Table of Content

15 August 2024, Volume 30 Issue 16

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Special Column of Tuberculosis

Preliminary analysis of immune status and main organ function in patients with pulmonary tuberculosis after liver transplantation

Fu Hongmei, Yu Zhaoxian, Wang Juan, Li Chunyan, Tan Yigang, Cen Ying, Li Hua, Liu Zhihui

2024, 30(16):  2641-2645.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.001

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Objective　To explore the clinical characteristics of immune status and organ function in patients with pulmonary tuberculosis after liver transplantation compared with common pulmonary tuberculosis patients, and to provide scientific basis for regulating the clinical diagnosis and treatment of anti-tuberculosis. Methods　The data of inpatients in Guangzhou Chest Hospital from 2014 to 2023 were retrospectively collected. A total of 24 inpatients with pulmonary tuberculosis after liver transplantation were selected as the study group, and 31 inpatients with pulmonary tuberculosis without organ transplantation were selected as the control group. The study group were all male, and the age ranged from 37 to 75 years old, with an average age of 57 years old. The control group were all male, and the age ranged from 32 to 75 years old, with an average age of 57 years old. The data of their first test results of blood routine test, inflammatory markers, liver function, kidney function, heart function, lymphocyte subsets, and other laboratory test results were collected and compared between the two groups. The abnormal proportions of the above indicators and various types of white blood cells and platelet count were compared between the two groups. χ² test and rank sum test were used. Results　The abnormal rates of leukocytes, lymphocytes, platelets, hemoglobin, γ-glutamyltranspeptidase, creatinine, cystatin C, creatine kinase, B-type natriuretic peptide precursor, and CD3⁺, CD4⁺, and CD8⁺ lymphocyte subsets in the study group were higher than those in the control group (all P<0.05). The lymphocyte-leukocyte ratio [0.13 (0.09, 0.17)] and lymphocyte-neutrophil ratio [0.17 (0.12, 0.25)] in the study group were lower than those in the control group [0.18 (0.12, 0.21) and 0.26 (0.15, 0.33)], and the monocyte-lymphocyte ratio [0.59 (0.49, 0.96)] was higher than that in the control group [0.40 (0.33, 0.63)] (all P<0.05). Conclusion　The impaired function of major organs including liver, kidney, and heart and hypoimmunity in patients with pulmonary tuberculosis after liver transplantation are very common, which must be paid close attention to in the process of clinical treatment.

Analysis of clinical features of Nocardia infection with suspected pulmonary tuberculosis

Tan Yigang, Luo Chunming, Cai Xingshan, Li Chunyan, Wang Min, Zheng Minli, Liu Zhihui

2024, 30(16):  2645-2649.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.002

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Objective　To investigate the clinical characteristics of Nocardia infection in patients with suspected pulmonary tuberculosis, and to improve the diagnosis of Nocardia pulmonary disease. Methods　A total of 115 patients with Nocardia infection and suspected pulmonary tuberculosis admitted to Guangzhou Chest Hospital from January 2020 to December 2023 were retrospectively selected as the study objects. There were 57 males and 58 females, aged 16-88 (50.26±17.26) years. According to the combination of pulmonary tuberculosis and non-tuberculous mycobacterium lung disease, 75 cases of pulmonary tuberculosis with Nocardia infection were classified as group A, 17 cases of non-tuberculous mycobacterium lung disease with Nocardia infection were classified as group B, and 23 cases of Nocardia infection alone were classified as group C. The CT imaging features of lung lesions and the occurrence of main suspected symptoms of pulmonary tuberculosis (cough, expectoration, hemoptysis, fever, shortness of breath, chest tightness, and chest pain) in the three groups were compared and analyzed. χ² test, independent sample t test, and rank sum test were used. Results　The detection time of Nocardia in group A was 4 (2,8) months after anti-tuberculosis treatment, and the detection time of Nocardia in group B was 10 (2,12) months after anti-nontuberculous mycobacterium treatment. Among the isolates, there were 113 strains of Nocardia farcinica, 1 strain of Nocardia pseudobrasiliensis, and 1 strain of Nocardia Africa/nova. CT images of the three groups showed lung consolidation, plaques, nodules, strips or hollow shadows, it was difficult to distinguish pulmonary tuberculosis, non-tuberculous mycobacterium lung disease, and Nocardia pulmonary infection. Anatomical sites involved: the incidences of multiple lobes involved in both lungs in group A, B, and C were 66.67% (50/75), 94.12% (16/17), and 69.57% (16/23), respectively, the incidence in group B was higher than that in group A (χ²=5.150, P=0.020), but there was no statistically significant difference between group A and group C or between group B and group C (χ²=0.067, P=0.796; χ²=3.683, P=0.055). There was no statistically significant difference in the incidence of suspected symptoms of pulmonary tuberculosis among the three groups (χ²=2.650, P=0.998). Conclusion　Nocardia infection is common in patients with pulmonary tuberculosis and non-tuberculous mycobacterium lung disease, but the clinical manifestations and imaging examination are difficult to distinguish, which should be paid enough attention to in clinical practice.

Clinical characteristics of tuberculous meningitis children with malnutrition and their relationships with short-term outcomes

Wang Xiaoxia, Huang Shaomei

2024, 30(16):  2649-2652.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.003

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Objective　To investigate the clinical characteristics of malnutrition in children with tuberculous meningitis (TBM) and their relationships with short-term TBM outcomes. Methods　A total of 80 TBM children admitted to the Department of Pediatrics, Guangzhou Chest Hospital from February 2016 to April 2022 were retrospectively selected as the study objects. According to the diagnostic criteria for malnutrition, the children were divided into a malnutrition group (66 cases) and a non-malnutrition group (14 cases). There were 35 boys and 31 girls in the malnutrition group; 6 cases aged 1 month - <1 year, 19 cases aged 1 - <3 years, 11 cases aged 3 - <6 years, and 30 cases aged 6 - <18 years; 64 cases lived in villages and towns, and 2 cases in cities. There were 9 boys and 5 girls in the non-malnutrition group; 1 case aged 1 month - <1 year, 3 cases aged 1 - <3 years, 2 cases aged 3 - <6 years, and 8 cases aged 6 - <18 years; 7 cases lived in villages and towns, and 7 cases in cities. The clinical characteristics of the two groups and their relationships with short-term outcomes were compared. χ² test and Fisher exact probability method were used. Results　Among the 80 children with TBM, 82.5% (66/80) were complicated with malnutrition, 71.2% (57/80) with anemia, and 51.2% (41/80) with hypoalbuminemia. The proportions of the malnutrition group living in villages and towns [97.0% (64/66)] and with disease course >14 days [81.2% (52/66)] were higher than those of the non-malnutrition group [50.0% (7/14) and 35.7% (5/14)] (both P<0.05). The incidences of anemia [77.2% (51/66)], hypoalbuminemia [57.6% (38/66)], drug-induced liver injury [51.5% (34/66)], sequelae [48.5% (32/66)], and abnormal cerebrospinal fluid findings at discharge [60.6% (40/66)] in the malnutrition group were all higher than those in the non-malnutrition group [42.8% (6/14), 21.4% (3/14), 21.4% (3/14), 14.3% (2/14), and 35.7% (5/14)] (all P<0.05). There was no statistically significant difference in the clinical stage, hydrocephalus, spinal cord lesions, or mortality between the two groups (all P>0.05). Conclusions　Malnutrition is prevalent among children with TBM, and is associated with worse short-term outcomes. Early identification of nutritional risks and prompt nutritional support are essential in managing TBM in children.

Analysis of the implementation effect and influencing factors of multi-drug resistant tuberculosis management strategy in Guangzhou from 2020 to 2022

Yang Zilong, Chen Zeying, Wang Min, Feng Zhiyu, Zhang Hong, Kuang Haobin

2024, 30(16):  2653-2658.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.004

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¹ Graduate School of Guangzhou Medical University, Guangzhou 511436, China; ² Department of Tuberculosis, Guangzhou Chest Hospital, Key Laboratory of Tuberculosis Research in Guangzhou, State Key Laboratory of Respiratory Disease, Guangzhou 510095, China

Analysis of perceived social support questionnaire in 205 cases of pulmonary tuberculosis in Guangzhou

Shen Huilan, Liang Wenli, Qin Huangping, Zhou Minjuan

2024, 30(16):  2658-2662.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.005

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Objective　To explore the feelings of tuberculosis patients on social support in Guangzhou, and to provide scientific basis and demand guidance for strengthening the introduction of social support policies for tuberculosis and the implementation of measures to improve the level of humanistic care for tuberculosis patients. Methods　From August 2023 to December 2023, 205 patients with pulmonary tuberculosis in Guangzhou Chest Hospital were selected as the study objects. There were 119 males and 86 females, 24 cases <25 years old, 68 cases 25 - <45 years old, 52 cases 45 - ≤60 years old, and 61 cases >60 years old. Self-made questionnaire and Perceptive Social Support Scale (PSSS) were used to investigate the perceptive social support status of tuberculosis patients from 12 items in 3 dimensions of family support, friend support, and other support. Rank sum test and χ² test were used. Results　The percentages of disagreeing, neutral, and agreeing in the three dimensions of family support, friend support, and other support were 1.95%-41.46%-56.59%, 14.39%-64.27%-21.34%, and 16.22%-62.32%-21.46%. There were statistically significant differences between the family support dimension and the friend support dimension, and between the family support dimension and the other support dimension (χ²=248.680, P<0.001; χ²=255.830, P<0.001); there was no statistically significant difference between the friend support dimension and the other support dimension (χ²=1.146, P=0.564). The scores of family support, friend support, and other support dimensions were 20 (18, 21) points, 16 (15, 18) points, and 16 (15, 18) points. There were statistically significant differences between the family support dimension and the friend support dimension, and between the family support dimension and the other support dimension (Z=11.808, P<0.001; Z=11.228, P<0.001); there was no statistically significant difference between the friend support dimension and the other support dimension (Z=0.524, P=0.600). The percentages of low support, intermediate support, and high support states were 3.90%, 87.81%, and 8.29%, respectively. There was no statistically significant difference in perceived social support among populations with different gender, age, marriage, education, living condition, occupation, medical payment methods, and self-care abilities (all P>0.05). Conclusion　The humanistic care for tuberculosis patients in Guangzhou area mainly comes from within the family, and the level of social support outside the family needs to be improved.

