Objective:To investigate the value of serum gastrin 17 (G-17), pepsinogen I (PG I), pepsinogen II (PG II), and programmed cell death protein 5 (PDCD5) in the identification of gastric precancerous state and the diagnosis of early gastric cancer.Methods:A total of 86 patients with early gastric cancer who received treatment at the Marine Police Corps Hospital of Chinese People's Armed Police Force from July 2018 to June 2022 were included in the gastric cancer group. Eighty patients with gastric precancerous states who concurrently received treatment in the same hospital were included in the precancerous state group. An additional 80 partiapants who concurrently received physical examination in the same hospital were included in the healthy group.The value of G-17, PG I, PG II, and PDCD5 in the diagnosis of early gastric cancer was analyzed.Results:The levels of G-17 and PG II in the precancerous state group [(10.87 ± 3.23) pmol/L, (15.78 ± 3.33) μg/L] and gastric cancer group [(18.78 ± 4.10) pmol/L, (21.25 ± 4.48) μg/L] were significantly higher compared with the healthy group [(5.56 ± 1.43) pmol/L, (13.52 ± 3.02) μg/L, F = 362.65, 94.12, all P < 0.05]. The levels of PG I and PDCD5 in the precancerous state group [(79.52 ± 16.62) μg/L, (1.35 ± 0.15) μg/L] and gastric cancer group [(50.06 ± 15.58) μg/L, (0.85 ± 0.13) μg/L] were significantly lower than those in the healthy group [(110.12 ± 30.23) μg/L, (1.60 ± 0.12) μg/L, F = 151.07, 650.56, all P < 0.05)].There were significant differences between the precancerous state and the gastric cancer groups in terms of family history of gastric cancer, consumption of high salt fried foods, alcohol consumption history, and Helicobacter pylori (Hp) infection ( χ2 = 10.39, 4.68, 11.47, 36.49, all P < 0.05). Family history of gastric cancer ( OR = 1.42, 95% CI = 1.03-1.96) and Hp infection ( OR = 3.76, 95% CI = 1.30-10.85) were identified as risk factors for gastric cancer ( P < 0.05). The combination of G-17, PG I, PG II, and PDCD5 had the highest predictive efficiency for early gastric cancer ( P < 0.05), with the area under the receiver operating characteristic curve being 0.982, sensitivity and specificity of 98.84% and 90.00%, respectively. Conclusion:Family history of gastric cancer and Hp infection are risk factors for gastric cancer. Patients with precancerous state and early gastric cancer have elevated serum levels of G-17 and PG II and reduced serum levels of PG I and PDCD5 protein. Combined detection of these four indicators has a high diagnostic value for early gastric cancer.
Objective:To investigate the effect of prolonged negative pressure drainage time after parotidectomy and analyze its relationship with the incidence of postoperative salivary fistula.Methods:The clinical data of 94 patients with benign parotid gland tumors who received treatment in the Department of Otolaryngology-Head and Neck Surgery of The First Affiliated Hospital of Xiamen University from July 2021 to June 2022 were retrospectively analyzed. These patients were divided into an observation group and a control group ( n = 47 per group). In the observation group, the negative pressure drainage tube was removed after 1 week of simple negative pressure drainage, while in the control group, conventional local bandaging of the parotid gland was performed for 2 weeks, and negative pressure drainage was given for 2-3 days. Postoperative drainage volume, pain degree, and the incidence of salivary fistula were recorded for each group. Results:The total drainage volume in the observation group was (77.93 ± 23.83) mL, which was significantly greater than (47.06 ± 24.71) mL in the control group ( t = 6.17, P < 0.001). The Visual Analogue Scale score in the observation group was (3.021 ± 1.07) points, which was significantly lower than (7.53 ± 1.27) points in the control group ( t = 18.63, P < 0.001). The incidence of postoperative salivary fistula in the observation group was 2.1% (1/47), which was significantly lower than 17.0% (8/47) in the control group ( χ2 = 4.42, P = 0.035). Conclusion:Simple prolongation of negative pressure drainage time can achieve full drainage, improve the quality of life of patients after parotidectomy and reduce the occurrence of postoperative salivary fistula, which is worthy of clinical promotion.
