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Table of Content

    25 April 2022, Volume 43 Issue 4
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    Protective effect of Sigma-1 receptor agonist PRE-084 against myocardial ischemia-reperfusion injury in rats
    WANG Rui, ZHANG Ling-ye, DU Yan-hua
    2022, 43(4):  377-380.  doi:10.3969/j.issn.1007-3205.2022.04.002
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    Objective  Sigma-1 receptor is a non-opioid receptor, and its agonist has a positive protective effect on the heart. The purpose of this study was to explore application effect of Sigma-1 receptor on myocardial ischemia-reperfusion(IR) injury.

    Methods  A total of 24 SD rats included in this study were randomly divided into three groups according to the numerical randomization method, including the IR group(n=8), the Sham operation group(Sham group, n=8) and the PRE-084 group(n=8). The IR and Sham groups received normal saline at 1 h before operation. In the meantime, according to relevant clinical experiment indicators, the PRE-

    084 group received the same amount of 1 mg/kg PRE-084, followed by ligation of the anterior descending artery for 30 min and reperfusion for 24 h. The effects of PRE-084 on the area of myocardial infarction, cardiac function, CK-MB, SOD, and MDA were evaluated.

    Results  The values of CK-MB and MDA in I/R group and PRE-084 group were higher than those in Sham group, while the values of SOD were lower than those in Sham group. The values of CK-MB and MDA in PRE-084 group were lower than those in I/R group, while the values of SOD were higher than those in I/R group(P＜0.05). At 24 h after reperfusion, compared with Sham group, the +dp/dtmax, -dp/dtmax and LVSP in PRE-084 group and I/R group decreased significantly, and increased significantly in PRE-084 group compared with I/R group(P＜0.05). Compared with Sham group, LVEDP in PRE-084 group and I/R group increased(P＜0.05), and there was no significant difference between I/R group and PRE-084 group(P＞0.05).

    Conclusion  PRE-084 pretreatment can reduce the area of myocardial infarction in rats with IR injury by reducing oxygen free radical damage.

    Effects of mandibular advancement device on the hypoglossal nerve in the treatment of obstructive sleep apnea in rabbits
    QIAO Xing, KANG Wen-jing, ZHANG Shi-long, MA Wen-sheng, LIU Chun-yan, LU Hai-yan
    2022, 43(4):  381-385.  doi:10.3969/j.issn.1007-3205.2022.04.003
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    Objective  To study obstructive sleep apnea(OSA)and the effect of mandibular advancement device(MAD) on the structure and function of the hypoglossal nerve by establishing a New Zealand white rabbit model of obstructive sleep apnea(OSA), in order to provide a theoretical basis for the further study of hypoglossal nerve and precision treatment of OSA.

    Methods  Eighteen 6-month-old male New Zealand white rabbits were randomly divided into control group, OSA group and MAD group. The rabbits were induced to sleep in supine position for 2 h every day, and general anesthesia was performed after 8 weeks. One side of hypoglossal nerve and genioglossal muscle were passively separated and exposed. Using signal acquisition and processing system, Taimeng BL-420F, the threshold intensity of genioglossal muscle contraction caused by stimulating hypoglossal nerve, the single contraction ability of genioglossal muscle when stimulating hypoglossal nerve intensity was 0.5 V and the latency of genioglossal muscle contraction caused by stimulating hypoglossal nerve were recorded. The threshold intensity, genioglossus contraction tension and latency of the three groups were compared. The hypoglossal nerve tissue specimen was prepared on the other side, and the tissue structure of nerve fibers was observed under optical microscope.

    Results  The threshold stimulation in OSA group was higher than that in control group and MAD group, the genioglossus contraction tension was lower than that in control group and MAD group, and the latency was longer than that in control group and MAD group(P＜0.05). There was no significant difference in threshold stimulation, genioglossus contraction tension and latency between control group and MAD group(P＞0.05). The nerve fibers in the control group had no obvious changes, the nerve fiber tissue structure was complete, the cells were arranged in layers, the nerve fiber tissue structure was closely arranged, and there was no obvious liquefaction, degeneration and necrosis. In OSA group, the hypoglossal nerve fibers showed degeneration to varying degrees, which showed that the nerve fibers were arranged disorderly, dissolved and denatured, and even condensed. The disorder and degeneration of nerve fibers in MAD group were milder than those in OSA group.

    Conclusion  OSA can reduce the conduction performance of the hypoglossal nerve and the contractible tension of the genioglossus muscle in OSA rabbits. OSA can lead to the disordered arrangement and even degeneration of the nerve fibers. MAD therapy can reduce the damage to the hypoglossal nerve caused by OSA and play a protective role in hypoglossal nerve.

    A clinical study on the interaction between smoking and anemia factors affecting the susceptibility to chronic obstructive pulmonary disease
    LIU Mei-xia, JIANG Hong-ying, ZHANG Na
    2022, 43(4):  386-390.  doi:10.3969/j.issn.1007-3205.2022.04.004
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    Objective  To explore the relationship and interaction between smoking, anemia and susceptibility to chronic obstructive pulmonary disease(COPD), and to provide evidence for screening high-risk population and prevention and treatment of COPD.

    Methods  Eighty-nine patients with COPD(COPD group) and 89 healthy people(control group) were selected. Age, body mass index(BMI), comorbid diseases, educational level, marital status, smoking status, smoking index(SI), anemia status, hemoglobin(Hb) level, forced expiratory volume in one second as a percentage of forced vital capacity(FEV1/FVC), and forced expiratory volume in one second as percentage of predicted value(FEV1% pred) were compared between two groups. Pearson correlation analysis was used to analyze the correlation between SI, Hb and FEV1/FVC, FEV1% pred, and the Logistic regression equation was used to analyze the related influencing factors of COPD. The relative excess risk ratio(RERI), attribution ratio(AP) and interaction index(S) were used to analyze the interaction between smoking, anemia and the susceptibility to COPD.

