Table of Content

15 March 2025, Volume 31 Issue 6

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Digestive Tract Diseases

Relationship between reflux esophagitis and Helicobacter pylori infection

Guliniga'er Alimu , Yan Chaoguang , Abuduwaili Abudukelimu , Maimaitijiang Ayiding, Chen Changchun , Ma Xiaoling, Chen Hui

2025, 31(6):  882-885.  DOI: 10.3760/cma.j.cn441417-20241012-06001

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Objective To explore the relationship between reflux esophagitis (RE) and Helicobacter pylori (Hp) infection. Methods Two hundred and twenty-five patients with RE treated at Xinjiang Uyghur Medical Hospital from March 2019 to April 2024 were selected as the research objects. They were years (47.0±13.1) old. According to the endoscopic results, they wereclassified into four levels based on the Los Angeles (LA) classification criteria: A, B, C, and D. The patients of grades A and B were included into a mild group, while the patients of grades C and D a severe group. The Hp infection was determined by the C14 breath test. The infection status of Hp in the patients with different grades of RE and in the patients of different ages was compared. The factors influencing Hp infection in the patients were analyzed by the multivariate logistic regression. χ2 test was used for the statistical analysis. Results Among the 225 patients, there were 104 males (46.2%), 121 females (53.8%), and 115 cases (51.1%) of Hp infection. The Hp infection rate in the mild group was higher than that in the severe group [54.9% (113/206) vs. 10.5% (2/19)]; the Hp infection rate in the Uyghur patients was higher than that in other ethnic groups [53.5% (106/198) vs. 33.3% (9/27)]; there were statistical differences (χ2 =13.679 and 3.381; both P<0.05). There was no statistical difference in the Hp infection rate between the males and the females (P>0.05). The detection rate of Hp increased with age; the Hp infection rates in the patients who were 60-<70 and 70-80 years old were higher than that in the patients who were 18-<30 years old, with statistical differences (χ2 =5.128 and 4.212; both P<0.05). The Hp infection rates in the patients of grades A, B, C, and D were 52.3% (79/151), 61.8% (34/55), 11.8% (2/17), and 0 (0/2), respectively, with a statistical difference (χ2 =15.235; P< 0.01). The Hp infection rate decreased as the endoscopic grading increased. Pharyngitis was a risk factor for Hp infection in the patients. Conclusions The severity of RE is inversely proportional to the infection rate of Hp; Hp plays a protective role in the occurrence and development of RE to a certain extent; the treatment process should strictly follow the eradication indications of Hp and select appropriate timing for clearance.

Research progress on microRNA function and clinical value in colorectal cancer

Zhu Peng, Tang Wenling, Qin Gang

2025, 31(6):  886-890.  DOI: 10.3760/cma.j.cn441417-20240918-06002

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Colorectal cancer (CRC) is one of the common gastrointestinal malignancies. The microRNA (miRNA) is a small single-stranded RNA with no coding function, can inhibit the expression of targeted genes, and regulates the physiological and pathological processes. Specific miRNAs can regulate the proliferation and invasion of CRC; as non-invasive biological markers, they have some value in the early diagnosis and prognosis assessment of CRC. CRC treatment methods targeting specific miRNAs have shown important value at basic research level, and also provide some references for the development of new CRC drugs.

Value of of miR-375, CCL20, and CEA in diagnosis of Hp-related gastric precancerous lesions

Zeng Qingfang, Zhu Panpan, Shi Hai

2025, 31(6):  890-895.  DOI: 10.3760/cma.j.cn441417-20240828-06003

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Objective　To explore the clinical value of serum microRNA-375 (miR-375), C-C motif chemokine ligand 20 (CCL20), and carcinoembryonic antigen (CEA) in the diagnosis of Helicobacter pylori (Hp) -related gastric precancerous lesions. Methods　Ninety patients diagnosed with chronic atrophic gastritis and Hp infection treated at Xi'an Daxing Hospital between June 2021 and June 2023 were selected for the case control study. All the patients underwent endoscopy, and were grouped according to the presence or absence of gastric precancerous lesions: the 26 patients with lesions were assigned to a study group, and the remaining 64 patients without lesions a control group. The clinical data in both groups were recorded. The serum levels of miR-375, CCL20, CEA, and pepsinogen I (PG I) and the PG I/PG II ratio were measured. The factors affecting gastric precancerous lesions were analyzed. χ² and t tests were used for the statistical analysis. Multivariate analysis was used to analyzed the influencing factors. The diagnostic efficacy of each marker was evaluated using the receiver operating characteristic curve (ROC). Results　There were no statistical differences in gender, age, family history of malignancy, or comorbidities between the two groups (all P>0.05). The PGⅠ level, PGⅠ/PGⅡ, and miR-375 expression level in the study group were lower than those in the control group [(51.12±15.15) μg/L vs. (69.48±12.66) μg/L, 12.05±2.34 vs. 15.11±2.51, and 0.77±0.09 vs. 0.88±0.06; t=-5.885, -5.342, and -6.772; all P<0.001]; the levels of CCL20 and CEA in the study group were higher than those in the control group [(32.88±5.11) ng/L vs. (17.22±5.02) ng/L and (10.22±2.12) U/ml vs. (6.13±1.56) U/ml; t=13.345 and 10.121; both P<0.001]; there were no statistical differences in the levels of PGⅡ and gastrin-17 (G-17) between the two groups (both P>0.05). The multivariate analysis revealed that serum miR-375, CCL20, and CEA were the influential factors for the development of gastric precancerous lesions. The ROC analysis indicated that miR-375, CCL20, and CEA had high diagnostic value, with the areas under the curves (AUC) of 0.848, 0.828, and 0.787, respectively. Combining these markers using logistic analysis yielded an AUC of 0.894. Conclusion　The combination of serum miR-375, CCL20, and CEA in the diagnosis of Hp-related gastric precancerous lesions is clinically valuable.