Objective:To investigate the effect of penehyclidine hydrochloride on respiratory mechanics, arterial blood gas, and inflammatory factors in patients undergoing one-lung ventilation during thoracoscopic lobectomy.Methods:A total of 100 patients who underwent thoracoscopic lobectomy with one-lung ventilation at Jinhua Central Hospital from January to November 2022 were included in this randomized controlled study. They were divided into groups A and B ( n = 50 per group) using a random digital number table. Patients in group A received an intravenous infusion of 0.02 mg/kg of pentylenethyclidine hydrochloride 30 minutes before surgery, while patients in group B received an equal amount of 0.9% sodium chloride injection 30 minutes before surgery. Clinical indicators, respiratory mechanical indicators (peak airway pressure, lung compliance), arterial blood gas analysis indicators (blood oxygen saturation, arterial pressure of oxygen, oxygenation index), inflammatory factor levels (interleukin-6, interleukin-8, tumor necrosis factor level-α), and pulmonary complications were compared between the two groups. Results:There were no significant differences in mechanical ventilation time or total infusion volume between the two groups (both P > 0.05). At the end of surgery (T1) and 1 day after surgery (T2), peak airway pressure in group A was (17.43 ± 2.69) cm H 2O and (16.81 ± 2.28) cm H 2O (1 cm H 2O = 0.098 kPa), respectively, which were significantly lower than (19.23 ± 3.40) cm H 2O and (18.29 ± 2.06) cm H 2O in group B, respectively ( t = 2.94, 3.41, P = 0.002, < 0.001). At T1 and T2, lung compliance in group A was (34.67 ± 2.93) cm H 2O and (36.26 ± 3.11) cm H 2O, respectively, which were significantly higher than (32.23 ± 2.85) cm H 2O and (33.84 ± 2.87) cm H 2O in group B, respectively ( t = 4.22, 4.04, P = 0.000, < 0.001). At T1 and T2, blood oxygen saturation, arterial partial pressure of oxygen, and oxygenation index in group A were significantly higher than those in group B ( t = 8.12, 3.07, 10.47, 3.16, 3.81, 4.15, all P < 0.05). At T1 and T2, interleukin-6, interleukin-8, and tumor necrosis factor-α levels in group A were significantly lower than those in group B ( t = 11.67, 13.55, 9.60, 15.71, 6.13, 11.50, all P < 0.001). The incidence of complications in group A was 4% (2/50), which was significantly lower than 16% (8/50) in group B ( χ2 = 4.00, P < 0.05). Conclusion:Penehyclidine hydrochloride has a good effect on respiratory mechanics, arterial blood gas, and inflammatory factors in patients undergoing thoracoscopic lobectomy with one-lung ventilation and thereby deserves clinical promotion.
目的:探讨老年女性骨质疏松性骨折患者腰大肌横截面积（CSA）、CT值及骨密度（BMD）的改变及意义。方法:选取2020年9月至2021年2月在义乌市中心医院检查的50例老年女性骨质疏松性骨折患者和50例老年女性骨质疏松非骨折者为研究对象，采用前瞻性病例对照研究方法，根据是否有骨折分为骨质疏松性骨折组和非骨折组。其中，伴有骨质疏松性骨折的患者50例为骨质疏松性骨折组，年龄67.3（55~86）岁；非骨折患者50例为非骨折组，年龄67.6（55~87）岁。于L 4~5椎间盘分别检测两侧腰大肌的CSA值、CT值及BMD，并进行比较分析。 结果:骨质疏松性骨折组左、右两侧腰大肌CSA分别为（583.97±140.70）mm 2、（572.83±138.68）mm 2，非骨折组CSA分别为（753.68±153.54）mm 2、（741.68±132.22）mm 2。骨质疏松性骨折组腰大肌CSA均小于非骨折组，差异均有统计学意义（ t=11.62、10.76，均 P < 0.001）。骨质疏松性骨折组左、右两侧腰大肌平均CT值分别为（42.00±9.00）Hu、（42.00±12.25）Hu，非骨折组CT值分别为（35.80±8.39）Hu、（35.50±10.75）Hu，骨质疏松性骨折组两侧腰大肌CT值显著高于非骨折组，差异均有统计学意义（ t=7.92、8.73，均 P < 0.05）。骨质疏松性骨折组BMD为（65.27±25.62）mg/cm 3，非骨折组BMD为（77.81±33.90）mg/cm 3，骨质疏松性骨折组BMD低于非骨折组，差异有统计学意义（ t=6.62， P < 0.05）。 结论:老年女性骨质疏松性骨折患者腰大肌面积明显缩小，肌密度减少。
The term "population medicine" refers to a branch of clinical medicine that focuses on both individual health care and group health enhancement, even for the benefit of humanity as a whole. It encompasses a wide range of comprehensive health care practices, including "health promotion, prevention, diagnosis, control, treatment, and rehabilitation" and is closely related to the theoretical and technological advancements in medical physics. The primary challenge that medical physics currently faces is how to best utilize its technological advancements to serve the need of the development of "population medicine".
