHSS) and proportion of the patients with midline shift in the good prognosis group were lower than those in the poor prognosis group [(15.34±2.61) vs. (20.18±3.32), 19.12%(13/68) vs.39.29%(11/28); both P<0.05]. The levels of TXB2 and S100B in cerebrospinal fluid in the good prognosis group were lower than those in the poor prognosis group[(156.04±17.31) ng/L vs. (190.35±18.29) ng/L, (1.72±0.34) μg/L vs. (1.93±0.47) μg/L; both P<0.05]. The score of NIHSS (OR=3.691, 95%CI 1.262-10.799), proportion of the patients midline shift (OR=3.425, 95%CI 1.171-10.019), and TXB2 (OR=5.675, 95%CI 1.939-16.602) and S100B (OR=4.486, 95%CI 1.533-13.125) in cerebrospinal fluid were the risk factors for the patients' prognosis (all P<0.05). The sensitivities of TXB2 and S100B in cerebrospinal fluid and their combination in the prediction of the patients, prognosis were 0.764, 0.727, and 0.799, respectively; the specificities were 0.641, 0.703, and 0.782, respectively; the areas under the curves were 0.731, 0.705, and 0.823, respectively. Conclusion　The changes in TXB2 and S100B in cerebrospinal fluid are related to the prognosis of patients with hypertensive intracerebral hemorrhage, and both indicators have good predictive efficacies for the patients' prognosis.

Value of M-BLI combined with albumin to alkaline phosphatase ratio in diagnosis of esophageal cancer

Yao Fen, Huang Mi, Yang Miaomiao

2024, 30(15):  2549-2552.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.017

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Objective　To analyze the value of magnifying endoscopy combined with blue laser imaging (M-BLI) and the albumin to alkaline phosphatase ratio (AAPR) in the diagnosis of esophageal cancer. Methods　From March 2022 to December 2023, 92 patients suspected with esophageal cancer taking examination at Ankang People's Hospital were selected, including 49 males and 43 females who were (51.27±15.19) years old. All the patients underwent pathological histological examination as the gold standard. Before the pathological examination, the patients underwent conventional white light endoscopy, M-BLI, and blood AAPR test in succession. The accuracy of M-BLI combined with AAPR in the diagnosis of esophageal cancer was evaluated. t test and Kappa test were used. A receiver operating characteristic curve (ROC) was plotted to assess the diagnostic value. Results　Among the 92 patients, 38 (41.30%) were diagnosed with early esophageal cancer, and 54 (58.70%) with non-neoplastic lesions via pathological examination. The positive predictive value, negative predictive value, accuracy, and Kappa value of M-BLI in the diagnosis of esophageal cancer were 78.05%, 88.24%, 83.70%, and 0.668. The AAPR's in the esophageal cancer group and the non-neoplastic lesion group were (0.57±0.14) and (0.69±0.21), respectively, with a statistical difference (t=3.072, P=0.003). The sensitivities of M-BLI, AAPR, and their combination for diagnosing esophageal cancer were 0.84, 0.72, and 0.84, respectively; the specificities were 0.83, 0.79, and 0.85, respectively; the areas under the curves were 0.835 (95%CI 0.770-0.901), 0.795 (95%CI 0.725-0.864), and 0.893 (95%CI 0.843-0.944), respectively. Conclusions　M-BLI combined with AAPR can be used for diagnosing esophageal cancer, with a high diagnostic accuracy.

Color Doppler ultrasound guided balloon dilation for arteriovenous fistula stenosis of patients with uremia taking maintenance hemodialysis

Zhou Mi, Li Jianfeng, Yu Fei

2024, 30(15):  2553-2557.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.018

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Objective　To explore the application value of color Doppler ultrasound (CDFI) guided balloon dilation of arteriovenous fistula (AVF) in the treatment of patients with uremia taking maintenance hemodialysis (MHD). Methods　Five hundred patients with uremia undergoing MHD AVF stenosis at Nanyang First People's Hospital from February 2020 to February 2023 were selected as the study objects, and were divided into an observation group (243 cases) and a control group (257 cases) according the surgical methods. There were 130 males and 113 females in the observation group; they were (49.53±6.23) years old. There were 122 males and 135 females in the control group; they were (50.11±6.98) years old. The observation group underwent CDFI guided AVF balloon dilation, while the control group internal fistula resection and repair. The surgical conditions, internal fistula repair status, oxidative stress indicators [superoxide dismutase (SOD), malondialdehyde (MDA), and myeloperoxidase (MPO)] before and after the dialysis, blood circulation indicators (peak flow rate, internal fistula blood flow volume, and vascular diameter), complications, and internal fistula restenosis 6 months after the dialysis were compared between the two groups. t and χ² tests were applied. Results　The surgery success rate and the patency rate of internal fistula in the observation group were higher than those in the control group [97.94% (238/243) vs. 82.88% (213/257) and 100.00% (243/243) vs. 80.54% (207/257)], with statistical differences (χ²=32.060 and 52.529; both P<0.05). Before the dialysis, there were no statistical differences in the oxidative stress indicators and blood circulation indicators between the two groups (all P>0.05). Three months after the dialysis, the SOD level, internal fistula blood flow volume, and vascular diameter in the observation group were higher than those in the control group [(89.43±9.76) IU/ml vs. (84.53±9.14) IU/ml, (447.54±27.28) ml/min vs. (383.69±25.39) ml/min, and (3.27±0.42) mm vs. (2.48±0.39) mm]; the levels of MDA and MPO and peak flow rate in the observation group were lower than those in the control group [(6.19±0.49) nmol/ml vs. (6.47±0.56) nmol/ml, (39.87±4.92) IU/L vs. (42.18±5.17) IU/L, and (241.64±19.87) cm/s vs. (267.52±20.13) cm/s]; there were statistical differences between the two groups (t=5.797, 27.106, 21.808, 5.936, 5.112, and 14.459; all P<0.05). The incidence of complications and the restenosis rate of internal fistula within 6 months after the dialysis in the observation group were lower than those in the control group [10.29% (25/243) vs. 16.34% (42/257) and 2.88% (7/243) vs. 7.78% (20/257)], with statistical differences (χ²=3.945 and 5.874; both P<0.05). Conclusion　CDFI guided AVF balloon dilation for uremic patients taking MHD can increase the patency rate of internal fistula and surgery success rate, improve their blood circulation, and reduce their oxidative stress response and the risk of postoperative internal fistula restenosis, and is safe.