Expression and clinical significance of HIPK2 and MDR-1 in gastric cancer tissue

Li Bingmei, Wang Jing, Wang Sijia, Xu Panpan

2025, 31(6):  896-899.  DOI: 10.3760/cma.j.cn441417-20240101-06004

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Objective　To detect the expressions of homodomain-interacting protein kinase-2 (HIPK2) and multiple drug resistance-1 (MDR-1) in gastric cancer tissue, and to explore their clinical significance. Methods　One hundred and fifty-six cases of gastric cancer tissue surgically resected in Binzhou Medical University Hospital from August 1, 2011 to October 1, 2015 were collected, including 99 males and 57 females who were 36-79 years old, with a median age of 56. The immunohistochemical method was used to detect the expressions of HIPK2 and MDR-1. The relationship between HIPK2 expression and clinicopathological parameters and the correlation with MDR-1 expression were analyzed. χ² test was used for the comparison between the groups; Pearson correlation analysis was used for the correlation analysis between the genes. Results　The immunohistochemistry results showed that the positive expression rates of HIPK2 and MDR-1 in the gastric cancer tissue were 29.5% (46/156) and 46.8% (73/156), respectively. There were no statistical differences in the HIPK2 positive-expression rate between the patients with different Lauren types, tumor sites, lymph-vessel invasion, lymph node metastasis, and genders (all P>0.05). The HIPK2 positive-expression rates in the patients with maximum tumor diameter≥6.5 cm and positive MDR-1 expression were lower than those in the patients with maximum tumor diameter<6.5 cm and negative MDR-1 expression (both P<0.05). HIPK2 expression was negatively correlated with MDR-1 expression (r=-0.167; P<0.05). Conclusion　HIPK2 is lowly expressed in gastric cancer tissue and negatively correlated with the expression of MDR-1, and may be involved in the processes of gastric cancer development and progression.

Short-term prognosis of 3D versus 2D laparoscopic surgery for patients with gastrointestinal cancers

Yu Mingying, Li Yuan, Yan Pu

2025, 31(6):  900-907.  DOI: 10.3760/cma.j.cn441417-20240913-06005

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Objective　To systematically evaluate the short-term prognosis of two dimension (2D) and three dimension (3D) laparoscopic surgery for patients with gastrointestinal cancers, and to provide evidence-based basis for clinical practice of 2D and 3D laparoscopic surgery for patients with gastrointestinal cancers. Methods　PubMed, EMbase, The Cochrane Library, China Knowledge Network, Wanfang Database, and VIP were searched for Chinese and English literature on the comparison of short-term prognosis of patients with gastrointestinal cancers treated by 2D and 3D laparoscopic surgery from their establishment to 31 July 2024, and the information related to short-term prognosis in the literature was extracted. The quality evaluation was performed using the Cochrane Risk of Bias Assessment Tool. Meta-analysis was performed using the RevMan 5.4.1 software. Results　In this study, 18 articles published from 2014 to 2021 were included, including 12 articles on gastric cancer, 2 articles on rectal cancer, 1 article on colon cancer, and 3 articles on colorectal cancer, with a total sample size of 2 100 cases.The results of the meta-analysis showed that the operation time of 3D laparoscopic surgery for gastrointestinal cancers was shorter than that of 2D laparoscopic surgery (MD=20.91; 95%CI 9.44-32.37; Z=3.57; P<0.001)]; the intraoperative bleeding volume in 3D laparoscopic surgery for gastrointestinal cancers was less than that in 2D laparoscopic surgery (MD=7.31; 95%CI 6.03-8.60; Z=11.19; P<0.001); the number of lymph nodes cleared in 3D laparoscopic surgery for gastrointestinal cancers was more than that in 2D laparoscopic surgery (MD=-0.83; 95%CI -1.26--0.40; Z=3.82; P<0.001); there were no statistical differences between 2D and 3D laparoscopic surgery for gastrointestinal cancers in terms of time to defecation, length of hospital stay, and postoperative complications (all P>0.05). The results of the heterogeneity test showed that there was no heterogeneity in intraoperative bleeding volume, number of lymph node dissection, time to exhaustion, hospital stay, and postoperative complications between 2D and 3D laparoscopic surgery for the patients with gastrointestinal cancers across the literature (all I²<50%); there was heterogeneity in the operation time (I²=93%). The patients were classified into 2 subgroups based on the types of cancer, and the results showed that there was heterogeneity in operation time between 2D and 3D laparoscopic surgery for patients with different types of gastrointestinal cancers (I²=91% for gastric cancer and I²=87% for colorectal cancer). Conclusions　2D and 3D laparoscopic surgery for patients with gastrointestinal cancers can achieve similar short-term prognosis. Compared with 2D laparoscopic surgery, 3D laparoscopic surgery has shorter operation time, less intraoperative bleeding volume, and more lymph nodes cleared out, but it has higher treatment cost, so the clinic can choose an appropriate method for the treatment of a patient according to his or her actual situation.

