Table of Content

15 September 2024, Volume 30 Issue 18

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Special Column of Bone and Joint

Research progress on complications after internal fixation of femoral neck fracture

Qi Ruifeng, Zhou Nan, Ma Mingliang, Du Gangqiang, Geng Zeyue, Wang Zhigang

2024, 30(18):  2993-2997.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.001

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At present, patients with femoral neck fracture under 65 years old are generally treated with internal fixation. Studies have shown several difficulties associated with the gradual advancement of internal fixation, and these complications can affect the patients' prognosis following internal fixation. This paper summarizes the risk factors and categories of postoperative complications of internal fixation reported in literatures to get more insight into the types of issues and potential risks associated with internal fixation of femoral neck fracture. The goal of the study is to prevent or minimize the incidence of postoperative complications as much as possible, and reasonably judge its prognosis.

Design and clinical application of traumatic tibial locking plate

Xu Weiqiang, Yuan Yanrong, Sun Guangchao, Liu Ying, Cui Chengcheng, Zhu Xiaodong

2024, 30(18):  2998-3002.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.002

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Objective　To design and develop a new locking steel plate that can effectively fix Pilon fracture, and to evaluate its efficacy compared with ordinary locking steel plate. Methods　A retrospective analysis was performed on 49 patients with Pilon fracture admitted to Binzhou Medical University Hospital from January 2016 to January 2023, and they were divided into an experimental group (new locking plate, 28 cases) and a control group (ordinary locking plate, 21 cases) according to whether the new locking plate was used or not. In the experimental group, there were 19 males and 9 females, aged (39.64±9.11) years. In the control group, there were 14 males and 7 females, aged (39.86±9.65) years. The operation time, intraoperative blood loss, and incidence of postoperative complications were recorded and compared between the two groups. The postoperative fracture reduction and healing were evaluated by Burwell-Charnley imaging evaluation criteria, and the ankle recovery was assessed using the Amerian Orthopaedic Foot Ankle Society (AOFAS) ankle-posterior foot score 3 and 6 months after surgery and at the last follow-up. t test and χ² test were used for statistical analysis. Results　All patients in both groups successfully completed the operation and received complete postoperative follow-up for 11 to 16 (13.27±1.44) months. The operation time of the experimental group was shorter than that of the control group [(92.82±8.05) min vs. (115.67±14.46) min], the early weight-bearing time was shorter than that of the control group [(7.21±0.92) weeks vs. (9.38±1.36) weeks], the excellence rate of Burwell-Charnley imaging was higher than that of the control group [100.0% (28/28) vs. 76.2% (16/21)], and the AOFAS ankle score at the last follow-up was higher than that of the control group [(91.86±1.51) points vs. (90.43±1.91) points], and the incidence of postoperative complications was lower than that of the control group [3.6% (1/28) vs. 23.8% (5/21)], with statistically significant differences (t=-7.046, P<0.001; t=-6.662, P<0.001; χ²=7.504, P=0.023; t=2.925, P=0.005; χ²=4.574, P=0.032). There were no statistically significant differences in the intraoperative blood loss and fracture healing time between the two groups (both P>0.05). Conclusion　The new locking plate has the advantages of high anatomical fit, strong ability to capture fracture fragments, and fewer complications, which can allow patients to perform functional exercises in advance, and has significant advantages over ordinary locking steel plate in the treatment of Pilon fracture.

Application of modified Y-shaped nano-bone plate in multilevel cervical spondylotic myelopathy

Tuo Wanbao, Ge Yulong, Zhang Yanxiang, Liang Guanwen, Song Qichun

2024, 30(18):  3003-3007.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.003

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Objective　To investigate the effect of modified Y-shaped nano-bone plate fixation in the operation of multilevel cervical spondylotic myelopathy (MCSM). Methods　The data of 103 patients with MCSM admitted to Baoji People's Hospital from January 2020 to March 2023 were reviewed, including 51 patients (control group) who received micro-titanium plate fixation combined with unilateral cervical muscle ligament preservation, and 52 patients (study group) who received modified Y-shaped nano-bone plate fixation combined with unilateral cervical muscle ligament preservation, and were followed up for 6 months. In the control group, there were 26 males and 25 females, aged (54.43±4.12) years, with a body mass index of (23.28±1.49) kg/m², and the diseased segments were C_2-7 in 5 cases, C_3-6 in 7 cases, C_3-7 in 30 cases, and C_4-7 in 9 cases. In the study group, there were 29 males and 23 females, aged (53.01±4.58) years, with a body mass index of (23.04±1.36) kg/m², and the diseased segments were C_2-7 in 6 cases, C_3-6 in 8 cases, C_3-7 in 33 cases, and C_4-7 in 5 cases. The operation, pain, cervical function, cervical imaging parameters, and complications were compared between the two groups. t test and χ² test were used. Results　The operation time and intraoperative blood loss in the study group were lower than those in the control group [(104.21±15.29) min vs. (115.98±18.54) min, (131.68±21.01) ml vs. (145.21±24.16) ml], with statistically significant differences (t=3.518, P=0.001; t=3.035, P=0.003). There was no statistically significant difference in the Visual Analogue Scale (VAS) score between the study group and the control group 3 months after surgery [(1.41±0.22) points vs. (1.47±0.21) points] (P>0.05). Six months after surgery, the Japanese Orthopaedic Association (JOA) score of the study group was higher than that of the control group [(21.98±2.03) points vs. (21.04±2.28) points], the Neck Dysfunction Index (NDI) was lower than that of the control group [(14.15±2.17)% vs. (15.26±2.43)%], and the ranges of motion of anterior flexion, posterior extension, left flexion, and right flexion were lower than those of the control group [(40.17±3.24)° vs. (42.01±3.62)°, (39.24±3.43)° vs. (41.68±3.75)°, (34.84±2.31)° vs. (36.05±2.74)°, (35.26±2.51)° vs. (37.01±2.72)°], with statistically significant differences (t=2.211, 2.446, 2.719, 3.447, 2.425, and 3.394, all P<0.05). There was no statistically significant difference in the physiological curvature of the cervical lateral position between the two groups 6 months after surgery [(10.34±1.43)° vs. (10.18±1.75)°] (t=0.509, P=0.612). The total complication rate of the study group was lower than that of the control group [5.77% (3/52) vs. 21.57% (11/51)], with a statistically significant difference (χ²=5.472, P=0.019). Conclusion　Compared with micro-titanium plate internal fixation, modified Y-shaped nano-bone plate fixation combined with unilateral cervical muscle ligament retention for MCSM surgery can reduce the operation time and blood loss, and has more advantages and safety in improving the function of patients' cervical vertebrae.

Influencing factors and their predictive value of cervical 5 nerve root palsy after anterior cervical decompression and fusion surgery

Li Min, Guo Yifan

2024, 30(18):  3008-3012.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.004

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Objective　To analyze the influencing factors and their predictive value of cervical 5 (C₅) nerve root palsy after anterior cervical decompression and fusion surgery. Methods　A total of 468 patients with anterior cervical decompression and fusion admitted to Shangluo Central Hospital between January 2019 and August 2022 were selected for the study, including 241 males and 227 females, aged (46.79±10.06) years. The selected patients were followed up for 1 year and were divided into an occurrence group (42 cases) and a non-occurrence group (426 cases) based on whether they were accompanied by C₅ nerve root palsy. The clinical and imaging data of the selected patients were collected and sorted. Univariate analysis (χ² test and t test) and multiple logistic regression analysis were used to analyze the relevant influencing factors, and the prediction model was constructed to analyze the predictive value. Results　The postoperative height of the C_4/5 intervertebral foramen [(9.05±0.44) mm] and proportion of the patients with high signal intensity in the C_3-5 spinal cord [42.86% (18/42)] in the occurrence group were higher than those in the non-occurrence group [(8.12±0.61) mm and 8.22% (35/426)], the preoperative transverse diameter of the C_4/5 intervertebral foramen was smaller than that in the non-occurrence group [(3.01±0.56) mm vs. (4.10±0.79) mm], and the horizontal spinal cord rotation angle (SRA) was larger than that in the non-occurrence group [(6.14±0.85)° vs. (3.46±0.52)°], with statistically significant differences (all P<0.001). The independent risk factors for C5 nerve root palsy after anterior cervical decompression and fusion were high postoperative height of the C_4/5 intervertebral foramen, small preoperative transverse diameter of the C_4/5 intervertebral foramen, large SRA at the C_4/5 level, and high signal intensity of the C_3-5 spinal cord (OR=2.408, 2.489, 2.757, and 2.214, all P<0.05). The area under the curve (AUC) of the predictive model's receiver operating characteristic curve was 0.916 (95%CI: 0.887-0.940). Conclusions　C₅ nerve root palsy in patients after anterior cervical decompression and fusion were associated with high height of the C_4/5 intervertebral space, small transverse diameter of the C_4/5 intervertebral foramen, high SRA at the C_4/5 level, and high signal intensity of the C_3-5 spinal cord. The prediction model constructed based on this had certain predictive value.

Application of anterolateral intermuscular approach combined with femoral neck preservation in total hip arthroplasty

Wang Linying, Gao Lianbing, Zhou Jiayi

2024, 30(18):  3012-3017.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.005

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Objective　To evaluate the application effect of anterolateral intermuscular approach combined with femoral neck preservation in total hip arthroplasty. Methods　The clinical data of 83 patients who underwent total hip arthroplasty in the Second Hospital of Weinan from January 2019 to January 2022 were retrospectively analyzed. Among them, 42 patients underwent minimally invasive total hip arthroplasty via anterolateral intermuscular approach, with femoral neck preservation, who were set as an observation group; 41 patients who underwent total hip arthroplasty via conventional posterolateral approach were set as a control group. In the observation group, there were 20 males and 22 females, aged (63.75±6.76) years. In the control group, there were 23 males and 18 females, aged (63.49±6.57) years. The perioperative indicators, serum creatine phosphokinase (CPK) levels before and 1 d after surgery, as well as Visual Analogue Scale (VAS) scores, Harris hip scores, Berg Balance Scale (BBS) scores, gait parameters, differences in bilateral limb length, and vertical and horizontal displacement of the hip center of rotation (HCOR) before and 12 months after surgery were compared between the two groups. t test and χ² test were used. Results　The operation time, intraoperative blood loss, incision length, drainage volume 1 d after surgery, and CPK level 1 d after surgery in the observation group were (60.26±7.41) min, (210.45±33.94) ml, (7.71±1.96) cm, (82.35±8.48) ml, and (384.75±29.76) U/L, and those in the control group were (68.97±8.35) min, (328.15±42.06) ml, (11.27±2.43) cm, (117.89±12.12) ml, and (668.40±45.94) U/L, with statistically significant differences (t=5.029, 14.047, 7.355, 15.510, and 33.299, all P<0.001). Twelve months after surgery, the VAS score, hip Harris score, BBS score, stride frequency, maximum step speed, percentage of single-leg support time, and plantar pressure difference in the observation group were (0.67±0.21) points, (90.45±9.37) points, (52.71±3.14) points, (96.79±8.12) steps/min, (89.94±10.63) cm/s, (46.59±5.31)%, and (9.02±1.03)%, and those in the control group were (0.89±0.27) points, (82.63±8.04) points, (45.42±4.83) points, (81.14±7.59) steps/min, (80.21±9.87) cm/s, (40.87±5.16)%, and (10.61±2.12) %, with statistically significant differences (t=4.137, 4.084, 8.131, 9.074, 4.323, 4.977, and 4.329, all P<0.001). Imaging results showed that the difference in bilateral limb length and vertical and horizontal displacement of the HCOR in the observation group were lower than those in the control group 12 months after surgery (t=5.473, 7.707, and 10.698, all P<0.001). Conclusion　Anterolateral intermuscular approach combined with femoral neck preservation appears to enhance postoperative recovery and improve hip joint function in patients undergoing total hip arthroplasty.