    Results  Pearson correlation analysis showed that SI was negatively correlated with FEV1/FVC and FEV1% pred(P＜0.05), while Hb was positively correlated with FEV1/FVC and FEV1% pred(P＜0.05). Smoking, anemia, FEV1/FVC, and FEV1% pred were related to the susceptibility to COPD(P＜0.05).  After smoking factor stratification, the distribution of anemia among the smokers′ groups was significantly different (P＜0.05). Smoking and anemia were related to the susceptibility to COPD, with OR values of 3.384 and 1.141, respectively. There was a positive additive interaction between smoking and anemia. When the two factors coexisted, the risk of COPD was 6.600 times that of non-smokers and non-anemia patients. The interaction analysis showed S=2.218, RERI=3.075, and AP=46.59%. The prevalence of COPD caused by the interaction of smoking and anemia was 3.075 times higher than that caused by other unpredictable factors. In addition, 46.59% of the risk of COPD in patients with coexistence of smoking and anemia was caused by the interaction of the two.

    Conclusion  Smoking, anemia and COPD are closely related. Smoking, anemia, and lung function are the influencing factors of susceptibility to COPD. Smoking and anemia have an interactive effect on susceptibility to COPD.

    Clinical study of endoscopic signs for diagnosing Helicobacter pylori infection by white light endoscopy
    YANG Yang, GAO Guang-zhou, HAO Ying-xia
    2022, 43(4):  391-396，封三.  doi:10.3969/j.issn.1007-3205.2022.04.005
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    Objective  To investigate the clinical value of endoscopic signs for diagnosing Helicobacter pylori(Hp) infection by white light endoscopy.

    Methods  In total, 786 patients who underwent ordinary white light gastroscopy and 13C urea breath test were included. The endoscopic images were reviewed to judge whether there were various endoscopic signs. Taking the results of 13C urea breath test as the diagnostic standard of Hp infection, they were divided into Hp positive group(n=386) and Hp negative group(n=400). The detection rates of various endoscopic signs in the two groups were compared. The statistically significant endoscopic signs were further analyzed by binary logistic regression. Finally, the area under the receiver operating characteristic(ROC) curve of subjects with various endoscopic signs and the sensitivity, specificity, positive predictive value and negative predictive value of diagnosing Hp infection were calculated.

    Results  The Hp infection rate in 786 patients was 49.1%. The proportion of diffuse redness, punctate redness, mucosal swelling, fold enlargement, chicken skin like changes, hyperplastic polyps, gastric ulcer, duodenal ulcer and closed atrophy in Hp positive group was higher than that in Hp negative group(P＜0.05). The proportion of regular arrangement of collecting venules(RAC), ridge redness, gastric fundus gland polyps and old bleeding points in Hp negative group was higher than that in Hp positive group(P＜0.05). Binary logistic regression analysis showed that diffuse redness, punctate redness, mucosal swelling, fold enlargement and duodenal ulcer were independent risk factors of Hp infection(P＜0.05). RAC and gastric fundus gland polyps were negatively correlated with Hp infection(P＜0.05). The are aunder the ROC curve(AUC) showed that the areas under the ROC curve of diffuse redness and mucosal swelling to predict Hp infection were 0.729 and 0.751 respectively, the corresponding sensitivity was 71.8% and 65.5% respectively, and the specificity was 74.5% and 85.3% respectively. The AUC of RAC in predicting non-Hp infection was 0.804, the sensitivity was 68.5%, and the specificity was 92.5%.

    Conclusion  The endoscopic signs by white light endoscopy can accurately diagnose Hp infection，especially the diffuse redness，mucosal swelling and RAC.

    Safety and efficacy of siglitine combined with losartan potassium in the treatment of diabetes mellitus complicated by hypertension
    ZHAO Xi-chen, JIN Yu-jing SUN Xiao-wei, ZHU Tie-hong
    2022, 43(4):  397-401，428.  doi:10.3969/j.issn.1007-3205.2022.04.006
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    Objective  To explore the effects of siglitine combined with losartan potassium on angiogenesis-like protein 2(Angptl2) and glucose metabolism in diabetic patients with hypertension.

    Methods  A total of 142 patients with diabetes mellitus and hypertension were selected as the subjects. According to the treatment methods, they were divided into siglitatin group(n=67, treated with siglitatin) and combination treatment group(n=75, treated with siglitatin combined with losartan potassium). The results of carotid ultrasound examination, blood pressure, vascular stiffness, glucose metabolism, renal function index and therapeutic effect were observed in the two groups, and the serum Angptl2 and vascular endothelial function was detected by enzyme linked immunosorbent assay(ELISA).

    Results  In the combination treatment group, endometrial intermediate thickness(IMT), Crouse score, plaque detection rate, blood pressure, vascular stiffness, glucose metabolism, renal function indexes, and the levels of serum Angptl2 and vascular endothelial function were lower after treatment(P＜0.05). Total effective rate was higher in combination treatment group after treatment(P＜0.05). The total incidence of adverse reactions was slightly higher in combination treatment group than in the siglitine group, but there was no statistical difference between two groups(P＞0.05).

    Conclusion  Siglitine and losartan potassium can effectively improve the clinical symptoms of patients with diabetes combined with hypertension, reduce the Angptl2 level, promote the normalization of sugar metabolism, and achieve good results with few adverse reactions. Therefore, it is worthy of promotion and popularization.