Exploration on causal relationship between insomnia and constipation by bidirectional Mendelian randomization approach

Xiao Zhengping, Xiao Xi, Li Baosong, Zhang Zhirui, Jiang Hong

2025, 31(6):  908-913.  DOI: 10.3760/cma.j.cn441417-20240717-06006

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Objective　To investigate the causal relationship between insomnia and constipation using the bidirectional Mendelian randomization (MR) approach. Methods　The bidirectional MR analysis was conducted. The data from the large-scale genome-wide association study (GWAS) database of the IEU Open GWAS project was extracted from its establishment to July 2024. This encompassed the data on insomnia (4 462 341 cases) and constipation (411 623 cases). The instrumental variables (IVs) highly associated with insomnia and constipation were selected based on association analyses, after addressing linkage disequilibrium, and removing weak instruments. The inverse variance-weighted (IVW) method was the primary analytical technique, and supplemented by MR-Egger regression, the weighted median approach, and simple mode analysis to evaluate the causal effects between the two traits. Additionally, the heterogeneity and pleiotropy of the IVs were assessed with the IVW and MR-Egger's Cochran Q test for heterogeneity, and with MR-Egger regression intercept and MR-PRESSO for pleiotropy examination. The leave-one-out sensitivity analysis was employed to assess the robustness of the results. Results　Under the support of IVs conforming to MR assumptions, the IVW analysis indicated that insomnia increases the risk of constipation (OR=1.684, 95%CI 1.107-2.560, P=0.015); on the other hand, the causal effect of constipation on insomnia was not statistically significant (P>0.05). The results suggest that insomnia may be a risk factor for constipation. Conclusions　Insomnia may increase the risk of constipation. Conversely, no causal association is found for constipation leading to insomnia.

Advances in research on impact of colonoscopy timing on prognosis of patients with ischemic colitis

Pan Wenxin, Jiang Weiwei

2025, 31(6):  914-917.  DOI: 10.3760/cma.j.cn441417-20240905-04007

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Ischemic colitis (IC) is a manifestation of gastrointestinal ischemia, and is primarily characterized by abdominal pain, diarrhea, and hematochezia. Its clinical presentation is similar to that of inflammatory bowel diseases, and the incidence rate is higher in the elderly population. The gold standard for diagnosing IC is colonoscopy. Treatment varies depending on the severity of ischemia. The clinical symptoms of IC, as well as its manifestations in imaging studies such as abdominal CT, resemble those of inflammatory bowel disease, infectious colitis, and other conditions. Therefore, failure to promptly diagnose IC can lead to incorrect treatment strategies, which may not only delay the appropriate management, potentially exacerbating the conditions, but also increase the patients' economic burden and psychological stress. Therefore, timely colonoscopy, when it is safe to do so, is crucial for diagnosing IC and improving the patients' outcomes.

New Medical Advances

Research progress on mechanism of TRIM22 against HIV-1

Zhang Ziyi, Sun Dakang

2025, 31(6):  918-922.  DOI: 10.3760/cma.j.cn441417-20240805-04008

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The infection of target cells by human immunodeficiency virus-1 (HIV-1) is limited by hosts' cell proteins; among which, the tripartite motif protein (TRIM) family is an important limiting factor with antiviral effects and regulation of innate immune responses. TRIM22, as a member of the TRIM family, can be strongly upregulated by interferon, and has been shown to play an important role in the anti-HIV-1 process. It can inhibit virus replication and transcription regulating the autophagy signaling pathway or transcription factor specific protein 1 (Sp1). This article mainly elaborates the structure, cellular localization, and mechanisms of TRIM22 in combating HIV-1, so as to provide theoretical basis for HIV-1 prevention and treatment.

Application of color Doppler flow imaging in retrobulbar hemodynamic testing 

Yi Wei, Mi Qianqian, Zhao Jie, Li Boyu, Wang Dan

2025, 31(6):  922-926.  DOI: 10.3760/cma.j.cn441417-20240603-06009

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With the rapid development of ophthalmic imaging technology, color Doppler flow imaging (CDFI) has been widely used in the diagnosis of ophthalmic diseases due to its advantages of non-invasiveness, multiple operations, intuitive and dynamic monitoring, etc. CDFI is indispensable in ophthalmic imaging diagnostic methods measuring the position, blood flow velocity, and direction of retrobulbar blood vessels to study the tissue structure, retrobulbar hemodynamic parameters, and pathological changes of the eyeball. This article briefly reviews the characteristics of CDFI and its application in eye diseases.

Drug therapy for thyroid associated ophthalmopathy

Chen Xiuzhu, Zhang Kai, Wei Yanxiao, Cong Chenyang

2025, 31(6):  927-929.  DOI: 10.3760/cma.j.cn441417-20240814-06010

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Thyroid-associated ophthalmopathy is a thyroid-related organautoimmune disease. It mainly occurs in patients with hyperthyroidsm, but may occur in patients with euthyroidism and subclinical or overt hypothyroidism. The current treatment is mainly drug therapy, but there are often adverse reactions in the application of drug therapy. This article reviews the thyroid related ophthalmic drugs, so as to provide references for the patients' treatment and nursing care.

Meta Analysis

Efficacies and safety of holmium and thulium laser enucleation in treatment of benign prostatic hyperplasia: a meta-analysis

Wang Jike, Liu Jinbo

2025, 31(6):  930-939.  DOI: 10.3760/cma.j.cn441417-20240731-06011

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Objective　To explore the effects and safety of holmium laser enucleation (HoLEP) versus thulium laser enucleation (ThULEP) for benign prostatic hyperplasia. Methods　The PubMed, EMbase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Data, and China Science and Technology Journal Database were searched for the clinical studies on HoLEP and ThULEP for benign prostatic hyperplasia from their establishment to April 2024. The methodological quality of the included literature was evaluated by the Cochrane Risk of Bias Assessment Tool, and the included data were statistically analyzed by the RevMan 5.4.1 software. Results　A total of 11 articles were included in this study, involving 2 029 patients with benign prostatic hyperplasia. The meta-analysis results showed that there were no statistical differences in the post-void residual urine (PVR), international prostate symptom score (IPSS), score of quality of life (QOL), urinary maximum flow rate (Qmax), prostate-specific antigen (PSA), incidence rate of complications, operation time, enucleation time, and extubation time between the patients with benign prostatic hyperplasia taking HoLEP and ThULEP (all P>0.05). The enucleation time of the patients taking HoLEP was longer than that of the patients taking ThULEP (P<0.05); the intraoperative bleeding volume in the patients taking HoLEP was higher than that in the patients taking ThULEP (P<0.05). There was no heterogeneity in postoperative PVR, IPSS, QOL, Qmax, PSA, incidence rate of complications, enucleation time, and extubation time (I²=0%-46%), and there was heterogeneity in operation time (I²=92%). Conclusion　The efficacies and safety of HoLEP and ThULEP in the treatment of benign prostatic hyperplasia are similar, but ThULEP has shorter enucleation time and less intraoperative bleeding than HoLEP.

