Table of Content

01 September 2024, Volume 30 Issue 17

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New Medical Advances

Role of popularizing concept of chronic disease management in medical education

Xu Xueyi, Xiao Bingjie, Lin Yujie, Jie Xina, Su Jingxu, Hu Xiaoxuan, Lu Zuochen, Fu Lizhe, Tang Fang, Wu Yifan, Lu Fuhua

2024, 30(17):  2817-2820.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.001

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With the rising incidence of chronic diseases, chronic diseases have become one of the challenges of global health, and chronic disease management has consequently become a public focus. This article mainly describes the concept of chronic disease management and related research progress, discusses the importance of popularizing the concept of chronic disease management in medical education and the challenges it faces, and puts forward suggestions in the design and development of the medical education curriculum for chronic disease management, so as to provide references for accelerating the construction of the talent team for chronic disease management in China.

Colunm of Stomatology

Relationship between peripheral blood TNFα/NF-κB/NEAT1 signaling pathway and chronic pain in patients with temporomandibular joint disorder

Gan Mingjing, Wu Aizhen, Qiu Qianqian, Yu Qiaolong, Chen Xin

2024, 30(17):  2822-2827.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.002

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Objective　To investigate the relationship between the peripheral blood tumor necrosis factor alpha (TNFα)/nuclear factor-κB (NF-κB)/long-stranded noncoding RNA nuclear enriched transcript 1 (NEAT1) signaling pathway and chronic pain in patients with temporomandibular disorder (TMD). Methods　Eighty-two patients with TMD admitted to Department of Stomatology, 73rd Group Army Hospital of People's Liberation Army of China from October 2022 to October 2023 were selected as a study group, including 35 males and 47 females who were (33.69± 9.84) years old. According to the pain scores, the patients were divided into a mild pain group (36 cases), a moderated pain group (27 cases), and a severe pain group (19 cases). The levels of TNF-α mRNA, NF-κB mRNA, and NEAT1 mRNA in peripheral blood were compared between the 3 groups. The correlations of the levels of TNF-α mRNA, NF-κB mRNA, and NEAT1 mRNA with the score of Visual Analogue Scale (VAS) were analyzed by the Pearson analysis. Fifty-one healthy oral examinees during the same period were selected as a control group, including 29 males and 22 females who were (34.25±7.14) years old. The baseline data and levels of TNF-α, NF-κB, and NEAT1 were compared between the study group and the control group. t test, χ² test, and analysis of variance were used. The relationship of levels of TNF-α mRNA, NF-κB mRNA, and NEAT1 mRNA with TMD was analyzed by multivariate logistic regression analysis. Results　The levels of TNF-α mRNA, NF-κB mRNA, and NEAT1 mRNA in the severe pain group were (0.93±0.11), (0.88±0.12), and (3.14±0.57); the levels in the moderate pain group were (0.76±0.14), (0.64±0.17), and (2.63±0.66); the levels in the mild pain group were (0.61±0.16), (0.53±0.15), and (1.96±0.59); there were statistical differences (F=31.672, 33.514, and 24.976; all P<0.05). The Pearson correlation analysis showed that the levels of TNF-α mRNA, NF-κB mRNA, and NEAT1 mRNA were positively correlated with the score of VAS (r=0.273, 0.260, and 0.245; all P<0.05). The proportions of the ones with psychological problems and poor sleep quality and the levels of TNF-α mRNA, NF-κB mRNA, and NEAT1 mRNA in the study group were higher than those in the control group [47.56% (39/82) vs. 21.57% (11/51), 69.51% (57/82) vs. 39.22% (20/51), (0.73±0.14) vs. (0.36±0.08), (0.65±0.15) vs. (0.28±0.07), and (2.45±0.61) vs. (1.17±0.18)], with statistical differences (χ²=9.055 and 11.840; t=17.193, 16.515, and 14.578; all P<0.05). The multivariate logistic regression analysis showed that psychological problems, sleep quality, TNFα mRNA, NF-κB mRNA, and NEAT1 mRNA were associated with TMD (all P<0.05). Conclusion　The peripheral blood TNFα/NF-κB/NEAT1 signaling pathway is positively correlated with pain level in patients with TMD, and may be involved in the development of TMD.

Effects of glass fiber post-core crowns and cobalt-chromium alloy post-core crowns in restoration of molar teeth residual roots and crowns

Zhang Nan, Lan Ting

2024, 30(17):  2828-2832.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.003

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Objective　To evaluate the effects of glass fiber post-core crowns versus cobalt-chromium alloy post-core crowns in the restoration of molar teeth with residual roots and crowns. Methods　One hundred and two patients with residual roots and crowns of molars treated at Shangluo Traditional Chinese Medicine Hospital from January 2021 to January 2023 were selected for the randomized controlled trial. They were divided into a control group and an observation group by the random number table method, with 51 cases in each group. There were 28 males and 23 females in the control group; they were (44.26±4.36) years old. There were 29 males and 22 females in the observation group; they were (44.38±4.47) years old. The control group received cobalt-chromium alloy post and core restorations, and the observation group received glass fiber post and core restorations. After one year's follow-up, the restoration effects, restoration success rates, periodontal indicators [sulcus bleeding index (SBI), gingival index (GI), and plaque index (PI)], masticatory efficiencies, occlusal function, levels of IL-6 and TNF-α in gingival crevicular fluid, and adverse reactions were compared between the two groups by χ² and t tests. Results　The Likert score and restoration success rate in the observation group were higher than those in the control group [25.02±1.69) vs. (22.16±1.31) and 96.08% (49/51) vs. 80.39% (41/51)], with statistical differences (t=9.552; χ²=6.044; both P<0.05). Before the restoration, there were no statistical differences in periodontal index, masticatory efficiency, occlusal function, and levels of IL-6 and TNF-α between the two groups (all P>0.05). After the restoration, the SBI, GI, PI, and levels of IL-6 and TNF-α in the observation group were lower than those in the control group [(0.61±0.19) vs. (0.98±0.26), (0.64±0.18) vs. (1.45±0.39), (0.82±0.21) vs. (1.38±0.25), (48.46±4.92) ng/L vs. (54.69±5.64) ng/L, and (4.69±1.02) ng/L vs. (5.75±1.14) ng/L], with statistical differences (t=8.205, 13.467, 12.249, 5.945, and 4.949; all P<0.05). The masticatory efficiency and occlusal function in the observation group were higher than those in the control group [(91.58±7.89)% vs. (86.25±7.65)% and (147.11±13.58) 1bs vs. (136.58±12.05) 1bs], with statistical differences (t=3.464 and 4.142; both P<0.05). The incidence of adverse reactions in the observation group was lower than that in the control group [5.88% (3/51) vs. 19.61% (10/51)], with a statistical difference (χ²=4.320; P<0.05). Conclusions　Glass fiber post-core crowns show better aesthetic results, periodontal health indicators, masticatory efficiency, and occlusal function compared to cobalt-chromium post-core crowns. They also effectively reduce the levels of IL-6 and TNF-α in gingival crevicular fluid and decrease the incidence of adverse reactions.

Correlation of Th1/Th2 and TNF-α levels with severity of chronic periodontitis in patients with type 2 diabetes mellitus

Ren Chan, Zhang Wei

2024, 30(17):  2833-2838.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.004

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Objective　To explore the correlation of Th1/Th2 and tumor necrosis factor alpha (TNF-α) levels with the severity of chronic periodontitis (CP) in patients with type 2 diabetes mellitus (T2DM). Methods　This retrospective analysis included 90 patients with T2DM and CP (a T2DM+CP group), 60 patients with CP (a CP group), and 60 healthy examinees (a control group) from Yulin Traditional Chinese Medicine Hospital between January and December 2023. There were 48 males and 42 females in the T2DM+CP group; they were (52.35±5.78) years old; their disease course was (3.44±0.91) years. There were 33 males and 27 females in the CP group; they were (52.63±5.69) years old; their disease course was (3.56±1.07) years. There were 31 males and 29 females in the control group; they were (52.58±5.64) years old. The patients with T2DM and CP were categorized into a mild group (33 cases), a moderate group (30 cases), and a severe group (27 cases) based on the periodontal assessment standards. Their general data were collected. The periodontal indicators [probing depth (PD), attachment loss (AL), gingival index (GI), and plaque index (PLI)], inflammatory markers [interferon gamma (INF-γ), interleukin 4 (IL-4), and tumor necrosis factor alpha (TNF-α)], and Th1/Th2 cell ratios were compared. The Spearman's correlation analysis was employed to assess the correlation of Th1/Th2 and TNF-α with the severity of periodontitis in the T2DM+CP group. The receiver operating characteristic curve (ROC) was used to evaluate the diagnostic values of Th1/Th2 and TNF-α for CP + T2DM. t, F, and χ² tests were applied. Results　There were no statistical differences in gender, age, body mass index, and CP course between the three groups (all P>0.05). The levels of INF-γ in the CP+T2DM group and the CP group were lower than that in the control group [(29.25±8.46) μg/L and (51.45±16.25) μg/L vs. (90.13±29.85) μg/L]; the PD, AL, GI, PLI, levels of IL-4 and TNF-α, and Th1/Th2 ratios in the CP+T2DM group and the CP group were higher than those in the control group [(6.38±1.23) mm and (4.82±0.64) mm vs. (1.93±0.52) mm, (5.79±0.82) mm and (3.02±1.06) mm vs. (0.42±0.11) mm, (1.63±0.25) and (1.13±0.18) vs. (0.52±0.14), (1.25±0.14) and (1.04±0.12) vs. (0.73±0.05), (25.84±3.72) μg/L and (20.04±5.18) μg/L vs. (14.38±2.16) μg/L, (67.88±22.22)μg/L and (56.47±15.03) μg/L vs. (25.17±8.42) μg/L, and (2.28±0.68) and (1.33±0.41) vs. (0.41±0.13)]; there were statistical differences (F=185.595, 423.411, 860.564, 533.540, 367.510, 160.486, 112.925, and 253.712; all P<0.05). The Th1/Th2 ratio and TNF-α level in the mild group, the moderate group, and the severe group were (1.47±0.21), (2.61±0.34), and (2.89±0.26) and (46.82±5.93) μg/L, (63.73±7.32) μg/L, and (98.24±6.89) μg/L, with statistical differences (F=233.226 and 436.772; both P<0.05). The Spearman's correlation analysis showed that Th1/Th2 and TNF-α were positively correlated wtih the severity of periodontitis (r=0.852 and 0.914; both P<0.05). The areas under the curves (AUC) of Th1/Th2 and TNF-α were 0.866 and 0.631; the sensitivities were 63.3% (57/90) and 57.8% (52/90); the specificities were 98.3% (59/60) and 63.3% (38/60). The AUC of the combination was 0.881; the sensitivity was 73.3% (66/90); the specificity was 88.3% (53/60). Conclusions　In patients with T2DM+CP, Th1/Th2 ratio and TNF-α are significantly positively correlated with the severity of periodontitis. Their combination provides good diagnostic efficacy for the disease.

