Journal of Shandong University (Health Sciences)

Application of enhanced recovery after surgery in perioperative management of lung cancer

Shugeng GAO

Journal of Shandong University (Health Sciences). 2022, 60(11): 1-10. doi:10.6040/j.issn.1671-7554.0.2022.1100

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Enhanced recovery after surgery (ERAS), as a comprehensive perioperative management concept, involves multiple disciplines. It is to promote the rapid recovery of patients by optimizing each stage of the perioperative period. With the vigorous development of modern science and technology, ERAS concept has been popularized in the field of thoracic surgery, and ERAS management model with characteristics of thoracic surgery has been improved. This article will summarize the clinical application and research progress of ERAS concept in the field of lung cancer in thoracic surgery in recent years, and review the current perioperative management of lung cancer from aspects of preoperative preparation, intraoperative management and postoperative rehabilitation, aiming to provide reference for clinicians to apply ERAS concept in the diagnosis and treatment of lung cancer.

Expert consensus of Ruijin Hospital on the concept of enhanced recovery after surgery in the clinical practice of thoracic surgery

Dingpei HAN,Yue YAN,Yuqin CAO,Xin SUN,Yanxia HU,Minxian WANG,Yan LUO,Yongmei SHI,Qing XIE,Junbiao HANG,Hecheng LI

Journal of Shandong University (Health Sciences). 2022, 60(11): 11-16. doi:10.6040/j.issn.1671-7554.0.2022.0669

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Since the proposal of enhanced recovery after surgery (EARS) concept in 1997, it has been widely used in thoracic surgery and other surgical fields. Through the multidisciplinary collaboration of surgery, anesthesia, nursing, rehabilitation and clinical nutrition, a series of perioperative optimization measures are adopted to reduce the physical and psychological stress of patients, shorten the length of hospital stay, reduce the incidence of complications and accelerate postoperative rehabilitation. Based on the consensus of multidisciplinary experts, this article summarizes the clinical practice carried out under the concept of ERAS in the Department of Thoracic Surgery of Ruijin Hospital for the reference of other medical staff.

It is necessary for enhanced recovery after surgery to keep pace with the times

Guowei CHE

Journal of Shandong University (Health Sciences). 2022, 60(11): 17-22. doi:10.6040/j.issn.1671-7554.0.2022.0658

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The development of minimally invasive surgical techniques and equipment continues to promote the progress of enhanced recovery after surgery (ERAS) and update our understanding. Conversely, the concept and realization of ERAS also need to keep pace with the times. This article illustrates several aspects of ERAS which need to be updated and developed based on the clinical practice in lung surgery, including the goals or objectives of ERAS, team building and thinking about ERAS, management and process optimization of ERAS, and the application of ERAS in promoting tiered diagnosis and treatment or whole-process management.

Minimally invasive sleeve lobectomy: opportunities and challenges in the era of immunotherapy

Huijiang GAO,Yucheng WEI

Journal of Shandong University (Health Sciences). 2022, 60(11): 23-27. doi:10.6040/j.issn.1671-7554.0.2022.0978

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Sleeve lobectomy, as a standard treatment for locally advanced resectable central lung cancer, can maximize the preservation of lung tissue and improve patients' quality of life without affecting survival, compared with total pneumonectomy. With the development of thoracoscopic and robotic technology, minimally invasive sleeve lobectomy has become a routine procedure in thoracic surgery, although bronchial sleeve lobectomy has increased the difficulty of operation. At present, with the development of immunotherapy in the field of neoadjuvant and induction therapy for lung cancer, a growing number of locally advanced resectable or potentially resectable lung cancer has been treated with immunotherapy. This not only improves the prognosis of patients, but also puts forward higher requirements for minimally invasive thoracic surgery, especially minimally invasive sleeve lobectomy. In this paper, the current situation of minimally invasive sleeve lobectomy is systematically described and the prospect is prospected.