Treatises

Precise blood transfusion thromboelastography versus four coagulation parameters for patients with liver cirrhosis

Du Xuli, Bai Yanli, Fan Yanting, Hou Aili

2025, 31(6):  940-944.  DOI: 10.3760/cma.j.cn441417-20240627-06012

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Objective　To explore the values of thromboelastography (TEG) versus four coagulation parameters in accurately guiding blood transfusion for patients with liver cirrhosis. Methods　This was a prospective study. One hundred and fifty-seven patients with liver cirrhosis who underwent blood transfusion at Xi'an International Medical Center Hospital from April 2022 to March 2024 were divided into a control group (78 cases) and an observation group (79 cases) by the random number table method. The control group had 42 males and 36 females who were (54.83±9.35) years old. The observation group had 44 males and 35 females who were (56.25±10.48) years old. The control group received blood transfusion guided by the results of four coagulation parameters, and the observation groups received blood transfusion guided by TEG indicators. The Pearson correlation analysis was used to evaluate the correlation between TEG indicators [reaction time (R), Angle angle, and maximum amplitude (MA)] and the four coagulation parameters [activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), and fibrinogen (FIB)] before blood transfusion. The amounts of blood component transfusion, coagulation parameters before and after the treatment, occurrence of transfusion-related adverse reactions, hospital stays, and hospitalization costs were compared between the two groups. t and χ² tests were used for the statistical analysis. Results　The results of Pearson correlation analysis showed that R was positively correlated with APTT (r=0.473; P<0.001); Angle angle was negatively correlated with PT (r=-0.367; P<0.001) and APTT (r=-0.392; P<0.001), and positively correlated with FIB (r=0.571; P<0.001); MA was positively correlated with FIB (r=0.594; P<0.001). The infusion volumes of fresh frozen plasma, cold precipitate, red blood cell suspension, and platelet suspension in the observation group were (203.75±37.58) ml, (13.26±4.04) U, (3.43±1.29) U, and (1.48±0.28) U, respectively, which significantly lower than those in the control group [(287.37±46.72) ml, (17.54±3.76) U, (4.87±1.54) U, and (2.05±0.26) U], with statistical differences (t=8.580, 4.638, 5.133, 9.921; all P<0.05). Twenty-four hours after the treatment, the PT, APTT, and TT in the observation group were significantly lower than those in the control group [(14.01±4.33) s vs. (17.26±3.26) s, (34.28±4.74) s vs. (39.32±4.18) s, and (19.87±3.52) s vs. (23.71±3.74) s], while the FIB level was higher [(1.81±0.24) g/L vs. (1.53±0.17) g/L], with statistical differences (t=5.308, 7.063, 6.626, 8.426; all P<0.05). The incidence rate of transfusion adverse reactions in the observation group was lower than that in the control group [1.27% (1/79) vs. 10.26% (8/78)], with a statistical difference (χ²=4.325; P=0.038). The hospitalization time and expense in the observation group were lower than those in the control group [(9.08±2.87) d vs. (11.23±3.27) d and (51 700±10 500) yuan vs. (58 300±12 100) yuan], with statistical differences (both P<0.05). Conclusions　TEG indicators are correlated with the four coagulation parameters. Guiding blood transfusion for patients with liver cirrhosis based on TEG indicators can reduce the amount of blood component infusion and transfusion complications, improve their coagulation function, shorten the hospital stay, and decrease medical cost.

Clinical characteristics and risk factors of high-risk complications in patients with deep neck infections

Gao Wenhao, Zhao Rui, Li Guilin

2025, 31(6):  945-949.  DOI: 10.3760/cma.j.cn441417-20241030-06013

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Objective　To analyze the clinical characteristics and high-risk complications of patients with deep neck infections. Methods　This was a retrospective study. One hundred and seventy-nine patients with deep neck infections treated at Xi'an Daxing Hospital from January 2019 to December 2023 were selected, including 93 males and 86 females who were (55.04±12.74) years old. They were divided into a high-risk group and a non-high-risk group according to whether they had high-risk complications. Their basic information, clinical manifestations, treatment methods, and treatment complications were collected. Descriptive statistics were used to analyze their clinical characteristics, and the logistic regression was used to analyze the risk factors for complications. The data were compared between the two groups by t and χ² tests. Results　Among the 179 patients, 63 (35.20%) had high-risk complications. The times for fever resolution, abscess closure, and pain relief and hospital stay in the high-risk group were longer than those in the non-high-risk group; the high-risk group were older than the non-high-risk group; more patients had diabetes, pharyngitis, cervicofacial lymphadenitis, and periodontal or pulp diseases and had used steroids or antibiotics in the high risk group than in the non-high-risk group; the fasting blood glucose, white blood cell count, and neutrophil percentage in the high-risk group were higher than those in the non-high-risk group; there were statistical differences (all P0.05). The multivariate analysis indicated that age, diabetes, periodontal or pulp diseases, historical use of steroids or antibiotics, high white blood cell count, and high neutrophil percentages were key factors significantly increasing the risk of high-risk complications (all P0.05). Conclusion　The occurrence of high-risk complications in patients with deep neck infections is associated with age, diabetes, periodontal or pulp diseases, historical use of steroids or antibiotics, high white blood cell count, and high neutrophil percentage.