Effect of negative pressure wound therapy combined with periosteum-carrying lower lateral malleolus flap in repairing forefoot soft tissue defects

Lian Haipeng, Wang Ke, Gu Yunong, Li Jianwu, Bai Guoxi, Li Zhanning

2024, 30(18):  3018-3022.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.006

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Objective　To investigate the effect of negative pressure wound therapy (NPWT) combined with periosteum-carrying lower lateral malleolus flap in repairing forefoot soft tissue defects. Methods　This study was a randomized controlled trial. A total of 92 patients with forefoot soft tissue defects admitted to Shaanxi Provincial Corps Hospital of the Chinese People's Armed Police Forces from February 2020 to February 2023 were divided into two groups by touching ball method, with odd numbers allocated to the control group (46 cases) and even numbers to the observation group (46 cases). In the control group, there were 25 males and 21 females, aged (38.69±3.25) years, including 24 cases of mechanical injury, 17 cases of traffic injury, and 5 cases of crushing injury. In the observation group, there were 24 males and 22 females, aged (38.51±3.12) years, including 25 cases of mechanical injury, 15 cases of traffic injury, and 6 cases of crushing injury. The control group was treated with traditional debridement combined with periosteum-carrying lower lateral malleolus flap repair, and the observation group was treated with NPWT combined with periosteum-carrying lower lateral malleolus flap repair. The clinical indicators, flap survival rate, pain degree [Visual Analogue Scale (VAS)], ankle function [American Orthopedic Foot and Ankle Society Ankle Hindfoot Scale (AOFAS)], sensory function, and complications were compared between the two groups. χ² test and t test were used. Results　After treatment, the operation time of the observation group was (44.96±4.25) min, the antibiotic use time was (5.69±1.14) d, the hospital stay was (18.98±2.87) d, the dressing change times were (4.28±1.01), the flap harvest area was (47.26±4.85) cm², and those of the control group were (61.02±5.69) min, (11.25±2.05) d, (28.65±3.16) d, (9.26±1.95), and (55.36±5.12) cm², with statistically significant differences (t=12.753, 16.464, 16.251, 12.355, and 8.309, all P<0.001). The overall survival rate of skin flap was 95.65% (44/46) in the observation group and 71.74% (33/46) in the control group, with a statistically significant difference (χ²=9.638, P=0.002). The AOFAS score of the observation group was higher than that of the control group [(19.79±3.02) points vs. (16.02±2.84) points], and the VAS score was lower than that of the control group [(2.32±0.59) points vs. (4.21±0.85) points], with statistically significant differences (t=6.168 and 12.389, both P<0.001). The recovery effect of sensory function in the observation group was better than that in the control group, and the total complication rate was lower than that in the control group, with statistically significant differences (χ²=9.902, P=0.007; χ²=4.389, P=0.036). Conclusion　NPWT combined with periosteum-carrying lower lateral malleolus flap repair demonstrates superior effectiveness in repairing forefoot soft tissue defects compared to traditional methods, shortening the treatment time, improving the flap survival rate, alleviating the pain, and enhancing the functional recovery.

Study on the application of unilateral biportal endoscopic fusion treatment in single-segment lumbar lateral recess stenosis

Zhang Linlin, Li Peng, Shan Lequn

2024, 30(18):  3023-3028.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.007

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Objective　To compare and analyze the effects of large-channel spinal endoscopic decompression surgery and unilateral biportal endoscopy (UBE) lumbar fusion surgery in the treatment of single-segment lumbar lateral recess stenosis. Methods　The clinical data of 85 patients with single-segment lumbar lateral recess stenosis admitted to Ankang People's Hospital from January 2021 to January 2023 were retrospectively analyzed. All patients were divided into two groups according to different treatment methods. In the large channel group, there were 23 males and 21 females, aged (65.88±7.35) years, with duration of disease of (3.42±0.68) years, who underwent large-channel spinal endoscopic decompression surgery. In the UBE group, there were 19 males and 22 females, aged (65.51±7.26) years, with duration of disease of (3.51±0.74) years, who underwent UBE lumbar fusion surgery. The perioperative indicators of the two groups were compared, the discomfort levels of the waist and lower extremities of the two groups were compared before, 1 day, and 5 days after surgery, and the recovery of the lateral recess before and 7 days after surgery were compared between the two groups. The Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), and Activities of Daily Living Scale (ADL) were used to compare the lumbar function and activity abilities of the two groups before, 1 month, and 6 months after surgery. The complications were also recorded. χ² test, t test, and analysis of variance were used. Results　The operation time, intraoperative blood loss, incision length, and hospital stay in the UBE group were (65.14±4.39) min, (17.02±2.32) ml, (2.02±0.31) cm, and (6.18±0.73) d, which were lower than those in the large channel group (t=6.309, 6.967, 4.449, and 7.077, all P<0.001). The pain scores of the waist and lower extremities in the UBE group 1 d and 5 d after surgery were lower than those in the large channel group, with statistically significant differences (all P<0.05). The angles of soft lateral recess and bone lateral recess in the UBE group were (31.40±4.19)° and (35.41±4.06)°, which were higher than those in the large channel group [(26.84±3.26)° and (28.12±3.31)°], with statistically significant differences (t=5.621 and 9.034, both P<0.001). One month after surgery, the JOA score and ADL score in the UBE group were higher than those in the large channel group, and the ODI was lower than that in the large channel group, with statistically significant differences (all P<0.05). Six months after surgery, there was no statistically significant difference in the JOA score, ADL score, or ODI between the two groups (all P>0.05). The complication rate was 7.32% (3/41) in the UBE group and 11.36% (5/44) in the large channel group, with no statistically significant difference (χ²=0.408, P=0.523). Conclusions　UBE technology offers advantages of minimal trauma and faster recovery, reducing postoperative pain and accelerating the recovery process of lumbar function in patients with single-segment lumbar lateral recess stenosis. However, there is no significant difference in the long-term recovery effects between the two techniques.

Clinical effect of Zhonggu granules combined with governor vessel moxibustion in the treatment of ankylosing spondylitis

Chen Kun, Shi Lei, Yang Feng

2024, 30(18):  3028-3033.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.008

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Objective　To evaluate the clinical efficacy of Zhonggu granules combined with governor vessel moxibustion in the treatment of ankylosing spondylitis. Methods　A total of 128 patients with ankylosing spondylitis admitted to Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from January 2022 to August 2023 were selected and were divided into an experimental group and a control group by coin tossing, with 64 cases in each group. In the control group, there were 33 males and 31 females, aged (34.89±8.21) years, and the course of disease was (8.29±4.63) years. In the experimental group, there were 32 males and 32 females, aged (34.56±8.43) years, and the course of disease was (8.34±4.57) years. The control group received conventional drug treatment, oral salazosulfapyridine enteric-coated tablets (1.0 g each time, twice a day) + celecoxib capsules (0.2 g each time, once a day). The experimental group received Zhonggu granules (10 g each time, twice a day, infused with warm water) combined with governor vessel moxibustion (100 min each time, once a week). The treatment course was 3 months. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Function Index (BASFI), traditional Chinese medicine (TCM) symptom score, inflammatory polarization indicators [M1 macrophage CD86 expression, M2 macrophage CD16 expression, matrix metalloproteinase 3 (MMP-3), and tumor necrosis factor (TNF)-α], bone metabolism indicators [N-terminal propeptide of type I procollagen (PINP), serum β-C-terminal telopeptide of type I collagen (β-CTX), and bone-specific alkaline phosphatase (BALP)], physical examination indicators (finger-to-floor distance, chest expansion, and occiput-to-wall distance), and clinical efficacy were compared between the two groups. Statistical methods included t test and χ² test. Results　After 3 months of treatment, the BASDAI, BASFI, and TCM symptom score of the experimental group were (2.82±0.40) points, (3.38±0.48) points, and (2.91±0.34) points, which were lower than those of the control group [(4.05±0.58) points, (4.26±0.61) points, and (4.64±0.66) points], with statistically significant differences (t=13.966, 9.070, and 18.642, all P<0.001). There were statistically significant differences in the M1 macrophage CD86 expression, M2 macrophage CD16 expression, and levels of MMP-3, TNF-α, PINP, β-CTX, and BALP between the two groups (t=2.761, 4.094, 4.245, 9.505, 4.056, 3.536, and 4.356, all P<0.05). The finger-to-floor distance, chest expansion, and occiput-to-wall distance of the experimental group were (16.24±3.04) cm, (5.11±0.94) cm, and (2.76±1.05) cm, and those of the control group were (22.39±3.15) cm, (4.42±1.08) cm, and (4.02±1.21) cm, with statistically significant differences (t=11.239, 3.855, and 6.292, all P<0.001). The total effective rate of the experimental group was higher than that of the control group [93.75% (60/64) vs. 79.68% (51/64)], with a statistically significant difference (χ²=5.494, P=0.019). Conclusion　Zhonggu granules combined with governor vessel moxibustion in the treatment of ankylosing spondylitis can effectively reduce the BASDAI and BASFI, alleviate the TCM symptoms, regulate the inflammatory polarization and bone metabolism indexes, and improve the physical examination indexes, proving to be a safe and effective treatment method.

Clinical efficacy of external application of Jinhuang ointment combined with Shangyao ointment in the treatment of early swelling in patients with distal radius fractures after surgery

Deng Pingzheng, Tao Lijuan, Zhou Longdian

2024, 30(18):  3034-3037.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.009

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Objective　To explore the clinical efficacy of external application of Jinhuang ointment combined with Shangyao ointment in the treatment of early swelling in patients with distal radius fractures after surgery. Methods　A total of 90 patients with early swelling after distal radius fracture surgery in Nanchang Hongdu Hospital of Traditional Chinese Medicine from September 2020 to August 2023 were selected as the study objects, and were divided into a control group (45 cases) and an observation group (45 cases) by the random number table method. The control group included 22 males and 23 females, the age was 30-68 (50.47±9.63) years old, the fracture time was 1.3-9.0 (4.23±1.82) h, there were 15 patients on the left side and 30 patients on the right side, and there were 9 cases of flexion type and 36 cases of extension type. The observation group included 21 males and 24 females, the age was 26-69 (50.53±9.68) years old, the fracture time was 1.0-8.2 (4.22±1.81) h, there were 17 patients on the left side and 28 patients on the right side, and there were 7 cases of flexion type and 38 cases of extension type. The control group was treated with conventional anti-inflammatory, analgesic, and infection prevention. On the basis of the control group, the observation group was treated with external application of Jinhuang ointment combined with Shangyao ointment. Both groups were treated for 2 weeks. The swelling situation before and after treatment, swelling resolution time, pain relief time, and treatment effect were compared between the two groups. Independent sample t test, paired t test, and χ² test were used. Results　After treatment, the swelling score of the observation group [(0.91±0.36) points] was lower than that of the control group [(1.18±0.39) points] (P<0.05). The swelling resolution time [(5.31±1.18) d] and pain relief time [(4.20±1.12) d] in the observation group were shorter than those in the control group [(7.24±1.06) d and (4.98±1.16) d] (both P<0.05). The total effective rate of the observation group [86.67% (39/45)] was higher than that of the control group [53.33% (24/45)] (P<0.05). Conclusion　External application of Jinhuang ointment combined with Shangyao ointment in the treatment of early swelling in patients with distal radius fractures after surgery can better promote swelling resolution, effectively alleviate the pain sensation, and improve the patients' quality of life.

