Table of Content

01 October 2024, Volume 30 Issue 20

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Special Column of Pathophysiology

Dexmedetomidine mitigating hypoxia/reoxygenation injury in H9C2 cardiomyocytes via STAT3/FoxO3a signaling pathway

Tan Yanhua, Jiang Long, Zou Sujuan, Hou Jie, Wang Yun, Kuang Xin

2024, 30(20):  3345-3350.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.001

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Objective　To establish a hypoxia/reoxygenation (H/R) model using rat cardiomyocyte line H9C2 cells to thoroughly investigate the regulatory role of STAT3/FoxO3a signaling pathway in the protective effects of dexmedetomidine (Dex) against H/R injury in cardiomyocytes. Methods　The study was conducted at Shenzhen Research Institute Laboratory, the University of Hong Kong from July to November 2023.Logarithmically growing H9C2 cardiomyocytes were used for the experiments, and they were divided into different groups: a control group (group C), a hypoxia/reoxygenation group (group H/R, with 6 hours of hypoxia followed by 12 hours of reoxygenation), a Dex pretreatment followed by H/R group (group D), and a STAT3 inhibitor Stattic plus Dex pretreatment followed by H/R group (group S). The cell viability was detected by the CCK8 kit, the degree of cell injury was detected by lactate dehydrogenase (LDH) kit, the oxidative stress level was detected by malondialdehyde (MDA) kit, and the related protein expressions were detected by Western blot. One-way analysis of variance was used. Results　The cell viability, Bcl-2 and P62 protein levels of H9C2 cells in group H/R were lower than those in group C, and the protein levels of LDH, MDA, Bax, CC-3, LC3 and Beclin-1 were higher than those in group C (all P<0.05).  The cell viability, P-STAT3 / STAT3 ratio and the protein levels of Bcl-2, P62 and FoxO3 a in group D were higher than those in group H/R, while the contents of LDH and MDA and the protein levels of Bax, CC-3, LC3 and Beclin-1 were lower than those in group H/R (all P<0.05).STAT3 inhibitor can attenuate the protective effect of Dex on myocardial cell injury. Conclusion　Dex preconditioning inhibited the apoptosis and autophagy of cardiomyocytes through STAT3/FoxO3a signal pathway, reduced the oxidative stress level, attenuated the H9C2 cell damage caused by H/R, and thus alleviated myocardial ischemia-reperfusion injury.

Role and mechanism of FIRRE in LPS-induced acute lung injury

Zhao Xiaoxia, Li Xiaomei, Sang Yi, Xu Conglei, Li Zhaolun, Sun Wenjing, Liu Xiaoming

2024, 30(20):  3351-3356.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.002

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Objective　To explore the role and mechanism of FIRRE in lipopolysaccharide (LPS) induced acute lung injury (ALI). Methods　The study was conducted at Binzhou Medical University Hospital from June 2020 to May 2022. Part I: The role of FIRRE in LPS-induced A549 cell injury. A549 cells were divided into a control group, a low molecular weight heparin calcium (LMWH) group, a LPS group, and a LPS+LMWH group, which were treat by normal saline, 5 IU/ml LMWH, 10 mg/L LPS, and 10 mg/L LPS+5 IU/ml LMWH for 24 h. The cell activity of each group was detected by CCK-8, the expressions of interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α were detected by enzyme-linked immunosorbent assay (ELISA), and the relative expression of FIRRE gene was detected by real-time quantitative PCR. Part Ⅱ: The role of FIRRE in LPS-induced ALI in C57BL/6J mice. Twenty-four healthy and clean SPF grade male C57BL/6J mice (body weight 25-30 g, 6-8 weeks old) were randomly divided into 3 groups. The control group was injected with equal volume of normal saline, the ALI group was injected with 5 mg/kg LPS to induce ALI, and the LMWH group was intraperitoneally injected with 5 mg/kg LPS + 5 AXa IU/kg LMWH. The changes of hair color, reaction ability, and resistance to external environment were evaluated at 6 h and 12 h after LPS injection. HE staining was used to observe the degree of lung tissue injury, and the lung injury score was calculated. Blood samples were collected from the abdominal main vein, and the expressions of IL-6 and IL-10 in serum were detected by ELISA. The levels of IL-6 and IL-10 in bronchoalveolar lavage fluid (BALF) were detected by ELISA. The relative expression of FIRRE gene was detected by RT-PCR. One-way analysis of variance, LSD-t test, and Dunnett-t test were used. Results　Part I: The activity of A549 cells in the LPS group was lower than that in the control group, and the activity of A549 cells in the LPS+LMWH group was higher than that in the LPS group, with a statistically significant difference among multiple groups (F=44.25, P<0.05). The levels of IL-6, IL-10, and TNF-α in the LPS group and LPS+LMWH group were higher than those in the control group and LMWH group, and the levels of IL-6, IL-10, and TNF-α in the LPS+LMWH group were lower than those in the LPS group (all P<0.05). The expression levels of FIRRE in A549 cells of the LPS group and LPS+LMWH group were higher than that of the control group, and that of the LPS+LMWH group was lower than that of the LPS group, with a statistically significant difference among multiple groups (F=242.23, P<0.001). Part II: The reaction ability and resistance to external environment of the mice in the ALI group and LMWH group were lower than those in the control group. At 6 h and 12 h after LPS injection, in the ALI group, HE staining of lung tissue sections showed a large number of inflammatory cell infiltration in the alveolar cavity, alveolar collapse, The lung injury score was 4. The inflammatory injury of lung tissue sections showed by HE staining in the LMWH group was lower than that in the ALI group. The levels of IL-6 and IL-10 in serum and BALF in the ALI group were higher than those in the control group (all P<0.05), and the levels of IL-6 and IL-10 in serum and BALF in the LMWH group were lower than those in the ALI group (all P<0.05).The FIRRE expressions in the ALI group and LMWH group were higher than that in the control group, and the expression in the LMWH group was lower than that in the ALI group, with statistically significant differences among multiple groups (F=7.23 and 6.51, both P<0.05). Conclusions　Part I: LMWH may reduce LPS-induced injury of A549 cells by inhibiting the expression of FIRRE gene and down-regulating the levels of inflammatory factors. Part II: LMWH may reduce LPS-induced ALI in C57BL/6J mice by inhibiting the expression of FIRRE gene and down-regulating the levels of inflammatory factors.

Effect of aloe-emodin combined with targeted inhibition of FOXC1 gene on the biological behavior of glioma cells

Jiang Zhuojun, Zhu Shuxia, Zhang Yuehua, Wang Ningning

2024, 30(20):  3356-3362.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.003

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Objective　To investigate the effects of aloe-emodin (AE) combined with siRNA-FOXC1 targeted silencing of the FOXC1 gene on regulating the Wnt/β-catenin pathway on the proliferation, apoptosis, and migration of glioma U251 cells. Methods　The study was conducted at the Medical Experimental Center of Binzhou Medical University Hospital from June 2022 to December 2023. The siRNA sequence (FOXC1-siRNA-2102) with the highest efficiency in targeting silencing of FOXC1 gene was selected, and the cells were transfected by liposome method. MTT method was used to detect the effects of different concentrations of AE on the proliferation of glioma U251 cells, and the IC50 value was calculated. CCK8 method was used to detect the changes of cell proliferation ability at 24 h, 48 h, 72 h, and 96 h after transfection. Cells were divided into a control group, a AE group, a siRNA-FOXC1 group, and a siRNA-FOXC1+AE group, and the effect on apoptosis in each group was detected by Annexin V-PE/7-AAD staining-flow cytometry. Transwell assay was used to detect the migration ability of cells in each group, qPCR assay was used to detect the mRNA expression level of the FOXC1 gene in each group, and Western blotting method was used to detect the protein expression levels of FOXC1, β-catenin, and C-myc in each group. F-test was used for statistical analysis. Results　With the increase of AE dose, the proliferation inhibition rate of glioma U251 cells was significantly increased [(0.04±12.86)% in the control group, (24.45±6.96)% in the 30 μmol/L group, (48.41±5.67)% in the 60 μmol/L group, (60.63±9.96)% in the 90 μmol/L group, and (78.23±13.34)% in the 120 μmol/L group], and the IC50 of AE in U251 cells was 61.43 μmol/L. The cell proliferation of the siRNA-FOXC1 group, AE group, and siRNA-FOXC1+AE group was higher than that of the control group over time, and the proliferation of the siRNA-FOXC1+AE group was the most significantly decreased; the apoptosis rates of the siRNA-FOXC1 group, AE group, and siRNA-FOXC1+AE group were higher than that of the control group over time, and the cell proliferation of siRNA-FOXC1+AE group was the most obvious; the mRNA expression levels of FOXC1 and protein expression levels of β-catenin, C-myc, and FOXC1 of the siRNA-FOXC1 group, AE group, and siRNA-FOXC1+AE group were lower than those of the control group over time, and those of the siRNA-FOXC1+AE group were the most significantly decreased(all P<0.05). The cell migration abilities of the siRNA-FOXC1 group, AE group, and siRNA-FOXC1+AE group were lower than that of the control group over time, and that of the siRNA-FOXC1+AE group was the most significantly decreased [the number of migrating cells was (193.00±14.17) in the control group was, (84.00±14.22) in the AE group, (80.67±5.69) in the siRNA-FOXC1 group, and (36.33±11.59) in the siRNA-FOXC1+AE group, with a statistically significant difference (F=93.55, P<0.05)]. Conclusions　AE can inhibit the proliferation and migration of glioma U251 cells and promote cell apoptosis. This mechanism is associated with FOXC1 gene regulation through Wnt/β-catenin pathway.

Effect of circMBOAT2 targeting miR-526b-3p on the proliferation and apoptosis of lung cancer A549 cells

Chen Dengzhen, Ma Qiang

2024, 30(20):  3363-3368.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.004

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Objective　To investigate whether circMBOAT2 affects the proliferation and apoptosis of lung cancer A549 cells by targeting miR-526b-3p. Methods　A total of 47 fresh lung cancer tissues and para-cancer tissues were collected from Shangluo Central Hospital from June 2021 to September 2023. Real-time quantitative PCR (qRT-PCR) was used to determine the expressions of circMBOAT2 and miR-526b-3p in lung cancer tissues. Lung cancer A549 cells were divided into a Con group ,a si-NC group (transfected with si-NC), a si-circMBOT2 group (transfected with si-circMBOT2), a pcDNA group (transfected with pcDNA), a pcDNA-circMBOAT2 group (transfected with pcDNA-circMBOAT2), a miR-NC group (transfected with miR-NC), a miR-526b-3p group (transfected with miR-526b-3p mimics), a si-circMBOAT2+anti-miR-NC group (co-transfected with si-circMBOAT2 and anti-miR-NC), a si-circMBOAT2+anti-miR-526b-3p group (co-transfected with si-circMBOAT2 and miR-526b-3p inhibitor). Cell proliferation, apoptosis, and protein expressions of Ki-67, Bcl-2, and Bax were measured by CCK-8, flow cytometry, and Western blotting. Dual luciferase reporter gene detection was used to analyze the targeting relationship between circMBOAT2 and miR-526b-3p. t test and SNK-q test were used. Results　The expression of circMBOAT2 in the lung cancer tissues was higher than that in the para-cancer tissues [(4.25±0.22) vs. (1.00±0.05)], and the expression of miR-526b-3p was lower than that in the para-cancer tissues [(0.33±0.04) vs. (1.00±0.07)], with statistically significant differences (t=98.76 and 56.97, both P<0.05). Interference with circMBOT2 or overexpression of miR-526b-3p inhibited the proliferation and protein expressions of Ki-67 and Bcl-2 of lung cancer A549 cells, and increased apoptosis rate and Bax protein expression (all P<0.05). circMBOAT2 targeted to regulate the expression of miR-526b-3p, and inhibition of miR-526b-3p expression reversed the effect of interfering circMBOAT2 expression on the proliferation and apoptosis of lung cancer A549 cells. Conclusion　circMBOAT2 is highly expressed in lung cancer tissues, and promotes the proliferation and inhibits apoptosis of lung cancer A549 cells by targeting the expression of miR-526b-3p.