    Study on the effect of debridement under arthroscopy combined with platelet-rich plasma in the treatment of moderate to severe knee osteoarthritis
    GU Wei
    2022, 43(4):  402-406，411.  doi:10.3969/j.issn.1007-3205.2022.04.007
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    Objective  To investigate the therapeutic effect and safety of debridement under arthroscopy combined with platelet-rich plasma(PRP) in patients with moderate to severe knee osteoarthritis(KOA), their impact on joint inflammation and oxidative stress and their correlation.

    Methods  A total of 64 patients with moderate and severe KOA were selected as the research subjects. According to the treatment methods, they were divided into observation group and control group, with 32 cases in each group. The observation group was treated with arthroscopic debridement combined with PRP. The control group was treated with arthroscopic debridement. Visual analogue scale(VAS) score was used to evaluate the pain relief before operation, and at 3 months and 12 months after operation. Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC) was used to evaluate the function of knee joint. The changes of tumor necrosis factor-α(TNF-α), interleukin-8(IL-8), superoxide dismutase(SOD) and nitric oxide(NO) were observed before and at 12 months after operation. The complications of the two groups were recorded. 

    Results  All 64 patients were followed up for 12-14 months, with a mean of(13.0±0.82) months. There were significant differences of interaction between groups, time points, time points between groups before operation, and at 3 months and 12 months after operation(P＜0.05). There were significant differences of interaction between groups, time points, and time points between groups with respect to WOMAC scores before operation, and at 3 and 12 months after operation(P＜0.05). At 12 months after operation, the levels of TNF-α, IL-8 and NO in the observation group were lower than those in the control group, while SOD was higher than that in the control group. In the observation group, the levels of TNF-α, IL-8 and NO were lower than those before operation, and SOD was higher than that before operation, with significant difference(P＜0.05). There was no significant difference before and after operation in the control group(P＞0.05). There was 1 case of lower limb swelling, and 1 case of incision infection in the observation group, as well as 2 cases of lower limb swelling, 1 case of incision infection and 1 case of thromboembolism in the control group. After corresponding treatment, the symptoms and signs disappeared. There was no significant difference in the incidence of complications between the two groups(χ2=0.136, P＞0.05).

    Conclusion  Compared with arthroscopic debridement, arthroscopic debridement combined with PRP in the treatment of moderate to severe KOA is more effective in relieving knee joint pain and improving knee function, and the incidence of complications is also lower. This may be related to the fact that arthroscopic debridement combined with PRP can reduce inflammation and oxidative stress in the joint cavity.

    Efficacy of Genetime combined with modified VSD technology in the treatment of refractory wounds and its impact on wound tissue-related growth factors and aesthetic satisfaction
    CHEN Xiao, LIU Ying
    2022, 43(4):  407-411.  doi:10.3969/j.issn.1007-3205.2022.04.008
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    Objective  To investigate the efficacy of GeneTime combined with modified vacuum sealing drainage(VSD) in the treatment of refractory wounds and its impact on wound tissue-related growth factors and aesthetic satisfaction.

    Methods  A total of 94 patients with refractory wounds were selected and divided into the research group(n=47) and the control group(n=47) according to a simple random number table method. On the basis of conventional treatment, the control group was treated with modified VSD, and the research group was treated with GeneTime on the basis of the control group for a total of 14 d. Therapeutic effects, visual analogue scale(VAS)wound pain score at 7 d and 14 d after treatment, levels of wound tissue-related growth factors［vascular endothelial growth factor(VEGF) and epidermal growth factor(EGF)］ before and at 14 d after treatment, incidence of complications, and aesthetic satisfaction were recorded in the two groups.

    Results  The total effective rate of the research group was higher than that of the control group(P＜0.05), and the VAS score of the research group was lower than that of the control group at 7 d and 14 d after treatment(P＜0.05). After treatment, the levels of VEGF and EGF were higher in both groups than those before treatment, and higher in the research group than in the control group(P＜0.05). There was no significant difference in the incidence of complications between two groups(P＞0.05), and the aesthetic satisfaction of the research group was higher than that of the control group(P＜0.05).

    Conclusion  The combination of GeneTime and modified VSD has a good effect in the treatment of refractory wounds, with fewer complications, and higher satisfaction of patients.

    Investigation into the status quo of stigma and alexithymia in patients with gynecological tumors in the Second Affiliated Hospital of Hainan Medical University and the effectiveness of predicting depression
    ZHANG Xiang-xiang, PENG Yi-ling, HU Tian-qiong
    2022, 43(4):  412-416，422.  doi:10.3969/j.issn.1007-3205.2022.04.009
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    Objective  To investigate the status quo of stigma and alexithymia in patients with gynecological tumors in the Second Affiliated Hospital of Hainan Medical University and the effectiveness of predicting depression.

    Methods  In total, 242 patients with gynecological tumor were selected as the research subjects. The Social Impact Scale(SIS) and the Toronto Alexithymia Scale(TAS-20) were used to investigate stigma and alexithymia, and Spearman was used to analyze the correlation between stigma, alexithymia and depression. Logistic regression model was used to analyze the influencing factors of depression in gynecological cancer patients, and ROC was used to predict the predictive value of stigma and alexithymia for depression in gynecological cancer patients.

