Hainan Medical University Research Articles

Clinical effect of minimally invasive technique of internal fixation device removal in patients with healed long tubular bone fractures.

To investigate the clinical effect of minimally invasive technique applied to internal fixation removal in patients with healed long tubular bone fractures. The records of patients with internal fixation of long tubular bone fracture who underwent the removal of the internal fixation device after fracture healing in The Second Affiliated Hospital of Hainan Medical College from May 2020 to December 2021 were reviewed. According to the different operation methods of taking out the internal fixation device, patients were divided into minimally invasive group (n=40) and traditional group (n=45). The perioperative indexes, levels of inflammatory factors tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), Karnofsky Performance Score (KPS), visual analog scale (VAS) pain score and complications were compared between the two groups. The drainage volume, bleeding volume, incision length and hospital stay in the minimally invasive group were significantly lower than those in the traditional group (P<0.05). The KPS score of minimally invasive group was significantly higher than that of traditional group at one week and one month after the operation, and the VAS score of minimally invasive group was significantly lower than that of traditional group at one day and one week after the operation (P<0.05). The levels of TNF-α and CRP in the observation group were significantly lower than those in the control group(P<0.05). There was one case of infection in the minimally invasive group, one case of secondary fracture and two cases of infection in the traditional group(P>0.05). Minimally invasive surgery for the removal of the internal fixation device in patients with healed long tubular bone fractures with internal fixation is associated with significantly improved clinical effect, relieved symptoms, reduced inflammatory response, and improved functional recovery of patients.

Correlation between Insulin Resistance and Microalbuminuria Creatinine Ratio in Postmenopausal Women.

Objective To study the relationship between insulin resistance and urinary microalbumin creatinine ratio in postmenopausal women. Methods The selected research group comprised 104 postmenopausal women with type 2 diabetes who were admitted to the Department of Endocrinology in the green card center at the First Affiliated Hospital of Hainan Medical University between 2017 and 2019 inclusive. Ninety-eight postmenopausal women with the normal blood glucose metabolism hospitalized in the same period were used as the control group. The age, body mass index, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, fasting blood glucose, fasting insulin (FINS), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), and urinary albumin-creatinine ratio (UACR) were analyzed. The insulin resistance index (HOMR-IR) was calculated, and the correlation between IR and UACR was analyzed. Results Levels of HOMA-IR, SBP, HbA1c, HDL-C, LDL-C, TC, TG, FPG, FINS, and UACR in the study group were higher than those in the control group, and a significant difference was found between the groups (P < 0.05). The level of DBP in the study group was lower than that in the control group, and the difference was statistically significant (P < 0.05). Pearson correlation analysis showed that UACR was positively correlated with HOMA-IR and HbA1c (r = 0.254, r = 0.565, P < 0.01). Multiple linear stepwise regression analysis further showed that HOMA-IR and age were positively correlated with UACR (P < 0.05). Conclusion There is a correlation between IR and UACR in postmenopausal women. IR is an independent risk factor for UACR.

Efficacy and safety of combined use of docetaxelgemcitabine chemotherapy and 5-fluorouracil targeted therapy in the treatment of advanced non-small cell lung cancer

Purpose: To determine the efficacy of combined use of docetaxel-gemcitabine chemotherapy and 5- fluorouracil (5-FU) targeted therapy for the treatment of advanced non-small cell lung cancer (NSCLC).&#x0D; Methods: Eighty advanced NSCLC patients in Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University) (March 2020 - March 2021) were selected and randomly assigned to chemo group (CHEG) and combination group (COMG), with 40 patients per group. All patients received docetaxel-gemcitabine chemotherapy. On the 1st, 8th and 15th day of treatment, docetaxel (20 mg/m2) was injected via intravenous drip. On the 2nd, 9th and 16th day, gemcitabine hydrochloride (1 g/m2) was injected, also via intravenous drip. The dose regimens were repeated once every 28 days. In addition, patients in COMG received 5-FU targeted therapy at a dose of 15 mg/kg body weight, in 5 % glucose solution, via intravenous drip for 5 - 8 h daily for 5 consecutive days. Thereafter, the dose was reduced by half and the drug injected once every other day. Therapeutic efficacy as well as various clinical and biochemical indices were assessed in both groups.&#x0D; Results: Compared with CHEG, COMG had a slightly higher objective remission rate and a higher disease control rate (p &lt; 0.05). After treatment, there was decrease in levels of serum carcinoembryonic antigen (CEA), squamous cell carcinoma (SCC) and cytokeratin 19 fragment antigen 21-1 (CY-FRA21- 1), with lower levels in COMG than in CHEG (p &lt; 0.05). The median survival time was shorter in CHEG than in COMG (p &lt; 0.05). However, no notable differences in the incidence of adverse reactions were observed between the two groups (p &gt; 0.05).&#x0D; Conclusion: Combined use of docetaxel-gemcitabine chemotherapy and 5-FU-targeted therapy downregulates the expressions of serum CEA, SCC and CY-FRA21-1 tumor markers, but significantly prolongs overall survival of patients. Therefore, this therapeutic strategy is safe but should be subjected to further clinical trials prior to application in clinical practice.&#x0D; Keywords: 5-Fluorouracil (5-FU; Advanced non-small cell lung cancer (NSCLC); docetaxel; Gemcitabine

