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    25 December 2024, Volume 45 Issue 12
    Effect of HYOU1 on apoptosis of diabetic Schwann cells and its effect on JAK-STAT pathway
    ZHOU Chen-ming1, CUI Fang1, SHI Ge-ming2, JIA Ke-qi3, AN Jia-hui3, XU Yan-nan4
    2024, 45(12):  1374-1379.  doi:10.3969/j.issn.1007-3205.2024.12.003
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    Objective To explore the effects of the endoplasmic reticulum molecular chaperone complex hypoxia up-regulated gene 1 (HYOU1) on apoptosis in diabetic Schwann cells and its mechanisms. 
    Methods A diabetic peripheral neuropathy cell model was constructed from logarithmic growth phase Schwann cells RSC96 using high sugar medium and transfected with a plasmid overexpressing HYOU1. The expression of HYOU1 in RSC96 cell line was detected by RT-qPCR and Western blot. The effect of HYOU1 on the apoptosis of RSC96 cells was detected by CCK8, fluorescence microscopy, transmission electron microscopy and flow cytometry. The effects of HYOU1 on apoptosis-related proteins and JAK-STAT signaling pathway were detected by Western blot. 
    Results The results of RT-qPCR and Western blot assay indicated that the RSC96 cell line overexpressing HYOU1 had been successfully constructed. CCK8, fluorescence microscopy, transmission electron microscopy and flow cytometry results showed that overexpression of HYOU1 resulted in a significant increase in cell viability and a significant decrease in the number of apoptotic cells (P<0.05). Western blot results indicated that after overexpression of HYOU1, the anti-apoptotic factors increased significantly, the pro-apoptotic factors decreased significantly, and the activation of JAK-STAT pathway was inhibited (P<0.05). 
    Conclusion HYOU1 may inhibit the apoptosis of RSC96 cells induced by high glucose by inhibiting JAK-STAT pathway. 

    Mining and analysis of adverse drug event signals of proton pump inhibitors in elderly patients based on openFDA database
    CHANG Ya-nan1, WANG Na2
    2024, 45(12):  1380-1386.  doi:10.3969/j.issn.1007-3205.2024.12.004
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    Objective To mine adverse drug event(ADE) signals for the use of proton pump inhibitors (PPIs) in elderly patients, and to provide a reference for the safe and rational clinical use of PPIs in elderly patients. 
    Methods Adverse event reports collected in the openFDA database from January 1, 2017 to September 30, 2022 were analyzed using both the reporting odds ratio (ROR) method and Medicines and Healthcare products Regulatory Agency (MHRA) to mine adverse event signals of five PPIs. 
    Results A total of 177 ADE signals were detected, involving 15 commonly used systems. Of these, there were a total of 68 signals for rabeprazole, 35 for lansoprazole, 33 for pantoprazole, 22 for omeprazole and 19 for esomeprazole. There were mainly 31 signals (36.64%) for renal and urinary disorders,25 signals (13.04%) for gastrointestinal disorders, and 19 signals (9.28%) for metabolic and nutritional disorders.Rabeprazole produced the highest variety and number of signals, mainly involving respiratory, thoracic and mediastinal disorders. 
    Conclusion For PPIs used in the elderly, in addition to the ADE already mentioned in the specification, the risks associated with renal function, electrolyte levels, and respiratory infections should be monitored, and certain preventive and therapeutic measures should be taken, or the application of PPIs should be avoided in high-risk populations and replaced by relatively safe PPIs, in order to ensure patientsafety. 

    Association between remnant cholesterol level and body mass index in patients with acute ischemic stroke
    LIU Zhong-zhong1, ZENG Ling-xia2, LU Qing-li1, ZHANG Na1, LIN Xue-mei1, WU Song-di1
    2024, 45(12):  1387-1393.  doi:10.3969/j.issn.1007-3205.2024.12.005
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    Objective To investigate the association between remnant cholesterol (RC) levels and body mass index (BMI) in patients with acute ischemic stroke (AIS). 