Correlation of urinary exosomal miR-155 and lipid levels with severity of diabetic nephropathy

Wei Xinlin, Yang Huihui, Liu Linbo, Xiong Zhaoliang

2025, 31(6):  949-954.  DOI: 10.3760/cma.j.cn441417-20241024-06014

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Objective　To explore the correlation of urinary exosomal miR-155 (exo-miR-155) and lipid levels with the severity of diabetic nephropathy (DN). Methods　A retrospective analysis was conducted on 150 patients with DN treated at Yulin Hospital, The First Affiliated Hospital of Xi'an Jiaotong University between June 2022 and June 2024. The patients were divided into a normoalbuminuria group [40 cases; 25 males and 15 females; (62.31±7.16) years old], a microalbuminuria group [48 cases; 28 males and 20 females; (62.65±7.32) years old], and a macroalbuminuria group [62 cases; 37 males and 25 females; (62.58±7.21) years old] based on the urinary albumin-to-creatinine ratio (UACR). The clinical and laboratory indicators were compared between the three groups. The multivariate logistic regression was used to identify the risk factors for DN severity. The Spearman correlation analysis was used to assess the relationships of urinary exosomal miR-155 and lipid levels with DN severity. The diagnostic performance was evaluated using the receiver operating characteristic curves (ROC). The statistical methods included analysis of variance (ANOVA), Kruskal-Wallis H test, χ² test, logistic regression analysis, Spearman correlation analysis, and ROC analysis. Results　There were no statistical differences in diabetes duration, hypertension history, systolic and diastolic blood pressures, UACR, tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), adiponectin, triglycerides, high-density lipoprotein (HDL), visfatin, and urinary exosomal miR-155 between the 3 groups (all P0.05). The logistic regression analysis identified adiponectin, triglycerides, HDL, visfatin, and urinary exo-miR-155 as the independent risk factors for DN severity (OR=1.211, 6.409, 0.023, 4.930, and 3.185; all P0.05). The Spearman correlation analysis revealed that DN severity was positively correlated with adiponectin (r=0.554), triglycerides (r=0.855), visfatin (r=0.845), and urinary exo-miR-155 (r=0.582) (all P0.05), and negatively correlated with HDL (r=-0.861; P0.05). The ROC analysis demonstrated that the combined detection of lipid levels and urinary exo-miR-155 achieved an area under the curve of 0.977 (95%CI 0.952-1.000). Conclusion　Urinary exo-miR-155, adiponectin, triglycerides, HDL, and visfatin are closely associated with DN severity.

Relationship between proliferative gene expression in endometrial cancer tissue and patient pathology and prognosis

Guo Yuge, Liu Weishuai, Ma Pingli

2025, 31(6):  954-959.  DOI: 10.3760/cma.j.cn441417-20240724-06015

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Objective　To explore the relationship between proliferative gene expression in endometrial cancer tissue and patient pathology and prognosis. Methods　The clinical data of 124 patients with endometrial cancer treated at Yangling Demonstration Zone Hospital from January 2018 to January 2022 were collected. All the patients were followed up for 2 years after the surgery. The patients who experienced cancer recurrence, metastasis, or death were classified into a poor prognosis group (43 cases), while the others were classified into a good prognosis group (81 cases). t and χ² tests were used for the statistical comparisons. The relative expression levels of proliferation genes [proliferating cell nuclear antigen (PCNA), cyclin D1, and cyclin-dependent kinase 4 (CDK4)] mRNA in the endometrial cancer tissue were measured by the real-time quantitative polymerase chain reaction (PCR), and the expression levels were compared between the patients with different clinicopathological characteristics. The logistic regression analysis was used to evaluate the factors influencing their poor prognosis. The applicability of proliferation genes in the patients' prognostic assessment was analyzed by the receiver operating characteristic curves (ROC). Results　The patients with poorly differentiated tumors, clinical stage Ⅲ, and lymph node metastasis had higher expression levels of PCNA, cyclinD1, and CDK4 in cancer tissue, with statistical differences (all P0.05). The follow-up results showed that the proportion of the patients with poor prognosis was 34.68% (43/124). The expression levels of PCNA, cyclinD1, and CDK4 in the poor prognosis group were higher than those in the good prognosis group (3.05±0.56 vs. 2.31±0.51, 2.48±0.44 vs. 1.79±0.38, and 2.14±0.32 vs. 1.81±0.24), with statistical differences (all P0.05). The multivariate analysis showed that the degree of tumor differentiation, stage, lymph node metastasis, and proliferation gene expression were all important factors affecting the patients' prognosis (all P0.05). ROC showed that the area under the curve of combined detection of proliferative gene expression was 0.970. Conclusion　Proliferative gene expression in endometrial cancer tissue is correlated with the patients' prognosis.

Serum JAK-STAT signaling pathway related proteins assessment of prognosis in patients with rheumatoid arthritis