Effect of afentanil combined with local nerve block in comfortable tooth extraction for children with dental phobia

Wang Jialiang, He Zhuan, Xie Yidun

2024, 30(17):  2838-2843.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.005

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Objective　To investigate the effect of afentanil combined with local nerve block in comfortable tooth extraction for children with dental phobia. Methods　A total of 116 children with dental phobia admitted to Xi 'an Third Hospital from July 2021 to October 2023 were selected for the randomized controlled trial, and were divided into a study group and a control group by the random number table method, with 58 cases in each group. There were 21 males and 37 females in the control group; they were (7.26±0.83) years old. There were 24 males and 34 females in the study group; they were (7.42±0.78) years old. The control group took local nerve block, and the study group afentanil combined local nerve block. The general conditions of operation (operation time, discharge time, anesthesia time, time remove laryngeal mask, and sevoflurane dosage), postoperative pain [evaluated by Visual Analogue Scale (VAS)], hemodynamics [mean artery pressure (MAP) and heart rate (HR)], stress response [cortisol (COR) and adrenocor ticotropic hormore (ACTH)], operator satisfaction, the use rate of vasoactive drugs, and incidences of restlessness and adverse reactions during recovery were compared between the two groups by t and χ² tests. Results　There were no differences in the operation time, discharge time, use rate of vasoactive drugs, and incidences of restlessness and adverse reactions between the two groups (all P>0.05). The anesthesia time in the study group was longer than that in the control group [(49.89±8.20) min vs. (42.14±7.68) min] (P<0.05); the time to remove laryngeal mask in the study group was shorter than that in the control group [(5.41±1.76) min vs. (7.20±2.45) min]; the sevoflurane dosage in the study group was lower than that in the control group [(36.11±4.63) ml vs. (42.27±5.81) ml]; there were statistical differences (t=5.253, 4.519, and 6.315; all P<0.05). One, 2, and 3 h after the surgery, the scores of VAS in the study group were lower than those in the control group [(2.72±0.49) vs. (3.45±0.56), (1.86±0.32) vs. (2.37±0.41), and (0.98±0.17) vs. (1.45±0.26)], with statistical differences (t=7.471, 7.467, and 11.523; all P<0.05). At T0, there were no statistical differences in the MAP and HR between the two groups (both P>0.05); at T1 and T2, the MAP and HR in the study group were lower than those in the control group, with statistical differences (t=3.260, 3.658, 2.511, and 3.581; all P<0.05). Before the surgery, there were no statistical differences in the serum levels of ACTH and COR between the two groups (both P>0.05); 2 h after the surgery, the serum levels of ACTH and COR in the study group were lower than those in the control group [(44.05±6.19) ng/L vs. (54.18±7.26) ng/L and (182.45±22.04) ng/L vs. (216.06±25.73) ng/L], with statistical differences (t=8.086 and 7.555; both P<0.05). The score of operator satisfaction in the study group was higher than that in the control group [(3.52±0.20) vs. (3.08±0.14)], with a statistical difference (t=13.726; P<0.05). The incidence of restlessness in the study group was lower than that in the control group [32.76% (19/58) vs. 51.72% (30/58)], with a statistical difference (χ²=4.275; P<0.05). Conclusion　Afentanil combined with local nerve block has analgesic effect in comfortable tooth extraction for children with dental phobia, can reduce stress response, help maintain hemodynamic stability, improve the operator satisfaction, reduce sevoflurane dosage, and is safe and reliable.

Relationship of Th1/Th2 and M1-M2 with severity and prognosis of patients with type 2 diabetes mellitus complicated with chronic periodontitis

Ding Lili, Wang Huan, Miao Di, Liu Yuan

2024, 30(17):  2844-2849.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.006

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Objective　To explore the imbalance of Th1/Th2 cell-mediated immunity and the changes in macrophage M1-M2 polarization in patients with type 2 diabetes mellitus (T2DM) complicated with chronic periodontitis (CP) and their relationship with the degree of periodontal lesions and treatment prognosis. Methods　Eighty patients with T2DM and CP who were treated at Department of Stomatology, Baoji People's Hospital from January 2022 to June 2023 were enrolled in this prospective study. Based on the severity of CP, the patients were divided into a mild group (57 cases) and a moderate-severe group (23 cases). According to the prognosis after the treatment, they were divided into a good prognosis group (33 cases) and a poor prognosis group (47 cases). There were 28 males and 29 females in the mild group; they were (48.00±6.03) years old; their T2DM duration was (3.54±1.15) years; their CP duration was (12.54±4.65) months. There were 11 males and 12 females in the moderate-severe group; they were (50.48±6.65) years old; their T2DM duration was (3.79±1.55) years; their CP duration was (12.71±4.76) months. The flow cytometry was used to assess the ratio of Th1/Th2 cells. The real-time quantitative PCR was employed to analyze the expression of M1 and M2 macrophage markers in periodontal tissue. The Pearson correlation analysis was performed to evaluate the correlations of Th1/Th2 ratio and M1/M2 polarization with the clinical parameters of periodontitis and prognosis. t and χ² tests were used. Results　The proportion of Th1 cells, Th1/Th2, and levels of tumor necrosis factor (TNF) -α, interleukin (IL) -2, IL-4, IL-6, IL-10, IL-1β, IL-12, IL-17, TNF-β, inducible nitric oxide synthase (iNOS), signal transducer and activator of transcription 6 (STAT6) mRNA, and arginase 1 (Arg1) mRNA in the moderate-severe group were higher than those in the mild group [(2.62±0.53)% vs. (1.62±0.41)%, (2.47±0.53) vs. (1.21±0.27), (51.83±6.25) ng/L vs. (36.74±5.47) ng/L, (27.54±50.00) μg/L vs. (14.58±4.65) μg/L, (72.63±8.95) ng/L vs. (46.68±6.57) ng/L, (41.85±2.61) ng/L vs. (37.08±3.54) ng/L, (4.76±1.13) ng/L vs. (3.87±1.16) ng/L, (23.10±5.86) μg/L vs. (16.78±2.54) μg/L, (11.76±5.37) ng/L vs. (9.16±2.16) ng/L, (12.78±2.14) μg/L vs. (10.54±1.63) μg/L, (1 370.0±160.0) μg/L vs. (910.0±140.0) μg/L, (800.0±180.0) μg/L vs. (260.0±110.0) μg/L, (930.0±190.0) μg/L vs. (430.0±110.0) μg/L, (760.0±130.0) μg/L vs. (560.0±90.0) μg/L, and (710.0±120.0) μg/L vs. (490.0±80.0) μg/L]; the proportion of Th2 cells and the levels of interferon γ (IFN-γ) and IL-23 in the in the moderate-severe group were lower than those in the mild group [(1.06±0.37)% vs. (1.34±0.41)%, (4.21±0.65)ng/L vs. (4.85±0.67)ng/L, and (6.84±0.83) ng/L vs. (14.65±1.81) ng/L]; there were statistical differences (t=9.05, 14.06, 10.71, 10.69, 14.35, 5.84, 3.12, 6.76, 3.10, 5.07, 12.76, 16.37, 14.73, 7.87, 9.57, 2.84, 3.95, and 19.81; all P<0.05). The severity of CP positively correlated with Th1, Th1/Th2, TNF-α, IL-2, IL-4, IL-6, IL-10, IL-1β, IL-12, IL-17, IL-23, TNF-β, STAT1, iNOS, STAT6 mRNA, and Arg1 mRNA (all P<0.01), and negatively with Th2, INF-γ, and IL-23 (all P<0.01). The proportion of Th1 cells, Th1/Th2, and levels of TNF-α and IL-1β in the good prognosis group were lower than those in the poor prognosis group [(1.31±0.21)% vs. (2.62±0.75)%, (0.94±0.21) vs. (2.70±0.48), (34.81±4.51) ng/L vs. (55.23±7.31) ng/L, (15.84±2.89) μg/L vs. (24.56±4.74) μg/L]; the proportion of Th2 cells in the good prognosis group was higher than that in the poor prognosis group [(1.39±0.24)% vs. (0.97±0.37)%]; there were statistical differences (t=9.75, 19.74, 14.24, 9.40, and 5.72; all P<0.05). Conclusion　The imbalance of Th1/Th2 and changes in M1-M2 polarization status in patients with T2DM and CP are closely related to the degree of periodontal lesions and treatment prognosis, indicating that modulating immune responses may have potential clinical significance in improving periodontal lesions and prognosis of patients with T2DM.