Effect of continuous passive activity combined with phased rehabilitation exercise on postoperative rehabilitation of elderly patients with femoral neck fractures

Duan Pengfei, Wei Jianing

2024, 30(18):  3038-3042.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.010

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Objective　To observe the effect of continuous passive activity therapy combined with phased rehabilitation exercise on postoperative rehabilitation of elderly patients with femoral neck fractures. Methods　A total of 113 elderly patients with femoral neck fractures admitted to the First Affiliated Hospital of Nanyang Medical College from January 2022 to March 2023 were prospectively selected as the study objects. The patients were divided into an exercise group (56 cases) and a combined group (57 cases) after the random sequence was generated by computer randomization method and assigned to hide. There were 33 males and 23 females in the exercise group, aged 65-75 (70.25±5.42) years, the course of disease was 7-14 (10.24±2.33) d, and the Garden fracture type was type II in 30 cases and type III in 26 cases. There were 34 males and 23 females in the combined group, aged 67-73 (70.36±5.33) years, the course of disease was 8-13 (10.32±2.19) days, and the Garden fracture type was type II in 32 cases and type III in 25 cases. All patients underwent surgical treatment. The exercise group received phased rehabilitation exercise after surgery, and the combined group received continuous passive activity therapy combined with phased rehabilitation exercise. Both groups were treated for 1 month and followed up for 1 year after treatment. The range of hip joint motion (flexion, extension, external rotation, and adduction), hip joint function [Harris Hip Score (HHS) and Visual Analogue Scale (VAS)], femoral vein blood flow parameters [peak flow velocity (Vp), mean flow velocity (Va), blood flow (BF), and flow resistance index (RI)] were compared between the two groups. Independent sample t test, paired t test, and χ² test were used. Results　After treatment, the motion ranges of hip joint flexion [(80.33±10.45)°], extension [(12.33±3.25)°], external rotation [(33.49±5.41)°], and adduction [(50.23±10.45)°] in the combined group were greater than those in the exercise group [(75.29±10.41)°, (10.39±2.44)°, (30.25±5.28)°, and (45.22±10.36)°] (all P<0.05). The HHS scores [(73.35±10.25) points and (82.49±10.44) points] in the combined group were higher than those in the exercise group [(68.42±10.44) points and (77.69±10.36) points] after 6 and 12 months of follow-up, and the VAS scores [(4.33±1.25) points and (2.28±0.46) points] were lower than those in the exercise group [(5.29±1.36) points and (3.36±0.45) points] (all P<0.05). After treatment, the Vp [(70.23±10.44) cm/s] and Va [(45.33±10.26) cm/s] of femoral vein in the combined group were higher than those in the exercise group [(65.44±10.28) cm/s and (40.29±10.36) cm/s], and the BF [(0.75±0.16) L/min] and RI [(1.33±0.72) kPa/s] were lower than those in the exercise group [(1.25±0.46) L/min and (1.62±0.41) kPa/s] (all P<0.05). Conclusion　Continuous passive activity therapy combined with phased rehabilitation exercise can improve the range of hip joint motion and hip joint function in elderly patients with femoral neck fractures after operation, and has positive significance in promoting the recovery of femoral vein blood flow.

Effect of auricular-point pressing bean of midnight-noon and ebb-flow doctrine on stabilizing preoperative patients with traumatic osteomyelitis

Bian Yanan, Ge Zhanzhou, Nie Xingyu, Zhou Rui

2024, 30(18):  3042-3046.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.011

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Objective　To study the effect of auricular-point bean pressing of midnight-noon and ebb-flow doctrine on the stability of blood pressure and anxiety state in patients with traumatic osteomyelitis before operation. Methods　A total of 126 patients with pre-traumatic osteomyelitis with elevated blood pressure and anxiety of different degrees admitted to the Fifth Department of Orthopedics, Puyang Hospital of Traditional Chinese Medicine from April 2020 to April 2023 were selected as the study objects, and were divided into a control group (63 cases) and an observation group (63 cases) by the random number table method. There were 40 males and 23 females in the control group, aged 32-71 (54.27±7.25) years. There were 38 males and 25 females in the observation group, aged 34-70 (53.61±6.71) years. The control group was given routine preoperative management, and the observation group was given auricular-point bean pressing of midnight-noon and ebb-flow doctrine since 5 days before surgery. The intervention lasted for 5 days in both groups. The effects of blood pressure stabilization, pain status [Visual Analogue Scale (VAS)], anxiety status [Hamilton Anxiety Scale (HAMA)], and mental resilience [Connor-Davidson Resilience Scale (CD-RISC)] before and after intervention were compared between the two groups. Independent sample t test, paired t test, and χ² test were used. Results　After intervention, the systolic blood pressure [(130.51±4.22) mmHg] (1 mmHg=0.133 kPa), diastolic blood pressure [(83.10±2.89) mmHg], and heart rate [(89.55±4.25) beats/min] in the observation group were lower than those in the control group [(133.12±3.85) mmHg, (86.32±3.11) mmHg, and (93.48±3.95) beats/min] (all P<0.05). The scores of VAS [(2.96±0.65) points] and HAMA [(10.21±2.53) points] of the observation group were lower than those of the control group [(4.12±0.78) points and (13.26±2.92) points] (both P<0.05). The CD-RISC score of the observation group was higher than that of the control group [(87.83±5.80) points vs. (81.23±5.39) points] (P<0.05). Conclusion　Auricular-point pressing bean of midnight-noon and ebb-flow doctrine can effectively relieve the pain and anxiety in patients with traumatic osteomyelitis before operation, improve their level of psychological resilience, stabilize the level of blood pressure, and have clinical promotion value.

New Medical Advances

Progress in the application of metabonomics in drug development

Zhao Bo, Li Siwei, Xue Caiqin, Xing Tian, Gao Ping, Li Min

2024, 30(18):  3047-3050.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.012

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Metabolomics is a qualitative and quantitative study of small molecule metabolites in the upstream and downstream of metabolic pathways in organisms to find the corresponding relationship between metabolic network and physiological and pathological changes. These small molecules participate in body activities and play an important role in the process of producing physiological and pathological effects or signal transduction. Changes in the metabolome show changes that are currently occurring, reflecting a combination of genetic changes and environmental influences. Studying significant changes in metabolite patterns has been recognized as a tool for understanding key aspects in drug development, such as drug efficacy and toxicity. The inclusion of metabolomics in the omics research platform brings us closer to defining phenotypes and allows us to look for alternative ways to improve the disease diagnosis. Advances in analytical strategies and statistical tools for studying metabolomics allow us to prevent drug failures at the early stages of drug development and reduce the financial losses of expensive phase Ⅱ and Ⅲ clinical trials. This article introduces metabonomics and some examples of its application in drug development, and discusses its future directions and challenges.

Meta Analysis

Meta-analysis on the improvement of pain in patients with low back pain by large-area separated moxibustion

Xu Jianying, Liu Yu, Chen Lijia, Guan Lijuan

2024, 30(18):  3051-3057.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.013

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Objective　To evaluate the effect of large-area separated moxibustion (dragon moxibustion, supervised moxibustion, spread moxibustion, etc.) on pain relief in patients with low back pain. Methods　The resources of PubMed, EMBASE, Cochrane Library, Clinicakey, SinoMed, VIP, WanFang, and CNKI were searched from the establishment of the databases to June 2022, and the randomized controlled trials of large-area separated moxibustion on pain improvement in patients with low back pain were collected. The results were statistically analyzed by RevMan 5.4 software. Results　A total of 27 literatures were included. Meta-analysis showed that compared with the control group with non-large area separated moxibustion, the treatment group with large area separated moxibustion could reduce the patients' pain [MD=-1.64, 95%CI (-2.00, -1.29), P<0.000 01], improve the lumbar neurological function [SMD=1.55, 95%CI (1.15, 1.95), P<0.000 01], and improve the lumbar dysfunction [SMD=-2.19, 95%CI (-3.22, -1.17), P<0.000 01]. Funnel graph analysis showed that the included literatures might have potential publication bias. Conclusions　Large area separated moxibustion has significant effects on the improvement of pain and lumbar function in patients with low back pain, and is worthy of wide application. However, the quality of the original literatures included in this study is not high, and it needs to be verified by higher quality clinical research in the future.

Treatises

Clinical value of 128-slice CT perfusion imaging in predicting postoperative recurrence in patients with invasive lung adenocarcinoma

Hou Yongzhi, Lu Jie, Wang Wenyu

2024, 30(18):  3058-3062.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.014

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Objective　To analyze the clinical value of 128-slice CT perfusion imaging in predicting postoperative recurrence in patients with invasive lung adenocarcinoma. Methods　A total of 100 patients with invasive lung adenocarcinoma were selected from March 2021 to March 2023 in Xingyang People's Hospital. The patients were followed up for 12 months after surgery, and were divided into a recurrence group (30 cases) and a non-recurrence group (70 cases) according to whether the disease recurred. In the recurrence group, there were 16 males and 14 females, aged (52.62±5.66) years, with a body mass index (BMI) of (24.62±0.94) kg/m². There were 38 males and 32 females in the non-recurrence group, aged (52.33±5.05) years, with a BMI of (24.68±0.84) kg/m². The general data of the two groups were collected, and the parameters of 128 slice CT perfusion imaging [blood volume (BV), blood flow (BF), surface permeability (PS), time to peak of contrast agent (TTP), and mean transit time of contrast agent (MTT)] were compared between the two groups. Logistic regression analysis was performed to identify the risk factors of postoperative recurrence in patients with invasive lung adenocarcinoma. The receiver operating characteristic curve (ROC) was used to analyze the predictive efficacy of 128 slice CT perfusion parameters for postoperative recurrence in patients with invasive lung adenocarcinoma. Independent sample t test and χ² test were used. Results　The PS in the recurrence group was lower than that in the non-recurrence group (P<0.05), and the contrast agent TTP and MTT in the recurrence group were higher than those in the non-recurrence group (both P<0.05). Logistic regression analysis showed that PS, contrast agent MTT, contrast agent TTP, lymph node metastasis, and differentiation degree were all influencing factors for postoperative recurrence in patients with invasive lung adenocarcinoma (all P<0.05). The area under the curve (AUC) (95%CI) of combination of PS, contrast agent MTT, and contrast agent TTP in predicting postoperative recurrence in patients with invasive lung adenocarcinoma was 0.850 (0.801-0.936). The sensitivity (93.08%) of combination of the three to predict postoperative recurrence of invasive lung adenocarcinoma was higher than that of single detection (75.82%, 68.25%, and 66.96%) (all P<0.05). Conclusions　Postoperative recurrence in patients with invasive lung adenocarcinoma can lead to a decrease in PS and an increase in contrast agent MTT and TTP. The combined detection of PS, contrast agent MTT, and contrast agent TTP can improve the predictive sensitivity of postoperative recurrence, which has important guiding significance.