Sedation effect of remimazolam tosilate in painless gastroenteroscopy

Zhang Xiude, Zhang Qi, Yang Lijing

2024, 30(15):  2558-2563.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.019

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Objective　To explore the sedation effect of remimazolam tosilate for injection in painless gastroenteroscopy. Methods　Four hundred and eight patients undergoing painless gastroenteroscopy in Yanggu County People's Hospital from December 2022 to January 2024 were selected for the randomized controlled trial, with 204 cases in each group. They were divided into a remimazolam tosilate for injection group (group R) and a propofol group (group P) by the random number table method, with 204 cases in each group. There were 113 males and 91 females in group R; they were (37.68±5.33) years old; their body mass index was (22.41±1.57) kg/m²; there were 127 cases of grade Ⅰ and 77 cases of grade Ⅱ of American Society of Anesthesiologists grading. There were 127 males and 77 females in group P; they were (38.09±5.76) years old; their body mass index was (22.56±1.74) kg/m²; there were 130 cases of grade Ⅰ and 74 cases of grade Ⅱ of ASA grading. The success rates, induction times and recovery times of sedation, incidences of hypotension, treated hypotension, and respiratory depression, and hemodynamic parameters [diastolic blood pressure (DBP), systolic blood pressure (SBP), heart rate (HR), blood oxygen saturation (SpO₂), respiratory rate (RR)] at different time points (before the induction and 1, 3, 6, 9, 12, 15, and 20 min after the induction) were compared between the two groups. The satisfaction and adverse reactions were recorded. The analysis of repeated measurement variance, t test, and χ² test were used. Results　The success rates of sedation in the two groups both were 100.00% (204/204). The induction time and recovery time of sedation in group R were shorter than those in group P [(34.19±4.52) s vs. (40.52±5.06) s and (5.72±1.07) min vs. (7.33±1.28) min; t=13.325 and 13.784; both P<0.05]. The incidences of hypotension, treated hypotension, and respiratory depression in group R were lower than those in group P [10.29% (21/204) 22.55% vs. (46/204), 2.94% (6/204) vs. 8.82% (18/204), and 5.39% (11/204) vs. 11.27% (23/204); χ²=11.161, 6.375, and 4.620; all P<0.05]. One, 3, 6, 9, and 12 min after the induction, the SBP, DBP, HR, RR, and SpO₂ decreased first and then increased in both groups, and there were statistical differences between the two groups (all P<0.05). The scores of satisfaction of the patients, anesthesiologists, and endoscopists in group R were higher than those in group P [(8.24±0.76) vs. (6.37±1.16), (8.08±0.82) vs. (6.53±1.37), (8.59±0.60) vs. (7.12±1.24); t=19.259, 13.866, and 15.242; all P<0.05]. The incidence of hypoxemia and total incidence of adverse reactions in group R were lower than those in group P [7.35% (15/204) vs. 18.14% (37/204) and 20.10% (41/204) vs. 31.37%(64/204); χ²=10.667 and 6.784; both P<0.05]. Conclusions　Sedation effect of remimazolam tosilate for injection is significant in painless gastroenteroscopy. It can maintain hemodynamics stability, shorten recovery time, reduce the incidence of adverse reactions (hypotension and hypoxemia), and improve satisfaction.

Effect of Mediterranean diet on patients with cachexia induced by colorectal cancer

Zhou Jingrong, Wang Gang

2024, 30(15):  2563-2569.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.020

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Objective　To explore the effects of Mediterranean diet on the nutritional status, muscle mass and strength, and inflammatory factors in patients with cachexia induced by colorectal cancer. Methods　One hundred and sixty-five patients with cachexia induced by colorectal cancer treated at Lianyungang Second People's Hospital from January 2020 to June 2023 were selected for the randomized controlled trial, and were divided into a control group (83 cases) and an observation group (82 cases) by the random number table method. There were 48 males and 35 females in the control group; they were (62.87±5.56) years old. There were 45 males and 37 females in the observation group; they were (63.36±4.84) years old. The control group took conventional nutritional support, and the observation group Mediterranean diet, for 8 weeks. After the intervention, the muscle mass, grip strengths, body weights, upper arm muscle circumferences, skinfold thicknesses, levels of chloride ion (Cl^-), sodium (Na), potassium (K), prealbumin (PA), albumin (ALB), total protein (TP), C-reactive proteins (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α), and total response rates were compared between the two groups by t and χ² tests. Results　There was no statistical difference in the total response rate between the two groups (χ²=1.652, P=0.199). After the intervention, the electrolyte test indicators, nutritional indicators, inflammatory factors, muscle mass, grip strength, body weight, upper arm muscle circumference, and skinfold thickness were better than those before the intervention in both groups (all P<0.05). After the intervention, the total body fat mass, total body muscle mass, trunk muscle mass, and trunk fat mass in the observation group were (44.36±2.06) kg, (14.46±2.65) kg, (26.85±3.11) kg, and (12.32±3.62) kg, which were higher than those in the control group (t=2.317, 2.689, 2.787, and 2.337; all P<0.05); the grip strength, body weight, upper arm muscle circumference, skinfold thickness, and levels of Cl^-, Na, K, TP, ALB, PA, CRP, IL-6, and TNF-α in the observation group were (267.84±8.45) N, (65.58±4.65) kg, (24.58±3.32) cm, (14.87±2.33) mm, (102.63±5.51) mmol/L, (139.85±7.52) mmol/L, (0.48±0.13) mmol/L, (68.97±4.62) g/L, (38.89±4.63) g/L, (215.65±13.32) g/L, (18.75±3.31) mg/L, (15.65±2.31) ng/L, and (20.12±2.86) ng/L, which were better than those in the control group (t=4.327, 3.309, 2.559, 3.285, 8.404, 8.668, 2.870, 6.547, 5.566, 4.430, 15.173, 14.300, and 19.883; all P<0.05). Conclusion　Mediterranean diet for patients with cachexia caused by colorectal cancer is effective, and can maintain their body needs, improve their nutritional status and muscle strength and quality, and reduce the levels of inflammatory factors, so it is worthy of promotion.

