Table of Content

01 October 2024, Volume 30 Issue 19

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Digestive Tract Diseases

Construction of an lncRNA molecular prediction model for efficacy of neoadjuvant radiotherapy and chemotherapy for rectal cancer

Cai Canfeng, Li Jinhong, Xin Haiyang, Zeng Jun, Gan Wenchang, Li Yingru, Zeng Bing

2024, 30(19):  3169-3175.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.001

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Advances and current status on surgical treatment for inflammatory bowel diseases

Zhao Xinzhe, Ke Jia

2024, 30(19):  3176-3180.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.002

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Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), represent a chronic inflammatory disorder of the gastrointestinal tract. Surgical intervention becomes imperative when pharmacological treatments fail or complications such as bowel obstruction, fistula formation, or perforation arise in patients with IBD. In the past decade, significant advancements have been made in surgical techniques and strategies aimed at improving patients' prognosis and reducing recurrence. This review summarizes and evaluates the recent progress and current state of surgical treatment for patients with IBD.

Controversies and progress of lymph node dissection during laparoscopic radical rectal cancer surgery

Ren Jiaqi, Diao Dechang, Zhang Xueyang

2024, 30(19):  3180-3184.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.003

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Laparoscopic rectal cancer surgery has become the primary treatment method for malignant tumors of the rectum. Lymph node dissection plays a crucial role in determining the curative intent of the procedure. The extent and technique of lymph node clearance are pivotal factors in achieving successful outcomes. In this article, we discuss the controversies and recent advancements related to lymph node dissection during laparoscopic rectal cancer surgery. Our aim is to provide references for selecting an optimal approach for rectal cancer lymph node dissection, and balancing oncological treatment efficacy and functional preservation in the patients.

Research progress of perioperative treatment for esophagogastric junction adenocarcinoma

Chen Xiaojiang, Li Yuanfang

2024, 30(19):  3184-3188.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.004

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The incidence of esophagogastric junction adenocarcinoma is still high in China. In recent years, surgical treatment combined with chemotherapy, radiotherapy, immunotherapy, and targeted therapy has gradually improved the prognosis of patients with gastric cancer, but there are still many controversies in the perioperative treatment. This study summarized the research progress related to perioperative treatment for esophagogastric junction adenocarcinoma, including preoperative neoadjuvant therapy, postoperative adjuvant therapy, perioperative radiotherapy, and immunotherapy, so as to clarify the current research direction.

Prevention and treatment of lymph leakage after laparoscopic radical resection of right colon cancer via artery first approach

Li Wei, Tang Xin, Diao Dechang

2024, 30(19):  3189-3192.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.005

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Application of right half colon radical operation teaching mode guided by programmatic concept of in training of training physicians

Lu Xinquan, Diao Dechang, Wang Jiahao, Li Hongming, Yi Xiaojiang, Feng Xiaochuang, Liao Weilin, Lin Jiaxin, Zhang Xueyang

2024, 30(19):  3193-3196.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.006

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Objective　To explore the application of the right half colon radical operation teaching mode guided by the programmatic concept of the professional training of gastrointestinal surgeons. Methods　Forty-five male surgeons taking training at Department of Gastrointestinal Surgery, Guangdong Hospital of Traditional Chinese Medicine from January 2021 to March 2024 were selected for the randomized controlled trial, and were divided into an experimental group (23 ones), (32.1±1.7) years old, and a control group (22 ones), (32.0±2.0) years old, by lottery. There were no statistical differences in age, education level, and training time between the two groups (all P>0.05). The control group were taught the process and main points of laparoscopic radical surgery for right half colon cancer by traditional teaching methods, while the experimental group used the right half colon radical operation teaching mode guided by the programmatic concept. After the training, the two groups were evaluated in theory and practice. The satisfaction rates were compared between the two groups. t test, Z test, and Fisher's precision probability test were used. Results　There were no statistical differences in the theoretical assessment scores between the two groups (all P>0.05). The scores of mesangial anatomical integrity, number of lymph node dissection, and intraoperative blood loss and total score of practical performance assessment in the experimental group were higher than those in the control group (all P<0.05). The overall satisfaction rate of the experimental group was higher than that of the control group [91.3% (21/23) vs. 72.7% (16/22); P=0.029]. Conclusion　The teaching mode of laparoscopic right half colon radical surgery guided by the programmatic concept is effective and feasible in the professional training of gastrointestinal surgeons.

Literature Analysis

Exploration based on network pharmacology and clinical testing for mechanism of action of Sophora flavescens lotion in treatment of mixed hemorrhoids

Zhong Hangyan, Liu Haiqin, Wang Jing

2024, 30(19):  3197-3202.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.007

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Objective　To explore the mechanism of action of Sophora flavescens lotion in the treatment of mixed hemorrhoids. Methods　The drugs' main active ingredients and disease targets were screened from online pharmacology databases; enrichment analysis and molecular docking were conducted; enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of interleukin-6 (IL-6) and transforming growth factor-β (TGF-β) in 100 patients with mixed hemorrhoids before and after the treatment with Sophora flavescens lotion at Shanghang County Traditional Chinese Medicine Hospital from January 1 to December 31, 2023. t test was used. Results　The main active ingredients of Sophora flavescens lotion are quercetin, luteolin, β-sitosterol, stigmasterol, and kaempferol. Sophora flavescens lotion interacts with the core targets of mixed hemorrhoids, such as protein kinase B (AKT1), interleukin-1β (IL-1β), IL-6, tumor necrosis factor (TNF), matrix metalloproteinase-9(MMP9), and TGF-β. The main active ingredients can effectively bind to the core targets. The enrichment analysis showed that it is mainly related to signaling pathways such as advanced glycation end product-receptor of advanced glycation end product (AGE-RAGE), phosphatidylinositol 3 kinase-v-akt murine thymoma viral oncogene homolog (PI3K-Akt), etc. The results of ELISA showed that the serum IL-6 level was lower after than before the treatment [10.15 (3.80, 14.48) vs (19.30(8.68, 27.00) mg/L) mg/L], and the TGF-β level was higher after than before the treatment [0.8 (0.6, 1.0) mg/L vs. 0.4 (0.2, 0.6) mg/L ] (both P<0.05). Conclusions　The effective active ingredients of Sophora flavescens lotion bind to the core targets, and exert therapeutic effects regulating the expression of inflammatory factors through signaling pathways such as AGE-RAGE and PI3K-Akt. This may be the main mechanism of Sophora flavescens lotion in treating mixed hemorrhoids.

New Medical Advances

Research progress on mechanism of bone destruction in middle ear cholesteatoma

Liu Xuehua, Zhang Xiaolin, Li Changye, Wang Yanfei

2024, 30(19):  3203-3207.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.008

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Middle ear cholesteatoma is a cystic structure that develops in the middle ear following the desquamation of keratinized squamous epithelium, and it should be noted that it is not a true neoplasm. Its clinical manifestations bear resemblance to those observed in chronic suppurative otitis media, primarily encompassing otorrhea, hearing impairment, vertigo, otalgia, etc. In severe cases, it can exert pressure on the surrounding bones, leading to destructive bone resorption and an array of complications that significantly impact patients' health and prognosis. Currently, the etiology of middle ear cholesteatoma remains elusive. The pathogenesis underlying bone destruction caused by this condition is multifaceted. In recent years, there has been growing attention toward the pivotal roles played by matrix metallo-proteinases, receptor activator of nuclear factor-κB ligand of osteoclasts /osteoprotegerin, inflammatory factors, macrophage, and keratinocyte growth factor in mediating bone destruction associated with middle ear cholesteatoma. This article provides an overview of the expression patterns exhibited by these aforementioned molecules in middle ear cholesteatoma as well as their contributions to bone destruction.

Reflections on connection between exosomes and circadian clock genes in nasopharyngeal carcinoma cells

Zhang Liping, Ren Xuebao, Ma Yuanling, Li Yanmei, Hou Li

2024, 30(19):  3207-3210.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.009

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Nasopharyngeal carcinoma is a polygenic genetic disease with racial susceptibility and high familial predisposition, which often involves the interaction between multiple genes or between genes and the environment. Exosomes derived from nasopharyngeal carcinoma are involved in the regulation of physiological and pathological activities, such as tumor immune response, angiogenesis, cell proliferation, invasion, migration, and resistance to radiotherapy and chemotherapy, are potential carriers for the formation and development of nasopharyngeal carcinoma, and play a key role in regulating the tumor and host microenvironment. In addition, the development of cancer is also related to the disruption of circadian rhythms, and biological clock genes are involved in tumor proliferation, migration, invasion, metastasis, cell cycle distribution, apoptosis, detection and repair of DNA damage, and cell sensitivity to anticancer drugs or radiation. Both circadian clock genes and nasopharyngeal carcinoma exosomes have many effects on the occurrence and development of nasopharyngeal carcinoma, and whether the cell-to-cell communication and nucleic acid and protein distribution involved in nasopharyngeal carcinoma exosomes are regulated by circadian clock patterns has not yet been described. The mechanism of whether nasopharyngeal carcinoma cell-derived exosomes regulate the occurrence, development, and drug resistance of circadian genes needs to be further studied.