Value of CCI combined with miR-21-5p in predicting the prognosis of elderly patients undergoing mechanical ventilation

Wang Jia, Chen Xiaofeng

2024, 30(18):  3062-3066.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.015

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Objective　To evaluate the value of Charlson Comorbidity Index (CCI) combined with microRNA-21-5p (miR-21-5p) in predicting the prognosis of elderly patients undergoing mechanical ventilation. Methods　A total of 280 elderly patients who received mechanical ventilation in the emergency department of Hanzhong People's Hospital from April 2018 to December 2023 were retrospectively selected as the study objects. According to the survival status at one-month of follow-up, the patients were divided into a survival group (208 cases) and a death group (72 cases). There were 135 males and 73 females in the survival group, with a body mass index (BMI) of (22.46±2.57) kg/m². There were 48 males and 24 females in the death group, with a BMI of (22.19±3.01) kg/m². The general data and clinical characteristics (gender, BMI, smoking history, causes of respiratory failure, mechanical ventilation time, CCI total score, and miR-21-5p expression level) were compared between the two groups. Multivariate logistic regression model was used to analyze the influencing factors of prognosis. The receiver operating characteristic curve (ROC) was used to analyze the predictive efficacies of CCI total score and miR-21-5p expression level for the prognosis of elderly patients undergoing mechanical ventilation. Independent sample t test and χ² test were used. Results　There was no statistically significant difference between the two groups in terms of gender, BMI, smoking history, or causes of respiratory failure (all P>0.05). The mechanical ventilation time [(12.60±3.82) d], the total score of CCI [(10.43±3.35) points], and the expression level of miR-21-5p [(3.54±1.09)] in the death group were higher than those in the survival group [(10.31±3.40) d, (5.91±2.17) points, and (2.31±0.73)], with statistically significant differences (all P<0.05). Multivariate logistic regression analysis showed that the total score of CCI and the expression level of miR-21-5p were independent predictors of death (both P<0.05). The areas under the curves (AUCs) (95%CI) of CCI total score and miR-21-5p expression level to predict the prognosis of elderly patients undergoing mechanical ventilation were 0.859 (0.806-0.913) and 0.825 (0.759-0.890), respectively, and the combined AUC (95%CI) was 0.946 (0.919-0.973). Conclusion　The total CCI score combined with expression level of miR-21-5p can effectively predict the one-month mortality risk in elderly patients undergoing mechanical ventilation, which has important reference value for clinical decision-making.

Correlations between EOS and FeNO levels and lung function in COPD patients

Wei Mian, Sang Chunli, Liu Xiangqun

2024, 30(18):  3067-3070.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.016

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Objective　To analyze the correlations between blood eosinophils (EOS) and fractional concentration of exhaled nitric oxide (FeNO) levels and lung function in patients with chronic obstructive pulmonary disease (COPD). Methods　A total of 200 patients with COPD treated in Xuzhou First People's Hospital from October 2019 to June 2023 were selected as the study objects and were set as the observation group. Among them, there were 138 males and 62 females, aged 55-88 (66.45±5.45) years, and the course of disease was 1-18 (10.23±3.23) years. According to the disease stage, the observation group was divided into an acute attack group (150 cases) and a stable stage group (50 cases). Another 100 patients with non-COPD who were hospitalized during the same period were selected as the control group. The general data, such as smoking history, drinking history, underlying diseases, and body mass index (BMI), were collected from the 300 subjects. The EOS level was detected by automatic blood cell analyzer, the FeNO level was detected by FeNO detector, and the lung function was detected by lung function detector. The correlations between EOS and FeNO levels in peripheral blood and lung function of COPD patients were analyzed by Pearson correlation analysis. Independent sample t test, F test, and χ² test were used. Results　The proportion of smoking history in the observation group [52.50% (105/200)] was higher than that in the control group [17.00% (17/100)] (P<0.05). The levels of EOS [(6.23±0.21)%, (6.42±0.58)%] and FeNO [(35.52±7.28) ppb, (46.28±7.08) ppb] in peripheral blood of the stable stage and acute attack groups were higher than those of the control group [(2.23±0.59)%, (15.23±7.34) ppb], and the FeNO level in the acute attack group was higher than that in the stable stage group (all P<0.05). The forced vital capacity (FVC) [(2.18±0.18) L, (2.16±0.15) L], forced expiratory volume in the first second (FEV1) [(1.16±0.31) L, (1.14±0.28) L], FEV1/FVC [(60.56±8.24)%, (59.23±8.21)%], and FEV1% [(65.23±8.59)%, (64.11±8.12)%] in the stable stage and acute attack groups were lower than those in the control group [(3.16±0.38) L, (2.21±0.41) L, (82.28±9.16)%, and (89.62±5.23)%] (all P<0.05). Pearson correlation analysis showed that the EOS level in peripheral blood of COPD patients was positively correlated with FeNO level (r=0.584, P=0.002), and negatively correlated with FEV1/FVC (r=-0.213, P=0.005). Conclusions　There is a significant correlation between EOS% and FeNO level as well as lung function in COPD patients. Clinically, changes in their levels can be used to assess the patients' condition and provide guidance for later treatment.

Clinical study on the treatment of lobar pneumonia in children with combination of traditional Chinese and western medicine

Liu Qiaojuan, Ren Xiaohong, Fan Ying, Zhang Jiao

2024, 30(18):  3071-3075.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.017

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Objective　To investigate the clinical effect of combined traditional Chinese and western medicine treatment for children with lobar pneumonia. Methods　A total of 100 children with lobar pneumonia aged 6-14 years admitted to the pediatric department of Baoji Maternal and Child Health Hospital from June 2021 to July 2023 were selected as the study objects, and were divided into a control group (50 cases) and a treatment group (50 cases) by the random number table method. In the control group, 27 boys and 23 girls were (9.03±1.42) years old, and the course of disease was (8.75±1.76) days. In the treatment group, 25 boys and 25 girls were (9.28±1.69) years old, and the course of disease was (8.46±1.63) days. The control group received conventional western medical treatment, and the treatment group was treated with oral Maimendong decoction and Liujunzi decoction combined with traditional Chinese medicine on the basis. Both groups were treated for 4 weeks. The clinical efficacy, symptom resolution time (duration of cough, fever resolution time, and improvement time of lung X-ray images), laboratory indicators [total white blood cell count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), and D-dimer], and lung function indicators [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), forced expiratory flow at 25%, 50%, and 75% of FVC (FEF25%, FEF50%, and FEF75%), and maximum mid-expiratory flow rate (MMEF)] were compared between the two groups. Independent sample t test and χ² test were used. Results　The total effective rate of the treatment group [96.00% (48/50)] was higher than that of the control group [84.00% (42/50)], with a statistically significant difference (P<0.05). The duration of cough [(7.13±1.55) d], fever resolution time [(2.44±1.04) d], and improvement time of lung X-ray images [(12.34±1.83) d] in the treatment group were shorter than those in the control group [(10.73±1.79) d, (4.39±1.35) d, and (16.68±2.46) d], with statistically significant differences (all P<0.05). After treatment, the levels of CRP [(8.79±3.75) mg/L], ESR [(16.48±3.58) mm/h], PCT [(0.48±0.27) μg/L], and D-dimer [(575.64±106.89) μg/L] in the treatment group were lower than those in the control group [(11.37±4.97) mg/L, (19.16±3.86) mm/h, (0.69±0.23) μg/L, and (798.46±113.78) μg/L], with statistically significant differences (all P<0.05). The FVC, FEV1, PEF, FEF 25%, FEF 50%, FEF 75%, and MMEF in the treatment group were higher than those in the control group (all P<0.05). Conclusions　The combination of traditional Chinese and western medicine in the treatment of lobar pneumonia can significantly improve the clinical efficacy rate in children, notably ameliorate the symptoms, significantly restore the physiological indicators, and notably improve the lung function. This approach holds promise for providing a new direction in the treatment of pediatric lobar pneumonia, and is worth further clinical application and promotion.

Efficacy and safety of Huotan Tongluo Decoction combined with beclomethasone propionate in the treatment of mycoplasma pneumonia in children

Liu Yanan, Fu Yunyun, Li Xiupeng, Xing Yaheng

2024, 30(18):  3076-3080.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.018

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Objective　To observe the efficacy and safety of Huotan Tongluo Decoction combined with beclomethasone propionate in the treatment of mycoplasma pneumonia (MP) in children. Methods　A total of 103 children with MP admitted to Xuchang Maternity and Child Health Hospital from February 2022 to January 2024 were retrospectively selected as the study objects. The 51 patients treated with beclomethasone propionate (aerosol inhalation) were set as the single group, and the 52 patients treated with Huotan Tongluo Decoction (oral) combined with beclomethasone propionate were set as the combined group. There were 32 boys and 20 girls in the combined group, aged 4-11 (7.46±1.31) years, and the course of disease was 3-18 (10.42±3.49) days. There were 28 boys and 23 girls in the single group, aged 4-10 (7.16±1.20) years, and the course of disease was 3-17 (10.13±3.26) days. Both groups were treated continuously for 14 days. The clinical efficacy, scores of traditional Chinese medicine (TCM) syndromes (cough, fever, asthma, and sputum), levels of inflammatory factors [interleukin-2 (IL-2), white blood cell count (WBC), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), and C-reactive protein (CRP)], immune capacity [immunoglobulin A (IgA), IgG, and IgM], and adverse reactions (rash, diarrhea, nausea/vomiting, etc.) were compared between the two groups. Independent sample t test, paired t test, and χ² test were used. Results　The total effective rate of the combined group [98.08% (51/52)] was higher than that of the single group [86.27% (44/51)] (P<0.05). After treatment, the scores of cough [(1.63±0.40) points], fever [(1.31±0.46) points], asthma [(0.56±0.19) points], and sputum [(1.22±0.39) points] in the combined group were lower than those in the single group [(2.38±0.65) points, (1.95±0.53) points, (0.94±0.26) points, and (1.59±0.67) points] (all P<0.05). The levels of IL-2 [(42.48±3.97) ng/L], WBC [(7.29±0.89)x10⁹/L], TNF-α [(18.33±2.03) ng/L], IFN-γ [(35.66±6.08) ng/L], and CRP [(5.86±1.29) mg/L] in the combined group were lower than those in the single group [(53.89±3.42) ng/L, (8.92±1.37)×10⁹/L, (23.08±2.94) ng/L, (69.34±17.39) ng/L, and (6.91±1.40) mg/L] (all P<0.05). The levels of IgA, IgG, and IgM in the combined group were higher than those in the single group (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion　Huotan Tongluo Decoction combined with beclomethasone propionate can relieve the clinical symptoms of MP children, inhibit the inflammatory response, enhance the immune capacity, and have good safety.

Correlations between CTRP3 and CTRP9 levels and glucose and lipid metabolism and insulin resistance in obese children in primary and secondary schools

Cheng Qianqian, Wang Tingting, Zhou Huiqin, Li Kefa, Liang Jianjun

2024, 30(18):  3080-3084.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.019

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Objective　To investigate the correlations between serum complement C1q/tumor necrosis factor-related protein (CTRP)3 and CTRP9 levels and glucose and lipid metabolism and insulin resistance in obese children in primary and secondary schools. Methods　A total of 80 obese children in primary and secondary schools, aged 8-14 years, who were treated in Zhumadian TCM Hospital from March 2022 to September 2023, were selected as the obese group. During the same period, 76 overweight children aged 8-14 years in primary and secondary schools were selected as the overweight group, 82 normal weight children aged 8-14 years were selected as the control group. The general data (gender, age, systolic blood pressure, diastolic blood pressure, waist circumference, hip circumference, etc.) of the children in the three groups were collected. The fasting insulin (FINS) level was detected by chemiluminescence immunoassay, the fasting blood glucose (FBG) level was detected by glucose oxidase assay, and the homeostasis model assessment insulin resistance (HOMA-IR) was calculated. The levels of total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C) were measured by automatic biochemical analyzer. Serum CTRP3 and CTRP9 levels were detected by enzyme-linked immunosorbent assay (ELISA). Pearson correlation analysis was used to analyze the correlations between serum CTRP3 and CTRP9 levels and blood glucose, blood lipids, and insulin resistance in obese children. Multivariate logistic regression analysis was used to analyze the influencing factors of childhood obesity. One-way analysis of variance, SNK-q test, and χ² test were used. Results　The levels of waist circumference, hip circumference, TC, TG, LDL-C, FINS, FBG, and HOMA-IR in the obese group were higher than those in the control group and the overweight group, and those in the overweight group were higher than those in the control group (all P<0.05). The HDL-C in the obese group was lower than that in the control group and the overweight group, and that in the overweight group was lower than that in the control group (all P<0.05). Serum CTRP3 [(190.36±60.22) μg/L] and CTRP9 [(101.15±26.49) μg/L] levels in the obese group were lower than those in the control group [(304.83±72.51) μg/L and (152.87±30.96) μg/L] and the overweight group [(236.75±64.71) μg/L and (124.13±27.89) μg/L]; those in the overweight group were lower than those in the control group (all P<0.05). There was a positive correlation between CTRP3 and CTRP9 in serum of obese children (P<0.05). Both were positively correlated with HDL-C (both P<0.05), and were negatively correlated with TC, TG, LDL-C, FINS, FBG, and HOMA-IR (all P<0.05). FINS was a risk factor for obesity in primary and secondary school children (P<0.05), and CTRP3 and CTRP9 were protective factors for obesity in primary and secondary school children (both P<0.05). Conclusion　The decrease of serum CTRP3 and CTRP9 levels is closely associated with obesity in primary and secondary school children, which can reflect the disorder of glucose and lipid metabolism and insulin resistance in children.

