30 March 2023, Volume 50 Issue 02

    

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  Effect of RNA interference with TMEM33 expression on cervical cancer cells

  DONG Jing, SHANG Shuang, GAO Shu-jun, XIE Feng

  jms. 2023, 50(02): 159-165. https://doi.org/10.3969/j.issn.1672-8467.2023.02.001

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  Objective To explore the expression of transmembrane protein 33 (TMEM33) and its relationship with the prognosis in cervical cancer through bioinformatics methods, and to observe the effect of TMEM33 on the growth of cervical cancer cells after RNA interference. Methods The GEPIA (Gene Expression Profiling Interactive Analysis) database was used to select the TMEM33 genes associated with cervical cancer, and two specific siRNA sequences were designed for RNA interference experiments. The experiment was divided into 3 groups:siTMEM33 # 1 interference group, siTMEM33 # 2 interference group, and negative control (non-specific siRNA) group. TMEM33 protein expression in SiHa/HeLa cells after siRNA interference was determined by Western blot. SiHa/HeLa cells proliferation was detected by CCK-8. Apoptosis and cell cycle was detected by flow cytometry.Expression of the key genes for apoptosis BCL-2 and Bax, and the cell cycle related proteins CyclinD1 and P21 were determined by Western blot. Results Compared with siRNA negative controls, specific siRNA significantly downregulated TMEM33 protein expression, cervical cancer cell proliferation was significantly suppressed, while apoptosis was remarkably increased, cell cycle S was significantly decreased (P<0.05); key apoptosis gene BCL-2 expression was decreased while Bax expression was upregulated. CyclinD1 level was decreased while P21 level was increased (P<0.05). Conclusion After RNA interference, TMEM33 can significantly inhibit the growth of cervical cancer cells. TEME33 may promote the growth of cervical cancer cells by influencing the cervical cancer cell cycle, regulating the expression of apoptosis and cell cycle-related proteins.
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  Efficacy and prognostic analyses of salvage WBRT and chemotherapy in relapsed/refractory primary central nervous system lymphoma

  YANG Yu, LIN Zhi-guang, MA Jing-jing, KANG Hui, LI Qing, ZHANG Meng-xue, MA Yan, CHEN Bo-bin

  jms. 2023, 50(02): 166-174. https://doi.org/10.3969/j.issn.1672-8467.2023.02.002

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  Objective To evaluate the efficacy of salvage therapeutic strategy with or without whole brain radiotherapy (WBRT) and analyze potential factors involving with prognosis in relapsed/refractory primary central nervous system lymphoma (R/R PCNSL). Methods Data from patients with the first time R/R PCNSL diagnosed at our institution between Jan 2016 to Dec 2020 were retrospectively analyzed.Patients receiving salvage treatment with or without WBRT were analyzed for survival and prognostic factors. Results A total of 104 patients were recruited including 37 patients treated with WBRT (WBRT group) and 67 patients with chemotherapy only (non-WBRT,nWBRT group). Objective response rate (ORR) was 70.6% in WBRT group and 29.2% in nWBRT group (P<0.01). In WBRT group and nWBRT group, median progression-free survival (PFS) was 6.1 months and 2.0 months (P<0.01), and median overall survival (OS) was 28.8 months and 30.2 months(P>0.05), respectively. Univariate and multivariate analysis showed that higher level of cerebral spinal fluid (CSF) protein and response to salvage therapy were related to PFS, while KPS score and response to salvage therapy were related to OS. Conclusion WBRT may be recommended as salvage treatment for the first time R/R PCNSL patients, which brought longer PFS and higher response rate but no benefit on OS compared with chemotherapy. CSF protein>0.45 g/L and failed to achieve PR within 3 courses of salvage therapy were independent unfavorable prognostic factors of R/R PCNSL.
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  A cross-sectional study of the current pediatric internal medicine health resource allocation and service supply in Shanghai municipal hospitals

  ZHANG Xiao-bo, FU Wei-jia, SHEN Bing, GUI Yong-hao, FENG Rui, TANG Liang-feng, HUANG Min, YE Ying-zi, GE Xiao-ling, YU Song-xuan, LI Fu-xing, WANG Miao, XU Hong

  jms. 2023, 50(02): 175-182. https://doi.org/10.3969/j.issn.1672-8467.2023.02.003

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  Objective To analyze the current situation of pediatric internal medicine health resource allocation and medical service supply in Shanghai municipal hospitals,so as to provide a perspective on pediatric internal medicine medical resource allocation and improvement. Methods Relying on the pediatric internal medicine alliance of municipal hospitals in Shanghai, we performed a questionnaire survey to collect data on the number of physicians and nurses, hospital beds, outpatient and emergency visits, and discharges in 2020. The enrolled hospitals in the alliance consisted of 4 tertiary pediatric hospitals, pediatrics departments of 15 general hospitals,and neonatal units of 3 obstetrics and gynecology hospitals. Data among different types of hospitals were compared,and they were compared with the overall human resources of healthcare in the city. Also, the current status of pediatric health resources and medical service supply in Shanghai municipal hospitals were presented, and suggestions for pediatric internal medicine medical resource allocation were provided. Results Among the enrolled municipal hospitals,there were 1 253 pediatricians, accounting for 1.68% of all the physicians in Shanghai. There were 2 029 pediatric nurses, accounting for 2.09% of all the nurses in Shanghai. The ratio of pediatricians to nurses was 1:1.62. The pediatricians were mainly with master's degrees (50.84%),pediatric nurses were mainly with bachelor's degrees (55.89%), and only 1.53% were with master's or doctor's degrees. Pediatricians were predominantly of median-grade titles as attending doctors (39.43%), while pediatric nurses were predominantly of junior professional titles (54.02%) and only 1.28% with senior professional titles. Children's specialized hospitals had an absolute advantage in the equipment resource utilization and medical service supply, with 81.71% of basic equipment allocation, 75.60% of bed resources allocation, 74.04% of emergency and outpatient visits, 83.58% of fever clinic visits and 80.42% of hospital discharges. Conclusion The resource allocation of pediatric medicine in Shanghai municipal hospitals was with priority in children's specialized hospitals, and the average health service utilization in children's specialized hospitals was higher than the average level. With the leadership and technical support from the tertiary children's specialized hospital in the pediatric health service alliance, the pediatric departments in general hospitals may improve their quality of medical care.
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  Effect of controlled hypertension on postoperative incisional blood effusion in patients undergoing vertical partial laryngectomy