Research progress of lactulose in combination with other drugs in bowel preparation

Huang Rongwei, Jia Lin, Sun Yancheng, Liu Yipin

2024, 30(19):  3211-3214.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.010

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Lactulose oral solution, as an osmotic laxative, can be used alone or in combination with other agents for preoperative bowel preparation, achieving comparable or even superior results to compound polyethylene glycol powder used alone. It is noteworthy that traditional bowel preparation methods often fail to achieve optimal results in patients with risk factors for inadequate bowel preparation. However, the use of a lactulose combination regimen can significantly improve the quality of bowel preparation in such patients. This review summarizes the current research on lactulose combination regimens for bowel preparation and provides insights aimed at offering clinical references and guidance.

Treatises

Influence of expression and methylation of DNA damage repair genes on survival prognosis of hepatocellular carcinoma and establishment of a risk prognostic scoring model

Zhang Jie, Wang Ruiping, Kou Xiaoni, Fan Xiaodan, Bian Qian

2024, 30(19):  3215-3222.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.011

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Objective　To investigate the effect of DNA damage repair gene expression and methylation on the prognosis of hepatocellular carcinoma ( HCC ) and the construction of risk scoring model. Methods　This study was from January to May 2024. The data set was obtained from the TCGA, GTEx, and GEO databases. Kaplan-Meier survival analysis was used to analyze the effect of DNA damage repair genes on the survival prognosis of the patients with HCC. Univariate and multivariate COX proportional hazards regression analyses were conducted to analyze the impact of key DNA damage repair genes, age, gender, tumor stage, and other factors on the patients' prognosis. A nomogram prediction model was constructed and validated, and the predictive effectiveness of the nomogram prediction model was constructed and verified. The concordance index (C-index) was used to evaluated the model's predictive effect. The risk prognostic scoring model for HCC survival prognosis was established using the Lasso regression analysis. The consistence of the results with the results of the above analyses was verified by the HPA database. Results　Eight differentially expressed DNA damage repair genes (FEN1, RNASEH2A, MCM6, EXO1, RECQL4, CETN2, PCNA, MCM4, MCM3, and MCM5) had impact on survival prognosis (all P<0.05). The COX regression analysis showed that the MCM6 and pTNM stage had independent effects on the overall survival rate of the patients with HCC. The nomogram model showed that MCM6 and pTNM stage were correlated with the patients' survival prognosis (both P<0.05, C-index=0.677). The prognostic risk scoring model showed that RECQL4, EXO1, and MCM6 were key genes influencing the survival prognosis of the patients with HCC. The methylation levels of RECQL4, EXO1 and MCM6 gene promoter regions decreased with the increase of HCC grade ( all P<0.05 ). Conclusions　DNA damage repair genes play a certain role in the progression of HCC. RECQL4, EXO1, and MCM6 are included in the risk prognostic scoring model for the survival prognosis of patients with HCC. MCM6 has an independent effect on the survival and prognosis of HCC patients.

Silencing lncRNA PSMB8-AS1 affects malignant biological behaviors of thyroid cancer cells regulating miR-144-5p expression

Sun Chongpu, Yi Liujun, Tang Yuanhuai, Yang Xiaoqing, Yang Xue

2024, 30(19):  3223-3228.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.012

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Objective　To investigate the effects of long noncoding RNA (lncRNA) PSMB8-AS1 on the proliferation and migration of thyroid cancer cells by targeting miR-144-5p. Methods　The study was conducted from March 2023 to May 2024 at the Scientific Research Center of the Affiliated Hospital of Qingdao University.The GeneCards database was used to analyze the expression of PSMB8-AS1 in thyroid cancer tissue. The real-time quantitative polymerase chain reaction (qPCR) was used to detect the expressions of PSMB8-AS1 in human normal thyroid epithelial cells HTori-3 and thyroid cancer cell lines (8505C, FTC-133, KTC-1, and TPC-1). The target gene of PSMB8-AS1 was predicted using the LncRBase and Cancer LncRNA Census databases and verified by the dual luciferase gene reporter assay. The FTC-133 cells were divided into a si-NC group and a si-PSMB8-AS1 group according to the different transfectants. The CCK-8 method and scratch assay were used to detect the effects of low-expression PSMB8-AS1 on the proliferation and migration of the FTC-133 cells. qPCR was used to detect the effects of low-expression PSMB8-AS1 on the expression of miR-144-5p and ITGA3 mRNA in the FTC-133 cells. Western blot was used to detect the effect of low-expression PSMB8-AS1 on the expression of ITGA3, Cyclin A, CDK2, FOXC2, and Hedgehog proteins in the FTC-133 cells. Results　The expression of PSMB8-AS1 in the thyroid cancer tissue was higher than that in the adjacent tissue (P<0.01). The expressions of PSMB8-AS1 in the 8505C, FTC-133, KTC-1, and TPC-1 cells were higher than that in the HTori-3 cells (all P<0.01). PSMB8-AS1 could target and bind to miR-144-5p (P<0.01). The expression of PSMB8-AS1 in the FTC-133 cells in the si-PSMB8-AS1 group was lower than that in the si-NC group [(1.07±0.54) vs. (6.69±1.16); t=8.78; P<0.01]. The migration rate of FTC-133 cells in the si-PSMB8-AS1 group was lower than that in the si-NC group [(27.89±6.01)% vs. (68.08±6.16)%; t=4.67; P<0.01]. The expression of miR-144-5p in the FTC-133 cells in the si-PSMB8-AS1 group was higher than that in the si-NC group, and the expression of ITGA3 mRNA was lower than that in the si-NC group (t=7.45 and 3.13; both P<0.01). Low-expression PSMB8-AS1 could inhibit the expressions of ITGA3, Cyclin A, CDK2, FOXC2, and Hedgehog proteins in the FTC-133 cells (all P<0.01). Conclusions　PSMB8-AS1 expression is significantly upregulated in thyroid cancer tissue and cell lines. Low-expression PSMB8-AS1 can inhibit the proliferation and migration of FTC-133 cells targeting and regulating miR-144-5p.

Construction and validation of a nomogram model for predicting significant weight loss in patients with nasopharyngeal carcinoma undergoing radiotherapy

Che Ya, Ren Yinghong, Guo Feng, Chen Genxiang, Zhao Benhua

2024, 30(19):  3229-3235.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.013

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Objective To construct and validate a nomogram model for predicting significant weight loss in patients with nasopharyngeal carcinoma (NPC) undergoing intensity-modulated radiation therapy (IMRT). Methods　This prospective study included 74 patients with nasopharyngeal carcinoma (NPC) who received IMRT at Shangluo Central Hospital from January 2018 to June 2023. Significant weight loss was defined as a weight loss ≥10% during radiotherapy. The patients were divided into a CWL group (34 cases) and a non-CWL group (40 cases). There were 25 males and 9 females in the CWL group; they were (48.29±8.47) years old. There were 28 males and 12 females in the non-CWL group; they were (45.79±7.69) years old. Univariate analysis was conducted on ages, body mass indexes (BMI), smoking history, pathological types, family history of tumors, and other data in both groups. Multivariate logistic regression analysis was used to identify the risk factors for significant weight loss in the patients; a nomogram prediction model was established based on the results. Calibration curves were used for the validation. t and χ² tests were employed for the statistical analysis. Results　There was a statistical difference in N staging of Union for International Cancer Control (UICC) between the two groups (χ²=12.730, P<0.05). The proportions of the patients using chemotherapy drugs during radiotherapy and whose Epstein-Barr virus (EBV) copy number >1 500 copies/ml, neck radiotherapy dosage in the CWL group were higher than those in the non-CWL group [97.74% (33/34) vs. 75.00% (30/40), 52.63% (23/34) vs. 37.50% (15/40), (70.61±2.79) Gy vs. (65.75±2.53) Gy]; the levels of albumin hemoglobin, and prealbumin after the radiotherapy in the CWL group were lower than those in the non-CWL group [(37.48±3.91) g/L vs. (40.24±4.79) g/L, (109.79±16.97) g/L vs. (120.97±17.82)g/L, and (206.58±37.16) mg/L vs. (229.75±34.39) mg/L]; there were statistical differences (χ²=7.066 and 6.686; t=7.855, 2.684, 2.749, and 2.783; all P<0.05). The multivariate logistic regression analysis revealed that high N staging, high neck radiation dosage, use of chemotherapy during radiotherapy, high EB virus copy number, and low levels of albumin, hemoglobin, and prealbumin after radiotherapy were independent risk factors for significant weight loss in the patients (all P<0.05). The nomogram model constructed could effectively predict the occurrence of significant weight loss in the patients, and the calibration curve validation indicated a good predictive accuracy of the model. Conclusion　Patients with high N staging, high neck radiation dosage, use of chemotherapy during radiotherapy, a high EB virus copy number, and low levels of albumin, hemoglobin, and prealbumin after radiotherapy have high risk of significant weight loss and should be given special attention and corresponding preventive measures during treatment.