Objective:To investigate the application value of auditory steady-state response (ASSR) combined with short sound auditory brainstem response (ABR) for hearing assessment in children with sensorineural hearing impairment, providing evidence for clinical diagnosis of the disorder.Methods:A total of 90 children with sensorineural hearing impairment who received treatment at Jiaxing Maternity and Child Health Care Hospital from January 2020 to June 2021 were included in this prospective study. These children were randomly divided into a control group and an observation group ( n = 45 per group). The children in the control group underwent ABR testing, while those in the observation group underwent ASSR testing in addition to ABR thresholds testing. The hearing impairment was compared between the two groups. The ABR and ASSR thresholds were compared among children with different degrees of hearing impairment. The correlation between ABR and ASSR at 2 and 4 kHz carrier frequencies was analyzed in the observation group. Results:The abnormal rate of hearing in the observation group was 68.89% (31/45), which was significantly higher than 44.44% (20/45) in the control group ( χ2 = 5.48, P = 0.019). At a carrier frequency of 0.5 kHz, the ASSR thresholds of children with moderate and severe hearing impairment in the observation group were (63.11 ± 6.82) dB nHL and (84.65 ± 5.31) dB nHL, respectively, which were significantly higher than the ABS thresholds (56.12 ± 4.63) dB nHL and (76.87 ± 5.15) dB nHL ( t = 2.94, 2.78, both P < 0.05). There was a positive correlation between ABR and ASSR thresholds at 2 and 4 kHz carrier frequencies in children with different degrees of hearing impairment in the observation group ( r = 0.896, 0.901, both P < 0.05). Conclusion:The combination of ABR and ASSR testings is more accurate in judging the degree of hearing impairment in children with sensorineural hearing impairment than the ABR testing, and can provide a reliable basis for later clinical treatment.
目的:探讨前庭康复锻炼联合健康教育对外周性眩晕患者前庭功能和睡眠质量的影响。方法:选择嘉兴市第二医院2021年1月至2022年6月外周性眩晕患者80例，采用随机数字表法将其分为观察组与对照组，各40例。对照组患者采取前庭康复锻炼，观察组在前庭康复锻炼基础上进行健康教育，两组干预周期4周。比较两组干预前后头晕评价量表（DHI）各维度评分，Berg平衡量表（BBS）评分，前庭症状指数（VSI）和相对于原位置的移行距离（DD）和偏转角度（DA），及睡眠质量变化。结果:干预后，观察组外周性眩晕患者DHI-P、DHI-F和DHI-E评分均低于对照组［（2.45±0.37）分比（3.74±0.42）分、（2.27±1.24）分比（4.34±1.08）分、（1.43±0.27）分比（3.08±0.46）分］（ t=14.58、7.96、19.56，均 P < 0.05）。干预后，观察组外周性眩晕患者BBS评分高于对照组［（50.83±3.25）比（43.24±4.18）分］（ t=9.07， P < 0.05）。干预后，观察组外周性眩晕患者VSI评分DD和DA低于对照组，（18.95±2.76）比（24.53±3.24）分、DD（49.73±10.48）比（68.48±13.42）cm、DA（38.98±3.16）比（44.12±3.25）°，（ t=8.29、6.96、7.17，均 P < 0.05）。干预后，观察组外周性眩晕患者PSQI评分低于对照组，［（5.67±0.43）比（6.46±0.67）分］（ t=6.28， P < 0.05）。 结论:外周性眩晕患者采用前庭康复锻炼联合健康教育可改善患者平衡功能、前庭功能和睡眠质量。
Objective:To analyze the relevant risk factors for recurrence of cervical intraepithelial neoplasia (CIN) in patients undergoing cervical conization.Methods:The clinical data of 205 patients with high-grade CIN (CIN ≥ II) who received treatment in Anxi County Maternal and Child Health Hospital from January 2016 to December 2022 were retrospectively analyzed. All of these patients received loop electrosurgical excision procedure or cold knife conization. The relevant risk factors for CIN recurrence were analyzed using univariate and multivariate risk models.Results:Univariate analysis results showed that there were significant differences in the number of full-term births ( HR = 1.512, 95% CI: 1.191-1.920, P < 0.05), history of premature birth ( HR = 7.255, 95% CI: 2.645-19.900, P < 0.05), history of miscarriage ( HR = 2.158, 95% CI: 1.273-3.660, P < 0.05), positive surgical margins ( HR = 1.724, 95% CI: 1.092-2.720, P < 0.05), conization depth ( HR = 0.953, 95% CI: 0.918-0.989, P < 0.05), history of smoking ( HR = 2.143, 95% CI: 1.264-3.634, P < 0.05), and history of comorbidities ( HR = 3.392, 95% CI: 2.022-5.691, P < 0.05) among the 205 included patients. Cox multivariate risk model indicated that positive surgical margins ( HR = 2.144, 95% CI: 1.317-3.492, P < 0.05), history of premature birth ( HR = 4.515, 95% CI: 1.598-12.754, P < 0.05), and history of comorbidities ( HR = 3.552, 95% CI: 1.952-6.462, P < 0.05) were independent risk factors for recurrence of CIN after cervical conization. Conclusion:In patients with high-grade CIN undergoing cervical conization, positive surgical margins, history of premature birth, and history of comorbidities are associated with an increased risk of CIN recurrence, while a conization depth of > 0.5 cm is associated with a low risk of CIN recurrence.