Treatises

Construction of an LASSO risk model for severe hypertriglyceridemic acute pancreatitis

Feng Shichuan, Zhang Ling, Du Baoli, Shen Hu, Wan Jinyi, Zhang Yixin, Zheng Rong, Li Qiuyi

2024, 30(17):  2850-2855.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.007

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Objective　To construct a model to predict the risk of severe hypertriglyceridemic acute pancreatitis (sHTGAP) by the LASSO regression model. Methods　The clinical data of 315 patients with hypertriglyceridemic acute pancreatitis (HTGAP) treated in Hanzhong Central Hospital between January 2019 and March 2022 were retrospectively analyzed. The patients were divided into an sHTGAP group (94 cases), including 59 males and 35 females who were (37.51±7.08) years old, and a non-sHTGAP group (221 cases), including 135 males and 86 females who were (41.87±6.28) years old, according to the disease severity. The clinical data and laboratory indicators were compared between the two groups. t test, rank sum test, and χ² test were applied. The LASSO regression model was used to screen the characteristic factors and construct the risk score model. Results　There were no statistical differences in gender, diabetes history, hypertension, smoking history, drinking history, and diet between the two groups (all P>0.05). The scores of Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) and Modified CT Severity Index (MCTSI), white blood cell count (WBC), C-reactive protein (CRP), glucose (Glu), and triglycerides (TG) in the sHTGAP group were higher than those in the non-sHTGAP group [9.00 (7.00, 11.00) vs. 4.00 (3.00, 6.00), 6.00 (5.00, 7.00) vs. 4.00 (3.00, 6.00), 12.22 (9.89, 14.34)×10⁹/L vs. 10.44 (8.58, 12.39)×10⁹/L, 164.25 (128.32, 217.58) mg/L vs. 56.15 (37.13, 76.95) mg/L, (12.16±2.99) mmol vs. (6.27±2.42) mmol, and (14.05±5.10) mmol/L vs. (11.46±4.78) mmol/L]; the hospitalization time in the sHTGAP group was shorter than that in the non-sHTGAP group [13.00 (8.00, 16.00) d vs. 9.00 (5.00, 13.00) d]; the calcium ion (Ca²⁺) in the sHTGAP group were lower than that in the non-sHTGAP group [(2.12±0.09) mmol/L vs. (2.17±0.09) mmol/L]; there were statistical differences (all P<0.05). The area under the curve (AUC) of the risk score model constructed by the LASSO regression was 0.998; it was better than any single indicator. Conclusions　APACHE Ⅱ score, MCTSI score, hospitalization time, WBC, and levels of CRP, Glu, Ca²⁺, and TG are closely related to the occurrence and severity of sHTGAP. Comprehensive evaluation of these indicators is of great significance to improve the prognosis of patients with sHTGAP.

Development of a machine learning model for predicting intradialytic hypotension

Luo Yehua, Zhou Hongming, Guo Qi, Dong Jingjing, Zhang Juanjuan, Yin Lianghong

2024, 30(17):  2856-2862.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.008

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Objective　To develop a predictive model for intradialytic hypotension (IDH) using machine learning techniques. Methods　A retrospective analysis was conducted on the demographic data and dialysis records of the patients who underwent hemodialysis at Fuding City Hospital between October 2020 and August 2022. The variables included age, gender, pre-dialysis blood pressure, and pre-dialysis weight. Three distinct machine learning algorithms, light Gradient Boosting Machine (LGBM), support vector machine (SVM), and TabNet, were employed to construct two predictive models, designated as IDH-1 and IDH-2. The IDH-1 model integrates real-time pre-dialysis data with historical dialysis data averages to predict IDH risk instantaneously. Conversely, the IDH-2 model incorporates comprehensive current dialysis data along with historical averages to forecast IDH risk during the subsequent dialysis session. The areas under the curves (AUC), accurate rates, and F1 scores by the three algorithms were compared. Results　A total of 77 808 hemodialysis treatment records of 434 patients were used as the initial data set. After rigorous data screening, the final data set of the IDH-1 model contained 416 patients and 71 427 hemodialysis records, and the IDH-2 model contained 416 patients and 71 011 hemodialysis records. TabNet outperformed both LGBM and SVM. The AUC of the TabNet algorithm in the IDH-1 model was 0.84, with a 95% confidence interval (CI) ranging from 0.810 to 0.860. In the IDH-2 model, the AUC of the TabNet algorithm was 0.83, with a 95%CI ranging from 0.805 to 0.850. Historical frequency of IDH episodes, as well as pre-dialysis and intra-dialysis systolic blood pressures, were identified as critical predictive factors for IDH. Conclusions　This study underscores the significant potential of employing machine learning methodologies, in conjunction with demographic data and dialysis parameters, to predict IDH in hemodialysis patients.

Effect of Shenqi Jiangtang granules combined with mecobalamin on blood glucose and pregnancy outcomes in patients with gestational diabetes

Zhang Zan, Kang Hui, Lei Lijian

2024, 30(17):  2863-2867.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.009

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Objective　To investigate the effect of Shenqi Jiangtang granules combined with mecobalamin on blood glucose control and pregnancy outcomes in patients with gestational diabetes. Methods　From June 2020 to June 2023, 150 patients with gestational diabetes who were treated in Xianyang Hospital, Yan'an University were selected, and were divided into a traditional Chinese medicine group, a western medicine group, and a combined treatment group, with 50 cases in each group. The traditional Chinese medicine group were (29.33±3.65) years old and (29.75±3.22) weeks pregnant, and took conventional treatment and Shenqi Jiangtang granules 1 g/time, 3 times/d. The western medicine group were (29.16±3.06) years old and (30.51±3.41) weeks pregnant, and took conventional treatment and mecobalamin 0.5 mg/time, 3 times/d. The combined treatment group were (30.21±3.16) years old and (30.81±3.36) weeks pregnant, and took conventional treatment, Shenqi Jiangtang granules1 g/time, 3 times/d, and mecobalamin 0.5 mg/time, 3 times/d. All the 3 groups were treated 1 month. The clinical treatment effects, blood glucose qualified rates, blood glucose and lipid indicators, and pregnancy outcomes of the three groups were compared. F, t, and χ² tests were applied. Results　The therapeutic efficacy of the traditional Chinese medicine group was 70.00% (35/50), that of the western medicine group 74.00% (37/50), and that of the combined treatment group 94.00% (47/50), with a statistical difference between the 3 groups (χ²=7.523, P<0.05). After 1 month's treatment, the levels of glycosylated hemoglobin (HbA1c), 2 hours postprandial plasma glucose (2hBG), fasting blood glucose (FBG), cystatin C (Cys-C), and homocysteine (Hcy) in the combined treatment group were lower than those in the traditional Chinese medicine group and the western medicine group [(5.02±0.63)% vs. (6.33±0.79)% vs. (6.21±0.96)%, (4.02±0.53) mmol/L vs. (5.96±0.75) mmol/L vs. (5.83±0.82) mmol/L, (5.69±0.62) mmol/L vs. (7.36±0.95) mmol/L vs. (6.91±0.77) mmol/L, (8.33±0.95) μmol/L vs. (11.02±1.20) μmol/L vs. (10.86±1.25) μmol/L, and (1.01±0.11) mg/L vs. (1.31±0.16) mg/L vs. (1.28±0.15) mg/L], with statistical differences between the 3 groups (all P<0.05). The incidence of adverse pregnancy outcomes in the combined treatment group was lower than that in the Chinese medicine group and the western medicine group [8.00% (4/50) vs. 30.00% (15/50) vs. 29.00% (14/50)], with a statistical difference between the 3 groups (P<0.05). The blood glucose qualified rate and spontaneous delivery rate of the combined treatment group were obviously higher than those of the traditional Chinese medicine group and the western medicine group [94.00% (47/50) vs. 70.00% (35/50) vs. 74.00% (37/50) and 70.00% (35/50) vs. 40.00% (20/50) vs. 44.00% (22/50)], with statistical differences between the 3 groups (both P<0.05); Conclusion　Shenqi Jiangtang granules combined with mecobalamin for patients with gestational diabetes can reduce their blood glucose levels, and can improve their adverse pregnancy outcomes.

Percutaneous microballoon compression assisted by neuronavigation and Hartel puncture for patients with trigeminal neuralgia

Wang Xiaohu, Wang Rui

2024, 30(17):  2868-2873.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.010

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Objective　To explore the application of neuronavigation- and Hartel puncture-assisted percutaneous microballoon compression (PMC) in patients with trigeminal neuralgia. Methods Eighty-two patients with primary trigeminal neuralgia to be treated with percutaneous balloon compression at First Hospital, Xi'an Jiaotong University from January 2018 to December 2020 were selected for the study, and were divided into a study group (40 cases) and a control group (42 cases) according to their treatment methods. There were 13 males and 27 females in the study group; they were (60.30±7.10) years old; their body mass index was (21.75±3.27) kg/m²; their disease course was (6.22±1.37) years; 13 cases had trigeminal neuralgia on their left limbs, and 27 cases their right limbs; there were 3 cases with the pain branch of type Ⅱ, 7 cases type Ⅲ, 24 cases types Ⅱ+Ⅲ, 4 cases types Ⅰ+Ⅱ, and 2 cases types Ⅰ+Ⅱ+Ⅲ. There were 16 males and 26 females in the study group; they were (59.85±6.22) years old; their body mass index was (22.19±3.10) kg/m²; their disease course was (6.50±1.19) years; 14 cases had trigeminal neuralgia on their left limbs, and 28 cases their right limbs; there were 4 cases with the pain branch of type Ⅱ, 8 cases type Ⅲ, 26 cases types Ⅱ+Ⅲ, 3 cases types Ⅰ+Ⅱ, and 1 case types Ⅰ+Ⅱ+Ⅲ. The control group took Hartel puncture-assisted PMC, and the study group neuronavigation-assisted PMC. The puncture, analgesic efficacies, operation times, hospitalization times, hospitalization costs, incidences of postoperative complications, and scores of Visual Analogue Scale (VAS) before and 1 d, 1 month, 6 months, 1 year, and 2 years after the surgery were compared between the two groups by t test, χ² test, repeated measurement analysis of variance, and Mann-Whitney U test. Results　The successful puncture rates in both groups were 100%. There was no statistical difference in the puncture times between the two groups (P>0.05). The successful puncture rate at the first time in the study group was higher than that in the control group [90.00% (36/40) vs. 71.43% (30/42)], with a statistical difference (P<0.05). The scores of VAS 1 d, 1 month, 6 months, 1 year, and 2 years after the surgery in both groups were lower than those before the surgery (all P<0.05). The score of VAS 1 d after the surgery in the study group was lower than that in the control group [(0.31±0.11) vs. (0.37±0.10); P<0.05]. There were no statistical differences in the scores of VAS 1 month, 6 months, 1 year, and 2 years after the surgery between the two groups (all P>0.05). There were no statistical differences in the analgesic efficacies 1 d, 1 month, 6 months, 1 year, and 2 years after the surgery between the two groups (all P>0.05). The operation time in the study group were longer than that in the control group [(36.27±4.78) min vs. (15.60±5.69) min; P<0.05]. The hospitalization cost in the study group was higher than that in the control group [(17 000±2 000) yuan vs. (13 600±2 400) yuan; P<0.05]. There was no statistical difference in the hospitalization time between the two groups (P>0.05). There were no statistical differences in the incidences of postoperative facial numbness, subcutaneous hematoma, herpes zoster of the mouth and lips, and biting muscle weakness between the two groups (all P>0.05). No serious complications, such as diplopia, corneal ulcer, cerebral infarction, cerebral hemorrhage, cerebrospinal fluid leakage, etc., occurred in both groups during the follow-up period. Conclusions　The long-term effects of neuronavigation- and Hartel puncture-assisted PMC for patients with trigeminal neuralgia are similar; neuronavigation-assisted PMC has a higher successful puncture rate at the first time and better short-term effect, but longer operation time and higher hospitalization cost, so the patients can choose an appropriate surgical plan according to the actual clinical situation.