    Methods Based on the Stroke Registry Study database platform, clinical baseline data and laboratory test results of AIS patients admitted to four grade-A tertiary hospitals in Xi′an City from January to December 2017 were retrospectively analyzed. Patients with AIS were divided into four groups according to BMI: low weight group (BMI <18.5), normal body mass group (BMI: 18.5-23.9), overweight group (BMI: 24.0-27.9) and obese group (BMI≥28.0), and compared differences in clinical characteristics in different BMI groups. Multivariate regression analysis was used to investigate the association between different BMI and RC levels in patients with AIS, which was further explored by stratifying according to age and gender. 
    Results A total of 2 059 patients with AIS were finally included, with a mean age of (64.3±12.4) years, including 1 575 (62.8%) males and 934 (37.2%) females. After adjusting for relevant confounders, multivariate regression analysis showed that RC level was 0.13 mmol/L higher in AIS patients in obese group compared with normal weight group (β=0.13, 95%CI:0.02-0.23, P=0.015), and the trend of RC level increasing with the increase of BMI was statistically significant (P=0.033). Stratified analysis according to age revealed that the RC level was 0.23 mmol/L higher in obese AIS patients aged 45-65 years compared with normal weight patients (β=0.23, 95%CI: 0.06-0.40, P=0.009),and elderly AIS patients aged ≥65 years with low weight had a 0.14 mmol/L lower RC level than those with normal body weight (β=-0.14, 95%CI: -0.26--0.03, P=0.017).Stratified analysis by gender revealed that RC levels were significantly higher in obese AIS patients compared to normal body weight only in men (β=0.16, 95%CI: 0.02-0.31, P=0.028), but there was no significant correlation between RC and normal weight in women. 
    Conclusion The level of RC is significantly increased in middle-aged and elderly obese male patients with AIS,which may be related to the prognosis of these patients, and warrant the attention of clinicians. 

    Observation of the efficacy of camrelizumab combined with gemcitabine and cisplatin chemotherapy in patients with advanced squamous cell lung cancer
    ZHANG Wen-juan1, LU Dong-ming1, AI Yue-qin1, CHENG Xiao-mei2
    2024, 45(12):  1394-1398.  doi:10.3969/j.issn.1007-3205.2024.12.006
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    Objective To explore the efficacy of carilizumab combined with gemcitabine and cisplatin chemotherapy in patients with advanced lung squamous cell carcinoma (LSCC). 
    Methods In total, 82 patients with advanced LSCC were divided into two groups according to the treatment plan. The control group consisted of 38 patients who received gemcitabine and cisplatin chemotherapy, while the observation group consisted of 44 patients who received treatment with combination therapy of carizolizumab on the basis of the control group. After 2 cycles of treatment, the short-term efficacy, drug toxicity, and tumor marker expression [squamous cell carcinoma antigen (SCC Ag), cytokeratin 19 fragment antigen (CYFRA) 21-1, thyroid transcription factor-1 (TTF -1)] of both groups were evaluated. They were followed up for 12 months, and the median overall survival (OS) and progression-free survival (PFS) of the patients were recorded. 
    Results The objective remission rate of the observation group was 29.55%, which was higher than that of the control group (10.53%), and the disease control rate was 77.27%, which was higher than that of the control group (52.63%) (P<0.05). After treatment, the serum levels of SCC Ag and CYFRA21-1 in both groups decreased compared with those before treatment, which were lower in the observation group than in the control group (P<0.05). There was no significant difference in TTF-1 levels between the two groups after treatment (P>0.05). There was no significant difference in the incidence of bone marrow suppression, gastrointestinal reactions, liver dysfunction, skin and mucosal toxicity, allergic reactions, and neurological toxicity between the two groups (P<0.05). The median PFS of the observation group and the control group were 4 months and 3 months, respectively, and the median OS was 11 months and 7 months, respectively. The difference in PFS and OS survival curves between the two groups was statistically significant (Log rank χ2=9.937, 12.471, P<0.05). 