    Results  The SIS score of gynecological tumor patients was higher than the domestic norm, and the TAS-20 score was higher than that of the normal control group(P＜0.05). SIS score and TAS-20 score of gynecological tumor patients were positively correlated with depression(r=0.605, P＜0.001; r=0.621, P＜0.001). Age ≥ 60 years, educational level of primary school and below, tumor diameter≥ 4 cm, self-payment, SIS score≥ 48, TAS-20 score ≥ 52, introversion, stage Ⅲ-Ⅳ and low differentiation were independent risk factors for depression in patients with gynecological tumors(P＜0.05). The AUC of SIS score in predicting depression was 0.849 (95%CI: 0.798-0.892). When the cut-off value was 50, the diagnostic sensitivity and specificity were 74.07% and 81.13% respectively. The AUC of TAS-20 score in predicting depression was 0.754 (95%CI: 0.695-0.807). When the cut-off value was 53, the diagnostic sensitivity and specificity were 57.14% and 84.91% respectively.

    Conclusion  Stigma and alexithymia are common in patients with gynecological tumors. Patients with gynecological tumors affected by these factors are prone to depression. In clinical practice, for patients with stigma and alexithymia, it is necessary to strengthen the prevention and perform the corresponding psychological adjustment to further reduce the risk of depression.

    The relationship between clinical features, laboratory-related indicators and prognosis of juvenile systemic lupus erythematosus
    ZHONG Liu-ming, LUO Ming, LAN Feng, LIN Liang, LIU Cai-hui, LI Wen-gen
    2022, 43(4):  417-422.  doi:10.3969/j.issn.1007-3205.2022.04.010
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    Objective  To study the relationship between clinical features, laboratory-related indicators and prognosis of juvenile systemic lupus erythematosus(SLE).

    Methods  A total of 145 juvenile patients with SLE were selected, and the incidence of poor prognosis was recorded. The clinical features and laboratory-related indicators of patients with different prognosis were compared. The independent influencing factors for the poor prognosis of juvenile SLE were analyzed by Cox risk model. According to the analysis results of Cox risk model, the prognostic index(PI) equation was established to analyze its value in evaluating the poor prognosis.

    Results  They were followed up for 1-10 years, with the median follow-up of(5.85±2.67) years. Of them, 3 cases were lost to follow-up, 5 cases died and 32 cases experiened recurrence. In addition, 37 cases had poor prognosis, and the poor prognosis rate was 25.52%. The incidence of Raynaud's disease, pulmonary infection, vertigo and vomiting in the poor prognosis group was significantly higher than that in the control group. The levels of reliable bit cast(RBC), 24 h urinary protein, total cholesterol(Cho), immunoglobulin A(IgA) and erythrocyte sedimentation rate(ESR) in the poor prognosis group were significantly higher than those in the control group, while the levels of complement 3(C3) and complement 4(C4) were significantly lower than those in the control group(P＜0.05). Cox risk regression model analysis showed that Raynaud's disease(β=0.934, HR=2.545, 95%CI=1.228-5.274, P=0.012), neuropsychiatric systemic lupus erythematosus(NPSLE)(β=0.806，HR=2.239，95%CI=1.102-4.549，P=0.026), IgA(β=0.921, HR=2.512, 95%CI=1.403-4.498, P=0.002), 24 h urinary protein quantification(β=0.784, HR=2.191, 95%CI=1.132-4.241, P=0.020) and C3(β=-0.523, HR=0.593, 95%CI=0.402-0.875, P=0.008) were independent influencing factors for the poor prognosis of juvenile patients with SLE. PI equation was established according to Cox risk regression model. Receiver operating characteristic(ROC) curve analysis showed that the area under ROC curve(AUC) of PI equation to evaluate the adverse prognostic risk of juvenile patients with SLE was 0.784(SE=0.091, 95%CI=0.606-0.963, P=0.032), the sensitivity was 0.800 and the specificity was 0.737.

    Conclusion  The prognosis of juvenile patients with SLE is related to its clinical features and laboratory-related indicators. The PI equation established accordingly has high accuracy in evaluating the poor prognosis of patients.

    Efficacy and safety of Yunnan Baiyao Capsule in reducing intranasal bleeding during endoscopic surgery and promoting nasal mucosa healing
    XUE Lin, ZANG Wen, YANG Li-ping, LI Jian-ying
    2022, 43(4):  423-428.  doi:10.3969/j.issn.1007-3205.2022.04.011
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    Objective  To evaluate the efficacy and safety of Yunnan Baiyao Capsule in reducing bleeding during sinusitis/nasal polyps endoscopic surgery and promoting the healing of nasal mucosa.

    Methods  A multicenter, double-blind, randomized, placebo-controlled study was used. A total of 200 patients who met the inclusion criteria were enrolled and randomly divided into the experimental group(n=100) and the control group(n=100). They were given Yunnan Baiyao Capsule and placebo(500 mg/time, 4 times a day)respectively which were initiated at 3 d before surgery, and continued at 6 h after surgery until 28 d after surgery. The intraoperative bleeding volume and bleeding volume per unit of the two groups, the healing of the nasal mucosal epithelium were observed, and the safety was evaluated.

    Results  Intention-to-treat(ITT) population analysis showed that intraoperative bleeding volume and bleeding volume per unit in the experimental group were less than those in the control group, and the difference was statistically significant(P＜0.05). PP population analysis showed that the intraoperative bleeding volume and bleeding volume per unit in the experimental group were less than those in the control group, and the difference was statistically significant(P＜0.05). In ITT population, the coverage rate of nasal mucosa epithelium in the experimental group and the control group at 8 weeks after operation was 56.12% in the experimental group and 38.14% in the control group, and there was significant difference between two groups(P=0.008). The total effective rate was 92.86% in the experimental group and 76.29% in the control group, and there was significant difference between  two groups(P=0.001). In PP population, the coverage rate of nasal mucosa epithelium in the experimental group and the control group at 8 weeks after operation was 56.67% in the experimental group and 41.86% in the control group, and there was significant difference between  two groups(P=0.041). The total effective rate was 95.56% in the experimental group and 82.56% in the control group, and there was significant difference between two groups(P=0.008). In ITT and PP population, Lund Kennedy endoscopic mucosal morphology score decreased at 2, 4, 6 and 8 weeks after operation in the experimental group and the control group, but the decrease was more significant in the experimental group. There were significant differences in the interaction between groups, time points, time points between groups(P＜0.05). There was no significant difference in the incidence of adverse events/adverse reactions between the two groups(P＞0.05).