目的:探讨雌激素软膏联合克林霉素磷酸酯阴道乳膏对老年细菌性阴道炎患者的疗效及其对雌二醇（E 2）等指标的影响。 方法:采用回顾性研究，选取2019年1月至2021年4月杭州市妇产科医院老年细菌性阴道炎患者治疗的288例，根据治疗方式差异分为两组。研究组患者161例，采用雌激素软膏联合克林霉素磷酸酯阴道乳膏治疗，对照组患者127例，则单纯采用克林霉素磷酸酯阴道乳膏治疗，比较两组患者的临床疗效等差异。结果:研究优良率（97.5%）显著高于对照组（82.7%）（χ 2=19.03， P < 0.001）；治疗前两组的雌激素指标差异均无统计学意义（均 P>0.05）；治疗后两组E 2均降低［（28.5±2.6）、（42.7±3.4）ng/L］，而FSH均升高［（149.0±8.3）、（108.5±6.5）ng/L］，且研究组变化更为显著（ t=3.37， P<0.05； t=3.62， P<0.05）。治疗前两组炎性指标差异均无统计学意义（均 P>0.05）；治疗后两组炎性指标均较治疗前降低［C反应蛋白：（8.5±1.6）、（22.7±2.4）mg/L；肿瘤坏死因子α：（16.0±2.3）、（36.5±4.5）pg/mL］，且研究组更甚（ t=3.69， P<0.05； t=3.55， P<0.05）。治疗后两组总不良反应发生率分别为6.8%、12.6%，差异均无统计学意义（χ 2=2.778， P>0.05）。治疗前两组阴道炎症评分差异均无统计学意义（ t=1.26， P>0.05），治疗后两组阴道炎症评分均较治疗前降低［（1.8±0.6）分、（2.2±0.9）分］，且研究组更甚（ t=3.62， P<0.05）。 结论:雌激素软膏联合克林霉素磷酸酯阴道乳膏对老年细菌性阴道炎的疗效较佳，不仅可改善患者的炎症状态，同时还可调节机体性激素水平，且不良反应发生率相似，值得临床推广应用。
Objective:To analyze the effect of different lithotomy positions on hemodynamics in patients undergoing laparoscopic total hysterectomy.Methods:A total of 50 patients who underwent laparoscopic total hysterectomy at Zhoushan Women and Children's Hospital between January 2020 and June 2021 were included in this study. The patients were randomly divided into a control group and an observation group using a random number table method, with 25 patients in each group. The control group underwent conventional lithotomy position total laparoscopic hysterectomy, while the observation group underwent high and low lithotomy position total laparoscopic hysterectomy. The general surgical indicators, respiratory function indicators, blood gas analysis indicators, hemodynamic levels, incidence of complications, and clinical efficacy were compared between the two groups.Results:The general surgical indicators and airway peak pressure indicators in the observation group were significantly lower than those in the control group (both P < 0.05). There was no statistically significant difference in partial pressure of end-tidal carbon dioxide (PCO 2) and arterial carbon dioxide partial pressure (PaCO 2) between the two groups (both P < 0.05). At 15 minutes after pneumoperitoneum, the PaCO 2 level increased in each group, and the PaCO 2 level in the observation group was significantly higher than that in the control group (all P < 0.05). At the same time, the HCO 3- level decreased in each group, and the HCO 3- level in the observation group was significantly lower than that in the control group (all P < 0.05). At 5 minutes before recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the control group were (76.52 ± 8.61) beats/minute, (113.52 ± 5.36) mmHg (1 mmHg = 0.133 kPa), and (86.91 ± 4.21) mmHg, respectively. At 5 minutes after recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the control group were (89.52 ± 8.61) beats/minute, (106.85 ± 5.63) mmHg, and (80.96 ± 3.65) mmHg, respectively. At 5 minutes before recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the observation group were (76.36 ± 8.61) beats/minute, (112.79 ± 5.28) mmHg, and (86.89 ± 4.54) mmHg. At 5 minutes after recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the observation group were (75.63 ± 6.86) beats/minute, (111.99 ± 5.51) mmHg, and (85.06 ± 3.21) mmHg, respectively. At 5 minutes after recovery of body position, heart rate in the control group was increased and that in the observation group was decreased compared with heart rate