    Conclusion The combination of carilizumab and gemcitabine+cisplatin chemotherapy for advanced LSCC can improve the anti-tumor effect of patients, regulate the expression of tumor-related biomarkers, and has good safety. 

    Effects of ultra-pure dialysate combined with high flux dialysis on oxidative stress, microinflammatory state and calcium-phosphorus metabolism in patients with end-stage renal disease undergoing MHD
    ZHANG Jian, YANG Ying-jia, WANG Feng-ping, DING Qi
    2024, 45(12):  1399-1403.  doi:10.3969/j.issn.1007-3205.2024.12.007
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    Objective To observe and explore the effects of ultra-pure dialysate combined with high flux dialysis on oxidative stress, microinflammatory state and calcium-phosphorus metabolism in patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis (MHD). 
    Methods Clinical data of 120 patients with ESRD undergoing MHD who were treated in our hospital were retrospectively analyzed, and the patients were divided into ultra-pure dialysate group (n=60) and non-ultra-pure dialysate group (n=60) according to different dialysis methods. The non-ultra-pure dialysate group received conventional dialysate, and the ultra-pure dialysate group received ultra-pure water + central liquid supply of concentrated A solution+ B powder cylinder configuration. All patients underwent high flux dialysis. Serum oxidative stress indicators [malondialdehyde (MDA), glutathione peroxidase (GSH-px)], microinflammatory state [interleukin-6 (IL-6), interleukin-13 (IL-13), C-reactive protein (CRP), albumin (ALB), hemoglobin (Hb), hematocrit (HCT)], renal function indicators [blood urea nitrogen (BUN), serum creatinine (SCr), β2 microglobulin (β2-MG), estimated glomerular filtration rate (eGFR)] and calcium-phosphorus metabolism were compared between the two groups after treatment. 
    Results After treatment, the levels of MDA, IL-6, CRP, ALB, Hb, HCT and blood calcium in both groups were significantly increased (P<0.05), while the levels of GSH-px, IL-13, BUN, SCr, β2-MG, eGFR, blood phosphorus and calcium-phosphorus product were significantly decreased (P<0.05), and the above indicators except ALB and HCT were significantly different between ultra-pure dialysate group and non-ultra-pure dialysate group (P<0.05).  
    Conclusion Ultra-pure dialysate combined with high flux dialysis can effectively improve the body′s oxidative stress response and microinflammatory state, help stabilize the balance of calcium-phosphorus metabolism and delay the loss of residual kidney function in patients with ESRD undergoing MHD, and it is worthy of clinical promotion and application. 

    Observation of prenatal diagnosis of fetal sex chromosome mosaicism and chromosome polymorphism for pregnancy outcomes
    TAN Lei, GAO Rui-hong
    2024, 45(12):  1404-1408.  doi:10.3969/j.issn.1007-3205.2024.12.008
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    Objective To observe the prenatal diagnosis of fetal sex chromosome mosaicism and chromosome polymorphism for pregnancy outcome. 
    Methods We selected 400 pregnant women in the middle and late stages of pregnancy who underwent diagnosis and treatment in the First Affiliated Hospital of Air Force Medical University, and underwent amniocentesis for analysis of amniotic fluid chromosome karyotype. The distribution of different types of abnormal karyotypes was observed, and the distribution of sex chromosome mosaicism was analyzed. Chromosomal polymorphism distribution and pregnancy outcomes were recorded. 