Correlation between ABO blood types and ovarian cancer

Du Shumin, Meng Yao, Zhu Zhenning, Gao Weihua

2024, 30(17):  2873-2877.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.011

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Objective　To evaluate the relationships of ABO blood types with ovarian cancer onset, International Federation of Gynecology and Obstetrics (FIGO) staging, pathological types. Methods　The relevant clinical data of 285 patients with ovarian cancer who underwent initial surgery and were pathologically diagnosed at Second Hospital, Shaanxi University of Traditional Chinese Medicine were enrolled, including age, menopausal status, presence of malignant ascites, FIGO staging, pathological types, serum carcinoembryonic antigen carcinoembryonic antigen (CA) 125, and blood types. Three hundred patients with benign ovarian tumors during the same period were selected as the controls. The relationships of ABO blood types with ovarian cancer onset risk, FIGO staging, and pathological types were retrospectively analyzed. Kolmogorov Smirnov test, F test, χ² test, and Fisher exact probability were used. Results　Among the 285 patients with ovarian cancer, there were 83 cases (29.1%) of blood type A, 95 cases (33.3%) of type B, 72 cases (25.3%) of type O, and 35 cases (12.3%) of type AB. Among the 300 patients with benign ovarian tumors, there were 77 cases (25.7%) blood type A, 90 cases (30.0%) of type B, 99 cases (33.0%) of type O, and 34 cases (11.3%) of type AB. Type O accounted the highest proportion in the patients with benign ovarian tumors, and type B in the patients with ovarian cancer. There were no statistical differences in age, FIGO staging, pathological types, menopausal status, and CA125 level between the patients of different blood types (all P>0.05). The logistic regression model showed that blood type B was a risk factor for ovarian cancer in the patients (OR=3.518, 95%CI 1.519-8.146, P<0.05). ABO blood types did not correlate with FIGO staging and pathological type of ovarian cancer (both P>0.05). Conclusions　Blood type B is the most common type in patients with ovarian cancer, and is associated with an increased risk of ovarian cancer. ABO blood types do not correlate with FIGO staging and pathological type of ovarian cancer

Construction of a clinical blood transfusion prediction model for patients with dangerous placenta previ

Tang Huizhen, Chen Fangyao, Wang Qian, Qu Mingli, Chu Xiaoyue

2024, 30(17):  2877-2882.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.012

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Objective　To construct a clinical blood transfusion prediction model for patients with dangerous placenta previa, to verify its prediction efficacy, and to guide the decision of clinical blood transfusion. Methods　A retrospective analysis was performed on 200 patients with dangerous placenta previa who were hospitalized in Northwest Women's and Children's Hospital from January 2021 to December 2023, including 90 patients in the blood transfusion group, who were (33.55±3.95) years old and (34.45±2.12) weeks pregnant, and 110 patients in the non-transfusion group, who were (32.50±4.21) years old and (35.27±1.85) weeks pregnant. The clinical data and pregnancy outcomes were compared between the two groups. The logistic regression algorithm was used to screen out the independent risk factors related to blood transfusion. A nomogram prediction model was constructed by R language, and the performance of the model was evaluated. t, χ², and rank sum tests were applied. Results　There were no statistical differences in age, body mass index, pregnant times, abortion history, hypertension, diabetes, thyroid function, and newborn's body weight between the two groups (all P>0.05). The proportions of the patients with pregnant times ≥3, prenatal anemia, and placenta implantation, ultrasound score, postpartum bleeding volume, and hospital stay in the transfusion group were higher than those in the non-transfusion group [5.6% (5/90) vs. 2.8% (3/110), 60.0% (54/90) vs. 30.0% (33/110), 90.0% (81/90) vs. 32.7% (36/110), 9 (8, 11) vs. 6 (5, 7), 1 800 (1 200, 2 500) ml vs. 600 (500, 800) ml, 8 (6, 12) d vs. 6 (5, 8.3) d]; the gestational weeks in the transfusion group was lower than that in the non-transfusion group [(34.45±2.12) weeks vs. (35.27±1.85) weeks]; there were statistical differences (χ²=23.660, 18.120, and 66.880; Z=8.080, 10.590, and 3.730; t=-2.820; all P<0.05). The multivariate logistic regression analysis showed that postpartum hemorrhage, prenatal anemia, placenta implantation, and placenta ultrasound score were independent risk factors for blood transfusion in the patients (all P<0.05). A nomogram prediction model was constructed; the area under the curve was 0.96 (95%CI 0.939-0.986), indicating that the model had good prediction performance. Conclusions　Postpartum hemorrhage, prenatal anemia, placenta implantation, and placenta ultrasound score are independent risk factors leading to blood transfusion in patients with dangerous placenta previa. The constructed nomogram prediction model can predict the patients' blood transfusion needs, and has high clinical decision-making value.

Construction of an intelligent prediction system for recurrence of patients with differentiated thyroid carcinoma after endoscopic surgery

Li Qiang, Tian Yangtao

2024, 30(17):  2883-2888.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.013

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Objective　To construct and verify an intelligent prediction system for recurrence of patients with differentiated thyroid cancer (DTC) after endoscopic surgery based on depth algorithm. Methods　The clinical data of 189 patients with DTC who underwent endoscopic surgery at Shangluo Central Hospital from October 2020 to October 2023 were retrospectively analyzed, and were divided into a training set (126 cases) and a validation set (63 cases) by simple random sampling according to the ratio of 2∶1. In the training set, there were 39 males and 87 females who were (49.14±7.78) years old. In the verification set, there were 22 males and 41 females who were (50.38±8.12) years old. The patients in the training set were divided into a recurrence group (24 cases) and a non-recurrence group (102 cases) according to whether they had recurred or not. The Cox regression analysis was used to explore the factors affecting the patients' recurrence. Based on the obtained influencing factors, the convolutional neural network (CNN) depth algorithm was used to construct an intelligent prediction system for the patients' recurrence. The receiver operating characteristic curve (ROC) was used to evaluate the predictive efficacy of the intelligent prediction system. t and χ² tests were applied. Results　The postoperative recurrence rate of the patients undergoing endoscopic treatment was 18.52% (35/189). Maximum tumor diameter ≥2 cm [hazard ratio (HR)=1.660, 95% confidence interval (95%CI) 1.169-2.358], moderate differentiation (HR=1.484, 95%CI 1.081-2.039), lymph node metastasis (HR=1.876, 95%CI 1.258-2.798), subtotal thyroidectomy (HR=1.800, 95%CI 1.238-2.618), no adjuvant therapy (HR=1.737, 95%CI 1.213-2.486), and serum thyroid globulin antibody (TgAb) ≥40 IU/ml (HR=1.590, 95%CI 1.126-2.246) were risk factors for the patients' recurrence (all P<0.05). The accuracy of the DTC endoscopic postoperative recurrence intelligent prediction system based on CNN dept algorithm was 0.85; the recall rate was 0.88; the F1 value was 0.88. The ROC analysis results showed that the areas under the curves (AUC) of the training set and the validation set of the DTC postoperative recurrence intelligent prediction system constructed based on CNN were 0.901 (95%CI 0.835-0.947) and 0.872 (95%CI 0.763-0.943). Conclusion　The intelligent prediction system for recurrence of patients with DTC after endoscopic surgery based on depth algorithm has good prediction efficacy, and has good application value in the prediction of recurrence of patients with DTC after endoscopic surgery.

Risk factors for MRSA infection in patients with cerebral infarction and establishment of a clinical prediction model

Mei Chuangchuang, Cai Donghao, Li Xiaojun

2024, 30(17):  2888-2894.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.014

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Objective　To identify the risk factors for methicillin-resistant Staphylococcus aureus (MRSA) infection in patients with cerebral infarction in Guangdong Provincial Second Hospital of Traditional Chinese Medicine and establish a clinical prediction model, which can provide references for the prevention and treatment of MRSA infection. Methods　A total of 277 patients diagnosed with cerebral infarction and Staphylococcus aureus infection who were hospitalized in Guangdong Provincial Second Hospital of Traditional Chinese Medicine from January 2021 to December 2023 were included in this retrospective analysis, including 188 males and 89 females who were 77 (29, 100) years old. According to whether they were methicillin-resistant, the patients were divided into a MRSA group and a methicillin-susceptible Staphylococcus aureus (MSSA) group. The data were compared between the two groups by χ² and rank sum tests. R 4.3.0 was used for the data statistics and visualization processing; the optimal subset regression analysis and multivariate logistic regression analysis were used to analyze the risk factors of the cerebral infarction patients complicated by MRSA infection; a corresponding nomogram model was established. The receiver operating characteristic curve (ROC) and DCA curve were drawn to evaluate the model. Results　The isolation rate of MRSA in Guangdong Provincial Second Hospital of Traditional Chinese Medicine was 71.84% (199/277). The multivariate logistic regression analysis showed that creatinine reduction (OR=0.995, 95%CI 0.992-0.999), using central venous catheterization (OR=2.390, 95%CI 1.262-4.223), history of hospitalization in respiratory department before infection (OR=4.683, 95%CI 1.377-15.929), and combined use of antibiotics (OR=2.270, 95%CI 1.231-4.187) were independent risk factors for MRSA infection in the patients. The area under the curve of the nomogram model based on the 6 variables obtained from the optimal subset regression analysis was 0.720; the sensitivity, specificity, and accuracy were 67.84%, 70.51%, and 68.59%, respectively. The diagnostic and predictive performance was acceptable. Conclusion　We should pay attention to the risk factors of MRSA infection in patients with cerebral infarction, and use the nomogram model to predict the occurrence of MRSA infection.