  FU Dan-yun, PAN Yi-ting, ZHANG Ming, FAN Qing

  jms. 2023, 50(02): 183-188. https://doi.org/10.3969/j.issn.1672-8467.2023.02.004

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  Objective To evaluate the effect of controlled hypertension on postoperative incisional blood effusion before the operative incision closure in vertical partial laryngectomy (VPL) surgery under general anesthesia. Methods A total of 70 patients scheduled for VPL surgery were recruited from Oct 2019 to Oct 2020 in Eye & ENT Hospital, Fudan University. The patients were randomly divided into the control group (NS group) and the controlled hypertension group (VP group) (n=35 in each group). The NS group was given NS within 10 min before incision closure,while the VP group was received ephedrine or phenylephrine, and the mean arterial pressure (MAP) was maintained 10% above the baseline value. The surgical field bleeding score before and after intervention was compared. The incisional drainage volume, gauze blood effusion, frequency of bloody sputum aspiration, nausea and vomiting and coughing score were also compared at the time points of leaving postanesthesia care unit (PACU) (T₁), 6 h (T₂) and 24 h (T₃) postoperatively. The serious cardiovascular and cerebrovascular complications, massive bleeding and other complications were recorded within 24 h postoperatively. Results Compared with the NS group, the surgical field bleeding score was significantly higher in the VP group (Z=-5.505,P<0.001). Compared with the NS group, the incisional drainage volume was significantly lower in the VP group at T₁, T₂ and T₃(Z=-2.773,P=0.003; Z=-4.195, P<0.001;Z=-3.745,P<0.001,respectively). Compared with the NS group, the blood effusion score and frequency of bloody sputum aspiration were also significantly lower in the VP group at T₁, T₂ and T₃ (all P<0.05). The nausea and vomiting score was significantly lower in the VP group at T₂ and T₃ (all P<0.05). No statistical difference was found in cough score on each time after surgery. No serious cardiovascular and cerebrovascular complications occurred in the two groups, and 1 case of postoperative massive hemorrhage was found in the NS group. Conclusion In the patients undergoing VPL surgery, the implementation of controlled hypertension before the operative incision closure was beneficial for surgeons to better hemostasis, thus reducing postoperative incisional drainage volume and blood effusion, and decreasing the incidence of frequency of bloody sputum aspiration, nausea and vomiting.
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  Analysis of reasons for failure in screening healthy subjects in phase I clinical trials

  ZHANG Li, MENG Xian-min, DONG Ping, WANG Bin

  jms. 2023, 50(02): 189-195,212. https://doi.org/10.3969/j.issn.1672-8467.2023.02.005

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  Objective To clarify the reasons for failure in screening healthy subjects(HS), and to demonstrate the factors influencing eligibility of HS for inclusion in phase Ⅰ clinical trials(PⅠCT). Methods We performed a retrospective study that described the processes of screening HS for inclusion in PⅠCT carried out in Shanghai Public Health Clinical Center between Jun 2016 and Sep 2020. The constituent ratio and incidence of reasons for screening failure (SF) were calculated and the impacts of demographic information and screening steps on the screening eligibility rate (ER) were analyzed. Results A total of 12 028 volunteers participated in screening for inclusion in 58 PⅠCT. Of these, 3 315 were evaluated by clinicians as "healthy" with an eligibility rate (ER) of 27.6%. The participants failing screening because of abnormal laboratory examination accounted for 47.2% of exclusions, followed by abnormal vital signs (VS), abnormal auxiliary examination and unqualified demographic information. The performance of urine nicotine test made a significant difference to ER (P=0.003), along with chest radiograph (P=0.025), and abdominal ultrasound (P=0.002). Conclusion The main reason for exclusion in the screening of HS is abnormal laboratory examination, followed by abnormal VS, abnormal auxiliary examination, and unqualified demographic information. Inclusion of urine nicotine test, chest radiograph, or abdominal ultrasound in screening may lower the ER for inclusion.
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  CT and MRI findings in primary renal neuroendocrine tumors

  WANG Rui-ting, DING Yu-qin, ZHONG Lian-ting, TANG Qi-ying, MAO Wei, DAI Chen-chen, ZENG Meng-su, ZHOU Jian-jun