    Results Among the 58 abnormal karyotypes, 39 patients (67.24%) had abnormal chromosome number, and the most common was trisomy 21 syndrome, including 14 patients (24.15%). There were 12 patients (20.69%) with chromosome Mosaic type, 19 patients (32.76%) with abnormal chromosome structure, as well as 8.62% patients with inversion and 6.89% with translocation. A total of 11 patients with sex chromosome mosaicism were detected, including 9 patients with 45,X mosaicism and 2 patients with other types of chromosomes. The most common indication for prenatal diagnosis was amniotic fluid karyotype verification. Through follow-up observation, 9 patients chose to terminate pregnancy, and 1 patient had blurred genitalia after induced labor. Two pregnant women with low proportion fetal karyotype of sex chromosome mosaicism 45,X[3]/46,XX[97] and 45,X[4]/46,XX[65] continued their pregnancy and delivered a full-term female neonate by cesarean section, and the physical status and IQ indexes of the neonate were normal. Through the follow-up observation of pregnancy outcomes, except 32 patients with chromosome polymorphism who were lost to follow-up, there were 4 patients with pregnancy termination due to fetal structural abnormalities, and 22 patients with continued pregnancy. Among the pregnant women who continued the pregnancy, 19 neonates had normal physical and intellectual health, and only 3 neonates had abnormalities after birth. 
    Conclusion Prenatal diagnosis can be performed by amniocentesis and chromosome karyotype analysis of amniotic fluid to inform pregnant women of possible abnormalities in the fetus, so as to avoid the birth of children with chromosome abnormalities, ensure the health of the fetus after birth, and reduce the burden of society and family. 

    The correlation between D-dimer/fibrinogen ratio and IVF-ET assisted pregnancy outcomes in infertile patients
    WEI Ji-yun, BAN Ting, SHI De-min, WEI Qing-miao, WEI Qiao-yi, WEI Lan-jing
    2024, 45(12):  1409-1414.  doi:10.3969/j.issn.1007-3205.2024.12.009
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    Objective To analyze the relationship between D-dimer/fibrinogen ratio (DFR) and in vitro fertilization and embryo transfer (IVF-ET) assisted pregnancy outcomes in infertile patients, and to provide experience for improving assisted pregnancy outcomes. 
    Methods A retrospective analysis of 152 infertile patients who received IVF-ET treatment in the Reproductive Medicine Center, the People′s Hospital of Hechi City, was conducted. According to the outcome of assisted pregnancy, 93 infertility patients who obtained clinical pregnancy were included in the pregnancy success group, and the remaining 59 patients were included in the pregnancy failure group. The D-dimer (DD) and fibrinogen levels of human chorionic gonadotropin (HCG) in the early morning of the day for injection in the two groups were collected, and the DFR was calculated to analyze the correlation between DFR and IVF-ET assisted pregnancy outcome of infertile patients. 
    Results The DD, fibrinogen, and DFR values in the pregnancy failure group were higher than those in the pregnancy success group, while the prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT) were shorter than those in the pregnancy success group, with significant differences (P<0.05). Point-biserial correlation analysis showed that DFR was positively correlated with IVF-ET outcome in infertile patients (r=0.776, P=0.030). Logistic regression analysis showed that elevated DD, fibrinogen, and DFR were risk factors for IVF-ET assisted pregnancy failure in infertile patients (OR>1, P<0.05), while prolonged PT, APTT, and TT were protective factors for IVF-ET assisted pregnancy failure in infertile patients (OR<1, P<0.05). The receiver operating characteristic (ROC) curve was drawn, and the results showed that DD, fibrinogen, DFR, PT, APTT, and TT had certain predictive value for IVF-ET assisted pregnancy outcomes in infertile patients, but DFR had the optimal predictive value.  
    Conclusion DFR is related to the IVF-ET assisted pregnancy outcome in infertile patients. Elevated DFR values can increase the risk of IVF-ET assisted pregnancy failure in infertile patients, and DFR values can provide important value for predicting IVF-ET assisted pregnancy outcomes in infertile patients. 

    Analysis of risk factors and vitamin D levels of neonatal early-onset sepsis
    YU Quan-ping1, FU Xiao-kang1, SU Qin1, HOU Feng-xiang1, YANG Jian-bao2, ZHAI Hong-ran1
    2024, 45(12):  1415-1419.  doi:10.3969/j.issn.1007-3205.2024.12.010
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    Objective To investigate the risk factors of early-onset sepsis (EOS) in neonates and its relationship with vitamin D levels. 