Clinical significance of serum free light chains combined with M-protein in patients with membranous nephropathy and monoclonal gammopathy of undetermined significance

Zhao Liaoliao, Chang Luyuan, Cao Li

2024, 30(17):  2894-2899.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.015

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Objective　To explore the clinical significance of serum free light chains (sFLC) and M-protein in patients with membranous nephropathy (MN) and monoclonal gammopathy of undetermined significance (MGUS). Methods　A prospective study design was employed. Eighty-two patients with MN treated at Yulin Hospital, First Hospital, Xi'an Jiaotong University from January 2021 to October 2023 were selected, and were divided into an MN group (53 cases) and a merge group (29 cases) according to whether they were combined with MGUS. There were 18 males and 11 females in the merge group; they were (52.64±7.33) years old. There were 33 males and 20 females in the MN group; they were (55.35±6.89) years old. The serological testing methods were used to detect the sFLC (sFLCκ and sFLCλ) and M-protein in these patients. Logistic regression analysis was used to explore their relationship with MN combined with MGUS, and the receiver operating characteristic curve (ROC) was used to test the diagnostic performance of sFLC combined with M-protein for MN combined with MGUS. t and χ² tests were applied. Results　The erythrocyte sedimentation rate (ESR), serum creatinine (Scr), C-reactive protein (CRP), and blood urea nitrogen (BUN) in the merge group were higher than those in the MN group [(48.52±5.65) mm/h vs. (36.34±4.35) mm/h, (84.51±10.26) µmol/L vs. (72.65±8.25) µmol/L, (2.18±0.64) mg/L vs. (1.26±0.35) mg/L, and (6.45±1.27) mmol/L vs. (5.12±1.12) mmol/L], with statistical differences (t=10.884, 5.702, 8.434, and 4.902; all P<0.05). The positive rate in the merge group was higher than that in the MN group [96.55% (28/29) vs. 3.77% (2/53)], with a statistical difference (χ²=69.543; P<0.05). The level of sFLCκ and sFLCκ/λ ratio in the merge group were higher than those in the MN group [(453.51±123.57) mg/L vs. (62.84±100.25) mg/L and (15.89±2.84) vs. (1.11±0.26)]; the level of sFLCλ in the merge group was lower than that in the MN group [(28.54±23.84) mg/L vs. (56.77±18.35) mg/L]; there were statistical differences (t=15.520, 37.791, and 5.979; all P<0.05). The correlation analysis showed that sFLCκ and sFLCκ/λ ratio were significantly correlated with renal impairment and inflammation level, while sFLCλ had relatively weaker correlation. The logistic regression analysis indicated that sFLCκ and sFLCκ/λ ratio significantly influenced diagnosis, whereas sFLCλ had a negative impact. The ROC analysis demonstrated that sFLC combined with M-protein for the diagnosis had a sensitivity of 96.6%, a specificity of 77.4%, a Youden's index of 73.9%, and an area under the curve (AUC) of 0.933, with a 95% confidence interval (CI) of 0.884 to 0.982. Conclusions　The detection of sFLC and M-protein is of significant clinical importance for the diagnosis and assessment of disease activity in patients with MN and MGUS. They are closely related to the degree of kidney function damage and can serve as important references for monitoring and assessing treatment efficacy.

Meta Analysis

Meta-analysis on efficacy of Nosenazone sodium in treatment of patients with spinal muscular atrophy

Zhou Xingyu, Zeng Jing

2024, 30(17):  2900-2904.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.016

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Objective　To verify the effectiveness of Nosenazone sodium in the treatment of patients with spinal muscular atrophy (SMA) by meta-analysis. Methods　The study objects were the patients with SMA treated by Nosenazone sodium. The databases, such as VIP Database, China National Knowledge Infrastructure, Wanfang Database, PubMed, et., were systematically searched from January 2016 to June 2023. RevMan5.7 was used to do the meta-analysis. The effectiveness of Nosenazone sodium for the domestic and foreign cases of SMA was systematically analyzed. Results　A total of 232 patients with SMA were included in 11 literatures. The risk difference for improvement in SMA patients treated by Nosenazone sodium was 0.67 (95%CI 0.39-0.96). Conclusion　Nosenazone sodium for patients with SMA is obviously effective.

Clinical Research

Curative effects of two dressings combined with autologous cell spray technique for patients with deep second-degree burn on their hands

Gao Dongdong, Hou Guoling, Zhang Hongfeng

2024, 30(17):  2905-2910.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.017

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Objective　To explore the efficacies of two different dressings combined with autologous cell spray technique in the treatment of patients with deep second-degree burns on their hands. Methods　Sixty-eight patients with deep second-degree burns on their hands who were treated at Department of Burn, Plastic, and Hand Surgery, Hospital Affiliated to Yan'an University from June 2020 to December 2023 were selected for the randomized controlled trial, and were divided into a control group and an observation group by the random number table method, with 34 cases in each group. There were 22 males and 12 females in the control group; they were (35.18±11.34) years old; their burn area was (17.41±3.52) cm². There were 20 males and 14 females in the observation group; they were (36.84±10.75) years old; their burn area was (18.28±3.39) cm². The control group were treated with moist exposed burn ointment (MEBO) and autologous cell spray technique, and the observation group with hydrogel dressing and autologous cell spray technique. Both groups were treated for 14 days. The serum levels of inflammatory factors, immune function, and serum levels of pain-inducing factors after 14 days' treatment, scores of hand function and scar 3 months after the treatment, and total efficacies were compared between the two groups using t test and χ² test. Results　After the treatment, the wound healing time in the observation group was shorter than that in the control group [(12.48±2.95) d vs. (14.31±3.26) d], with a statistical difference (t=2.43; P<0.05). After 14 days' treatment, the levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-8 , high-sensitivity C-reactive protein (hs-CRP), and CD8⁺ in the observation group were lower than those in the control group; the levels of CD3⁺, CD4⁺, and CD4⁺/CD8⁺ in the observation group were higher than those in the control group; there were statistical differences (all P<0.05). The serum levels of pain-inducing factors, prostaglandin E2 (PGE2), neuropeptide Y (NPY), and 5-hydroxytryptamine (5-HT), in the observation group were lower than those in the control group [(155.88±28.10) ng/L vs. (172.30±29.97) ng/L, (140.61±19.89) μg/L vs. (154.58±25.79) μg/L, and (118.92±16.75) ng/L vs. (129.57±16.61) ng/L], with statistical differences ( t=2.33, 2.50, and 2.63; all P<0.05). Three months after the treatment, the scores of tactile, pain, and motor function of the hands in the observation group were higher than those in the control group [(79.25±8.01) vs. (74.79±7.15), (84.71±9.06) vs. (80.58±7.68), and (68.40±7.88) vs. (63.73±7.17)], with statistical differences (t=2.42, 2.03, and 2.56; all P<0.05). The scores of vascular distribution, color, thickness, and softness of the scars in the observation group were lower than those in the control group, with statistical differences (all P<0.05). The overall efficacy in the observation group was higher than that in the control group (χ²=5.40; P<0.05). Conclusion　Hydrogel dressing combined with autologous cell spray technique for patients with deep second-degree burn on their hands can accelerate wound healing, reduce inflammation, alleviate pain, promote hand function recovery, and improve scar quality and overall efficacy.

Correlation of VEGF and PD-L1 expressions with clinical pathological characteristics in patients with cervical cancer and HPV infection

Shi Fang, He Jianhua, Zhao Jianfang

2024, 30(17):  2910-2916.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.018

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Objective　To investigate the relationship of the expressions of vascular endothelial growth factor (VEGF) and programmed cell death 1 ligand 1 (PD-L1) with clinical pathological characteristics in patients with cervical cancer and HPV infection. Methods　Eighty patients with advanced cervical cancer treated at Yan'an Traditional Chinese Medicine Hospital from March 2016 to March 2021 were prospectively included in the study. They were (58.41±7.81) years old. There were 18 cases of high differentiation, 30 cases of moderate differentiation, and 32 cases of low differentiation. The immunohistochemical methods were used to detect the expressions of VEGF and PD-L1 in the collected tumor tissue slices. The correlation between VEGF and PD-L1 was analyzed. The Kaplan-Meier and Log-Rank methods were used to analyze the overall survival and differences between different subgroups. The Cox regression method was used to analyze the prognostic risk factors. Results　Among the 80 patients, 39 cases (48.75%) died from the progression of malignant tumors, and 41 cases (51.25%) still survived. The immunohistochemical results showed that the positive expression rates of VEGF and PD-L1 in the patients were 61.25% (49/80) and 52.50% (42/80), respectively. The Spearman correlation analysis showed a positive correlation between VEGF and PD-L1 (r=0.682, P=0.015). The expressions of VEGF and PD-L1 related to their degree of differentiation, distant metastasis, and FIGO stage (all P<0.05); the higher the FIGO stage and lower the degree of differentiation, the higher the relative expression levels of VEGF and PD-L1. The median OS of the patients with positive and negative VEGF expressions were 13.08 months and 14.73 months, respectively; the median OS of the patients with positive and negative PD-L1 expressions were 13.56 months and 15.12 months, respectively. The prognosis of the patients with negative VEGF expression was better than that of the patients with positive VEGF expression, and the prognosis of the patients with negative PD-L1 expression was better than that of the patients with positive PD-L1 expression (Log χ²=9.962 and 6.018; P<0.05). The Cox multivariate regression analysis suggested that VEGF expression, PD-L1 expression, distant metastasis, and FIGO staging were the risk factors affecting the patients' independent prognosis (HR=2.443, 2.251, 2.194, and 2.587; all P<0.05). Conclusion　VEGF and PD-L1 can serve as important indicators for evaluating the prognosis of patients with cervical cancer and HPV infection, and have certain clinical value.