Effect of nursing intervention based on the knowledge-attitude-practice theory on the expectoration compliance of respiratory rehabilitation in patients with NTM lung disease

Huang Liping, Chen Yanxia, Chen Hua, Feng Cuilian

2024, 30(16):  2663-2667.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.006

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Objective　To explore the effects of nursing intervention based on the knowledge-attitude-practice (KAP) theory on the expectoration compliance of respiratory rehabilitation and quality of life in patients with nontuberculous mycobacterium (NTM) lung disease complicated with bronchiectasis. Methods　A randomized controlled trial was conducted on 98 patients with NTM lung disease combined with bronchiectasis, chest tightness, and shortness of breath admitted to the non-tuberculous Mycobacteriosis Diagnosis and Treatment Center of Guangzhou Chest Hospital from March 2022 to June 2023. The patients were divided into an observation group (49 cases) and a control group (49 cases) by the random number table method. In the control group, there were 17 males and 32 females, aged (61.08±13.23) years, with a median age of 62.0 years old. In the observation group, there were 19 males and 30 females, aged (59.65±11.29) years, with a median age of 62.0 years old. Both groups were instructed to undergo respiratory rehabilitation expectoration training. The control group was given routine nursing, and the observation group was given nursing intervention based on the KAP theory based on routine nursing. Both groups were treated for 1 week. The KAP level of respiratory rehabilitation expectoration (self-designed questionnaire on the KAP status quo of respiratory rehabilitation expectoration in NTM patients with bronchiectasis), expectoration compliance of respiratory rehabilitation (respiratory rehabilitation expectoration compliance scale), and quality of life [Leicester Cough Questionnaire in Mandarin-Chinese (LCQ-MC)] were compared between the two groups before intervention, 1 week and 1 month after discharge. Independent sample t test, paired t test, and χ² test were used. Results　The KAP level of respiratory rehabilitation expectoration in the observation group was higher than that in the control group 1 week and 1 month after discharge (both P<0.05). The expectoration compliance of respiratory rehabilitation 1 week and 1 month after discharge in the observation group [(3.12±0.53) points and (2.76±0.52) points] were higher than those in the control group [(2.90±0.51) points and (2.27±0.45) points] (both P<0.05). The scores of physiological dimension [(5.00±0.97) points and (5.00±1.03) points], psychological dimension [(5.35±1.01) points and (5.22±1.08) points], and social dimension [(5.31±1.02) points and (5.20±0.98) points] and total score of the LCQ-MC [(15.66±2.42)points and (15.42±2.31)points] in the observation group 1 week and 1 month after discharge were higher than those in the control group [(4.52±1.18) points, (4.27±1.13) points, (4.70±1.11) points, (4.65±1.08) points, (4.58±1.15) points, (4.56±1.20) points, (13.80±2.68) points, and (13.49±2.64) points] (all P<0.05). Conclusion　Nursing intervention based on the KAP theory can effectively improve the expectoration compliance of respiratory rehabilitation in patients with NTM lung disease complicated with bronchiectasis, and improve the patients' comfort and quality of life.

Special Column of Lung Diseases

Relationships between LMR, MPVLR and radiation pneumonia after radical radiotherapy in patients with stage Ⅲ lung cancer

Dai Zhen, Zhang Yongtong, Huang Fang, Liu Hua, Wang Tianchang, Wang Fenggang

2024, 30(16):  2668-2672.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.007

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Objective　To explore the relationships between lymphocyte to monocyte ratio (LMR), mean platelet volume to lymphocyte ratio (MPVLR) and radiation pneumonia after radical radiotherapy in patients with stage Ⅲ lung cancer. Methods　A total of 102 patients with stage Ⅲ lung cancer who received radical radiotherapy in the Department of Radiotherapy, Shaanxi Provincial Cancer Hospital from February 2020 to March 2023 were selected as the study objects. There were 85 males and 17 females, aged 32-76 (51.17±8.27) years, with a body mass index (BMI) of 22.46-24.52 (23.06±1.57) kg/m². The monocyte count, mean platelet volume, and lymphocyte count before radiotherapy were measured by automatic blood analyzer, and the LMR and MPVLR values were calculated according to the test results. The patients were followed up for 3 months and were divided into an occurrence group (23 cases) and a non-occurrence group (79 cases) according to whether they developed radiation pneumonia. The receiver operating characteristic curve (ROC) was used to evaluate the predictive values of peripheral blood LMR and MPVLR for radiation pneumonia after radical radiotherapy in patients with stage Ⅲ lung cancer. Multivariate logistic regression analysis was used to explore the influencing factors of radiation pneumonia after radical radiotherapy in patients with stage Ⅲ lung cancer. Independent sample t test and χ² test were used. Results　The LMR and MPVLR before radiotherapy in the occurrence group were lower than those in the non-occurrence group (both P<0.05). The areas under the curves (AUCs) (95%CI) of peripheral blood LMR and MPVLR before radiotherapy for predicting radiation pneumonia after radical radiotherapy in patients with stage Ⅲ lung cancer were 0.745 (0.695-0.791) and 0.862 (0.812-0.907), respectively, and the AUC (95%CI) of the combined detection was 0.916 (0.871-0.966). The proportions of the patients with central gross type, tumor diameter ≥5 cm, and total dose ≥60 Gy in the occurrence group were higher than those in the non-occurrence group (all P<0.05). Multivariate logistic regression analysis showed that total radiation dose (OR=2.217, 95%CI: 1.452-3.385), tumor diameter (OR=2.368, 95%CI: 1.409-3.980), decreased LMR (OR=2.649, 95%CI: 1.658-4.231), and elevated MPVLR (OR=3.177, 95%CI: 1.868-5.404) were risk factors for radiation pneumonia after radical radiotherapy in patients with stage Ⅲ lung cancer (all P<0.05). Conclusions　Low expression of LMR and high expression of MPVLR in the peripheral blood of lung cancer patients with radiation pneumonia after radical radiotherapy are observed, and LMR and MPVLR have a certain relationship with the occurrence of radiation pneumonia after radical radiotherapy. Both of them are influencing factors for the occurrence of radiation pneumonia after radical radiotherapy for lung cancer, and their combined detection has a higher value in the evaluation of radiation pneumonia after radical radiotherapy for lung cancer.

Clinical efficacy of Osimertinib combined with Savolitinib as second-line therapy for T790M mutation-positive metastatic NSCLC during EGFR-TKI treatment

Wang Dingjun, Shi Lei, Zhang Juan

2024, 30(16):  2673-2677.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.008

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Objective　To investigate the efficacy and safety of Osimertinib combined with Savolitinib as second-line therapy for T790M mutation-positive metastatic non-small cell lung cancer (NSCLC) during treatment with epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI). Methods　A total of 94 patients with metastatic NSCLC with T790M mutation during EGFR-TKI treatment in Ankang People's Hospital from January 2021 to January 2022 were selected. The patients were divided into a study group (47 cases) and a control group (47 cases) by the random number table method. During the treatment period, 7 cases were lost to follow-up and 40 cases were enrolled in the study group. In the control group, 9 cases were lost to follow-up, and 38 cases were enrolled. In the control group, there were 24 males and 14 females, aged (60.32±5.71) years, with a body mass index (BMI) of (18.06±1.61) kg/m². There were 27 males and 13 females in the study group, aged (61.05±6.64) years, with a BMI of (18.13±1.54) kg/m². The control group was treated with Osimertinib, and the study group was treated with Savolitinib on the basis of the control group. After 3 months of treatment, the efficacy and adverse reactions of the two groups were compared. The serum levels of carcinoembryonic antigen (CEA), cytokeratin 19 fragment antigen 21-1 (CYFRA21-1), vascular endothelial growth factor (VEGF), and matrix metalloproteinase-9 (MMP-9) were compared between the two groups before and after treatment. The median progression-free survival (PFS) and median overall survival (OS) were recorded after 2 years of follow-up. Independent sample t test, paired t test, χ² test, Kaplan-Meier analysis, and Log-rank test were used. Results　After treatment, the levels of CEA [(65.30±14.29) μg/L], CYFRA21-1 [(1.62±0.69) μg/L], VEGF [(381.04±27.64) ng/L], and MMP-9 [(151.98±25.47) μg/L] in the study group were lower than those in the control group [(73.59±16.03) μg/L, (2.57±0.76) μg/L, (396.61±26.51) ng/L, and (169.07±26.54) μg/L], with statistically significant differences (all P<0.05). The disease control rate [85.00% (34/40)] and objective response rate [62.50% (25/40)] of the study group were higher than those of the control group [65.79% (25/38) and 39.47% (15/38)], with statistically significant differences (both P<0.05). There was no statistically significant difference in the total incidence of adverse drug reactions between the two groups (P>0.05). There were statistically significant differences in the PFS and OS between the two groups (both P<0.05). Conclusion　Osimertinib combined with Savolitinib as second-line therapy for metastatic NSCLC with T790M mutation during EGFR-TKI treatment helps to improve the disease control rate and prolong the patients' survival, with good safety.

Effect of afatinib combined with pemetrexed and carboplatin chemotherapy in patients with gefitinib resistant lung adenocarcinoma

Zhai Tingting, Wang Feng

2024, 30(16):  2678-2681.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.009

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Objective　To investigate the clinical effect of afatinib combined with pemetrexed and carboplatin chemotherapy in patients with gefitinib resistant lung adenocarcinoma. Methods　A total of 84 patients with gefitinib-resistant lung adenocarcinoma admitted to Shangqiu First People's Hospital from January 2021 to December 2022 were selected and were divided into an observation group (42 cases) and a control group (42 cases) according to the random number table method. In the control group, there were 24 males and 18 females, the age was 37-68 (52.58±2.21) years old, the body mass index (BMI) was 18-27 (23.11±1.17) kg/m², the lesions were at left upper in 18 cases, left lower in 16 cases, right upper in 5 cases, and right lower in 3 cases, and the clinical stage was stage III in 20 cases and stage IV in 22 cases. In the observation group, there were 21 males and 21 females, the age was 37-68 (52.67±2.24) years old, the BMI was 18-27 (23.06±1.14) kg/m², the lesions were at left upper in 17 cases, left lower in 14 cases, right upper in 5 cases, and right lower in 6 cases, and the clinical stage was stage III in 18 cases and stage IV in 24 cases. The control group received pemetrexed and carboplatin chemotherapy, and the observation group received afatinib treatment on the basis of the control group. Both groups were treated for 2 courses. The therapeutic effect, tumor markers [carbohydrate antigen 199 (CA199), carcinoembryonic antigen (CEA), and neuron-specific enolase (NSE)], immune function (T lymphocyte subsets CD3⁺, CD4⁺, and CD8⁺), and adverse reactions were compared between the two groups. Independent sample t test and χ² test were used. Results　The total effective rate of the observation group [76.19% (32/42)] was higher than that of the control group [52.38% (22/42)] (P<0.05). After treatment, the levels of CA199 [(44.39±3.88) μg/L], NSE [(13.45±1.22) μg/L], and CEA [(6.17±0.57) μg/L] in the observation group were lower than those in the control group [(61.02±5.24) μg/L, (18.69±1.74) μg/L, and (9.26±0.81) μg/L] (all P<0.05). After treatment, the levels of CD3⁺ [(65.39±5.22)%] and CD4⁺ [(36.15±2.71)%] in the observation group were higher than those in the control group [(57.69±4.38)% and (31.58±2.64)%], but the level of CD8⁺ [(27.16±1.53)%] was lower than that in the control group [(30.87±2.07)%] (all P<0.05). During treatment, there was no statistically significant difference in the total incidence of adverse reactions between the observation group [26.19% (11/42)] and the control group [19.05% (8/42)] (P>0.05). Conclusion　Afatinib combined with pemetrexel and carboplatin chemotherapy has a significant therapeutic effect in patients with gefitinib-resistant lung adenocarcinoma, which can reduce the levels of tumor markers and the damage on immune function, and has high safety.