New Medical Advances

Role of oxidative stress-related pathways in doxorubicin-induced cardiomyopathy

Li Yang, Cheng Jinfeng, Wei Jingxun, Cui Mingli, Cheng Yanli

2024, 30(20):  3369-3372.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.005

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Doxorubicin (DOX) is a potent chemotherapy drug commonly used alone or in combination to treat a variety of cancers. However, its clinical application may lead to severe cardiotoxicity. Oxidative stress has been found to play an important role in doxorubicin-induced cardiomyopathy (DIC). This review summarizes the signaling pathways related to oxidative stress in DIC, including Nrf2/Keap1/ARE and Sirt1/p66Shc signaling pathways, and the roles of nitric oxide synthase (NOS), nitric oxide (NOX), and Fe²⁺ in oxidative stress, in an attempt to explain the mechanism of DIC from the perspective of oxidative stress and to provide a theoretical basis or a new way of thinking for the pharmacological research of DIC prevention and treatment.

Literature Analysis

Network pharmacology predicting the potential active ingredients and mechanism of Scutellaria baicalensis-Polygonum cuspidatum against chronic bronchitis

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

2024, 30(20):  3373-3379.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.006

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Objective　To predict the potential active ingredients and mechanism of Scutellaria baicalensis-Polygonum cuspidatum against chronic bronchitis (CB) by network pharmacology. Methods　The active ingredients were searched in the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) with Scutellaria baicalensis and Polygonum cuspidatum as keywords, and the screening criteria were oral bioavailability (OB) ≥30% and drug-like (DL) ≥0.18. Using "chronic obstructive pulmonary disease" and "chronic bronchitis" as search terms, the CB disease targets were manually identified from OMIM and GeneCards databases from the establishment of the databases to April 2024. The protein-protein interaction (PPI) network was obtained by using the STRING database. David database was used for gene ontology (GO) functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis, and Cytoscape 3.8.0 software was used to draw "drug-component-target-map" and "component-target-pathway map". Results  A total of 23 active ingredients and 258 targets of Scutellaria baicalensis-Polygonum cuspidatum were obtained through TCMSP data screening and supplementation of key compounds. Disease targets were retrieved in GeneCards and OMIM databases, and 668 targets were obtained after deduplication and 80 intersecting targets were obtained. The core targets including TNF, IL-6, JUN, IL-1β, AKT1, VEGFA, TP53, CASP3, IL-10, and CXCL8 were determined by PPI network analysis. GO functional enrichment analysis showed that the biological processes of anti-CB of Scutellaria baicalensis-Polygonum cuspidatum mainly involved inflammatory response, oxidative stress, apoptosis, angiogenesis, and autophagy. KEGG pathway enrichment analysis showed that the anti-CB pathway of Scutellaria baicalensis-Polygonum cuspidatum might involve PI3K-AKT signaling pathway, TNF signaling pathway, IL-17 signaling pathway, cellular senescence, and so on. Conclusion  The potential active ingredients of Scutellaria baicalensis-Polygonum cuspidatum anti-CB include scutellarin, baicalin, wogonin, polydatin, and emodin, and the mechanism of action may play a therapeutic role by regulating PI3K-AKT signaling pathway, TNF signaling pathway, and IL-17 signaling pathway, thereby reducing inflammatory response, improving apoptosis, and promoting autophagy.

Treatises

Recombinant human endostatin combined with immune checkpoint inhibitors for the treatment of non-small cell lung cancer: a real-world retrospective study

Wan Renping, Liao Hongliang

2024, 30(20):  3380-3387.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.007

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Objective　To evaluate the efficacy and safety of recombinant human endostatin injection combined with immune checkpoint inhibitors (ICIs) in the first-line treatment of non-small cell lung cancer (NSCLC). Methods　A retrospective analysis was performed on 484 patients with unresectable NSCLC who received at least 4 cycles of anti-tumor therapy in Yuebei People's Hospital from January 2020 to January 2022, and they were divided into 3 groups according to the treatment methods. Among the 85 cases of the E+ICI group, there were 58 males and 27 females, aged 68 (61, 76) years, and they were treated with recombinant human endostatin injection +ICIs. Recombinant human endostatin injection was injected 210 mg each time with continuous chemotherapy pump for 3 d, once every 3 weeks; ICIs were used according to the operating instructions; recombinant human endostatin injection and ICIs did not allow dose reduction. Among the 351 cases of the C+ICI group, there were 256 males and 95 females, aged 61 (51, 70) years, and they were treated with chemotherapy +ICIs. The chemotherapy drugs included carboplatin (AUC=5) or cisplatin 75 mg/m², gemcitabine 1 g/m², docetaxel 75 mg/m², and pemetrexed 500 mg/m² or paclitaxel 175 mg/m². The dose of chemotherapy drugs was adjusted according to clinical routine, and the patients with less than 75% standard dose were excluded. Among the 48 cases of the ICI group, there were 37 males and 11 females, aged 72 (68, 78) years, and they received ICIs monotherapy. After 4 to 6 cycles of palliative treatment, the E+ICI group was given maintenance treatment with the same dose of recombinant human endostatin injection and ICIs, and the C+ICI group and ICI group were given ICI maintenance treatment once a month until the disease progressed or the intolerant toxicity occurred. The primary endpoints were progression-free survival (PFS) and overall survival (OS), and the secondary endpoints were objective response rate (ORR) and PFS and OS in the elderly subgroup. χ² test, Kruskal-Wallis H test, and Log-rank test were used. Results　The PFS (mPFS: 8.12 months vs. 8.96 months, P=0.131) and OS (mOS: 16.32 months vs. 17.28 months, P=0.160) of the E+ICI group and C+ICI group were similar. The PFS and OS of the E+ICI group were superior to those of the ICI group (mPFS: 8.12 months vs. 6.16 months, P=0.009; mOS: 16.32 months vs. 10.10 months, P=0.001). The ORRs of the E+ICI group, C+ICI group, and ICI group were 52.94%, 48.43%, and 35.42%, respectively, with no statistically significant difference (P=0.142). The incidence of treatment-related adverse events (AEs) above grade 3 in the E+ICI group was lower than that in the C+ICI group. There were 41 cases ≥70 years old in the E+ICI group, 111 cases in the C+ICI group, and 27 cases in the ICI group, respectively. Among the elderly patients (≥70 years old), the mPFS and mOS in the E+ICI group were higher than those in the ICI group (10.08 months vs. 6.16 months, P=0.003; 16.68 months vs. 10.03 months, P<0.001). Conclusion　Recombinant human endostatin injection combined with ICIs is well tolerated in the treatment of NSCLC, and its efficacy is comparable to that of chemotherapy combined with ICIs, but superior to ICIs monotherapy.

Clinical study of Furmonertinib combined with Toripalimab in the treatment of advanced non-small cell lung cancer with EGFR gene mutation positivity

Li Chao, Lai Jing, Yang Jun

2024, 30(20):  3387-3392.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.008

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Objective　To explore the efficacy and safety of Furmonertinib combined with Toripalimab in the treatment of advanced non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) gene mutation positivity. Methods　This study was a randomized controlled trial. A total of 164 patients with EGFR gene mutation-positive advanced NSCLC admitted to Ankang Central Hospital from February 2019 to February 2021 were selected as the study objects. They were divided into an experimental group and a control group by the random number table method, with 82 cases in each group. There were 45 males and 37 females in the experimental group, aged (63.28±6.75) years. There were 45 males and 37 females in the control group, aged (65.02±7.19) years. The basic treatment included intravenous infusion of pemetrexed at a dose of 500 mg·m^-2, once every 21 days, with 21 days as a treatment cycle. The control group received oral administration of 40 mg of Furmonertinib mesylate tablets, twice a day. On the basis of the control group, the experimental group received intravenous infusion of Toripalimab injection at a dose of 3 mg·kg^-1 every 21 days, with 21 days as a treatment cycle. After 3 cycles of treatment, the efficacy, adverse reactions, and levels of cytokeratin19 fragment antigen 21-1 (CYFRA21-1), carbohydrate antigen-199 (CA-199), CD4⁺, and CD4⁺/CD8⁺ were compared between the two groups. The survival prognosis of the two groups was compared after 2 years of follow-up. χ² test and t test were used. Results　During the treatment period, 5 cases were lost to follow-up in the experimental group, resulting in data collection from 77 cases; in the control group, 8 cases were lost to follow-up, resulting in data collection from 74 cases. After 3 cycles of treatment, the levels of CYFRA21-1 in the experimental group and the control group were (5.18±1.62) µg·L^-1 and (7.03±1.89) µg·L^-1, the levels of CA-199 were (36.71±6.93) U·ml^-1 and (49.46±8.02) U·ml^-1, the levels of CD4⁺ were (39.06±5.32)% and (31.92±4.15)%, and the levels of CD4⁺/CD8⁺ were (1.48±0.53) and (1.05±0.48), with statistically significant differences between the two groups (t=6.467, 10.465, 9.171, and 5.219, all P<0.05). The disease control rates of the experimental group and the control group were 88.31% (68/77) and 75.68% (56/74), respectively, with a statistically significant difference between the two groups (χ²=4.103, P=0.043). By the end of follow-up, 30 patients in the experimental group died, and the median progression-free survival (PFS) was 19 months, which did not reach the median overall survival (OS). In the control group, 35 patients died, and the median PFS was 15 months, which did not reach the median OS. There was a statistically significant difference in the PFS between the two groups (Log-rank χ²=2.608, P=0.031). Conclusion　In the treatment of EGFR gene mutation-positive advanced NSCLC, Furmonertinib combined with Toripalimab can improve the disease control rate, reduce the levels of tumor markers (CYFRA21-1 and CA-199), and prolong the PFS, which does not increase the incidence of adverse drug reactions, with good safety.