Compstatin for patients with diabetic retinopathy

Wang Bing, Su Anle, Zhu Hongna, Lu Huiqin, Qu Xiaoyu

2024, 30(15):  2569-2574.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.021

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Objective　To explore the influence of compstatin on the serum levels of human monocyte chemoattractant protein-1 (MCP-1) and placental growth factor (PlGF) in patients with diabetic retinopathy(DR). Methods　A prospective clinical study was conducted. One hundred and ninety-three patients with DR treated at Xi'an First Hospital from May 2020 to August 2022 were selected as the study objects. All the patients were treated with compstatin injection. One month after the treatment, the clinical efficacy was evaluated; the patients were categorized into a poor efficacy group (27 cases) and a good efficacy group (166 cases). There were 15 men and 12 women in the poor efficacy group; they were (53.14±9.45) years old; their DR course was (12.63±2.89) years. There were 86 men and 80 women in the good efficacy group; they were (51.86±9.72) years old; their DR course was (10.82±3.51) years. The clinical data and serum levels of MCP-1 and PlGF were compared between the two groups. The logistic regression was used to analyze the risk factors of the effect of compstatin injection for the patients with DR and to assess the efficacy of serum MCP-1 and PlGF in the prediction of the treatment effect. t and χ² tests were applied. Results　The diabetes mellitus duration and levels of glycosylated hemoglobin (HbA1c), vascular endothelial growth factor (VEGF), MCP-1, and PIGF in the poor efficacy group were higher those in the good efficacy group [(12.63±2.89) years vs. (10.82±3.51) years, (9.03±0.81)% vs. (8.52±0.94)%, (102.47±21.57) ng/L vs. (89.65±20.18) ng/L, (906.49±83.52) ng/L vs. (684.53±70.42) ng/L, and (75.83±9.25) ng/L vs. (62.01±8.43) ng/L], with statistical differences (t=2.541, 2.662, 3.032, 14.786, and 7.793; all P<0.05). The multifactorial regression analysis showed that HbA1C, VEGF, MCP-1, and PlGF were risk factors affecting the treatment effect of compstatin injection for the patients with DR (all P<0.05). The receiver operating characteristics curve analysis revealed that the areas under the curves of MCP-1, PIGF, and their combination in the prediction of the treatment effect of compstatin injection for the patients with DR were 0.833, 0.811, and 0.909, respectively. Conclusion　The combination of serum MCP-1 and PIGF is effective in predicting the therapeutic effect of compstatin injection for patients with DR.

Relationship between cricoid-mental distance based on external neck landmarks and laryngeal mask size selection

Liu Baoyun, Huang Haoxian, Huang Minzhen, Sheng Hengwei

2024, 30(15):  2574-2578.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.022

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Objective　To explore a new method for selecting laryngeal mask sizes measuring the cricoid-mental distance (CMD) based on external neck landmarks. Methods　This was prospective study. Ninety-eight patients undergoing selective surgery under general anesthesia with classic laryngeal masks at Sanshui District People's Hospital from November 2019 to October 2020 were selected, and 4 cases cancelled the surgery because of their personal reasons. Ninety-four patients were included, including 36 males and 58 females who were 18-65 years old. During the preoperative visit, their gender, age, height, body weight, modified Mallampati classification, and degree of mouth opening were recorded. The CMD was measured before the anesthesia. The patients with successful laryngeal mask insertion were grouped according to the laryngeal mask sizes. The general data and CMD were compared between the three groups. The logistic regression analysis was used to identify the factors influencing laryngeal mask size selection. The analysis of variance and χ² test were applied. Results　There were statistical differences in age, body weight, and CMD between the patients using 3 different laryngeal mask sizes [(37.75±9.05) years vs. (33.62±11.98) years vs. (29.11±9.80) years, (46.74±3.58) kg vs. (57.26±6.52) kg vs. (70.86±10.61) kg, and (7.85±0.83) cm vs. (9.34±0.74) cm vs. (11.64±0.65) cm; F=7.643, 51.126, and 156.135; all P<0.05]. The logistic regression analysis revealed correlation of laryngeal mask size selection with weight and CMD (both P<0.05). The 95% confidence intervals for CMD of the three laryngeal mask sizes were as below: laryngeal mask 3's CMD 6.19-9.51 cm (17.02%, 16 cases); laryngeal mask 4's CMD 7.87-10.81 cm (53.19%, 50 cases); laryngeal mask 5's CMD 10.34-12.94 cm (29.79%, 28 cases). Conclusions　CMD can serve as an indicator for selecting laryngeal mask sizes. If the CMD is 7.87～10.81 cm, laryngeal mask 4 is recommended; CMD <7.87 cm, laryngeal mask 3; CMD >10.81 cm, laryngeal mask 5.