Correlations between the expressions of PD-L1 and EGFR in the plasma exosomes and clinical features and prognosis in patients with non-small cell lung cancer

Bao Hui, Wang Kai, Li Weiwei

2024, 30(16):  2682-2686.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.010

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Objective　To detect the expressions of programmed death ligand 1 (PD-L1) and epidermal growth factor receptor (EGFR) in the plasma exosomes in patients with non-small cell lung cancer (NSCLC), and analyze their correlations with clinical features and prognosis. Methods　A total of 312 NSCLC patients treated in Yan'an University Affiliated Hospital from January 2015 to March 2016 were retrospectively selected as the research objects. There were 178 males and 134 females, ≥55 years old in 180 cases and <55 years old in 132 cases, tumor length ≥5 cm in 169 cases and <5 cm in 143 cases. The expressions of exosomal marker proteins CD63, CD81, and TSG101 were detected by Western blot technique, and the expressions of PD-L1 and EGFR in the plasma exosomes were detected by enzyme-linked immunosorbent assay (ELISA). Kaplan-Meier survival curve was used for prognostic analysis. The factors influencing the prognosis of NSCLC patients were analyzed by COX regression analysis. χ² test was used. Results　The PD-L1 and EGFR levels in the plasma exosomes were higher in patients with lower degree of differentiation, lymph node metastasis, and smoking history (all P<0.05). High level of PD-L1 in the plasma exosomes was closely related to high level of EGFR (P<0.05). Among the 312 patients, 27 patients were lost to follow-up, with a follow-up rate of 91.35% (285/312). The 5-year survival rate of the 285 patients was 62.46% (178/285). The survival rate of the patients with high level of PD-L1 was 30.77% (48/156), and that of the patients with low level of PD-L1 was 83.33% (130/156), with a statistically significant difference (log-rank χ²=92.743, P<0.05). The survival rate of the patients with high EGFR level was 20.51% (32/156), and that of the patients with low EGFR level was 93.59% (146/156), with a statistically significant difference (log-rank χ²=119.215, P<0.05). Multifactor analysis showed that high levels of plasma exosome PD-L1 and EGFR expression, lower degree of differentiation, and lymph node metastasis were independent risk factors affecting the prognosis in NSCLC patients (all P<0.05). Conclusion　Plasma exosomal PD-L1 and EGFR expressions are closely associated with disease progression of NSCLC, and can be used as predictors of prognosis.

Influence of body weight on perioperative complications of thoracoscopic lobectomy

Wei Xudong

2024, 30(16):  2687-2690.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.011

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Objective　To investigate the influence of body weight on perioperative complications of thoracoscopic lobectomy. Methods　A total of 190 patients who underwent thoracoscopic lobectomy in the Department of Thoracic Surgery, Anyang Tumor Hospital from January 2023 to May 2023 were retrospectively selected as the study objects. According to the Chinese body mass index (BMI) standard, the patients were divided into a normal weight group (18.5 kg/m²≤BMI<24.0 kg/m²) of 76 cases and a high weight group (BMI ≥24.0 kg/m²) of 114 cases. There were 41 males and 35 females in the normal weight group, the age was (61.0±8.7) years old, the BMI was (21.9±1.4) kg/m², the preoperative American Society of Anesthesiologists (ASA) classification was grade I in 6 cases and grade II in 70 cases, and the tumor size was (2.3±1.6) cm. There were 53 males and 61 females in the high weight group, the age was (61.9±9.3) years old, the BMI was (26.9±2.3) kg/m², the preoperative ASA classification was grade I in 13 cases and grade II in 101 cases, and the tumor size was (2.3±1.8) cm. The incidence of postoperative complications and clinical outcomes were compared between the two groups. χ² test and t test were used. Results　In this study, the operation time of enrolled patients was (155.2±50.8) min, and the operation time of the normal weight group [(157.5±51.4) min] was slightly longer than that of the high weight group [(153.6±50.6) min], with no statistically significant difference (P>0.05). There was no statistically significant difference in the incidence of intraoperative bleeding between the two groups (P>0.05). The length of hospital stay after surgery of enrolled patients in this study was (17.7±4.5) d, and there was no statistically significant difference in the length of hospital stay between the normal weight group [(17.6±4.9) d] and the high weight group [(17.8±4.3) d] (P>0.05). There was no statistically significant difference in the incidence of complications within 30 d after surgery between the normal weight group [44.7% (34/76)] and the high weight group [28.9% (33/114)] (P>0.05), and no death occurred within 30 d after surgery between the two groups. Conclusion　High body weight does not increase the incidence of perioperative complications in patients undergoing thoracoscopic lobectomy, and thoracoscopic lobectomy is safe and feasible for patients with high body weight.

Effects of sevoflurane combined with remifentanil on analgesia, sleep, and inflammation in patients undergoing thoracoscopic lobectomy

Xue Yao, Meng Min

2024, 30(16):  2691-2695.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.012

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Objective　To evaluate the safety and efficacy of sevoflurane combined with remifentanil in patients undergoing thoracoscopic lobectomy. Methods　This was a randomized controlled trial. A total of 86 patients who underwent thoracoscopic lobectomy in Shenmu Hospital from January 2021 to October 2023 were included and were divided into two groups according to the random number table method. One group received conventional analgesic drugs (sevoflurane group), the other group received sevoflurane combined with remifentanil (combined group), with 43 cases in each group. In the sevoflurane group, there were 23 males and 20 females, aged (28.14±4.65) years. In the combined group, there were 25 males and 17 females, aged (29.57±4.64) years. The sevoflurane group received sevoflurane inhalation anesthesia, and the concentration was maintained at 1.2-2.0 MAC (minimum alveolar concentration) to ensure sufficient depth of anesthesia. Anesthesia induction in the combined group was the same as that in the sevoflurane group. Sevoflurane inhalation anesthesia was used for maintenance anesthesia, but the concentration was maintained at 0.7-1.5 MAC, which was slightly lower than that in the sevoflurane group. Analgesia was maintained by adding remifentanil on the basis of sevoflurane to improve the analgesia effect, and remifentanil was continuously transfused at a rate of 0.2-0.5 μg/(kg·h). The differences in analgesic effects [rescue analgesia rate and Visual Analogue Scale (VAS) score], sleep quality indicators [arousal index (AI), sleep efficiency index (SEI), and proportion of rapid eye movement sleep time (REM)], inflammatory indexes [interleukin (IL)-1, IL-6, IL-10, C-reactive protein (CRP), and tumor necrosis factor α (TNF-α)], and adverse reactions were compared between the two groups. Independent sample t test and χ² test were used. Results　Compared with those in the sevoflurane group, the rescue analgesia rate was lower in the combined group [11.63% (5/43) vs. 30.23% (13/43)]; 1, 24, and 48 h after surgery, the VAS score of the combined group was lower [(5.16±1.52) points vs. (6.53±1.82) points, (2.69±1.11) points vs. (3.41±1.31) points, (1.25±0.66) points vs. (1.57±0.62) points], with statistically significant differences (all P<0.05). The AI and SEI at night in the combined group were lower than those in the sevoflurane group 1 d after surgery (both P<0.05). The levels of IL-6, IL-10, IL-1β, TNF-α, and CRP in the combined group were lower than those in the sevoflurane group 1 d after surgery, with statistically significant differences (all P<0.05). The total incidence of adverse reactions in the combined group was lower than that in the sevoflurane group [4.65% (2/43) vs. 18.60% (8/43)], with a statistically significant difference (χ²=4.074, P=0.044). Conclusions　Sevoflurane combined with remifentanil in patients undergoing thoracoscopic lobectomy can significantly improve the analgesic effect and sleep quality while reducing the inflammatory response. This analgesic scheme is safe and effective.

AECOPD患者T淋巴细胞亚群及血清CD64、TLR2与出院后再次发作的关系

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

2024, 30(16):  2696-2700.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.013

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Objective　To explore the relationships between T lymphocyte subsets and serum CD64, Toll like receptor 2 (TLR2) and recurrence after discharge in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods　A retrospective analysis was conducted on 120 cases of AECOPD admitted to Xi'an Central Hospital from January 2020 to October 2023. Among them, there were 70 males and 50 females, aged 51-84 (69.01±11.09) years, and the course of COPD was 6-12 (8.95±2.29) years. All patients were divided into a recurrence group (40 cases) and a non-recurrence group (80 cases) based on whether they had relapsed (acute deterioration worsened) within 90 days of telephone or outpatient follow-up after discharge. The general information [gender, age, COPD course, underlying diseases, smoking history, drinking history, and COPD Patient Self-Assessment Test (CAT) score], T lymphocyte subsets (CD3⁺, CD4⁺, CD8⁺, and CD4⁺/CD8⁺), CD64, and TLR2 levels were compared between the two groups. The influencing factors of recurrence in AECOPD patients after discharge were identified by multi-factor unconditional logistic stepwise regression analysis. Finally, the values of forced expiratory volume in 1 second/forced vital capacity (FEV₁/FVC), T lymphocyte subsets, CD64, and TLR2 levels in predicting recurrence in AECOPD patients after discharge were analyzed by the receiver operating characteristic curve (ROC). Independent sample t test and χ² test were used. Results　The levels of FEV₁/FVC, CD3⁺, CD4⁺, and CD4⁺/CD8⁺ in the recurrence group were lower than those in the non-recurrence group, and the levels of CD8⁺, CD64, and TLR2 were higher than those in the non-recurrence group, with statistically significant differences (all P<0.05). Multivariate logistic regression analysis showed that the levels of FEV₁/FVC, T lymphocyte subsets, CD64, and TLR2 were the influencing factors for recurrence in AECOPD patients after discharge (all P<0.05). ROC analysis confirmed that FEV₁/FVC, CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺, CD64, and TLR2 levels could be used to predict recurrence in AECOPD patients after discharge, with the areas under the curves of 0.810, 0.639, 0.912, 0.793, 0.945, 0.632, and 0.908 (all P<0.05). Conclusion　The recurrence of AECOPD patients after discharge is influenced by FEV₁/FVC, T lymphocyte subsets, CD64, and TLR2 levels, which should be closely monitored clinically.

Establishment of a short-term death warning model for elderly COPD patients with severe multidrug-resistant Acinetobacter baumannii pneumonia

Zhang Xiao, Dai Xi, Li Yongtao, Wang Rui

2024, 30(16):  2701-2707.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.014

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Objective　To construct a model based on the LASSO (Least Absolute Shrinkage and Selection Operator) -logistic regression method, and to predict the short-term mortality risk in elderly patients with chronic obstructive pulmonary disease (COPD) and severe multidrug-resistant Acinetobacter baumannii pneumonia. Methods　In this study, 74 elderly COPD patients with severe multidrug-resistant Acinetobacter Baumannii pneumonia from the Department of Respiratory and Critical Care Medicine of Xi'an Gaoxin Hospital from January 2022 to December 2023 were selected as the study objects, including 55 males and 19 females, 41 patients <70 years old and 33 patients ≥70 years old. The LASSO-logistic regression algorithm was used to identify clinical variables significantly associated with short-term death risk, and these variables were used to construct a risk prediction model. The 10-fold cross-validation and Bootstrap method were used to validate the model internally, and the performance of the model was evaluated from the aspects of discrimination [area under the curve (AUC)] and calibration (calibration curve). χ² test and independent sample t test were used. Results　The survival of the patients within 30 days was observed. According to the final outcomes, the patients were divided into a death group (21 cases) and a survival group (53 cases), with a mortality rate of 28.37% (21/74). After LASSO cross-validation to determine the optimal parameters, the model selected five variables that were closely related to short-term death from general data, clinicopathological features, and previous treatment information: mechanical ventilation, fiberoptic bronchoscopy, sedation, septic shock, and use of antifungal medications. These variables were included in the logistic regression model, and the regression analysis showed that they were independent influencing factors for death in elderly COPD patients with severe multidrug-resistant Acinetobacter baumannii pneumonia (all P<0.05). The forest plot model constructed based on these predictors demonstrated excellent predictive performance for predicting short-term death in elderly COPD patients with severe multidrug-resistant Acinetobacter baumannii pneumonia, with an AUC of 0.927. In the analysis of the training set, the 1 000 bootstrap resamples and calibration curve analysis showed that the model's prediction results were highly consistent with the actual situation, with a mean absolute error (MAE) of 0.027. The Hosmer-Lemeshow goodness of fit test also confirmed the model's good calibration. Conclusions　The LASSO-logistic regression model constructed in this study can effectively predict the short-term death risk in elderly COPD patients with severe multidrug-resistant Acinetobacter Baumannii pneumonia. This model helps clinicians to better identify high-risk patients during the treatment decision-making process, so that appropriate treatment measures can be taken in time.