    Methods A total of 56 neonates with EOS admitted to the Second Affiliated Hospital of Hebei North University were selected as the EOS group, and another 60 neonates born in the same period excluding infections were selected as the control group. The clinical data of neonates and corresponding mothers in the two groups were collected, and the levels of 25-hydroxyvitamin D [25-(OH)D] in venous blood of neonates and mothers in the two groups were detected. The clinical data and vitamin D levels in the two groups were analyzed. 
    Results The incidences of maternal chorioamnionitis, premature rupture of membranes≥18 h, placental abruption, meconium-stained amniotic fluid, fetal distress and asphyxia at birth in EOS group were higher than those in the control group (P<0.05). The levels of 25-(OH)D of mothers and neonates in EOS group were significantly lower than those in the control group (P<0.01). Multivariate Logistic regression analysis showed that maternal chorioamnionitis, premature rupture of membranes≥18 h and neonatal asphyxia at birth were risk factors for EOS (P<0.05). Neonatal 25-(OH)D level was a protective factor for EOS (P<0.05). The area under the receiver operating characteristic curve (AUC) of neonatal 25-(OH)D level for the prediction of EOS was 0.833 (P=0.013), and the Jordan index was 0.512. The cut-off value of neonatal 25-(OH)D level was 21.29 nmol/L, and the sensitivity and specificity for the prediction of EOS were 83.3% and 67.9% respectively. The levels of 25-(OH)D in mothers and neonates were positively correlated in both EOS group and control group (P<0.05). 
    Conclusion Maternal chorioamnionitis, premature rupture of membranes≥18 h and neonatal asphyxia at birth are risk factors for EOS, while neonatal 25-(OH)D level is a protective factor for EOS and also a good predictive index. Pregnant women should pay attention to vitamin D supplementation to reduce the incidence rate of EOS. Early identification of risk factors and detection of vitamin D levels is helpful for comprehensively assessing the risk of EOS. 

    Application and valence analysis of the simplified Chinese version of the PSQ questionnaire in the diagnosis of sleep apnea syndrome in children
    ZHANG Bi-yun1, FENG Dan-ni2, LIN Hong-jun1, TU Ge-te2
    2024, 45(12):  1420-1425.  doi:10.3969/j.issn.1007-3205.2024.12.011
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    Objective Obstructive sleep apnea syndrome (OSAS) in children is a common respiratory disease that affects growth and development in children. Currently, there is a lack of fast and efficient assessment methods. In order to detect OSAS in children at an early stage, this study aims to explore the application and valence evaluation of the Pediatric Sleep Questionnaire (PSQ) in the latest diagnostic criteria for OSAS in children. 
    Methods Children with snoring and mouth breathing during sleep who were aged 3-14 years presented to the First Affiliated Hospital of Guangzhou Medical University for overnight polysomnography (PSG). They were divided into OSAS group (n=147), and the control group (without OSAS after PSG, n=67). The valence of PSG in the latest diagnostic criteria for pediatric OSAS was analyzed by calculating standardized load factors and logistic regression analysis.  
    Results Amos model was used to analyze the exploratory factors on 21 items and indicated KOM=0.703, and Barlett′s test of sphericity P<0.001. Comparing the respiratory items of questionnaires in the two groups, there was a significant difference between the OSAS group and the control group with respect to A3 (P<0.001), A4 (P<0.001), A5 (P<0.001) and A6 (P<0.001), while there was no significant difference in A24, A25 and B7. This suggested that children in the OSAS group were mainly characterized by snoring during sleep, with less mouth breathing, dry mouth, and dizziness, while B4 was significantly different (P<0.004), indicating that children in the OSAS group were more prone to daytime drowsiness or a tendency to sleep excessively. In terms of behavior items, there were significant differences between the OSAS group and the control group with respect to C3 (P<0.001), C5 (P<0.001), C8 (P<0.001), and C10 (P<0.001), indicating that OSAS children had significant attention deficit. The logistic regression analysis showed that the overall reliability Cronbach coefficient was 0.772, and the internal correlation coefficient was 0.754. Adverse outcome of OSAS was strongly positively correlated with A2, A3, A4, A5, A7, A25, B4, C10, and A32, which indicated the respiratory related questionnaire playing crucial roles in OSAS outcome. The critical value of PSQ in the latest diagnostic criteria for OSAS was 4.5, with a sensitivity of 82.3%, aspecificity of 85.1%, positive predictive value of 0.924, and negative predictive value of 0.687. 