Relationship between level of LECT2 and occurrence of necrotizing pneumonia in children with Streptococcus pneumoniae pneumonia and its clinical significance

Huang Meizi, Yang Jun, Zhang Miao

2024, 30(20):  3393-3397.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.009

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Objective　To explore the relationship between level of leukocyte derived chemokine 2 (LECT2) and occurrence of necrotizing pneumonia in children with Streptococcus pneumoniae pneumonia and its clinical significance, in order to provide a reference for early diagnosis and treatment of Streptococcus pneumoniae pneumonia. Methods　The clinical data of 104 children with Streptococcus pneumoniae pneumonia admitted to Xi'an Gaoxin Hospital from January 2022 to January 2024 were retrospectively analyzed. According to the occurrence of necrotizing pneumonia, the children were divided into a necrotizing pneumonia group (49 cases) and a non-necrotizing pneumonia group (55 cases). In the necrotizing pneumonia group, there were 26 boys and 23 girls, aged (7.62±2.58) years. In the non-necrotizing pneumonia group, there were 27 boys and 28 girls, aged (7.18±2.03) years. The levels of LECT2, blood routine [C-reactive protein (CRP), lactate dehydrogenase (LDH), and procalcitonin (PCT)], and cytokines [tumor necrosis factor α (TNF-α) and γ interferon (IFN-γ)] were compared between the two groups. The relationship between LECT2 level and necrotizing pneumonia was analyzed, and the influencing factors of necrotizing pneumonia in children with Streptococcus pneumoniae pneumonia were analyzed. The prediction model for necrotizing pneumonia was established and its prediction efficiency was analyzed. χ² test and t test were used. Results　There were statistically significant differences between the two groups in terms of the duration of fever, hospital stay, pleural effusion, and pleural thickening (all P<0.05). The levels of LECT2, CRP, LDH, and PCT in the necrotizing pneumonia group were (28.36±4.46) mg/L, (91.47±7.48) mg/L, (462.27±61.44) U/L, and (0.25±0.10) µg/L, and those in the non-necrotizing pneumonia group were (26.07±5.17) mg/L, (77.65±7.59) mg/L, (346.85±48.93) U/L, and (0.11±0.04) µg/L, with statistically significant differences (t=2.404, 9.332, 10.649, and 9.564, all P<0.05). LECT2, CRP, LDH, and PCT were the influencing factors of secondary necrotizing pneumonia in children with Streptococcus pneumoniae pneumonia (all P<0.05). The area under the curve of LECT2 was 0.636 for predicting secondary necrotizing pneumonia in children with Streptococcus pneumoniae pneumonia, and the area under the curve of the combined detection of all indicators was 0.988, which was of higher diagnostic value. Conclusions　The level of LECT2 is closely related to the occurrence of necrotizing pneumonia in children with Streptococcus pneumoniae pneumonia, and its increase may elevate the risk of developing necrotizing pneumonia. Therefore, LECT2 can serve as a potential biomarker for predicting the development of necrotizing pneumonia in children with Streptococcus pneumoniae pneumonia, aiding clinicians in taking more targeted treatment measures at an early stage to improve the prognosis of affected children.

Effect of implantable titanium nail intermaxillary traction combined with titanium plate internal fixation on patients with mandibular angle fracture

Zhou Qian, Ta Rui, Hu Yanjing, Tian Ying

2024, 30(20):  3398-3402.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.010

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Objective　To investigate the effects of implantable titanium nail intermaxillary traction combined with titanium plate internal fixation on pain, mastication, and limitation of mouth opening in patients with mandibular angle fracture. Methods　This study was a randomized controlled trial. A total of 108 patients with mandibular angle fracture admitted to Affiliated Hospital of Yan'an University from September 2019 to September 2023 were enrolled in this study and were divided into an observation group and a control group using the random number table method, with 54 cases in each group. In the observation group, there were 31 males and 23 females, aged (46.21±5.03) years, and the fracture site was on the left side in 26 cases and on the right side in 28 cases. In the control group, there were 33 males and 21 females, aged (45.79±6.18) years, and the fracture site was on the left side in 29 cases and on the right side in 25 cases. The observation group received implantable titanium nail intermaxillary traction combined with titanium plate internal fixation, and the control group received arch splint intermaxillary traction external fixation combined with titanium plate internal fixation. The changes of Visual Analogue Scale (VAS) score, masticatory function, mouth opening degree, and mandibular mobility before and after surgery were compared between the two groups, and the healing status of the two groups at 3 months after surgery was evaluated. χ² test, rank sum test, and t test were used. Results　At 1 month and 3 months after surgery, the VAS scores of the two groups were lower than those before surgery, and those of the observation group were lower than those of the control group [(2.03±0.86) points vs. (2.49±0.71) points, (0.22±0.05) points vs. (0.29±0.07) points] (t=3.031 and 5.980, both P<0.05). At 1 month and 3 months after surgery, the masticatory function scores of the two groups were higher than those before surgery, and those of the observation group were higher than those of the control group [(5.76±1.13) points vs. (5.02±1.07) points, (8.65±0.67) points vs. (8.23±0.59) points] (t=3.494 and 3.457, both P<0.05). At 1 month and 3 months after surgery, the mouth opening and mandibular anterior-to-posterior motion of the two groups were higher than those before surgery, and those of the observation group were higher than those of the control group (all P<0.05). In the observation group, there were 29 cases of first stage healing, 23 cases of second stage healing, and 2 cases of third stage healing; in the control group, there were 22 cases of first stage healing, 21 cases of second stage healing, and 11 cases of third stage healing; there was a statistically significant difference between the two groups (Z=3.971, P=0.046). Conclusion　Implantable titanium nail intermaxillary traction combined with titanium plate internal fixation helps to improve the pain, mastication, and limitation of mouth opening in patients with mandibular angle fracture, and promote the fracture healing and recovery.

Correlation between serum CCL11 level and T2DM complicated with coronary atherosclerotic heart disease

Wang Chenge, Li Yanping

2024, 30(20):  3402-3406.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.011

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Objective　To investigate the correlation between serum CC chemokine ligand 11 (CCL11) level and type 2 diabetes mellitus (T2DM) complicated with coronary atherosclerotic heart disease (CAD). Methods　A total of 146 T2DM patients admitted to Shangluo Central Hospital from January 2022 to April 2024 were selected and were divided into a CAD group (70 patients) and a T2DM group (76 patients) according to whether they were complicated with CAD or not. In the CAD group, there were 43 males and 27 females, aged (61.53±8.24) years. In the T2DM group, there were 42 males and 34 females, aged (59.30±6.86) years. The general clinical data of the two groups were collected, and the serum CCL11 level and related metabolic indicators were detected. t test and χ² test were used. Results　The duration of diabetes in the CAD group was longer than that in the T2DM group [(7.41±3.12) years vs. (6.08±2.58) years], and the levels of low density lipoprotein cholesterol (LDL-C) and serum CCL11 were higher than those in the T2DM group [(3.06±1.01) mmol/L vs. (2.60±0.78) mmol/L, (65.53±21.28) ng/L vs. (46.47±18.36) ng/L], with statistically significant differences (t=2.815, 3.094, and 5.807, all P<0.05). Binary logistic regression analysis showed that long duration of diabetes, high LDL-C and serum CCL11 levels were risk factors for CAD in T2DM patients (all P<0.05). The receiver operator characteristic curve (ROC) analysis showed that the area under the curve (AUC) of serum CCL11 level for diagnosing T2DM with CAD was 0.751, the sensitivity was 65.7%, the specificity was 78.9%, and the Youden index was 0.446. Conclusions　Long duration of diabetes, high LDL-C and serum CCL11 levels are independent risk factors for T2DM complicated with CAD. Serum CCL11 level has good diagnostic value in predicting T2DM complicated with CAD.

Study on the factors affecting poor prognosis and risk prediction in children with spastic cerebral palsy receiving rehabilitation treatment

Bai Xinchao, He Wei

2024, 30(20):  3407-3412.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.012

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Objective　To investigate the risk factors for poor prognosis in children with spastic cerebral palsy receiving rehabilitation treatment, and to establish a risk prediction model. Methods　A total of 168 children with spastic cerebral palsy, including 105 boys and 63 girls, aged (6.75±2.04) years, who received rehabilitation treatment in Xi'an Traditional Chinese Medicine Brain Disease Hospital from January 2018 to March 2023, were retrospectively included. They were divided into a poor prognosis group and a good prognosis group based on the prognosis after one year of following-up. The clinical data of the two groups were compared, and the influencing factors for poor prognosis in children with spastic cerebral palsy were analyzed by multivariate logistic regression analysis. A Nomogram model to predict the risk of poor prognosis in children was constructed, and the predictive value of the model was validated. χ² test was used. Results　The proportions of severe illness, quadriplegia, severe abnormalities of amplitude integrated electroencephalogram (aEEG), and malnutrition in the good prognosis group were lower than those in the poor prognosis group [32.11% (35/109) vs. 55.93% (33/59), 12.84% (14/109) vs. 28.81% (17/59), 13.76% (15/109) vs. 59.32% (35/59), 22.94% (25/109) vs. 40.68% (24/59)], with statistically significant differences (all P<0.05). Multivariate logistic regression analysis showed that severe illness, quadriplegia, severe abnormality of aEEG, and malnutrition were all risk factors for poor prognosis in children with spastic cerebral palsy after rehabilitation treatment (all P<0.05). A Nomogram model for predicting the risk of poor prognosis in children with spastic cerebral palsy after rehabilitation treatment was constructed based on the four risk factors screened through multiple logistic regression analysis. The model was validated, and the calibration curve showed that the calibration curve fitted well with the ideal curve, and the receiver operating characteristic curve (ROC) showed that the area under the curve, sensitivity, and specificity were 0.881, 84.75%, and 83.05%, respectively, and the decision curve showed that when the threshold probability was from 0.29 to 0.94, the model predicted that poor prognosis of rehabilitation treatment for children with spastic cerebral palsy could achieve net benefits. Conclusions　Severe illness, spastic quadriplegia, severe abnormalities of aEEG, and malnutrition are all risk factors for poor prognosis in children with spastic cerebral palsy after rehabilitation treatment, and the Nomogram model for predicting the risk of poor prognosis in children constructed based on the above factors has good predictive value, and it can be used to guide clinical screening of high-risk children with poor prognosis, so as to adjust treatment plans in a timely manner.

Effect of Th1/Th2 cell balance on fetal intrauterine distress in patients with intrahepatic cholestasis of pregnancy

Chang Qingfen, Hou Juan, Zhang Xiaocai

2024, 30(20):  3412-3417.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.013