Evaluation of the effect of cognitive-behavioural intervention on elderly patients with chronic obstructive pulmonary disease complicated with cognitive decline

Wang Fu, Zhang Junmei, Cheng Yisa, Mao Pan, Zhu Shan

2024, 30(16):  2707-2712.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.015

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Objective　To investigate the effect of cognitive-behavioural intervention on elderly patients with chronic obstructive pulmonary disease (COPD) complicated with cognitive decline. Methods　A total of 120 COPD patients with cognitive decline who were treated in Henan Provincial People's Hospital from March 2021 to March 2022 were simply randomly divided into a control group (60 cases) and an observation group (60 cases). In the control group, there were 38 males and 22 females, aged 60-78 (69.25±4.19) years, the course of disease was 1-15 (8.00±1.53) years, and the lung function grading was grade Ⅱ in 35 cases and grade Ⅲ in 25 cases. In the observation group, there were 40 males and 20 females, aged 60-78 (69.58±4.00) years, the course of disease was 1-15 (8.15±1.40) years, and the lung function grading was grade Ⅱ in 38 cases and grade Ⅲ in 22 cases. The control group received routine nursing intervention, and the observation group received cognitive-behavioral intervention on the basis of the control group. After discharge, both groups were intervened for 6 months by outpatient visit or telephone follow-up and were followed up for 1 year. The differences in frailty level, cognitive function score, self-care ability, and quality of life score were compared between the two groups. t test was used for the measurement data and χ² test was used for the count data. Results　After 6 months and 1 year, the frailty scores in the observation group were (2.57±0.11) points and (2.00±0.18) points, which were lower than those in the control group [(3.00±0.15) points and (2.71±0.20) points] (t=17.906 and 20.439, both P<0.05); the cognitive function scores in the observation group were (22.68±1.05) points and (25.69±1.20) points, which were higher than those in the control group [(20.36±1.00) points and (23.18±1.11) points] (t=12.394 and 11.894, both P<0.05); the scores of self-care ability in the observation group were (83.15±5.28) points and (88.63±6.47) points, which were higher than those in the control group [(75.26±4.16) points and (80.23±5.18) points] (t=9.092 and 7.581, both P<0.05); the quality of life scores in the observation group were (45.60±3.09) points and (40.23±2.69) points, which were lower than those in the control group [(50.18±4.00) points and (45.18±3.15) points] (t=7.019 and 9.256, both P<0.05). Conclusion　Cognitive-behavioural intervention can effectively delay the cognitive decline process of elderly patients with COPD and cognitive decline, improve their cognitive function and quality of life, and enhance their self-care ability.

Prognostic value of MuLBSTA score based on clinical characteristics for viral pneumonia

Zhang Hongying, Wang Ting, Pan Jianguang, Han Ximei, Weng Ling, Lin Qing

2024, 30(16):  2712-2717.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.016

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Objective　To evaluate the prognostic value of MuLBSTA score based on clinical characteristics for viral pneumonia. Methods　A retrospective analysis was conducted on patients who were discharged from Fuzhou Pulmonary Hospital of Fujian between January 1, 2013 and December 31, 2022 and were diagnosed as viral pneumonia. The Pneumonia Severity Index (PSI), CURB-65 (C for consciousness, U for blood urea nitrogen, R for respiratory rate, B for blood pressure, 65 for age), and MuLBSTA scores were calculated and stratified. The differences in ICU admission and mortality rate among patients with different grades were compared, and the corresponding receiver operating characteristic curve (ROC) was drawn to analyze the predictive values of the three scores to death. Analysis of variance, rank sum test, and χ² test were used. Results　A total of 137 patients were enrolled in this study, including 88 males and 49 females, aged 19-93 years. There were 69 cases of COVID-19, 50 cases of influenza A viral pneumonia, 18 cases of human infection with H7N9 avian influenza pneumonia, with 71 cases of severe illness (51.82%), 22 cases (16.06%) admitted to ICU, and 15 cases of death (10.95%). The hierarchical analysis of PSI, CURB-65, and MuLBSTA scores for patients admitted to ICU and mortality rate showed that there were statistically significant differences (all P<0.05). The higher the risk of scoring, the higher the proportions of admission to ICU and death from illness. However, only CURB-65 and MuLBSTA scores predicted death in patients with viral pneumonia. The area under the curve of MuLBSTA was 0.750, the diagnostic specificity was 100.00%, the accuracy was 60.55%, and the cutoff value was 7.5. Conclusion　The MuLBSTA score can be used for prognostic evaluation of viral pneumonia, which is simple and easy to memorize, and is suitable for promotion in outpatient and grassroots hospitals.

Effect of high-flow nasal cannula on blood gas parameters, inflammatory markers, and clinical conditions in adult patients with severe pneumonia and respiratory failure

Xing Xiaoyan, He Xiaolong, Liu Lirui

2024, 30(16):  2718-2723.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.017

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Objective　 To investigate the effects of high-flow nasal cannula (HFNC) on blood gas parameters, inflammatory markers, and clinical conditions in adult patients with severe pneumonia and respiratory failure, and compare the efficacy of noninvasive positive pressure ventilation (NIPPV) with it. Methods　A retrospective analysis was performed on 95 adult patients with severe pneumonia and respiratory failure treated in Yan'an Hospital of Traditional Chinese Medicine from January 2021 to October 2023. Forty-five patients who received NIPPV were assigned to the control group, and 50 patients who underwent HFNC treatment were assigned to the observation group. In the observation group, there were 28 males and 22 females, aged (63.64±4.31) years. In the control group, there were 24 males and 21 females, aged (64.38±4.57) years. The two groups were compared in terms of blood gas parameters [arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), and oxygen saturation (SaO₂)], respiratory rate (RR), sputum viscosity, inflammatory markers [tumor necrosis factor (TNF)-α, interleukin (IL)-6, high mobility group protein B1 (HMGB-1), high-sensitivity C-reactive protein (hs-CRP), and soluble myeloid cell trigger receptor (sTREM)], and changes in condition [Borg scale and Pneumonia Severity Index (PSI) scores] before treatment and 1 week after treatment, treatment efficiency, and complications. Independent sample t test and χ² test were used. Results　After treatment, the PaO₂, RR, PaCO₂, and SaO₂ in the observation group were (92.19±5.76) mmHg (1 mmHg = 0.133 kPa), (20.71±2.81) times/min, (45.99±5.33) mmHg, and (93.30±9.39)%, those in the control group were (82.99±6.33) mmHg, (23.68±2.96) times/min, (48.19±5.76) mmHg, and (83.50±9.43)%, with statistically significant differences between the two groups (all P<0.05). The phlegm viscosity of the observation group was lower than that of the control group after treatment (P=0.017). The levels of inflammatory factors in the observation group decreased after treatment compared with those before treatment, and there were statistically significant differences compared with those in the control group [the levels of TNF-α, IL-6, HMGB-1, hs-CRP, and sTREM in the observation group were (17.83±5.70) mg/L, (19.46±5.47) ng/L, (113.05±28.36) μg/L, (33.23±4.08) mg/L, and (15.95±2.68) ng/L, and those in the control group were (32.02±7.44) mg/L, (33.50±5.62) ng/L, (216.46±25.11) μg/L, (53.91±6.14) mg/L, and(35.89±4.49) ng/L] (all P<0.001). After treatment, the Borg index and PSI scores of the observation group were (3.48±0.39) and (67.99±7.82) points, which were lower than those of the control group [(4.34±0.48) and (78.97±8.98) points], with statistically significant differences (both P<0.001). The weaning time, hospital stay, dyspnea relief time, and disappearance time of pulmonary rales in the observation group were (3.63±0.72), (7.75±1.16), (1.04±0.36), and (4.32±0.77) d, which were shorter than those in the control group [(4.75±0.85), (8.46±1.33), (1.64±0.51), and (5.88±1.06) d], with statistically significant differences (all P<0.05). There was no statistically significant difference in the total incidence of complications between the two groups (P>0.05). Conclusion　HFNC therapy has a positive effect on adult patients with severe pneumonia and respiratory failure, effectively improving blood gas parameters, reducing inflammatory markers, and decreasing sputum viscosity, thus facilitating recovery.

A case of pulmonary infection caused by Mycobacterium Gordon

Chen Minhong, Cai Xingdong, Ma Hongming

2024, 30(16):  2724-2726.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.018

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In clinical practice, the disease caused by Mycobacterium Gordon is rare. A case of pulmonary infection caused by Mycobacterium Gordon in the First Affiliated Hospital of Jinan University was reported. After the epidemiological history, clinical manifestations, imaging features, needle biopsy of lung, and bronchoalveolar lavage were analyzed, the diagnosis of nontuberculous mycobacterial pulmonary disease (NTM-PD) was made. After anti-nontuberculous mycobacterial treatment, CT images showed no further progression, confirming the diagnosis.

New Medical Advances

Applications of superb microvascular imaging in tumors

Duan Shuhui, Xiong Zhengbiao, Xu Haoyang, Yan Junhong

2024, 30(16):  2727-2731.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.019

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The superb microvascular imaging is a new type of ultrasonic imaging technology that can display slower and smaller blood flow signals, evaluating the characteristics of microvessels. Vascular changes are of great significance for the growth and metastasis of tumors. Superb microvascular imaging, as a non-invasive examination, can provide valuable information for the diagnosis, monitoring, and treatment of tumors, and has broad application prospects. This article mainly elaborates on the clinical application and research status of superb microvascular imaging in tumors, and evaluates the application value of superb microvascular imaging in various tumors.

Literature Analysis

Overviews of the effect of exercise on chemotherapy-induced peripheral neuropathy

Zhang Xinyue, Liu Jingyuan, Zhang Fan, Zhou Wenqin

2024, 30(16):  2732-2737.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.020

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Objective　To evaluate the systematic reviews of the effect of exercise on chemotherapy-induced peripheral neuropathy, with a view to provide a basis for the development of exercise intervention programs for patients with peripheral neuropathy due to cancer chemotherapy. Methods　Systematic reviews/meta-analysis of the effect of exercise on chemotherapy-induced peripheral neuropathy were searched in nine databases by combining subject terms with free words: CNKI, Wangfang, VIP, CBM, PubMed, Web of Science, EMBASE, The Cochrane Library, and CINAHL. The search time limit was from the inception of the database until August 20, 2023, and the literatures obtained were independently screened and extracted by two researchers. Results　A total of 9 systematic reviews/meta-analyses were included, and the methodological quality assessment of the systematic reviews showed that 3 were of low quality and 6 were of very low quality. The grades of recommendations assessment, development and evaluation (GRADE) grading of the 23 pieces of evidence showed 1 piece of high-level evidence, 5 pieces of intermediate evidence, 9 pieces of low-level evidence, and 8 pieces of extremely-low-level evidence. Conclusion　The systematic reviews/meta-analysis of the literatures on the effect of exercise on chemotherapy-induced peripheral neuropathy are of generally low quality, with low volume and overall strength of evidences, and multicenter, large-sample, high-quality studies are still needed to further assess its effect in the future.

