Table of Content

28 December 2022, Volume 11 Issue 4 Previous Issue    Next Issue

Commentary

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Thermal ablation in treatment of benign and malignant thyroid tumors： Current status and future perspectives ZHU Chenfang, CHEN Jiangbo, LIN Tingyu, FEI Jian 2022, 11 (4):  221-226.  doi: 10.3969/j.issn.2095-378X.2022.04.001 Abstract ( 345 )   PDF (1179KB) ( 945 )   Save In recent years the application of thermal ablation （TA） in the treatment of benign and malignant thyroid tumors has drawn wide attention. Many studies have shown that compared with traditional surgery, TA is a minimally invasive and cosmetic surgery. In particular, the safety and effectiveness of TA in the treatment of benign thyroid tumors have been generally proven, but are still controversial in the treatment of papillary thyroid microcarcinoma. This article reviewed related literature, and focused on the principles of different thermal ablation techniques, indications and contraindications for the treatment of benign and malignant thyroid tumors, the safety and effectiveness of TA, and the advantages and disadvantages of TA compared with traditional surgery. References | Related Articles | Metrics

Original article

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Comparative study of clinical outcomes of different surgical approaches for cardiac cancer YUAN Ronghua, YU Xiaoqiang, WANG Chunzhan, XIA Chunqiu, ZHONG Chongjun, HUANG Haitao 2022, 11 (4):  227-231.  doi: 10.3969/j.issn.2095-378X.2022.04.002 Abstract ( 161 )   PDF (1345KB) ( 467 )   Save Objective To compare the clinical outcomes of patients with cardiac cancer undergoing radical resection by laparotomy or thoracotomy. Methods A total of 198 patients with cardiac cancer were selected from January 2014 to December 2017. Among them, 108 patients in the study group received trans-abdominal cancer resection and 90 patients in the control group received trans-thoracic cancer resection. General clinical characteristics, surgery time, intraoperative and postoperative hemorrhage volumes, postoperative complications, lymph nodes resection rate, positive surgical margins, tumor node metastasis （TNM） stages, hospital mortality rate, hospital stay, and 5-year survival were compared between the two groups. Results No significant difference was found in general clinical characteristics （P>0.05）. Compared with the control group, the surgery time, intraoperative and postoperative hemorrhage volumes, postoperative complication rate, lymph nodes resection rate, and hospital stay were superior in the study group （P<0.05）. No difference in positive surgical margin rate was found between the two groups, both with complete resection. There was no significant difference in 5-year survival rate between the two groups （P>0.05）. Conclusion Complications more frequently happen, operative trauma is larger, and 5-year survival is not increased after trans-thoracic cardiac cancer resection, though more esophagus and mediastinal lymph nodes can be removed. Therefore, trans-abdominal cardiac cancer resection is recommended. References | Related Articles | Metrics

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Expressions of 5-LOX in gastric carcinoma and its relationships with COX-2 and FPR2 and their clinicopathological implications LI Qing, XU Fen, LEI Lang, LI Lixiang, HAO Hua 2022, 11 (4):  232-237.  doi: 10.3969/j.issn.2095-378X.2022.04.003 Abstract ( 140 )   PDF (11181KB) ( 377 )   Save Objective To investigate 5-lipoxygenase （5-LOX） expression in gastric carcinoma, its relationships with cyclooxygenase-2 （COX-2） and formyl peptide receptor type 2 （FPR2）, and their clinicopathological implications. Methods Expressions of the above three indexes were detected from 70 gastric carcinoma patients by immunohistochemistry. The relationships among them and clinicopathological features were analyzed. Moreover, whether knockdowning 5-LOX had effects on COX-2 and FPR2 mRNA expression in SGC-7901 cells was investigated. Results The positive expression rates of 5-LOX were 76.0％ in cases ≤45 years and 84.4％ in cases >45 years; 82.1％ in cases with tumor diameter ≤3 cm and 81.0％ in cases with tumor diameter >3 cm; 80.0％, 80.0％, and 90.0％ in cases of poorly differentiated, middle-highly differentiated, and mucinous adenocarcinoma, respectively, with no significant difference （P>0.05）. The positive expression rates of 5-LOX in cases of gastric carcinoma without and with axillary node metastasis were 71.8％ and 93.5％; in cases at stage Ⅰ-Ⅱ and Ⅲ-Ⅳ, 75.0％ and 95.5％ respectively, with significant difference （P<0.05）. The positive expression rates of 5-LOX in cases of gastric carcinoma with positive COX-2 expression and negative COX-2 expression were 81.6％ and 81.0％ resepctively, without significant difference （P>0.05）, and the values in cases of gastric carcinoma with positive FPR2 expression and negative FPR2 expression were 78.1％ and 84.2％ respectively, without significant difference as well （P>0.05）. Moreover, silencing 5-LOX had no effects on COX-2 and FPR2 mRNA expressions in SGC-7901 cells. Conclusion 5-LOX plays an important role in the invasion and metastasis of gastric carcinoma, and combined targeting 5-LOX and COX-2 would be an effective approach for gastric carcinoma. References | Related Articles | Metrics