Analysis of risk factors for early neurological deterioration in patients with perforating artery atherosclerosis treated by intravenous thrombolysis with ateplase

Wang Wenjuan, Wang Shifeng, Chen Peng, Cao Xue

2024, 30(17):  2916-2921.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.019

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Objective　To explore the risk factors of early neurological deterioration in patients with perforating artery atherosclerosis treated by intravenous thrombolysis with alteplase. Methods　A retrospective study was conducted on 639 patients with acute cerebral infarction who were hospitalized in Department of Neurology, Xianyang Central Hospital from January 2021 to January 2023 and received intravenous thrombolysis with ateplase. After intravenous thrombolysis, magnetic resonance diffusion-weighted imaging and angiography were completed, confirming the diagnosis of newly diagnosed cerebral infarction. According to the Chinese ischemic stroke subclassification (CISS) classification criteria, 162 patients who met BAD were selected, including 112 males (69.1%) and 50 females (30.9%); they were (63.71±11.44) years old. According to whether the patient experienced early neurological deterioration (END) within 72 hours of intravenous thrombolysis with ateplase, they were divided into an END group (28 cases) and a non-progression group (134 cases). The data were compared between the two groups by independent-sample t test, χ² test, or Fisher's precision probability test, and Mann-Whitney U test. Single factor analysis and multivariate logistic regression analysis were used to identify the risk factors of early neurological deterioration in the patients with perforating artery atherosclerosis treated by intravenous thrombolysis with ateplase. Results　The univariate analysis showed that the score of National Institute of Health Stroke Scale (NIHSS) before thrombolysis, moderate to severe stroke (NIHSS score 5-21), systolic blood pressure at admission, door-to-needle time (DNT), and moderate to severe white matter osteoporosis in the END group were higher than those in the non-progression group (all P<0.05). Further multivariate logistic regression analysis showed that the score of NIHSS before thrombolysis (OR=5.947, 95%CI 2.822-46.775, P=0.020) and moderate to severe white matter osteoporosis (OR=3.162, 95%CI 1.272-22.357, P=0.034) were risk factors for BAD in the patients. Conclusion　NIHSS score before thrombolysis and degree of moderate to severe white matter osteoporosis are risk factors for END in patients with perforating artery atherosclerosis treated by intravenous thrombolysis with alteplase.

Application of improved intermittent injection in hysterosalpingography

Huang Huang, Huang Yubin, Ye Zhiqiu

2024, 30(17):  2922-2925.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.020

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Objective　To evaluate the clinical effect of the improved intermittent injection method and the routine injection method in hysterosalpingography (HSG). Methods　One hundred infertile patients (200 fallopian tubes) taking HSG at Guangdong Women and Children Hospital from January 2023 to December 2023 were selected, and were divided into a control group and an observation group according to the routine injection method or the improved intermittent injection method they took, with 50 cases in each group. The control group were 24-45 years old, with a median of 28. The observation group were 22-44 years old, with a median of 27. Both groups took HSG 3-7 d after the menstruation was clean. The unobstructed fallopian tubes and abdominal pain during HSG were observed and compared by χ² test. Results　In the control group, 54 (54.0%) fallopian tubes were unobstructed, 28 (28.0%) not completely obstructed, and 18 (18.0%) completely obstructed. In the observation group, 63 (63.0%) fallopian tubes were unobstructed, 25 (25.0%) not completely obstructed, and 12 (12.0%) completely obstructed. The incidence of abdominal pain in the control group was 66% (33/50), and that in the observation group 36% (18/50), with a statistical difference (χ²=51.680, P<0.01). Conclusions　Both methods can evaluate the patency of fallopian tubes; the improved intermittent injection method is better than the routine injection method in the incidence of abdominal pain.

Buzhong Wenyang Tang combined with levothyroxine sodium for pregnant patients with hypothyroidism

Xu Shan, Duan Bei, Zhang Xiaocai, Wang Min, Song Lihua

2024, 30(17):  2926-2930.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.021

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Objective　To evaluate the effect of traditional Chinese medicine combined with thyroid hormone on lipid regulation and maternal and neonatal health in pregnant patients with hypothyroidism. Methods　Ninety-eight pregnant women with hypothyroidism treated at Second Hospital, Shaanxi University of Traditional Chinese Medicine from July 2022 to June 2023 were selected for the randomized controlled trial, and were divided into a control group and a combination group by the random number table method, with 49 cases in each group. The control group were 27-36 (31.67±4.81) years old; their body mass index at admission was (22.43±3.67) kg/m²; their gestational age was (19.09±1.34) weeks. The combination group were 29-39 (32.07±5.13) years old; their body mass index at admission was (22.19±3.28) kg/m²; their gestational age was (19.84±1.17) weeks. Both groups took levothyroxine sodium tablets at an initial dosage of 25 μg/d; they revisited every 4 weeks; if their level of thyroid-stimulating hormone (TSH) did not return to normal, they took the tablets 50-100 μg/d according to their resistance until their TSH level was normal; they were treated for 12 weeks. In addition, the combination group took Buzhong Wenyang Tang in the morning and at night one dosage per day for 12 weeks. After 12 weeks' treatment, the free thyroxine (FT4), TSH, thyroid peroxidase antibody (TPOAb) positive rates, serum total cholesterol (TC), triglycerides (TAG), low-density lipoprotein cholesterol (LDL-C), maternal and neonatal outcomes, neonatal development [assessed by the Bayley Scales of Infant Development (BSID)], and overall clinical efficacies in both groups were observed and analyzed. t and χ² tests were used. Results　The overall clinical efficacy in the combination group was higher than that in the control group [85.71% (42/49) vs. 67.35% (33/49)], with a statistical difference (χ²=4.60, P<0.05). After delivery, the levels of TSH and TPOAb and TPOAb positive rate in the combination group were lower than those in the control group [(1.97±0.46) IU/ml vs. (2.87±0.62) IU/ml, (8.12±1.47) IU/ml vs. (10.96±1.82) IU/ml, and 6.12% (3/49) vs. 20.41% (10/49)], with statistical differences (t=8.16 and 8.50; χ²=4.35; all P<0.05). After delivery, the levels of TC, TAG, and LDL-C in the combination group were lower than those in the control group, with statistical differences (all P<0.05). Three months after birth, the scores of Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) in the combination group were higher than those in the control group [(86.94±5.86) vs. (80.27±5.14) and (85.72±5.15) vs. (80.98±5.23)], with statistical differences (both P<0.05). There was no statistical difference in the incidence of adverse outcomes between the combination group and the control group [4.08% (2/49) vs. 16.33% (8/49); χ²=4.01; P<0.05]. Conclusion　Buzhong Wenyang Tang combined with low-dose levothyroxine sodium for pregnant women with hypothyroidism can effectively improve their thyroid function and neonatal development, lower their lipid levels, optimize maternal and neonatal outcomes.

Effect of low-frequency pulse electrostimulation combined with rehabilitation robots on cognitive and motor functions in stroke patients

Ping Xingtuan, Zhao Fuqiang, Qu Bo, Wu Xiaoli, Wang Nan, Chen Yue

2024, 30(17):  2931-2935.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.022

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Objective　To investigate the effect of low-frequency pulsed electrostimulation combined with rehabilitation robots for stroke patients. Methods　Eighty stroke patients treated at Xi'an Encephalopathy Hospital of Traditional Chinese Medicine from January 2021 to August 2023 were selected for the randomized controlled trial. They were numbered upon admission; the first 40 patients were assigned to a control group, and the latter 40 to an observation group. The observation group included 25 males and 15 females who were (56.64±7.25) years old. The control group included 23 males and 17 females who were (56.34±6.34) years old. The control group took basic treatment; in addition, the observation group took low-frequency pulsed electrostimulation and rehabilitation robot treatment. Both groups were treated 8 weeks. The clinical efficacies, cognitive function, motor function, and serum levels of brain-derived neurotrophic factor (BDNF), and nerve growth factor (NGF) were evaluated. t and χ² tests were applied. Results　The effective rate in the observation group was higher than that in the control group [92.5% (37/40) vs. 65.00% (26/40)], with a statistical difference (χ²=9.04; P<0.05). The score of National Institutes of Health Stroke Scale (NIHSS) in the observation group was lower than that in the control group [(6.34±2.18) vs. (8.29±2.57)], with a statistical difference (t=3.66; P<0.05). After 4 and 8 weeks' treatment, the scores of cognitive function in the observation group were higher than those in the control group [(20.21±5.18) vs. (17.84±4.66) and (26.81±5.49) vs. (21.96±4.65)], with statistical differences (t=2.15 and 4.26; both P<0.05); the scores of Fugl-Meyer Assessment and Barthel Index in the observation group were higher than those in the control group [(53.75±10.37) vs. (48.88±8.65), (63.69±13.54) vs. (55.00±12.25), (49.64±9.62) vs. (33.36±8.39), and (73.31±11.64) vs. (54.68±10.33)], with statistical differences (t=2.28, 3.01, 8.07, and 7.57; all P<0.05); the levels of BDNF and NGF in the observation group were higher than those in the control group [(6.65±1.03) μg/L vs. (5.89±0.97) μg/L, (8.51±1.26) μg/L vs. (7.61±1.14) μg/L, (3.64±0.54) μg/L vs. (3.21±0.65)μg/L, (4.69±0.79) μg/L vs. (3.25±0.72) μg/L], with statistical differences (t=3.40, 3.35, 3.22, and 8.52; all P<0.05). Conclusion　Low-frequency pulsed electrostimulation combined with rehabilitation robots for stroke patients can improve their serum levels of BDNF and NGF and cognitive and motor functions.

Effect of Shuxuetong injection for patients with acute cerebral infarction

Cao Yunhong, Zeng Wucheng, Du Jinlin

2024, 30(17):  2936-2941.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.023

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Objective　To study the clinical effect of Shuxuetong injection in the treatment of patients with acute cerebral infarction. Methods　Eighty-six patients with acute cerebral infarction treated at Zengguang Health Center from September 2022 to April 2023 were selected for the randomized controlled trial, and were divided into a control group and a Shuxuetong group by the random number table method, with 43 cases in each group. There were 20 males who were (60.63±2.39) years old and 23 females who were (63.16±1.38) years old in the control group. There were 21 males who were (58.08±2.35) years old and 22 females who were (63.72±2.87) years old in the Shuxuetong group. Both groups took routine treatment; in addition, the Shuxuetong group intravenously dripped 6 ml Shuxuetong added into 250 ml normal saline. Seven days were one treatment course, and both groups were treated 2 courses. The total effective rates, satisfaction rates, incidences of adverse reactions, physical signs, and scores of the Mos 36-Item Short Form Health Survey (SF-36) and traditional Chinese medicine symptoms were compared between the two groups by the rank sum test, χ² test, and t test. Results　After the treatment, the total effective rate and comprehensive treatment satisfaction rate in the Shuxuetong group were higher than those in the control group [95.35% (41/43) vs. 81.40% (35/43) and 97.67% (42/43) vs. 79.07% (34/43)], with statistical differences (χ²=4.07 and 7.24; both P<0.05). The incidence of adverse reactions in the control group was higher than that in the control group [27.91% (12/43) vs. 9.30% (4/43)], with a statistical difference (χ²=4.91; P<0.05). Before the treatment, there were no statistical differences in the physical signs and the scores of SF-36 and traditional Chinese medicine symptoms between the two groups (all P>0.05); after the treatment, the physical signs and the scores of SF-36 and traditional Chinese medicine symptoms in the Shuxuetong group were better than those in the control group (P<0.05). Conclusion　Routine treatment combined with Shuxuetong for patients with acute cerebral infarction is effective, with a high satisfaction rate and an effective rate, so it is worth being generalized.