  jms. 2023, 50(02): 196-201. https://doi.org/10.3969/j.issn.1672-8467.2023.02.006

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  Objective To investigate the CT and MRI features of primary renal neuroendocrine tumor (PRNET) in order to improve the diagnostic level of this rare disease. Methods Eight cases of PRNETs confirmed by pathology were retrospectively analyzed, of which, 4 cases underwent CT scan, 3 cases underwent MRI scan, and 1 case underwent both CT and MRI scans. The imaging characteristics were summarized and compared with pathology. Results Among the 8 PRNETs, 6 cases were well-differentiated, graded as G1 (n=3) and G2 (n=3), 2 cases were poorly-differentiated, graded as G3. Four lesions were located in the left kidney and the other four lesions were located in the right kidney, with an average diameter of (4.1±1.7) cm, ranging from 2.0 cm to 7.0 cm. There were 5 cases of round shape, 3 cases of irregular shape, 4 cases of cystic degeneration, 6 cases of hemorrhage, 2 cases of necrosis, and 0 case of calcification. One lesion was located at the upper pole of the kidney, and 7 cases were located near the renal hilum. One case of well-differentiated PRNETs showed lymph node metastasis, and 1 case of intravascular tumor thrombus, respectively. One case of the poorly-differentiated PRNETs demonstrated intravascular tumor thrombus, multiple metastases in the liver, bone and lymph nodes. All lesions showed slightly high attenuation on CT plain scan. Among the well-differentiated PRNETs, 3 cases showed iso-signal intensity (SI) and 1 case with high SI on T1WI. There was 1 case with iso-SI and 3 cases with slightly low SI on T2WI. All 4 lesions showed low SI on the ADC map. The well-differentiated PRENTs showed moderate and obvious enhancement, and the poorly-differentiated PRNETs showed mild to moderate enhancement after contrast enhancement, of which 7 cases showed continuous enhancement, and 1 case showed "wash-in and wash-out" enhancement. Conclusion The imaging findings of PRNETs have certain characteristics, usually located near the renal hilum, showing slightly high attenuation on plain CT scan, iso or slightly low SIs on T2WI. Well-differentiated PRNETs are prone to cystic degeneration, with moderate and obvious enhancement, while poorly-differentiated PRNETs are prone to hemorrhage and necrosis, and with mild and moderate enhancement.
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  Effect of epidural labor analgesia on renal function of parturients with preeclampsia

  SUN Shen, TIAN Fu-bo, HUANG Shao-qiang

  jms. 2023, 50(02): 202-206. https://doi.org/10.3969/j.issn.1672-8467.2023.02.007

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  Objective To observe the effect of epidural labor analgesia on renal function of parturients with preeclampsia. Methods Fifty singleton cephalic primiparas with preeclampsia who planned vaginal delivery were selected, among which 25 chose epidural labor analgesia or 25 did not. Pain scores and mean arterial pressure were recorded when and 4 h after entering the delivery room. Urine microalbumin,urine microprotein/creatinine,blood creatinine,urea nitrogen and uric acid were measured when entering the delivery room and 24 h after delivery. Apgar score and umbilical arterial blood gas were recorded. Results The pain score and mean arterial pressure in labor analgesia group was significantly lower than that in control group 4 h after entering the delivery room (P=0.001,0.001). There were no significant differences in urinary microprotein、serum creatinine、urea nitrogen and uric aicd between the two groups 24 h after delivery. Urinary microalbumin/creatinine in labor analgesia group was significantly lower than that in control group 24 h after delivery (P=0.01). There were no significant differences in Apgar score and umbilical arterial blood gas between the two groups. Conclusion Epidural labor analgesia can reduce urinary microalbumin/creatinine levels in preeclampsia parturients,and has a certain protective effect on renal function in preeclampsia parturients.
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  Value of Caprini thrombosis assessment model and RCOG guideline score for predicting the risk of perinatal venous thromboembolism: a comparative study

  HAO Zong, PAN Jie, YANG Wen-chao, DAI Jie-min, GUAN Jun-hua, GAO Bin

  jms. 2023, 50(02): 207-212. https://doi.org/10.3969/j.issn.1672-8467.2023.02.008

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  Objective To compare the predictive value of Caprini thrombosis assessment model and the Royal College of Obstetricians and Gynaecologists (RCOG) guideline score for the risk of maternal perinatal venous thromboembolism(VTE). Methods A retrospective analysis was conducted in the Department of Obstetrics and Gynecology,the Fifth People's Hospital of Shanghai,Fudan University from Feb 2014 to Feb 2020. A total of 347 maternal patients diagnosed with VTE In the perinatal period were enrolled, and a randomly selected group of 1391 maternal patients with no-VTE during the same period served as the control with a ratio of 1:4. The risks of VTE in both groups were evaluated by Caprini thrombosis assessment model and RCOG guideline score, and the predictive effects were compare between them. Results The results of prenatal VTE stratification from Caprini thrombosis assessment model in all subjects were significantly lower than those of postnatal assessment (χ²=937.268,P<0.001). The results of prenatal VTE stratification from RCOG guideline score in all subjects were also lower than those of postnatal assessment (χ²=1 324.195,P<0.001). Furthermore, the ROC curves for prenatal period showed no significant difference in the area under the curve (AUC) between Caprini thrombosis assessment model and RCOG guideline score (0.671±0.017 vs. 0.689±0.018,P=0.456 7). However, the AUC of Caprini thrombosis assessment model for postnatal period was smaller than that of RCOG guideline score (0.611±0.017 vs. 0.711±0.013,P<0.000 1). Conclusion Caprini thrombus assessment model and RCOG guideline score can predict the occurrence of perinatal maternal VTE, while RCOG guideline score is more suitable for maternity because of its pertinence and veracity.
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  Prevalence and the correlation factors analysis of maternal morbidity for postpartum women

  WANG Xiao-jiao, LI Zhao-run, QIAN Xu, GU Chun-yi

  jms. 2023, 50(02): 213-223. https://doi.org/10.3969/j.issn.1672-8467.2023.02.009

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  Objective To investigate the prevalence of maternal morbidity(MM) for postpartum women and to explore the relationship between postpartum adverse physical symptoms and life function impairment, anxiety and depression. Methods A total of 771 postpartum women who received postpartum health examination at Obstetrics and Gynecology Hospital,Fudan University and met the inclusion and exclusion criteria were selected and investigated for questionnaire survey from Nov 2020 to Dec 2021. They were required to use the Chinese version of Maternal WOICE Tool (postpartum questionnaire). The types and current status of women's physiological symptoms, psychological and life function impairment were collected and a network diagram of physiological symptoms of maternal morbidity were drawn. Results The self-reported postpartum adverse physical symptoms of 771 participants involved 13 categories and 62 symptoms. The average self-reported number of maternal morbidity was 8.20±6.35. The top three self-reported maternal morbidities were breast symptoms (72.24%,557/771),constitutional symptom(61.61%,475/771)and movement system symptoms (61.48%,474/771). The number of postpartum maternal morbidity was a risk factor of postpartum women's psychological state and the life function impairment. The risk of postpartum depression in the high symptom group (≥ 10) was 19.986 times as much as that in the asymptomatic group (95%CI:2.685‒148.784). The risk of postpartum anxiety in the high symptom group (≥ 10) was 11.693 times as much as that in the asymptomatic group (95%CI:2.737‒49.950). Meanwhile, the risk of life function impairment in the symptomatic group (5-9) was 2.864 times as much as that in the asymptomatic group (95%CI:1.452‒5.649). And this risk rose with the increase of the number of symptoms. Conclusion The number of maternal morbidity is a common risk factor for life function impairment, anxiety and depression in postpartum women.
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  Comparison of effects of epidural analgesia and intravenous analgesia on postoperative sleep quality in patients undergoing radical resection of colorectal cancer