Investigation on Dry Eye of College Students in Hainan Medical College and Analysis of Its Influencing Factors

Investigation on Dry Eye of College Students in Hainan Medical College and Analysis of Its Influencing Factors

Risk factors for delirium after surgery for craniocerebral injury in the neurosurgical intensive care unit

BACKGROUNDPostoperative delirium is common in patients who undergo neurosurgery for craniocerebral injury. However, there is no specific medical test to predict postoperative delirium to date.AIMTo explore risk factors for postoperative delirium in patients with craniocerebral injury in the neurosurgery intensive care unit (ICU). METHODSA retrospective analysis was performed in 120 patients with craniocerebral injury admitted to Hainan People’s Hospital/Hainan Hospital Affiliated to Hainan Medical University, The First Affiliated Hospital of Hainan Medical University, and The Second Affiliated Hospital of Hainan Medical University between January 2018 and January 2020. The patients were categorized into groups based on whether delirium occurred. Of them, 25 patients with delirium were included in the delirium group, and 95 patients without delirium were included in the observation group. Logistic regression analysis was used to explore the association between sex, age, educational level, Glasgow coma scale (GCS), complications (with or without concussion, cerebral contusion, hypoxemia and ventricular compression) and site of injury and delirium. RESULTSThe GCS score above 8 and concomitant disease of cerebral concussion, cerebral contusion, hypoxemia and ventricular compression, and damage to the frontal lobe were associated with delirium in patients admitted to neurosurgical intensive care unit (ICU) (all P < 0.05). However, age, sex, administration more than three medicines, and educational level were not significantly associated with the onset of delirium in patients with craniocerebral injury in the neurosurgical ICU (P < 0.05). Multivariate logistic regression analysis showed that GCS score above 8, cerebral concussion, cerebral contusion, hypoxemia, ventricle compression, and frontal lobe disorders were independent risk factors for delirium in patients with craniocerebral injury in the neurosurgical ICU (P < 0.05).CONCLUSIONGCS score, concussive concussion, cerebral contusion, hypoxemia, ventricle compression, and damage to frontal lobe are risk factors of postoperative delirium.

P-232 The developmental potential of human embryos with subtypes of multinucleation in cleavage stages

Abstract Study question Does subtypes of multinucleation in cleavage stage affect the developmental and implantation potential of human embryos? Summary answer Different subtypes of multinucleation presented diverse effects on morphokinetic abnormality and blastocyst rate, but achieved comparable implantation rate with blastocysts transfer. What is known already Time-lapse images reveals many abnormal events in early embryonic development. Blastomere multinucleation (MN) has the highest incidence, thus attracts extensive attention. More and more studies have been conducted on the generation mechanism, reproductive potential and utilization value of multinucleation embryos, but the impact of different subtypes of MN on embryo developmental potential, morphokinetics and clinical outcomes have not been well identified. Study design, size, duration Using a time-lapse incubator (EmbryoScope plus), we retrospectively explored the associations between the subtypes of MN with morphokinetic parameters, blastocyst rate and clinical pregnancy. This study assessed 4416 embryos, including 628 MN embryos from single embryo transfers after 1521 ICSI cycles conducted in Reproductive Medical Center of the First Affiliated Hospital of Hainan Medical University between October 2019 and October 2021. Participants/materials, setting, methods ubtypes of MN, morphokinetic parameters, blastocyst rate, preimplantation genetic testing for aneuploidy (PGT-A) result and clinical pregnancy were studied retrospectively. The quantitative variables were expressed as mean SD and were compared by means of Student two-sample t test. The categoric variables were expressed as frequency and percentage and were compared between groups by means of Pearson chi-square test or Fisher exact test. Main results and the role of chance The rate of MN was the highest (14.22%) among abnormal events. The blastocyst rate of MN embryos was significantly reduced (52.48%). The blastocyst rate of MN at 2-cell stage was significantly higher than that at 4-cell stage, but there was no significant difference in euploid rate and implantation rate with single blastocyst transfer. We chose embryos with only one blastomere multinucleation (MN-1) at 2-cell stage to analyze the effect of subtypes of MN, including two equal size nuclei (Bi-), two unequal size nuclei (micro-), more than two equal nuclei (poly-) and more than two unequal nuclei (cluster-), on developmental and implantation potential of human embryos. There were significant morphokinetic delay and reduced blastocyst rate in cluster-nucleation and poly-nucleation groups, but they could achieve competence implantation rate after blastocyst transfer. It was interesting that when we separately analyze the MN embryos which could survive to blastocyst, the morphokinetic data didn’t show significant delay in micro-nucleation group, only the cleavage time to the 3-cell stage was significant longer in Bi-nucleation group, and the time of pronuclear fading and cleavage time to the 2-cell stage were significant longer in poly-nucleation group. Limitations, reasons for caution The population size was relatively small and the current study is restricted by its retrospective nature and absence of live birth information. Wider implications of the findings It would be interesting to explore, prospectively in multi-clinics, whether these subtypes of multinucleation embryos equal to non-multinucleation embryos with blastocyst transfer. Further studies are needed, notably to explore the underline "self-repair" mechanism of Blastomere multinucleation. Trial registration number 0