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Application of automatic DNA image cytometry （DNA-ICM） in cervical cancer screening YAO Qiong, LIU Xiufen, SHENG Youhua 2022, 11 (4):  238-241.  doi: 10.3969/j.issn.2095-378X.2022.04.004 Abstract ( 227 )   PDF (2324KB) ( 435 )   Save Objective To investigate the application value of cellular antomatic DNA image cytometry （DNA-ICM） in cervical cancer screening. Methods Ten cases of normal cervical tissues with diploid DNA content were selected as the control group; 69 cases of no intraepithelial or malignant lesions （NILM）, 30 cases of low grade squamous intraepithelial leisons （LSIL）, 65 cases of high grade squamous intraepithelial leisions （HSIL）, and 28 cases of squamous cell carcinoma （SCC） were selected as the experimental groups. Pap staining cytological screening, automatic DNA-ICM and ploidy analysis after Feulgen staining, and Ki-67 immunocytochemical staining were performed. Results The sensitivity of DNA-ICM and HPV SIL+ screening was 65.9% and 84.6% （χ2=34.217, P<0.001）, and the specificity was 72.5% and 55.1% （χ2=10.340, P = 0.006） respectively. The DI thresholds of NILM, LSIL, HSIL, and SCC were ≤4, ≤4, ≤6, and ≤5, respectively. The average number of anploid cells was 0.9, 3.9, 9.4, and 12.0, and the average number of Ki-67 positive cells was 3.1, 10.5, 88.6, and 255.6, respectively, with a significant difference between the two groups （χ2=14.680, P<0.05）. The proportion of few （≤2） anploid cells was 10.1%, 33.3%, 26.1%, and 28.6%, respectively. The detection rates of cell DNA heteroploidy in the low, medium, and high risk HPV groups were 12.1%, 57.5%, and 82.3%, respectively, with a significant difference among the groups （χ2=43.420, P<0.001）. Conclusion DNA index （DI） reflects the structural and quantitative changes of DNA during the cell cycle. The number and DI threshold of DNA anploid cells have important application values for cytological diagnosis, evaluation of proliferation activity and progression of lesions. References | Related Articles | Metrics