Correlation between dyslipidemia and p53 mutation in endometrial cancer

Liu Weilong, Yao Tongtong, Hu Ruiqi, Shi Hongtang, Chen Yinggang, Liu Zhiqiang

2024, 30(19):  3236-3240.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.014

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Objective　To explore the incidence of dyslipidemia in patients with endometrial cancer and the correlation between dyslipidemia and the risk of p53 mutant endometrial cancer. Methods　A total of 136 patients who underwent no preoperative treatment and were pathologically diagnosed with endometrial cancer after surgery at Binzhou Medical University Hospital from November 2019 to April 2024 were selected, including 64 cases of wild-type p53 and 72 cases of p53 mutation. The blood lipid levels were collected during their first fasting period at admission for the univariate analysis. The statistically significant factors were included in the multivariate logistic regression analysis. The receiver operating characteristic curve (ROC) was drawn. The patients' postoperative pathological parameters, depth of myometrial infiltration, staging, degree of tissue differentiation, and lymph node metastasis, were collected; their relationship with p53 mutant endometrial cancer was analyzed. t test, Mann-Whitney U test and χ² test were used for statistical comparison. Results　The level of TC, TG, LDL, and HDL in the p53 mutant endometrial cancer group were higher than those in the p53 wild-type endometrial cancer group, with statistical differences (all P<0.001). The inclusion of binary logistic regression analysis resulted in TC (OR=0.959, 95%CI 0.253-3.757, P=0.952), TG (OR=1.398, 95%CI 0.703-2.965, P=0.357), LDL (OR=8.205, 95%CI 1.472-50.567, P=0.019), and HDL (OR=2.252, 95%CI 0.373-14.255, P=0.378). The ROC analysis showed that the sensitivity of LDL in predicting the occurrence of p53 mutant endometrial cancer was 0.828; the specificity was 0.792; the optimal cutoff value was 2.41; the area under the curve (AUC) was 0.843. There were statistical differences in staging, tissue differentiation, and lymph node metastasis (all P<0.05) but no statistical difference in the depth of muscle infiltration (P>0.05) between wild-type and mutant p53 endometrial cancer. Conclusions　LDL is a risk factor for developing p53 mutant endometrial cancer, with high predictive value. Moreover, the prognosis of patients with p53 mutant endometrial cancer is poor. LDL is expected to become an indicator for predicting the classification and malignancy of endometrial cancer.

Cervical COOK balloon induced labor outcomes and related influencing factors in puerperae with full-term pregnancy

Li Haiying, Men Yaping, He Yiping

2024, 30(19):  3240-3244.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.015

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Objective　To explore the outcomes of cervical COOK balloon induced labor in puerperae with full-term pregnancy and to analyze the related influencing factors. Methods　The data of 196 puerperae with full-term pregnancy treated at Xianyang Maternal and Child Health Hospital were retrospectively analyzed. They were (29.48±4.61) years old. Their body mass index (BMI) was (26.52±1.86) kg/m². Their cervical Bishop score before placing the balloons was (4.03±0.46). All the patients were induced by cervical COOK balloons. According to the induced labor outcomes, the puerperae were divided into a successful induced labor group and a failed induced labor group. The factors affecting the induced labor outcomes were analyzed. The data were compared between the two groups by the independent-sample t test and χ² test. The influencing factors were analyzed by bivariate logistic regression analysis. The receiver operating characteristic curve (ROC) was used to analyze the value on predicting their pregnancy outcomes. Results　Among the 196 puerperae, there were 145 cases of successful induced labor and 51 cases of failed induced labor, including 10 cases of forceps delivery, 9 cases of drug-assisted induced induction, and 32 cases of cesarean section. The age, neonatal weight, proportions of the women with prenatal BMI>25 kg/m², primiparity, and balloon placement time>12 h in the failed induced labor group were higher than those in the successful induced labor group (all P<0.05), while the Bishop score was significantly lower than that in the successful induced labor group (P<0.05). There were no statistical differences in gestational age, complications, indications for induction of labor, and proportion of the women with premature rupture of membranes between the two groups (all P>0.05). The multivariate logistic regression analysis showed that increased age, prenatal BMI>25 kg/m², primiparity, and elevated neonatal weight were the risk factors for failed induced labor in the puerperae (all P<0.05), and the increase of Bishop score was the favorable factor for successful induced labor (P<0.05). The ROC analysis revealed that the area under the curve, sensitivity, and specificity of the above factors in predicting the failed induced labor by cervical COOK balloons in the puerperae were 0.812, 72.55%, and 75.17%, respectively. Conclusions　For puerperae with full-term pregnancy, the application of cervical COOK balloon induced labor has a certain risk of induced labor failure. Increased age, proportion of prenatal BMI>25 kg/m², primiparity, and neonatal weight increase are risk factors for induced labor failure in puerperae with full-term pregnancy.

Plasma lipid metabolism characteristics of pregnant women with hypothyroidism and their association with pregnancy outcomes

Zhang Xiaocai, Xu Shan, Wang Min, Duan Bei, Wang Jing, Gou Yuanfeng, Pei Qiaoli

2024, 30(19):  3245-3249.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.016

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Objective　To explore the characteristics of plasma lipid metabolism in pregnant women with hypothyroidism and their association with pregnancy outcomes. Methods　One hundred and fourteen late pregnant patients with hypothyroidism who visited Second Hospital, Shaanxi University of Traditional Chinese Medicine from January 2022 to January 2024 were selected as an observation group; they were (30.41±4.22) years old. One hundred and fourteen normal late pregnant women during the same period were selected as a control group; they were (29.73±5.06) years old. The levels of triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), phosphatidylcholine (PC), lysophosphatidylcholine (LPC), and phosphatidylethanolamine (PE) were compared between the two groups by independent-sample t test. The correlations of the lipid indicators with thyroid stimulating hormone (TSH), triiodothyronine (FT3), and total thyroxine (FT4) were analyzed by the Pearson correlation analysis. The values of PC, LPC, and PE in the prediction of adverse pregnancy outcomes were analyzed by the receiver operating characteristic curve (ROC). Results　The levels of TG, TC, LDL-C, PC, LPC, and PE of the observation group were higher than those of the control group [(4.58±1.01) mmol/L vs. (2.66±0.72) mmol/L, (6.72±1.03) mmol/L vs. (4.89±1.11) mmol/L, (3.92±1.00) mmol/L vs. (2.62±0.68) mmol/L, (382.45±36.66) ng/L vs. (334.20±41.18) ng/L, (16.40±1.81) μg/L vs. (14.22±1.95) ng/L, (17.40±1.81) μg/L vs. (14.05±1.68) ng/L, and (5.12±0.77) uIU/L vs. (1.26±0.22) uIU/L; all P<0.05]; the levels of FT3 and FT4 of the observation group were lower than those of the control group [(3.81±0.72) pmol/L vs. (4.50±0.68) pmol/L and (6.00±0.81) pmol/L vs. (10.44±0.77) pmol/L; both P<0.05]. PC, LPC, PE were positively correlated with TSH (r=0.472, 0.453, and 0.552; all P<0.05), and negatively with FT3 and FT4 (r=-0.322, -0.341, -0.399, -0.336, -0.314, and -0.417; all P<0.05). The levels of PC, LPC, and PE of the women with adverse pregnancy outcomes in the observation group were higher than those in the women without adverse pregnancy outcomes [(399.74±38.81) ng/L vs. (372.36±39.40) ng/L, (17.95±1.92) μg/L vs. (15.50±1.87) μg/L, and (18.22±1.92) μg/L vs. (16.92±1.81) μg/L; all P<0.05]. The areas under the ROC's of PC, LPC, and PE for predicting adverse pregnancy outcomes were 0.733, 0.854, and 0.724, respectively (all P<0.05). Conclusions　Pregnant women with combined hypothyroidism have increase in blood lipid related indicators; among which, PC, LPC, and PE are correlated with the three indicators of hypothyroidism and pregnancy outcomes. At the same time, they have certain application value in predicting adverse pregnancy outcomes.

Mechanism of miR-339-5p influencing chemotherapy resistance of breast cancer cells via regulating EMT

Li Zhilu, Qiao Xiting, Jiao Wan, Wang Xiaojuan, Si Xiaomin

2024, 30(19):  3250-3254.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.017

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Objective　To analyze the mechanism of miR-339-5p influencing chemotherapy resistance of breast cancer cells via regulating epithelial mesenchymal transformation (EMT). Methods　From February 2023 to February 2024, MCF10A mammary epithelial cells and MCF-7 breast cancer cell lines were cultured in vitro. The paclitaxel resistant breast cancer cell line (MCF-7/paclitaxel) was constructed. The MCF-7/paclitaxel cells were divided into a miR-339-5p mimics group, a miR-339-5p mimetic negative control group (miR-NC group), a miR-339-5p inhibitor group, and a miR-339-5p inhibitor control group (NC group). The real-time fluorescence quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to detect the expression level of miR-339-5p. The methyl thiazolyl tetrazolium (MTT) assay was used to determine the inhibition rate of cell proliferation. The flow cytometry was used to determine cell apoptosis. The expression of EMT related proteins [E-cadherin (E-cad) and Vimentin (Vim)] was detected using the Western blot method. The independent sample t test, one-way ANOVA, and LSD-t test were used for the statistical analysis of the obtained data. Results　The expression level of miR-339-5p in the MCF-7 cells was lower than that in the MCF10A cells [(0.36±0.07) vs. (0.73±0.08); P<0.05]. Forty-eight h after transfection, the proliferation inhibition rate and apoptosis rate in the miR-339-5p mimics group were higher than those in the miR-NC group [(45.86±4.92)% vs. (20.44±2.16)% and (16.54±1.67)% vs. (4.23±0.45)%; both P<0.05]. The cell proliferation inhibition rate and apoptosis rate of the miR-339-5p inhibitor group were lower than those of the NC group [(9.74±1.05)% vs.(17.18±1.84)% and (2.28±0.46)% vs. (5.43±0.59)%, both P<0.05]. The E-cad level in the miR-339-5p mimics group was higher than that in the miR-NC group [(0.78±0.07) vs. (0.42±0.05); P<0.05]; the Vim level in the miR-339-5p mimics group was lower than that in the miR-NC group [(0.42±0.05) vs. (0.61±0.07); P<0.05]. The E-cad level in the miR-339-5p inhibitor group was lower than that in the NC group [(0.23±0.04) vs. (0.34±0.05); P<0.05]; the Vim level in the miR-339-5p inhibitor group was higher than that in the NC group [(0.84±0.09) vs. (0.69±0.08); P<0.05]. Conclusions　MiR-339-5p can reduce chemotherapy resistance of breast cancer cells, inhibit cell proliferation, and promote cell apoptosis. The mechanism may be that it inhibits EMT regulating EMT related proteins——E-cad and Vim.