Zhang Xuefeng, Lyu Yanyan, Dai Lu

2025, 31(6):  960-964.  DOI: 10.3760/cma.j.cn441417-20241030-06016

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Objective　To explore the value of serum Janus kinase (JAK) and signal transducer and activator of transcription (STAT) signaling pathway markers in the assessment of the prognosis in patients with rheumatoid arthritis. Methods　From January 2022 to January 2024, 118 patients with rheumatoid arthritis treated at Shaanxi Integrated Traditional Chinese and Western Medicine Hospital were enrolled. After the enrollment, the serum levels of JAK and STAT3 proteins and the levels of inflammatory markers [tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), IL-6, and macrophage migration inhibitory factor (MIF)] were measured. The patients were treated with methotrexate and prednisone acetate for 4 weeks, and their conditions was evaluated. Based on the improvement in symptoms, the patients were categorized into a good prognosis group and a poor prognosis group. There were 49 males and 34 females in the good prognosis group; they were (38.45±4.72) years old. There were 22 males and 14 females in the poor prognosis group; they were (38.73±4.88) years old. The levels of the markers were compared between the two groups. The logistic regression analysis was used to identify the risk factors for poor prognosis. The diagnostic value of serum JAK and STAT3 expression levels for predicting outcomes was assessed using the receiver operating characteristic curve (ROC). t and χ² tests were used for the statistical analysis. Results　Among the 118 patients, 35 (29.66%) had poor prognosis. Before the treatment, the serum levels of JAK and STAT3 in the poor prognosis group were higher than those in the good prognosis group (1.61±0.35 vs. 1.34±0.28 and 1.55±0.34 vs. 1.30±0.26), with statistical differences (both P<0.05). The levels of TNF-α, IL-1β, IL-6, and MIF in the poor prognosis group before the treatment were higher than those in the good prognosis group [(65.82±7.13) μg/L vs. (58.42±6.36) μg/L, (20.17±3.42) μg/L vs. (15.24±2.39) μg/L, (28.56±4.02) μg/L vs. (23.30±3.19) μg/L, and (20.39±3.15) μg/L vs. (16.42±2.48) μg/L], with statistical differences (all P<0.05). The logistic regression analysis showed that the levels of JAK, STAT3, and inflammatory factors before the treatment were significant predictors of their prognosis (all P<0.05). ROC showed that the area under the curve of JAK combined with STAT3 predicted poor prognosis in rheumatoid arthritis patients was 0.809. Conclusion　The JAK-STAT signaling pathway plays a significant role in rheumatoid arthritis, and may influence the treatment outcomes and prognosis.

Function and clinical significance of glyceraldehyde-3-phosphate dehydrogenase in laryngeal squamous cell carcinoma

Wen Fei, Cen Ruixiang

2025, 31(6):  965-972.  DOI: 10.3760/cma.j.cn441417-20240520-06017

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Objective　To analyze the expression of glyceraldehyde-3-phosphate dehydrogenase (GAPDH) in laryngeal squamous cell carcinoma (LSCC) and its relationship with prognosis. Methods　The clinical information and RNA-seq expression profiles of tumor tissue samples from the patients with LSCC were analyzed using The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases. The expression levels of GAPDH in cancerous tissue and adjacent normal tissue were compared. A retrospective analysis was conducted on 79 patients with LSCC diagnosed and surgically treated at Huangshi Central Hospital from January 2014 to June 2020. There were 67 males and 12 females who were 39 to 81 years old. The immunohistochemistry (IHC) was employed to detect the expression of GAPDH in these 79 patients, serving as external validation. The role of GAPDH in LSCC prognosis was evaluated using the Kaplan-Meier survival curves and univariate and multivariate Cox proportional hazards regression models. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) gene set enrichment analyses were conducted to reveal the tumor biological processes associated with GAPDH. The single-sample gene set enrichment analysis algorithm was used to analyze the relationship between GAPDH expression, immune function, and immune cell infiltration. χ² test was used for the statistical analysis. Results　The GAPDH expression level in the LSCC tissue was higher than that in the adjacent normal tissue (P<0.05), showing significant differences across lymph node stages, histological grades, and clinical stages (all P<0.05). The receiver operating characteristic curve indicated that GAPDH expression effectively distinguished LSCC from adjacent normal tissues (area under the curve=0.816). The patients with high GAPDH expression had lower overall survival and progression-free survival than those with low GAPDH expression (both P<0.05). The multivariate Cox analysis demonstrated that high GAPDH expression (HR=4.294, P<0.05) and positive IHC staining (HR=1.403, P<0.05) were independent risk factors for OS in patients with LSCC. The GO and KEGG enrichment analyses indicated that GAPDH might promote tumor progression participating in hypoxia regulation processes. GAPDH mRNA expression was negatively correlated with CC chemokine receptor, human leukocyte antigen function, and the infiltration levels of various immune cells (such as active B cells, active CD8⁺ T cells, dendritic cells, and central granulocytes) in tumors (all P<0.05). Conclusions　GAPDH is significantly overexpressed in LSCC tissue and has good diagnostic efficacy for distinguishing normal and cancerous tissues. As an independent prognostic factor for LSCC, GAPDH may contribute to the disease's development and progression through hypoxia and tumor immune microenvironment regulation, making it a potential target for LSCC diagnosis and therapy.

A random forest-based multimodal neural electrophysiological index model for predicting frailty risk in elderly patients with stroke

Zhang Xiaowen, Qin Liyun, Chen Wenqian, Sun Yi

2025, 31(6):  973-978.  DOI: 10.3760/cma.j.cn441417-20240910-06018

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Objective　To construct a prediction model of frailty risk in elderly patients with stroke based on multimodal neuroelectrophysiological indicators, and to explore its application value in early intervention. Methods　This was retrospective study. Two hundred and sixty-five elderly patients with first acute stroke treated at Dongping Hospital, Shandong First Medical University from January 2021 to January 2023 were selected, including 148 males and 117 females. They were (70.42±8.63) years old. There were 220 cases of ischemic stroke and 45 cases of hemorrhagic stroke. Their baseline data and neurophysiological indicators were collected. The fried frailty phenotype was used to evaluate their frailty status. Independent-sample t test, rank sum test, and χ² test were used for the univariate analysis. The logistic regression was used for the multivariate analysis. The random forest algorithm was used to construct a prediction model and compared with the logistic regression model. Results　Among the 265 patients, there were 212 cases in the training group and 53 cases in the testing group; there were no statistical differences in the general features, clinical data, laboratory examination, and neuroelectrophysiological indicators between the two groups (all P>0.05). There were 98 cases in the frailty group and 167 cases in the non-frailty group; there were statistical differences in the age, score of National Institute of Health stroke scale (NIHSS), albumin, neuroelectrophysiological indicators, and scores of function and cognition between the two groups (all P<0.05). The multivariate analysis showed that the baseline score of NIHSS (OR=1.17), score of Montreal Cognitive Assessment (MoCA) (OR=0.87), age (OR=1.09), transcranial magnetic stimulation (TMS) cortical resting period (OR=1.11), albumin (OR=0.89), quantitative electroencephalography (qEEG) δ wave power (OR=1.05), and score of Geriatric Depression Scale (GDS-15) (OR=1.18 ) were the independent predictors of frailty after stroke (all P<0.05). The area under the receiver operating characteristic curve (ROC) of the random forest model was significantly higher than that of the multivariate logistic regression model (0.728 vs. 0.629, P=0.029). Conclusion　The integration of multimodal neuroelectrophysiological indicators and clinical features can significantly improve the prediction accuracy of post-stroke fraility.