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Impact on cardiopulmonary function of mitral valve repair surgery for mitral regurgitation through right mini-thoracotomy or conventional full sternotomy HUANG Haitao, WANG Fei, DING Shengguang, XIA Chunqiu, ZHONG Chongjun, YU Xiaoqiang 2022, 11 (4):  242-252.  doi: 10.3969/j.issn.2095-378X.2022.04.005 Abstract ( 169 )   PDF (17793KB) ( 396 )   Save Objective Conventional full sternotomy （CFS） is considered the best treatment for mitral regurgitation （MR）. But the surgical trauma of CFS is great. Minimal invasive （MI） mitral valve （MV） repair for MR through right mini-thoracotomy has been developed to decrease operative trauma; however, the safety and efficacy are not defined yet. In the present study, clinical outcomes were compared between patients with MR who received MI or CFS. Methods The data of 96 patients who mainly suffered from MR during the same period were collected. Among them, 51 patients received CFS （CFS group）, and 45 patients received MI （MI group）. Patients' demographics, surgical data, pre- and post-operative cardiopulmonary parameters were compared between the two groups. Postoperative overall survival, reoperation, and recurrent MR survival were estimated using the Kaplan-Meier method, and comparisons between groups were performed by log-rank test. Results The procedures were successfully performed in all patients. The incision length was significantly shorter in the MI group. Compared with the CFS group, intraoperative blood loss, postoperative blood transfusion, and thoracic drainage were less in the MI group. Atrial fibrillation ablation was performed in the two groups. In the CFS group, a better result of atrial fibrillation ablation was achieved; however, a lower incidence rate of new-onset postoperative atrial fibrillation was observed in the MI group. More pulmonary complications were found in the MI group. The inflammatory response was lighter in the CFS group on post operative day（POD） 1 and 2. On postoperative day 2, the inflammatory response in the MI group reduced significantly. No statistical difference was found in overall survival, reoperation-free survival, and recurrence-free survival. Conclusion The efficacy and safety of MI for MR are the same as CFS. MI could be performed in the vast majority of patients with MR. References | Related Articles | Metrics

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Safety and efficacy of radiofrequency ablation for hyperthyroidism SU Jiqin, ZHOU Lixin 2022, 11 (4):  253-256.  doi: 10.3969/j.issn.2095-378X.2022.04.006 Abstract ( 192 )   PDF (1147KB) ( 724 )   Save Objective To explore the safety and efficacy of ultrasound-guided radiofrequency ablation （RFA） in the treatment of hyperthyroidism. Methods Twenty-seven patients with hyperthyroidism from The Second Affiliated Hospital of Xiamen Medical College in the period of July 2018 to June 2019 were treated with ultrasound-guided RFA. Thyroid volume, total triiodized thyroid hormone （TT3）, free triiodized thyroid hormone （FT3）, total tetriodized thyroid hormone （TT4）, free tetriodized thyroid hormone （FT4）, thyroid stimulating hormone （TSH）, clinical symptoms, and complications were compared before and after RFA. Results The clinical symptoms of patients were significantly improved after surgery （P<0.05）. The thyroid volumes were significantly reduced 3, 6, 12 months after surgery （P<0.05）. Serum TT3, TT4, FT3, and FT4 levels decreased significantly and TSH increased significantly after surgery （P<0.05）. The hoarseness rate reached 3.7% and tachycardia rate reached 11.1%, which all recovered after treatment without recurrence and no other complications occurred. Conclusion Ultrasound-guided percutaneous RFA is a safe and effective method for hyperthyroidism, which can improve the symptoms significantly with few complications. References | Related Articles | Metrics

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Comparison of alfentanil and sufentanil combined with propofol anesthesia in painless bronchoscopy LI Jing 2022, 11 (4):  257-259.  doi: 10.3969/j.issn.2095-378X.2022.04.007 Abstract ( 207 )   PDF (1181KB) ( 467 )   Save Objective To observe and compare the anesthesia effects of alfentanil and sufentanil combined with propofol in painless bronchoscopy. Methods A total of 80 patients who underwent painless bronchoscopy from March 2021 to July 2021 were selected. According to random number table method, they were divided into a control group and an observation group, 40 cases in each group. Sufentanil was used in the control group （0.2 μg/kg）, and at alfentanil in the control group （20 μg/kg）. Mean blood pressure （before induction of anesthesia, 3 min after induction, and the end of the examination）, wake-up time, orientation recovery time, respiratory depression, coughing and other adverse reactions were recorded in the two groups. Results The mean blood pressure levels of the observation group 3 min after induction and after examination in the observation group declined less than those in the control group （P<0.05）. The wake-up time and orientation recovery time of the observation group were shorter than those of the control group （P<0.05）. Conclusion Painless bronchoscopy using alfentanil combined with propofol anesthesia results in quick recovery time, stable hemodynamics, and short recovery time for orientation. References | Related Articles | Metrics