measured at 5 minutes before recovery of body position. At 5 minutes after recovery of body position, heart rate in the observation group was significantly lower than that in the control group. Diastolic blood pressure and systolic blood pressure decreased in each group, and the amplitudes of reductions in diastolic blood pressure and systolic blood pressure in the observation group were significantly lower than those in the control group. ( t = 6.04, 3.26, 4.22, all P < 0.05). There was no statistically significant difference in incidence of adverse reactions between the two groups ( P > 0.05). The overall response rate in the observation group was significantly higher than that in the control group ( P < 0.05). Conclusion:Compared with conventional lithotomy position total laparoscopic hysteretsotomy, high and low lithotomy position total laparoscopic hysterectomy takes a shorter duration for total laparoscopic hysterectomy, leads to a shorter length of hospital stay, results in less blood loss, causes fewer postoperative infections, and results in more stable hemodynamics and a lower incidence of complications.
目的:探讨快速康复外科理念对腹腔镜子宫肌瘤剔除术患者负性心理和生活质量的影响。方法:回顾性分析武警海警总队医院2019年1月至2021年6月行腹腔镜子宫肌瘤剔除术患者144例的临床资料，采用不同的护理干预措施分为快速康复外科理念组（72例）和对照组（72例），分别接受快速康复外科理念干预和常规干预，观察比较两组应激指标、手术指标、心理状况、疼痛情况及生活质量。结果:干预后，快速康复外科理念组舒张压［（75.83±4.15）mmHg］（1 mmHg=0.133 kPa）、收缩压［（106.17±5.11）mmHg］、心率［（81.19±4.96）次/min］、呼吸频率［（15.39±2.28）次/min］均显著低于对照组［（89.34±4.02）mmHg、（129.78±6.21）mmHg、（101.45±5.53）次/min、（19.97±4.58）次/min］（ t=19.84、24.91、23.14、7.60，均 P < 0.05）；干预后，快速康复外科组肛门排气时间［（17.35±3.47）h］、下床活动时间［（10.53±1.75）h］、住院时间［（6.53±1.05）d］均显著短于对照组的［（19.92±3.23）h、（12.46±1.64）h和（9.19±1.36）d］（ t=3.94、4.57、6.12，均 P < 0.05）；干预后，快速康复外科理念组视觉模拟疼痛评分（VAS）［（2.02±0.45）分］、焦虑自评量表（SAS）评分［（42.74±4.15）分］、抑郁自评量表（SDS）评分（［42.81±3.95）分］均显著低于对照组［（2.73±0.53）分、（48.97±4.02）分、（50.03±4.17）分］（ t=8.67、9.15、10.67，均 P < 0.05）；干预后，快速康复外科理念组生理功能（86.23±3.24）分、社会活动（89.52±5.27）分、躯体活动（84.34±5.42）分、情感反应（76.64±5.99）分、精神健康（86.39±3.91）分，均显著高于对照组的（77.35±3.85）分、（83.26±5.39）分、（79.96±6.67）分、（72.85±5.7）分、（80.69±4.66）分（ t=14.97、7.05、4.32、3.88、7.95，均 P < 0.05）。 结论:快速康复外科理念干预可以显著降低腹腔镜子宫肌瘤剔除术患者应激反应，缓解其负性心理和疼痛情况，有助于患者术后恢复和提高患者生活质量。
Objective:To investigate the value of Brock model and the Lung Reporting and Data System (LU-RADS) in the differential diagnosis of benign and malignant pulmonary nodules.Methods:A total of 84 patients with pulmonary nodules who received treatment at Zhejiang Jinhua Guangfu Tumor Hospital from March 2021 to March 2022 were retrospectively included in this study. The patients were divided into a benign group ( n = 26) and a malignant group ( n = 58) based on their pathological examination results. The Brock model parameters and LU-RADS classification were compared between the two groups. The value of the Brock model and the LU-RADS in the differential diagnosis of benign and malignant pulmonary nodules was analyzed. Results:In the malignant group, the the Brock model parameters including age, nodule diameter, the presence of spicule signs surrounding the nodule, the composition of mixed ground glass nodules, the proportion of multiple nodules, and the probability of malignancy were (56.25 ± 4.15) years, (14.65 ± 2.35) mm, 44.8%, 77.6% , 51.7%, and (0.26 ± 0.11), respectively. These parameters were (47.35 ± 3.56) years, (8.92 ± 1.65) mm, 15.4%, 53.8%, 26.9%, and (0.05 ± 0.02) in the benign group. There were significant differences in these parameters between the two groups ( t = 9.48, 11.18, χ2 = 6.78, 4.84, 4.48, t = 9.63, all P < 0.05). The proportion of malignant nodules under LU-RADS classification in the malignant group was 79.3%, which was significantly higher than 42.3% in the benign group ( χ2 = 11.27, P < 0.05). According to the Receiver Operating Characteristic (ROC) curve, the Brock model outperformed LU-RADS in the differential diagnosis of benign and malignant pulmonary nodules. Conclusion:Compared with LU-RADS classification, the Brock model demonstrates higher value in the differential diagnosis of benign and malignant pulmonary nodules, and this evaluation method can be prioritized in clinical practice.
与干姜配伍是附子减毒的基本手段，但囿于医学伦理的相关规定以及动物实验的局限性，附子与干姜配伍减毒实验采用传统的实验方法难以有效开展；虚拟仿真技术为该实验的高质量开展提供了可能，且虚拟仿真实验具有安全性高、可重复操作、不受时空限制等优点。
Objective:To investigate the application value of auricular point pressing with beans combined with Chinese medicine for rehabilitation in older adults after total hip arthroplasty.Methods:This is a prospective case-control study. A total of 80 older adult patients with femoral neck fractures who underwent total hip arthroplasty at Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from September 2020 to January 2022 were included in this study. These patients were randomly divided into a control group and an observation group, with 40 patients per group. The control group underwent conventional interventions, while the observation group underwent auricular point pressing with beans combined with Chinese medicine. Clinical efficacy was compared between the two groups.Results:The overall response rate in the observation group was 85.00% (34/40), which was significantly higher than 65.0% (26/40) in the control group ( χ2 = 4.27, P = 0.036). Before surgery, there were no significant differences in various indicators between the two groups (all P > 0.05). At 2 weeks after surgery, the hemoglobin level and Harris scores in the observation group were higher than those in the control group ( t = -7.11, -5.81, both P < 0.05). At 1 and 3 days and 2 weeks after surgery, the D-dimer level, prothrombin time, activated partial thrombin time, thrombin time, Visual Analogue Scale score, and Pittsburgh Sleep Quality Index (PSQI) in the observation group were significantly lower than those in the control group (all P < 0.05). At 3 days and 2 weeks after surgery, C-reactive protein, thigh and calf circumference of the affected limb in the observation group were significantly lower than those in the control group ( t = 2.34, 6.85, 4.47, 3.89, 6.63, 4.35, all P < 0.05). After surgery, the time to get off the bed and the length of hospital stay in the observation group were (3.58 ± 2.43) days and (7.14 ± 2.18) days, respectively, which were significantly shorter than (5.47 ± 2.35) days and (9.13 ± 2.14) days in the control group ( t = 3.54, 4.12, both P < 0.001). The incidence of postoperative deep vein thrombosis in the observation group was 5.00% (2/40), which was significantly lower than 10.00% (4/40) in the control group ( χ2 = 0.72, P = 0.396). Conclusion:Auricular point pressing with beans combined with Chinese medicine can promote rapid rehabilitation of older adult patients with femoral neck fractures after total hip arthroplasty.