Da Vinci robotic resection of esophageal cancer in Qilu Hospital

Hui TIAN,Wenbo YI,Shuhai LI

Journal of Shandong University (Health Sciences). 2022, 60(11): 28-32. doi:10.6040/j.issn.1671-7554.0.2022.0670

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Da Vinci Surgical System, an advanced robotic platform designed to perform complex surgical operations by minimally invasive methods, is currently the most widely used surgical robot throughout the world. The fourth-generation Da Vinci surgical robot system was put into use in Qilu Hospital of Shandong University on July 20, 2020. Professor Tian Hui, leader of the Department of Thoracic Surgery, successfully completed the first resection of esophageal cancer in Shandong Province using the system, created a world record of the shortest time for completing 100 cases of Da Vinci robot surgeries, and formulated the procedures of Qilu Artificial Intelligence Robotic Surgery. So far, Professor Tian has completed more than 1, 300 Da Vinci robotic surgeries, including more than 100 resections of esophageal cancer. This paper summarizes our clinical experience of the resection of esophageal cancer (McKeown operation) by Da Vinci robot, expecting to provide reference for colleagues in thoracic surgery.

Optimization of the procedures in minimally invasive esophagectomy: the Qilu practices

Zhenguo SUN,Hui TIAN

Journal of Shandong University (Health Sciences). 2022, 60(11): 33-37. doi:10.6040/j.issn.1671-7554.0.2022.0588

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Esophageal cancer, as a common malignant cancer with high morbidity and mortality, is mainly treated with surgery. With the development of endoscope technology, minimally invasive esophagectomy (MIE) is taking the place of open esophagectomy. Enhanced recovery after surgery (ERAS) is a new research area in the treatment of esophageal cancer. Guided with the principles of ERAS, our team has optimized the procedures of MIE to ensure that patients undergo the perioperative period smoothly. In this paper, we will summarize these optimized procedures of MIE in order to provide reference for thoracic surgeons.

Comparison of 34 cases of thoracoscopic wedge resection and 21 cases of segmental resection for stage ⅠA1 non-small cell lung cancer in area P

Huining LIU,Jun PENG,Yingchun REN,Guang YANG,Wenhao WANG,Jinfeng LIU,Qing TIAN

Journal of Shandong University (Health Sciences). 2022, 60(11): 38-43. doi:10.6040/j.issn.1671-7554.0.2022.0606

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Objective: To investigate the selection of minimally invasive thoracoscopic surgery for stage ⅠA1 non-small cell lung cancer (NSCLC) in area P by dividing the lung segment location of the lesion according to the imaging data, and to compare the prognosis of the two methods. Methods: A retrospective analysis was performed on 55 patients who underwent thoracoscopic wedge resection and segmentectomy, and the patients were divided into wedge resection group (group A, n=34) and segmentectomy group (group B, n=21). Results: In groups A and B, the operation time, postoperative hospital stay, intraoperative bleeding, hospitalization costs, and incidence of postoperative pulmonary air leakage were (18.50±5.55) vs. (61.23±9.83), (3.14±0.95) d vs. (4.95±1.39) d, (12.67±6.54) mL vs. (103.71±16.99) mL, (35, 900±5, 000) yuan vs. (61, 900±10, 200) yuan, 5.88% (2 cases) vs. 28.57% (6 cases), respectively, with statistically significant differences (all P < 0.05). Univariate Logistic regression analysis showed a significant correlation between operation time, postoperative hospital stay, incidence of lung leakage and different operation methods (P < 0.05). Multivariate binary Logistic regression analysis showed that compared with group B, group A had shortened operation time (OR=2.58, 95%CI: 1.71-3.90, P < 0.001), shorter postoperative hospital stay (OR=2.91, 95%CI: 1.01-8.84, P=0.04) and reduced incidence of lung leakage (OR=7.12, 95%CI: 1.13-37.21, P=0.04). Conclusion: For patients with stage ⅠA1 NSCLC, thoracoscopic wedge resection of lung with lesion located in area P has a significant advantage over segmental resection.