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Objective　To explore the effect of Th1/Th2 cell balance on fetal intrauterine distress in patients with intrahepatic cholestasis of pregnancy (ICP), and provide reference for clinical prevention of fetal intrauterine distress. Methods　A total of 96 ICP patients admitted to Xi'an People's Hospital from January 2023 to January 2024 were selected as the case group, including 62 primiparas and 34 multiparas, aged (28.46±4.20) years, with a gestational age of (33.70±2.34) weeks. Another 96 healthy pregnant women during the same period were selected as the control group, including 66 primiparas and 30 multiparas, aged (27.60±4.12) years, with a gestational age of (32.85±2.42) weeks. The case group was subdivided into an occurrence group and a non-occurrence group based on whether fetal intrauterine distress had occurred. The levels of Th1 cytokines [tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ)] and Th2 cytokine [interleukin (IL) -4] were detected by enzyme-linked immunosorbent assay (ELISA), and IFN-γ/IL-4 and TNF-α/IL-4 were calculated. The differences in TNF-α, IFN-γ, IL-4, IFN-γ/IL-4, and TNF-α/IL-4 were compared between the case group and the control group, as well as between the occurrence group and the non-occurrence group. Univariate and multivariate logistic regression analysis were used to analyze the influencing factors of fetal intrauterine distress in ICP patients. The receiver operating characteristic curve (ROC) was drawn to analyze the predictive value of Th1/Th2 cytokines for fetal intrauterine distress in ICP patients. Independent sample t test and χ² test were used. Results　The levels of TNF-α, IFN-γ, IFN-γ/IL-4, and TNF-α/IL-4 in the case group were higher than those in the control group [(102.31±18.33) ng/L vs. (64.20±12.62) ng/L, (166.78±32.33) ng/L vs. (138.39±28.10) ng/L, (3.36±0.22) vs. (1.15±0.12), (2.06±0.12) vs. (0.53±0.08)], but the level of IL-4 was lower than that in the control group [(49.57±16.32) ng/L vs. (120.54±20.36) ng/L], with statistically significant differences (t=16.779, 6.494, 86.407, 103.943, and 26.649, all P<0.001). Among the 96 ICP patients, 22 cases (22.92%) experienced fetal intrauterine distress, including 8 cases of acute fetal distress and 14 cases of chronic fetal distress. The levels of total serum bile acids, total serum bilirubin, TNF-α, IFN-γ, IFN-γ/IL-4, and TNF-α/IL-4 in the occurrence group were higher than those in the non-occurrence group, but the level of IL-4 was lower than that in the non-occurrence group, with statistically significant differences (all P<0.05). Multivariate logistic regression analysis showed that total serum bile acids, TNF-α, IFN-γ, IL-4, IFN-γ/IL-4, and TNF-α/IL-4 were independent influencing factors for the occurrence of fetal distress in ICP patients (all P<0.05). The ROC curve was drawn, it was found that the areas under the curves (AUCs) of TNF-α, IFN-γ, and IL-4 in predicting fetal distress in ICP patients were all >0.70, and the AUCs of IFN-γ/IL-4 and TNF-α/IL-4 in predicting fetal distress were both >0.85. Conclusion　The shift of Th1/Th2 balance towards Th1 in ICP patients affects the risk of fetal intrauterine distress, and detecting IFN-γ/IL-4 and TNF-α/IL-4 helps to predict fetal intrauterine distress.

Correlations between serum NLR and irisin levels and disease activity and bone density in patients with rheumatoid arthritis

Wang Feng, Han Gang

2024, 30(20):  3418-3422.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.014

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Objective　To explore the expression levels of serum neutrophil-to-lymphocyte ratio (NLR) and irisin in patients with rheumatoid arthritis (RA) and their correlations with disease activity and bone density. Methods　A total of 123 RA patients admitted to No.215 Hospital of Shaanxi Nuclear Industry from April 2022 to April 2024 were selected as the observation group for a retrospective study. According to the disease activity, they were divided into a low activity group (27 cases), a moderate activity group (58 cases), and a high activity group (38 cases). Additionally, 50 healthy adults who underwent physical examination during the same period were selected as the control group. In the observation group, there were 39 males and 84 females, aged (47.49±9.31) years, with a body mass index (BMI) of (21.41±1.72) kg/m². In the control group, there were 14 males and 36 females, aged (48.02±10.08) years, with a body mass index of (21.39±1.66) kg/m². Serum samples were analyzed for NLR and irisin levels, and their correlations with disease activity and bone density were assessed. Independent sample t test, ANOVA, χ² test, Spearman correlation analysis, and Pearson correlation analysis were used. Results　The levels of NLR (3.35±0.83) and irisin (195.74±24.39) µg/L in the observation group were higher than those in the control group [(1.85±0.72) and (258.93±41.84) µg/L], with statistically significant differences (t=11.179 and 12.381, both P<0.001). The levels of NLR and irisin were (2.46±0.22) and (213.84±12.27) µg/L in the low activity group, (3.15±0.31) and (195.93±16.98) µg/L in the moderate activity group, (4.39±0.55) and (184.27±9.14) µg/L in the high activity group, with statistically significant differences (F=216.474 and 35.360, both P<0.001). The bone mineral density of femoral neck [(0.75±0.12) g/cm²], total hip joint [(0.82±0.11) g/cm²], lumbar spine [(0.84±0.09) g/cm²], and greater trochanter [(0.90±0.18) g/cm²] in the observation group were lower than those in the control group [(0.89±0.09) g/cm², (0.96±0.08) g/cm², (0.97±0.10) g/cm², and (1.05±0.23) g/cm²], with statistically significant differences (all P<0.05). Spearman correlation analysis showed that serum NLR was positively correlated with disease activity (r=0.879, P<0.001), and serum irisin level was negatively correlated with disease activity (r=-0.615, P<0.001). Pearson correlation analysis showed that serum NLR was negatively correlated with bone mineral density of femoral neck, total hip joint, lumbar spine, and greater trochanter (r=-0.358, -0.366, -0.525, and -0.174, all P<0.05), and serum irisin level was positively correlated with bone mineral density of femoral neck, total hip joint, lumbar spine, and greater trochanter (r=0.378, 0.430, 0.352, and 0.232, all P<0.05). Conclusion　Abnormal expressions of serum NLR and irisin are closely associated with disease activity and bone density in RA patients, and can be used as effective biomarkers to evaluate the disease activity and predict the bone mineral density.

Study on intraoperative blood transfusion and analysis of risk factors in high-risk cesarean pregnancies

Qu Mingli, Shi Xiaoying, Tang Huizhen, He Yiping

2024, 30(20):  3423-3427.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.015

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Objective　To explore the situation of intraoperative blood transfusion in high-risk cesarean delivery, and to analyze its risk factors. Methods　A retrospective analysis was conducted on 150 cases of high-risk cesarean delivery admitted to Northwest Women's and Children's Hospital from January 2022 to August 2023, aged 29-43 years, with a gestational age of 31-40 weeks, and they were divided into a transfusion group (63 cases) and a non-transfusion group (87 cases) according to whether they receive blood transfusion during the operation. The clinical data such as age, gestational age, educational background, medical history, distribution of diseases, and coagulation indicators were compared between the two groups, and the risk factors for intraoperative blood transfusion in high-risk cesarean delivery were determined by multivariate logistic regression analysis. t test and χ² test were used. Results　In the transfusion group, there were 15 cases (23.81%) with a gestational age ≥37 weeks, 32 cases (50.79%) of 34-37 weeks, and 16 cases (25.40%) ≤34 weeks, respectively, and those in the non-transfusion group were 68 cases (78.16%), 17 cases (19.54%), and 2 cases (2.30%), with a statistically significant difference (χ²=46.679, P<0.001). There were statistically significant differences in the placenta previa rate, placenta implantation rate, hemoglobin (Hb), prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT) between the transfusion group and the non-transfusion group [77.78% (49/63) vs. 13.79% (12/87), 87.30% (55/63) vs. 11.49% (10/87), (103.21±8.69) g/L vs. (117.75±10.25) g/L, (11.59±2.35) s vs. (10.22±2.01) s, (29.63±4.14) s vs. (27.22±3.89) s, (18.15±3.02) s vs. (16.81±2.86) s] (all P<0.05). Multivariate logistic regression analysis showed that prolonged gestational age and elevated Hb level were protective factors for intraoperative blood transfusion in high-risk cesarean pregnancy (OR=0.074 and 0.733, both P<0.05), and placenta previa, placental implantation, and elevated PT level were independent risk factors for intraoperative blood transfusion (OR=102.338, 258.237, and 1.964, all P<0.05). Conclusions　In high-risk cesarean pregnancy, prolonged gestation age and elevated Hb level are protective factors for intraoperative blood transfusion, while placenta previa, placenta implantation, and elevated PT level are independent risk factors. Physicians should better assess the need for blood transfusion during high-risk cesarean deliveries and take appropriate preventive measures.

Clinical Research

Efficacy of single nucleotide polymorphisms in predicting the outcomes in patients with chronic hepatitis C treated by direct-acting antivirals

Wu Liexiu, Ning Bo, Yang Jianjun, Zhang Yingying, Du Feng

2024, 30(20):  3428-3432.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.016

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Objective　To investigate the efficacy of single nucleotide polymorphisms in predicting the outcomes in patients with chronic hepatitis C (CHC) treated by direct-acting antivirals (DAAs). Methods　A total of 112 patients with CHC admitted to Baoji Central Hospital from June 2020 to June 2022 were collected, including 64 males and 48 females, 41 cases aged ≥60 years and 61 cases aged <60 years. All patients were treated with DAAs for 6 months, and IL-28B gene polymorphism was detected before treatment. After treatment, the patients were divided into a response group and a non-response group according to whether there was a virologic response. The IL-28B gene polymorphism of the two groups was compared, and the relationships between prognosis and clinical features of CHC patients were analyzed. The influencing factors of prognosis in CHC patients were analyzed by multivariate logistic regression analysis. The receiver operator characteristic curve (ROC) was drawn to evaluate the predictive efficacies of influencing factors for patients' prognosis. Results　Of the 112 CHC patients, 89 patients (79.46%) had a virologic response and 23 patients (20.54%) had no response. There were 79 cases (88.76%) of rs8099917TT and 78 cases (87.64%) of rs12979860CC in the response group, and 10 cases (43.48%) and 11 cases (47.82%) in the non-response group, with statistically significant differences (χ²=22.969 and 17.754, both P<0.001). There were 85 cases (95.51%) without fatty liver and 35 cases (39.32%) with Child liver function grade A in the response group, and 17 cases (73.91%) and 6 cases (26.09%) in the non-response group, with statistically significant differences (both P<0.05). Multivariate logistic regression analysis showed that fatty liver, Child liver function grade C, rs8099917TG, and rs12979860CT were all prognostic factors in CHC patients (RR=4.513, 3.666, 2.998, and 3.575, all P<0.05). ROC analysis results showed that fatty liver, Child liver function grade C, rs8099917TG, and rs12979860CT had high value in predicting the prognosis of CHC patients. Conclusion　Fatty liver, Child liver function grade C, rs8099917TG, and rs12979860CT are all prognostic factors of CHC patients, and we can guide clinical treatment according to the above indicators.

Expressions of ErbB3 and miR-27a in esophageal cancer tissues and their relationships with clinical prognosis

Guo Xiaoning, Zhu Wenlong, Gong Huilin, Liu Zhanfei

2024, 30(20):  3433-3437.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.017

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Objective　To investigate the expressions of Erb-B2 receptor tyrosine kinase 3 (ErbB3) and microRNA-27A (miR-27a) in esophageal cancer tissues and their relationships with clinical prognosis. Methods　A total of 120 patients with esophageal cancer admitted to the Department of Pathology, Yangling Demonstration Zone Hospital from June 2019 to June 2023 were retrospectively selected as the study objects. According to the Glasgow Prognostic Score (GPS), the patients were divided into a good prognosis group (97 cases) and a poor prognosis group (23 cases). Additionally, 50 healthy individuals undergoing routine health checks during the same period were selected as controls. The general data were compared between the good prognosis group and the poor prognosis group, and the expressions of ErbB3 and miR-27a were compared between the patients with esophageal cancer and the control group. Logistic regression analysis was used to analyze the factors influencing prognosis in patients with esophageal cancer, and a nomogram was constructed. Spearman correlation analysis was used to analyze the correlations between ErbB3 and miR-27a and prognosis. The predictive efficacies of ErbB3 and miR-27a for prognosis in patients with esophageal cancer were analyzed by the receiver operating characteristic curve (ROC). Independent sample t test, ANOVA, and χ² test were used. Results　There were 55 males and 42 females in the good prognosis group, aged 47-68 years. There were 14 males and 9 females in the poor prognosis group, aged 45-66 years. The proportions of the patients with stage III tumors and lymph node metastasis in the poor prognosis group were higher than those in the good prognosis group, and the proportion of the patients with low differentiation was lower than that in the good prognosis group (all P<0.05). The expression levels of ErbB3 [(1.59±0.45)] and miR-27a [(2.59±0.95)] in the poor prognosis group were higher than those in the good prognosis group [(1.28±0.37) and (1.84±0.52)] and the control group [(0.72±0.28) and (0.85±0.33)], and those in the good prognosis group were higher than those in the control group (all P<0.05). Logistic regression analysis showed that tumor stage, degree of differentiation, lymph node metastasis, and expressions of ErbB3 and miR-27a were all prognostic factors in patients with esophageal cancer (all P<0.05). Spearman correlation analysis showed that the expressions of ErbB3 and miR-27a in patients with esophageal cancer were positively correlated with GPS (r=0.294 and 0.282, P=0.001 and 0.002). ROC analysis results showed that the area under the curve (AUC) predicted by ErbB3 combined with miR-27a was greater than that predicted by ErbB3 or miR-27a alone (0.873 vs. 0.715 and 0.715). Conclusion　The expressions of ErbB3 and miR-27a in esophageal cancer tissues have significant prognostic value for patients with esophageal cancer.