P16/Ki67 dual staining in cytologic diagnosis of cervical atypical glandular cells

Wang Xing, Li Bo, Wang Yueyuan, Zhou Qingyun

2025, 31(6):  979-982.  DOI: 10.3760/cma.j.cn441417-20240730-06019

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Objective　To explore the adjunctive diagnostic value of P16/Ki67 dual staining for cervical atypical glandular cells (AGC). Methods　This study included the samples from 47 patients diagnosed with AGC by liquid-based cytology at Gansu Provincial Maternal and Child Health Hospital between June 2019 and December 2020. The corresponding histopathological results were collected, and all the cases were subjected to dual staining for P16/Ki67 and testing for high-risk human papillomavirus (HR-HPV). Histologically confirmed CIN1 and higher lesions were used as the positive standard. This study utilized χ² test to compare the detection rates of cervical CIN1 and higher lesions between the two methods, and the sensitivity, specificity, positive predictive value, and negative predictive value by each testing method were calculated. The receiver operating characteristic curve (ROC) was drawn. Results　Among the 47 patients, 20 (42.6%) had positive histopathological results; 28 (59.6%) were positive in HR-HPV; 14 (29.8%) were positive in P16/Ki67 dual staining. The sensitivity, specificity, positive predictive value, and negative predictive value of P16/Ki67 dual staining for detecting lesions above CIN1 were 70.0% (14/20), 100.0% (27/27), 100.0% (14/14), and 81.8% (27/33), respectively. In contrast, the sensitivity, specificity, positive predictive value, and negative predictive value of HR-HPV were 70.0% (14/20), 48.1% (13/27), 50.0% (14/28), and 68.4% (13/19), respectively. The specificity, positive predictive value, and negative predictive value of P16/Ki67 dual staining exceeded those of HR-HPV, with comparable sensitivity between the two methods. There was statistical difference in the detection rate of lesions above CIN1 between the two methods (P<0.05). The area under the curve (AUC) for HR-HPV detection is 0.591, P=0.292, and the AUC of P16/Ki67 dual staining detection is 0.850, P<0.001. Conclusions　In patients with AGC of cervical cytology, P16/Ki67 dual staining offers superior diagnostic assistance compared to HR-HPV testing.

Relationship between expression levels of non-coding long RNA and microRNA in serum and prognosis of patients in primary lung cancer

Xie Ziyang, Jiang Xiaojian, Sun Jia, She Yanru

2025, 31(6):  983-989.  DOI: 10.3760/cma.j.cn441417-20240825-06020

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Objective　To explore the expression levels of non-coding long stranded RNA (lncRNA) -GAS5, lncRNA UCA1, and microRNA (miR) -29a-3p in primary lung cancer and their relationship with prognosis. Methods　Four hundred and two patients with primary lung cancer treated at Xi'an Central Hospital from January 2020 to December 2023 were selected as a lung cancer group, including 196 males and 206 females. They were (58.87±6.31) years old. All the patients took lobectomy. Another 402 healthy individuals who had physical examination in the hospital during the same time period were selected as a healthy control group, including 179 males and 223 females. They were (59.31±5.96) years old. The expression levels of lncRNA-GAS5, lncRNA UCA1, and miR-29a-3p in the serum of the subjects were detected by real-time fluorescence quantitative polymerase chain reaction (PCR). After 12 months' follow-up, the patients were divided into a survival group and a death group according to their survival prognostic outcomes. t and χ² tests were used for the statistical comparisons. The binary logistic regression were used to analyze the influencing factors of the patients' prognosis, and to assess the relationship of lncRNA-GAS5, lncRNA UCA1, and miR-29a-3p with their prognosis. Results　Among the 402 patients, 162 cases died, with a mortality rate of 40.30%. The expression levels of lncRNA-GAS5 and miR-29a-3p in the lung cancer group were lower than those in the healthy control group (both P<0.05), while the expression level of lncRNA UCA1 was higher (P<0.05). The proportions of smokers, poorly differentiated tumors, TNM stage Ⅲ, tumor size, and lncRNA UCA1 in the death group were higher than those in the survival group (all P<0.05); the levels of lncRNA-GAS5 and miR-29a-3p in the death group were lower than those in the survival group (both P<0.05). Smoking (OR=3.117, 95%CI 1.066-9.121), degree of differentiation (OR=3.337, 95%CI 1.140-9.762), TNM staging (OR=4.899, 95%CI 1.674-14.332), tumor size (OR=4.023, 95%CI 1.375-11.769), lncRNA UCA1 (OR=3.600, 95%CI 1.231-10.533), lncRNA-GAS5 (OR=0.242, 95%CI 0.083-0.708), and miR-29a-3p (OR=0.201, 95%CI 0.069-0.589) were the factors influencing the patients' death (all P<0.05). The sensitivities of lncRNA-GAS5, lncRNA UCA1, miR-29a-3p, and their combination in predicting the patients' death were 0.713, 0.804, 0.706, and 0.883, respectively; the specificities were 0.772, 0.781, 0.687, and 0.901, respectively; the areas under the curves were 0.728, 0.783, 0.739, and 0.886, respectively. The survival curve comparison between the different lncRNA-GAS5 expression groups, between the different lncRNA UCA1 expression groups, and between different miR-29a-3p expression groups showed statisticall differences (all P<0.05). Conclusion　The increased expression of lncRNA UCA1 and the decreased expression of lncRNA-GAS5 and miR-29a-3p are related to the prognosis of patients with primary lung cancer.