Comprehensive application of anatomical partial lobectomy and enhanced recovery after surgery

Yue PENG,Lei LIU,Yuan LI,Fenglong BIE,Bolun ZHOU,Runze LI,Ying JI,Guangyu BAI,Fengwei TAN,Yushun GAO,Juwei MU,Qi XUE,Bin QIU,Shugeng GAO

Journal of Shandong University (Health Sciences). 2022, 60(11): 44-53. doi:10.6040/j.issn.1671-7554.0.2022.0960

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Objective: To summarize the application of anatomical partial lobectomy (APL) and enhanced recovery after surgery (ERAS) in order to provide clinical reference and theoretical support for the comprehensive management of minimally invasive surgical treatment of lung cancer. Methods: The clinicopathological and perioperative data of 6, 449 patients who underwent APL during Nov. 1, 2013 and Oct. 31, 2021 were retrospectively collected, including gender, age, smoking history, surgical method, pathology, postoperative hospital stay and other indicators. The period from 2014 to 2018 was regarded as the experience accumulation stage, and the period from 2019 to 2021 the technology maturity stage. The number of surgery, percentage of benign nodules, average postoperative hospital stay, and percentage of postoperative hospital stay over 7 days were compared between the two stages. Results: Of the 6, 449 patients, 2, 094 were males and 4, 355 were females. Among them, 88 bilateral lung surgeries were performed in stages, and 8 bilateral surgeries were performed simultaneously, and altogether 6, 493 APL surgeries were performed. Compared with the experience accumulation stage, in the technology maturity stage, the annual average monthly number of operations increased, the percentage of benign nodules decreased, the average postoperative hospital stay shortened, and the percentage of postoperative hospital stay longer than 7 days decreased (P < 0.05). With the application of ERAS from 2014 to 2021, the average annual postoperative hospital stay for APL gradually decreased from 6.98 days to 3.96 days. The percentage of patients with postoperative hospital stay exceeding 7 days decreased from 23.80% to 2.87%. The results of multivariate Logistic regression analysis showed that gender, age, surgical procedure, and surgical stage were independent risk factors for postoperative hospital stay more than 7 days after APL. Conclusion: ERAS can optimize the perioperative management of APL and accelerate postoperative recovery of patients. APL can be performed on the premise of oncology principles, preserve more healthy lung tissue, minimize the scope of surgical resection and surgical trauma, so that the concept of ERAS can be better applied and promoted in radical surgery for lung cancer.

Mechanism of acute injury of eosinophil EOL-1 induced by formaldehyde

LI Na, GUO Zengli, CHI Lingyi, YANG Lizhuo, MA Zhiyong, FU Zhijie

Journal of Shandong University (Health Sciences). 2022, 60(11): 54-62. doi:10.6040/j.issn.1671-7554.0.2022.0797