Different doses of nafamostat mesilate for patients taking hemodialysis

Quan Xing, Xiao Qian, Song Li, Quan Zilin, Yin Yan, Feng Zhonglin

2024, 30(15):  2579-2584.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.023

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Objective　To explore the anticoagulant effect and safety of different dosages of nafamostat mesylate for patients taking hemodialysis. Methods　According to the dosages of nafamostat mesylate, the patients were divided into a 10 mg/h nafamostat mesilate group (33 cases), including 23 males and 10 females who were (58.8±16.0) years old, and a 20 mg/h nafamostat mesilate group (32 cases), including 17 males and 15 females who were (62.6±15.7) years old. All the patients took hemodialysis for 4 h per time, 3 times per week. The data were compared between the two groups by independent-sample t test or non-parameter test. The rates of venous clotting, artery clotting, and cumulative catheter blockage were compared between the two groups by Kaplan-Meier survival analysis and log-rank test. Results　A total of 65 patients undergoing maintenance dialysis were included; they underwent 178 case times of nafamostat mesilate anticoagulation, including 87 case times in the 10 mg/h nafamostat mesilate group and 91 case times in the 20 mg/h nafamostat mesilate group. There were no statistical differences in gender, age, body weight, height, coronary heart disease, diabetes mellitus, bleeding causes, and laboratory indicators between the two groups (P>0.05). More patients had venous clotting score of 3 in the 10 mg/h nafamostat mesilate group than in the 20 mg/h nafamostat mesilate group [6.9% (6/87) vs. 3.3% (3/91)], with a statistical difference (P<0.05). The treatment time in the 20 mg/h nafamostat mesilate group was longer than that in the 10 mg/h nafamostat mesilate group [(225.0±21.3) min vs. (217.0±18.1) min], with a statistical difference (t=-2.587; P<0.05). The pre-dialysis transmembrane pressure and arterial pressure in the 20 mg/h nafamostat mesilate group were significantly lower than those in the 10 mg/h nafamostat mesilate group [(57.0±43.4) mmHg (1 mmHg=0.133 kPa) vs. (77.3±31.2) mmHg and (-82.3±28.9) mmHg vs. (-71.1±29.4) mmHg], with statistical differences (t=3.488 and 2.448; both P<0.05). The survival analysis showed that there was no statistical difference in the catheter blockage rate between the two groups (P>0.05). After anticoagulation with nafamostat mesilate, 2 cases (3.1%) experienced aggravated bleeding in the 65 patients. Conclusion　Anticoagulation with nafamostat mesilate in standard hemodialysis treatment has a low incidence of venous clotting occlusion and minor bleeding risk. The 20 mg/h dosage of nafamostat mesilate exhibits better effectiveness, can reduce the rate of venous clotting and offer a new anticoagulation method for patients taking maintenance dialysis at high risk of bleeding.

Expression of T lymphocyte subsets and IL-6 in patients with gastric cancer and their correlation with prognosis

Zhou Guangting, Wang Gang

2024, 30(15):  2585-2589.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.024

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Objective　To analyze the expression of peripheral blood T lymphocyte subsets and interleukin-6 (IL-6) in patients with gastric cancer, and to explore their correlation with prognosis. Methods　A total of 106 patients with gastric cancer treated at Lianyungang Second People's Hospital from June 2021 to June 2023 were selected as an experimental group, and their peripheral blood T lymphocyte subsets (CD3⁺, CD4⁺, and CD8⁺) and IL-6 levels were detected the day after they were admitted to the hospital. Eighty healthy people who came to the hospital for physical examination at the same time were selected as a control group, and their peripheral blood T lymphocyte subsets and IL-6 levels were detected on the day of physical examination. The T lymphocyte subsets and IL-6 levels were compared between the two groups. The patients were followed up 6 months after discharge, and were divided into a poor prognosis group (17 cases) and a good prognosis group (89 cases) according to death and survival. There were 10 males (58.82%) and 7 females (41.18%) in the poor prognosis group; they were (60.47±5.89) years old; 9 cases' (52.94%) education level was middle school or above, and 8 cases' (47.06%) below middle school. In the good prognosis group, there were 55 males (61.80%) and 34 females (38.20%); they were (60.08±5.71) years old; 32 cases' (35.96%) education level was middle school or above, and 57 cases' (64.04%) below middle school. The logistic regression analysis was done for the prognostic factors in the patients. The receiver operating characteristic curves (ROC) were drawn to evaluate the values of peripheral blood T lymphocyte subsets and IL-6 in the prediction of the patients' prognosis. t and χ² were applied. Results　The levels of CD3⁺ and CD4⁺ in the experimental group were lower than those in the control group [(55.27±8.72)% vs. (68.97±6.45)% and (26.42±10.21)% vs. (38.12±5.07)%]; the levels of CD8⁺ and IL-6 in the experimental group were higher than those in the control group [(33.36±6.02)% vs. (24.66±3.75)% and (6.97±3.29) ng/L vs. (3.62±1.01) ng/L]; there were statistical differences (t=-11.821, -9.413, 11.360, and 8.803; all P<0.05). The levels of CD3⁺ and CD4⁺ in the poor prognosis group were lower than those in the good prognosis group [(45.12±10.06)% vs. (57.21±6.97)% and (20.01±10.12)% vs. (27.64±9.81)%]; the levels of CD8⁺ and IL-6 and the proportion of the patients of tumor stage Ⅳ in the poor prognosis group were higher than those in the good prognosis group [(40.12±6.01)% vs. (32.07±5.12)%, (9.75±3.16) ng/L vs. (6.44±3.05) ng/L, and 70.59% (12/17) vs. 32.58% (29/89)]; there were statistical differences (t=-6.068, -2.924, 5.774, and 4.077; χ²=8.692; all P<0.05). The logistic regression analysis showed that tumor stage and CD3⁺, CD8⁺, and IL-6 levels were the factors influencing the patients' prognosis (all P<0.05). The areas under the ROC's of CD3⁺, CD8⁺, and IL-6 for predicting the patients' adverse prognosis were 0.847, 0.853, and 0.768, respectively. Conclusions　In patients with gastric cancer, the levels of CD3⁺ and CD4⁺ are low, and the levels of CD8 ⁺ and IL-6 are high. The levels of CD3⁺, CD8⁺, and IL-6 affect the prognosis of patients with gastric cancer.