P-511 Measuring patient-centredness in publicly funded fertility care and private funded fertility care in China

Abstract Study question Does the Patient-Centred Questionnaire-Infertility (PCQ-Infertility) validate in China? Do patients experience different on patient-centredness in public fertility care compared to that in private fertility care? Summary answer PCQ-Infertility is valid in China. The patients in private fertility care have better experiences on patient-centredness than that in publicly fertility from results of PCQ-Infertility. What is known already Patient-centredness is one of the most important elements of quality of care. The PCQ-Infertility has validated to be a reliable tool to assess the extent of patient-centredness of fertility care in many countries, cross European counties to New Zealand. In China, physicians in many hospitals have recognized the importance of patient-centred infertility care, but lack of using instrument to measure it and then to improve it. Study design, size, duration This is a cross-sectional study. A survey with written questionnaire was performed among patients who diagnosed with infertility in Reproductive Medical Center of the First Affiliated Hospital of Hainan Medical University (publicly funded fertility care and Reproductive Medical Center of Hainan Modern Women and Children’s Hospital (private funded fertility care) between July and December 2021. Participants/materials, setting, methods In this study, 315 patients and 189 patients completed the survey at two reproductive medical centers. We used patient’s questionnaires to collect data on the patients’ experience with the quality of care. The PCQ-Infertility content, besides background questions, the questionnaire included 46 care aspects. Psychometric tests included inter-item and reliability analyses. An elaborate multivariate multilevel regression analysis was performed to assess the PCQs ability to measure differences in patient-centredness between reproductive medical centers. Main results and the role of chance The questionnaire was completed by 315 and 189 patients from the two hospitals. Patients’ mean scores on overall patient-centredness and the eight subscales (possible range 0–3) were calculated. High scores represent positive experiences with care. Both private and public hospitals scored high on care organization and communication. The lowest scores for both hospitals were the subscale, namely,‘information’. The significant differences between two hospitals were in “accessibility, respect for patient’s values, continuity and transition”. Limitations, reasons for caution This study is cross-sectional, the sample size is small, and enrolled fertility care centers are only two. Wider implications of the findings The PCQ-infertility is encouraged to be used in China to measure the patient-centredness, and can be adopted for quality improvement especially for publicly funded fertility care. Trial registration number ChiCTR2100053616

The Effect of TLR9, MyD88, and NF-κB p65 in Systemic Lupus Erythematosus.

Purpose This study was conducted to characterize the expression level of peripheral blood toll-like receptors 9 (TLR9), nuclear factor kappa-B protein 65 (NF-κB p65), and myeloid differentiation factor88 (MyD88) of active systemic lupus erythematosus (SLE) and analyse their clinical significance. Methods The prospective cohort study enrolled 30 active SLE patients (SG1 group), 30 stable SLE patients (SG2 group), and 20 healthy individuals (RG group) in the First Affiliated Hospital of Hainan Medical University between January 2018 and June 2020. All SLE patients were treated with methylprednisolone tablets. Quantitative polymerase chain reaction (qPCR) was used to determine the levels of TLR9, MyD88, and NF-κB p65 in the peripheral blood mononuclear cell (PBMC). ELISA was adopted for the determination of serum interleukin (IL-6) and tumor necrosis factor-α (TNF-α). Results Patients in SG1 showed the highest mRNA levels of TLR9, MyD88, and NF-κB p65, followed by SG2, and then RG. SG1 had the highest serum levels of IL-6 and TNF-α, followed by SG2 and RG. The level of TLR9 was positively correlated with the SLE disease activity index (SLEDAI) and negatively correlated with complement component 3 (C3) and complement component 4 (C4). MyD88 and NF-κB p65 were positively correlated with SLEDAI. Conclusion Compared with a healthy status, SLE induces an increase in TLR9, MyD88, NF-κB p65, IL-6, and TNF-α levels, and the activation of the TLR9-MyD88-NF-κB p65 signal path was associated with the pathogenesis of SLE.