  SHI Chao, JIA Li-hong, YANG Li, XU Ping-bo, ZHANG Jun

  jms. 2023, 50(02): 224-230. https://doi.org/10.3969/j.issn.1672-8467.2023.02.010

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  Objective To compare the effects of epidural analgesia and intravenous analgesia on postoperative sleep quality in patients undergoing radical resection of colorectal cancer. Methods Seventy patients who underwent elective laparoscopic radical resection of colorectal cancer were selected, with no gender limitation, age of 25-65 years old,ASA Ⅰ-Ⅱ grade,18.5 kg/m² ≤ BMI<28 kg/m². Using SPSS19.0 software, they were randomly divided into two groups, epidural analgesia group (group E) and intravenous analgesia group (group V). In group E, an epidural catheter of 4-6 cm was placed by puncture at the T12-L1 or T11-12 accessory approach before induction of general anesthesia, and intraoperative and postoperative analgesia was mainly based on epidural analgesia. In group V without epidural puncture, intravenous infusion of sufentanil was mainly used for analgesia during and after surgery. The Pittsburgh Sleep Quality Index (PSQI) and the incidence of severe sleep disorders were recorded on the 1, 3, 7, and 30 days after surgery, and the Postoperative Recovery Quality Scale-15 (QoR-15) was recorded on the 3, 7 and 30 days after the surgery. We recorded heart rate, systolic and diastolic blood pressure of the patients before and during the skin incision,postanesthesia care unit (PACU) stay time, PACU ventilator support ventilation time and postoperative hospital stay,and observe the occurrence of major adverse events during the patient's hospitalization. Results There was no significant difference in the total PSQI score and the incidence of severe sleep disorders on the 1, 3, 7 and 30 days after the operation between the two groups. There was no significant difference in QoR-15 score on the 3, 7 and 30 days after operation between the two groups. There was no significant differences in the PACU ventilator support ventilation time, postoperative hospital stay, and adverse events between the two groups. Compared with group V, patients in group E had shorter PACU stay (P<0.05), and lower systolic and diastolic blood pressure during skin incision (P<0.05). Compared with preoperation, the total PSQI scores of the two groups were increased on the 1, 3, 7 and 30 days after operation(P<0.05).Compared with 30 days after operation, the incidence of severe sleep disturbance was higher in the two groups on the 1, 3 and 7 days after operation(P<0.05). Conclusion Patients undergoing radical resection of colorectal cancer have higher incidence of severe sleep disorders within 1 week after operation, and different methods of analgesia may have no effect on the sleep quality and postoperative recovery of patients. Epidural analgesia can better inhibit surgery stimulation, and accelerate the transfer of patients from PACU.
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  Perioperative care of first transcatheter annulus contraction for treating severe tricuspid regurgitation in China

  XU Xiao-hua, LIU Rui-yan, LIN Ying, ZHU Li, ZHANG Wen-jun, HUANG Chen-xu, ZHOU Da-xin, PAN Wen-zhi, SUN Ying-ying, LING Hua-xing

  jms. 2023, 50(02): 231-236. https://doi.org/10.3969/j.issn.1672-8467.2023.02.011

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  Objective To summarize the perioperative care of 15 patients with severe tricuspid regurgitation undergoing transcatheter tricuspid annulus contraction. Methods Preoperative care was performed with disease observation, heart failure symptom relief, respiratory training, and psychological support. Intraoperative care was mainly cooperation with the surgeon,and postoperative care was conducted with close hemodynamic and respiratory monitoring, prevention and timely management of complications such as coronary ischemia and acute right heart failure, and early exercise rehabilitation. The effect of the perioperative care was varified by counting the number of surgical complications, recording the management process and outcomes of postoperative complications, and comparing patients' preoperative and postoperative Barthel daily mobility scores and six-minute walk test distances. Results Through postoperative monitoring, 2 cases of coronary ischemia, 1 case of acute right heart failure, and 1 case of subcutaneous bleeding were found, which may be related to surgical complications. All 15 patients were discharged successfully, and the mean Barthel Daily Activity Score improved from 35.32±6.50 preoperatively to 52.45±5.35 before discharge (t=-7.88,P<0.01). The six-minute walking test distance on the day of discharge was (191.30±15.21) meters, which was a significant improvement compared to (153.51±18.57) meters preoperatively (t=5.45,P<0.01). Conclusion Close monitoring of the condition, comprehensive complication prevention and management measures ensure a safe perioperative period and successful recovery for patients undergoing transcatheter tricuspid valve annulus contraction.
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  The application value of digital breast tomosynthesis in differentiating benign and malignant breast radial lesions