Treatises

Application of electroacupuncture at Jiaji points and lower limb rehabilitation robot combined with kinesio taping in patients with ISCI

Li Chao, Zhang Nannan, Fan Xiaoyan, Ji Yingxin, Lei Yan

2024, 30(16):  2738-2742.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.021

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Objective　To explore the application effect of electroacupuncture at Jiaji points and lower limb rehabilitation robot combined with kinesio taping in the rehabilitation of incomplete spinal cord injury (ISCI). Methods　A total of 104 ISCI patients treated in the Department of Exercise Therapy, Shaanxi Provincial Rehabilitation Hospital from April 2022 to April 2023 were selected for a randomized controlled trial. The patients were divided into a control group (52 cases, receiving conventional gait rehabilitation combined with kinesio taping treatment) and a combined group (52 cases, receiving electroacupuncture at Jiaji points and lower limb rehabilitation robot combined with kinesio taping treatment) according to the random number table method. The treatment period was 12 weeks. In the control group, there were 30 males and 22 females, aged (41.29±9.19) years, and the American Spinal Cord Injury Association (ASIA) classification was grade C in 24 cases and grade D in 28 cases. In the combined group, there were 28 males and 24 females, aged (42.40±8.29) years, and the ASIA classification was grade C in 26 cases and grade D in 26 cases. The gait parameters (stride length, step frequency, and comfortable walking speed), walking function [Functional Ambulation Category Scale (FAC)], lower extremity muscle strength (quadriceps femoris, gluteus maximus, hamstrings, tibialis anterior, and gastrocnemius), spasticity of lower extremity [modified Ashworth Scale (MAS)], lower limb function [American Spinal Cord Injury Association - Lower Extremity Muscle Function Scale (ASIA-LEMS) score], balance function [Berg Balance Scale (BBS) score], and daily living activities [modified Barthel index (BI)] were compared between the two groups. t test and χ² test were used. Results　After treatment, the stride length [(0.49±0.13) m vs. (0.43±0.11) m], step speed [(0.37±0.07) m/s vs. (0.29±0.06) m/s], step frequency [(1.04±0.34) steps/s vs. (0.86±0.22) steps/s], muscle strength score of quadriceps femoris [(3.05±0.75) points vs. (2.44±0.59) points], gluteus maximus [(3.09±0.81) points vs. (2.64±0.58) points], hamstrings [(1.79±0.48) points vs. (1.41±0.34) points], tibialis anterior [1.37±0.24) points vs. (1.26±0.22) points], and gastrocnemius [(0.42±0.07) points vs. (0.38±0.07) points], and scores of FAC [(3.78±0.48) points vs. (2.42±0.51) points], ASIA-LEMS [(37.95±9.22) points vs. (29.13±8.90) points], BBS [(35.22±5.46) points vs. (28.43±7.08) points], and BI [(88.20±2.65) points vs. (74.34±5.48) points] in the combined group were higher than those in the control group, and the MAS score [(1.49±0.52) points vs. (1.97±0.73) points] was lower than that in the control group (all P<0.05). Conclusion　Electroacupuncture at Jiaji points and lower limb rehabilitation robot combined with kinesio taping effectively improves the gait parameters, lower limb muscle strength, walking and balance functions, reduces the muscle spasms, and enhances the patients' ability to perform daily living activities independently.

Relationships between Th1, Th17, and miR-150 expressions and disease progression in patients with psoriasis vulgaris

Lyu Mingjun, Yao Jiawen, Song Ying

2024, 30(16):  2743-2746.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.022

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Objective　To investigate the relationships between the expression levels of peripheral blood T helper cell (Th)1, Th17, and miR-150 and the progression of psoriasis vulgaris (PV). Methods　A total of 112 PV patients admitted to Baoji People's Hospital from February 2021 to April 2023 were selected as a PV group, and 60 healthy individuals during the same period were selected as a control group. There were 63 males and 49 females in the PV group, aged (46.89±12.35) years. In the normal group, there were 32 males and 28 females, aged (44.36±11.22) years. According to the Psoriasis Area and Severity Index (PASI), the PV group was divided into mild, moderate, and severe groups. The levels of Th1, Th17, and miR-150 in the PV group and the control group were compared, and the levels of Th1, Th17, miR-150, and related cytokines [interleukin (IL)-2, IL-17, and IL-22] in the mild, moderate, and severe groups were compared. The correlations between the expression levels of Th1, Th17, and miR-150 and PASI score were analyzed. The statistical methods used were t test, F test, χ² test, and Pearson correlation analysis. Results　The levels of Th1 and Th17 in the PV group were higher than those in the control group [(22.76±3.21)% vs. (16.83±1.65)%, (3.35±0.68)% vs. (1.25±0.37)%], and the level of miR-150 was lower than that in the control group [(0.80±0.09) vs. (0.99±0.15)], with statistically significant differences (t=13.38, 22.21, and 10.38, all P<0.05). The levels of Th1 and Th17 in the mild group were lower than those in the moderate and severe groups, and the level of miR-150 was higher than those in the moderate and severe groups, with statistically significant differences (F=85.29, 19.41, and 92.93, all P<0.05). The levels of IL-2, IL-17, and IL-22 in the mild group were lower than those in the moderate and severe groups, with statistically significant differences (F=66.03, 42.79, and 23.34, all P<0.05). Pearson correlation analysis showed that the levels of Th1 and Th17 in the peripheral blood of PV patients were positively correlated with PASI score (r=0.771 and 0.514, both P<0.05), and the level of miR-150 was negatively correlated with PASI score (r=-0.703, P<0.05). Conclusion　Increased levels of Th1 and Th17 and decreased miR-150 level in the peripheral blood of PV patients are associated with the severity of PV progression.

Clinical Research

Effect of photodynamic therapy combined with tacrolimus ointment in the treatment of facial rosacea

Han Peipei, Yang Chun, Zhang Ping'an

2024, 30(16):  2747-2751.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.023

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Objective　To investigate the clinical effect of photodynamic therapy combined with tacrolimus ointment in the treatment of facial rosacea and its influence on the levels of serum inflammatory factors. Methods　A total of 78 patients with facial rosacea admitted to the Department of Dermatology and Plastic Surgery, the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from May 2020 to January 2023 were prospectively selected as research objects, and were divided into a control group and an observation group with 39 cases in each group by the random number table method. In the control group, there were 24 males and 15 females, the age was (34.51±3.17) years old, and the course of disease was (2.13±0.39) years. In the observation group, there were 27 males and 12 females, the age was (33.38±3.25) years old, and the course of disease was (2.19±0.37) years. The control group received photodynamic therapy. The observation group received photodynamic therapy combined with tacrolimus ointment (2 times/day, respectively in the morning and evening, for 1 month). Both groups were treated for 1 month. The clinical efficacy (improvement time of skin flushing, telangiectasia, and erythema), levels of serum inflammatory factors [interleukin 1α (IL-1α), IL-8, and tumor necrosis factor α (TNF-α)], skin lesion scores, and Echelle d'Evaluation Clinique des Cicatrices d'acné (ECCA) scores before and after treatment, and adverse reactions were compared between the two groups. Statistical methods used were t test and χ² test. Results　The improvement time of skin flushing, telangiectasia, and erythema in the observation group were shorter than those in the control group [(10.82±1.05) d vs. (14.39±1.70) d, (12.68±1.66) d vs. (15.11±1.00) d, (16.77±1.53) d vs. (19.84±2.81) d], with statistically significant differences (t=11.16, 7.83, and 5.99, all P<0.05). After treatment, the levels of IL-1α, IL-8, and TNF-α, skin lesion score, and ECCA score in the observation group were lower than those in the control group [(4.74±1.11) ng/L vs. (6.43±1.26) ng/L, (23.94±3.11) ng/L vs. (31.30±4.31) ng/L, (27.95±3.45) ng/L vs. (53.13±6.88) ng/L, (3.44±1.04) points vs. (7.50±1.64) points, (26.46±3.08) points vs. (39.92±4.27) points], with statistically significant differences (t=6.29, 8.65, 20.43, 13.06, and 15.97, all P<0.05). The incidence of adverse reactions in the observation group was lower than that in the control group [7.69% (3/39) vs. 25.64% (10/39)], with a statistically significant difference (χ²=4.52, P<0.05). Conclusion　The combined treatment of facial rosacea with photodynamic therapy and tacrolimus ointment effectively improves the skin flushing, telangiectasia, erythema, serum inflammatory factor levels, skin lesions and scar evaluation, and reduces the occurrence of adverse reactions, so as to enhance the clinical efficacy.

Comparison of the preventive effects of fondaparinux sodium and nadroparin calcium on postoperative thrombosis in patients with fractures

Wang Duan, You Ya

2024, 30(16):  2751-2755.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.024

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Objective　To compare the effects of fondaparinux sodium injection and nadroparin calcium injection in preventing thrombotic disease in fracture patients after surgery. Methods　This study was a randomized controlled trial. A total of 130 patients who underwent fracture surgery in Northwest University First Hospital from January 2022 to January 2024 were selected and were divided into two groups with 65 patients in each group by the random number table method. In the fondaparinux sodium group, there were 38 males and 27 females, the age was (52.37±12.71) years old, and the body mass index (BMI) was (26.5±3.2) kg/m². In the nadroparin calcium group, there were 39 males and 26 females, the age was (53.19±13.20) years old, and the BMI was (26.7±3.1) kg/m². In the fondaparinux sodium group, subcutaneous injection of fondaparinux sodium was immediately started after surgery at a dose of 2.5 mg, once a day, lasting for 14 days. In the nadroparin calcium group, subcutaneous injection of nadroparin calcium was given every 12 hours at a dose of 4 100 AXaIU each time for 14 days. The deep vein thrombosis (DVT), pulmonary embolism (PE), swelling and pain of lower limbs, coagulation function indicators, and incidence of adverse reactions were compared between the two groups. Statistical methods used were t test and χ² test. Results　There were no statistically significant differences in the incidences of DVT and PE between the fondaparinux sodium group and the nadroparin calcium group [13.84% (9/65) vs. 10.76% (7/65), 3.07% (2/65) vs. 1.53% (1/65)] (χ²=0.29 and 0.34, both P>0.05). There was no statistically significant difference between the two groups in terms of postoperative swelling and pain in lower limbs (both P>0.05). The prothrombin time (PT) was (9.49±1.21) s in the fondaparinux sodium group and (9.47±1.08) s in the nadroparin calcium group before surgery, and (14.61±1.09) s and (14.27±1.12) s on the 14th day after surgery; the thrombin time (TT) was (9.05±1.20) s in the fondaparinux sodium group and (9.07±1.23) s in the nadroparin calcium group before surgery, and (13.24±1.33) s and (15.22±1.29) s on the 14th day after surgery; the PT and TT after surgery were higher than those before surgery in both groups (all P<0.05). The hypersensitive C-reactive protein (hs-CRP) in the nadroparin calcium group was lower than that in the fondaparinux sodium group on the 14th day after surgery [(13.82±1.77) mg/L vs. (17.71±1.53) mg/L], with a statistically significant difference (t=13.40, P<0.05). The incidence of adverse reactions was 7.69% (5/65) in the fondaparinux sodium group and 10.76% (7/65) in the nadroparin calcium group, with no statistically significant difference (χ²=0.37, P>0.05). Conclusion　Fondaparinux sodium injection and nadroparin calcium injection have similar effects and safety in preventing postoperative thrombotic disease in fracture patients after surgery, which can provide a certain reference for clinical practice.