The 496th case:recurrent syncope for 8 years

A 25-year-old women was admitted to the department of Neurology in Affiliated 2nd Hospital of Hainan Medical University due to recurrent syncope for 8 years and return for 2 months. She had multiple episodes of syncope at onset. She presented with the feeling of weakness in both lower limbs, and fatigue in the past year. She experienced pain in the waist and limbs joint in recent three months. Physical examination showed joint hyperactivity in metacarpophalangeal joints of both upper limbs, increased skin elasticity. Active-standing transcranial Doppler (TCD) test showed that the average heart rate (HR) and the average middle cerebral artery (MCA) blood flow velocity in the supine position were 79 beats/min and 62 cm/s, respectively; while the average HR and the average MCA blood flow velocity in the standing position were 126 beats/min, 47 cm/s. Meanwhile,the blood pressure was normal during the test of supine-to-standing TCD. Genetic testing indicated LDB3 transgenation. The patient was diagnosed as postural tachycardia syndrome (joint-hypermobility-related), Ehlers-Danlos syndrome, and relieved by fluid infusion and rehabilitation therapy.

Analysis of intestinal microbial diversity in Leopoldamys edwardsi based on illumina sequencing technique

To explore the composition and diversity of the intestinal microflora of Leopoldamys edwardsi in Hainan Island. In November 2019, DNA was extracted from fecal samples of 25 adult Leopoldamys edwardsi (14 males and 11 females) in Hainan Island at the Joint Laboratory of tropical infectious diseases of Hainan Medical College and Hong Kong University. Based on the IonS5TMXL sequencing platform, single-end sequencing (Single-End) was used to construct a small fragment library for single-end sequencing. Based on Reads shear filtration and OTUs clustering. The species annotation and abundance analysis of OTUs were carried out by using mothur method and SSUrRNA database, and further conducted α diversity and β diversity analysis. A total of 1481842 high quality sequences, belonging to 14 Phyla, 85 families and 186 Genera, were obtained from 25 intestinal excrement samples of Leopoldamys edwardsi. At the level of phyla classification, the main core biota of the Leopoldamys edwardsi contained Firmicutes (46.04%),Bacteroidetes (25.34%), Proteobacteria (17.09%), Tenericutes (7.38%) and Actinobacteria (1.67%), these five phyla account for 97.52% of all phyla. The ratio of Helicobacter which occupied the largest proportion at the genus level was 12.44%, followed by Lactobacillus (11.39%), Clostridium (6.19%),Mycoplasma (4.23%) and Flavonifractor (3.52%). High throughput sequencing analysis showed that the intestinal flora of Leopoldamys edwardsi in Hainan Island was complex and diverse, which had the significance of further research.

Effective dose and adverse reactions analysis of Remimazolam for sedation in elderly patients undergoing gastroscopy

Objective: To explore the 50% effective dose (ED50) and 95% effective dose (ED95) of Remimazolam during gastroscopic sedation in elderly patients, and to observe the adverse reactions during anesthesia. Methods: From July to November 2020, 39 elderly patients, of which there were 18 males and 21 females, aged from 65 to 82 (72±5) years, were examined by gastroscopy in the Second Affiliated Hospital of Hainan Medical University, who American Society of Anesthesiologists (ASA) was grade Ⅰ or Ⅱ. Sufentanil 0.1 μg/kg and test dose Remimazolam were injected intravenously, and the initial dose of Remimazolam was 0.17 mg/kg. The dose of the next patient was determined according to the modified Dixon sequential method. If the former patient had a positive reaction during gastroscopy, such as cough, nausea, vomiting and/or body movement reaction occurred when the gastroscope was placed into the pharynx or in the 2 min, the next patient would increase the dose, otherwise, the dose would be reduced. The dose increase and decrease gradient of Remimazolam was 0.01 mg/kg, and the test was stopped after 12 times of return. At the same time, the occurrence of adverse reactions during anesthesia was observed. Results: A total of 39 elderly patients completed the trial, of which 21 were effective and 18 were ineffective. When the elderly patients were sedated by gastroscopy, the ED50 of single intravenous injection of Remimazolam was 0.153 mg/kg (95%CI:0.151-0.154 mg/kg) and the ED95 was 0.164 mg/kg (95%CI:0.160-0.166 mg/kg). The total dose of Remimazolam was (10.6±2.8) mg, the recovery time was (10.0±3.4) min, and the stay time in resuscitation room was (8.2±2.6) min. During anesthesia, nausea and vomiting occurred in 1 case, transient hypotension in 4 cases, and no other adverse reactions were found. Conclusion: The ED50 of Remimazolam during gastroscopic sedation in elderly patients is 0.153 mg/kg, ED95 is 0.162 mg/kg, and the incidence of adverse reactions is low.