    Conclusion This study shows that the simplified Chinese version of PSQ can be a primary tool for screening OSAS patients in clincal practice. 

    Application of high-frequency ultrasound and elastography technology in evaluating the rehabilitation effect after supraspinatus tendon repair
    YE Hui1, LU Bo2, LI Lu-qi1, ZHU Ya-ru1, DENG He-ping1
    2024, 45(12):  1426-1432.  doi:10.3969/j.issn.1007-3205.2024.12.012
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    Objective To explore the application value of high-frequency ultrasound and elastography technology in following up the rehabilitation effect after supraspinatus tendon repair. 
    Methods A total of 39 patients who underwent arthroscopic rotator cuff repair due to simple supraspinatus tendon tear in the Department of Shoulder and Elbow, the Third Hospital of Hebei Medical University were enrolled. The results of high-frequency ultrasound and elastography technology measuring the thickness, width and shear wave velocity(SWV) of the supraspinatus tendon at 1 month, 3 months and 6 months after surgery were retrospectively analyzed. The visual analog scale (VAS) score and Constant-Murley shoulder joint score of the patients were also collected. The changes of ultrasound indicators of supraspinatus tendon at different periods after surgery were compared, the correlation between ultrasound indicators and VAS scores was analyzed, and the judgment efficiency of each ultrasound indicator for the rehabilitation effect was analyzed based on the Constant-Murley score of 70. 
    Results When comparing each other at each postoperative period, there was no significant difference in the width of the supraspinatus tendon on the affected side (P>0.05), while there was a significant difference in the thickness of the supraspinatus tendon on the affected side between 1 month and 3 months after surgery, and between 1 month and 6 months after surgery(P<0.05). There was no significant difference in the thickness of the supraspinatus tendon on the affected side between 3 months and 6 months after surgery (P>0.05). The difference in SWV value of supraspinatus tendon on the affected side was significant between 1 month and 3 months after surgery, between 3 months and 6 months after surgery, and between 1 month and 6 months after surgery (P<0.05).The difference in thickness and SWV value of the supraspinatus tendon between the affected side and the healthy side was significant at 1 month after surgery (P<0.05), but the difference in width was not significant (P>0.05). At 3 months and 6 months after surgery, the difference in SWV value of the supraspinatus tendon between the affected side and the healthy side was significant (P<0.05), but there was no significant difference in the thickness and width (P>0.05). Spearman correlation analysis showed that the SWV value had a moderate positive correlation with the VAS score of the shoulder joint (rs=0.591, P<0.001), while the thickness and width had no significant correlation with the VAS score of the shoulder joint. Based on the Constant-Murley score of 70, the area under the curve (AUC) of the SWV value was 0.781, and the AUC of the thickness and width was 0.531 and 0.466 respectively. 
    Conclusion High-frequency ultrasound and elastography technology can evaluate the changes in postoperative morphology and stiffness of patients' supraspinatus tendon in a timely manner. SWV has certain reference value in evaluating VAS and judging the effect of functional rehabilitation, which is helpful to clinicians and rehabilitation physicians to develop an appropriate rehabilitation plan.