    Conclusion  Yunnan Baiyao Capsules used in endoscopic sinus surgery can effectively reduce intraoperative bleeding volume and bleeding volume per unit, promote the healing of nasal mucosa, and have no obvious adverse effects.

    A sampling survey report of permanent tooth caries among students aged 12-15 in Hainan Province（2015-2016）
    WANG Yuan-yuan, XIE Li-li, GUO Dong-mei, GUO Qiu-yun, QUAN Tao, BAO Bai-cheng
    2022, 43(4):  429-438.  doi:10.3969/j.issn.1007-3205.2022.04.012
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    Objective  To evaluate caries status of permanent teeth among students aged 12-15 in Hainan Province, and to provide information support for oral health prevention and health care in Hainan Province.

    Methods  According to the Program of the Fourth National Epidemiological Survey of Oral Health, a total of 3 479 children aged 12-15 years in Hainan Province were selected by an equal-sized stratified multistage randomly sampling. All of them underwent a dental examination using community periodontal index(CPI) probe. SPSS 17.0 software was used for statistical analysis.

    Results  The prevalence of caries of students aged 12-15 years was 60.5%, with a mean decayed-missing-filled teeth(DMFT) of 1.95. The prevalence of caries and the mean DMFT were higher in rural areas(63.9%, 2.20) than in urban areas(57.3%, 1.72), and higher in females(66.1%, 2.27) than in males(54.9%, 1.64), suggesting significant difference(P＜0.05). The prevalence of caries was the highest in mandibular first molars. The prevalence of caries in maxillary central incisors were higher than that in maxillary first molars. The filling rate of caries was 17.0%, and the rate of sealant was 1.4%. The filling rate of caries and the rate of sealant were higher in urban areas(20.5%, 2.2%) than in rural areas(14.1%, 0.5%), with significant difference(P＜0.05), but no significant difference was found between males and females(P＞0.05).

    Conclusion  The prevalence of permanent teeth caries in students aged 12-15 years in Hainan Province is high, but the filling rate of caries and the rate of sealant are low. Oral health care measures should be further strengthened, especially in rural areas.

    Study on the levels of C-reactive protein of first-degree relatives of schizophrenia patients and its related factors
    ZHANG Shun, LI Na, LIANG Jing, WANG Li-ping, MA Wen-you
    2022, 43(4):  433-438.  doi:10.3969/j.issn.1007-3205.2022.04.013
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    Objective  To observe the expression of C-reactive protein(CRP) of first-degree relatives(FDR) of schizophrenia patients, and to analyze the related factors of changes of serum CRP.

    Methods  In total, 100 schizophrenia patients who were hospitalized and 175 FDR were selected as research subjects. Patients with schizophrenia were taken as schizophrenia group, and the FDR served as FDR group. Another 200 healthy people who underwent physical examination in the hospital were selected as healthy control group. The serum CRP levels of all subjects were detected, and FDR was assessed by the symptom checklist(SCL-90), MATRICS consensus cognitive battery(MCCB) and positive and negative symptom scale(PANSS). The expressions of serum CRP levels were compared among the three groups, and the SCL-90 scores of FDR group and healthy control group were compared. The expression of CRP levels of FDR with different gender, age, mental health status, cognitive function, severity of symptoms were compared, and linear regression analysis was used to analyze the potential factors related to abnormal CRP levels in FDR.

    Results  Among three groups, the serum CRP level of schizophrenia group was the highest, followed by FDR group and healthy control group, and the difference was statistically significant between groups(P＜0.05). The compulsive symptoms, somatization, interpersonal sensitivity, anxiety, depression, hostility, fear, paranoia, psychotic scores and total score in FDR group were higher than those in healthy control group, suggesting significant differences(P＜0.05). The results of linear regression analysis showed that poor mental health, poor cognitive impairment and moderate to severe symptoms might be related factors affecting serum CRP levels in FDR of patients with schizophrenia(P＜0.05).

    Conclusion  The serum CRP level of FDR of patients with schizophrenia is highly expressed, which may be related to the poor mental health status, poor cognitive impairment, and combined symptoms of FDR with certain degree of schizophrenia. For people with a family history of schizophrenia treatment, if the schizophrenia patient is FDR, attention should be paid to the changes of expression of serum CRP levels. Serum CRP that is found to be abnormally high should be promptly intervened to reduce the incidence of schizophrenia.

    Effects of diary for diet management on nutritional status of discharged elderly patients after surgery for esophageal cancer
    XUE Shan, LI Lai-you
    2022, 43(4):  439-443.  doi:10.3969/j.issn.1007-3205.2022.04.014
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    Objective  To explore the actual effect of diary for diet management program on improving the nutritional status of discharged elderly patients after surgery for esophageal cancer.

    Methods  A total of 100 elderly patients with esophageal cancer who underwent surgery for the first time were selected as the research subjects. Among them, 50 patients treated from February 2019 to October 2019 served as the control group, and 50 patients treated from November 2019 to October 2020 served as the experimental group. The patients in the control group received routine nutrition management and the patients in the experimental group were given diary for diet management program on this basis. The changes in body weight and body mass index(BMI), serum albumin(ALB), prealbumin(PAB), hemoglobin(Hb), and incidence of nutritional risk of the two groups were observed and analyzed at one month after intervention.