Postoperative patency rate of venous stent and risk factors in patients with deep venous post-thrombotic syndrome of lower extremity

Cui Jie, Huang Zhiwei, Lu Jian, Che Haijie

2024, 30(18):  3085-3088.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.020

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Objective　To investigate the postoperative patency rate of venous stent and risk factors in patients with deep venous post-thrombotic syndrome (PTS) of lower extremity. Methods　A total of 106 patients with lower extremity PTS admitted to Yantai Laiyang Central Hospital and Yantai Yuhuangding Hospital from January 2021 to January 2023 were retrospectively selected as the study objects. There were 65 males and 41 females, aged 29-79 (58.71±9.64) years. All enrolled patients were treated with venous balloon dilation combined with stent implantation, and were followed up for 1 year after surgery to assess the patency of venous stent. According to the patency of venous stent, they were divided into a patency group and a non-patency group. The general information of the two groups were compared, and logistic regression analysis was used to analyze the risk factors affecting the patency of venous stent. Independent sample t test, χ² test, and rank sum test were used. Results　According to statistics, among the 106 PTS patients of lower extremity, there were 88 cases of venous stent patency within 1 year after operation, and the patency rate was 83.02% (88/106). Logistic regression analysis showed that BMI, having varicose veins, and number of stents were risk factors for stent patency (OR=2.349, 3.509, and 2.604, P=0.002, 0.002, and 0.007); thrombus clearance grading, anticoagulant drug - rivaroxaban treatment, duration of anticoagulant treatment, receiving antiplatelet therapy, and receiving compression therapy were all protective factors for stent patency (OR=0.400, 0.335, 0.460, 0.316, and 0.356, P=0.016, 0.028, 0.003, 0.028, and 0.016). Conclusions　The patency rate of venous stent in patients with lower extremity PTS is affected by many factors. Controlling body weight, improving patients' varicose veins, effectively removing thrombus, reasonably choosing anticoagulant drugs as well as anticoagulation for more than 6 months, and performing antiplatelet therapy and compression therapy after surgery may be able to effectively improve the patency rate of venous stent and safeguard the therapeutic effect.

Effect of hierarchical diagnosis and treatment model of compact county medical community on the treatment for patients with moderate to severe COPD

Wan Jun, Bai Yinglian, Li Peigen, Huang Hua, Shao Weiping, Wang Mingxing, Deng Hong

2024, 30(18):  3089-3093.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.021

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Objective　To explore the impact of hierarchical diagnosis and treatment model of compact county medical community on the treatment for patients with moderate to severe chronic obstructive pulmonary disease (COPD). Methods　A total of 150 patients with moderate to severe COPD who were admitted to the grassroots central branch of the medical community and the leading hospital of our country (Lianzhou People's Hospital) from May 2022 to April 2023 were selected as a study group, and 150 patients with moderate to severe COPD from May 2021 to April 2022 were selected as a control group. In the control group, there were 120 males and 30 females, aged (67.25±7.63) years, with 60 cases of grade C and 90 cases of grade D. In the study group, there were 123 males and 27 females, aged (66.83±7.55) years, with 56 cases of grade C and 94 cases of grade D. The study group was managed by the hierarchical diagnosis and treatment model of compact county medical community, while the control group was managed by the routine diagnosis and treatment model. After 1 year of follow-up, the compliance, mortality, forced expiratory volume in the first second (FEV₁%), COPD Assessment Test (CAT) score, 6-min walking distance, annual acute exacerbation times, and quality of life were compared between the two groups. t test and χ² test were used. Results　The mortality rate of the study group was 3.33% (5/150), which was lower than that of the control group [9.33% (14/150)], with a statistically significant difference (χ²=7.545, P=0.006). There were 25 cases (16.67%) lost to follow-up in the study group and 16 cases (10.67%) in the control group. The control group and the study group were followed up successfully with 120 cases each. The follow-up rate, smoking cessation rate, and inhaler usage rate in the study group were 81.67% (98/120), 79.17% (95/120), and 92.50% (111/120), which were higher than those in the control group [30.00% (36/120), 28.33% (34/120), and 59.17% (71/120)], with statistically significant differences (all P<0.05). After 1 year of follow-up, compared with the control group, the FEV₁% of the study group was higher [(44.97±6.16) % vs. (37.16±5.24) %], the number of acute exacerbations and CAT score were lower [(1.20±0.45) vs. (1.90±0.55), (17.75±5.35) points vs. (22.10±5.05) points], the 6-min walking distance was longer [(263.28±93.06) m vs. (177.65±95.12) m], and the annual medical expenses were lower [(12 071.25±390.63) yuan vs. (13 519.94±386.75) yuan], with statistically significant differences (all P<0.05); the quality of life scores of the study group were higher than those of the control group (all P<0.001). Conclusion　The hierarchical diagnosis and treatment model of compact county medical community is helpful to slow down the further deterioration of lung function in patients with moderate to severe COPD, reduce the number of acute exacerbations, reduce the annual medical expenses and mortality rate, and improve the patients' living tolerance and prognosis, which is worthy of promotion and application.

Clinical Research

Analgesic effect of anterior serratus nerve block combined with general anesthesia for radical resection of lung cancer

Wu Lin, Liao Yanling

2024, 30(18):  3094-3098.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.022

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Objective　To explore the analgesic effect of anterior serratus nerve block combined with general anesthesia for radical resection of lung cancer. Methods　A total of 92 patients admitted to Wuyishan Municipal Hospital from December 2018 to December 2022 for elective radical resection of lung cancer were selected as the study objects, and were divided into two groups according to the random number table method, with 46 cases in each group. In the control group, there were 25 males and 21 females, aged (51.15±3.96) years, with a body mass index of (22.87±1.15) kg/m², and the TNM stage was stage I in 8 cases and stage II in 38 cases. In the observation group, there were 27 males and 19 females, aged (51.28±4.12) years, with a body mass index of (22.92±1.13) kg/m², and the TNM stage was stage I in 7 cases and stage II in 39 cases. The control group received combined intravenous and inhalation general anesthesia, and the observation group received ultrasound-guided anterior serratus nerve block (after anesthesia induction, 22G nerve block needle was used, and when it reached the surface of the anterior serratus muscle, 2 ml of ropivacaine was given firstly, and then 20 ml of 0.375% ropivacaine was injected after liquid dark area was found, and no blood or air was withdrawn) combined with general anesthesia. The changes of heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) of the two groups were measured at different time points during operation and after operation. The amount of postoperative sufentanil use, postoperative awakening time, recovery time of spontaneous breathing, and number of times of self-controlled intravenous analgesia compressions were recorded, the pain degree was evaluated at different time points after operation, and the occurrence of adverse reactions was observed. t test and χ² test were used. Results　There were no statistically significant differences in the HR, SBP, or DBP between the two groups before induction (T0), at incision (T1), or 30 min after operation (T2) (all P>0.05); the HR, SBP, and DBP in the observation group were lower than those in the control group immediately after extubation (T3) and 5 min after extubation (T4) (all P<0.05). The amount of postoperative sufentanil use [(10.22±2.54) μg vs. (20.52±4.58) μg], postoperative awakening time [(15.02±3.06) min vs. (22.58±4.72) min], recovery time of spontaneous breathing [(16.82±3.34) min vs. (25.75±4.18)] min], and number of times of self-controlled intravenous analgesia compressions [(10.22±2.27) vs. (18.72±3.72)] in the observation group were lower than those in the control group (all P<0.05). The pain scores at rest and under activity in the observation group were lower than those in the control group 6 h, 12 h, 24 h, and 48 h after surgery (all P<0.05). The incidence of adverse reactions in the observation group was lower than that in the control group [6.52% (3/46) vs. 23.91% (11/46)] (χ²=5.391, P=0.020). Conclusion　The use of ultrasound-guided anterior serratus nerve block combined with general anesthesia can maintain the stability of intraoperative hemodynamics, reduce the degree of postoperative pain, reduce the dosage of anesthetic drugs and the number of self-controlled intravenous analgesic compressions, promote the rapid postoperative recovery, and reduce the anesthesia related adverse reactions, which is worthy of popularization and application.

Influence of flexible ureteroscopic lithotripsy on renal function and pain stress in male patients with renal calculi

Guo Chao, Yan Shuxian, Li Shuhua, Yang Xingqiang, Xing Dongliang

2024, 30(18):  3098-3102.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.023

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Objective　To observe the influence of flexible ureteroscopic lithotripsy on renal function, pain stress indicators, and recurrence rate in male patients with renal calculi. Methods　A total of 92 male patients with chronic renal calculi with diameter <2.5 cm admitted to the 989th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China from June 2018 to June 2023 were included and were divided into an observation group and a control group by simple randomization method, with 46 cases in each group, which were treated by flexible ureteroscopic lithotripsy and percutaneous nephrolithotomy, respectively. The observation group was (42.39±6.12) years old, and the maximum diameter of the stones was (1.94±0.22) cm. The control group was (41.87±5.96) years old, and the maximum diameter of the stones was (1.88±0.50) cm. The perioperative parameters (operation time, intraoperative blood loss, postoperative hospital stay, and stone clearance rate), renal function indexes [cystatin C (Cys-C) and serum creatinine (Scr)] and pain stress indexes [cortisol (Cor) and endothelin-1 (ET-1)] before surgery and 3 d after surgery, postoperative complications, and stone recurrence rate within 6 months after surgery were compared between the two groups. χ² test, Fisher exact probability method, and t test were used. Results　The operation time of the observation group was (86.45±11.27) min, which was longer than that of the control group [(47.29±6.31) min]; the intraoperative blood loss was (9.01±2.32) ml, which was lower than that of the control group [(24.72±6.69) ml]; the postoperative hospital stay was (4.62±0.86) d, which was shorter than that of the control group [(5.57±0.99) d], with statistically significant differences (t=20.563, 14.048, and 4.913, all P<0.001). The serum levels of Cys-C, Scr, Cor, and ET-1 in the observation group 3 d after surgery were (2.29±0.60) mg/L, (90.33±6.09) μmol/L, (150.67±25.38) mg/L, and (113.70±21.09) ng/L, respectively, which were lower than those in the control group [(2.77±0.72) mg/L, (95.71±6.38) μmol/L, (188.76±29.80) mg/L, and (132.84±26.72) ng/L], with statistically significant differences (t=3.474, 4.137, 6.600, and 3.814, all P<0.001). The total incidence of postoperative complications in the observation group was 2.17% (1/46), which was lower than that in the control group [15.22% (7/46)], with a statistically significant difference (χ²=4.913, P=0.026). The recurrence rate was 2.63% (1/46) in the observation group and no recurrence in the control group within 6 months after surgery, without statistically significant difference in the recurrence rate between the two groups (P=1.000). Conclusion　There is no significant difference in the stone clearance rate or recurrence rate in flexible ureteroscopic lithotripsy compared to percutaneous nephrolithotomy in the treatment of male renal calculi with diameter <2.5 cm, but the intraoperative blood loss, postoperative hospital stay, and incidence of complications are lower, and the postoperative renal function and pain stress indicators recover faster.