Relationship of miRNA-106a and miRNA-20a with severity and prognosis of patients with neonatal respiratory distress syndrome

Lyu Tao, Wu Wanli

2024, 30(19):  3254-3259.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.018

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Objective　To investigate the correlation of serum levels of microRNA (miRNA)-106a and miRNA-20a with the severity and prognosis of patients with neonatal respiratory distress syndrome (NRDS). Methods　One hundred and fifty-six patients with NRDS treated at Red Cross Hospital, Xi'an Jiaotong University from March 2021 to April 2024 were selected as an NRDS group, including 77 boys and 79 girls whose gestational age was (33.87±2.01) weeks. Based on the chest imaging results, the neonates were divided into a mild group (50 cases), a moderate group (74 cases), and a severe group (32 cases). According to their outcomes, the neonates were classified into a good prognosis group (132 cases) and a poor prognosis group (24 cases). Additionally, 150 healthy preterm infants, including 77 males and 73 females whose gestational age was (34.05±1.83) weeks, were selected as a control group. The serum levels of miRNA-106a and miRNA-20a were measured using quantitative real-time polymerase chain reaction (qPCR). Pearson correlation analysis was used to analyze the relationship of the serum levels of miRNA-106a and miRNA-20a with the Score for Neonatal Acute Physiology, Version Ⅱ (SNAPPE-Ⅱ) and 1-minute Apgar score in the neonates. The predictive values of serum miRNA-106a and miRNA-20a levels for the prognosis of the neonates with NRDS were assessed using the receiver operating characteristic curve (ROC). t and χ² tests were used. Results　The serum levels of miRNA-106a and miRNA-20a in the NRDS group were significantly lower than those in the control group [(0.97±0.30) vs. (1.70±0.53) and (0.88±0.32) vs. (1.57±0.55)], with statistical differences (t=14.750 and 13.346; both P<0.05). There were statistical differences in the serum levels of miRNA-106a and miRNA-20a and the 1-minute Apgar score between the severe group, the moderate group, and the mild group (all P<0.05). Compared with those in the good prognosis group, the serum levels of miRNA-106a and miRNA-20a in the poor prognosis group were lower, and the SNAPPE-Ⅱ score was higher [(0.40±0.19) vs. (1.07±0.36), (0.39±0.17) vs. (0.97±0.34), and (34.25±6.50) vs. (18.10±3.58)], with statistical differences (t=13.438, 12.718, 11.850, all P<0.05). The serum levels of miRNA-106a and miRNA-20a were negatively correlated with the SNAPPE-Ⅱ score (both P<0.05), and positively with the 1-minute Apgar score (both P<0.05). The sensitivity and specificity of miRNA-106a for predicting the poor prognosis in the patients with NRDS were 95.8% and 93.2%, respectively, with an area under the curve (AUC) of 0.961 (95%CI 0.929-0.992); the sensitivity and specificity of miRNA-20a were 91.7% and 89.4%, respectively, with an AUC of 0.938 (95%CI 0.900-0.976). The sensitivity and specificity of the combination of miRNA-106a and miRNA-20a were 91.7% and 97.7%, respectively, with an AUC of 0.984 (95%CI 0.967-1.000), indicating a higher predictive efficacy. Conclusions　The serum levels of miRNA-106a and miRNA-20a are significantly reduced in patients with NRDS, and decrease as the disease severity increases. Both have significant value in predicting the prognosis of patients with NRDS.

Clinical Research

Influence of reconstruction of posterior urethral fascia during radical prostatectomy on postoperative urinary control

Qiang Yayong, Ma Yadong, Wang Tao

2024, 30(19):  3260-3266.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.019

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Objective　To explore the influence of reconstruction of posterior urethral fascia during radical prostatectomy (RP) on postoperative urinary control. Methods　A retrospective study was conducted. One hundred and twenty patients with prostate cancer taking reconstruction of posterior urethral fascia during RP at Yan'an Hospital of Traditional Chinese Medicine from September 2020 to September 2023 were selected as the study objects. According to the postoperative recovery of urinary control function, the patients were divided into a recovered group (97 cases) and an unrecovered group (23 cases). The baseline data and perioperative indicators were compared between the two groups by t and χ² tests. The binary logistic regression analysis was used to examine the influencing factors of urinary control function recovery after urethral posterior fascia reconstruction during RP. A nomogram model was constructed based on the regression analysis results and internally validated. Results　The length of urethral stricture in the unrecovered group was longer than that in the recovered group [(2.69±0.54) cm vs. (2.08±0.51) cm]; the distance from stenosis to bladder neck in the unrecovered group was shorter than that in the recovered group [(2.46±0.59) cm vs. (3.15±0.62) cm; the proportions of the patients who underwent laparoscopic radical prostatectomy (LRP) and had a history of transurethral prostatectomy (TURP) in the unrecovered group were higher than those in the recovered group [69.57% (16/23) vs. 28.90% (29/97) and 78.26% (18/23) vs. 37.11% (36/97)]; the proportions of the patients who retained the bladder neck and nerve and vascular bundles and underwent regular anal lifting training after surgery in the unrecovered group were lower than those in the recovered group [30.43% (7/23) vs. 62.89% (61/97), 17.39% (4/23) vs. 60.82% (59/97), and 39.13% (9/23) vs. 70.10% (68/97)]; there were statistical differences (t=5.117 and -4.801; χ²=12.482, 12.718, 7.973, 14.064, and 7.757; all P<0.05). The logistic regression analysis showed that LRP surgery method, history of TURP, and length of urethral stricture were independent risk factors affecting the recovery of urinary control function in the patients (all P<0.05); the distance from stricture to bladder neck, preservation of bladder neck, and preservation of neurovascular bundles were protective factors for postoperative recovery of urinary control function in the patients (all P<0.05). Based on the above influencing factors, a nomogram was constructed; the C-index value was 0.973, indicating good discrimination of the model. The receiver operating characteristic curve was drawn to internally validate the model, and the results showed that the area under the curve of the model in the prediction of urinary control function recovery in the patients was 0.973 (95% CI 0.941-1.000, P<0.05); the model had certain predictive value the specificity, sensitivity, and Jordan index were 0.948%, 0.913%, and 0.861%, respectively. Conclusion　Surgical methods, history of TURP, length of urethral stricture, distance from stricture to bladder neck, preservation of bladder neck, and preservation of neurovascular bundles are important influencing factors for the recovery of urinary control function in patients with prostate cancer undergoing posterior urethral fascia reconstruction during RP. Building a nomogram model based on these factors can effectively predict the recovery of urinary control function in these patients.

Clinical features and drug resistance of Escherichia coli bloodstream infection at some hospital

Liu Canhua, Cai Donghao, Li Ran, Su Xin, Tan Junqing

2024, 30(19):  3267-3271.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.020

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 Objective　To analyze the clinical features and drug resistance of 221 patients with Escherichia coli bloodstream infection at Guangdong Provincial Second Hospital of Traditional Chinese Medicine, and to provide references for the rational use of antimicrobial drugs and the prevention and control of hospital infection in clinical practice. Methods　The data of positive blood culture strains at Guangdong Provincial Second Hospital of Traditional Chinese Medicine from January 2021 to December 2023 were collected. The clinical information and drug sensitivity results of 221 patients with non-duplicative Escherichia coli bloodstream infection were screened, including 95 males (42.99%) and 126 females (57.01%); they were 26-97 years old. According to the production of extended spectyum beta-lactamase (ESBLs), they were divided into an ESBLs group (105 cases) and a non-ESBLs group (116 cases). The resistance rates were compared between the two groups by χ² test. Results　From January 2021 to December 2023, there were 552 cases of positive blood culture in the hospital, including 221 patients with Escherichia coli bloodstream infection. The patients were mainly from the departments of acupuncture (55 cases) and oncology (31 cases). There were 105 ESBLs-producing Escherichia coli strains, accounting for 47.51% of the total strains. Escherichia coli had high resistance rates to levofloxacin (54.30%), cotrimoxazole (50.68%), ceftriaxone (53.39%), and cefuroxime (53.85%), but had high sensitivity to amikacin (3.62%), carbapenems (5.43%), and ertapenem (5.43%). ESBLs-producing Escherichia coli had higher resistance rates to imipenem, ertapenem, ceftazidime, cefepime, ceftriaxone, cefuroxime, and levofloxacin than non-ESBL-producing Escherichia coli (all P<0.05). Conclusions　Escherichia coli bloodstream infection is mainly distributed in the departments of acupuncture and oncology. Most strains produce ESBLs and are resistant to many common antibiotics, but they are highly sensitive to carbapenems, so antimicrobial drugs should be reasonably selected in clinical practice to reduce the generation of drug-resistant bacteria.