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Effects of skin and soft tissue expansion on wound healing and complications in plastic surgery of burn scar deformity FANG Mingxing, CHEN Jianchong, HUANG Jiaxin 2022, 11 (4):  260-262.  doi: 10.3969/j.issn.2095-378X.2022.04.008 Abstract ( 113 )   PDF (1245KB) ( 432 )   Save Objective To investigate the effect of skin and soft tissue expansion in the plastic surgery of burn scar deformity on wound healing and complications. Methods From March 2018 to March 2022, 68 burn patients were selected and divided into a study group （34 cases） and a control group （34 cases）. The study group was treated with skin and soft tissue expansion, while the control group was treated with composite skin grafting. The wound healing time, complications, blood supply recovery time, and wound satisfication of the two groups were compared and analyzed. Results The wound healing time and blood supply recovery time in the study group were shorter than those in the control group （P<0.05）, and the incidence of complications in the study group was lower than that in the control group （P<0.05）. The satisfaction with the wound in the study group was higher than that in the control group （P <0.05）. Conclusion The application of skin and soft tissue expansion in burn scar deformity plastic surgery can effectively shorten the time of wound healing and blood supply recovery, and improve patients' satisfaction with the wound. It is safe and can be clinically promoted. References | Related Articles | Metrics

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Application of ultrasound-guided iliac fascia space block in hip arthroplasty in elderly patients LIANG Huana, CHEN Dequan, ZHENG Xiaoyun 2022, 11 (4):  263-265.  doi: 10.3969/j.issn.2095-378X.2022.04.009 Abstract ( 107 )   PDF (1177KB) ( 422 )   Save Objective To observe the effect of ultrasound-guided fascia iliac space block on anesthesia and postoperative pain in elderly patients undergoing hip arthroplasty. Methods From January 2018 to January 2021, a total of 80 elderly patients with hip replacement surgery were randomly selected and divided into two groups. Forty cases in the study group were treated with ultrasound-guided fascia iliac space block, and another 40 cases in the control group were not given fascia iliac space block. Pain score, Bromage score of affected limbs, and adverse reactions were evaluated at different time points after operation. Results The pain scores of the study group at 6, 12, 24 and 48 h after operation were lower than those of the control group （P<0.05）. At 2, 24, and 48 h after operation, there was no difference in Bromage score of motor block between the two groups （P>0.05）. The adverse reaction rate of the study group was lower than that of the control group （P<0.05）. Conclusion Ultrasound-guided fascia iliac space block in the treatment of elderly patients undergoing hip replacement surgery has a significant postoperative analgesic effect, and does not cause adverse reactions or affect the postoperative limb motor block, showing ideal prognosis. References | Related Articles | Metrics

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Effects of dexmedetomidine on stress in patients undergoing general anesthesia with endotracheal intubation and gynecological laparoscopic surgery YANG Hongxia, CHEN Jingyu 2022, 11 (4):  266-269.  doi: 10.3969/j.issn.2095-378X.2022.04.010 Abstract ( 142 )   PDF (1189KB) ( 438 )   Save Objective To investigate the effects of dexmedetomidine on stress in patients undergoing gynecological laparoscopic surgery under general anesthesia with endotracheal intubation. Methods From May 2019 to May 2022, a total of 90 patients undergoing gynecological laparoscopic surgery under general anesthesia with endotracheal intubation were selected and randomly divided into 3 groups, namely Group A （dextrometomidine 0.2 μg/kg, n=30）, Group B （dexmedetomidine 0.4 μg/kg, n=30）, and Group C （dexmedetomidine 0.6 μg/kg, n=30）. The differences of stress index, serum norepinephrine, and adrenaline levels 5 min before induction, 5 min after intubation, and at the completion of surgery were analyzed. Results There was no significant difference in SpO2 level among the three groups at three time points （P>0.05）. There were no significant differences in MAP and HR among the three groups 5 min before induction and 5 min after intubation （P>0.05）, except at the completion of surgery （P<0.05）. There was no significant difference in serum norepinephrine level among the three groups 5 min before induction （P>0.05）, but the level in Group B was significantly lower than those in other groups 5 min after intubation and at the completion of surgery （P<0.05）. The adrenaline level varied in the same manner as the norepinephrine level （P<0.05）. Conclusion Dexmedetomidine can reduce the stress response of patients undergoing gynecological laparoscopic surgery under general anesthesia with endotracheal intubation, and decrease the levels of serum norepinephrine and adrenaline, which is worthy of clinical promotion. References | Related Articles | Metrics