    Effect of stele ganglion block on nausea, vomiting and acute stress disorder in elderly patients undergoing thoracoscopic surgery
    SHEN Lei1, HU Xiao-lu1, ZHANG Qing-he2
    2024, 45(12):  1433-1438.  doi:10.3969/j.issn.1007-3205.2024.12.013
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    Objective To investigate the effects of stele ganglion block (SGB) on postoperative nausea and vomiting (PONV) and acute stress disorder in elderly patients after thoracoscopic surgery under general anesthesia. 
    Methods A total of 92 elderly patients undergoing elective thoracoscopic lung lesion resection in the Affiliated Hospital of Xuzhou Medical University were selected and divided into research group (n=46) and control group (n=46) by random number table method. Both groups received general anesthesia and the research group was given SGB under ultrasound guidance with 0.25% ropivacaine 4 mL. Postoperative indexes, postoperative pain, PONV, acute stress disorder, stress response and related proteins were compared between the two groups. 
    Results The dosage of remifentanil (1 653.08±69.76) μg and propofol (417.34±45.06) mg in the study group were lower than those in the control group (1 725.14±75.62) μg and (487.09±51.23) mg (P<0.05). The recovery time of the study group (15.18±2.38) min was shorter than that of the control group (19.37±3.45) min (P<0.05). There was no statistically significant difference in the first exhaust time and first getting out of bed time between the two groups (P>0.05). Interactions between two groups of visual analog scores (VAS): between groups, between time points, and between groups and time points. The difference was statistically significant (P<0.05), and there was a significant difference in PONV grading between the two groups (P<0.05). The incidence of PONV 24 hours after surgery in the study group (21.74%) was lower than that in the control group (54.35%) (P<0.05). There was a statistically significant difference (P<0.05) in the interaction between two groups of acute stress disorder scale (ASDS) scores, including between groups, time points, and between groups and time points. 24 hours after surgery, the levels of serum cortisol (CORT), norepinephrine (NE), phosphorylated tau-181 (p-tau-181), and β-amyloid 1-42 (β-amyloid 1-42, A β 1-42) in both groups increased (P<0.05), while the study group was lower than the control group (P<0.05). 
    Conclusion SGB can reduce the amount of anesthesia in elderly patients undergoing thoracoscopic surgery, reduce the risk of PONV, and alleviate symptoms related to acute stress response. 

    Impact of renal anemia on HbA1c in diabetic and non-diabetic patients
    SHI Dong-sha1, ZHOU Hui-min1, FENG Wen-li2, DONG Zuo-liang1
    2024, 45(12):  1439-1444.  doi:10.3969/j.issn.1007-3205.2024.12.014
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    Objective To determine the effect of renal anemia on the glycosylated hemoglobin A1c (HbA1c)in patients with diabetes mellitus (DM) and patients without DM. 
    Methods A total of 165 patients with renal anemia treated in General Hospital of Tianjin Medical University to including 67 patients with simple renal anemia and 98 with DM and renal anemia, were respectively analyzed. Correspondingly, the control group included 160 healthy controls and 272 patients with simple DM. Blood routine, fasting plasma glucose (FPG) and HbA1c of the four groups were collected and statistically explored. 
    Results The FPG of the simple DM group and the DM and renal anemia group was 6.80(2.90) mmol/L and 6.30(3.40) mmol/L respectively, showing no significant difference (Z=-1.420, P=0.156). The HbA1c levels of the simple DM group and DM and renal anemia group were 7.50(2.10%) and 6.50(1.8)% respectively. The HbA1c of the DM complicated with renal anemia were significantly lower than that of the simple DM (Z=-6.195, P<0.001) and absolute difference was 1.0%. In addition, there was a positive correlation between HbA1c and hemoglobin levels in DM patients (r=0.294, P<0.001). Both the FPG and the HbA1c levels were significantly lower in the simple renal anemia group than in the healthy control group (both P<0.05). There was no significant difference in the ratio of FPG to HbA1c between the two groups (Z=-0.835, P=0.404). Furthermore, the correlation between FPG and HbA1c (r=0.618, P<0.001) was significantly lower in the moderate to severe anemia group than in the healthy control group (r=0.718, P<0.001), while the correlation did not decrease in the mild anemia group. 