Analysis of prevalence and risk factors of emotional abnormalities in patients with anal cryptitis

Wei Ni, Sun Linmei, Su Hongbo, Tang Lin, Yin Xinyuan, Sun Xingwei

2024, 30(19):  3271-3277.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.021

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Objective　To analyze the prevalence and risk factors of emotional disorders in patients with anal cryptitis (AC). Methods　Three hundred and twenty outpatients and inpatients with AC treated at Xi 'an Hospital of Traditional Chinese Medicine from January 2021 to January 2024 were selected as the study objects. All the patients were evaluated by Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS). According to the occurrence of emotional abnormalities, the patients with emotional abnormalities were set as an emotional abnormality group, including 55 males and 71 females whose body mass index was (25.10±1.39) kg/m², and the patients without emotional abnormalities a non-emotional abnormality group, including 89 males and 105 females whose body mass index was (24.88±1.41) kg/m². All the patients' baseline data were statistically analyzed. The relationship of anxiety and depression with intestinal flora was analyzed by bivariate correlation Pearson. Binary logistic regression was used to analyze the risk factors of emotional abnormalities in the patients with AC, and a nomogram was constructed. t, non-parameter Mann-Whitney U, and χ² tests were used. Results　The scores of SAS and SDS in the emotional abnormality group were higher than those in the non-emotional abnormality group [(68.66±5.82) vs. (52.87±3.59) and (69.18±5.03) vs. (53.62±3.65)], with statistical differences (t=30.02 and 32.03; both P<0.05). The levels of Lactobacillus, Enterococcus, and Bifidobacterium in the emotional abnormality group were lower than those in the non-emotional abnormality group [(6.67±1.02) logN/g vs. (8.28±1.26) logN/g, (6.75±1.32) logN/g vs. (7.88±1.09) logN/g, and (7.11±1.13) logN/g vs. (8.02±1.04) logN/g], with statistical differences (t=12.01, 8.33, and 7.39; all P<0.05). The scores of SAS and SDS were negatively correlated with the levels of Lactobacillus, Enterococcus, and Bifidobacterium (all r<0; all P<0.05). The disease course in the emotional abnormality group was longer than that in the non-emotional abnormality group (P<0.05); the scores of Numeric Pain Rating Scale (NRS) and Insomnia Severity Index (ISI) and the proportions of the patients with concomitant diseases and the patients who did not took the primary treatment in the emotional abnormality group were higher than those in the non-emotional abnormality group (all P<0.05). The scores of NRS and ISI and concomitant diseases were the risk factors of emotional abnormalities in the patients with AC (all OR>1; all P<0.05); the levels of Lactobacillus, Enterococcus, and Bifidobacterium were the protective factors of of emotional abnormalities in the patients with AC (all OR<1; all P<0.05). Bootstrap was used to verify the nomogram model; the internal verification was carried out through the modeling group; the results showed that the C-index value was 0.944, and the calibration curve was in good agreement with the ideal curve; the area under the curve (AUC) was 0.917 (95%CI 0.869-0.965, P<0.001). Conclusions　The levels of intestinal flora in patients with AC is closely related to the occurrence of anxiety and depression. The scores of NRS and ISI and concomitant diseases are closely related to the occurrence of emotional abnormalities in patients with AC.

Effect of stepped grip strength exercise on patients with forearm hypervascularity of stage 4 chronic kidney disease

Xiong Hui, Chen Zhuomin, Wan Xiaohui, Pan Jie, Zhang Jing, Xie Kaixuan, Liu Nana, Nie Ronglu

2024, 30(19):  3278-3281.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.022

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Objective　To investigate the effect of stepped grip strength exercise on patients with forearm hypervascularity of stage 4 chronic kidney disease (CKD). Methods　A total of 54 patients diagnosed with stage 4 CKD at 908th Hospital of Joint Logistic Support Force, Chinese People's Liberation Army from February 2018 to December 2021 were selected for the randomized controlled trial, and were divided into a control group and an experimental group by the random number table method, with 27 cases in each group. There were 17 males and 10 females in the control group; they were 32 to 74 (49.67±13.03) years old; their disease course was 5 - 21 (10.26±4.19) years. There were 15 males and 12 females in the experimental group; the were 28-71 (50.31±14.43) years old; their disease course was 6-23 (10.35±3.80) years. The control group did exercise with electronic grip apparatus, and the experimental group did stepped grip strength exercise with intelligent grip balls. The vascular diameters and blood flow velocities before exercise and 4 and 8 weeks after exercise and compliance were compared between the two groups. t and χ² tests used. Results　After 8 weeks' exercise, the internal diameter of cephalic vein in the control group was lower than that in the experimental group [(1.98±0.15) mm vs. (2.12±0.21) mm], with a statistical difference (t=4.63; P<0.05). After 4 and 8 weeks' exercise, the radial artery blood flow velocities in the control group were lower than those in the experimental group [(19.32±0.59) cm/s vs. (19.85±0.43) cm/s and (21.07±0.49) cm/s vs. (23.38±0.53) cm/s], with statistical differences (t=3.77 and 16.63; both P<0.05). After 8 weeks' exercise, the compliance in the experimental group was higher than that in the control group [85.19% (23/27) vs. 51.85% (14/27)], with a statistical difference (χ²=6.95; P<0.05). Conclusion　Stepped grip strength exercise for patients with forearm hypervascularity of stage 4 CKD can dilate their inner diameter of the cephalic vein, accelerate the radial artery blood flow, and improve their vascular conditions, with high exercise compliance.

Value of of IgG4 and Th17/Treg in serum in evaluation of effect of hormone therapy for AIP patients

Yan Huanhuan, Zhang Jialong

2024, 30(19):  3282-3286.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.023

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Objective　To analyze serum immunoglobulin 4 (IgG4) and helper T 17 (Th17)/regulatory T cells (Treg) in the assessment of response to hormone therapy in patients with autoimmune pancreatitis (AIP). Methods　A total of 95 patients with AIP treated at Tongchuan People's Hospital from April 2021 to September 2023 were selected, including 55 males and 40 females; they were (54.28±5.51) years old; 48 cases had smoking history; 49 cases had drinking history. Before the treatment, the flow cytometry was used to detect Th17 and Treg, and Th17/Treg was calculated. The level of AMY was detected by the enzyme-linked immunosorbent assay. All the patients took hormone therapy, and were divided into an effective group (complete response and partial response) and an ineffective group (treatment failure) according to the effect. The basic data and serological indicators of the two groups were compared to analyze the influencing factors and predictive value of serum IgG4 and Th17/Treg for evaluating the efficacy of hormone therapy for the patients. t and χ² tests were used. The binary logistic stepwise regression model was used to analyze the influencing factors. The receiver operating characteristic curve (ROC) was drawn to evaluate the prediction efficacy. Results　After hormone therapy for the patients, 43 patients had complete remission, 30 partial remission, and 22 treatment failure. The effective rate was 75.00% (73/95), and the ineffective rate 23.16% (22/95). The Th17/Treg and levels of D-D, AMY, and IgG4 in the effective group were lower than those in the ineffective group [(1.05±0.14) vs. (2.21±0.34), (0.23±0.05) mg/L vs. (0.52±0.12) mg/L, (296.56±15.74) U/L vs. (436.26±18.52) U/L, and (2.47±0.41) g/L vs. (4.62±0.78) g/L], with statistical differences (t=23.475, 16.556, 35.005, and 17.091; all P<0.001). The binary logistic regression analysis results showed that the Th17/Treg (OR=4.486, 95%CI 1.533-13.125) and levels of D-D (OR=3.333, 95%CI 1.139-9.753), AMY (OR=3.912, 95%CI 1.337-11.445), and IgG4 (OR=3.077, 95%CI 1.052-9.003) were the influential factors for the efficacy of hormone therapy for the patients (all P<0.05). According to the ROC analysis, the sensitivities of Th17/Treg, D-D, AMY, IgG4, and their combination in the prediction of the ineffectiveness of hormone therapy for the patients were 77.27%, 63.64%, 68.18%, 72.73%, and 90.91%, respectively; the specificities were 76.71%, 68.49%, 69.86%, 73.97%, and 91.78%, respectively. Conclusions　Th17/Treg and the levels of D-D, AMY, and IgG4 are related to the ineffective hormone therapy for patients with AIP; the combined detection is more accurate and efficient in predicting the efficacy of hormone therapy for patients with AIP.