Analysis on 60 cases of different superior mesenteric artery ischemic diseases

Li Heng, Jiang Shijie, Lian Peng, Zhang Hui

2024, 30(17):  2941-2945.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.024

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Objective　To investigate the clinical features, imaging features, and risk factors of patients with different superior mesenteric artery ischemic diseases (SMAI). Methods　The clinical data of 60 patients with SMAI treated at Xi'an High-tech Hospital between December 2019 and December 2022 were retrospectively analyzed. There were 40 males and 20 females. They were (66.47±10.33) years old. Among them, there were 28 cases of mesenteric artery dissection (SMAD), 18 cases of mesenteric artery embolism (SMAE), and 14 cases of mesenteric artery thrombosis (SMAT). The clinical data of the SMAD group, the SMAE group, and the SMAT group were compared by t test or χ² test. The risk factors of SMAI were analyzed by logistic regression. Results　The age, proportions of the patients with hypertension and atrial fibrillation, neutrophil percentage, and levels of fibrinogen and D dimer in the SMAD group were (64.37±2.20) years, 19 cases (67.86%), 1 case (3.57%), (77.70±3.52)%, (4.25±0.62) g/L, and (4.65±0.44) mg/L; those in the SMAE group were (68.55±3.25) years, 17 cases (94.44%), 10 cases (55.56%), (88.71±4.50)%, (4.86±0.80) g/L, and (3.97±0.53) mg/L; those in the SMAT group were (64.88±2.25) years, 8 cases (57.14%), 1 case (7.14%), (82.59±4.38)%, (4.20±0.69)g/L, and (4.15±0.42) mg/L; there were statistical differences (all P<0.05). The influencing factors were included in the multivariate logistic regression analysis, and the results showed that age [odds ratio (OR)=1.394, 95% confidence interval (CI) 1.135-1.712], hypertension (OR=1.910, 95%CI 1.127-3.236), atrial fibrillation (OR=2.140, 95%CI 1.084-4.225), neutrophils (OR=3.080, 95%CI 1.336-7.099), fibrinogen (OR=3.554, 95%CI 1.167-10.819), and D-dimer (OR=3.242, 95%CI 3.214-24.821 were risk factors for SMAI (all P<0.05). Conclusions　SMAI tends to occur in the elderly population and is often complicated with hypertension, atrial fibrillation, and other complications. Its CT imaging shows intestinal wall thickening, intestinal dilation, abdominal fluid accumulation, etc. Age, hypertension, atrial fibrillation, neutrophil, fibrinogen, and D-dimer are risk factors for SMAI.

Effect of modified Shenling Baishu Powder combined with dapagliflozin for patients with type 2 diabetes

Zhang Jialin, Ji Yandan, Pei Ruixia, Bai Xiaolin, Yang Guochun

2024, 30(17):  2946-2950.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.025

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Objective　To explore the effect of modified Shenling Baishu Powder combined with dapagliflozin for patients with type 2 diabetes. Methods　A total of 120 patients with type 2 diabetes treated at Xi 'an Hospital of Traditional Chinese Medicine from January 2021 to January 2024 were selected for the randomized controlled trial, and were divided into a monotherapy group and a combination group by lottery, with 60 cases in each group. There were 34 males and 26 females in the monotherapy group; they were (65.58±7.71) years old; there were 28 cases of hypertension and 21 cases of coronary heart disease. There were 35 males and 25 females in the combination group; they were (65.64±7.87) years old; there were 26 cases of hypertension and 23 cases of coronary heart disease. The monotherapy group were treated with dapagliflozin, and the combination group with dapagliflozin and modified Shenling Baishu Powder, for 10 weeks. The metabolic and cognitive functions, cerebrovascular hemodynamics, and traditional Chinese medicine (TCM) syndrome scores before and after the treatment and adverse reactions were compared between the two groups by χ² and t tests. Results　After the treatment, the fasting blood glucose (FBG), glycated hemoglobin (HbA1c), homeostatic model assessment of beta-cell function (HOMA-β), and homeostatic model assessment of insulin resistance (HOMA-IR) in the combination group were lower than those in the monotherapy group [(6.04±0.51) mmol/L vs. (7.51±0.68) mmol/L, (5.85±0.51)% vs. (7.12±0.73)%, (18.44±1.82) vs. (29.03±3.21), and (1.04±0.17) vs. (1.43±0.24); t=13.396, 11.047, 22.230, and 10.271; all P<0.05]; the scores of Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE), peak velocity (Vp), and mean velocity (Vm) in the combination group were higher than those in the monotherapy group [(25.72±4.08) vs. (21.88±3.17), (25.38±3.37) vs. (22.55±2.72), (72.22±8.87) cm/s vs. (63.41±7.70) cm/s, and (36.33±4.46c) m/s vs. (33.41±3.77) cm/s; t=5.757, 5.062, 5.810, and 3.873; all P<0.05]; the pulsatility index (PI), resistance index (RI), and scores of TCM syndromes in the combination group were lower than those in the monotherapy group [(0.77±0.26) vs. (0.90±0.42), (0.45±0.15) vs. (0.60±0.37), (1.14±0.27) vs. (2.45±0.85), (1.08±0.11) vs. (2.15±0.26), (0.81±0.27) vs. (1.86±0.42), and (0.86±0.13) vs. (1.57±0.44); t=2.039, 2.910, 11.378, 29.358, 16.289, and 11.987; all P<0.05]. There was no statistical difference in the incidence of adverse reactions between the monotherapy group and the combination group [6.7% (4/60) vs. 8.3% (5/60); χ²=0.120; P=0.729]. Conclusion　Modified Shenling Baishu Powder combined with dapagliflozin for patients with type 2 diabetes can improve their metabolic function, cognitive function, cerebrovascular hemodynamics, and TCM syndrome scores.

Diagnostic value of ultrasound and clinical pathological features for Delphian lymph node metastasis in patients with papillary thyroid carcinoma

Zhe Wenli, Xu Xinli, Li Yanting, Li Xin

2024, 30(17):  2951-2956.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.026

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Objective　To explore the diagnostic value of ultrasound and clinical pathological features for Delphian lymph node (DLN) metastasis in patients with papillary thyroid carcinoma (PTC). Methods　One hundred and twenty patients with PTC treated at Tongchuan People's Hospital from February 2021 to August 2023 were selected as the study objects, including 36 males and 84 females who were (43.69±6.85) years old. They were divided into a metastatic group and a control group (without metastasis) based on the presence or absence of DLN metastasis. Both groups underwent ultrasound examination. The information on their ultrasound and clinical pathological features was collected. The factors affecting DLN metastasis in the patients were analyzed. The diagnostic efficacy of ultrasound and clinical pathological features for DLN metastasis in the patients was evaluated using the receiver operating characteristic curve (ROC). t test, rank sum test, and χ² test were applied. Results　A total of 145 lesions were detected in the 120 patients. There were 93 lesions in the patients without DLN metastasis and 52 lesions in the patients with DLN metastasis. There statistical differences between the metastatic group and the control group in terms of age [>45 years: 30.56% (11/36) vs. 54.76% (46/84)], tumor location [isthmus and upper lobe 1/3: 67.31% (35/52) vs. 21.51% (20/93)], longitudinal diameter [≥10 mm: 59.62% (31/52) vs. 38.71% (36/93)], aspect ratio [≥1: 55.77% (29/52) vs. 32.26% (36/93)], multiple lesions [41.67% (21/36) vs. 20.24% (67/84)], capsule invasion [63.46% (33/52) vs. 40.86% (38/93)], and lymph node metastasis in the non-central area of the larynx [53.85% (24/52) vs. 31.18% (64/93)] (χ²=5.921, 29.718, 5.864, 7.639, 5.917, 6.818, and 7.180; all P<0.05). The results of logistic regression analysis showed that the risk factors for DLN metastasis in the patients with PTC were tumors located in the isthmus and upper one-third of the lateral lobe, aspect ratio ≥ 1, capsule invasion, and lymph node metastasis in the non-central area of the larynx (OR=3.267, 7.576, 3.130, and 8.306; all P<0.05). The ROC displayed the area under the curve (AUC), sensitivity, and specificity of the combination were 0.775, 67.31%, and 78.49%, respectively. The AUC's of tumor location, aspect ratio, capsule invasion, and lymph node metastasis in the non-central area of the larynx were 0.729, 0.618, 0.613, and 0.613 (all P<0.05). Conclusions　Among the ultrasound and clinical pathological features of patients with PTC, the presence of tumors in the isthmus and upper 1/3 of the lateral lobe, aspect ratio ≥ 1, capsule invasion, and lymph node metastasis in the non-central area of the larynx are risk factors for DLN metastasis; their combination has high diagnostic value.