Efficacy and safety of empagliflozin in patients with heart failure after acute myocardial infarction

Shi Xiuming, Peng Jinhua, He Weixi

2024, 30(18):  3103-3106.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.024

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Objective　To investigate the efficacy and safety of empagliflozin in patients with heart failure (HF) after acute myocardial infarction (AMI). Methods　A total of 72 patients with HF after AMI treated in Jingdezhen First People's Hospital from June 2022 to January 2024 were selected and were divided into two groups according to the random number table method, with 36 cases in each group. In the control group, there were 19 males and 17 females, aged (62.18±6.19) years, and the New York Heart Association (NYHA) grade was grade Ⅱ in 5 cases, grade Ⅲ in 17 cases, and grade Ⅳ in 14 cases. In the empagliflozin group, there were 20 males and 16 females, aged (62.33±6.21) years, including 6 cases of grade Ⅱ, 18 cases of grade Ⅲ, and 12 cases of grade Ⅳ. The control group was treated with basic drugs, and the empagliflozin group was additionally treated with empagliflozin (10 mg/time, once a day) for 3 months. The treatment effect, cardiac function indexes [left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), and left ventricular end-diastolic diameter (LVEDD)], 6-min walking distance (6MWD), cardiovascular adverse events, and adverse reactions were compared between the two groups. χ² test and t test were used. Results　The total effective rate of the empagliflozin group [91.67% (33/36)] was higher than that of the control group [72.22% (26/36)] (P<0.05). After 3 months of treatment, the LVEF and 6MWD were increased in both groups, which were higher in the empagliflozin group than in the control group; the LVESD and LVEDD were decreased in both groups, which were lower in the empagliflozin group than in the control group (all P<0.05). The incidence of cardiovascular adverse events in the empagliflozin group [5.56% (2/36)] was lower than that in the control group [22.22% (8/36)] (P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the empagliflozin group [22.22% (8/36)] and the control group [19.44% (7/36)] (P>0.05). Conclusion　Empagliflozin has significant efficacy in HF patients after AMI, which can improve the patients' cardiac function and reduce the incidence of cardiovascular adverse events, with high safety.

Effect of Qingjin Zhike Jieji Decoction in the treatment of phlegm-dampness accumulation of lung during acute attack of chronic bronchitis in the elderly

Liu Xueping, Chen Ruyue, Lian Mengyao, Fan Xiaochen, Song Qiurong

2024, 30(18):  3107-3111.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.025

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Objective　To observe the effect of Qingjin Zhike Jieji Decoction in the treatment of phlegm-dampness accumulation of lung during acute attack of chronic bronchitis in the elderly. Methods　A total of 118 elderly patients with phlegm-dampness accumulation of lung during acute attack of chronic bronchitis admitted to Xi'an Hospital of Traditional Chinese Medicine from June 2021 to March 2023 were selected as the study objects, and were divided into an observation group (59 cases) and a control group (59 cases) by the random number table method. In the observation group, there were 33 males and 26 females, with an age of (68.71±5.49) years old and a disease course of (9.24±1.58) years. In the control group, there were 35 males and 24 females, with an age of (69.57±5.35) years old and a disease course of (9.64±1.62) years. The control group was treated with conventional western medicine, and the observation group was treated with Qingjin Zhike Jieji Decoction (take 300 ml of decoction, and warm and oral take it in the morning and evening respectively) on the basis of the control group for 2 weeks. The traditional Chinese medicine (TCM) syndrome score, clinical efficacy, remission time of clinical symptoms, blood gas indexes, levels of inflammatory factors, and safety were compared between the two groups. t test and χ² test were used. Results　After treatment, the scores of TCM syndromes in the observation group were lower than those in the control group (all P<0.05). After treatment, the total effective rate of the observation group was higher than that of the control group [91.53% (54/59) vs. 71.19% (42/59)] (χ²=8.045, P=0.005). After treatment, the remission time of cough, sputum, chest tightness, and asthma in the observation group were shorter than those in the control group [(6.24±2.73) d vs. (9.75±2.94) d, (5.31±2.67) d vs. (8.86±3.15) d, (4.65±3.43) d vs. (7.41±2.98) d, (3.73±1.17) d vs. (6.23±2.56) d] (all P<0.05). After treatment, the arterial partial pressure of carbon dioxide (PaCO₂) level in the observation group was lower than that in the control group [(41.65±2.14) mmHg (1 mmHg = 0.133 kPa) vs. (45.27±3.31) mmHg] (P<0.05), but the arterial partial pressure of oxygen (PaO₂) level was higher than that in the control group [(95.82±9.36) mmHg vs. (91.47±9.24) mmHg] (P<0.05). After treatment, the levels of C-reactive protein (CRP), neuron-specific enolase (NSE), and anti-neutrophil cytoplasmic antibodies (ANCA) in the observation group were lower than those in the control group (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion　Qingjin Zhike Jieji Decoction can effectively improve the TCM syndromes in elderly patients with phlegm-dampness accumulation of lung during acute attack of chronic bronchitis, improve the clinical efficacy, shorten the remission time of clinical symptoms, improve the blood gas indexes, and reduce the levels of inflammatory factors, which is worthy of promotion.

Curative effect of Shenqu Xiaoshi oral liquid combined with Mosapride citrate on children with functional dyspepsia

Tang Hongqiang, Zhou Weiling

2024, 30(18):  3111-3115.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.026

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Objective　To evaluate the efficacy of Shenqu Xiaoshi oral liquid combined with Mosapride citrate in improving gastric motility indicators and alleviating symptoms in children with functional dyspepsia. Methods　This study was a randomized controlled trial. A total of 150 children with functional dyspepsia admitted to Baoji Maternal and Child Health Hospital from May 2021 to May 2023 were selected as the study objects, and were divided into a control group (75 cases) and an observation group (75 cases) by the random number table method. In the control group, 41 boys and 34 girls were (6.89±1.13) years old and the course of disease was (5.76±1.08) months. In the observation group, 44 boys and 31 girls were (7.10±1.22) years old and the course of disease was (5.85±1.13) months. The control group was treated with Mosapride citrate (for children under 7 years old, 2.5 mg each time, 3 times a day; for children ≥7 years old, 5.0 mg each time, 3 times a day), and the observation group was treated with Shenqu Xiaoshi oral liquid (for children under 5 years old, 5 ml each time, 3 times a day; for children ≥ 5 years old, 10 ml each time, 3 times a day) combined with Mosapride citrate for 2 weeks. The gastric motility indicators [antral contraction frequency (ACF), antral contraction amplitude (ACA), and motility index (MI)], intestinal flora (Escherichia coli, Enterococcus, Bifidobacterium, and Lactobacillus), symptom scores, and adverse reactions (dry mouth, diarrhea, dizziness, fatigue, and vomiting) were compared between the two groups before and two weeks after treatment. t test and χ² test were used. Results　After treatment, the ACF, ACA and MI levels in the observation group were (4.06±0.67) times/min, (52.43±5.24) mm, and (2.18±0.20), which were higher than those in the control group [(1.94±0.43) times/min, (49.54±4.95) mm, and (1.82±0.17)], with statistically significant differences (all P<0.05). After treatment, the counts of Bifidobacterium and Lactobacillus in the observation group were (9.78±1.23) CFU/g and (9.79±1.38) CFU/g, which were higher than those in the control group [(7.39±1.71) CFU/g and (6.89±1.44) CFU/g]; the counts of Escherichia coli and Enterococcus were (4.41±0.43) CFU/g and (3.85±0.37) CFU/g, which were lower than those in the control group [(7.33±1.22) CFU/g and (6.52±0.74) CFU/g], with statistically significant differences (all P<0.05). After treatment, the dimension scores of primary and secondary symptoms in the observation group were lower than those in the control group, with statistically significant differences (all P<0.05). The total incidence of adverse reactions in the observation group was higher than that in the control group [17.33% (13/75) vs. 10.67% (8/75)], but the difference was not statistically significant (χ²=1.384, P=0.239). Conclusion　The combined treatment of Shenqu Xiaoshi oral liquid and Mosapride citrate in children with functional dyspepsia can effectively improve their gastric motility indicators and intestinal flora, alleviate the symptoms of functional dyspepsia, and reduce the occurrence of adverse reactions, demonstrating good safety.

Curative effect of Tiandan Tongluo tablets combined with atorvastatin on carotid atherosclerosis with wind-phlegm-blocked collaterals syndrome

Li Jia, Qiu Gaofeng

2024, 30(18):  3116-3121.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.027

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Objective　To investigate the curative effect of Tiandan Tongluo tablets combined with atorvastatin in the treatment of carotid atherosclerosis (CAS) with wind-phlegm-blocked collaterals syndrome.Methods　A total of 92 CAS patients with wind-phlegm-blocked collaterals syndrome were selected from Shenmu Hospital from March 2019 to December 2022, and were divided into a study group and a control group with 46 cases in each group by the random number table method. In the control group, there were 26 males and 20 females, aged (52.36±7.09) years, 21 cases of soft plaque and 25 cases of mixed plaque, who were treated with atorvastatin calcium tablets (20 mg/time, once a day). In the study group, there were 24 males and 22 females, aged (51.48±7.23) years, 17 cases of soft plaque and 29 cases of mixed plaque, who were treated with Tiandan Tongluo tablets (2.075 g/time, 3 times each day) combined with atorvastatin calcium tablets. Both groups were treated for 3 months. The traditional Chinese medicine (TCM) symptom score, plaque status, clinical efficacy, blood lipids, vascular endothelial function, platelet function indexes, and adverse reactions were compared between the two groups. t test and χ² test were used. Results　After treatment, the main symptom score and secondary symptom score of the study group were lower than those of the control group [(3.74±0.72) points vs. (4.53±0.81) points, (3.47±0.51) points vs. (3.91±0.58) points], with statistically significant differences (both P<0.05). After treatment, the carotid intima-media thickness, plaque number, and plaque area in the study group were lower than those in the control group [(1.32±0.22) mm vs. (1.54±0.26) mm, (1.41±0.23) vs. (1.76±0.29), (0.65±0.12) cm² vs. (0.89±0.16) cm²], with statistically significant differences (all P<0.05). The total effective rate of the study group was higher than that of the control group [93.48% (43/46) vs. 78.26% (36/46)], with a statistically significant difference (P<0.05). After treatment, the levels of triglyceride, total cholesterol, and low density lipoprotein cholesterol in the study group were lower than those in the control group [(1.61±0.28) mmol/L vs. (1.84±0.31) mmol/L, (4.51±0.86) mmol/L vs. (5.02±0.93) mmol/L, (3.69±0.51) mmol/L vs. (4.03±0.59) mmol/L], but the level of high-density lipoprotein cholesterol was higher than that in the control group [(1.36±0.24) mmol/L vs. (1.24±0.21) mmol/L], with statistically significant differences (all P<0.05). After treatment, the levels of vascular endothelial growth factor and nitric oxide in the study group were higher than those in the control group [(18.12±2.59) ng/L vs. (16.03±2.38) ng/L, (6.98±1.02) μg/L vs. (6.01±0.98) μg/L], but the endothelin-1 level was lower than that in the control group [(40.35±5.04) ng/L vs. (43.61±5.91) ng/L], with statistically significant differences (all P<0.05). After treatment, the levels of platelet activating factor, von Willeilia factor, and thromboxen B2 in the study group were lower than those in the control group [(8.46±1.38) ng/L vs. (9.14±1.62) ng/L, (85.14±10.83) IU/ml vs. (91.42±12.67) IU/ml, (118.34±17.92) ng/L vs. (132.16±20.34) ng/L], with statistically significant differences (all P<0.05). There were no obvious adverse reactions during treatment in both groups. Conclusion　Tiantan Tongluo tablets combined with atorvastatin has significant efficacy in the treatment of wind-phlegm-blocked collaterals syndrome of CAS, which can significantly improve the clinical symptoms, reduce the plaques, regulate the blood lipids, improve the vascular endothelial function, regulate the secretion of peripheral blood inflammatory factors, and is safe and reliable.