Application value of intraoperative neuroelectrophysiological monitoring technique in patients undergoing spinal surgery

Yuan Yang, Qi Huaguang, Zhang Xin, Yan Bo, Yan Liang

2024, 30(16):  2756-2760.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.025

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Objective　To investigate the application value of intraoperative neuroelectrophysiological monitoring (IONM) in patients undergoing spinal surgery, in order to provide guidance for improving the effectiveness and safety of spinal surgery. Methods　A total of 200 patients who were planned to undergo spinal surgery were selected from Xi'an Honghui Hospital and Xi'an Daxing Hospital from May 2022 to May 2023. The patients were randomly divided into an intraoperative monitoring group and a reference group with 100 cases in each group by the computer numbered odd-even number method. There were 55 males and 45 females in the intraoperative monitoring group, aged 32-74 (58.92±10.35) years, with a body mass index (BMI) of 18-30 (23.15±2.09) kg/m². There were 57 males and 43 females in the reference group, aged 33-73 (59.14±10.62) years, with a BMI of 18-30 (23.27±2.15) kg/m². Conventional spinal surgery was performed in both groups. IONM technique was applied in the monitoring group, while no IONM technique was applied in the reference group. The perioperative indexes, spinal cord nerve function (evaluation time was 1 day before surgery and 7 days after surgery), serum inflammatory factors (evaluation time was 1 day before surgery and 1 day after surgery), and postoperative complications were compared between the two groups. Statistical methods used were χ² test and t test. Results　The time of postoperative anal exhaust, the time of getting out of bed, and the length of hospital stay in the monitoring group were shorter than those in the reference group [(10.84±1.56) hours vs. (15.20±2.30) hours, (3.84±0.69) days vs. (5.71±0.83) days, (9.47±1.66) days vs. (12.84±2.30) days], with statistically significant differences (t=15.69, 17.33, and 11.88, all P<0.05). The Japanese Orthopaedic Association Evaluation Treatment Score (JOA) of the two groups 7 days after surgery were higher than those 1 day before surgery (both P<0.05), and that in the intraoperative monitoring group was higher than that in the reference group [(25.94±2.30) points vs. (21.50±2.57) points], with a statistically significant difference (t=12.87, P<0.05). The incidence of postoperative complications in the monitoring group was lower than that in the reference group [6.00% (6/100) vs. 20.00% (20/100)], with a statistically significant difference (χ²=8.67, P<0.05). The levels of serum inflammatory factors in the two groups 1 day after surgery were higher than those 1 day before surgery, but those in the monitoring group were lower than those in the reference group (all P<0.05). Conclusion　The application of IONM technology in spinal surgery can promote the patients' early recovery, improve the spinal nerve function, reduce the risk of complications, and alleviate the inflammation.

Efficacy of tirofiban combined with mechanical stent thrombectomy in patients with acute ischemic stroke

Wang Jianghong, Ma Haiyang, Ji Lihua

2024, 30(16):  2760-2765.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.026

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Objective　To explore the effects of tirofiban combined with mechanical stent thrombectomy on vascular recanalization and plasma viscosity in patients with acute ischemic stroke. Methods　A total of 106 patients with acute ischemic stroke admitted to Xingyuan Hospital of Yulin from June 2021 to June 2023 were prospectively selected as the study objects, and were divided into a control group and an observation group with 53 patients in each group by the random number table method. In the control group, there were 29 males and 24 females, aged (62.38±7.24) years, and the course of disease was (2.54±0.56) h. In the observation group, there were 27 males and 26 females, aged (62.63±7.36) years, and the course of disease was (2.48±0.49) h. The control group received mechanical stent thrombectomy; the observation group received intravenous infusion of tirofiban for 24 h after mechanical stent thrombectomy. The vascular recanalization after treatment was recorded in both groups. The coagulation function [thrombin time (TT), prothrombin time (PT), thrombomodulin (TM), and thrombin-activatable fibrinolysis inhibitor (TAFI)], hemorheology, cerebral hemodynamics [cerebral vascular resistance (CVR), mean blood flow (Qmean), and mean blood flow velocity (Vmean)], and neurotrophic factors were compared between the two groups before and 2 weeks after treatment. The neurological function and quality of life were evaluated in both groups before and after treatment. Statistical methods were χ² test and t test. Results　The rate of total vascular recanalization in the observation group after treatment was higher than that in the control group [92.45% (49/53) vs. 66.04% (35/53)], with a statistically significant difference (χ²=11.24, P<0.05). After treatment, the TT, PT, Qmean, and Vmean in the observation group were higher than those in the control group [(17.97±2.61) s vs. (16.29±2.42) s, (14.81±2.30) s vs. (12.76±2.24) s, (8.62±0.95) ml/s vs. (7.74±0.74) ml/s, (19.51±2.84) cm/s vs. (17.08±2.57) cm/s], with statistically significant differences (t=3.44, 4.65, 5.32, and 4.62, all P<0.05). After treatment, the TM, TAFI, and CVR in the observation group were lower than those in the control group [(14.13±2.01) μg/L vs. (18.14±2.23) μg/L, (23.16±3.54) mg/L vs. (40.45±5.97) mg/L, (70.53±7.26) kPa·s/m vs. (79.32±8.34) kPa·s/m], with statistically significant differences (t=9.72, 18.14, and 5.79, all P<0.05). After treatment, the hemorheological indexes of the observation group were lower than those of the control group, and the levels of neurotrophic factors were higher than those of the control group, with statistically significant differences (all P<0.05). The scores of National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) in the observation group after treatment were lower than those in the control group [(5.23±1.01) points vs. (7.10±1.13) points, (1.81±0.35) points vs. (2.29±0.43) points], but the score of Stroke-Specific Quality of Life (SS-QOL) was higher than that in the control group [(163.99±24.26) points vs. (131.52±20.18) points], with statistically significant differences (t=8.98, 6.30, and 7.49, all P<0.05). Conclusion　Mechanical stent thrombectomy combined with tirofiban therapy can improve the vascular revascularization rate and reduce the plasma viscosity in patients with acute ischemic stroke.

Clinical efficacy of Chai-Zhi Ping-Gan decoction combined with Xiao-Pi Kuan-Wei decoction in the treatment of liver-stomach disharmony type chronic gastritis

Zhou Caicai, Su Yinxu

2024, 30(16):  2766-2771.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.027

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Objective　To evaluate the clinical efficacy of Chai-Zhi Ping-Gan decoction combined with Xiao-Pi Kuan-Wei decoction in the treatment of liver-stomach disharmony type chronic gastritis. Methods　A total of 94 patients with liver-stomach disharmony type chronic gastritis admitted to No.215 Hospital of Shaanxi Nuclear Industry from January 2020 to April 2023 were included and were divided into a study group and a control group by stratified random sampling method, with 47 cases in each group. In the control group, there were 24 males and 23 females, aged (44.81±5.62) years, with a duration of disease of (2.60±1.35) years. In the study group, there were 23 males and 24 females, aged (45.20±5.47) years, with a duration of disease of (2.56±1.24) years. The control group received standard quad therapy, esomeprazole magnesium enteric-coated tablets, amoxicillin tablets, furazolidone tablets, and bismuth potassium citrate capsules for 2 weeks, after stopping the use of amoxicillin tablets, furazolidone tablets, and bismuth potassium citrate capsules, and continued to take esomeprazole magnesium enteric-coated tablets for 2 weeks. The study group received Chai-Zhi Ping-Gan decoction combined with Xiao-Pi Kuan-Wei decoction treatment. The treatment course of both groups was 4 weeks. The clinical efficacy, traditional Chinese medicine (TCM) symptom score, gastrointestinal function indexes [somatostatin (SST), gastrin (GAS), motilin (MTL), and vasoactive intestinal peptide (VIP)], inflammatory markers [interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), and tumor necrosis factor α (TNF-α)], disappearance time of abdominal pain, acid reflux, and belching, and eradication rate of Helicobacter pylori (Hp) of the two groups were compared. Statistical methods used were t test and χ² test. Results　The total effective rate of clinical treatment in the study group was higher than that in the control group [97.87% (46/47) vs. 85.11% (40/47)], with a statistically significant difference (χ²=4.919, P=0.027). After 4 weeks of treatment, the total TCM symptom score in the study group was (3.70±0.53), and that in the control group was (5.52±0.79), with a statistically significant difference (t=13.116, P<0.001); the levels of SST, GAS, MTL, and VIP in the study group were (299.60±20.18) ng/L, (81.38±6.15) ng/L, (51.60±6.28) ng/L, and (22.35±2.79) ng/L, and those in the control group were (200.19±17.96) ng/L, (70.18±5.62) ng/L, (43.57±5.65) ng/L, and (26.16±4.15) ng/L, with statistically significant differences (t=25.228, 9.216, 6.517, and 5.223, all P<0.001); the levels of IL-6, hs-CRP, and TNF-α in the study group were (22.52±7.16) µg/L, (10.65±1.46) mg/L, and (1.50±0.28) µg/L, which were lower than those in the control group [(35.51±7.74) µg/L, (15.88±2.18) mg/L, and (1.94±0.34) µg/L], with statistically significant differences (t=8.446, 13.666, and 6.849, all P<0.001). The disappearance time of abdominal pain, acid reflux, and belching in the study group were (3.57±2.02) d, (3.01±1.11) d, and (3.47±1.33) d, and those in the control group were (7.72±3.57) d, (8.07±3.64) d, and (7.02±4.02) d, with statistically significant differences (t=6.936, 9.116, and 5.748, all P<0.001). Within 30 d after withdrawal, the eradication rate of Hp in the study group was higher than that in the control group [95.74% (45/47) vs. 82.95% (39/47)], with a statistically significant difference (χ²=4.029, P=0.045). Conclusion　Chai-Zhi Ping-Gan decoction combined with Xiao-Pi Kuan-Wei decoction shows significant clinical efficacy in the treatment of liver-stomach disharmony type chronic gastritis, effectively improves the patients' symptoms and physiological indicators, and increases the Hp eradication rate, proving to be a safe and effective treatment choice.