    Results  At one month after intervention, the body weight and BMI of the experimental group were significantly lower than those of the control group(P＜0.05). The levels of ALB and PAB in the experimental group were significantly higher than those in the control group(P＜0.05). There was no significant difference in Hb between two groups(P＞0.05). The incidence of nutritional risk in experimental group was lower than that in control group(P＜0.05).

    Conclusion  Applying the diary for diet management program to discharged elderly patients after surgery for esophageal cancer can improve the nutritional status of patients to a certain extent and benefit patients.

    Application of intranasal administration of dexmedetomidine in the ultrasound-guided hydraulic enema reduction in children with intussusception
    DU Wen-kang, ZHANG Chuan-bo, CHENG Li-ming, ZHANG Ming, GU Hai-fei, LIN Li-jia
    2022, 43(4):  444-448.  doi:10.3969/j.issn.1007-3205.2022.04.015
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    Objective  To evaluate the safety and efficacy of  intranasal administration of dexmedetomidine in the ultrasound-guided hydraulic enema reduction in children with intussusception.

    Methods  In total, 100 children with intussusception who underwent the ultrasound-guided hydraulic enema reduction in Kunming Children′s Hospital were selected as the research subjects. The patients were randomly divided into two groups: experimental group(group A, intranasal administration of 2 μg/kg dexmedetomidine) and control group(group B, with an equal amount of saline). Heart rate(HR), mean arterial pressure(MAP) and pulse oxygen saturation(SpO2) were recorded at the time of entering the room( T0), at 30 min after nasal drip(T1), at one-time enema reduction of anal canal(T2), immediately after successful reduction(T3) and at the time of leaving the room after recovery(T4). The success rate and reduction time of different pressures, hospitalization expenses and related complications after sedation were recorded.

    Results  HR and MAP decreased initially and then increased in group A, and increased initially and then decreased in group B. There were significant differences in interaction between two groups, different time points and time points between groups(P＜0.05). SpO2 in the two groups increased initially and then decreased. There was no significant difference in the interaction between groups and time points between groups(P＞0.05), and there was significant difference between different time points(P＜0.05). The success rate of group A at the reset pressure of 11.1 -13 kPa was higher than that of group B(P＜0.05), and there was no significant difference between two groups at the reset pressure of 13.1-15 kPa(P＞0.05). There was no significant difference in the incidence of reflux, aspiration, respiratory depression and laryngeal spasm between two groups(P＞0.05). The satisfaction of family members in group A was higher than that in group B(P＜0.05). The reduction time and hospitalization expenses in group A were less than those in group B(P＜0.05).

    Conclusion  Intranasal administration of  2 μg/kg dexmedetomidine can be safely used in  the ultrasound-guided hydraulic enema reduction in children with intussusception, which can not only improve the success rate of reduction, but also reduce the hospitalization expenses, with high satisfaction of children′s families.

    The impact of multidisciplinary team management model based on FTS concept on the condition, neurological function and prognosis of patients with aneurysmal inferior cavity hemorrhage
    CHEN Xing, FENG Juan
    2022, 43(4):  449-454.  doi:10.3969/j.issn.1007-3205.2022.04.016
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    Objective  To explore the application value of a multidisciplinary team management model based on the concept of fast track surgery(FTS) in patients with aneurysmal inferior cavity hemorrhage.

    Methods  The clinical data of 113 patients with aneurysmal inferior cavity hemorrhage in our hospital were collected for retrospective analysis and case-control study was carried out. According to nursing plans, they were divided into control group(n=56) and research group(n=57). Both groups underwent coil embolization, the control group received traditional nursing, and on the basis of traditional nursing, the research group received a multidisciplinary team management model based on the FTS concept. The complications, intraoperative blood pressure and heart rate fluctuations, recovery of illness［length of hospitalization, defecation time, recovery time of bowel sounds, glasgow outcome scale(GOS) score at discharge］, and nursing satisfaction degree were calculated in the two groups. The National Institutes of Health Stroke Scale(NIHSS), activity of daily living(ADL), and generic quality of life inventory-74(GQOLI-74) at admission and discharge were compared.

    Results  The intraoperative blood pressure and heart rate fluctuations in the research group were lower than those in the control group(P＜0.05). In the research group, the length of hospitalization, defecation time, recovery time of bowel sounds, and anal exhaust time were shorter than those of the control group, while the GOS score at discharge was higher than that of the control group(P＜0.05). The NIHSS and ADL scores of the research group were lower than those of the control group at discharge(P＜0.05). The scores of mental function, physical function and social function of the research group were higher than those of the control group at 1 month after discharge(P＜0.05). The complication rate of the research group was 3.51%, which was lower than that(15.79%) in the control group, and the degree of nursing satisfaction was 92.98%, which was higher than that(80.36%) of the control group(P＜0.05).

    Conclusion  The multidisciplinary team management model based on the FTS concept can reduce intraoperative blood pressure and heart rate fluctuations in patients with aneurysmal inferior cavity hemorrhage, promote their recovery, which can improve patients′ neurological function, ADL and quality of life, reduce the incidence of complications, and improve the prognosis of the disease.

    The role of thyroid ultrasound combined with serum Tg and TgAb in the diagnosis of postoperative recurrence of thyroid cancer
    ZHANG Xue-he
    2022, 43(4):  455-459,465.  doi:10.3969/j.issn.1007-3205.2022.04.017
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    Objective  To explore the role of thyroid ultrasound combined with serum thyroglobulin(Tg) and anti-thyroglobulin antibody(TgAb) in the diagnosis of postoperative recurrence or metastasis of thyroid cancer(TC).