Application of Sacubitril/Valsartan sodium tablets combined with Tongxinluo capsules in patients after PCI for acute myocardial infarction

Li Ping, Wang Xin, Li Zhen

2024, 30(20):  3438-3442.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.018

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Objective　To investigate the application value of Sacubitril/Valsartan sodium tablets combined with Tongxinluo capsules in patients after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Methods　A total of 194 AMI patients who underwent PCI at Xi'an Hospital of Traditional Chinese Medicine from November 2021 to October 2023 were selected for the study objects. They were randomly divided into a control group (97 cases) and a combined group (97 cases) using computer coding method. In the control group, there were 56 males and 41 females, aged 36-74 (55.83±8.42) years, 1-6 (3.49±0.63) h after PCI. There were 53 males and 44 females in the combined group, aged 36-75 (55.87±8.46) years, 1-6 (3.53±0.58) h after PCI . The control group was treated with Sacubitril/Valsartan sodium tablets combined with conventional treatment, while the combined group additionally received Tongxinluo capsules. After 8 weeks of treatment, they were followed up for 6 months. The blood flow grading of thrombolysis in myocardial infarction (TIMI), cardiac function [left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), and left ventricular ejection fraction (LVEF)] and levels of inflammatory factors [hypersensitive C-reactive protein (hs-CRP) and interleukin (IL) -6] before and after treatment, and incidence of major adverse cardiovascular events (MACE) during follow-up were compared between the two groups. Independent sample t test, paired t test, rank sum test, and χ² test were used. Results　After treatment, the TIMI blood flow grading in the combined group was better than that in the control group (P<0.05). After treatment, the LVESD [(32.44±4.29) mm] and LVEDD [(40.35±4.92) mm] in the combined group were lower than those in the control group [(38.64±4.82) mm and (47.82±5.73) mm], and the LVEF [(65.83±5.78)%] was higher than that in the control group [(58.36±5.36)%] (all P<0.05); the levels of hs-CRP [(3.11±1.28) mg/L] and IL-6 [(12.43±3.27) ng/L] in the combined group were lower than those in the control group [(6.84±1.93) mg/L and (15.68±3.94) ng/L] (both P<0.05). During follow-up, the total incidence of MACE in the combined group [12.37% (12/97)] was lower than that in the control group [26.80% (26/97)] (P<0.05). Conclusion　The combination of Sacubitril/Valsartan sodium tablets and Tongxinluo capsules can improve the cardiac function and the levels of inflammatory factors in AMI patients after PCI, and reduce the total incidence of MACE.

BIS monitoring the effect of remimazolam combined with propofol on manual reduction of hip dislocation in elderly patients

Wu Lei, Sun Yanni, Niu Qing

2024, 30(20):  3442-3447.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.019

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Objective　To explore the application effect of remimazolam combined with propofol in manual reduction of hip dislocation in elderly patients under bispectral index (BIS) monitoring. Methods　A total of 75 elderly patients with hip dislocation who underwent manual reduction in Shangluo Traditional Chinese Medicine Hospital from January 2021 to December 2022 were prospectively selected as the study objects. There were 44 males and 31 females, aged 60-85 years, the American Society of Anesthesiologists (ASA) grade was grade I to II, and the body mass index (BMI) was 18.2-25.1 kg/m². The patients were divided into group A (25 cases), group B (25 cases), and group C (25 cases) by the random number table method. All the three groups were given intravenous general anesthesia. Group A was given propofol (intravenous injection), group B was given remimazolam (intravenous injection), and group C was given remimazolam combined with propofol during manual reduction anesthesia (intravenous injection). The anesthetic effect (anesthetic induction time, anesthetic awakening time, anesthetic recovery time, and reduction time), hemodynamic indexes [mean arterial pressure (MAP) and heart rate (HR)], stress indexes [cortisol (Cor), adrenaline, and neuropeptide Y (NPY)], and adverse reactions (hypotension, bradycardia, respiratory depression, nausea and vomiting, and injection pain) were compared among the 3 groups. Analysis of variance, LSD-t test, χ² test, and Fisher exact probability method were used. Results　There was no statistically significant difference in the reduction time among the three groups (P>0.05). The anesthetic induction time [(62.31±4.15) s], awakening time [(17.26±3.45) min], and recovery time [(6.25±1.56) min] in group C were shorter than those in group A [(68.47±4.56) s, (21.47±4.29) min, and (9.48±1.89) min] and group B [(69.85±4.66) s, (22.36±4.47) min, and (9.24±1.85) min] (all P<0.05); there was no statistically significant difference in the anesthetic induction time, awakening time, or recovery time between group A and group B (all P>0.05). During and after reduction, the levels of MAP [(85.77±4.29) mmHg (1 mmHg=0.133 kPa) and (85.36±4.27) mmHg] and HR [(75.21±3.76) beats/min and (75.68±3.78) beats/min] in group C were lower than those in group A [(89.29±4.46) mmHg, (88.73±4.44) mmHg, (79.24±3.96) beats/min, and (80.15±4.02) beats/min] and group B [(90.21±4.51) mmHg, (89.56±4.47) mmHg, (78.33±3.93) beats/min, and (79.66±3.98) beats/min] (all P<0.05); there was no statistically significant difference in the level of MAP or HR between group A and group B (both P>0.05). After reduction, the levels of Cor [(291.42±32.38) nmol/L], epinephrine [(211.47±14.11) μg/L], and NPY [(118.41±14.81) μg/L] in group C were lower than those in group A [(326.85±36.32) nmol/L, (231.46±15.43) μg/L, and (137.65±17.21) μg/L] and group B [(321.54±34.73) nmol/L, (228.75±15.25) μg/L, and (135.24±16.91) μg/L] (all P<0.05); there was no statistically significant difference in the level of Cor, epinephrine, or NPY between group A and group B (all P>0.05). The total incidence of adverse reactions in group A [56.00% (14/25)] was higher than that in group B [16.00% (4/25)] and group C [12.00% (3/25)] (both P<0.05); there was no statistically significant difference in the total incidence of adverse reactions between group B and group C (P>0.05). Conclusion　Remimazolam combined with propofol for manual reduction anesthesia in elderly patients with hip dislocation under BIS monitoring can effectively improve the anesthetic effect, reduce the respective dosage, promote the analgesia, and is safe.

Observation on the effects of fumigation and steaming with Yiqi Wenjing Huoxue Prescription on oxaliplatin induced peripheral neurotoxicity and TCM syndromes in patients with colorectal cancer undergoing adjuvant chemotherapy after surgery

Wu Hao, Tang Xing, Han Pengyu, Yang Zhenyu, Zhao Canjun, Geng Bizhu, Wu Yichao, Zheng Jin

2024, 30(20):  3448-3452.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.020

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Objective　To explore the effects of fumigation and steaming with Yiqi Wenjing Huoxue Prescription on oxaliplatin induced peripheral neurotoxicity and traditional Chinese medicine (TCM) syndromes in patients with colorectal cancer undergoing adjuvant chemotherapy after surgery. Methods　This study was a randomized controlled trial. A total of 91 patients with colorectal cancer requiring adjuvant chemotherapy after surgery were selected from March 2022 to March 2024 in the Department of Traditional Chinese and Western Medicine Oncology, the Second Affiliated Hospital of PLA Air Force Military Medical University. The patients were divided into a treatment group (46 cases) and a control group (45 cases) by the random number table method. A total of 8 cases fell off, and 42 cases were finally included in the treatment group and 41 cases in the control group. There were 23 males and 19 females in the treatment group, aged (52.37±5.25) years, and the pathological staging was stage Ⅱ in 11 cases and stage Ⅲ in 31 cases. There were 22 males and 19 females in the control group, aged (54.21±5.23) years, and the pathological staging was stage Ⅱ in 12 cases and stage Ⅲ in 29 cases. The control group was treated with XELOX regimen chemotherapy [oxaliplatin (intravenous infusion) combined with capecitabine (oral)], and the treatment group was given fumigation and steaming with Yiqi Wenjing Huoxue Prescription on the basis of the control group. Both groups were treated for 6 cycles, with 21 d as a cycle. The incidence of peripheral neurotoxicity, toxicity grading, TCM syndrome score, and levels of serum inflammatory factors [superoxide dismutase (SOD) and nerve growth factor (NGF)] were compared between the two groups. Independent sample t test, paired t test, χ² test, and rank sum test were used. Results　At the 4th and 6th cycle, the incidence of peripheral neurotoxicity in the treatment group [57.1% (24/42) and 66.7% (28/42)] was lower than that in the control group [92.6% (38/41) and 97.5% (40/41)] (both P<0.05). After 4 and 6 cycles of treatment, the degree of peripheral neurotoxicity in the treatment group was better than that in the control group (Z=-5.051, P<0.001; Z=-5.276, P<0.001). After 6 cycles of treatment, the levels of SOD [(69.63±9.11) kU/L] and NGF [(176.21±26.79) ng/L] in the treatment group were higher than those in the control group [(55.23±8.77) kU/L and (139.24±21.78) ng/L], and the TCM syndrome score [(6.62±1.31) points] was lower than that in the control group [(8.94±2.97) points] (all P<0.05). Conclusion　The application of fumigation and steaming with Yiqi Wenjing Huoxue Prescription can reduce the oxaliplatin induced peripheral neurotoxicity and improve the TCM syndromes in patients with colorectal cancer undergoing adjuvant chemotherapy after surgery.