Effects of Runpo Decoction combined with Bifidobacterium Triple Viable Capsules for elderly patients with diabetic constipation

Xi Xiaowen, Deng Qing, Liu Jieqiong

2024, 30(19):  3287-3291.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.024

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Objective　To explore the effects of Runpo Decoction combined with Bifidobacterium Triple Viable Capsules on anorectal dynamics and intestinal flora levels in elderly patients with diabetic constipation. Methods　From January 2021 to January 2024, 122 elderly patients with diabetic constipation treated at Nuclear Industry 215 Hospital of Shaanxi Province were selected for the randomized controlled trial, and were divided into a control group and a combined group by the random number table method, with 61 cases in each group. There were 16 males and 45 females in the control group; they were (64.83±9.97) years old; their diabetic course was (7.49±2.31) years; the constipation course was (1.40±0.61) years. There were 19 males and 42 females in the combined group; they were (65.18±10.16) years old; their diabetic course was (7.36±2.27) years; the constipation course was (1.37±0.52) years. Both groups took Bifidobacterium Triple Viable Capsules; in addition, the combined group took Runpo Decoction. The symptoms of defecation, intestinal flora levels, anorectal dynamics, and quality of life before and 2 weeks after the treatment and incidences of adverse reactions were compared between the groups using t and χ² tests. Results　Before the treatment, there were no statistical differences in symptoms of defecation, intestinal flora levels, anorectal dynamics, and quality of life between the two groups. After the treatment, the defecation frequency, counts of lactobacillus and bifidobacterium, and rectal evacuation pressure in the combined group were higher than those in the control group [(6.93±1.18) times/week vs. (5.15±1.07) times/week, (7.04±0.61) IgCFU/g vs. (6.18±0.67) IgCFU/g, (8.73±0.79) IgCFU/g vs. (7.45±0.80) IgCFU/g, and (54.69±3.86) mmHg(1 mmHg=0.133 kPa) vs. (41.63±1.72) mmHg]; the defecation time in the combined group was shorter than that in the combined group [(7.75±1.64) min/time vs. (10.89±1.58) min/time]; the count of Escherichia coli, residual anal pressure, rectal evacuation threshold, initial rectal sensation threshold, and scores of physical discomfort, psychosocial discomfort, anxiety concerns, and satisfaction in the combined group were lower than those in the control group [(5.28±0.39) IgCFU/g vs. (6.40±0.48) IgCFU/g, (46.92±3.37) mmHg vs. (62.08±3.98) mmHg, (160.18±3.85) ml vs. (165.07±4.01) ml, (40.93±2.97) ml vs. (46.93±3.14) ml, (3.98±1.17) vs. (5.17±1.08), (11.64±1.75) vs. (15.75±2.06), (14.56±2.95) vs. (23.78±2.86), and (5.34±1.97) vs. (8.15±2.18)]; there were statistical differences (t=8.728, 7.413, 8.892, 24.137, 10.769, 14.144, 22.704, 6.870, 10.842, 5.837, 11.876, 17.526, and 7.469; all P<0.05). There was no statistical difference in the incidence of adverse reactions between the two groups (χ²=0.209,P=0.648). Conclusion　Runpo decoction combined with Bifidobacterium Triple Viable Capsules for elderly patients with diabetic constipation can significantly improve their anorectal dynamics and intestinal flora levels, promote their restoration of intestinal function, and is safe, so it is worth being clinically generalized.

composition ratio and drug resistance rate of pathogenic bacteria in pus of focal area of granulomatous lobular mastitis

Wang Jing, Chai Tingting

2024, 30(19):  3292-3296.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.025

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Objective　To investigate the composition ratio and drug resistance rate of pathogenic bacteria in the pus of the focal area of granulomatous lobular mastitis. Methods　Two hundred patients with granulomatous lobular mastitis admitted to Tongchuan People's Hospital from August 2021 to August 2022 were selected as the study objects; they were (32.15±3.85) years old; their disease course was (29.56±6.12) days. The pus from the lesion area of all the patients was collected on the second day after admission for culture, isolation, and identification. The distribution of pathogenic bacteria in the pus was analyzed. Drug sensitivity tests were conducted on the Gram positive bacteria. The drug resistance of the pathogenic bacteria was analyzed. Results　Among the 200 patients, Gram positive bacteria was detected in 162 ones (81.00%), Gram negative bacteria in 35 (17.50%), and Candida albicans in 3 (1.50%). Among the Gram positive bacteria, Corynebacterium accounted for 68.50% (137/200). Among the Gram negative bacteria, Acinetobacter accounted for 8.50% (17/200). Among the 137 cases of Corynebacterium pyogenes, Microbacterium, Aquatic Corynebacterium, Group G Corynebacterium, and Group A Corynebacterium accounted for 30.66% (42/137), 15.33% (21/137), 13.87% (19/137), and 9.49% (13/137), respectively. The resistance rates of genus Corynebacterium against oxacillin, clindamycin, and erythromycin were 74.74% (71/95), 85.26% (81/95), and 81.05% (77/95), respectively; the resistance rates against vancomycin, linezolid, rifampicin, and gentamicin were 0. The resistance rates of Gram positive bacteria against oxacillin and clindamycin were 60.00% (15/25) and 72.00% (18/25), respectively; the resistance rates against vancomycin and linezolid were 0. Conclusions　Gram-positive bacteria are the main pathogens in the pus of the focal area of granulomatous lobular mastitis, and Corynebacterium accounts for the highest proportion. Gram positive bacteria have a very low resistance rate to vancomycin, linezolid, rifampicin, and gentamicin, so the above drugs could be selected for the treatment.

Relationship between HOPX expression and efficacy of neoadjuvant chemotherapy for patients with locally advanced breast cancer

Li Chong, Wang Fei

2024, 30(19):  3296-3301.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.026

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Objective　To investigate the relationship of the expression of homologous domain protein homeobox (HOPX) and the methylation of HOPX in peripheral blood with the efficacy of neoadjuvant chemotherapy for patients with locally advanced breast cancer. Methods　The data of 129 patients admitted to Xianyang Central Hospital were analyzed. They were (50.69±5.48) years old. There were 71 cases of high differentiation and 58 cases of low differentiation. There were 48 cases of stage ⅡB and 81 cases of stage Ⅲ. Eighty-seven cases had lymph node metastasis. According to the efficacy of neoadjuvant chemotherapy, they were divided into pathological complete response (pCR) and non-pCR. The expression of HOPX and the methylation level of HOPX in peripheral blood in the patients before neoadjuvant chemotherapy were detected. The relationship of HOPX expression in cancer tissue and HOPX methylation rate in peripheral blood with the pathological features of the patients with locally advanced breast cancer was analyzed. The factors influencing the efficacy of neoadjuvant chemotherapy were analyzed. The relative expression of HOPX mRNA in cancer tissue and the methylation rate of HOPX in peripheral blood in predicting the efficacy of neoadjuvant chemotherapy for the patients were analyzed. t and χ² tests were used. The Cox proportional risk model was used for the influencing factors. The receiver operating characteristic curve (ROC) was used to evaluate the prediction efficacy. Results　The relative expression level of HOPX mRNA in the cancer tissue was higher than that in the adjacent tissue [(1.97±0.32) vs. (1.13±0.21); P<0.05]. The relative expression level of HOPX mRNA and the methylation rate of HOPX in peripheral blood of the patients with low differentiation, stage Ⅲ, and lymph node metastasis were higher than those of the patients with middle and high differentiation, stage ⅡB, and no lymph node metastasis [(2.19±0.37) vs. (1.79±0.32), (2.23±0.39) vs. (1.53±0.26), (2.14±0.35) vs. (1.62±0.28), 81.03% (47/58) vs. 56.34% (40/71), 75.31% (61/81) vs. 54.17% (26/48), and 73.56% (64/87) vs. 54.76% (23/42); all P<0.05]. The Cox regression analysis showed that tumor stage (RR=5.557, 95%CI 2.286-13.505), differentiation degree (RR=5.360, 95%CI 2.206-13.027), relative expression level of HOPX mRNA (RR=4.455, 95%CI 1.833-10.827), and HOPX methylation rate (RR=4.362, 95%CI 1.795-10.602) were the factors affecting the efficacy of neoadjuvant chemotherapy for the patients (all P<0.05). The ROC analysis results showed that the relative expression level of HOPX mRNA combined with HOPX methylation rate had AUC in predicting the efficacy of neoadjuvant chemotherapy for the patients than single one (0.894 vs. 0.774 and 0.894 vs. 0.768). Conclusions　The relative expression level of HOPX mRNA in cancer tissue and the methylation rate of HOPX in peripheral blood of patients with locally advanced breast cancer are closely related to pathological characteristics and the efficacy of neoadjuvant chemotherapy. The combination of the two can predict the efficacy of neoadjuvant chemotherapy well.

Correlation of expression levels of TCAB1 and lncRNA DLEU2 with and clinical pathological parameters and prognosis in patients with papillary thyroid carcinoma

Qi Xinchun, Li Yang, Cheng Wei

2024, 30(19):  3302-3306.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.027

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Objective　To investigate the correlation of the expression levels of telomerase Cahalin protein 1 (TCAB1) and long chain non-coding RNA (lncRNA) DLEU2 in the tissues of patients with papillary thyroid carcinoma with their clinical pathological parameters and prognosis. Methods　Eighty patients with PTC treated at Shaanxi Provincial Tumor Hospital from January 2018 to January 2021 were selected, including 35 males and 45 females who were 38-78 (54.65±4.75) years old. The patients' cancer tissue and adjacent tissue were collected for immunohistochemical examination. The immunohistochemical staining was used to detect the expression levels of TCAB1 and lncRNA DLEU2 in the cancer tissue and adjacent tissue. The expression levels of TCAB1 and lncRNA DLEU2 in the patients with different pathological parameters were analyzed. Spearman correlation analysis was used to analyze the correlation of TCAB1 and lncRNA DLEU2 with the clinical pathological parameters of PTC. All the patients were followed up for 3 years, and were divided into 2 subgroups based on their prognosis. Twenty patients with new metastases and recurrent lesions and who died were set as a poor prognosis group. The remaining 60 patients were set as a good prognosis group. The expression levels of TCAB1 and lncRNA DLEU2 in the two groups were analyzed. The logistic regression analysis model was used to analyze the prognostic predictive values of TCAB1 and lncRNA DLEU2 for PTC. t and χ² tests were used. Results　The relative expression level of lncRNA DLEU2 and the positive rate of TCAB1 in the cancer tissue were significantly higher than those in the adjacent tissue [(1.44±0.27) vs. (0.75±0.12), 72.78% (49/80) vs. 14.79% (22/80), ], with statistical differences (t=16.14; χ²=18.46; both P<0.05). There were statistical differences in the relative expression of lncRNA DLEU2 and TCAB1 positivity rate between the patients with different TNM stages and with and without lymph node metastases (all P<0.05). The results of Spearman correlation analysis showed that TCAB1 was positively associated with clinical stage and lymph node metastasis (r=0.428 and 0.353; both P<0.05), and lncRNA DLEU2 was positively associated with clinical stage and lymph node metastasis (r=0.430 and 0.401; both P<0.05). The relative expression level of lncRNA DLEU2 and the positive rate of TCAB1 in the poor prognosis group were significantly higher than those in the good prognosis group [(1.68±0.25) vs. (1.25±0.13) and 85.00% (17/20) vs. 53.33% (32/60)], with statistical differences (t=8.48 and χ²=6.34; both P<0.05). Positive expression of TCAB1 and increased relative expression of lncRNA DLEU2 were independent prognostic factors for PTC (OR=2.791, 95%CI 1.457-5.745; OR=2.146, 95%CI 1.525-6.795; both P<0.001). Conclusions　The expression levels of TCAB1 and lncRNA DLEU2 in the cancer tissue of PTC patients are increased, and are closely related to the occurrence and development of PTC. The expression levels of TCAB1 and lncRNA DLEU2 can be detected to predict the prognosis of patients with PTC.