  MA Guang-hui, HUANG Hai-xia, ZUO Xiang, HUANG Yin-hua, LUO Yang, XU Guo-hou, WANG Ding-yao

  jms. 2023, 50(02): 237-242. https://doi.org/10.3969/j.issn.1672-8467.2023.02.012

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  Objective To evaluate the diagnostic value of digital breast tomosynthesis (DBT) in differentiating benign and malignant breast radial lesions. Methods A retrospective analysis was conducted on the clinical, digital mammography (DM) and DBT examinations of 67 patients with breast radial lesions confirmed histologically from Jun 2019 to Jan 2022 in the Convalescent Hospital of East China. The histological results were taken as the golden standard. Patients were divided into benign and malignant groups. The general baseline data between the two groups of patients were compared. The diagnostic efficacy of DM and DBT in breast radial lesions was compared. The central density, micro calcification, central size, overall size and spiculation length of the benign and malignant groups were analyzed and compared on DBT. Results In this study, 38 benign lesions and 29 malignant lesions were included. There were significant differences in age and menopause between the malignant group and the benign group with radial lesions (P<0.05). As regard for the detection rate and diagnostic accuracy in radial lesions,it was 61.94% (41/67) and 100% (67/67) of DM,and 65.85% (27/41) and 74.63% (50/67) of DBT, respectively. The detection rate between the two methods was significantly different (P<0.001), while the diagnostic accuracy between the two measuerments was not. At the same time there were no statistical differences in the sensitivity[65.38% (17/26) vs. 82.76% (24/29)], specificity[66.67% (10/15) vs. 68.42% (26/38)], misdiagnosis rates[33.34% (5/15) vs. 31.58% (12/38)] and missed diagnosis rates[34.62% (9/26) vs.17.24% (5/29)] between DM and DBT in the diagnosis of malignant radial lesions (P>0.05). The central size of lesions[(3.30±0.63) mm vs. (4.12±0.65) mm], overall size[(24.64±5.28) mm vs. (30.22±7.29) mm] and spiculation length[(11.32±3.38) mm vs. (13.24±2.23)mm] between the benign and malignant groups were significant different (P<0.05). However, the central density and micro calcification distribution of radial lesions between the two groups did not have statistical differences. Conclusion DBT have relative advantages in the diagnosis of breast radial lesions.
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  “Zhongshan Model” closed-loop management of narcotic and psychotropic drugs assisted by the intelligent medicine cabinet

  CHEN Yun-guang, HUANG Jian, QIAN Li, MIAO Chang-hong, ZHONG Jing

  jms. 2023, 50(02): 243-248,254. https://doi.org/10.3969/j.issn.1672-8467.2023.02.013

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  Objective To explore whether the use of intelligent medicine cabinet (IMC) can promote the standardized management of narcotic and psychotropic drugs in the operating room. Methods We studied the use and management of narcotic and psychotropic drugs in 12 operating rooms using traditional medicine box (TMB) and 12 operating rooms using "Zhongshan Model" IMC in Zhongshan Hospital, Fudan University. All the objects were divided into the TMB group (n=12) and the IMC group (n=12). The errors of drugs and the work efficiency and satisfaction of anesthesiologists were compared between the two groups in 22 workdays in Apr 2021. Results Errors of narcotic and psychotropic drugs occurred 18 times in the TMB group, and the IMC group had one error due to hardware failure. Median of errors in the TMB group was 1(1, 2) which was significantly higher than that in the IMC group 0(0, 0) (W=140.5, P<0.001). Total number of errors in drugs in the TMB group was 50, with an error rate of 0.52%. Total number of errors in the IMC group was 1, with an error rate of 0.01%, which was significantly lower than that in the TMB group (χ²=40.378, P<0.001). Mean time required for accounting of each surgery was (255.26±14.62)s; in the TMB group and (76.45±3.87) s, in the IMC group (t=40.947, P<0.001). The mean score of customer efforts in the TMB group was 4.17±0.17, while 6.40±0.26 in the IMC group (t=24.48, P<0.001). The overall customer satisfaction in the TMB group was 66.67%, and net promoter score was -16.67%, while both were 100% in the IMC group. Conclusion Under the "Zhongshan Model" closed-loop management of narcotic and psychotropic drugs assisted by the IMC, the drug error rate was lower and the work efficiency and satisfaction of anesthesiologists were higher than those of the TMB. The use of IMC can promote the error-free management of narcotic and psychotropic drugs in the operating room.
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  Prospective study on survival analysis and risk factors of primary patency in hemodialysis patients with autogenous arteriovenous fistula

  LU Wen-wen, HUANG Bi-hong, YUAN Li, CAO Yan-pei

  jms. 2023, 50(02): 249-254. https://doi.org/10.3969/j.issn.1672-8467.2023.02.014

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  Objective To investigate the primary patency and risk factors in hemodialysis patients with autogenous arteriovenous fistula (AVF). Methods The patients with new creation of AVF at a single institution from Sep 2016 to Apr 2019 were enrolled in this prospective study. Clinical data including demographic data, ultrasound data, concomitant diseases, operative information and primary patency were collected and analyzed.Kaplan-Meier survival curves and Cox proportional hazard models were used to determine the primary patency and associated factors. Results The primary patency rates for 1, 2 and 3 years were 77.5%, 71.5% and 65.1%,respectively. The median time of primary patency was 35.85 months. Univariate Cox regression reveals that age, education level, nephrology follow-up, diabetes, initial surgery, fistula site, central venous catheter, arterial diameter and venous diameter were the composite risk factors of primary patency.After adjustment,multivariate Cox regression revealed that diabetes, initial surgery and venous diameter were the independent factors for AVF primary patency. Conclusion Diabetes, initial surgery and venous diameter were significantly associated with primary patency in newly created AVF.
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  Prenatal ultrasonographic diagnosis and pregnancy outcomes of absent ductus venosus