Effects of side-lying position delivery in the second stage of labor on the birth outcomes and pelvic floor function

Dai Lifang, Dong Xiaoqiong, Li Chenjie, Wang Xiaomei

2024, 30(20):  3453-3457.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.021

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Objective　To explore the effects of side-lying position delivery in the second stage of labor on the birth outcomes and pelvic floor function. Methods　This study was a randomized controlled trial. A total of 360 primiparas undergoing delivery in the Second Affiliated Hospital of Wenzhou Medical University from November 2020 to March 2021 were selected as the research objects, and were divided into a side-lying group (180 cases) and a supine group (180 cases) by the random number table method. The side-lying group was delivered in the side-lying position during the second stage of labor, and the supine group was delivered in the supine position during the second stage of labor. Due to fetal distress requiring forceps assistance and postpartum loss of follow-up, 150 cases were collected in both groups. The general data (age, body weight, body mass index, and gestational week), intrapartum indexes [neonatal body weight, second stage of labor, 1 min Apgar score, Visual Analogue Scale (VAS) score in the second stage of labor, bleeding at postpartum 2 h, and rate of vaginal delivery transferring to cesarean section], perineal condition (perineal integrity rate and perineal lateral resection rate), pelvic floor muscle strength changes at postpartum 42 d and 3 months, complications at postpartum 3 months (vaginal relaxation, uterine prolapse, urinary incontinence, and lumbosacral pain), and quality of life [Sickness Impact Profile (SIP)] at postpartum 3 months were compared between the two groups. Independent sample t test and χ² test were used. Results　The age of the side-lying group was (27.82±2.01) years old, and the gestational age was (38.62±1.12) weeks. The age of the supine group was (28.23±2.31) years old, and the gestational age was (39.24±0.95) weeks. The rate of vaginal delivery transferring to cesarean section [8.67% (13/150)], second stage of labor [(48.65±9.41) min], and VAS score in the second stage of labor [(3.22±1.18) points] in the side-lying group were better than those in the supine group [18.67% (28/150), (62.11±10.21) min, and (5.51±1.36) points] (all P<0.05). The perineal integrity rate in the side-lying group was higher than that in the supine group [10.67% (16/150) vs. 3.33% (5/150)], and the perineal lateral resection rate was lower than that in the supine group [6.67% (10/150) vs. 13.33% (20/150)] (both P<0.05). At postpartum 42 d and 3 months, the proportions of pelvic floor muscle strength ≥ grade 3 in the side-lying group [58.00% (87/150) and 80.67% (121/150)] were higher than those in the supine group [30.00% (45/150) and 64.00% (96/150)] (both P<0.05). At postpartum 3 months, the vaginal dynamic pressure, incidences of vaginal relaxation, uterine prolapse, urinary incontinence, and lumbosacral pain, and quality of life score (scores of 3 dimensions and total score) in the side-lying group were better than those in the supine group (all P<0.05). Conclusion　Side-lying position delivery in the second stage of labor can effectively reduce the rate of vaginal delivery transferring to cesarean section, shorten the second stage of labor, reduce the degree of perineal laceration and postpartum pelvic floor muscle injury, and improve the quality of life.

Observation on the effect of cardiac rehabilitation treatment in patients with heart disease after PCI

Zhu Ke, Li Rui, Liu Dan

2024, 30(20):  3457-3461.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.022

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Objective　To observe the effects of cardiac rehabilitation treatment on endothelin-1 level and cardiac function in patients with heart disease after percutaneous coronary intervention (PCI). Methods　A total of 77 patients with heart disease after PCI admitted to Zhumadian Central Hospital from March 2022 to October 2023 were prospectively selected as the study objects and were divided into a control group (38 cases) and an observation group (39 cases) by the random number table method. In the control group, there were 22 males and 16 females, aged 43-69 (57.71±5.28) years, and the course of disease was 1-7 (3.76±1.25) years. In the observation group, there were 24 males and 15 females, aged 44-70 (58.12±5.32) years, and the course of disease was 1-8 (3.82±1.31) years. The control group received conventional treatment, and the observation group received cardiac rehabilitation therapy on the basis of the control group. Both groups were treated for 3 months. The mastery of cardiac rehabilitation (cardiac rehabilitation cognition survey scale), self-management ability [Coronary Heart Disease Self-Management Behavior Scale (CSMS)], exercise endurance (6 min walking distance), vascular endothelial function (endothelin-1, von Willebrand factor, and endothelium-dependent diastolic function), cardiac function (left ventricular ejection fraction, left ventricular end-systolic diameter, left ventricular end-diastolic diameter, and cardiac output), and quality of life (SF-36) were compared between the two groups before and after treatment. Independent sample t test, paired t test, and χ² test were used. Results　After treatment, the mastery of cardiac rehabilitation [(60.72±2.96) points], self-management ability [(82.98±3.79) points], and exercise endurance [(496.88±27.34) m] of the observation group were better than those of the control group [(55.49±3.45) points, (78.39±4.22) points, and (451.69±35.45) m] (all P<0.05). After treatment, the levels of endothelin-1 [(3.79±0.51) ng/L] and von Willebrand factor [(219.64±29.15)%] in the observation group were higher than those in the control group [(3.12±0.45) ng/L and (197.89±28.46)%], and the level of endothelium-dependent diastolic function [(5.15±0.43)%] was lower than that in the control group [(5.97±0.62)%] (all P<0.05). After treatment, the left ventricular ejection fraction [(64.96±1.26)%] and cardiac output [(6.13±0.45) min/L] in the observation group were higher than those in the control group [(61.99±1.31)% and (5.77±0.65) min/L], and the left ventricular end-systolic diameter [(37.79±1.37) mm] and left ventricular end-diastolic diameter [(41.65±1.28) mm] were shorter than those in the control group [(39.35±1.24) mm and (48.43±1.42) mm] (all P<0.05). After treatment, the scores of 8 dimensions of life quality of the observation group were higher than those of the control group (all P<0.05). Conclusions　Cardiac rehabilitation therapy has a definite effect on the treatment of heart disease patients after PCI, which can effectively improve the patients' vascular endothelial function and cardiac function, improve their quality of life, and facilitate their prognosis. It can be clinically applied and promoted.

Study on the curative effect of acupotomy on lumbar degenerative disease based on quantitative magnetic resonance imaging

He Xihua, Li Xiaomin, Liu Zhanling, Li Xibo, Li Jun, Kong Weisheng, Ou Ganqu, Xu Mintao, Xie Minghua

2024, 30(20):  3462-3465.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.023

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Objective　To explore the value of quantitative magnetic resonance imaging (MRI) in evaluating the efficacy of acupotomy in the treatment of lumbar degenerative disease. Methods　A total of 71 patients with lumbar degenerative disease admitted to Dongguan Wanjiang Hospital from October 2021 to August 2023 were selected as the study objects, including 50 males and 21 females, aged 38-76 (52.14±3.48) years, with a disease course of 2-17 (10.75±1.42) years. All patients were treated with acupotomy once a week, and the treatment was withdrawn if it was ineffective for 3 consecutive times. Before and after treatment, the patients underwent quantitative MRI, including delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T2 mapping. The MRI results were analyzed, and the glucosaminoglucide (GAG) concentration, proteoglycan content, and T1 and T2 relaxation time were compared before and after treatment. Paired t test and analysis of variance were used. Results　On MRI, there were 32 cases of annulus fibrosis degeneration, and 20 cases of lumbar vertebrae showed banded and flacy-like hypersignal on T2WI. In 27 cases, the necrotic cells in the nucleus pulposus were debris and reactive hyperplasia, and the T1WI showed spotty low signal in the nucleus pulposus. There were 8 cases of annulus fibulation, and T1WI and T2WI showed low signal in the corner of nucleus pulposus. Intervertebral disc cartilaginous endplate degeneration was observed in 4 cases with low signal on T2WI. At 12 h, 24 h, and 48 h after treatment, the GAG concentration [(77.21±5.36) mg/L, (84.45±5.84) mg/L, and (90.36±6.48) mg/L] and proteoglycan content [(5.23±0.12) μg/mg, (5.25±0.11) μg/mg, and (5.18±0.13) μg/mg] were higher than those before treatment [(51.15±4.35) mg/L and (1.82±0.21) μg/mg] (all P<0.05). At 12 h, 24 h, and 48 h after treatment, the T1 relaxation time [(712.25±58.86) ms, (698.85±57.12) ms, and (684.45±56.89) ms] was longer than that before treatment [(356.52±37.25) ms], and the T2 relaxation time [(49.21±4.36) ms, (47.25±4.11) ms, and (46.23±4.05) ms] was shorter than that before treatment [(77.25±8.15) ms] (all P<0.05).Conclusion　Quantitative MRI technique can be used to evaluate the cartilage condition and component changes in patients with lumbar degenerative diseases before and after acupotomy, and the efficacy evaluation is accurate.

Nursing Research

Effects of stepped nursing mode on home care and lung function in patients undergoing thoracoscopic radical resection for lung cancer

Chen Xu, Zhu Maoshan, Dai Qin

2024, 30(20):  3466-3470.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.024

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Objective　To explore the effects of stepped nursing mode on home care and lung function in patients undergoing thoracoscopic radical resection for lung cancer. Methods　A total of 100 patients undergoing thoracoscopic radical resection for lung cancer admitted to the Thoracic Surgery of Lianyungang Hospital of Traditional Chinese Medicine and the Thoracic Surgery of the Second People's Hospital of Lianyungang from November 2020 to November 2023 were selected as the study objects, and the patients were divided into a control group (50 cases) and an intervention group (50 cases) by the random number table method. In the control group, there were 31 males and 19 females, aged (68.42±7.67) years, including 32 cases of TNM stage Ⅱ and 18 cases of TNM stage Ⅲ. In the intervention group, there were 29 males and 21 females, aged (68.56±8.46) years, including 28 cases of TNM stage Ⅱ and 22 cases of TNM stage Ⅲ. The control group adopted routine rehabilitation nursing mode, and the intervention group adopted stepped nursing mode on the basis of the control group. The nursing observation time was 4 weeks in both groups. The home care level [Family Resilience Assessment Scale (FRAS)], pulmonary function indicators [forced vital capacity (FVC), vital capacity (VC), maximum ventilation volume (MVV), and total lung volume (TLC)], and postoperative complications (respiratory failure, pulmonary infection, arrhythmia, and pulmonary atelectasis) were compared between the two groups. Independent sample t test, paired t test, and χ² test were used. Results　After intervention, the scores of 6 dimensions of the FRAS in the intervention group were higher than those in the control group (all P<0.05); the levels of FVC [(85.47±5.53)%], VC [(2.47±0.50) L], MVV [(89.46±5.47)%], and TLC [(6.45±1.32) L] in the intervention group were higher than those in the control group [(80.53±3.66)%, (1.85±0.42) L, (83.58±4.63)%, and (5.62±1.41) L] (all P<0.05). The total incidence of postoperative complications in the intervention group [2.00% (1/50)] was lower than that in the control group [16.00% (8/50)] (P<0.05). Conclusion　The stepped nursing mode can improve the home care and lung function in patients undergoing thoracoscopic radical resection for lung cancer, and reduce the postoperative complications.