Clinical value of propranolol combined with oxaliplatin and tigio in concurrent chemoradiotherapy for locally advanced gastric cancer

Objectives:To investigate the clinical value of propranolol combined with oxaliplatin and tigio in concurrent chemoradiotherapy for locally advanced gastric cancer.Methods:A total of 74 patients with locally advanced gastric cancer admitted to the First Affiliated Hospital of Hainan Medical University from August 2018 to June 2020 were selected as the subject and divided into two groups by random number table method: Group-A and Group-B, with 37 cases in each group. Patients in Group-A were treated with oxaliplatin injection and oral administration of tigio combined with concurrent radiotherapy, while patients in Group-B were given propranolol on the basis of treatment in Group-A. The clinical efficacy and incidence of adverse reactions in the two groups were observed.Results:The response rate (RR) of Group-B was higher than that of Group-A, but with no statistically significant difference (P>0.05). No statistical difference was observed in the incidence of gastrointestinal reaction, bone marrow suppression, oral mucositis, and the incidence of grade III-IV adverse reactions in the two groups (P>0.05). There were no serious adverse reactions related to propranolol in Group-B, and the levels of tumor markers CEA, CA50, CA125, and CA242 in Group-B were lower than those in Group-A.Conclusion:Propranolol combined with oxaliplatin and tigio boasts satisfactory sensitization safety in radiotherapy for gastric cancer, but its sensitization effect needs to be further investigated in a multi-center study involving large sample size.

Value of CT Radiomics and Clinical Features in Predicting Bone Metastases in Patients with NSCLC.

Objective To explore the CT radiomic features and clinical imaging features of the primary tumor in patients with nonsmall cell lung cancer (NSCLC) before treatment and their predictive value for the occurrence of bone metastases. Methods From June 2017 to June 2021, 195 patients with NSCLC who were pathologically diagnosed without any treatment in the Cancer Hospital Affiliated to Hainan Medical College were retrospectively analyzed, and they were divided into a bone metastasis group and a nonbone metastasis group. The relationship between clinical imaging features and bone metastasis in patients was analyzed by the t-test, rank sum test, and χ2 test. At the same time, ITK software was used to extract the radiomic characteristics of the primary tumor of the patients, and the patients were randomly divided into a training group and a validation group in a ratio of 7 : 3. The training model was validated in the validation group, and the performance of the model for predicting bone metastases in NSCLC patients was verified by the ROC curve, and a multivariate logistic regression prediction model was established based on the omics parameters extracted from the best prediction model combined with clinical image features. Results Seven features were screened from the primary tumor by LASSO to establish a model for predicting metastasis. The area under the curve was 0.82 and 0.73 in the training and validation sets. The best omics signature and univariate analysis suggested clinical imaging factors (P < 0.05) associated with bone metastases were included in multivariate binary logistic analysis to obtain clinical characteristics of the primary tumor such as gender (OR = 0.141, 95% CI: 0.022–0.919, P = 0.04), increased Cyfra21-1 (OR = 0.12, 95% CI: 0.018–0.782, P = 0.027), Fe content in blood (OR = 0.774, 95% CI: 0.626–0.958, P = 0.018), CT signs such as lesion homogeneity (OR = 0.052, 95% CI: 0.006–0.419, P = 0.006), pleural indentation sign (OR = 0.007, 95% CI: 0.001–0.696, P = 0.034), and omics characteristics glszm_Small Area High Gray Level Emphasis (OR = 0.016, 95% CI: 0.001–0.286, P = 0.005) were independent risk factors for bone metastasis in patients. Conclusion The prediction model established based on radiomics and clinical imaging features has high predictive performance for the occurrence of bone metastasis in NSCLC patients.

Effect of Interference Electric Stimulation at Baliao and Dachangshu Acupoints Combined with Mosapride on Constipation Patients with Diabetes