  ZHAO Fan-gui, FU Zhong-peng, YAN Ying-liu, KONG Fan-bin, HUANG Xiao-wei, REN Yun-yun

  jms. 2023, 50(02): 255-261. https://doi.org/10.3969/j.issn.1672-8467.2023.02.015

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  Objective To study the prenatal ultrasonographic findings of absent ductus venosus (ADV) and its relationship with pregnancy outcomes. Methods Sonograms and clinical data of 21 ADV cases who visited ultrasound diagnosis department of Obstetrics and Gynecology, Fudan University from Jan 2017 to Feb 2020 were retrospectively reviewed. The cases of ADV were analyzed according to the new classification of Achiron, et al's:Type Ⅰ was umbilical-systemic shunt (USS); Type Ⅱ was ductus venosus-systemic shunt (DVSS); Type Ⅲ was divided into Type Ⅲa,intrahepatic portal-systemic shunt (IHPSS) and Type Ⅲb, extrahepatic portal systemic shunt (EHPSS). Fetomaternal clinical characteristics and outcomes (postnatal follow-ups to 42 days) were investigated by means of medical files, imaging documentation and telephone interviews (live birth, postpartum ultrasound, liver function, or routine physical examination results) with the mothers. Results A total of 21 cases were identified in 3 types:10 (47.6%) with Type Ⅰ,7 (33.3%) with Type Ⅱand 4 (19.0%) with Type Ⅲa. There were 6 cases (60%) combined with cardiomegaly in type Ⅰ, 2 cases (50%) combined with cardiomegaly in Type Ⅲa, and there was no case combined with cardiomegaly in Type Ⅱ (P=0.012). A total of 16 cases (76.2%) were combined with intracardiac and extracardiac malformations, i.e., 9 cases (90%), 4 cases (57.1%) and 3 cases (75%) in the three types, respectively (P=0.288). There were 3 cases with fetal growth restriction, accounting for 10%, 28.6% and 0 in the three types, respectively (P=0.309). Pregnancy outcomes:5 cases were lost to follow-up; 9 cases with severe malformations were terminated of pregnancy; the remaining 7 cases were born lively, 1 case (10%), 4 cases (57.1%) and 2 cases (50%) in the three types, respectively (P=0.077). Conclusion In this study, there were significant ultrasonographic findings in three types of ADV. The incidences of cardiomegaly and intracardiac and extracardiac malformations were higher in USS type cases with poor outcomes. Postnatal outcome was associated with the types of ADV,the presence and severity of cardiomegaly, and associated malformations.
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  Analysis of relevant factors of outpatients' visit in a tertiary children's hospital during the COVID-19 epidemic in Shanghai

  SHEN Guo-mei, GAO Xuan, ZHOU Li-jun, ZHANG Bing-feng, QIAN Yu-ping, XU Hui, TIAN Jun-hua, ZHAI Xiao-wen

  jms. 2023, 50(02): 262-266,279. https://doi.org/10.3969/j.issn.1672-8467.2023.02.016

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  Objective To figure out the solutions of how to improve services for the patients from regular outpatient visit and internet visit upon the COVID measurements. Methods During the COVID-19 epidemic in Shanghai in May 2022,a questionnaire survey was investigated in the parents of outpatients in Children's Hospital,Fudan University during the recent COVID-19 epidemic in Shanghai, 644 patients' parents received the questionnaire survey, including their social demography, medical needs, satisfaction to the medical service, awareness of internet hospitals and willingness to use, etc. Results Being affected by the COVID-19 epidemic, the hospital visit outpatient numbers decreased substantially, and the patient's behavior for medical care changed accordingly. Since waiting time on average was less than that before the epidemic (12.82 min vs. 23.21 min), doctors spent more time in treating each child. In this study, the difference in respondents' satisfaction with the waiting order and waiting time before and during the epidemic was statistically significant (P<0.05), and the patients had a better experience in the medical service. Additionally, the younger parents (<39 year) intended to use the internal hospital (P<0.05). Conclusion The management, comprehensive diagnosis and treatment of hospital capacity faced a huge challenge during the epidemic. The changes of traditional medical service pattern, including integration of internet service with current hospital conventional management and service mode, accessibility of medical resources, will be critical for improvement of medical service at post-epidemic period.
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  Application value of intracardiac echocardiographic guidance in transcatheter closure of latent patent foramen ovale

  PENG Song, ZHANG Xiao-chun, LI Ming-fei, ZHANG Lei, CHEN Hai-yan, ZHOU Da-xin, GE Jun-bo

  jms. 2023, 50(02): 267-272. https://doi.org/10.3969/j.issn.1672-8467.2023.02.017

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  Objective To investigate the application value of intracardiac echocardiography (ICE) in transcatheter closure of latent patent foramen ovale (PFO). Methods This was a retrospective study of patients admitted to Zhongshan Hospital,Fudan University from Jun to Sep 2021 who showed atrium level shunt after valsalva maneuver by right heart contrast echocardiography and received transcatheter closure. They were divided into transthoracic echocardiography (TTE) group and ICE group according to using ICE or not. The general condition, ultrasound results, comorbidity, complications, operative and fluoroscopy time of two group were recored. Pearson correlation was used to analyze the correlation between diameter of foramen ovale measured by ICE during the operative and transesophageal echocardiography (TEE) before. Results Among 56 patients, there were 37 patients in TTE group and 19 patients in ICE group. Correlation analysis showed that the diameter of foramen ovale measured by ICE was positively associated with TEE (R=0.81,P<0.01). ICE could guide wire to pass through the foramen ovale during operation, which reduced the operation time and radiation exposure time. Conclusion ICE had significant value in transcatheter closure of latent PFO. It has not only a higher successful rate and safety, but also reduce the operation time and radiation exposure time compared to TTE.
Methods and Techniques
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  Feasibility analysis of a new electrochemical analyzer BA200 in clinical detection of airway inflammation