Effect of Kangfuxin Solution combined with Jinhuang Paste on wound healing and anal function in patients with mixed hemorrhoids after operation

Liu Zhi, Xu Xiulan

2024, 30(15):  2590-2594.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.025

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Objective　To investigate the effect of Kangfuxin Solution combined with Jinhuang Paste on wound healing and anal function in patients with mixed hemorrhoids after surgery. Methods　Ninety-six patients with mixed hemorrhoids who received surgical treatment at Lianxi District Hospital of Traditional Chinese Medicine from March 2023 to March 2024 were selected for the randomized controlled trial, and were divided into a control group and a treatment group by drawing lots, with 48 cases in each group. There were 26 males and 22 females in the control group; they were (42.52±4.62) years old; their disease course was (7.57±1.15) years; their wound area was (3.11±0.86) cm². There were 27 males and 21 females in the treatment group; they were (42.88±4.70) years old; their disease course was (7.63±1.30) years; their wound area was (3.30±0.75) cm². The control group received conventional treatment after the operation; in addition, the treatment group were treated with Kangfuxin Solution and Jinhuang Paste; both groups were treated for 7 days. The degrees of postoperative wound pain, wound healing, inflammation indicators, and anal function were compared between the two groups. The measurement data of normal distribution were tested by t test. The count data were tested by χ² test. Results　After the treatment, the score of Visual Analogue Scale in the treatment group was lower than that in the control group [(2.54±0.85) vs. (3.97±0.97)], with a statistical difference (t=7.682; P<0.001). The time for disappearance of wound edema, the time of granulation formation and wound flatness, and the time of wound healing in the treatment group were shorter than those in the control group [(5.11±1.12) d vs. (6.78±1.30) d, (11.25±1.85) d vs. (14.25±1.65) d, and (16.35±2.87) d vs. (20.84±2.98) d], with statistical differences (t=6.743, 8.385, and 7.519; all P<0.05). After the treatment, the levels of interleukin 6 and C-reactive protein in the treatment group were lower than those in the control group [(12.01±1.55) ng/L vs. (16.58±2.14) ng/L and (9.25±1.02) mg/L vs. (13.52±2.14) mg/L]; the anal canal resting pressure, maximum anal systolic pressure, and anal diastolic pressure in the treatment group were higher than those in control group [(55.85±5.87) mmHg vs. (50.24±4.97) mmHg (1 mmHg=0.133 kPa), (122.25±13.65) mmHg vs. (115.69±12.24) mmHg, and (93.52±16.35) mmHg vs. (86.24±15.42) mmHg], with statistical differences (t=11.982, 12.479, 5.053, 2.479, and 2.242; all P<0.05). Conclusion　Kangfuxin Solution and Jinhuang Paste for patients with mixed hemorrhoids can alleviate their postoperative wound pain, promote their wound healing, reduce inflammatory response, and improve their anal function.

Case Report

Resection of one case of large pelvic abdominal mass and perioperative thinking

Xu Yanting, Zhang Xiaonan

2024, 30(15):  2595-2597.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.026

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Pelvic abdominal mass comes from various sources, and is difficult to diagnose before operation. Giant mass compresses the surrounding organs, and easily leads to ischemia and reperfusion injury. This article reports a recent successful case of large pelvic abdominal mass (22.5 kg) in Weihai Central Hospital, Qingdao University and does the perioperative thinking.

One child with Burkitt leukemia and onset of extensive bone marrow necrosis and review of literatures

Ding Hui, Guo Qingwei, Li Fu, Yang Xiaomei

2024, 30(15):  2598-2601.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.027.

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Burkitt lymphoma most commonly occurs in the abdomen, followed by the head and neck. It is defined as Burkitt leukemia when bone marrow tumor cells exceed 25%, but it is rare to start with extensive bone marrow necrosis (BMN) and difficult to diagnose. In this paper, the clinical features, diagnosis, treatment, and prognosis of a child with Burkitt leukemia complicated with extensive BMN are retrospectively analyzed, and the relevant literatures are summarized.

Nursing Research

Impact of different risk level nursing mode based on score of modified early warning scoring system on patients with severe pneumonia

Jin Yuan, Hou Yukun, Song Dan

2024, 30(15):  2602-2606.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.028

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Objective　To explore and analyze the impact of different risk level nursing mode based on the score of modified early warning scoring system (MEWS) on patients with severe pneumonia. Methods　A total of 80 patients with severe pneumonia treated at Lianyungang First People's Hospital from May 2020 to May 2023 were selected by the simple random sampling method. They were divided into a control group and a treatment group by computer random numbering, with 40 cases in each group. There were 25 men and 15 women in the control group; they were 28-59 (48.45 ± 6.75) years old; their disease course was 5-13 (8.25±2.02) d; they adopted routine clinical nursing intervention. There were 23 men and 17 women in the treatment group; they were 27-60 (48.18 ± 6.54) years old; their disease course was 6-15 (8.30±2.18) d; they were intervened by the different risk level nursing mode based on the MEWS score. The next day after admission and one day before discharge, the levels of pulmonary function, the effects of symptom improvement, and incidences of complications were analyzed and compared between the two groups by χ² and t tests. Results　After the intervention, the forced expiratory volume in the first second (FEV₁), forced lung volume (FVC), and FEV₁/FVC in the treatment group were significantly higher than those in the control group [(2.12±0.45) L vs. (1.81±0.40) L, (2.55±0.51) L vs. (2.30±0.45) L, and (83.14±6.14)% vs. (78.69±6.65)%], with statistical differences (t=3.26, 2.33, and 3.11; P<0.05). The fever remission time, time for disappearance of rales, cough duration, and running nose duration in the treatment group were shorter than those in the control group [(4.36±1.25) d vs. (5.14±1.45) d, (6.85±1.20) d vs. (8.74±1.15) d, (9.74±1.96) d vs. (12.11±2.38) d, and (7.11±1.30) d vs. (8.45±1.28) d], with statistical differences (t=2.58, 7.19, 4.86, and 4.65; all P<0.05). The total incidence of complications in the treatment group were lower than that in the control group [2.50% (1/40) vs. 20.00% (8/40)], with a statistical difference (χ²=4.51, P<0.05). Conclusion　The application of different risk level nursing mode based on MEWS score in patients with severe pneumonia is effective, and can improve their lung function, reduce the risk of complications, and shorten the duration of clinical symptoms.