    Methods  In total, 192 patients with differentiated thyroid carcinoma(DTC) who needed to be retreated with 131I clearanceafter treatment with surgical resection and 131I clearance in our hospital were selected as the research subjects. Thyroid ultrasonography was performed and serumTg and TgAb levels were detected. 131I whole-body single photon emission computed tomography(SPECT) imaging was performed at 1 week after retreatment with 131I clearance. The results of ultrasound and Tg levels compared with whole body scan(WBS) were recorded. The effects of TgAb levels and Tg on the diagnosis of recurrence or metastasis after DTC were analyzed, and binary Logistic regression analysis was used to analyze the correlation of ultrasound and positive Tg with WBS results.

    Results  The accuracy, specificity and sensitivity of ultrasound, Tg and the combination of the two in the diagnosis of recurrence or metastasis after DTC were 75.00%, 58.33%, 78.85%; 75.00%, 66.67%, 76.92%; 92.11%, 71.43%, 96.77 %, respectively. When TgAb≥100 U/mL and ＜100 U/mL, the diagnostic efficiency of Tg for recurrence or metastasis after DTC was 52.17%, 50.00%, 52.38% and 87.80%, 70.00%, 93.55%, respectively.Binary Logistic regression analysis showed that the risk of positive WBS in ultrasound and Tg-positive patients was 5.218 and 6.667 times that of negative patients.

    Conclusion  Thyroid ultrasound combined with serum Tg and TgAb detection can effectively improve the diagnosis efficiency of recurrence or metastasis after DTC. Comprehensive multiple indicators can be used for judgement, and 131I-WBS examination should be performed, when necessary, to reduce the rate of missed diagnosis.

    Study of the half effective dose of sufentanil combined with dexmedetomidine for sedation by contrast-enhanced transesophageal echocardiography
    PENG Yu-chuan, ZHANG Shi-hao, GU Jun-feng, XIAO Yun
    2022, 43(4):  460-465.  doi:10.3969/j.issn.1007-3205.2022.04.018
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    Objective  To explore the half effective dose of sufentanil combined with dexmedetomidine for sedation by contrast-enhanced transesophageal echocardiography(cTEE)using a sequential method.

    Methods  A prospective research design was adopted, and 26 inpatients aged 18-65 years that were scheduled to undergo cTEE at the Ultrasound Imaging Center of People's Hospital of Shiyan City and classified by American Society of Anesthesiologists(ASA) as grade Ⅰ-Ⅱ were enrolled in this study. For the first patient, the first loading dose of dexmedetomidine was set to 0.8 μg/kg, and the stepped dose was 0.1 μg/kg. The cTEE stress response of the previous patient was used to determine the load of the next patient. When the cTEE stress response of the previous patient was positive, the next patient's load of dexmedetomidine was increased by 0.1 μg/kg. When the cTEE stress response of the previous patient was negative, the load of dexmedetomidine was reduced by 0.1 μg/kg in the next patient. cTEE negative stress response was taken as the inflection point, and so on, until 7 inflection points appeared, when the test was completed. Mean arterial pressure(MAP), heart rate(HR), pulse oxygen saturation(SpO2) and Ramsay sedation score before anesthesia,before probe placement, during probe placement, at 2 min after probe placement, and at the end of the examination were recorded. Left ventricular ejection fraction(LVEF) before and after anesthesia, left ventricular fraction shortening(FS), left ventricular stroke volume(SV)were recorded. Whether the patients could perform a Valsalva maneuver was recorded. Cough and choking, nausea, hypotension, bradycardia and other adverse reactions and complications were recorded.

    Results  The half effective dose of sufentanil combined with dexmedetomidine for sedation by transesophageal echocardiography was 0.66 μg/kg(95%CI: 0.59-0.72). HR and MAP before probe placement, during probe placement, at 2 min after probe placement, and at the end of the examination were lower than those before anesthesia(P＜0.05); HR and MAP during probe placement were higher than those before probe placement, at 2 min after probe placement, and at the end of the examination(P＜0.05). The corresponding SpO2 at each time point and the LVEF, FS, and SV before and after anesthesia did not change significantly(P＞0.05).The Ramsay sedation score(2.91±0.58) of all patients after anesthesia inhibited the stress response was between 2 and 4 points in the ideal sedation depth, and they were able to perform a Valsalva maneuver during the examination, and there was no adverse reaction, such as hypoxia, hypotension, or bradycardia.

    Conclusion  The half effective dose of sufentanil combined with dexmedetomidine for sedation by cTEE was determined by the sequential method to be 0.66 μg/kg(95%CI: 0.59-0.72).

    The effect of different approaches of sciatic nerve block on analgesia and stress in patients with ankle fracture
    ZHANG Cheng-zhang, LI Zhen-wei, YU Jian-hua, PENG De-liang, LIAO Rong-zong
    2022, 43(4):  466-469,475.  doi:10.3969/j.issn.1007-3205.2022.04.019
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    Objective  To explore the analgesic effect of different approaches(transtrochanteric planar approach and transpopliteal approach) of sciatic nerve block applied to patients with ankle fracture during surgery, and their impact on stress state.

    Methods  A total of 78 patients with ankle fractures were selected, and based on the random number table method, they were divided into group A(sciatic nerve anesthesia block via the greater trochanter plane approach) and group B(sciatic nerve anesthesia block via the upper popliteal approach), with 39 cases in each group. Nerve block-related indicators, visual analogue scale（VAS） scores for pain at different time points after surgery, and muscle strength of the posterior femoral muscles at 8 h after surgery were compared, and the occurrence of adverse reactions was recorded.