Efficacy of leuprolide combined with growth hormone in girls with idiopathic central precocious puberty

Wei Zejun, Liang Jing

2024, 30(18):  3122-3125.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.028

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Objective　To investigate the efficacy of leuprolide combined with growth hormone in girls with idiopathic central precocious puberty (ICPP), in order to guide the development of clinical therapeutic interventions for the clinical benefit of ICPP girls. Methods　Using the random number table method, 80 girls with ICPP admitted to Putian Maternal and Child Health Care Hospital from January 2021 to December 2022 were divided into two groups, with 40 cases in each group. The age of the observation group was (8.05±1.47) years old; the course of disease was (13.67±3.10) months; the height was (137.62±2.73) cm; the Tanner stage was stage II in 19 cases, stage III in 17 cases, and stage IV in 4 cases. The age of the control group was (8.11±1.35) years old; the course of disease was (13.96±3.87) months; the height was (137.06±2.96) cm; the Tanner stage was stage II in 18 cases, stage III in 19 cases, and stage IV in 3 cases. The control group was injected subcutaneously with leuprorelin, with the first dose of 3.75 mg, and then 120 μg/kg each time, once every 4 weeks, for 6 months. Based on this, the observation group was subcutaneously injected with growth hormone 30 min before going to bed, 0.15 IU/kg each time, once a day, for 6 months. The treatment effect, uterine/ovarian volume, and levels of sex hormones were compared between the two groups, and the incidence of adverse reactions during treatment was statistically analyzed. t test, χ² test, and rank sum test were used. Results　The total effective rate of the observation group was 97.50% (39/40), which was higher than that of the control group [80.00% (32/40)] (P<0.05). The volumes of uterus and ovary were decreased in both groups after treatment, and those in the observation group were smaller compared to the control group (all P<0.05). The levels of estradiol (E₂), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were decreased in both groups after treatment, and those in the observation group were lower compared to the control group (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the observation group and the control group [12.50% (5/40) vs. 7.50% (3/40)] (P>0.05). Conclusion　The efficacy of leuprolide combined with growth hormone in ICPP girls is satisfactory, which can adjust the levels of sex hormones and reduce the volumes of uterus and ovary, with good safety.

Analysis of clinical characteristics and development trend in patients with psychiatric diseases in a hospital from 2014 to 2023

Xie Yichao, Zhang Shaoxia, Liu Weiting, Liu Xiaoyan, Wang Dantong

2024, 30(18):  3126-3132.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.029

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Objective　To explore the clinical characteristics and development trend in patients with psychiatric diseases in a hospital from 2014 to 2023. Methods　The clinical data of 33 745 patients in the Department of Psychiatry, Dongguan Seventh People's Hospital from 2014 to 2023 were retrospectively analyzed, including gender, age, admission/discharge date, International Classification of Diseases (ICD) -10 code, clinical diagnosis, case type, etc. The patients' basic situation, overall disease distribution, and annual distribution, gender distribution, and age distribution of the top 10 diseases were analyzed. Results　The overall number of psychiatric patients increased from 2014 to 2023, and fluctuated from 2022 to 2023. There were 19 664 males and 14 081 females, and the overall male-female ratio was 1.4:1. The majority of the patients were between 31 and 45 years old, with a total of 11 828 cases, accounting for 35.05% of the total. From 2014 to 2023, the number of the patients ≤17 years old showed a fluctuating upward trend. The main type of cases was general type, with a total of 25 495 cases, accounting for 75.55% of the total. The number of acute type, difficult type, and critical type patients showed a fluctuating upward trend, and the fluctuation was obvious in 2022 and 2023. According to the ICD-10 four-digit code classification, there were 186 kinds of diseases in 45 disease entities, of which the top 4 were schizophrenia, bipolar disorder, psychotic disorder, and depression. Among the top 10 diseases, the number of the inpatients with psychotic disorder showed a fluctuating downward trend, while the remaining 9 diseases showed a fluctuating upward trend as a whole, and the change trends of schizophrenia, bipolar disorder, and depression were the same. The number of the inpatients with behavioral and emotional disorders usually occurring in childhood and adolescence increased year by year. The number of the patients with depression, anxiety-related psychiatric disorders, and behavioral and emotional disorders usually occurring in childhood and adolescence were all on the rise in 2023. Among the gender distributions of the top 10 diseases, schizophrenia, bipolar disorder, psychotic disorders, alcohol, drug, and psychoactive substance related addictive psychiatric disorders, mania, mental retardation related psychiatric disorders were more prevalent in males than in females, while depression, behavioral and emotional disorders usually occurring in childhood and adolescence, anxiety-related disorders, and recurrent depression were more prevalent in females than in males, and 95.01% (1 714/1 804) of alcohol, drug, and psychoactive substance related addictive psychiatric disorders occurred in men. The patients with the top 10 diseases were mostly 18-45 years old, and 96.49% (550/570) of the patients with behavioral and emotional disorders usually occurring in childhood and adolescence were ≤17 years old. Conclusions　From 2014 to 2023, the overall number of psychiatric patients showed a fluctuating upward trend, mainly middle-aged and young men, and the diseases were mainly schizophrenia, bipolar disorder, psychotic disorder, and depression. The number of the inpatients with behavioral and emotional disorders usually occurring in childhood and adolescence increased year by year. The majority of the patients with alcohol, drug, and psychoactive substance related addictive psychiatric disorders were men. We should pay more attention to the prevention and treatment of psychiatric diseases, especially schizophrenia and bipolar disorder, and pay more attention to the adolescents' mental health.

Nursing Research

Evaluation on effect of clinical nursing pathway combined with health education in patients with NTM lung disease complicated with bronchiectasis

Fen Cuilian, Chen Yanxia, Chen Hua, Huang Liping

2024, 30(18):  3133-3136.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.030

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Objective　To study the effect of clinical nursing pathway combined with health education in patients with nontuberculosis mycobacterium (NTM) lung disease complicated with bronchiectasis. Methods　A total of 206 patients with NTM lung disease and bronchiectasis admitted to Guangzhou Chest Hospital from January to December 2022 were selected and were divided into an experimental group (105 cases) and a control group (101 cases) according to the principle of balanced and comparable basic characteristics between groups. In the experimental group, there were 32 males and 73 females, aged (60.20±9.06) years. In the control group, there were 38 males and 63 females, aged (63.18±10.96) years. The control group received routine nursing, and the experimental group received NTM lung disease clinical nursing pathway combined with health education on the basis of routine nursing, until the patients were discharged. The knowledge about NTM lung disease complicated with bronchiectasis, including disease knowledge, medication knowledge, diet, and sputum excretion, was investigated by questionnaire in the experimental group and the control group. The awareness rates of disease knowledge, medication knowledge, diet, and sputum excretion, length of hospital stay, and satisfaction of health education  were compared between the two groups. χ² test and independent sample t test were used. Results　The awareness rates of disease knowledge, medication knowledge, diet, and sputum excretion in the experimental group were (93.29±7.72)%, (86.27±5.26)%, (86.56±8.09)%, and (83.82±6.23)%, which were higher than those in the control group [(85.59±9.91)%, (81.34±5.19)%, (82.87±8.10)%, and (80.59±7.12)%]; the length of hospital stay of the experimental group was (15.97±5.45) d, which was shorter than that of the control group [(17.95±5.98) d], and the satisfaction score was (4.39±0.83) points, which was higher than that of the control group [(4.10±0.17) points], with statistically significant differences between the two groups (all P<0.05). Conclusion　In the patients with NTM lung disease complicated with bronchiectasis, the use of NTM lung disease clinical nursing pathway combined with health education can effectively increase the patients' grasp of health knowledge, and improve the nursing satisfaction, thus promote the rehabilitation of the disease and shorten the length of hospital stay.

Effect of semi lying breastfeeding combined with nipple protection patch on improving breastfeeding rate in patients with nipple cracking during lactation

Wang Hua, Wang Jinxiang, Fan Lijing

2024, 30(18):  3137-3141.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.031

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Objective　To explore the effect of semi lying breastfeeding combined with nipple protection patch on improving breastfeeding rate in patients with nipple cracking during lactation. Methods　A total of 97 hospitalized patients with nipple cracking during lactation from Xi'an International Medical Center Hospital from December 2020 to January 2022 were prospectively selected as the study subjects, all of whom were married pregnant women. They were divided into two groups according to the order of admission. In the study group, 49 cases aged 23-35 (28.35±1.32) years were treated with semi-lying breastfeeding combined with nipple protection patch. In the control group, 48 cases aged 22-37 (28.27±1.33) years received traditional feeding. The breast-feeding rate within 4 weeks, the success rate of neonatal spontaneous nipple insertion, the self-evaluation of nipple pain at different time points after 7 days of lactation, the scores of Breastfeeding Self-Efficacy Scale (BSES) and Mental Status Scale in Non-Psychiatric Settings (MSSNS) at admission and 7 days later were analyzed in the two groups. Statistical methods used were χ² test and t test. Results　The breast-feeding rate and the success rate of neonatal spontaneous nipple insertion in the study group were higher than those in the control group [87.76% (43/49) vs. 64.58% (31/48), 83.33% (40/49) vs. 58.33% (28/48)], with statistically significant differences (χ²=4.45 and 3.88, both P<0.05). The self-evaluation scores for nipple pain in the study group on the 3rd and 7th day after admission were lower than those in the control group [(4.24±0.77) points vs. (5.20±0.58) points, (0.91±0.29) points vs. (2.57±0.53) points], with statistically significant differences (t=7.01 and 19.19, both P<0.05). The BSES and MSSNS scores of the study group were better than those of the control group after 7 days of lactation [(118.49±15.03) points vs. (107.52±14.86) points, (64.35±8.74) points vs. (70.29±7.93) points], with statistically significant differences (t=3.61 and 3.50, both P<0.05). Conclusion　For patients with nipple cracking during lactation, semi-lying breastfeeding combined with nipple protection patch can improve the breastfeeding rate, and is worthy of application.