Multidisciplinary collaborative tiered emergency nursing care for patients with cardiac arrest caused by arrhythmias

Lei Yali, Li Man, Liu Xiaorong, Zhao Xirong

2024, 30(15):  2606-2612.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.029

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Objective　To explore the application of multidisciplinary collaborative tiered emergency nursing care in patients with cardiac arrest caused by arrhythmias. Methods　A prospective study design was used. Ninety-six patients with cardiac arrest caused by arrhythmias treated at Xi'an Hospital of Traditional Chinese Medicine from January 2021 to December 2022 were selected. The patients were divided into a control group and an experimental group according to the time of admission, with 48 patients in each group. The control group included 24 males and 24 females; they were (58.35±7.78) years old; primary diseases: there were 20 cases of coronary heart disease, 10 cases of myocarditis, 8 cases of hypertensive heart disease, 6 cases of valvular heart disease, and 4 cases of myocardial infarction. The experimental group included 23 males and 25 females; they were (58.47±7.82) years old; primary diseases: there were 21 cases of coronary heart disease, 9 cases of myocarditis, 9 cases of hypertensive heart disease, 5 cases of valvular heart disease, and 4 cases of myocardial infarction. The control group received conventional emergency nursing care, while the experimental group received multidisciplinary collaborative tiered emergency nursing care. Both groups were intervened until the patients were discharged. The recovery times of vital signs (spontaneous breathing, sinus rhythm, and autonomous circulation), rescue success rates, hospital stays, and scores of Glasgow Coma Scale (GCS), Simplified Chinese version of Depression-Anxiety-Stress Scale-21 (DASS-21), and General Quality of Life Inventory-74 (GQOLI-74) were compared between the two groups. t and χ² tests were applied. Results　The recovery times for spontaneous breathing, sinus rhythm, and autonomous circulation in the experimental group were shorter than those in the control group [(56.27±16.48) h vs. (108.67±27.84) h, (2.24±0.69) d vs. (5.68±1.34) d, and (42.87±13.68) h vs. (129.56±36.37) h], with statistical differences (t=11.22, 15.81, and 15.46; all P<0.05). The rescue success rate and score of GCS after the intervention in the experimental group were higher than those in the control group [93.75% (45/48) vs. 79.17% (38/48) and (7.74±0.91) vs. (5.37±0.76)]; the hospital stay in the experimental group was shorter than that in the control group [(10.96±2.13) d vs. (15.68±3.24) d]; there were statistical differences (χ²=4.36; t=13.85 and 8.43; all P<0.05). The scores of stress, depression, and anxiety after the intervention in the experimental group were lower than those in the control group [(6.86±1.21) vs. (9.37±1.34), (4.57±1.27) vs. (6.15±1.37), and (6.38±1.67) vs. (9.57±2.16)], with statistical differences (t=9.63, 5.86, and 8.10; all P<0.05). The scores of physical function, social function, material living conditions, and psychological function after intervention in the experimental group were higher than those in the control group, with statistical differences (t=11.40, 11.52, 9.76, and 8.93; all P<0.05). Conclusion　Multidisciplinary collaborative tiered emergency nursing care for patients with cardiac arrest caused by arrhythmias can significantly improve the rescue success rate, shorten the recovery times of vital signs, reduce hospital stay, alleviate their negative emotions, improve their GCS scores and quality of life, and provide effective practical guidance for the emergency nursing care for patients with cardiac arrest caused by arrhythmias.

Efficacy of time-care respiratory training combined with sputum evacuation management for patients with lung cancer after surgery

Feng Jinge, Fan Qiaohong

2024, 30(15):  2612-2616.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.030

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Objective　To analyze the efficacy of time-care respiratory training and sputum evacuation management for patients with lung cancer after surgery. Methods　One hundred and twenty patients with lung cancer surgically treated at Xianyang Central Hospital from January 2020 to January 2023 were selected as the observation objects. The 60 patients who took routine care from January 2020 to June 2022 were set as a control group, and the 60 patients who took time-care respiratory training and sputum expectoration management from February 2022 to January 2023 were set as an observation group. In the control group, there were 45 males and 15 females; they were (65.39±6.25) years old; their body mass index (BMI) was (23.54±2.15) kg/m².In the observation group, there were 43 males and 17 females; they were (65.85±5.48) years old; their BMI was (23.68±2.24) kg/m². The 6-minute walking test (6MWT) and Quality of Life Scale for Lung Cancer Patients (QLQ-C30) were used to evaluate their walking ability and quality of life. The pulmonary function indicators and sputum evacuation abilities were compared between the two groups by t and χ² tests. Results　After the intervention, the 6MWT and sputum evacuation volume in the observation group were higher than those in the control group [(5.38±0.59) m vs. (4.96±0.85) m and (52.69±5.12) ml vs. (50.26±5.36) ml]; the cough time in the observation group was shorter than that in the control group [(2.96±0.45) d vs. (3.21±0.56) d]; there were statistical differences (t=3.14, 2.54, and 2.70; all P<0.05). The tidal volume, vital capacity, functional residual capacity, and total lung capacity in the observation group were higher than those in the control group [(0.52±0.08) L vs. (0.48±0.11) L, (3.38±0.31) L vs. (3.21±0.21) L, (2.26±0.26) L vs. (2.15±0.28) L, and (5.21±0.56) L vs. (4.86±0.57) L], with statistical differences (t=2.28, 3.55, 2.23, and 3.39; all P<0.05). The scores of lung cancer questions, body function, emotion function, contact/social function, and functional status in the observation group were higher than those in the control group [(72.59±3.48) vs. (70.48±3.59), (72.58±3.59) vs. (70.58±3.56), (75.63±5.45) vs. (73.58±5.48), (72.59±3.59) vs. (70.59±3.57), and (73.69±2.57) vs. (72.48±2.48)], with statistical differences (t=3.27, 3.06, 2.06, 3.06, and 2.62; all P<0.05). Conclusion　Time-care respiratory training combined with sputum evacuation management for patients with lung cancer after surgery can improve their lung function, walking, sputum evacuation ability, and quality of life.