Case Report

One case of low rectal endometriosis and literature review

Chen Yinggang, Zhu Yuanyuan, Xu Yujie, Liu Weilong, Tian Shulei, Guan Dongdong

2024, 30(19):  3307-3309.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.028

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Endometriosis is the presence of endometrium-like tissue outside the uterus and causes chronic inflammatory response. Patients with low rectal endometriosis are rare. In order to increase clinicians' understanding of low rectal endometriosis, the treatment of a middle-aged woman with low rectal endometriosis was reported and related literatures were retrospectively analyzed.

One case of seminal vesicle cystadenoma treated by laparoscopic excision and literature review

Zhang Linying, Wang Tao, Li Qing, Liu Yufeng

2024, 30(19):  3310-3312.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.029

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Primary seminal vesicle tumors are rare. Most of them are malignant tumors, and benign tumors are rarer. Seminal vesicle cystadenoma is a very rare tumor originated from the seminal vesicles, and contains mixed benign epithelial ingredient and interstitial ingredients. we treated a case of seminal vesicle cystadenoma by laparoscopic excision, and got satisfactory results. We retrospectively analyzed the literatures in recent years and summarizes the feasibility of laparoscopic surgical resection for this type of tumor.

Nursing Research

Impact of sleep state intervention nursing on immune function of patients undergoing cervical cancer excision

He Jinli, Xiao Yuanyuan, Cao Jiaojiao, Shang Jing, Wan Yanmei

2024, 30(19):  3313-3317.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.030

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Objective　To investigate the impact of sleep state intervention nursing on the immune function of patients undergoing cervical cancer excision. Methods　Eighty-two patients with cervical cancer treated at Yulin Hospital, First Hospital, Xi'an Jiaotong University from October 2021 to October 2023 were selected for the randomized controlled trial. All the patients underwent hysterectomy and lymph node dissection. They were divided into a control group and an observation group by the random number table method, with 41 patients in each group. The control group received conventional nursing; in addition, the observation group received combined sleep state intervention. Both groups were intervened for one month. The postoperative recovery conditions of the two groups were compared. The Visual Analogue Scale (VAS) was use to evaluate the patients' pain in both groups 1 d, 1 week, and 1 month after the operation. The patients' sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI) before and 1 month after the intervention. The serum levels of immunoglobulins were measured before and after the intervention. The patients' quality of life before and after the intervention was assessed in the physical, psychological, social, and environmental domains using the World Health Organization Quality of Life-BREF Scale (WHOQOL-BREF). t test and χ² test were used for statistical comparison Results　The postoperative time for off-bed activity, time to first flatus, time to first bowel movement, and hospital stay in the observation group were shorter than those in the control group [(11.62±1.45) h vs. (19.04±2.38) h, (29.88±4.01) h vs. (56.72±7.19) h, (2.90±0.47) d vs. (4.26±0.63) d, and (6.61±1.13) d vs. (10.84±2.45) d], with statistical differences (all P<0.001). The VAS scores of the observation group were lower than those of the control group 1 day, 1 week and 1 month after surgery, and the differences were statistically significant (all P<0.001). One month after the intervention, the scores of PSQI and life quality and levels of immunoglobulins in the observation group were better than those in the control group, with statistical differences (all P<0.05). Conclusion　Sleep state intervention can aid in the postoperative recovery of patients taking cervical cancer excision, and improve their sleep quality, immune function, and life quality.

Application of intervention program based on nursing outcome classification in nursing care for patients with benign prostatic hyperplasia

Gao Juan, Niu Wentao, Zhang Jing, Mao Ling, Zhang Zhihua, Yang Xu, Yang Qiong

2024, 30(19):  3318-3322.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.031

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Objective　To observe the impact of implementing the intervention program based on nursing outcome classification in nursing care for benign prostatic hyperplasia on its nursing quality. Methods　Five hundred and fifty-two with patients benign prostatic hyperplasia admitted to Xianyang Central Hospital between January 2022 and October 2023 were selected and divided into an observation group and a control group according to the different intervention plans, with 276 cases in each group. The observation group were (74.99±5.91) years old; their disease course was (7.03±0.48) months. The control group were (73.52±5.44) years old; their disease course was (7.11±0.57) months. The observation group took the intervention program based on the nursing outcome classification. The control group took the conventional care program. The nursing effects were compared between the two groups. The prostatic states and life quality in both groups were evaluated by International Prostate Symptom Score (IPSS-CH) and Quality of Life Measurement Scale (The European Organization for Research and Treatment of Cancer 30, QLQ-C30). The SPSS26.0 software was used to statistically analyze the clinical data. The data were compared by t test. Results　On the day of admission, there were no statistical differences in the scores of IPSS-CH and QLQ-C30 between the two groups (all P>0.05). One day before discharge, the scores of appetite, spirit, daily life, fatigue, and pain and full score of QLQ-C30 and the scores of sleep state, mental sate, and urinary function of nursing effect in the observation group were higher than those in the control group [(33.95±3.77) vs. (31.99±3.64), (34.64±4.08) vs. (32.71±3.89), (32.97±3.66) vs. (30.98±3.43), (35.58±4.32) vs. (33.51±4.22), (37.71±3.91) vs. (35.82±3.77), (172.45±22.45) vs. (161.99±20.33), (40.23±3.65) vs. (37.83±3.22), (39.93±3.22) vs. (36.73±3.11), and (39.18±3.55) vs. (36.99±3.05)], with statistical differences (all P<0.05). The scores of difficulty in holding urine, dysuria, thinning of the urine line, frequent micturition, and number of interruptions of urination of IPSS-CH in the observation group were lower than those in the control group [(1.08±0.11) vs. (1.99±0.25), (1.15±0.19) vs. (1.57±0.33), (1.21±0.16) vs. (1.77±0.20), (1.17±0.15) vs. (1.35±0.25), and (0.99±0.09) vs. (1.32±0.14)], with statistical differences (all P<0.05). Conclusion　Intervention program based on nursing outcome classification for patients with benign prostatic hyperplasia can significantly improve the nursing effect, their prostate symptoms, and their quality of life.

PDCA nursing mode combined with traditional Chinese medicine enema for patients with ulcerative colitis

Li Xi, Liu Jun'e, Song Xuehong, Jia Tong, Chen Xiaokang

2024, 30(19):  3322-3327.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.032

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Objective　To explore the effect of the Plan-Do-Check-Act (PDCA) nursing mode combined with traditional Chinese medicine enema for patients with ulcerative colitis. Methods　This was a prospective study. Eighty-two patients with ulcerative colitis treated at Hanzhong Hospital of Traditional Chinese Medicine from April 2019 to March 2023 were divided into an experimental group and a control group using the random number table method, with 41 patients in each group. The experimental group included 27 males and 14 females, with an age of (41.73±6.18) years and a disease duration of (7.04±1.31) months; there were 22 mild cases and 19 moderate cases. The control group included 23 males and 18 females, with an age of (42.59±6.43) years and a disease duration of (6.72±1.53) months; there were 23 mild cases and 18 moderate cases. The control group received conventional treatment and routine nursing intervention, while the experimental group received conventional treatment, PDCA nursing, and traditional Chinese medicine enema, for 4 weeks. The recovery effects, serum levels of inflammatory factors, and scores of Ulcerative Colitis Disease Activity Index (UCDAI) and Inflammatory Bowel Disease Questionnaire (IBDQ) were compared between the two groups by t and χ² tests. Results　The total effective rate of the experimental group was higher than that of the control group [90.24% (37/41) vs. 73.17% (30/41)], with a statistical difference (x²=3.998; P=0.046). After the intervention, the levels of C-reaction protein (CRP) and interleukin-6 (IL-6) in the experimental group were lower than those in the control group [(4.04±0.64) mg/L vs. (6.12±0.73) mg/L and (1.67±1.07) ng/L vs. (2.98±1.15) ng/L], with statistical differences (t=13.719 and 5.340; both P<0.05); the scores of rectal bleeding, diarrhea, endoscopic findings, and physician evaluation in the experimental group were lower than those in the control group [(1.23±0.29) vs. (1.38±0.31), (1.21±0.27) vs. (1.43±0.26), (1.06±0.23) vs. (1.16±0.22), and (1.14±0.31) vs. (1.39±0.28)], with statistical differences (t=2.263, 3.758, 2.012, and 3.832; all P<0.05); the scores of intestinal symptoms, systemic symptoms, social function, and emotional function in the experimental group were higher than those in the control group [(67.84±4.73) vs. (60.13±4.26), (29.71±2.73) vs. (27.36±2.68), (27.72±2.31) vs. (24.06±2.08), and (69.82±5.36) vs. (64.67±4.79)], with statistical differences (t=7.755, 3.933, 7.539, and 4.587; all P<0.05). Conclusion　PDCA nursing mode combined with traditional Chinese medicine enema has significant advantages in treating patients with ulcerative colitis, and effectively improving the treatment effect and their quality of life.