  XUE Li-ping, GONG Ying, ZHAO Zhen, HU Li-juan, JIN Mei-ling, SONG Yuan-lin, LI Li

  jms. 2023, 50(02): 273-279. https://doi.org/10.3969/j.issn.1672-8467.2023.02.018

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  Objective To verify the test feasibility of a new portable electrochemical analyzer BA200 (domestic) in measuring the fractional exhale nitric oxide (FeNO), a marker of airway inflammation. Methods FeNO was tested in 137 patients with airway diseases by using BA200 and NIOX VERO,respectively,and Bland-Altman method was used for consistency analysis. Intraclass correlation coefficient (ICC) method was used for repeatability analysis in other 50 patients with airway disease. ROC curve was used to compare the sensitivity and specificity of the two analyzers in 80 patients with asymptomatic and symptomatic asthma among the 137 patients at different critical values. Results In the consistency study,Bland-Altman analysis on the 3 groups of different levels[<25×10^-9,(25-50)×10^-9,>50×10^-9] and the overall sample showed that the 95% of limit of agreement (LoA) for the difference was (-3.239 2-6.724 4)×10^-9, (-6.829 0-7.923 4)×10^-9,(-14.310 1-17.485 9)×10^-9 and (-7.922 0-10.704 4)×10^-9, respectively. Most of the differences were within 95%LoA of the mean value of difference between the two machines. In the repeatability study, the ICC values of BA200 and NIOX VERO were 0.995 3 and 0.996 8, respectively, which were greater than 0.75 (P<0.001). In ROC curve analysis, when 49.9×10^-9 was used as the cut-off value, the specificity of both machines was equal, and the sensitivity of BA200 was higher than that of NIOX VERO. Conclusion Compared with the classical electrochemical analyzer NIOX VERO, the results of FeNO measured by BA200 have good consistency and repeatability. BA200 can be used as a clinical alternative product of NIOX VERO with good clinical application value.
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  Application of restricted cubic spline Cox proportional hazards model in the tumor prognosis analysis

  ZHANG Peng-yan, LIU Zhen-qiu, FAN Hong, SUO chen, CHEN Xing-dong, ZHANG Tie-jun

  jms. 2023, 50(02): 280-285. https://doi.org/10.3969/j.issn.1672-8467.2023.02.019

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  Objective To investigate the application of restricted cubic spline Cox proportional hazards model in tumor prognosis analysis. Methods The prognosis of 686 patients with primary breast cancer was analyzed by using the restricted cubic spline Cox proportional hazards model. Concordance index (C-index), net reclassification improvement (NRI), integrated discrimination improvement (IDI) and calibration between restricted cubic spline Cox proportional hazards model and the traditional Cox proportional hazards model were compared. Results Age at first surgery, number of positive lymph nodes, progesterone receptor and estrogen receptor were nonlinearly associated with breast cancer recurrence. The C-index of traditional Cox proportional risk model was better than that of restricted cubic spline Cox proportional risk model when the prediction time was less than 511 days, while the C-index of restricted cubic spline Cox proportional risk model was superior to traditional Cox proportional risk model when the prediction time was greater than 511 days. The NRI, IDI and calibration of restricted cubic spline Cox proportional hazards model were better than that of traditional Cox proportional hazards model without overfitting phenomenon, which had a good predictive value in the prognosis analysis of patients with primary breast cancer. Conclusion Although restricted cubic spline is affected by the number and position of the spline function nodes, and the presence of high subterms affects the interpretability of the model, restricted cubic spline Cox proportional hazards model fitting the nonlinear relationship of the independent variables still showed advantages in tumor prognosis analysis when the follow-up data did not satisfy the log-linear assumption of traditional Cox proportional risk model.
Clinical Case Discussion
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  Perioperative nursing care of patients with severe tricuspid regurgitation undergoing transjugular tricuspid valve replacement

  SHEN Zhi-yun, LIN Ying, ZHOU Da-xin, ZHANG Yuan, HUANG Chen-xu, LIU Rui-yan, PAN Wen-zhi

  jms. 2023, 50(02): 286-291. https://doi.org/10.3969/j.issn.1672-8467.2023.02.020

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  Because of the complexity of tricuspid valve structure and location, no mature transcatheter tricuspid valve replacement products have been widely used in clinical practice. The new transjugular tricuspid valve replacement device (LuX-Valve-Plus), independently developed by domestic scholars, is superior to other existing technologies in terms of concept,design,and fixation technology. The Department of Cardiology in our hospital successfully completed 5 cases of transjugular tricuspid valve replacement. All the patients recovered and were discharged. We discussed and summarized the perioperative nursing priorities and difficulties,which include:volume management,posture nursing,wound nursing,pain nursing,monitoring and nursing of complications (thrombosis,arrhythmia,thrombocytopenia, infection), rehabilitation nursing, and discharge guidance,hoping to provide a solid nursing guarantee for China's new medical technology on the road to independent innovation.
Review
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  Research progress on the application of metaverse in chronic diseases health management

  SUN Meng-ting, YANG Da-wei, XIE Lin-shan, ZHOU Jian, SONG Yuan-lin, BAI Chun-xue

  jms. 2023, 50(02): 292-295,316. https://doi.org/10.3969/j.issn.1672-8467.2023.02.021

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  The metaverse has broken into the limelight with the convergence of emerging technologies such as virtual reality, digital twins, the Internet of Things, and blockchain. The current healthcare system, for example, for chronic obstructive pulmonary disease (COPD), obstructive sleep apnea-hypopnea syndrome (OSAHS), pulmonary nodules, coronary heart disease, and the management of chronic diseases still faces problems such as uneven distribution of medical resources, difficulties in follow-up, and overburdened specialists. While metaverse in medicine platforms that are industrial level and incorporate advanced artificial intelligence, brain-computer interfaces, and other digital technologies may gradually solve these problems. With the development of these new computer and information technologies, the metaverse + medical scenario is promising to reshape the next generation of digital health care based on the excellent paving effect of digital health care to carry on. In this paper, we will review and discuss how these technologies are converging to form meta-universe medicine and the prospects of its practical application in digital health care.
Short Report
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  Research on satisfaction survey and strategy optimization of incentive mechanism for pediatric hospital staff