Nursing and literature analysis of a patient with multisystem organ failure undergoing emergency carotid endarterectomy after intravenous thrombolysis

Zhang Chun, Chen Min, Zhao Jun, Li Qian, Zhao Chang, Fang Yan, Chen Jing, Wang Zhizhong

2024, 30(15):  2617-2621.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.031

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This study provides an in-depth analysis of the integrated care for a patient undergoing urgent carotid endarterectomy after intravenous thrombolytic therapy and complicated by multisystem failure. Through the detailed preoperative assessment and the implementation of specialized nursing measures, such as cardiac complication management, respiratory support technology, prevention of pulmonary infection, regulation of blood pressure and cerebral perfusion pressure, wound and bleeding control, sedation and analgesic strategies, nutritional support and follow-up management, etc., the importance and effectiveness of comprehensive specialty nursing in the treatment of high-risk CEA patients were highlighted, and the latest progress and research trends of current CEA nursing were discussed in combination with relevant literature analysis. Through a comprehensive analysis of the relevant literatures, this paper not only summarizes the nursing experience of this case, but also deeply discusses the key issues and future research directions in nursing practice, so as to improve the understanding of the care strategies of such high-risk patients and provide references for clinical nursing practice.

Construction of nutritional nursing quality evaluation system for patients at department of gastroenterology

Ma Yan, Wang Ling, Song Yuling

2024, 30(15):  2622-2627.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.032

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Objective　To construct a nutritional nursing quality evaluation system for patients at department of gastroenterology by the 3D quality structure mode, and to provide some standardized and guiding references for improving nutritional nursing quality. Methods　The databases of the European Society for Endenteric Nutrition, the China Guide Network, the American Society for Endenteric Nutrition, CNKI, Wanfang, VIP, and JBI were systematically searched. The literatures were systematically screened and evaluated, and the comprehensive evidences were obtained. Combined with the actual situation of the patients in Department of Gastroenterology, Ansai District People's Hospital, the initial nutritional nursing quality questionnaire was made. The Delphi method was used to carry out 2 rounds of correspondence on 27 experts from Beijing, Shanghai, Guangzhou, and Zhengzhou. All the experts were female. They were (47.28±5.79) years old. The experts' degree of authority was expressed by the authority coefficient. The experts' coordination degree was described by coefficient of variation and Kendall's concordance coefficient. The importance of each index was clarified. The weight level of each item was established by the analytic hierarchy process. Results　The judgment coefficient of the first round expert correspondence was 0.97; the degree of familiarity with the research content was 0.89; the degree of authority was 0.93. The judgment coefficient of the second round was 0.89; the degree of familiarity with the research content was 0.87; the degree of authority was 0.88. Finally, 3 primary indicators (construction indicators, process indicators, and outcome indicators), 6 secondary indicators (environment and equipment, human resource, clinical service, nutritional nursing procedure, risk management, and service results), and 21 tertiary indicators were formed. Conclusions　It is scientific to construct the nutritional nursing quality evaluation system for patients at department of gastroenterology. It can reflect the clinical nursing needs and provide reference basis for improving nursing quality, and have guiding effect on continuously improving the nursing quality of department of gastroenterology.

Effect of traditional Chinese medicine fumigation combined with moxibustion after surgery for patients with mixed hemorrhoids

Li Danyao, Xiong Dan, Chen Yanping, Hu Xiaoyang

2024, 30(15):  2627-2631.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.033

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Objective　To analyze the effect of traditional Chinese medicine fumigation combined with moxibustion after surgery for patients with mixed hemorrhoids. Methods　Sixty-eight patients with mixed hemorrhoids who underwent surgical treatment in Second Hospital, Jiangxi University of Traditional Chinese Medicine from January 2022 to May 2023 were selected for the randomized controlled trial, and were divided into a control group and an observation group by the random number table method, with 34 cases in each group. There were 18 males and 16 females in the observation group; they were (42.01±6.19) years old; their disease course was (3.28±1.13) years; their body weight was (60.29±6.32) kg. There were 20 males and 14 females in the control group; they were (45.05±6.14) years old; their disease course was (3.35±1.05) years; their body weight was (60.31±6.21) kg. The control group received routine nursing care; in addition, the observation group received traditional Chinese medicine fumigation and moxibustion; both groups received continuous intervention for 7 d. The postoperative recovery, anal edema degrees, anal pain degrees [Visual Analogue Scale (VAS)], quality of life [Generic Quality of Life Inventory (GQOLI-74)], incidences of complications, and nursing satisfaction were compared between the two groups. t and χ² tests were used. Results　The times for the disappearance of swollen anus and secretion and wound-healed time in the observation group were shorter than those in the control group [(4.73±0.53) d vs. (5.68±0.85) d, (6.02±1.25) d vs. (7.89±1.54) d, and (14.58±2.68) d vs. (17.89±2.62) d; t=5.530, 5.497, and 5.150; all P<0.001]. After the intervention, the scores of anal edema and VAS in the observation group were lower than those in the control group [(1.23 ±0.15) vs. (1.62 ±0.16) and (2.16±0.28) vs. (2.69±0.46); t=10.369 and 5.739; both P<0.001]. After the intervention, the scores of body function, psychological function, social function, and material life in the observation group were lower than those in the control group [(83.23 ±2.15) vs. (78.62 ±2.16), (84.16±2.28) vs. (79.69±2.46), (84.16±2.46) vs. (78.69±2.53), and (84.16±2.98) vs. (78.69±2.52); t=8.820, 7.771, 9.039, and 8.173; all P<0.001]. The total incidence of complications in the observation group was lower than that in the control group [5.88% (2/34) vs. 29.41% (10/34); χ²=6.476; P<0.05]. The scores of nurse-patient communication, operation level, ward environment, and patients' feeling in the observation group were higher than those in the control group [(21.86±3.21) vs. (17.77±2.35), (21.56±2.36) vs. (18.33±2.38), (22.65±2.45) vs. (20.73±2.36), and (22.12±2.32) vs. (19.73±2.38); t=5.995, 5.619, 3.291, and 4.193; all P<0.001]. Conclusion　Traditional Chinese medicine fumigation combined with moxibustion after surgery for patients with mixed hemorrhoid can shorten their wound-healed time, reduce their anal edema and pain and the risk of complications, and improve their nursing satisfaction and quality of life.