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Objective To explore the acute injury effect of formaldehyde on human eosinophils(EOL-1)and the mechanism. Methods EOL-1 cells were cultured in vitro. Eol-1 cells treated with formaldehyde for 2 hours at room temperature were set as the 0 mmol, 5 mmol, 10 mmol, 25 mmol and 50 mmol groups. Cells co-treated with DPI, Tiron and NAC and 25 mmol formaldehyde were divided into control group, formaldehyde group, formaldehyde + DPI group, formaldehyde + Trion group, and formaldehyde + NAC group. According to the different concentrations of NAC, the cells were set as the control group, formaldehyde group, formaldehyde + 0.01 mmol NAC group, formaldehyde + 0.1 mmol NAC group, and formaldehyde +1 mmol NAC group. Cell apoptosis and death were detected with propidium iodide(PI)and Hoechst fluorescent staining. The mitochondrial function damage was detected with rhodamine 123(Rho-123)fluorescent labeling method. The expressions of Bax and Bcl-2 were detected with Western blotting. Results The cell death rates of different concentrations of formaldehyde(0, 5, 10, 25, 50 mmol)were(3.313±2.395)%,(8.205±5.719)%,(20.335±5.167)%,(19.387±6.056)%, and(28.043±8.851)%, respectively. Compared with the 0 mmol group, the 5 mmol group had unchanged cell apoptosis and death(P=1.00), but the 10 mmol(P=0.030), 25 mmol(P=0.033)and 50 mmol groups(P=0.001)had significantly increased cell death, with EC₅₀=25 mmol. The cell mortality rates of formaldehyde group, formaldehyde + DPI group, formaldehyde + Trion group and formaldehyde + NAC group were(61.430±9.885)%,(57.907±13.619)%,(55.700±18.487)% and(21.837±6.674)%, respectively. Formaldehyde + DPI group(P=1.00)and formaldehyde + Trion group(P=1.00)had no effect on formaldehyde-induced cell damage, but formaldehyde + NAC group reversed the formaldehyde-induced cell death(P=0.01). Compared with formaldehyde group(52.853±11.338)%, with different concentrations of NAC, the cell mortality was different ［formaldehyde + 0.01 mmol NAC(10.620±4.483)%, formaldehyde + 0.1 mmol NAC(6.257±6.265)%, formaldehyde + 1 mmol NAC(4.002±2.50)%］, and the reverse effect of formaldehyde on cell death was concentration-dependent. The results of Rho-123 fluorescence labeling showed that compared with the 0 mmol group, the 10 mmol, 25 mmol, and 50 mmol groups had reduced mitochondrial function(P<0.001), while formaldehyde + NAC group reversed the mitochondrial function damage induced by formaldehyde(809.339±163.210 vs 675.552±126.993, P=0.021). Western blotting results showed that, compared with the control group, 25 mmol formaldehyde significantly down-regulated the protein expression of Bcl-2(0.401±0.122, P<0.001)but up-regulated the protein expression of Bax(2.937±1.388, P=0.006); formaldehyde + NAC group significantly reduced the protein expressions of Bax(1.196±0.597, P=0.018)and Bcl-2(0.717±0.246, P=0.018). Conclusion Formaldehyde ≥10 mmol can induce eosinophil EOL-1 damage by inhibiting mitochondrial function and regulating Bcl-2/Bax signal pathway, while antioxidant NAC can reduce the damage and signal pathway of eosinophil EOL-1 caused by formaldehyde.

Effects and mechanism of tetramethylpyrazine on monocrotaline induced pulmonary arterial hypertension in rats

ZENG Yuanyuan, YANG Dongpeng, DONG Zhu, ZHANG Ben, CAO Yiqiu, WANG Xiaowu

Journal of Shandong University (Health Sciences). 2022, 60(11): 63-69. doi:10.6040/j.issn.1671-7554.0.2022.0107

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Objective To investigate the effects and mechanism of tetramethylpyrazine(TMP)on monocrotaline(MCT)induced pulmonary arterial hypertension(PAH)in rats. Methods A total of 36 male SD rats were randomly divided into control, model and TMP groups, with 12 rats in each group. The rats in the model and TMP groups were given intraperitoneal injection of MCT 50 mg/kg on the 1st day to establish PAH model. After 28 days, the TMP group was given tetramethylpyrazine 80 mg/kg by gavage once a day for 4 weeks. At the end of the experiment, the right ventricular systolic pressure(RVSP)was detected and right ventricular hypertrophy index(RVHI)was counted; the pathomorphological changes of lung tissue were observed with hematoxylin-eosin(HE)staining and Masson staining, and the percentage of wall thickness(WT%)and wall area(WA%)were calculated. The structure of lung tissue was observed with a transmission electron microscope. The expressions of Hippo signal pathway related proteins YAP1, WWTR1 and TEAD1 in lung tissue were detected with immunohistochemical staining and Western blotting. Results Compared with the control group, the model group had increased RVSP and RVHI(P<0.001, P<0.001), significantly narrowed lumen of pulmonary arteries, proliferated collagen fibers, and increased protein expressions of YAP1, WWTR1 and TEAD1(P=0.004, P<0.001, P=0.013). Compared with the model group, the TMP group had decreased RVSP and RVHI(P=0.001, P<0.001), improved pulmonary artery remodeling and right ventricular hypertrophy, reduced fibrosis, and decreased protein expressions of YAP1, WWTR1 and TEAD1(P=0.045, P=0.011, P=0.034). Compared with the control group, the TMP group had increased RVSP and RVHI(P=0.045, P=0.045), and increased protein expressions of YAP1, WWTR1 and TEAD1(P=0.080, P=0.013, P=0.468), in which, the difference of WWTR1 protein expression was significant, suggesting that TMP has limited effects. Conclusion TMP has effects on MCT-induced PAH rat model. The underlying mechanism may be related to the inhibition of expressions of Hippo signal pathway related proteins.