Construction of a risk prediction model of postoperative recurrence of breast cancer based on multimodal ultrasound and MRI

Wu Zhonglan, Wang Yuejun

2024, 30(17):  2957-2965.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.027

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Value of hemorheological parameters in prediction of pregnancy outcomes in patients with gestational diabetes mellitus

Wu Jie, Xiang Qiongli

2024, 30(17):  2965-2969.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.028

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Objective　To analyze and explore the value of hemorheological changes in the prediction of pregnancy outcomes in patients with gestational diabetes mellitus (GDM). Methods　A retrospective analysis was conducted on 80 patients with GDM (a GDM group) who underwent obstetric examination and delivery at Huangshi Maternal and Child Health Hospital from January to December 2020. The patients were divided into a good pregnancy outcome group (35 cases) and a poor pregnancy outcome group (45 cases) according to the pregnancy outcomes. Sixty-eight healthy pregnant women who underwent prenatal examination during the same period were selected as a control group. The GDM group was (30.55±4.23) years old; their body weight was (67.52±6.34) kg; 30 cases' education level was high school or below, 25 cases' college, and 25 cases' bachelor's degree or above. The control group was (29.84±3.91) years old; their body weight was (66.08±6.01) kg; 28 cases' education level was high school or below, 20 cases' college, and 20 cases' bachelor's degree or above. The hemorheological parameters were compared between the two groups by χ² and t tests. The multivariate logistic regression model was used to analyze the risk factors affecting poor pregnancy outcomes in the patients. The diagnostic efficacies of hemorheological parameters in predicting poor pregnancy outcomes in the patients were assessed using the receiver operating characteristic curve (ROC). Results　The plasma viscosity (PV), hematocrit (HCT), high shear whole blood viscosity (HWBV), low shear whole blood viscosity (LWBV), and erythrocyte sedimentation rate (ESR) of the GDM group were higher than those of the control group [(1.78±0.32) mPs·s vs. (1.54±0.33) mPs·s, (45.60±6.56)% vs. (37.64±5.71)%, (9.41±0.89) mPs·s vs. (7.61±1.44) mPs·s, (7.93±1.34) mPs·s vs. (5.36±1.73) mPs·s, and (62.05±8.73) mm/h vs. (49.55±6.81) mm/h], with statistical differences (all P<0.05). The PV, HCT, HWBV, and LWBV of the good pregnancy outcome group were lower than those of the poor pregnancy outcome group [(1.56±0.33) mPs·s vs. (1.95±0.17) mPs·s, (39.77±2.11)% vs. (50.14±5.12)%, (8.66±0.88) mPs·s vs. (10.00±0.16) mPs·s, and (6.75±0.74) mPs·s vs. (8.85±0.95) mPs·s], with statistical differences (all P<0.05); there were no statistical differences in the ESR between the two groups (P>0.05). PV, HCT, HWBV, and LWBV were correlated with the occurrence of adverse pregnancy outcomes in the patients and were the potential risk factors for adverse pregnancy outcomes (OR=17.618, 1.160, 5.697, and 1.890; all P<0.05). The sensitivity, specificity, and area under the curve of the combination of the four indicators for assessing adverse pregnancy outcomes in the patients were 95.6%, 97.1%, and 0.980. Conclusion　Hemorheological indicators have significant value in predicting the pregnancy outcomes of GDM patients, and combined detection can significantly improve the sensitivity and specificity of the diagnosis.

Nursing Research

Nursing care for a child with X-linked adrenoleukodystrophy undergoing hematopoietic stem cell transplantation

Feng Minxian, Li Xynyu, Cen Xiuxian, Ke Bixia

2024, 30(17):  2970-2973.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.029

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The overall nursing experience of a child with X-linked adrenoleukodystrophy who received allogeneic hematopoietic stem cell transplantation was summarized. The main nursing measures were as below. ⑴Preparation before transplantation: early identification of changes in the conditions and comprehensive nursing evaluation; strengthening education on disease and transplant related knowledge, providing personalized psychological care interventions, and ensuring the patients' and their families' psychological health. ⑵Nursing during transplantation: strict medication management during the pre-treatment period of transplantation to ensure medication safety; strictly implementing sterile procedures and safely administering hematopoietic stem cells. ⑶Post transplantation management: close monitoring and early detection and management of transplant related complications; strictly implementing infection prevention and control measures; providing targeted health education and continuous care. After 68 days' careful treatment and care, the patient was successfully implanted and discharged with stable conditions.

Gancao Xiexin oral care solution for improving oral state of stroke patients

Shi Hua, Fu Xiaohong, Wang Le, Shu Yapan, Zhang Zhuoqi

2024, 30(17):  2974-2978.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.030

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Objective　To explore the role of Gancao Xiexin oral care solution for improving the oral state of stroke patients. Methods　Eighty stroke patients hospitalized at department of Neurosurgery, First Hospital, Henan University of Chinese Medicine from December 2021 to October 2023 were selected for the randomized controlled trial. They were divided into a control group and an observation group by the random number table method, with 40 cases in each group. There were 25 males and 15 females in the control group; they were (52.20±4.95) years old. There were 26 males and 14 females in the observation group; they were (52.20±6.37) years old. The control group used 0.9% sodium chloride injection (normal saline, NS) for oral care, the observation group used Gancao Xiexin oral care solution for oral care. The gingival index, plaque index, oral pH, oral moisture, oral odor, and oral mucositis before and after the treatment and adverse reactions were compared between the two groups. t and χ² tests were applied. Results　Before the treatment, there were no significant differences in the gingival index, plaque index, oral pH, oral moisture, and oral odor between the two groups (all P>0.05). After 5 and 10 days' treatment, the scores of gingival index, plaque index, oral moisture, and oral odor in the observation group were lower than those in the control group [(1.23±0.42) vs. (1.98±0.16), (0.65±0.48) vs. (1.10±0.30), (1.44±0.50) vs. (1.93±0.27), (0.78±0.48) vs. (1.20±0.52), (0.65±0.53) vs. (0.98±0.42), (0.15±0.36) vs. (0.65±0.53), (2.28±0.45) vs. (2.50±0.51), and (1.45±0.60) vs. (1.90±0.38)]; the oral pH values in the observation group were higher than those in the control group [(6.53±0.08) vs. (6.42±0.11) and (6.98±0.10) vs. (6.62±0.14)]; there were statistical differences (t=10.506, 4.987, 5.416, 3.814, 3.086, 4.936, 2.096, 4.007, 5.115, and 13.234; all P<0.05). After the treatment, the incidence of oral mucositis in the observation group was lower than that in the control group [(5.0%(2/40) vs. 15.0%(6/40)], with a statistical difference (χ²=6.486; P<0.05). No adverse reactions occurred in both groups. Conclusion　Gancao Xiexin oral care solution can improve the oral health status of stroke patients and is easy and safe to operate, with high patient compliance, so it is worth being clinically generalized.

Correlation of postoperative depression with distress disclosure and sleep quality in patients with breast cancer

Liu Liqin, Yuan Hong, Chang Yingzhi, Zeng Jingting, Huang Qing, Lin Yunyong

2024, 30(17):  2978-2982.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.031

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Objective　To explore the relationship of postoperative depression with distress disclosure and sleep quality in patients with breast cancer. Methods　A retrospective analysis was conducted on the questionnaire survey of 236 patients with breast cancer admitted to Department of Breast Surgery, Guangzhou First People's Hospital from November 2023 to May 2024. Among the patients, 44 cases were below 40 years old, and 192 cases were ≥40 years old. There were 68 cases of clinical stage Ⅰ, 84 cases of stage Ⅱ, 70 cases of stage Ⅲ, and 14 cases of stage Ⅳ. Sixty-eight cases took breast-conserving surgery, 132 cases modified radical mastectomy for breast cancer, and 36 cases modified radical mastectomy + reconstruction. All the patients completed the Patient Health Questionnaire-9 (PHQ-9) depression scale, the Pain Disclosure Index scale, and the Pittsburgh Sleep Quality Index scale. According to the scores of PHQ-9 depression scale after surgery, the patients were divided into a depression group and a non-depression group. χ²test, Kendall's tau, and linear correlation analysis were employed for the statistical analysis. Results　Among the 236 patients, 124 cases had depression after surgery, and 112 did not. The proportions of the patients who were < 40 years old and whose marriage duration < 10 years in the depression group were higher than those in the non-depression group (36 cases vs. 8 cases and 28 cases vs.4 cases), with statistical differences (χ²=18.589 and 18.143; both P<0.001). The depression level in the patients with breast cancer after surgery was positively correlated with the score of the total Pittsburgh Sleep Quality Index (r=0.620, P<0.001), while their distress disclosure level was negatively correlated with the sleep disorder score (r=-0.370, P=0.004). Conclusion　The sleep quality of patients with breast cancer after surgery significantly affects their depression status, and their distress disclosure level affects the sleep disorder score.

Gradient training based on assessment of speech rehabilitation degree for patients with postoperative language dysfunction after intracranial aneurysms

Yu Yanling, Cui Ping, Zhu Yuanyuan, Shen Na, Yang Hanli

2024, 30(17):  2983-2987.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.032

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Objective　To analyze the effect of gradient training based on assessment of speech rehabilitation degree for patients with postoperative language dysfunction after intracranial aneurysms. Methods　One hundred patients taking intracranial aneurysm surgery at First Hospital, Xi'an Medical College between January 2020 and January 2023 were selected for the randomized controlled trial. The patients were divided into an observation group and a control group by the random number table method, with 50 cases in each group. There were 35 males and 15 females in the control group; they were (45.69±2.55) years old; their disease course was (2.48±0.21) years. There were 32 males and 18 females in the observation group; they were (45.65±2.48) years old; their disease course was (2.54±0.22) years. The control group took routine care, and the observation group took gradient training of assessment of speech rehabilitation degree. The next day after admission and after 6 months' intervention, the patients' language function, communication function, and life quality were assessed. t and χ² were used. Results　Before the intervention, there were no statistical differences in the scores of language function, communication function, and life quality between the two groups (all P>0.05). After the intervention, the scores of language function, communication function, and life quality in the observation group were higher than those in the control group [(128.52±9.45) vs. (123.52±8.46), (17.42±2.16) vs. (16.16±2.16), and (13.12±1.31) vs. (12.25±1.26)], with statistical differences (t=2.787, 2.917, and 3.385; all P<0.05). Conclusion　Gradient training based on assessment of speech rehabilitation degree for patients with postoperative language dysfunction after intracranial aneurysms can improve their language function, communication function, and life quality.

Erxianzhen combined with Wenyang Yiqi Fang paste for patients with cancer-related fatigue taking chemotherapy after surgery for intestinal cancer

Peng Xing, Qiao Zi'ao, Huang Li, Xiong Liyan, Zheng Wei, Chen Jian

2024, 30(17):  2987-2991.  DOI: 10.3760/cma.j.issn.1007-1245.2024.17.033

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肠癌；癌因性疲乏；化疗；耳掀针；温阳益气方