<sec><title>Objective</title> To observe the clinical effect of interference electric stimulation at Baliao and Dachangshu acupoints combined with mosapride on constipation patients with diabetes. </sec><sec><title>Methods</title> A total of 40 constipation patients with diabetes in the outpatient department of the Second Affiliated Hospital of Hainan Medical College from January 2018 to December 2019 were randomly assigned to the control group and the observation group, with 20 cases in each group. The control group was treated with oral mosapride plus lifestyle intervention, and Mosapride was given orally five mg a time, three times a day, continuous treatment for two weeks. The observation group received interference electric stimulation at Baliao and Dachangshu acupoints on the basis of oral mosapride and lifestyle intervention. The frequency was (4 000±100) Hz, and the intensity was subject to the patients tolerance, 20 minutes each time, once a day, continuous treatment for two weeks. Before and after treatment, the surface electromyography (EMG) of pelvic floor muscle was measured by multifunctional biological stimulation feedback instrument, the pelvic floor muscle strength was evaluated by Laycock score system, the quality of life of patients was evaluated by the MOS item short from health survey (SF-36), the constipation symptoms were evaluated by constipation symptom score scale, and the clinical effects of two groups were compared. </sec><sec><title>Results</title> There was no significant difference in the scores of pelvic floor surface EMG, pelvic floor muscle strength and quality of life between the two groups before treatment (<italic>P</italic>>0.05). ① Pelvic floor electromyography: compared with that before treatment, the Pre baseline resting EMG and Post baseline resting EMG were decreased significantly (<italic>P</italic><0.05), and the fast muscle systolic EMG, systolic EMG of synthetic muscle and slow muscle systolic EMG of two groups after the treatment were increased significantly (<italic>P</italic><0.05); compared with the control group, the Pre baseline resting EMG and Post baseline resting EMG in the observation group after the treatment were decreased significantly (<italic>P</italic><0.05), and the fast muscle systolic EMG, systolic EMG of synthetic muscle and slow muscle systolic EMG were increased significantly (<italic>P</italic><0.05). ② Pelvic floor muscle strength: compared with that before treatment, the pelvic floor muscle strength of two groups after the treatment was increased significantly (<italic>P</italic><0.05); compared with the control group, the pelvic floor muscle strength in the observation group after the treatment was increased significantly (<italic>P</italic><0.05). ③ Clinical efficacy: compared with that before treatment, the scores of constipation symptoms such as defecation interval, stool characteristics, difficult/laborious defecation, incomplete defecation and anal/rectal obstruction were significantly reduced in the two groups (<italic>P</italic><0.05); compared with the control group, the scores of constipation symptoms in the observation group after the treatment was reduced significantly (<italic>P</italic><0.05). The clinical effect of the observation group was higher than that of the control group (<italic>P</italic><0.05). ④ SF-36 score: compared with that before treatment, the quality of life score of two groups after the treatment was increased significantly (<italic>P</italic><0.05); compared with the control group, the quality of life score in the observation group after the treatment was increased significantly (<italic>P</italic><0.05). </sec><sec><title>Conclusion</title> Interference electric stimulation at Baliao acupoint and Dachangshu acupoint combined with mosapride can more effectively accelerate gastrointestinal peristalsis, relax anal sphincter and activate pelvic floor muscle, so as to promote defecation and improve defecation function. </sec>

The Relevance of Regenerating Gene 1a Polymorphisms to Radiation Sensitivity and Survival of Nasopharyngeal Carcinoma Receiving Radiotherapy in a Southern Chinese Population.

ObjectiveGene polymorphism is closely related to tumor development, therapeutic response and prognosis. The relationship between regenerating gene 1A (Reg1A) polymorphism and nasopharyngeal carcinoma (NPC) is unclear. This retrospective study aimed to analyze the association between Reg1a polymorphisms and metastasis, radiation sensitivity and survivals in patients with NPC.MethodsA total of 308 patients who had received radiotherapy at the Affiliated Xinhua Hospital, Hainan Medical College, between January 2010 and December 2018 with NPC, were enrolled for assessment of Reg1a polymorphisms through direct DNA sequencing.ResultsIn the polymorphism of gene REG1A, patients with rs10165462 20CC genotype had later T stages (OR = 4.051, 95% CI: 1.775–9.244, P = 0.001), whereas carriers with rs12072 2922CC genotype had earlier T stages (OR = 1.891, 95% CI: 1.018–3.514, P = 0.044) after adjustments for age and gender, respectively. Among rs10165462 20 C/T polymorphism, 20TT wild-type was associated with better radiation response (P = 0.0019), and multivariate analysis showed that it was the only genotype of polymorphism that was significantly associated with better radiation response (OR = 0.265, 95% CI: 0.096–0.727, P = 0.01). Patients with the 20TT wild-type had a better five-year overall survival (60.9%) rate and five-year progression-free survival (60.8%) than those with the 20CC genotype (41.8% and 39.4%, P = 0.01 and P = 0.004, respectively). Patients with variant alleles (CC + CT) had significantly poorer OS (45.2%) and PFS (41.8%) compared with wild-type (TT) carriers (60.9% and 60.8%; P = 0.037 and P = 0.015, respectively). As for rs12072, patients with variant alleles (TT + TC) had significantly adverse OS and PFS compared with wild-type (CC) carriers (62.5% vs 44.8% and 62.5% vs 42.9%; P = 0.024 and P = 0.027, respectively). Cox regression showed that rs10165462 20CT was the only prognostic factor for OS (HR = 1.642, 95% CI 1.038–2.598, P = 0.034) and PFS (HR = 1.705, 95% CI 1.080–2.692, P = 0.022).ConclusionReg1a polymorphisms may be a predictor of radiation response, local invasion, OS and PFS in patients with NPC who undergo radiotherapy treatment.