Network pharmacologic mechanism of Huangqi Guizhi Wuwu Decoction in treating heart failure

FAN Xiaoyan, WANG Yuangeng, CHEN Zetao

Journal of Shandong University (Health Sciences). 2022, 60(11): 70-81. doi:10.6040/j.issn.1671-7554.0.2022.0911

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Objective To explore the mechanism of action of Huangqi Guizhi Wuwu Decoction(the Decoction)in the treatment of heart failure by using network pharmacology-molecular docking technique. Methods The drug components of the Decoction were obtained from the TCMSP database, the targets of drug components were obtained from the Uniprot database, the targets of heart failure were obtained from the GeneCard, OMIM, pharmgkb, TTD, DrugBank databases, and the common targets of the Decoction and heart failure were analyzed with R software. Protein-protein interaction(PPI), gene ontology(GO), Kyoto encyclopedia of genes and genomes(KEGG), and molecular docking analyses were performed using R, Cytoscape, Autodock, and pymol softwares. Results A total of 84 targets of the Decoction, 1,430 differential genes of heart failure, and 118 common targets were obtained. Pathway enrichment analysis of common targets showed that they were mainly related to mitogen activated protein kinase(MAPK)and interleukin-17(IL-17). The results of molecular docking showed that the core target of heart failure had good affinity with the main components of the Decoction, which could bind freely and effectively. Conclusion Quercetin, isorhamnetin and formononetin in the Decoction can play a role in the treatment of heart failure through anti-oxidative stress and anti-fibrosis. The Decoction has multi-level, multi-channel and multi-target effects on heart failure.

Bronchoalveolar lavage fluid cytokine profile contributes to discriminating local inflammation in children with mycoplasma lobar pneumonia

ZHANG Amin, LI Guosheng, LI Fuhai

Journal of Shandong University (Health Sciences). 2022, 60(11): 82-88. doi:10.6040/j.issn.1671-7554.0.2022.0177

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Objective To explore the relationship between cytokines in bronchoalveolar lavage fluid(BALF)with lobar pneumonia associated with mycoplasma pneumoniae(MP)in children. Methods A total of 80 children with MP lobar pneumonia treated during Sep. and Dec. 2021 were enrolled. The children were divided into two groups according to metagenome second generation sequencing(mNGS): MP group(n=51), and streptococcus pneumoniae(SP)group(n=29). According to fever duration, The MP group was subdivided into fever duration ≤7 d group(n=22)and >7 d group(n=29). According to pleural effusion, the MP group was subdivided into pleural effusion group(n=18)and non-pleural effusion group(n=33). Cytokines in BALF were compared. Results The levels of IL-6/IL-10 and IL-1β/IL-10 in the BALF of MP group were higher than those in the SP group(P=0.027, P=0.015), while the level of IL-17/IL-10 was lower in MP group than that in SP group(P=0.045). The levels of IL-6/IL-10, IL-1β/IL-10, IL-17/IL-10, IL-12p70/IL-10, IL-4/IL-10 in fever during >7 days were higher than those in the fever duration ≤7 days(P=0.007, P=0.008, P=0.009, P=0.02, P=0.01). The level of IL-6/IL-10 in the pleural effusion group was significantly higher than that in the non-pleural effusion group(P=0.005). The area under the curve(AUC)of IL-6/IL-10, IL-1β/IL-10, IL-17/IL-10, IL-12p70/IL-10, and IL-4/IL-10 in the fever duration >7day were 0.721, 0.719, 0.716, 0.691 and 0.712, respectively. The AUC of IL-6/IL-10 in the pleural effusion group was 0.739. Conclusion The levels of IL-6, IL-1β, IL-17 and IL-4 in BALF of MP lobar pneumonia are associated with the local inflammatory response, which can be used as important indicators to evaluate disease progression in children.