  CHEN Xiao-wen, ZHU Yong-kai, JIA Pin, ZHENG Yin-yan, HAN Li-yuan, ZHOU Wen-hao, QIAN Li-ling

  jms. 2023, 50(02): 296-301. https://doi.org/10.3969/j.issn.1672-8467.2023.02.022

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  The survey was carried out in the form of online questionnaires, in order to understand the recent work status, awareness and satisfaction of incentive policies of pediatric hospital staff, and provide reference for hospital management to formulate relevant incentive policies. A total of 427 valid questionnaires were collected and SPSS23.0 software was used for statistical analysis. The analysis methods included t test, rank sum test and Logistic regression analysis. The employee's recent work situation satisfaction rate is 3.68 points, of which the most satisfying aspect is the relationship between colleagues (4.31) and the respect given by the boss (4.26); the most unsatisfactory aspect is overtime (2.72). Hospital staff believe that the main factors affecting their work enthusiasm are ranked in the top five in order of "higher wages" "reasonable vacations" "reasonable work intensity and workload" "fair,reasonable and perfect performance" and "harmonious relationship" respectively. Measures to offer salary allowance, adjust the business structure, optimize the promotion mechanism, refine the performance appraisal and reward mechanism, create a public service atmosphere and strengthen spiritual incentives are recommended to optimize the incentive mechanism and improve the job satisfaction of medical staff in a children's hospital.
Case Reports
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  Immunotherapy for lung adenocarcinoma induced diabetic ketoacidosis: a case report

  ZHANG Jie-qing, LYU Qian-zhou, LI Xiao-yu, JIN Mei-ling, YE Xiao-fen

  jms. 2023, 50(02): 302-305. https://doi.org/10.3969/j.issn.1672-8467.2023.02.023

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  The lung adenocarcinoma is one subtype of non-small cell lung cancer (NSCLC), its incidence keeps increasing in China, accounting for 40%-55% of the total number of lung cancers. The emergence of immune checkpoint inhibitors (ICIs) has changed the treatment prospects for patients with NSCLC. Studies have shown that monotherapy or combination therapy with ICIs resulted in a significantly higher 5-year survival rates for patients with advanced NSCLC. With the increased use of ICIs, immune-related adverse events are frequent. Diabetic ketoacidosis caused by ICIs was rarely reported, which should arouse the attention of physicians and pharmacists. Here we report a male patient with lung adenocarcinoma who developed multiple vomiting and fatigue after 4 cycles of treatments of chemotherapy combined with immunotherapy (pemetrexed disodium+nedaplatin+bevacizumab+camrelizumab). Blood test on admission:the fasting blood glucose> 60 mmol/L, ketone body 1.96 mmol/L, fasting insulin 92.7 μU/mL, fasting C-peptide 0.28 ng/mL, β-hydroxybutyric acid 1.20 mmol/L, amylase 148 U/L, blood gas analysis (no oxygen) pH=7.17. The patient was diagnosed as diabetes ketoacidosis. The ketone body turned negative after treating with fluid infusion and insulin, and correction of electrolyte disorder and acidosis. After discontinuation of camrelizumab and continued insulin therapy, the blood glucose was controlled three weeks later.
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  Percutaneous transcatheter closure of double-holes atrial septal defect guided by ICE: a case report

  ZHANG Xuan, ZHANG Xiao-chun, ZHANG Lei, LI Ming-fei, CHEN Sha-sha, PAN Wen-zhi, ZHOU Da-xin, GE Jun-bo

  jms. 2023, 50(02): 306-311. https://doi.org/10.3969/j.issn.1672-8467.2023.02.024

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  This paper reports a case of intracardiac echocardiography (ICE)-aided catheter-based closure with double-holes atrial septal defect (ASD). The patient was diagnosed as double-holes secundum ASD by transthoracic echocardiography (TTE), and the size of two holes was 12 mm and 13 mm respectively. The distance between the two holes was about 6 mm. Under the guidance of digital subtraction angiography (DSA) and ICE, the 20 mm septal occlude (small waist and large atrial) was successfully applied to the patient. Immediately after the closure, ICE indicated that there was no atrial septal shunt; the position, size and shape of the device were suitable;and there is no influence to the surrounding structures.
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  Pregnancy complicated with hemophagocytic syndrome: 3 cases report

  SHI Dong-dong, CHENG Yan, ZHANG Qing-ying

  jms. 2023, 50(02): 312-316. https://doi.org/10.3969/j.issn.1672-8467.2023.02.025

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  Hemophagocytic syndrome (HPS) is a syndrome of excessive inflammatory response caused by abnormal immune regulation. However, the incidence of HPS in pregnancy is low, and the lack of specific clinical manifestations makes it easy to misdiagnose and delay treatment. This study retrospectively analyzed the clinical data of 3 pregnant women with HPS who were admitted to Obstetrics and Gynecology Hospital,Fudan University. The primary symptoms of case 1 and case 2 were pruritus and impaired liver function in late trimester of pregnancy,but after termination of pregnancy,the patients developed repeated high fever, hepatosplenomegaly and elevation of liver enzymes,three or two lines of blood cells decreased, serum ferritin increased significantly, bone marrow puncture suggested HPS. The primary symptoms of case 3 were lymphadenopathy and fever during the second trimester of pregnancy. After antibiotic treatment, the fever was still repeated, accompanied by the decrease of the three systems in the blood routine, the increase of the liver enzyme, and finally the bone marrow puncture suggested HPS. All the 3 cases achieved remission after treatment with high-dose glucocorticoids, and prognosis was good. Pregnancy with HPS is complicated and easy to be misdiagnosed. For persistent high fever, ineffective antibiotic treatment accompanied by elevated liver enzymes,two or three-line cytopenia, hepatosplenomegaly and other related clinical manifestations, the possibility of pregnancy complicated with HPS should be considered. Timely diagnosis and reasonable treatment can improve the prognosis.