Correlation of the controlling nutritional status score and the prognostic nutritional index with the prognosis of patients treated with radiotherapy for small-cell lung cancer.

We aimed to explore the associations between the controlling nutritional status (CONUT), the prognostic nutritional index (PNI), and prognostic outcomes in patients with small-cell lung cancer (SCLC) receiving radiotherapy. A total of 93 SCLC patients who received radiotherapy at the hematology department in the First Affiliated Hospital of Hainan Medical University were retrospectively included in this analysis. Patient CONUT and PNI values were calculated. Receiver operating characteristic (ROC) curves were utilized to determine the optimal cut-off, the area under the curve (AUC), sensitivity, and specificity of CONUT and PNI in discriminating patient outcomes. Kaplan-Meier curve analysis was performed, and overall survival (OS) was compared for patients with CONUT >3 and ≤3, or those with PNI >47.7 and ≤47.7. Univariate and multivariate analysis using the Cox proportional hazard model was performed to identify the risk factors for patient death. The AUCs for CONUT and PNI were 0.95 and 0.82, respectively. The CONUT results indicated that patient OS decreased significantly from normal to mildly malnourished. Meanwhile, the OS for moderately malnourished patient decreased to severely malnourished (P for trend <0.001). Patients with CONUT >3 or PNI ≤47.7 had significantly shorter OS than those with CONUT ≤3 (median survival time 12 vs. 23 months; P<0.001) or with PNI >47.7 (median survival time 20 vs. 15 months; P=0.010). Multivariate analysis indicated that the TNM stage [hazard ratio (HR) =1.21; 95% confidence interval (CI): 1.03-1.66], CONUT score (HR =2.33; 95% CI: 1.76-3.91), and PNI ≤47.7 (HR =1.33; 95% CI: 1.09-1.99) were independent prognostic indicators for patient death. The CONUT and PNI were potential indicators for the outcome of patients with SCLC. CONUT >3 or PNI ≤47.7 indicated an unfavorable prognosis for SCLC patients.

Development of a random forest model for hypotension prediction after anesthesia induction for cardiac surgery

BACKGROUNDHypotension after the induction of anesthesia is known to be associated with various adverse events. The involvement of a series of factors makes the prediction of hypotension during anesthesia quite challenging.AIMTo explore the ability and effectiveness of a random forest (RF) model in the prediction of post-induction hypotension (PIH) in patients undergoing cardiac surgery.METHODSPatient information was obtained from the electronic health records of the Second Affiliated Hospital of Hainan Medical University. The study included patients, ≥ 18 years of age, who underwent cardiac surgery from December 2007 to January 2018. An RF algorithm, which is a supervised machine learning technique, was employed to predict PIH. Model performance was assessed by the area under the curve (AUC) of the receiver operating characteristic. Mean decrease in the Gini index was used to rank various features based on their importance.RESULTSOf the 3030 patients included in the study, 1578 (52.1%) experienced hypotension after the induction of anesthesia. The RF model performed effectively, with an AUC of 0.843 (0.808-0.877) and identified mean blood pressure as the most important predictor of PIH after anesthesia. Age and body mass index also had a significant impact.CONCLUSIONThe generated RF model had high discrimination ability for the identification of individuals at high risk for a hypotensive event during cardiac surgery. The study results highlighted that machine learning tools confer unique advantages for the prediction of adverse post-anesthesia events.

The Impact of Different Insulin-Related Measures on the Risk of Prediabetes Among the Chinese Han Population.

IntroductionDiabetes mellitus (DM) has a serious impact on people’s lives in the world. Interventions that affect risk factors for prediabetes can prevent and reduce diabetes occurrence. Proinsulin (PI), true insulin (TI), and proinsulin to insulin ratio (PI/TI) are risk factors for diabetes. The roles of these indicators in prediabetes are unclear. This study aimed to evaluate the impact of PI, TI, PI/TI, 2-h proinsulin (2hPI), 2-h true insulin (2hTI), and 2hPI/2hTI on the risk of prediabetes among the Chinese Han population.MethodsThis cross-sectional study recruited 1688 subjects including 718 prediabetes cases and 970 non-prediabetes controls from Hainan Affiliated Hospital of Hainan Medical University. The cases involved 292 men and 426 women. The controls involved 324 men and 646 women. The mean age was 53.62 ± 12.43 years in the prediabetes group and 44.24 ± 12.87 years in the non-prediabetes group.ResultsOur results showed that PI, TI, PI/TI, 2hPI, 2hTI, and 2hPI/2hTI were significantly correlated with prediabetes (all p < 0.05). Logistic regression analysis revealed that PI (OR 1.022, 95% CI 1.014–1.031, p = 0.00011), TI (OR 1.005, 95% CI 1.003–1.007, p = 0.00012), PI/TI (OR 1.517, 95% CI 1.080–2.131, p = 0.016), and 2hTI (OR 1.000, 95% CI 1.000–1.001, p = 0.002) were significantly associated with an increased risk of prediabetes. Receiver operating characteristic curve (ROC) analysis indicated that the area under the ROC curve (AUC) of the combination (PI + TI + PI/TI + 2hPI + 2hTI + 2hPI/2hTI) in diagnosing prediabetes was 0.627, which was larger than the diagnostic value of HOMA-IR (AUC 0.614) and HOMA-β (AUC 0.387).ConclusionsOur study showed that PI, TI, PI/TI, and 2hTI could significantly enhance the risk of prediabetes in the Chinese Han population, which suggested that PI, TI, PI/TI, and 2hTI might be available risk factors for prediabetes.