目的:探讨基于互联网下远程健康教育对炎症性肠病（IBD）患者自我管理能力、睡眠质量和心理状况的影响。方法:选取温州医科大学附属第一医院2021年9月至2022年8月诊治的IBD患者80例进行随机对照研究，采用随机数字表法分为观察组、对照组各40例。对照组采用常规院外管理方法，观察组在对照组基础上采取基于互联网下远程健康教育。两组干预时间3个月。比较两组药物治疗依从性、自我管理能力、睡眠质量、心理状况情况及患者满意度。结果:观察组药物治疗依从良好率为95.0%（38/40），高于对照组的75.0%（30/40）（χ 2=6.27， P < 0.05）。干预后，观察组成年人自我管理能力测定量表评分为（142.31±17.48）分，高于对照组的（105.37±12.25）分（ t=-10.94， P < 0.001）；观察组匹兹堡睡眠质量指数量表评分为（8.74±2.01）分，低于对照组的（11.98±1.35）分（ t=8.46， P < 0.001）；观察组抑郁［（4.34±0.76）分］、焦虑［（3.84±1.07）分］和压力［（3.18±0.56）分］评分均低于对照组［（7.25±1.08）分、（7.61±1.53）分和（7.14±0.68）分］（ t=4.18、12.77、28.43，均 P < 0.001）。观察组患者总满意率为95.0%（38/40），高于对照组，的77.5%（31/40）（χ 2=5.16， P < 0.05）。 结论:IBD患者采用基于互联网下远程疗法可提高患者自我管理能力，改善患者睡眠质量及心理状况。
目的:观察整体干预模式对丹斛通痹汤联合穴位贴敷治疗2型糖尿病（T2DM）冠心病心绞痛效果的影响。方法:回顾性选取温岭市中医院拟行丹斛通痹汤联合穴位贴敷治疗T2DM冠心病心绞痛患者126例为研究对象，根据干预方式不同分为对照组和观察组，每组63例。对照组接受传统干预模式，观察组接受整体干预模式。比较两组自我效能、中医证候、自我管理、生存质量、血糖控制以及不良事件。结果:干预3个月后，观察组中医证候评分、心绞痛发作频率及持续时间［（7.15±2.30）分、（1.51±0.39）次/周、（1.59±0.60）min］均低于对照组的（13.07±3.52）分、（3.35±1.20）次/周、（3.51±1.85）min（ t=11.17、11.57、7.84，均 P < 0.001）；观察组患者自我管理能力评分［（50.08±5.65）分］高于对照组［（47.31±4.81）分］（ t=-2.96， P=0.004）；观察组糖尿病生存质量评分［（50.08±5.65）分］低于对照组［（63.01±5.31）分］（ t=5.84， P < 0.001）；观察组空腹血糖、糖化血红蛋白水平［（6.30±0.69）mmol/L、（6.30±0.41）%］均低于对照组［（8.58±1.05）mmol/L、（7.46±0.55）%］（ t=14.40、14.42，均 P < 0.001）。观察组不良事件发生率为6.35%（12/63），明显低于对照组的19.05%（4/63）（χ 2=4.58 ，P=0.032）。 结论:整体干预模式可促进T2DM冠心病心绞痛患者治疗依从性，促进症状改善，同时提升自我管理能力与生活质量，具有一定临床应用优势。
目的:前瞻性研究预见性护理干预在有创动脉血压监测危重新生儿中的应用效果。方法:选取2021年4月至2023年1月安徽省妇幼保健院收治的有创动脉血压监测危重新生儿60例为研究对象，按不同护理方法分为研究组和对照组，各30例。研究组患儿采用预见性护理干预方法，对照组患儿采用常规护理干预，对比两组患儿的监测时间、血压变化、患儿家长护理满意度及并发症的发生情况。结果:研究组患儿监测时间短于对照组（ t=5.88， P < 0.001），收缩压明显优于对照组（ t=-2.69， P=0.027），舒张压明显优于对照组（ t=-2.40， P=0.043），研究组患儿家长对护理满意度为100.00%，对照组为70.00%，差异有统计学意义（χ 2=8.37， P=0.004）；研究组患儿总并发症发生率为6.67%（2/30），明显低于对照组的36.67%（11/30）（χ 2=6.28， P=0.012）。 结论:对有创动脉血压监测危重新生儿实施预见性护理干预，有利于患儿血压水平稳定，并使家长满意度提升，同时降低患儿并发症的发生率，值得临床推广。
The incidence of open femoral fractures is relatively low, primarily caused by high-energy trauma and often associated with multiple injuries. The management of open femoral fractures is considered one of the most challenging lower limb injuries due to their serious nature, multiple traumas, high disability rate, high infection rate, and high amputation rate. Most scholars currently recommend that open grade I and grade II fractures of the femur be treated with thorough debridement and open reduction, and internal fixation at the initial stage when the patients are in good condition. However, for open grade III femur fractures, many studies still show that staged treatment strategies are preferred, but the fixation method at the initial stage is still controversial. For patients with severe open femoral fractures, the medical team should create an individualized treatment plan, taking into account the patient's and family's preferences, the medical team's experience, and available resources, rather than simply relying on the salvage or amputation scoring system to make the final decision. This review discusses the epidemiology, classification, surgical management options, and strategies for limb salvage and amputation in the treatment of open femur fractures, providing practical guidance for healthcare professionals who manage these patients.