Hepatic epithelioid hemangioendothelioma complicated with hepatitis B cirrhosis: a case report and literature review

LI Xiangze, WANG Xianming, SONG Gesheng, CUI Jing, SUN Kai, WANG Haochen, WANG Tiancheng, HAN Shaoqi, TIAN Hu

Journal of Shandong University (Health Sciences). 2022, 60(11): 89-95. doi:10.6040/j.issn.1671-7554.0.2022.0572

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Objective To analyze the clinical and imaging characteristics of a patient with hepatic epithelioid hemangioendothelioma misdiagnosed preoperatively as hepatocellular carcinoma complicated with hepatitis B cirrhosis, so as to improve the understanding of this disease, reduce misdiagnosis and guide clinical diagnosis and treatment. Methods The clinical data of the patient were collected and analyzed, relevant case reports were retrieved and literature review was reviewed. Results The patient, a 51-year-old male, was admitted due to “isolated liver space-occupying lesions found in physical examination for more than 3 days”, and no other special abnormalities were obsevred. There were no obvious abnormalities in tumor markers. MRI of liver showed that plain scan was not characteristic. DWI and ADC suggested limited diffusion at the edge of the lesion, and unrestricted diffusion at the central area, suggesting combined necrosis. Enhanced scanning showed similar results, presenting uneven peripheral enhancement, which tended to invade inwards and clear during the delay period. Postoperative pathology confirmed hepatic epithelioid hemangioendothelioma. Conclusion In clinical diagnosis and treatment, the possibility of liver solid space-occupying lesions should be considered when there are no typical manifestations of common diseases such as hepatocellular carcinoma, cholangiocarcinoma and hepatic hemangioma, especially when imaging suggests typical “capsule retraction sign”, “target sign” or “lollipop sign”.

Exploring the clinicopathological features of three cases of gastric cancer in one pedigree during short-term

MU Yanxi, WANG Wenjie, CHEN Kang, YAO Yalong, LI Jinzhou, WEI Haoqi, LIU Haipeng, HUANG Zeping, CHEN Xiao

Journal of Shandong University (Health Sciences). 2022, 60(11): 96-101. doi:10.6040/j.issn.1671-7554.0.2022.0476

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Objective To summarize the clinical features of familial clustered gastric cancer to provide reference for the prevention and treatment. Methods The clinical data of 3 brothers and sisters from the same family admitted during Dec. 2016 and Jan. 2022 due to gastric cancer were retrospectively collected. The general condition, clinical characteristics, treatment and outcomes were analyzed. All patients were followed up until March 2022. Results Gastric cancer was clustered in this family, including 2 males and 1 female, with an average age of 47 years at the time of onset. The 3 patients had common living and eating habits, which were in line with the diagnosis of familial clustered gastric cancer. After surgery and postoperative chemotherapy, 1 patient was deceased, and the other 2 were regularly followed up. Conclusion The incidence of familial clustered gastric cancer is relatively low. It is rare that all three siblings in the same family have gastric cancer in a short period of time. Therefore, when there are more than 2 people in the family suffering from gastric cancer, familial aggregation of gastric cancer must be alerted.

Prostate clear cell adenocarcinomas: a report of 3 cases and literature review

ZHU Yongcun, ZHAO Xiushi, SUN Nannan, YAO Zhigang, ZHOU Xingchen, MU Kun

Journal of Shandong University (Health Sciences). 2022, 60(11): 102-107. doi:10.6040/j.issn.1671-7554.0.2022.0322

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Objective To explore the clinicopathological features and differential diagnosis of primary clear cell adenocarcinoma(CCA)of the prostate. Methods The pathological data of 3 cases of primary prostate CCA were retrospectively analyzed and relevant literature was reviewed. Immunohistochemistry(IHC)was performed with a group of differential antibodies. Results The patients aged 29 to 54 years. The CCA was located in prostatic utricle in 2 cases and in prostatic parenchyma in 1 case. The clinical manifestation was hematospermia in 2 cases and progressive dysuria in 1 case. Microscopically, a mixture of three histological structures were observed, including glandular, papillary and solid patterns. The so-called hobnail pattern was visible in the glandular and papillary surfaces. Immunohistochemically, CK7, PAX-8, HNF-1β were positive, and AMACR, NapsinA, CA125 were partially positive. During the follow-up of 12 to 15 months, 1 patient was lost, 1 developed metastases of the lung and inguinal lymph nodes, and the other had no recurrence or metastasis. Conclusion The serum CA125 level might be elevated while prostate specific antigen(PSA)level is normal for patients with prostate CCA. Young patients with hemospermia should be altered. The diagnosis relies on histopathological examination and immunohistochemical staining. The prognosis of patients with tumor located in prostatic parenchyma is worse than that located in prostatic utricle.