Effect of early neonatal sucking guidance on breastfeeding behavior and breast complications

Liu Jing, Liu Jing, Zhang Jing, Hou Dandan, Liu Yingjie, Wang Yanxia

2024, 30(20):  3471-3475.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.025

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Objective　To investigate the effect of early neonatal sucking guidance on breastfeeding behavior and breast complications. Methods　A total of 194 pregnant women with successful delivery and breastfeeding enrolled in Northwest Women's and Children's Hospital from January 2022 to January 2023 were prospectively selected as the research objects, and were divided into a control group (97 cases) and an observation group (97 cases) by the random number table method. In the control group, the age of the pregnant women was (29.82±2.56) years old, and the gestational age was (39.66±0.47) weeks, including 74 primiparas and 23 multiparas. In the observation group, the age of the pregnant women was (30.20±2.78) years old, and the gestational age was (39.15±0.52) weeks, including 61primiparas and 36 multiparas. The control group received routine nursing, and the observation group received early neonatal sucking guidance from midwives on the basis of the control group. Both groups were intervened until the pregnant women were discharged from hospital and were followed up until 6 months after delivery. The breastfeeding status (initiation time of lactation and adequacy of milk supply before discharge), breastfeeding rate, and breastfeeding efficacy [Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF)], and breast complications (mastitis, hypergalactosis, and nipple injury) within 6 months after delivery were compared between the two groups. Statistical methods used were t test and χ² test. Results　The initiation time of lactation in the observation group was shorter than that in the control group [(1.22±0.31) d vs. (2.43±0.78) d], and the adequacy rate of milk supply was higher than that in the control group [91.75% (89/97) vs. 79.38% (77/97)], with statistically significant differences between the two groups (both P<0.05). The breastfeeding rates at postpartum 1 month, 2 months, 4 months, and 6 months in the observation group were 93.81% (91/97), 88.66% (86/97), 84.54% (82/97), and 78.35% (76/97), which were higher than those in the control group [81.44% (79/97), 73.20% (71/97), 64.95% (63/97), and 56.70% (55/97)], with statistically significant differences between the two groups (all P<0.05). The scores of skills and inner activity of the breastfeeding efficacy in the observation group were (33.37±3.88) points and (26.63±2.43) points, which were higher than those in the control group [(29.60±2.46) points and (21.10±2.51) points], with statistically significant differences between the two groups (both P<0.05). The incidence of breast complications in the observation group was lower than that in the control group [9.28% (9/97) vs. 21.65% (21/97)], with a statistically significant difference between the two groups (P<0.05). Conclusion　Early neonatal sucking guidance can shorten the initiation time of lactation and increase the lactation volume, helps to improve the maternal breastfeeding rate, enhance the maternal breastfeeding self-efficacy, and reduce the incidence of breast complications.

Effect of early enteral nutrition on immune regulation and prognosis in patients with severe sepsis

Hu Xiaolu, Zhao Juxin, Wang Weijiu, Sun Hang, Li Shujuan, Zhang Qinghua, Wu Jinhai

2024, 30(20):  3476-3480.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.026

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Objective　To investigate the clinical effect of early enteral nutrition on patients with severe sepsis. Methods　A total of 86 patients with severe sepsis admitted to Nanyang First People's Hospital (Nanyang Key Laboratory of Sepsis Transformation) from September 2022 to January 2024 were included in this study for retrospective analysis. All patients were divided into a study group (43 cases) and a control group (43 cases) according to the timing of enteral nutrition. Both groups received enteral nutrition therapy, and gastric tubes were placed within 24 h after admission. The patients in the study group received enteral nutrition therapy within 24 h after admission, and the patients in the control group received enteral nutrition therapy within 48-72 h after admission. In the study group, there were 24 males and 19 females, aged (64.32±15.21) years, the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score was (19.85±4.10) points, and the sites of infection were at respiratory tract in 32 cases, urinary tract in 6 cases, skin in 3 cases, and other in 2 cases. In the control group, there were 25 males and 18 females, aged (64.17±14.89) years, the APACHEⅡ score was (20.06±3.87) points, and the sites of infection were at respiratory tract in 33 cases, urinary tract in 7 cases, skin in 2 cases, and other in 1 case. Intestinal mucosal barrier indexes, inflammatory response related indexes, and immune function related indexes were compared between the two groups on day 1 and day 7 after treatment, and the length of ICU stay and 28-day mortality were compared between the two groups. t test, χ² test, and Fisher exact probability method were used. Results　On day 7 after treatment, the levels of intestinal mucosal barrier related indexes in both groups were decreased compared with those on day 1 after treatment, and the levels of these indexes in the study group were lower than those in the control group (all P<0.05). On day 7 after treatment, the levels of immunoglobulin A (IgA), IgG, CD4⁺, and CD4⁺/CD8⁺ in both groups were increased compared with those on day 1 after treatment, and the levels of the above indexes in the study group were higher than those in the control group (all P<0.05). On day 7 after treatment, the levels of white blood cell count (WBC), C-reactive protein (CRP), and procalcitonin (PCT) in both groups were decreased compared with those on day 1 after treatment, and the levels of the above indexes in the study group were lower than those in the control group (all P<0.05). The length of ICU stay in the study group was shorter than that in the control group [(11.32±4.50) days vs. (15.02±3.78) days] (P<0.05). The 28-day mortality rate of the study group was lower than that of the control group [2.33% (1/43) vs. 4.71% (2/43)], but the difference was not statistically significant (P>0.05). Conclusion　Compared with delayed enteral nutrition therapy, early enteral nutrition therapy applied in patients with severe sepsis can improve the intestinal microcirculation, contributes to the improvement of immune function, and can reduce the inflammatory response and improve the prognosis.

Intervention effect of nutritional-psychological dual-wheel-driven ERAS nursing on patients in hepatobiliary surgery

Li Hongmei, Cui Liping, Si Ying

2024, 30(20):  3481-3486.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.027

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Objective　To investigate the intervention effects of nutritional-psychological dual-wheel-driven enhanced recovery after surgery (ERAS) nursing on nutritional status and psychological stress in patients from hepatobiliary surgery. Methods　A total of 206 patients admitted to Hepatobiliary Surgery, Xianyang Central Hospital from July 2019 to June 2022 were selected as the study objects, and were divided into a control group and an observation group with 103 patients in each group by the random number table method. In the control group, there were 75 males and 28 females, aged 18-65 (45.25±6.30) years, and there were 16 cases of pancreatic cancer, 20 cases of gallbladder cancer, 53 cases of hepatocellular carcinoma, and 14 cases of intrahepatic bile duct carcinoma. There were 73 males and 30 females in the observation group, aged 18-65 (46.04±6.78) years, and there were 17 cases of pancreatic cancer, 20 cases of gallbladder cancer, 54 cases of hepatocellular carcinoma, and 12 cases of intrahepatic bile duct carcinoma. The control group adopted the conventional perioperative accelerated nursing program, while the observation group adopted the nutritional-psychological dual-wheel-driven ERAS nursing program (constructing a multidisciplinary team, carrying out simultaneous nutritional and psychological assessment and intervention) until 72 h after surgery. The differences in terms of demographic data, clinical data, wound healing, body weight, length of hospital stay, gastrointestinal function recovery, Nutritional Risk Screening 2002 (NRS2002) score, Self-rating Anxiety Scale (SAS) score, and comprehensive line length of appetite Visual Analogue Scale (VAS) were compared between the two groups. t test, ANOVA, and χ² test were used. Results　The postoperative first exhaust time, first feeding time, first defecation time, length of hospital stay, and wound healing time in the observation group were shorter than those in the control group [(14.84±4.36) h vs. (16.47±5.08) h, (11.20±2.19) h vs. (12.65±2.50) h, (48.48±6.43) h vs. (54.16±7.38) h, (9.37±2.09) d vs. (10.26±2.47) d, (6.38±2.05) d vs. (8.76±3.14) d] (all P<0.05). There was no statistically significant difference in the NRS2002 score between the two groups at admission (P>0.05). The NRS2002 score of the observation group was lower than that of the control group 24 h before surgery and on the next day after surgery (t=2.487 and 3.481, both P<0.05). Overall comparison: the differences among groups, time, and interactions were statistically significant (all P<0.001). There was no statistically significant difference in the SAS score or comprehensive line length of appetite VAS between the two groups at admission (both P>0.05). The SAS score of the observation group on the next day after surgery was lower than that of the control group at the same time point and that of the observation group at admission (both P<0.001). The comprehensive line length of appetite VAS in the observation group on the next day after surgery was longer than that in the control group at the same time point and that of the observation group at admission (both P<0.001). There was no statistically significant difference in the body weight of the observation group between on the next day after surgery and at admission (P>0.05), while the body weight of the control group on the next day after surgery was lower than that at admission (t=2.205, P=0.030), and the body weight of the observation group was higher than that of the control group on the next day after surgery (t=2.197, P=0.029). Conclusion　Nutritional-psychological dual-wheel-driven ERAS nursing program can effectively shorten the postoperative recovery time of gastrointestinal function in patients from hepatobiliary surgery, promote the improvement of patients' nutritional status, reduce the postoperative anxiety, promote the recovery of appetite, and avoid the postoperative weight loss, which contributes to the rapid recovery of the disease.

Analysis of risk factors of respiratory critical illness after cardiac surgery in the elderly

Li Yukun, Fan Longhui

2024, 30(20):  3487-3491.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.028

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Objective　To analyze the risk factors of respiratory critical illness after cardiac surgery in the elderly. Methods　A total of 686 inpatients who underwent cardiac surgery in Fuwai Central China Cardiovascular Hospital from May to November 2022 were retrospectively selected as the study objects, and they were divided into a PPCs group (122 cases) and a control group (564 cases) according to whether the postoperative pulmonary complications (PPCs) occurred. After collecting the patients' baseline information, univariate analysis was performed for each index, and the indexes with P<0.05 were included in the multivariate logistic regression analysis. With the occurrence of PPCs as the dependent variable and baseline characteristics as the independent variables, multivariate logistic regression analysis was used to determine the independent risk factors for PPCs. χ² test was used. Results　There were 65 males and 57 females in the PPCs group, 86 cases (70.49%) aged ≥70 years, and 82 cases (67.21%) with course of disease >3 years. There were 293 males and 271 females in the control group, 304 cases (53.90%) aged ≥70 years, and 242 cases (42.91%) with course of disease >3 years. Logistic regression analysis showed that age ≥70 years old (OR=4.855, 95%CI: 1.981-7.728), course of disease >3 years (OR=4.678, 95%CI: 1.908-7.447), smoking history >3 years (OR=23.248, 95%CI: 9.843-36.653), initial New York Heart Association (NYHA) grade III-IV (OR=4.567, 95%CI: 1.984-7.150), hypertension (OR=29.871, 95%CI: 11.390-48.352), diabetes (OR=4.343, 95%CI: 1.875-6.812), asthma (OR=31.134, 95%CI: 13.612-48.655), apnea syndrome (OR=3.282, 95%CI: 1.317-5.247), operation time >45 min (OR=18.722, 95%CI: 6.781-30.663), operation in supine position (OR=4.299, 95%CI: 1.598-7.000), lung compliance T value <70% of normal value (OR=6.826, 95%CI: 2.627-11.025), anemia (OR=4.150, 95%CI: 1.696-6.603), emergency surgery (OR=23.495, 95%CI: 8.998-37.991), and chronic obstructive pulmonary disease (COPD) (OR=5.663, 95%CI: 2.004-9.322) were the risk factors of respiratory critical illness after cardiac surgery in the elderly (all P<0.05). Conclusions　The logistic risk predictors of respiratory critical illness after cardiac surgery in the elderly are clear, which can effectively predict the occurrence of complications. We look forward to conducting large-sample, prospective evidence-based clinical trials to improve the prediction equation.