    Conclusion Renal anemia can significantly decrease the HbA1c in DM patients, so that HbA1c cannot truly reflect the blood glucose level of patients. Therefore, the results of HbA1c detection in patients with DM and renal anemia should be treated with caution. Renal anemia patients without DM have lower blood glucose levels than normal people, and monitoring their long-term blood glucose levels with HbA1c does not make the results unreliable. 

    Analysis on current situation and influencing factors of medical narrative ability of clinical medical graduates in Hebei Province
    LI Zi-qi1, LIU Yun2
    2024, 45(12):  1445-1451.  doi:10.3969/j.issn.1007-3205.2024.12.015
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    Objective To evaluate the medical narrative ability, humanistic care quality and empathy ability of clinical medical graduates from 6 medical colleges and universities in Hebei Province (including medical colleges/departments of comprehensive universities, hereinafter referred to as medical colleges), and to explore the influencing factors of medical narrative ability of clinical medical students. 
    Methods The clinical medical graduates of 6 medical colleges in Hebei Province were investigated by Questionnaire Star platform with convenient sampling method. The medical narrative ability, empathy ability and humanistic care quality of the survey subjects were evaluated using the Chinese physician Narrative Behavior Ability Scale, the Chinese version of Jefferson Empathy Ability Scale and Humanistic Care Quality Scale. 
    Results The scores of medical narrative ability,humanistic care quality and empathy ability were (88.84±14.57) points, (119.27±14.87) points, and (57.02±8.22) points, respectively. The main factors affecting the medical narrative ability of clinical medical students were gender, frequency of holding narrative medicine related conferences or training projects, humanistic care concept and humanistic care perception (P<0.05). 
    Conclusion The medical narrative ability of clinical medical students is above the average level, which, however, needs to be improved. The humanistic care quality is good, while empathy ability is poor. It is suggested to set up narrative medicine courses to strengthen the training of narrative ability, strengthen the training of teachers to improve the medical narrative level of teachers, pay attention to the humanistic construction of schools and hospitals, strengthen the professional responsibility of medical students and improve the medical narrative ability of clinical medical students. 

    Medical staff′s attitudes to withdrawal of effective treatment in China: A cross-sectional study
    ZHANG Qian-kun, LUO Xi, ZHANG Xin-qing
    2024, 45(12):  1452-1458.  doi:10.3969/j.issn.1007-3205.2024.12.016
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    Objective To understand medical staff′s attitude to withdrawal of effective treatment in China, and to analyze its influencing factors. 
    Methods Based on Medical Staff′s Employment Survey in 2023, random sampling was used to select hospitals in eastern, central and western China for investigation. A self-administered online questionnaire was designed based on expert opinions, and a total of 8 386 valid questionnaires were retrieved. The collected data were analyzed by descriptive statistics for frequency distribution, chi-square test for attitude of medical staff with different characteristics towards withdrawal of effective treatment, and binary logistic regression analysis for influencing factors. 
    Results In total, 21.1% (1 769/8 386) of people chose "Yes" to agree to the request of the patient′s guardian; there were significant differences in attitudes towards "withdrawal of effective treatment" among medical staff of different genders, ages, marital status, the highest education level, job categories, professional titles, departments, and hospital types (P<0.05). In addition, 66.5% of medical staff adopted different measures based on clinical practice. The results of binary logistic regression analysis showed that males, postgraduate degree, medical staff, emergency department and non-private hospitals were risk factors for the choice of medical staff to"withdraw effective treatment". Medical staff aged 44 and above, with higher job satisfaction and patient trust, were less likely to agree to the patient′s family′s request to "withdraw effective treatment" (P<0.05). 
    Conclusion In-depth research on policies, regulations and ethics related to withdrawal of treatment should be carried out, to provide guidance for medical decisions on life and death of end-stage patients. Standard procedures for withdrawal of treatment should be established to explore feasible models for shared decision making.