Objectives:To investigate the distribution characteristics and mechanism of drug-resistant genes in carbapenem-resistant Klebsiella pneumoniae.Methods:A total of 58 strains of carbapenem-resistant Klebsiella pneumoniae isolated from clinical specimens at Weihai Central Hospital,Qingdao University, from January to December 2021 were collected. Their phenotypes were confirmed by modified Hodge test and modified carbapenem inactivation test. Polymerase chain reaction was used for amplification. Pulsed field gel electrophoresis clustering and multilocus sequence typing were performed to characterize the molecular epidemiology of the strains.Results:Carbapenem-resistant Klebsiella pneumoniae had a sensitivity rate of 51.7% to amikacin, a high (> 60%) resistance rate to antibiotics such as ciprofloxacin, levofloxacin, compound sulfamethoxazole, piperacillin/tazobactam, and a 100.0% resistance to cefazolin, ceftazidime, cefotetan, and cefepime. The modified Hodge test was positive in 46 (79.3%) of the 58 strains, and the modified carbapenem inactivation test was positive in 31 strains (53.5%). Polymerase chain reaction amplification and gene sequencing showed that 42 strains (72.41%) carried mainly the KPC-2 gene, 12 strains (20.7%) carried the IMP-4 gene, and 4 strains (6.9%) carried the NDM-1 gene. The 12 strains carrying the IMP-4 gene all carried the KPC-2 gene and were double positive for the modified Hodge test and the modified carbapenem inactivation test. Pulsed field gel electrophoresis clustering and multilocus sequence typing analysis showed that the KPC-2 producing strains were mainly ST11-B and ST395-A, the KPC-2- and IMP-4-producing strains were mainly ST345-M and ST11-B, and NDM-1-producing strains were ST263-F and ST15-C. Conclusion:Carbapenem-resistant Klebsiella pneumoniae is highly drug-resistant and carries a variety of carbapenemases, including the KPC-2 and IMP-4 genes.
Objective:To investigate the efficacy of hemodiafiltration combined with hemoperfusion in the treatment of secondary hyperparathyroidism (SHPT) in patients undergoing maintenance hemodialysis (MHD).Methods:A total of 40 patients with SHPT undergoing MHD who received treatment at the Blood Purification Center of The First Affiliated Hospital of Anhui University of Science and Technology from February 2021 to March 2023 were included in this prospective cohort study. They were randomly divided into a control group and an observation group ( n = 20/group).The control group received a single high flux hemodialysis, while the observation group used a combination of hemodialysis filtration and hemoperfusion for 3 months. In both groups, the changes in hemoglobin, blood urea nitrogen, serum creatinine, serum calcium, serum phosphorus,and parathyroid hormone levels were compared before and after dialysis. Results:After dialysis, the hemoglobin level in the observation group was (119.45 ± 5.27) g/L, which was significantly higher than (106.30 ± 6.52) g/L in the control group ( t = -7.02, P < 0.001). The serum phosphorus level in the observation group was (1.18 ± 0.17) mmol/L, which was significantly lower than (1.52 ± 0.22) mmol/L in the control group ( t = 5.49, P < 0.001). The parathyroid hormone level in the observation group was (122.14 ± 40.57) ng/L, which was significantly lower than (168.78 ± 78.27) ng/L in the control group ( t = 2.39, P = 0.023). Conclusion:Hemodiafiltration combined with hemoperfusion can reduce clinical symptoms, increase hemoglobin level, and reduce phosphorus and parathyroid hormone levels in patients with SHPT undergoing MHD, which deserves clinical promotion.