Safety and predictive factors of efficacy of polyethylene glycol interferon in the treatment of chronic hepatitis B with low HBeAg level

Gong Xuelian, Wang Pengyan, Li Wei, Tian Hao, Zhang Yan, Sun Yinghua, Chen Xilian

2024, 30(16):  2766-2771.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.028

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Objective　To analyze the safety of Polyethylene glycol interferon α-2b (PEG-IFNα-2b) in the treatment of chronic hepatitis B (CHB) with low hepatitis B e antigen (HBeAg) level, and to explore the related factors to predict the efficacy. Methods　The clinical data of 188 CHB patients with HBeAg positive and quantitative < 50 S/CO who received PEG-IFNα-2b treatment for the first time in Yantai Qishan Hospital from June 2020 to June 2023 were retrospectively analyzed. Among them, there were 137 males and 51 females, aged (35.04±7.13) years, and the weekly dose of PEG-IFNα-2b was (122.45±27.59) µg. The patients receiving nucleoside (acid) analogues (NAs) were given PEG-IFNα-2b once a week in addition to the original treatment; the patients receiving antiviral therapy for the first time were injected with PEG-IFNα-2b only once a week. If HBeAg turned negative before 48 weeks of treatment, the treatment was consolidated for 12 weeks, otherwise, the treatment was extended to 72 to 96 weeks. According to the efficacy of interferon, they were divided into a HBeAg negative group and a HBeAg non-negative group. The incidence of adverse reactions during the treatment was counted, and the baseline characteristics, biochemical indicators, and virological markers were analyzed. t test, χ² test, and rank sum test were used. Multivariate logistic regression analysis was used to analyze the early factors affecting the efficacy of PEG-IFNα-2b, and the receiver operating characteristic curve (ROC) was used to evaluate the predictive efficacy of related influencing factors on the efficacy. Results　Among the 188 patients, 41 cases (21.81%), 58 cases (30.85%), 74 cases (39.36%), and 89 cases (47.34%) achieved HBeAg negative conversion after 12, 24, 48, and 96 weeks of treatment. During the treatment, 151 patients (80.32%) had adverse reactions. After intervention, 119 cases (78.81%) were improved. There were statistically significant differences in administration regimen, hepatitis B surface antigen (HBsAg), HBeAg, hepatitis B virus deoxyribonucleic acid (HBV DNA), HBV pregenomic RNA (pgRNA), hepatitis B core-related antigen (HBcrAg), treatment time, and treatment compliance between the two groups (all P<0.05). Multivariate logistic regression analysis showed that administration regimen (OR=0.536, 95%CI=0.348-0.826), treatment compliance (OR=0.461, 95%CI=0.256-0.831), treatment time (OR=0.546, 95%CI=0.315-0.948), HBeAg (OR=1.876, 95%CI=1.537-2.289), pgRNA (OR=2.070, 95%CI=1.256-3.412), and HBcrAg (OR=1.602, 95%CI=1.134-2.263) were all early influencing factors for the efficacy of PEG-IFN in the treatment of CHB with low HBeAg level (all P<0.05). ROC analysis showed that the above related factors had certain predictive value for the efficacy of PEG-IFNα-2b in the treatment of CHB with low HBeAg level. Conclusion　Administration regimen, treatment compliance, treatment time, HBeAg, pgRNA, and HBcrAg are all early associated factors for the efficacy of PEG-IFNα-2b in the treatment of CHB with low HBeAg level, and have certain value in predicting the efficacy.

Nursing Research

Mediating effect of fatigue between pain and return-to-work self-efficacy in postcardiac surgery patients

Wu Lingzi, Lai Jing, Ma Danying, Wang Wei, Li Li, Huang Fang

2024, 30(16):  2777-2782.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.029

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Objective　To explore the mediator effect of fatigue between pain and return-to-work self-efficacy (RTW-SE) during home-based rehabilitation in postcardiac surgery patients. Methods　The convenience sampling method was used to select 200 patients who were discharged from Guangdong Provincial People's Hospital, South Medical University for more than 3 months after cardiac surgery from January to December 2023. Among them, there were 120 males and 80 females, aged (45.23±11.67) years, the types of disease included 121 cases of valvular heart disease, 11 cases of coronary heart disease, 58 cases of infective endocarditis, and 10 cases of other diseases, and the duration of disease was <1 year in 133 cases, 1-5 years in 33 cases, and >5 years in 34 cases. The patients were surveyed using the Chinese version of the Return-to-Work Self-Efficacy Questionnaire, Global Pain Scale, and Multidimensional Fatigue Inventory. t test, one-way ANOVA, and Pearson correlation analysis were used. Results　The influencing factors of RTW-SE included economic burden (t=4.075, P=0.018), fatigue level (t=12.444, P<0.001), whether to take pain medication (t=2.215, P=0.028), and pain level (t=20.093, P<0.001). The RTW-SE of postcardiac surgery patients was negatively correlated with postoperative pain and fatigue (r=-0.450 and -0.498, both P<0.01), and fatigue was positively correlated with pain level (r=0.521, P<0.01). The results of Bootstrap test revealed that fatigue had a significant negative predictive effect on RTW-SE in postcardiac surgery patients (B=-0.021, t=-5.153, P<0.01), and the mediating effect accounted for 40.91% of the total effect. Conclusions　Fatigue partially mediates pain and RTW-SE in postcardiac surgery patients. Healthcare teams should pay attention to the assessment and intervention of pain and fatigue in cardiac surgery patients, especially those undergoing home-based rehabilitation, and develop targeted interventions to improve their RTW-SE level.

Study on the effect of bowel preparation protocol on the efficiency of colonoscopy based on Bristol stool characters typing

Ren Yangyang, Wang Hong, Gui Ying

2024, 30(16):  2783-2787.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.030

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Objective　To investigate the effect of bowel preparation protocol on the efficiency of colonoscopy based on Bristol stool characters typing. Methods　A randomized controlled trial was conducted on 88 patients scheduled for colonoscopy at the Second Affiliated Hospital of Xi'an Medical University from October 2020 to September 2022. The patients were divided into an observation group (44 cases) and a control group (44 cases) using the random number table method. In the control group, there were 22 males and 22 females, aged (48.71±3.44) years. In the observation group, there were 21 males and 23 females, aged (48.55±3.40) years. The control group received standard bowel preparation protocol, while the observation group received bowel preparation protocol based on Bristol stool characters typing. The success rate of bowel preparation, colon cleanliness [Boston Bowel Preparation Scale (BBPS)], colonoscope insertion time, and overall examination time were compared between the two groups after receiving different bowel preparation schemes. t test and χ² test were used. Results　The qualified rate of bowel preparation in the observation group was higher than that in the control group [79.55% (35/44) vs. 47.73% (21/44)], with a statistically significant difference (χ²=9.625, P=0.002). The BBPS scores for the right, middle, and left colon sections of the observation group were higher than those of the control group [(2.11±0.69) points vs. (1.71±0.52) points, (2.31±0.48) points vs. (1.95±0.57) points, (2.29±0.47) points vs. (1.99±0.67) points], and the colonoscope insertion time and overall examination time were shorter than those of the control group [(11.20±0.85) min vs. (11.62±1.05) min, (15.17±1.24) min vs. (16.28±1.73) min], with statistically significant differences (t=3.071, P=0.003; t=3.205, P=0.002; t=2.432, P=0.017; t=2.062, P=0.042; t=3.459, P=0.001). Conclusion　Bowel preparation protocol based on Bristol stool characters typing significantly optimizes the efficiency and quality of colonoscopy by improving the success rate of bowel preparation and colon cleanliness, as well as reducing the colonoscope insertion time and overall examination time, offering a more effective bowel preparation method for clinical practice.

Application of perioperative nursing guided by knowledge behavior model in patients undergoing colorectal cancer surgery

Guo Xiaohua, Wang Kaili, Wu Yanyan, Hui Hui

2024, 30(16):  2787-2791.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.031

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Objective　To explore the value of perioperative nursing model guided by knowledge behavior model in patients undergoing colorectal cancer surgery. Methods　A total of 90 patients with colorectal cancer surgery admitted to the Department of General Surgery, Xi'an Jiaotong University Affiliated Honghui Hospital from August 2020 to August 2023 were selected by the simple random sampling method, and were divided into two groups by the random number table method, after excluding the patients who fell off ,with 44 cases in each group. In the control group, there were 24 males and 20 females, aged (60.86±7.60) years. In the observation group, there were 26 males and 18 females, aged (60.23±6.08) years. The control group received conventional perioperative nursing, and the observation group received perioperative nursing model guided by knowledge behavior model on the basis of the control group. Both groups were intervened from the next day of admission to the day before discharge. The psychological state and self-management ability on the next day of admission and the day before discharge, efficiency of postoperative functional recovery, and complication rate were compared between the two groups. Statistical methods used were χ² test and t test. Results　There were no statistically significant differences in the score of psychological stress scale or self-management scale of cancer patients on the next day of admission between the two groups (both P>0.05). The scores of psychological stress scale of cancer patients of both groups on the day before discharge were lower than those on the next day of admission, and the scores of self-management scale of cancer patients were higher than those on the next day of admission (all P<0.05). On the day before discharge, the psychological stress scale score of cancer patients in the observation group was lower than that of the control group [(39.68±6.74) points vs. (46.14±5.70) points], and the self-management scale score of cancer patients was higher than that of the control group [(140.39±10.99) points vs. (125.68±11.86) points], with statistically significant differences (t=4.853 and -6.033, both P<0.001). The exhaust time, feeding time, extubation time, and hospital stay in the observation group were shorter than those in the control group [(1.32±0.49) d vs. (1.89±0.51) d, (2.19±0.40) d vs. (2.60±0.48) d, (2.82±0.89) d vs. (3.33±0.83) d, (5.08±1.08) d vs. (5.88±1.22) d], with statistically significant differences (t=5.397, P<0.001; t=4.378, P<0.001; t=2.777, P=0.007; t=3.243, P=0.002). There was no statistically significant difference in the incidence of complications between the two groups (χ²=1.980, P=0.159). Conclusion　The perioperative nursing guided by knowledge behavior model can alleviate the adverse psychological state in patients undergoing colorectal cancer surgery, improve the self-management ability, and promote the postoperative functional recovery.

Application effect of traditional Chinese medicine appropriate technology combined with humanistic care in postoperative intestinal cancer

Tang Wenying, Tang Wenfang, Yang Jianmei, Guo Cuimei

2024, 30(16):  2792-2795.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.032

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Objective　To compare the effects of traditional Chinese medicine (TCM) appropriate technology combined with humanistic care and conventional care in the rehabilitation of patients with intestinal cancer after surgery, so as to provide more effective nursing measures, enrich the clinical nursing theory, and promote the application and development of TCM appropriate technology in modern medical treatment. Methods　This study was a randomized controlled trial. A total of 120 patients with intestinal cancer who received surgical treatment in Jiangmen Wuyi Hospital of Traditional Chinese Medicine from 2021 to 2022 were selected and were randomly divided into two groups. In the control group, there were 33 males and 27 females, aged (56.8±9.2) years, and the course of disease was (14.3±3.7) months. In the observation group, there were 32 males and 28 females, aged (57.2±8.8) years, and the course of disease was (14.1±3.5) months. The observation group used TCM appropriate technology combined with humanistic care, and the control group only used conventional nursing care. The intestinal rehabilitation, postoperative complications, and quality of life score were compared between the two groups. t test and χ² test were used. Results　The postoperative bowel sound recovery time, first exhaust time, and first defecation time were (1.46±0.31) d, (1.85±0.32) d, and (2.47±0.33) d in the observation group, and (2.28±0.33) d, (2.59±0.60) d, and (3.60±0.92) d in the control group, respectively, with statistically significant differences (t=13.992, 8.505, and 8.975, all P<0.001). The total incidence of postoperative complications in the observation group was lower than that in the control group [11.67% (7/60) vs. 30.00% (18/60)], with a statistically significant difference (χ²=6.114, P=0.013). After intervention, the scores of physiological function, physiological role, and mental health in the observation group were higher than those in the control group [(69.90±3.83) points vs. (61.75±5.85) points, (75.38±6.74) points vs. (66.19±5.52) points, (86.00±7.38) points vs. (79.83±10.57) points], with statistically significant differences (t=9.031, 8.167, and 3.706, all P<0.001). Conclusions　TCM appropriate technology combined with humanistic care has significant advantages in the postoperative care of intestinal cancer, which can significantly reduce the incidence of postoperative complications, promote the patients' recovery, and improve their quality of life. It is recommended to widely apply this comprehensive nursing method.