Influencing factors of mild cognitive impairment in elderly patients with type 2 diabetes

YU Shujuan, WANG Meijuan, CHEN Li, CAO Yingjuan LYU Xiaoyan, LIU Xueyan, LIN Peng, YAN Jingzheng

Journal of Shandong University (Health Sciences). 2022, 60(11): 108-112. doi:10.6040/j.issn.1671-7554.0.2022.0345

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Objective To analyze the influencing factors of mild cognitive impairment(MCI)in elderly patients with type 2 diabetes, and to provide reference for the development of targeted intervention measures. Methods A total of 110 elderly patients with type 2 diabetes were selected with convenience sampling method during Nov. and Dec. 2021, and divided into MCI group and non-MCI group. The influencing factors of MCI were analyzed with univariate and multivariate non-conditional Logistic regression. Results Of the 110 patients, 72(65.45%)had MCI. There were statistically significant differences in age, education level, monthly family income, duration of diabetes and blood glucose before bedtime between MCI group and non-MCI group(P<0.05). Multivariate Logistic regression analysis showed that the monthly family income(OR=0.236, 95%CI: 0.096-0.581), duration of diabetes(OR=1.077, 95%CI: 1.005-1.154), and blood glucose before bedtime(OR=1.213, 95%CI: 1.030-1.428)were the influencing factors of MCI(P=0.002, P=0.036, P=0.020). Conclusion The prevalence of MCI in patients with type 2 diabetes is high. Low family monthly income, long course of diabetes and high blood glucose before bedtime may increase the risk of MCI and should arouse attention.

Time distribution and influencing factors of hepatitis B vaccine birth dose in 1,614 newborns of HBsAg positive women, Jinan City

ZOU Liping, HE Yujing, XIE Yuanzhong, ZHAO Jianyun, XU Chunhua, MA Yongsheng, LI Chuanbin, LIU Xiaoxue, LIU Chong, ZHAO Xiaodong, SUN Hongyun

Journal of Shandong University (Health Sciences). 2022, 60(11): 113-120. doi:10.6040/j.issn.1671-7554.0.2022.0357

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Objective To investigate the time distribution of the birth dose of hepatitis B(HepB)vaccine in newborns of HBsAg-positive mothers in Jinan, and to evaluate possible problems and difficulties of hospitals in implementing the scheme. Methods Descriptive analysis was applied to describe general information and distribution of birth dose of HepB vaccine. Chi-square test and binary Logistic regression were used to analyze influencing factors. Qualitative field interview materials were analyzed and summarized with subject frame method to investigate the status and problems of current implementation practice. Results In 2020, 1,614 HBsAg positive pregnant women were hospitalized and gave birth at hospital. The rate of HepB vaccine birth dose within 24 hours and 12 hours were 98.76% and 78.81%, respectively. Newborns born at 8-11 and 14-16 oclock had the highest timely vaccination rate. Natural birth(OR=2.083), low birth weight(OR=2.793), birth time at night(OR=1.260)and first birth(OR=1.515)were risk factors affecting timely vaccination(all P<0.05). Qualitative interviews found that personnel and training needs increased after stricter time limit was issued. Conclusion The timely vaccination rate of HepB birth dose among infants of HBsAg positive women was high in 2020 in Jinan. Newborns delivered by caesarean section, with non-low birth weight, non-first-born and born before the peak time of obstetrical vaccination are more likely to be vaccinated in time. Personnel and training needs are the main concerns after stricter time limit is issued. It is suggested to strengthen the training of medical personnel and arrange the vaccination shifts reasonably in order to improve the timely vaccination rate.

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