Influencing factors of elderly patients visiting medical and nursing outpatient service: a qualitative study 

Luo Zimiao, Wang Lingzhen, Liang Guixing, Peng Lu, Hu Peixin, Ding Meizhu

2024, 30(18):  3141-3145.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.032

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Objective　To explore the influencing factors of elderly patients visiting medical and nursing outpatient service, and to provide an important basis for the exploration of elderly care services with Chinese characteristics. Methods　Using the qualitative research method, 12 elderly patients who were treated in the outpatient department of The Second Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2022 to July 2022 were selected as interviewees for semi-structured interview, and the seven-step method of Colaizzi was used for thematic analysis. Results　The influencing factors of elderly patients visiting medical and nursing outpatient service included four themes: personal factors (lack of knowledge of medical care, limited information channels, trust in medical staff, and personal economic status), family factors (family support), social factors (medical insurance policy and public recognition), and service factors (efficacy expectation, demand diversification, and appointment smoothness). Conclusion　It is suggested to strengthen the publicity, broaden the publicity channels, cultivate the concept of family care, improve the outpatient medical insurance policy combining medical care, optimize the medical treatment process, and give full play to the combination of elderly care services with traditional Chinese medicine characteristics.

Observation on the curative effect of Chinese medicine granule soaking formula combined with naftifine/ketoconazole cream in the treatment of interlacing erosion tinea of hands and feet

Wan Changlan, Wu Hui, Li Huiyan, Mo Xiaoying, Li Zhenjie, Wang Yanfang

2024, 30(18):  3146-3149.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.033

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Objective　To observe the effect of Chinese medicine granule soaking and washing combined with naftifine/ketoconazole cream in the treatment of interlacing erosion tinea of hands and feet. Methods　From April 2023 to April 2024, 120 patients with interlacing erosion tinea of hands and feet admitted to Guangzhou Dermatology Hospital of Zhongshan Fourth Road were selected for a prospective study, and were divided into a control group and an observation group by the random number table method, with 60 cases in each group. In the control group, there were 35 males and 25 females, aged (37.65±10.66) years, and the course of disease was (16.75±9.16) months. In the observation group, there were 32 males and 28 females, aged (38.25±10.17) years, and the course of disease was (15.23±8.41) months. The control group was treated with external application of naftifine/ketoconazole cream, and the dosage was one fingertip unit, twice a day. On the basis of the treatment of the control group, the observation group was treated with Chinese medicine granule soaking and washing, and the granule formula was: kuhseng, shechuangzi, cortexphellodendri, and garden burnet root granules, once a day, 20 min each time. Both groups were treated for 4 weeks. The scores of skin related symptoms before and after treatment, therapeutic effect, and safety were compared between the two groups. Statistical methods used were χ² test and t test. Results　After treatment, the scores of skin damage, pruritus, effusion, and pain in the observation group were lower than those in the control group [(0.45±0.15) points vs. (1.34±0.17) points, (0.66±0.14) points vs. (1.42±0.21) points, (0.53±0.14) points vs. (1.38±0.18) points, (0.55±0.12) points vs. (1.33±0.19) points], with statistically significant differences (t=10.78, 10.53, 10.56, and 10.11, all P<0.05). The total effective rate of the observation group was higher than that of the control group [88.33% (53/60) vs. 65.00% (39/60)], with a statistically significant difference (χ²=9.37, P<0.05). The fungal clearance rate of the observation group was higher than that of the control group [86.67% (52/60) vs. 68.33% (41/60)], with a statistically significant difference (χ²=8.67, P<0.05). During treatment, no significant adverse symptoms were observed in both groups. Conclusion　On the basis of naftifine/ketoconazole cream, combined application of Chinese medicine granule soaking formula can effectively improve the treatment effect of interlacing erosion tinea of hands and feet, and it is safe and worthy of clinical promotion.

Application effect of modified fluid cushion on the prevention of facial pressure injury in patients undergoing spinal surgery in prone position

Huang Weishan, Lin Chuchun, Lin Jinchun, Huang Zhiduo, Chen Jiyu

2024, 30(18):  3150-3154.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.034

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Objective　To investigate the application effect of modified fluid cushion on the prevention of facial pressure injury in patients undergoing spinal surgery in prone position. Methods　A total of 120 patients who underwent spinal surgery in prone position in the operating room of Jieyang People's Hospital from July 2022 to August 2023 were selected for a randomized controlled trial, and were divided into a control group and an observation group by the envelope drawing method, with 60 patients in each group. The control group included 29 males and 31 females, aged (56.90±7.47) years. The observation group included 33 males and 27 females, aged (56.37±7.48) years. The control group used traditional gel head cushion, and the observation group used modified fluid head cushion. The occurrence of postoperative facial pressure injury of surgical patients in the two groups and the satisfaction of surgical nurses with the use of head cushion in the preoperative, intraoperative, and postoperative periods were recorded. Statistical methods used were χ² test and t test. Results　The incidence of postoperative facial pressure injury in the observation group was lower than that in the control group [13.33% (8/60) vs. 0], with a statistically significant difference (χ²=8.81, P<0.05). The nurses' satisfaction with the use of head cushion in the observation group was higher than that in the control group [98.33% (59/60) vs. 68.33% (41/60)], with a statistically significant difference (χ²=19.44, P<0.05). Conclusions　The modified fluid cushion can effectively reduce the incidence of facial pressure injury in patients undergoing spinal surgery in prone position, maintain the neutral position of the head and neck, reduce the postoperative complications, and alleviate the patients' pain. At the same time, the modified fluid head cushion is easy to use, which can reduce the working pressure of surgical nurses, improve the satisfaction of use, and is worthy of clinical application.

Application effect of holistic nursing model in prevention of deep vein thrombosis after thoracic surgery

Zhang Shufang, Liu Huiying, Wu Yan

2024, 30(18):  3154-3158.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.035

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Objective　To investigate the preventive effect of holistic nursing mode for deep vein thrombosis (DVT) in postoperative thoracic surgery patients. Methods　A total of 80 thoracic surgery patients admitted to Fuzhou First People's Hospital from January 2021 to June 2023 were prospectively enrolled and were divided into a control group and an observation group according to the random number table method, with 40 cases in each group. In the control group, there were 25 males and 15 females; the age was (57.39±4.84) years old; the disease types were lung cancer in 22 cases, esophageal cancer in 14 cases, and lung benign lesions in 4 cases; the types of surgery were thoracoscopic lobectomy in 17 cases, pulmonary wedge resection in 5 cases, pleural biopsy fixation in 4 cases, and esophagectomy in 14 cases. There were 24 males and 16 females in the observation group; the age was (57.35±4.82) years old; the disease types were lung cancer in 21 cases, esophageal cancer in 14 cases, and lung benign lesions in 5 cases; the types of surgery were thoracoscopic lobectomy in 17 cases, pulmonary wedge resection in 4 cases, pleural biopsy fixation in 5 cases, and esophagectomy in 14 cases. The control group received routine nursing, and the observation group received holistic nursing intervention for 1 week. The incidence of postoperative DVT, postoperative recovery time, psychological status [Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS)], and quality of life [36-item Short-Form Health Survey (SF-36)] were compared between the two groups. t test and χ² test were used. Results　The incidence of DVT in the observation group within 1 week after surgery was lower than that in the control group [2.50% (1/40) vs. 20.00% (8/40)], with a statistically significant difference (χ²=4.507, P=0.034). The first time of getting out of bed [(25.18±2.32) h], the recovery time of bowel sound [(17.59±1.66) h], the indentation time of chest tube [(4.02±0.51) d], and the length of hospital stay [(11.05±1.21) d] in the observation group were shorter than those in the control group [(39.15±3.72) d, (19.89±1.87) h, (7.64±0.87) d, and (13.49±1.28) d], with statistically significant differences (t=20.153, 5.817, 22.703, and 8.761, all P<0.001). After nursing, the SAS and SDS scores decreased, the SF-36 score increased in both groups (all P<0.05); the scores of SAS and SDS in the observation group were lower than those in the control group [(45.12±4.52) points vs. (49.58±4.96) points, (46.09±4.62) points vs. (50.19±5.11) points], and the score of SF-36 was higher than that in the control group [(75.71±7.58) points vs. (62.06±6.25) points], with statistically significant differences (t=4.203, 3.764, and 8.787, all P<0.001). Conclusions　Holistic nursing mode can effectively reduce the incidence of DVT in patients after thoracic surgery, shorten the patients' postoperative recovery time, relieve their negative emotions, and improve their quality of life. It can provide reference for the formulation of nursing plan for thoracic surgery patients in the future.

Impacts of ICF theory combined with empowerment intervention of main family caregivers on medication compliance, prognosis, and caregivers' discharge readiness in stroke patients

Cheng Yi, Gong Jun, Xie Fang, Yang Xianghong, Huang Dong, Miao Rui

2024, 30(18):  3159-3163.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.036

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Objective　To explore the effect of International Classification of Functioning, Disability and Health (ICF) theory combined with empowerment intervention of main family caregivers on medication compliance, prognosis, and caregivers' discharge readiness in stroke patients. Methods　A total of 100 stroke patients admitted to the Department of Neurology, Shaanxi Second Provincial People's Hospital from May 2020 to May 2022 were prospectively selected as the study objects. They were randomly divided into 2 groups with 50 cases in each group. In the control group, there were 28 males and 22 females, aged (58.55±10.24) years, the duration of disease was (1.85±0.77) months, the types of lesions were cerebral infarction in 30 cases and cerebral hemorrhage in 20 cases, and the relationships between patients and caregivers were husband-wife relationship in 35 cases, parent-child relationship in 12 cases, and other relationships in 3 cases. In the observation group, there were 30 males and 20 females, aged (59.17±10.55) years, the course of disease was (2.01±0.85) months, the types of lesions were cerebral infarction in 32 cases and cerebral hemorrhage in 18 cases, and the relationships between patients and caregivers were husband-wife relationship in 36 cases, parent-child relationship in 12 cases, and other relationships in 2 cases. The control group was given routine nursing intervention, and the observation group was given ICF theory combined with empowerment intervention of main family caregivers. Both groups were intervened from admission to discharge. The medication compliance, prognosis, and caregivers' discharge readiness of the two groups were compared.t test and χ² test were used. Results　The excellent and good rate of medication compliance in the observation group was 90.00% (45/50), which was higher than that in the control group [72.00% (36/50)], with a statistically significant difference (χ²=5.263, P=0.022). Before intervention and at discharge, the scores of ICF stroke core factor scale were (82.69±13.66) and (65.74±8.51) points in the observation group, and (83.18±13.04) and (71.65±10.12) points in the control group, respectively; the scores of ICF stroke core factor scale in both groups at discharge were lower than those before intervention (both P<0.05), and the score of ICF stroke core factor scale in the observation group was lower than that in the control group at discharge (t=3.161, P=0.002). Before intervention and at discharge, the scores of Barthel index (BI), Montreal Cognitive Assessment (MoCA), Stroke Specialized Quality of Life Scale (SS-QOL), and caregivers' discharge readiness in the observation group were (56.15±6.25), (17.07±4.16), (76.15±6.68), (73.69±3.66), (85.73±4.86), (26.43±4.87), (185.15±20.68), and (83.74±4.51) points, and those in the control group were (56.68±6.87), (16.89±3.78), (75.58±7.07), (74.18±3.74), (72.76±4.65), (21.48±4.16), (126.58±15.07), and (77.65±4.12) points; the scores of BI, MoCA, SS-QOL, and caregivers' discharge readiness in both groups at discharge were all higher than those before intervention (all P<0.05), and the scores in the observation group were higher than those in the control group at discharge (t=13.635, 5.465, 16.185, and 7.050, all P<0.001). Conclusion　ICF theory combined with empowerment intervention of main family caregivers can improve the medication compliance in stroke patients, prognosis, and discharge readiness of caregivers.

Progress in the application of aromatherapy combined with music therapy to agitation behavior of mental illness

Xie Dongzhi, Liang Yanfang, Li Qiuyuan

2024, 30(18):  3164-3166.  DOI: 10.3760/cma.j.issn.1007-1245.2024.18.037

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