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Synchronous occurrence of medullary thyroid carcinoma and papillary thyroid carcinoma： a case report and literature review MA Qiang, LIANG Chunli 2022, 11 (4):  270-273.  doi: 10.3969/j.issn.2095-378X.2022.04.011 Abstract ( 170 )   PDF (5493KB) ( 428 )   Save Objective To investigate the clinicopathological features, diagnosis, and treatment of medullary thyroid carcinoma （MTC） complicated with papillary thyroid carcinoma （PTC）. Methods A retrospective analysis was conducted of a case of MTC and PTC and related literature was reviewed. Results A female patient was admitted to the hospital due to bilateral thyroid nodules. Preoperative calcitonin： >2000.0 pg/mL, CEA： 132.0 ng/mL, pro-GPR： 440.0 ng/mL. Preoperative diagnosis： medullary carcinoma? Intraoperative frozen pathology suggested PTC on the left and MTC on the right. Total thyroidectomy with bilateral central lymph node dissection was performed. Postoperative pathological results revealed right MTC and left PTC. Conclusion Synchronous occurrence of MTC and PTC in a patient is rare. This case report and literature review provide references for the diagnosis and treatment of such patients. References | Related Articles | Metrics

Medical instrument

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Discussion on management of hospital medical consumables in the context of COVID-19 epidemic and post-epidemic era WANG Hao 2022, 11 (4):  274-276.  doi: 10.3969/j.issn.2095-378X.2022.04.012 Abstract ( 129 )   PDF (1269KB) ( 476 )   Save From the perspective of hospital medical consumables supply management department, this paper discussed the management of hospital medical consumables in the context of COVID-19 and post-epidemic era, aiming to strengthen the effective management of medical consumables and equipment in special environment, to improve the management level of medical consumables and equipment, thus to promote the continuous improvement of medical quality and save cost investment. References | Related Articles | Metrics

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Selection of hospital maintenance outsourcing service providers based on DE-AHP WANG Xingang, HUANG Yicheng, MI Rong 2022, 11 (4):  277-280.  doi: 10.3969/j.issn.2095-378X.2022.04.013 Abstract ( 130 )   PDF (1264KB) ( 336 )   Save With the rise of maintenance service outsourcing practice, the outsourcing management ability of hospitals is facing severe challenges. How a hospital establishes a scientific and professional evaluation system to evaluate outsourcing companies directly determines the quality of hospital maintenance in the future. This paper systematically analyzed the selection mode of outsourcing service providers for hospital maintenance services. AHP fuzzy comprehensive evaluation method was introduced to study the identification of key indicators for outsourcing company selection, which provides a practical evaluation scheme for the selection of outsourcing services. References | Related Articles | Metrics

Education and management on public health

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Discussion on application of clinical research information management platform based on integrated digital thinking mode ZHENG Yunlu, DONG Ningxin 2022, 11 (4):  281-284.  doi: 10.3969/j.issn.2095-378X.2022.04.014 Abstract ( 202 )   PDF (1446KB) ( 600 )   Save Objective To summarize the experience of clinical research information management platform based on integrated digital thinking mode. Methods The links of project approval, start-up preparation, project implementation, quality supervision, and conclusion were connected, and then the informatization and standardization of the whole process were realized in combination with the guidance of clinical research at all levels. Results The construction of the clinical research information management platform provided high-quality data assets and helped hospital digital transformation. Conclusion The digital clinical research management platform has greatly standardized the process of clinical research in the hospital, realized efficient management of clinical research, and promoted the medical quality, medical scientific research exploration, and the construction and development of clinical disciplines. References | Related Articles | Metrics