    Results  Onset time of sensory block, operation time of nerve block, depth of sciatic nerve, the dosage of intraoperative fentanyl and the VAS score at 8 h after surgery were significantly lower in group B than in group A, and the difference was statistically significant(P＜0.05). At 15 min and 30 min after anesthesia, the systolic blood pressure, diastolic blood pressure and heart rate of group B were significantly lower than those of group A, with significant difference(P＜0.05). The differences of interaction between groups, time points and time points between groups were statistically significant(P＜0.05). The overall muscle strength of the posterior femoral muscles of group B was significantly higher than that of group A at 8 h after surgery, and the difference was statistically significant(P＜0.05). No adverse reactions occurred in the two groups.

    Conclusion  Compared with the greater trochanter approach, the upper popliteal approach for sciatic nerve block is simpler and has a more significant analgesic effect, and it can better retain the muscle strength of the posterior femoral muscles.

    The effect of angular pocket injection technique on diaphragmatic paralysis after supraclavicular brachial plexus obstruction
    LIU Ya-jun, ZHANG Ming-zhe, WANG Guo-rui, LIU Wen-ping, LV Rui-zhao, JING Yu-mo
    2022, 43(4):  470-475.  doi:10.3969/j.issn.1007-3205.2022.04.020
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    Objective  To explore the effect of horn pocket injection technique on diaphragmatic paralysis after supraclavicular brachial plexus block(SCBPB).

    Methods  In total, 40 patients who underwent upper limb fracture surgery in our hospital were selected, and randomly divided into a research group(n=20) and a control group(n=20). SCBPB was performed in both groups, the research group was given ultrasound-guided angle pocket injection technique, and the control group was given traditional plexus block anesthesia. The duration of operation of anesthesia block, the score of block effect, the duration of anesthesia, the onset time of each peripheral nerve block, diaphragmatic paralysis under different respiratory states and the incidence of adverse reactions were compared between two groups. Diaphragmatic movement and lung function indicators［forced expiratory volume in first second(FEV1), forced vital capacity(FVC)］ before and at 30 min after block were compared.

    Results  There was no significant difference in duration of operation of anesthesia block, block effect score and anesthesia duration between research group and the control group(P＞0.05). There was no significant difference in the onset time of radial nerve, median nerve, ulnar nerve, musculocutaneous nerve and medial forearm cutaneous nerve block between two groups(P＞0.05). At 30 min after block, the diaphragmatic movement of the two groups in the state of calm breathing and forced breathing was lower than that before block, which was higher in the research group than in the control group(P＜0.05). FEV1 and FVC in the two groups were lower than those before block, which were higher in the research group than in the control group(P＜0.05). The rate of diaphragmatic paralysis at 30 min after block in the research group was lower than that in the control group(P＜0.05). There was no significant difference in the incidence of adverse reactions between two groups(P＞0.05).

    Conclusion  Under the premise of ensuring the effective anesthesia block effect, the corner pocket injection technique can significantly reduce the incidence of diaphragmatic paralysis after SCBPB, improve the patient's lung function indicators, and provide new ideas for SCBPB.

    Application effect of remifentanil combined with propofol target-controlled infusion to maintain anesthesia in children undergoing tonsillectomy
    ZHANG Li-li, BAI Xiao-li, CHEN Lei, LI Fang, YANG Dong-xue, SHANG Rui-yuan
    2022, 43(4):  476-480.  doi:10.3969/j.issn.1007-3205.2022.04.021
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    Objective  To explore the application effect of remifentanil combined with propofol target-controlled infusion(TCI) to maintain anesthesia in children undergoing tonsillectomy.

    Methods  Samples of 85 children with chronic tonsillitis who were treated in Hebei Eye Hospital were selected for retrospective analysis. According to the different anesthesia plans adopted during the operation, they were divided into general anesthesia group and target-controlled anesthesia group. Children in the general anesthesia group received propofol, fentanyl, and atracurium for induction of anesthesia, and children in the target-controlled anesthesia group received remifentanil combined with propofol target-controlled infusion to maintain the anesthesia. The time interval from the end of the operation to extubation, the time to recover spontaneous breathing, and the time to wake up after the operation were compared between two groups of children. Heart rate(HR), mean arterial pressure(MAP) and blood oxygen saturation(SpO2) before anesthesia induction(T1), at the beginning of the operation(T2), at the end of the operation(T3) and at the time of recovery of spontaneous breathing(T4) were compared between two groups. The pediatric anesthesia emergence delirium（PAED） agitation scores of two groups when they were sent to the anesthesia recovery room after the operation, and the OAA/S rating of the children at 5 min after the extubation, and the occurrence of respiratory complications during the recovery period of the two groups of children were compared.

    Results  The duration from the end of the operation to the extubation, the recovery time after the end of operation, and the recovery time of the spontaneous breathing of the children in the target-controlled anesthesia group were lower than those in the general anesthesia group(P＜0.05). The differences of interaction between groups, and time points were statistically significant with respect to HR(P＜0.05). The differences of interaction between groups, time points and time points between groups were statistically significant with respect to MAP(P＜0.05). There was a statistical difference in time points between groups in terms of SpO2(P＜0.05). The pediatric anesthesia emergence delirium(PAED) score of children in the target-controlled anesthesia group was significantly lower than that of general anesthesia group(P＜0.05). There was no difference in the number of cases with OAA/S grade 3 and below between two groups(P＞0.05). The incidence of coughing and airway spasm in the target-controlled anesthesia group during the recovery period was significantly lower than that of general anesthesia group(P＜0.05).

    Conclusion  Remifentanil combined with propofol target-controlled infusion to maintain anesthesia can help children undergoing tonsillectomy to stabilize hemodynamics, reduce the incidence of postoperative restlessness, promote the recovery of children, and reduce the incidence of respiratory complications.