Application research of tracking methodology combined with FMEA in hand hygiene management for nosocomial infection prevention and control

Guo Jianfen, Li Xiaojun, Yan Ping, Liu Chunxiao, Duan Yan

2024, 30(16):  2796-2800.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.033

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Objective　To investigate the application effect of tracking methodology combined with failure mode and effect analysis (FMEA) in hand hygiene management for nosocomial infection prevention and control in the post-epidemic era. Methods　A hand hygiene management tracking and inspection team was set up to track and inspect the hand hygiene management process using tracking methods such as data review, on-site interviews, and field inspections. A total of 100 cases of medical personnel who were directly involved in patient diagnosis and treatment operations in Guangdong Second TCM Hospital from January 2022 to June 2023 were selected and were divided into a control group (from January 2022 to September 2022, pre-implementation) and an observation group (from October 2022 to June 2023, post-implementation) with 50 cases in each group. In the control group, there were 31 males and 19 females, aged (31.88±4.56) years, with working duration of (4.72±1.73) years. In the observation group, there were 29 males and 21 females, aged (30.24±6.08) years, with working duration of (4.84±1.63) years. FMEA was applied to carry out risk assessment, and thereafter corresponding interventions were carried out. A hand hygiene tracking and inspection team was established to determine the tracking and inspection process. The members of the inspection team conducted the assessment and inspection on the hand hygiene condition according to the process and recorded the problems found in the inspection. The control group was conducted by means of no intervention and no training before the inspection and random check. The observation group first conducted intensive on-site hand hygiene knowledge training (the training contents included hand hygiene facility requirements, hand hygiene principles, 5 opportunities for hand washing, hand hygiene and nosocomial infection related knowledge, and watching seven-step washing manipulation video, etc.), and then assessed the members after the training. The differences in hand hygiene compliance, correct rate of hand hygiene, awareness rate of hand hygiene knowledge, and qualification rate of hand hygiene disinfection effect monitoring were compared between the two groups. t test and χ² test were used. Results　Hand hygiene assessment, hand hygiene practices, and hand hygiene training were important failure mode risk factors for hand hygiene management. In the control group, the compliance rates of the medical staff before contact with patients, after contact with patients, after contact with body fluids/blood, after contact with surrounding environment, and before aseptic manipulation were 64.0% (32/50), 72.0% (36/50), 84.0% (42/50), 58.0% (29/50), and 80.0% (40/50), and those in the observation group were 72.0% (36/50), 82.0% (41/50), 100.0% (50/50), 90.0% (45/50), and 100.0% (50/50); there were statistically significant differences in the compliance rate between the two groups after contact with body fluids/blood, after contact with surrounding environment, and before aseptic manipulation (χ²=8.696, P=0.003; χ²=13.306, P=0.001; χ²=11.111, P=0.001). The correct rate of hand hygiene, awareness rate of hand hygiene knowledge, and qualification rate of hand hygiene disinfection effect monitoring in the control group were 74.0% (37/50), 80.0% (40/50), and 82.0% (41/50), and those in the observation group were 98.0% (49/50), 100.0% (50/50), and 98.0% (49/50), with statistically significant differences (χ²=11.960, P=0.001; χ²=11.111, P=0.001; χ²=7.111, P=0.008). Conclusion　The application of tracking methodology combined with FMEA can effectively enhance the efficiency of hand hygiene management, warranting further promotion and implementation.

Evaluation of the effect of pain management-oriented rehabilitation nursing after laparoscopic cholecystectomy

Liu Shouzhen, Xia Enqin, Li Qingna

2024, 30(16):  2801-2805.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.034

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Objective　To explore the effects of pain management-oriented rehabilitation nursing on pain control and prognosis in patients undergoing laparoscopic cholecystectomy for acute cholelithiasis. Methods　This study was a randomized controlled trial. A total of 113 patients undergoing laparoscopic cholecystectomy for acute cholelithiasis in Ankang Hospital of Traditional Chinese Medicine from May 2022 to May 2023 were selected and were randomly divided into a control group (56 cases) and an observation group (57 cases) based on their bed numbers. In the control group, there were 30 males and 26 females, aged (59.38±4.02) years, with a course of disease of (5.12±1.24) h. In the observation group, there were 35 males and 22 females, aged (59.44±4.07) years, with a course of disease of (5.10±1.22) h. The control group received standard care, while the observation group received pain management-oriented rehabilitation nursing. The postoperative recovery process (anal exhaust time, liquid feeding time, first ambulation time, and length of hospital stay), pain control at different postoperative time points [Visual Analogue Scale (VAS)], complication rate (incision infection, arrhythmia, adhesive intestinal obstruction, and lower limb thrombosis), and prognosis [Generic Quality of Life Inventory (GQOLI-74)] were compared between the two groups. Statistical methods used were t test and χ² test. Results　The anal exhaust time, liquid feeding time, first ambulation time, and length of hospital stay in the observation group were (14.45±2.01) h, (9.74±1.27) h, (1.06±0.34) d, and (7.80±1.03) d, which were shorter than those in the control group [(18.64±2.17) h, (12.58±1.69) h, (2.37±0.76) d, and (11.54±1.59) d], with statistically significant differences (t=10.664, 10.110, 11.862, and 14.866, all P<0.001). The pain scores of the observation group 24 h, 48 h, and 72 h after surgery were (6.03±0.97), (4.66±0.69), and (3.13±0.63) points, which were lower than those of the control group [(7.24±1.26), (5.98±0.95), and (4.55±1.02) points], with statistically significant differences (t=5.726, 8.439, and 8.921, all P<0.001). The complication rate of the observation group was lower than that of the control group [12.28% (7/57) vs. 28.57% (16/56)], with a statistically significant difference (χ²=4.624, P=0.032). The scores of social function, body function, material life, and psychological function of the GQOLI-74 in the observation group were (21.35±2.54), (22.24±2.40), (23.51±2.44), and (22.12±2.77) points, which were higher than those in the control group [(17.41±2.26), (16.05±2.21), (18.35±2.46), and (19.29±2.23) points], with statistically significant differences (t=8.706, 14.256, 11.194, and 5.976, all P<0.001). Conclusion　The application of pain management-oriented rehabilitation nursing in patients undergoing laparoscopic cholecystectomy for acute cholelithiasis can effectively improve the pain control, enhance the postoperative recovery process and quality of life, and reduce the incidence of complications.

Risk factors and intervention strategies of early postoperative complications in elderly patients with gastric cancer undergoing minimally invasive radical gastrectomy

Yang Liping, Si Yi, Ren Guangzhuo

2024, 30(16):  2806-2810.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.035

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Objective　To investigate the potential risk factors and intervention strategies for early postoperative complications in elderly patients with gastric cancer treated with minimally invasive radical gastrectomy. Methods　A retrospective analysis was conducted on 423 elderly individuals suffering from gastric cancer who underwent minimally invasive radical gastrectomy in Baoji Hospital of Traditional Chinese Medicine between May 2019 and September 2023. The patients were divided into two groups: a complication group consisting of 115 cases and a non-complication group consisting of 308 cases based on whether the complications occurred in the early stage (within 1 week after surgery). The clinical data of elderly patients with gastric cancer were analyzed, the risk factors related to early postoperative complications in elderly patients with gastric cancer were analyzed by univariate analysis (t test and χ² test) and logistic regression analysis, and the receiver operating characteristic curve (ROC) prediction model was constructed accordingly. Results　In the complication group, there were 78 males and 37 females, aged (88.08±2.85) years, with a body mass index (BMI) of (22.77±2.23) kg/m², tumor length ≥4 cm in 71 cases and <4 cm in 44 cases. In the non-complication group, there were 185 males and 123 females, aged (83.46±2.07) years, with a BMI of (22.81±2.21) kg/m², tumor length ≥4 cm in 176 cases and <4 cm in 132 cases. Univariate analysis showed that the age, preoperative comorbidities, intraoperative blood loss, vascular invasion, and serum prealbumin (PA) level in the complication group were significantly different from those in the non-complication group (all P<0.05). Multivariate logistic regression analysis showed that the independent risk factors of early postoperative complications in elderly patients with gastric cancer were older age (OR=1.514, 95%CI = 1.167-1.965), preoperative comorbidities (OR=1.766, 95%CI = 1.322-2.361), intraoperative blood loss ≥200 ml (OR=1.501, 95%CI = 1.116-2.018), vascular invasion (OR=1.395, 95%CI = 1.090-1.786), and low serum PA level (OR=1.484, 95%CI = 1.148-1.919) (all P<0.05). ROC analysis results showed that when logit (P) >12.91, the area under the curve (AUC) value was 0.762 (0.687-0.826), the sensitivity was 79.65%, and the specificity was 61.90%. Conclusions　Older age, preoperative comorbidities, intraoperative blood loss ≥ 200 ml, vascular invasion, and low serum PA level are independent risk factors for early postoperative complications in elderly patients with gastric cancer undergoing minimally invasive radical gastrectomy. Clinical interventions can be targeted for elderly patients with gastric cancer undergoing minimally invasive radical gastrectomy with the above characteristics to reduce the incidence of early postoperative complications.

Effects of focused solution mode on mental resilience and quality of life in diabetic retinopathy patients undergoing vitrectomy

Wang Jing, Zhao Xin, Tao Yuan, Nie Qiaoli

2024, 30(16):  2811-2816.  DOI: 10.3760/cma.j.issn.1007-1245.2024.16.036

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Objective　To investigate the effects of focused solution mode on the level of mindfulness, mental resilience, and quality of life in diabetic retinopathy patients undergoing vitrectomy. Methods　A total of 158 diabetic retinopathy patients undergoing vitrectomy admitted to Jinan Second People's Hospital from February 2023 to January 2024 were prospectively selected as the study objects, and were divided into an observation group and a control group by the random number table method, with 79 cases in each group. In the control group, there were 49 males and 30 females, aged (58.06±6.67) years, and the course of disease was (3.91±0.69) d. In the observation group, there were 47 males and 32 females, aged (58.85±7.35) years, and the course of disease was (3.68±0.90) d. The control group received routine vitrectomy nursing intervention for diabetic retinopathy during hospitalization, and the observation group received focused solution mode intervention based on routine nursing. The awareness, mental resilience, mental capital, and quality of life of the two groups were observed and compared before and after intervention. t test was used for the measurement data and χ² test was used for the count data. Results　After intervention, the attention score (66.77±11.12), awareness score (68.15±10.17), behavioral awareness score (65.23±11.27), emotional response score (66.23±10.26), resilience scale self-reliance score (76.25±5.26), and resilience scale optimism score (84.21±4.62) in the observation group were higher than those in the control group [(50.09±10.04), (50.23±8.18), (52.33±9.64), (56.73±8.64), (69.31±5.71), and (79.55±5.31)], with statistically significant differences (t=9.896, 12.204, 7.731, 6.295, 7.945, and 5.885, all P<0.001). The scores of self-efficacy (59.35±6.91), resilience (69.15±3.14), optimism (70.25±6.42), hope (80.21±6.16) of mental capital scale in the observation group were higher than those in the control group [(53.83±7.27), (60.12±3.10), (62.31±6.73), and (69.55±6.33)]; the scores of symptom and visual function (87.27±9.35), physical function (79.15±5.11), social activity (69.35±6.91), mental psychology (69.15±7.16) of quality of life scale in the observation group were higher than those in the control group [(69.16±6.75), (73.13±7.36), (61.83±7.37), and (65.12±6.18)], with statistically significant differences (t=4.892, 18.190, 7.588, 10.727, 13.959, 5.972, 6.616, and 3.787, all P<0.001). Conclusion　The focused solution mode intervention can significantly improve the perception, mental resilience, mental capital, and quality of life in diabetic retinopathy patients undergoing vitrectomy, and can improve the rehabilitation effect.