Nursing

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Application of PDCA to improve standard rate of emergency deployment equipment use in emergency rescue rooms JIN Yuhong, CHEN Xuemei 2022, 11 (4):  285-289.  doi: 10.3969/j.issn.2095-378X.2022.04.015 Abstract ( 147 )   PDF (2076KB) ( 688 )   Save Objective To explore the application of PDCA in improving the standard rate of emergency deployment equipment use in emergency rescue rooms. Methods PDCA cycle was applied to the management of emergency deployment equipment in emergency rescue rooms. A project quality improvement group was established based on the focus of current problems and cause analysis, and carried out continuous quality improvement according to the PDCA process of planning, doing, checking, and acting. Results The standard rate of emergency deployment equipment use in emergency rescue rooms increased from 76.25% before implementation to 95.00% after implementation, indicating that the nurses in rescue rooms improved their standard operation ability regarding emergency deployment equipment. Conclusion The application of PDCA can effectively improve the standard rate of emergency deployment equipment use of nurses in emergency rescue rooms, and ensure the safety of clinical nursing. References | Related Articles | Metrics

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Construction of evaluation indicators of home nursing service quality of long-term care insurance nursing stations SHEN Min, XU Xiaomin, LIU Xiaoqing, MENG Wenjun, GAO Yan, ZHOU Ye 2022, 11 (4):  290-296.  doi: 10.3969/j.issn.2095-378X.2022.04.016 Abstract ( 123 )   PDF (1224KB) ( 430 )   Save Objective Based on the development of long-term care insurance in Putuo District, Shanghai, to provide reference for improving the quality of home nursing service in this area through the construction of evaluation indicators for home nursing service quality of long-term care insurance nursing stations. Methods Based on the theoretical framework of structure-process-result, combined with literature review and qualitative interview, evaluation indicators were initially formulated. Through two rounds of Delphi expert consultations the evaluation indicators of home nursing service quality of long-term care insurance nursing stations were constructed. Results The effective recovery rates of the two rounds of expert consultation questionnaires were both 100%, and the degree of authority of the experts was 0.755-0.955. The final evaluation indicators of home nursing service quality of nursing stations provided by long-term care insurance included 3 first-level dimensions, 10 second-level dimensions, and 34 third-level items. The Kendall concordance coefficient （W） increased from 0.234 in the first round to 0.271 in the second round （both P<0.01）. Conclusion The evaluation indicators of home nursing service quality of long-term care insurance nursing stations conform to the development trend of long-term nursing insurance in Putuo District, Shanghai, and are scientific and reliable. References | Related Articles | Metrics

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Application of multidisciplinary early prevention in management of pressure injury in operating rooms ZHANG Juanjuan, XU Linlin 2022, 11 (4):  297-300.  doi: 10.3969/j.issn.2095-378X.2022.04.017 Abstract ( 111 )   PDF (1233KB) ( 358 )   Save Objective To explore the effect of multidisciplinary early prevention on the management of pressure injury in operating rooms. Methods A total of 208 patients who underwent gastrointestinal surgery from January to June 2021 were selected as study subjects and divided into control group and observation group. Body temperature, incidence of pressure injury, patients' satisfaction, and nurses' professional ability of pressure injury prevention before and after intervention were compared between the two groups. Results The body temperature of patients in the observation group was higher than that in the control group before operation, 2 h during operation, and immediately after operation. The theoretical knowledge and operation skills of nurses related to pressure injury prevention after intervention were higher than those before intervention. The incidence rate of pressure injury in the control group was 7.84% immediately after operation and 1.96% 5 d after operation. In the observation group, the incidence rate was 1.88% and 0% respectively. The satisfaction score of patients in the control group was lower than that in the observation group, and the difference was statistically significant （P<0.05）. Conclusion By establishing multidisciplinary teams and developing effective preventive measures, nurses can improve their professional ability of pressure injury prevention, resulting in reduced incidence of intraoperative pressure injury and increased satisfaction of patients. References | Related Articles | Metrics