Analysis of the correlations between asthmatic children's control level and family function and environment

Shang Li, Quan Peixin, Cai Miao

2024, 30(20):  3491-3496.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.029

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Objective　To analyze the correlations between the control level of asthmatic children and family function and environment. Methods　A total of 100 children with asthma and their guardians who were admitted to Northwest Women's and Children's Hospital from March 2021 to March 2023 were retrospectively selected as the study objects, and the Childhood Asthma Control Test (C-ACT) was used to assess the asthma control levels among the children and their guardians. According to the C-ACT score, the children were divided into 3 groups: a fully controlled group (≥23 points) with 24 cases, including 13 boys and 11 girls, aged (8.95±2.14) years; a partially controlled group (20-22 points) with 26 cases, including 15 boys and 11 girls, aged (9.02±2.21) years; a uncontrolled group (≤19 points) with 50 cases, including 28 boys and 22 girls, aged (9.11±2.16) years. The general data of the three groups were compared. The Family Environment Scale - Chinese version (FES-CV) and the Family Assessment Device (FAD) were used to evaluate the family function and environment of the children, and the correlations between asthma control level and family function and environment were analyzed. Statistical methods used were ANOVA, χ² test, and Pearson correlation analysis. Results　The scores of each dimension of the FES-CV of the fully controlled group were better than those of the partially controlled group and the uncontrolled group [control: (3.21±1.30) points vs. (3.93±1.62) points and (4.79±1.36) points; organization: (6.33±1.20) points vs. (5.50±1.76) points and (4.85±1.46) points; religious views: (6.16±1.01) points vs. (5.11±1.21) points and (4.42±1.32) points; entertainment: (6.54±1.88) points vs. (5.29±2.10) points and (2.95±1.54) points; culture: (6.59±1.10) points vs. (5.13±1.74) points and (3.65±1.58) points; independence: (5.71±0.96) points vs. (5.11±1.10) points and (4.75±1.12) points; contradiction: (1.40±1.24) points vs. (2.73±1.62) points and (4.47±1.56) points; emotional expression: (6.99±1.10) points vs. (6.11±1.13) points and (4.72±1.34) points; intimacy: (8.29±0.82) points vs. (7.63±0.91) points and (5.94±1.66) points], with statistically significant differences (all P<0.05). The scores of each dimension of the FAD in the fully controlled group were lower than those in the partially controlled group and the uncontrolled group [problem solving ability: (1.91±1.67) points vs. (2.23±0.46) points and (2.82±0.76) points; communication: (1.89±0.26) points vs. (2.18±0.28) points and (2.56±0.40) points; role division: (2.00±0.36) points vs. (2.32±0.29) points and (2.64±0.40) points; emotional response: (1.98±0.32) points vs. (2.42±0.63) points and (3.05±0.87) points; emotional intervention: (2.17±0.35) points vs. (2.50±0.38) points and (3.01±0.48) points; behavioral control: (1.96±0.27) points vs. (2.18±0.30) points and (2.68±0.54) points; total function: (1.79±0.18) points vs. (2.08±0.27) points and (2.42±0.36) points], with statistically significant differences (all P<0.05). The control level of asthmatic children was negatively correlated with control and contradiction of the FES-CV, but not correlated with achievement, and was positively correlated with other dimensions (all P<0.05). It was negatively correlated with all FAD dimensions (all P<0.05). Conclusions　There are significant correlations between asthma control level in children and family function and environment. Strengthening family education and intervention, optimizing family environment and function during the nursing process are of great significance in improving the control of asthma in children.

Construction and practice of SOP management for patients with chronic diseases based on medicine and prevention integration

Yin Na, Ye Weijian, Zhang Guoliang, Liang Chibo, Liu Hanhai, Luo Ruhuai

2024, 30(20):  3497-3502.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.030

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Objective　To explore the standard operating procedure (SOP) construction and practice effect on patients with chronic diseases under the integration of medical treatment and prevention. Methods　The outpatient visits and follow-up of 413 patients with chronic diseases in Dongguan Chang'an Community Health Service Center from October 2022 to March 2023 were retrospectively analyzed, and the 413 patients were divided into a routine group (263 cases) and a standardized group (150 cases) according to the management methods. In the routine group, there were 178 males and 85 females, aged (45.69±7.24) years, they had been included in the community chronic disease management for (4.57±1.65) years, and there were 152 cases of hypertension, 74 cases of type 2 diabetes mellitus (T2DM), and 37 cases of hypertension complicated with T2DM. In the standardized group, there were 89 males and 61 females, aged (44.28±8.65) years, they had been included in the community chronic disease management for (4.39±1.43) years, and there were 95 cases of hypertension, 37 cases of T2DM, and 18 cases of hypertension complicated with T2DM. The routine group adopted the routine management, and the standardized group constructed and implemented the general practice diagnosis and follow-up SOP under the integration of medical treatment and prevention on the basis of the routine management. The writing qualities of outpatient medical records and follow-up forms, duration of follow-up, medication compliance, patient satisfaction, patient awareness, and satisfaction of medical staff were compared between the two groups. χ² test and independent sample t test were used. Results　The writing qualities of outpatient medical records and follow-up forms in the standardized group were higher than those in the routine group [(92.31±5.89) points vs. (85.23±4.68) points, (93.54±6.24) points vs. (87.27±5.67) points], with statistically significant differences (both P<0.001). The duration of follow-up and medication compliance of the standardized group were better than those of the routine group, with statistically significant differences (both P<0.05). The patient satisfaction, patient awareness, and satisfaction of medical staff in the standardized group were higher than those in the routine group [98.00% (147/150) vs. 84.79% (223/263), 98.66% (148/150) vs. 84.79% (223/263), 95.00% (19/20) vs. 71.73% (99/138)], with statistically significant differences (all P<0.05). Conclusion　The SOP of chronic disease management under the integration of medicine and prevention can effectively improve the diagnosis and treatment ability of general practice of community health service center, harmonize the relationship between doctors and patients, improve the patients' self-management compliance, improve the work efficiency, improve the professional identity of medical staff, and improve the patients' service experience.

Preventive Medicine

Prevalence and correlation between overweight and obesity and poor vision among primary and middle school students in Baoshan District, Shanghai 

Mai Yiyi, Huang Aiyi, Zhao Hailei, Li Guangping, Ji Wei, Luo Ying, Sun Xiuli, Rong Fen

2024, 30(20):  3503-3508.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.031

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Objective　To understand the prevalence trends and correlations of overweight and obesity and poor vision among primary and middle school students in Baoshan District of Shanghai from 2013 to 2019, and to provide evidence for the prevention of overweight, obesity, and poor vision among primary and middle school students. Methods　Based on the physical examination data of primary and middle school students in Baoshan District of Shanghai from 2013 to 2019, 507 993 primary and middle school students with complete data were selected as the research objects, including 269 327 boys (53.0%) and 238 666 girls (47.0%), 330 621 students (65.0%) in primary schools, 131 796 students (25.9%) in junior middle schools, and 45 576 students (8.9%) in senior middle schools. The prevalence and correlation of overweight and obesity and poor vision among primary and middle school students were analyzed. Trend Chi-square test was used for trend analysis, and Kruskal-Wallis H test was used for comparison between groups. Results　From 2013 to 2019, the prevalence rates of overweight and obesity and poor vision among primary and middle school students showed an increasing trend (both P<0.001). The rate of overweight and obesity of the primary school students [35.47% (117 272/330 621)] was higher than that of the junior middle school students [31.88% (42 010/131 796)] and senior middle school students [27.39% (12 485/45 576)] (P<0.001). The rate of overweight and obesity of the boys [40.37% (108 725/269 327)] was higher than that of the girls [26.41% (63 042/238 666)] (P<0.001). The rate of poor vision in the senior middle school students [89.13% (40 623/45 576)] was higher than that in the primary school students [51.08% (168 877/330 621)] and junior middle school students [79.72% (105 065/131 796)] (P<0.001). The rate of poor vision in the girls [64.02% (155 191/238 666)] was higher than that in the boys [59.17% (159 374/269 327)] (P<0.001). The rate of moderate poor vision was higher among overweight/obese primary school students [20.19% (11 173/55 343) and 20.73% (12 833/61 919)], and the rate of severe poor vision was higher among overweight/obese junior and senior middle school students [junior middle school students: 51.70% (11 790/22 804) and 49.31% (9 471/19 206); senior middle school students: 69.86% (5 422/7 761) and 68.88% (3 254/4 724)]. Conclusions　The prevalence of overweight and obesity and poor vision among primary and middle school students in Baoshan District of Shanghai from 2013 to 2019 showed an increasing trend, and there was a correlation between overweight and obesity and poor vision. Comprehensive prevention and control measures should be taken.

Medical Education

Application and prospect of simulation head mold in oral clinical practice teaching

Wang Shengyuan, Zhao Jian, He Wenhuan, Liu Ziyu, Xu Yan

2024, 30(20):  3509-3513.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.032

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Clinical stomatology is a highly applied discipline that requires equal emphasis on theory and practice. Oral clinical operation is an indispensable basic skill for stomatology students, and while mastering the theoretical knowledge of modern stomatology, stomatology students also need to master certain clinical operation skills. The simulation head mold system is a dental professional teaching tool that simulates the real clinical operation environment, which can simulate the clinical diagnosis and treatment links and the corresponding oral environment to a certain extent, and helps stomatology students to experience and master some basic clinical operation skills, standardize the operation process, and cultivate the clinical thinking ability before experimental teaching and clinical practice. At present, a large number of studies have been conducted to explore the application of the simulation head mold system in oral medicine education.But with the rapid development of digital technology, the simulation head mold system also faces challenges such as high cost, limited simulation degree, and poor interaction and real-time performance. This article mainly reviews the application of the simulation head mold system in the practical education of different stomatology disciplines and different clinical scenarios, analyzes its opportunities and challenges, and provides a reference for the further optimization of stomatology education.

Application effect of video feedback combined with situation simulation teaching mode in PICC maintenance teaching

Yang Dongjing, Zhou Guoli, Li Jing, Ding Bingxin, Wang Yameng, Jiang Xiaojie

2024, 30(20):  3513-3517.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.033

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Objective　To investigate the application effect of video feedback combined with situation simulation teaching mode in peripherally inserted central catheter (PICC) maintenance teaching. Methods　Eighty female nursing interns in the Thyroid and Breast Surgery, Department of Gastroenterology, Department of Geriatrics, and Department of Oncology of Hebi People's Hospital from July to November 2023 were selected as the research objects and were randomly divided into a study group (41 cases) and a control group (39 cases) according to their respective departments. The study group was (20.29±0.64) years old, including 1 case of bachelor degree and 40 cases of college degree. The control group was (20.18±0.82) years old, including 1 case of bachelor degree and 38 cases of college degree. The study group adopted video feedback combined with situation simulation teaching mode for PICC maintenance teaching, while the control group adopted conventional teaching mode for PICC maintenance teaching. The teaching lasted for 4 weeks. The general information, theoretical and operational performance, and teaching satisfaction were compared between the two groups. Independent sample t test and χ² test were used. Results　The theoretical and operational scores of the study group were higher than those of the control group [(18.24±1.59) points vs. (15.46±1.00) points, (94.14±1.82) points vs. (88.57±1.99) points], with statistically significant differences (both P<0.05). The teaching satisfaction of the study group was higher than that of the control group in 6 dimensions, such as  arousing the learning interest of PICC specialist nurses and team communication skills, with statistically significant differences (all P<0.05). Conclusion　The application of video feedback combined with scene simulation teaching mode in the instruction of PICC maintenance teaching is conducive to the cultivation of nursing interns' comprehensive quality and enhancing the proficiency of specialized nurses at an advanced level.

Observation on the effect of PBL combined with reflective teaching in the teaching of nursing interns in geriatric medicine department

Zhang Chaoli, Li Jian, Qiu Yan, Guo Man, Liang Yingyan

2024, 30(20):  3518-3520.  DOI: 10.3760/cma.j.issn.1007-1245.2024.20.034

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