Impact of HPV infection on vaginal microecology and maternal and neonatal outcomes.

Human papillomavirus (HPV) is a kind of spherical DNA virus, which is related to many factors such as immune status and pregnancy. Due to the decrease of immunity, pregnant women are more likely to have HPV infection, which causes serious imbalance of vaginal microecology and is not beneficial to pregnancy outcome. Therefore, this study focuses on the impact of HPV infection on vaginal microecology and maternal and neonatal outcomes. A total of 140 pregnant women with HPV infection during pregnancy, who received obstetric examination in the First Affiliated Hospital of Hainan Medical College from November 2017 to July 2019, were selected as a HPV infection group, and 150 normal pregnant women with HPV negative in the same period were selected as a control group. Vaginal secretions were collected from all the pregnant women at 28-34 weeks of gestation to evaluate vaginal pH, cleanliness and microecological status, and to record pregnancy outcomes for all pregnant women. The proportions of vaginal pH>4.5, constituent ratio of flora density and diversity of I-II, positive detection rate of vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV) in HPV infected pregnant women were significantly higher than those in the control group (all P<0.05). There was no significant difference in vaginal cleanliness, dominant bacteria classification, detection rate of trichomonas vaginitis (TV), BV negative, and BV intermediate type between the 2 groups (all P>0.05). The incidence of microecological imbalance in pregnant women with HPV infection was significantly higher than that in the control group (P<0.05). There was no significant difference in natural delivery rate and cesarean section rate between the control group and the HPV infection group (P>0.05). The incidences of premature delivery, puerperal infection, postpartum hemorrhage, and chorioamnionitis in the HPV infection group were significantly higher than those in the control group (all P<0.05). There was no significant difference in the incidence of premature rupture of membranes between the 2 groups (P>0.05). The incidences of premature delivery, postpartum hemorrhage, and premature rupture of membranes of HPV-infected pregnant women in microecological imbalance group were significantly higher than those in the microecological normal group (all P<0.05). There was no significant difference in the incidences of puerperal infection and chorioamnionitis between the microecological normal group and the microecological imbalance group (all P>0.05). Pregnant women with HPV infection during pregnancy are more likely to have vaginal microecological disorders, and can increase the risk of adverse pregnancy outcomes such as premature delivery and chorioamnionitis.

Prognostic value of hemodynamic indices in patients with sepsis after fluid resuscitation.

BACKGROUNDSepsis usually causes hemodynamic abnormalities. Hemodynamic index is one of the factors to identify the severity of sepsis and an important parameter to guide the procedure of fluid resuscitation. The present study investigated whether the assessment of hemodynamic indices can predict the outcomes of septic patients undergoing resuscitation therapy.AIMTo evaluate the prognostic value of hemodynamic indices in patients with sepsis after fluid resuscitation.METHODSA retrospective study was conducted in 120 patients with sepsis at Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University between October 2016 and October 2019. All patients were treated with sodium chloride combined with dextran glucose injection for fluid resuscitation. Patients’ hemodynamic parameters were monitored, including heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI), mean arterial pressure (MAP), central venous pressure (CVP), and central venous oxygen saturation. The prognostic value of hemodynamic indices was determined based on the prognosis status.RESULTSDuring fluid resuscitation, 86 patients developed septic shock and 34 did not. Ninety-nine patients survived and 21 patients died at 28 d after the treatment. Heart rate, CI, mean arterial pressure, SVRI, and CVP were higher in patients with septic shock and patients who died from septic shock than in non-shock patients and patients who survived, and central venous oxygen saturation was lower in patients with shock and patients who died than in non-shock patients and the survivors (P < 0.05). When prognosis was considered as a dependent variable and hemodynamic parameters was considered as independent variables, the results of a logistic regression analysis showed that CI, SVRI, and CVP were independent risk factors for septic shock, and CI was an independent risk factor for 28-d mortality (P < 0.05).CONCLUSIONHemodynamic indices can be used to evaluate the prognosis of septic patients after fluid resuscitation.