Effect of objective structured clinical examination in training of nurses taking continued education for blood purification

Mai Jianling, Ma Shu'e, Wu Cuicui, Gui Ping, Zhang Wenchao, Yang Min, Fang Kunyang

2024, 30(15):  2632-2636.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.034

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Objective　To explore the effect of objective structured clinical examination (OSCE) in the training of nurses taking continued education for blood purification, to improve their clinical ability, and to promote the reform of the training mode of clinical specialized nurses. Methods　One hundred and seven nurses taking continued education for blood purification at General Hospital, Guangdong Hospital of Traditional Chinese Medicine from October 2016 to October 2022 were selected as the study objects. The 54 nurses taking the education from October 2016 to October 2019 were set as a control group, and the 53 nurses from November 2019 to October 2022 an observation group. There were 3 males and 51 females in the control group; they were (32.21±5.19) years old. There were 1 male and 52 females in the observation group; they were (32.34±5.33) years old. The control group adopted the traditional conventional teaching and assessment mode, and the observation group the OSCE mode. The comprehensive ability and satisfaction with the training effect were compared between the two groups. t and χ² tests were applied. Results　There were no statistical differences in the scores of comprehensive ability between the two groups before the training (all P>0.05). After the training, the scores of critical thinking, practical ability, nurse-patient communication, health education, and emergency response ability and total score in the observation group were higher than those in the control group [(18.27±0.39) vs. (17.55±0.31), (18.30±0.43) vs. (17.52±0.30), (18.23±0.76) vs. (17.13±0.92), (14.08±0.73) vs. (13.38±0.99), (14.08±0.83) vs. (13.42±0.97), and (89.64±1.71) vs. (87.89±1.55)], with statistical differences between the two groups (t=9.475, 10.954, 7.015, 4.284, 4.089, and 5.650; all P<0.05). The satisfaction with the training effect of the observation group was higher than that of the control group [92.45% (49/53) vs. 77.78% (42/54)], with a statistical difference (χ²=4.530; P=0.033). Conclusion　The scientific application of OSCE training and assessment mode in nurses taking continued education for blood purification can improve their comprehensive quality and satisfaction with teaching, so as to achieve better teaching effect.

Frailty of elderly inpatients with pancreatic tumors and associated factors

Zhang Miao, Liu Jingjing, Zhang Min, Wei Xiaoyan

2024, 30(15):  2636-2640.  DOI: 10.3760/cma.j.issn.1007-1245.2024.15.035

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Objective　To investigate the conditions of frailty in elderly inpatients with pancreatic tumors, to collect their general information and pertinent laboratory indicators, to analyze the correlation between these factors and the occurrence of frailty, to assess the influencing factors of frailty in the patients, and to provide references for healthcare professionals in screening and treating frailty. Methods　Two hundred and fifteen elderly inpatients with pancreatic tumors who were ≥ 60 years old and and treated at First Ward Division, Department of Pancreatic Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University from January to October 2023 were selected for the case-control study. They were divided into a frail group and a non-frail group using a general information questionnaire and the questionnaire of Vulnerable Elders Survey-13 (VES-13). The clinical data and information were compared between the two groups. Data processing and analysis were performed using SPSS 22.0. The measurement data were expressed as median and interquartile range, and compared between the two groups using the Mann Whitney test. The count data were expressed as frequency and percentage, and compared between the two groups using the χ² test. Single-factor analysis was done. The factors with statistical differences in the single-factor analysis were selected for the binary multivariate logistic regression analysis. Results　This study included 215 patients, comprising 126 males and 89 females, with an age of (68.53±5.96) years. The incidence of frailty was 84.65% (182/215). There were no statistical differences between the two groups in gender, age, education level, special diseases, special medication status, food intake reduction in the past week, and history of chemotherapy or radiotherapy (all P>0.05). There were statistical differences in body mass index (BMI) , hemoglobin level, red blood cell count, immunoglobulin A (IgA) level, and D-dimer level between the two groups (all P<0.05). Low BMI (OR=0.176, 95%CI 0.086-0.361) and elevated IgA level (OR=1.839, 95%CI 1.094-3.091) were the independent risk factors for frailty in the inpatients (both P<0.05). Conclusions　The incidence of frailty in elderly inpatients with pancreatic tumors is high. Compared to non-frail elderly pancreatic tumor patients, the frail patients have lower BMI, hemoglobin, and red blood cell count and higher levels of IgA and D-dimer. BMI and IgA are independent risk factors for frailty. Healthcare professionals should proactively assess and screen for pertinent influencing factors, and intervene promptly against the risk factors.