Effect of local ice pack cold compress combined with infrared radiation for patients with inguinal hernia after surgery

Fan Yijin, He Ying, Huang Yuhua

2024, 30(19):  3327-3331.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.033

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Objective　To study the clinical effect of local ice pack cold compress combined with infrared radiation for patients with inguinal hernia after surgery. Methods　A total of 88 patients with inguinal hernia who underwent surgical treatment at the Guangzhou First People's Hospital from January 2021 to December 2022 were selected. The patients were divided into a control group and a treatment group according to different postoperative treatments, with 44 cases in each group. In the control group, there were 39 males and 5 females; the time from onset to surgery was (6.35±0.52) d; they were (49.43±2.89) years old; there were 17 cases of left inguinal hernia and 27 cases of right inguinal hernia; they were treated with sandbags and infrared radiation after surgery. In the treatment group, there were 37 males and 7 females; the time from onset to surgery was (6.16±0.79) d; they were (49.16±2.73) years old; there were 18 cases of left inguinal hernia and 26 cases of right inguinal hernia; they were treated with local ice pack cold compress and infrared radiation after surgery. Both groups were treated for 1 week. The therapeutic effects and the relevant evaluation indexes before and after treatment were compared between the two groups.  χ² and independent sample t test were used for statistical comparison. Results　The total effective rate of incision healing in the treatment group was higher than that in the control group [93.18% (41/44) vs. 75.00% (33/44)], with a statistical difference between the two groups (χ²=5.436, P=0.020). After the treatment, the scores of Visual Analogue Scale and comfort, the levels of interleukin (IL) -10 and C reaction protein, and white blood cell count in the treatment group were better than those in the control group [(1.23±0.08) vs. (5.30±0.25), (18.39±2.17) vs. (15.24±2.25), (4.32±1.08) ng/L vs. (6.95±2.16) ng/L, (4.43±1.68) ng/L vs. (6.16±2.05) ng/L, and (4.13±0.75)×10⁹/L vs. (7.75±1.62)×10⁹/L], with statistical differences (all P<0.05). The incidences of delayed wound healing, wound infection, and wound bleeding in the treatment group were lower than those in the control group [2.27% (1/44) vs. 20.45% (9/44), 0 vs. 11.36% (5/44), and 2.27% (1/44) vs. 18.18% (8/44)], with statistical differences (all P<0.05). The number of incision dressing changes in the treatment group was lower than that in the control group [(3.67±1.29) times vs. (6.98±1.53) times], with a statistical difference (P<0.05). The incision healing time and the total hospitalization time in the treatment group were shorter than those in the control group [(6.10±1.42) d vs. (9.24±1.61) d and (4.29±1.24) d vs. (8.62±2.55) d], with statistical differences (both P<0.05). In the treatment group, 36 cases had grade Ⅰ bleeding, 8 grade Ⅱ, and 0 grade Ⅲ; in the control group, 18 cases had grade Ⅰ bleeding, 19 grade Ⅱ, and 7 grade Ⅲ; there was a statistical difference (all P<0.05). Conclusion　Local ice pack cold compress combined with infrared radiation for patients with inguinal hernia after surgery can effectively control wound dressing bleeding, reduce dressing changes, inflammatory reactions, and pain level, shorten wound healing time, and hospitalization time, and improve comfort.

Construction of a home extended care service mode leaded by tertiary hospitals and with internet as the core

Du Juan, Song Yuanyuan, Li Yan, Zhang Xiaodong, Zhang Ling

2024, 30(19):  3332-3337.  DOI: 10.3760/cma.j.issn.1007-1245.2024.19.034

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Objective　To construct a home extended care service mode leaded by tertiary hospitals and with internet as the core, and to provide references for the implementation of personalized nursing service for elderly homebound patients. Methods　This was a retrospective study. Sixty patients taking the "internet+" and "combining medical care with home care" nursing mode in Hanzhong People's Hospital from December 2021 to November 2022 were selected as the research objects, including 35 males and 25 females who were (70.34±3.57) years old. There were 125 registered nurses on the platform, including 8 males and 117 females who were (34.12±3.23) years old. There were 60 main caregivers for the patients, including 15 males and 45 females who were (45.23±5.51) years old. The results of completed home care projects were statistically calculated. The patients' satisfaction was investigated. The burden scores of the caregivers and the scores of professional identity of the nurses before and after the implementation of this service were compared. t and χ² tests were applied. Results　A total of 60 elderly homebound patients were served, with a total of 155 cases and a patient satisfaction rate of 100.00%. The scores of responsibility burden and personal burden and total score of the patients' primary caregivers were lower after than before the implementation of the "internet+" and "combining medical care with home care" continuous nursing mode [(12.12±2.28) vs. (15.23±3.23), (22.34±4.78) vs. (27.22±5.23), and (35.17±6.23) vs. (43.21±6.56)], with statistical differences (t=4.975, 4.356, and 5.621; all P<0.05). The scores of professional cognition, social support, social communication skills, frustration coping, and self-reflection and total score of the nurses were higher after than before the implementation [(33.24±3.12) vs. (30.23±3.23), (24.24±2.67) vs. (20.23±3.11), (25.45±2.56) vs. (21.12±3.11), (24.34±2.56) vs. (21.23±2.89), (13.68±1.67) vs. (10.23±1.89), and (120.56±5.56) vs. (112.23±4.87)], with statistical differences (t=3.671, 5.358, 5.888, 4.412, 7.492, and 6.173; all P<0.05). Conclusions　Under the policy background of medical and nursing integration, the implementation of the "internet+" and "combining medical care with home care" nursing mode can improve the satisfaction of elderly homebound patients, reduce the burden of caregivers, and improve the professional identity of nurses. It can promote the development of the nursing service industry to a higher level.

Effect of Teach-back combined with narrative care for elderly patients after percutaneous coronary intervention

Zhang Le, Chang Xiaoqi

2024, 30(19):  3337-3342.  DOI: 2024-03088

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Objective　To explore the effects of Teach-back combined with narrative care on cognitive function and self-management ability in elderly patients after percutaneous coronary intervention (PCI). Methods　This was a prospective study. Eighty-two elderly patients with coronary heart disease who underwent PCI at Xianyang First People's Hospital from July 2021 to June 2023 were selected as the study objects. They were divided into a reference group and an experimental group by the random number table method, with 41 cases in each group. There were 23 males and 18 females in the reference group; they were (68.82±5.39) years old; their disease course was (2.74±0.82) years. There were 21 males and 20 females in the experimental group; they were (69.14±5.67) years old; their disease course was (2.76±0.89) years. The reference group took conventional nursing care. The experimental group received Teach-back and narrative nursing. Both groups were intervened until 30 d after discharge, and were followed up for 6 months. The rehabilitation progress [exercise duration (ED), 6-minute walk test (6MWD), left ventricular ejection fraction (LVEF)], cognitive function [Senior Cognitive Function Scale (SECF) score], and self-management ability [Coronary Heart Disease Self-Management Scale (CSMS) score] were evaluated in the two groups. The incidences of adverse events in both groups were recorded. t and χ² tests were used for the statistical analysis. Results　Before the intervention, there were no statistical differences in the rehabilitation progress, cognitive function, and self-management ability between the two groups (all P>0.05). The ED, LVEF, 6MWT, total score of SECF, and scores of disease knowledge, emergency management, unhealthy habits, symptom management, emotional management, daily life, and treatment compliance in the experimental group were better than those in the reference group [(449.79±58.52) s vs. (391.82±56.48) s, (307.55±9.45) m vs. (266.57±9.78) m, (64.27±6.18)% vs. (56.93±5.74)%, (86.03±7.36) vs. (73.92±7.14), (16.92±1.17) vs. (13.50±1.02), (9.84±1.39) vs. (7.62±1.14), (15.49±1.05) vs. (13.34±1.07), (13.14±1.78) vs. (9.83±1.45), (13.63±1.67) vs. (12.24±1.51), (15.26±1.38) vs. (12.48±1.29), and (6.67±1.08) vs. (5.52±1.10)], with statistical differences (t=4.564, 19.295, 5.572, 7.562, 14.108, 7.907, 9.183, 9.232, 3.953, 9.423, and 4.777; all P<0.05). The incidence of adverse cardiovascular events in the experimental group was lower than that in the control group [4.88% (2/41) vs. 21.95% (9/41)], with a statistical difference (χ²=5.145; P=0.023). Conclusion　Teach-back combined with narrative care for elderly patients after PCI can significantly improve their cognitive function and self-management ability and rehabilitation effect, and reduce the occurrence of adverse events.