Clinical characteristics, diagnosis, and treatment of spinal dural arteriovenous fistula

Fu Hongxia, Li Pan, Li Yang

2025, 31(6):  989-992.  DOI: 10.3760/cma.j.cn441417-20240801-06021

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Objective　To investigate the clinical presentations, imaging features, and treatment of spinal dural arteriovenous fistula (SDAVF). Methods　29 patients with SDAVF trented at Department of Neurology and Department of Neurosurgery, Chinese PLA General Hospital from February 2015 to April 2021 were selected for this retrospective study. The patients were averagely 60.93 years old. The disease course was 20 d to 38 months. The patients' medical history, the clinical features, and results of digital subtraction angiography (DSA) and spinal magnetic resonance imaging (MRI) were collected. Results　Among the 29 patients, 21 cases had lower limb weakness, 16 aching and numbness of limbs, 13 bladder or bowel disfunction, 3 waist and back pain, and 3 others symptoms; 7 cases aggravated after treatment with glucocorticosteroid. DSA and spinal MRI were performed to determine the location of fistula. Two cases had fistula on the cervical segment,21 the thoracic segment, 1 the thoracolumbar segment, 4 the lumbar segment, and 1 the lumbosacral segment. Six cases took interventional embolization, and 23 surgery. Conclusions　SDAVF is a rare spinal vascular malformation, with a variety of clinical manifestations. DSA is the golden standard for its diagnosis. Early diagnosis and treatment can significantly improve the patients' prognosis.

Clinical Research

Effect of lean management in prevention and control of multidrug-resistant bacteria infections

Zhong Yanyun, Zhao Yanqun, Gong Bo, Yi Wenhua

2025, 31(6):  993-996.  DOI: 10.3760/cma.j.cn441417-20241011-06022

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Objective To evaluate the effect of lean management in the prevention and control of multidrug-resistant bacteria infections in hospitals. Methods　A total of 451 patients with multidrug-resista bacteria detected at First Affiliated Hospital of Guangdong Pharmaceutical University from January to June 2023 were selected as a control group, and 387 patients with multidrug-resistant bacteria detected from July to December 2023 were selected as an experimental group. There were 297 males and 154 females in the control group; they were (73.93±16.95) years old. There were 260 males and 127 females in the experimental group; they were (71.35±16.22) years old. The basic data were compared between the two groups. The implementation rates of core multidrug-resistant bacteria prevention and control measures and nosocomial infection rates were compared between before and after the implementation of lean management. The effect of lean management was assessed. t and χ² tests were used for the statistical analysis. Results　The execution rate of contact isolation, hand hygiene compliance rate, aseptic operation execution rate, qualified rate of cleaning and disinfection, and execution rate of core prevention and control measures in the experimental group were higher than those in the control group [96.90% (375/387) vs. 80.93% (365/451), 80.80% (324/387) vs. 60.58% (252/451), 82.95% (321/387) vs. 61.86% (279/451), 82.43% (319/387) vs. 65.63% (296/451), and 82.43% (319/387) vs. 54.17% (244/451)], with statistical differences (χ²=119.820, 40.145, 42.761, 17.836, and 53.101; all P<0.05). The awareness rates of multidrug-resistant bacteria prevention and control knowledge by doctors, nurses, and sanitation workers were 69.80% (245/351), 73.15% (436/596), and 50.25% (102/203) before the implementation of lean management; after the the implementation of lean management, the overall awareness rate was 90.60% (1 002/1 106) (all P<0.05). The incidence rate of multidrug-resistant bacteria nosocomial infections in the experimental group was lower than that in the control group [0.15% (33/21 619) vs. 0.29% (55/19 265)], with a statistical difference (χ²=8.717; P<0.05). Conclusion　The lean management mode is effective in the prevention and control of multidrug-resistant bacteria, and can reduce the occurrence of multidrug-resistant bacteria nosocomial infections.

Value of combined detection of serum AMH, INHB, and TGF-β1 levels in diagnosis of premature ovarian failure

Tian Bo, Shi Dongdong, Shen Yanxing

2025, 31(6):  996-1000.  DOI: 10.3760/cma.j.cn441417-20241011-06023

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Objective　To explore the value of combined detection of serum anti-Müllerian hormone (AMH), inhibin B (INHB), and transforming growth factor beta receptor 1 (TGF-β1) levels in the diagnosis of premature ovarian failure. Methods　A total of 105 patients with premature ovarian failure treated at Puyang Oilfield General Hospital from March 2023 to March 2024 were selected as an observation group; 105 healthy female examinees with normal menstrual cycles in the same period were selected as a control group. The observation group were 25-39 (32.15±2.78) years old; their body mass index was 19.9-26.8 (23.24±1.62) kg/m². The control group were 24-38 (31.51±3.04) years old; their body mass index was 19.7-26.9 (22.96±1.58) kg/m². The serum levels of AMH, INHB and TGF-β1 were compared between the two groups. The correlation of the serum levels of AMH, INHB and TGF-β1 with the occurrence of premature ovarian failure was analyzed. The risk of premature ovarian failure was analyzed. The diagnostic value of serum levels of AMH, INHB and TGF-β1 for premature ovarian failure was analyzed. t test was used for the statistical analysis. Results　The levels of serum AMH, INHB, and TGF-β1 in the observation group were lower than those in the control group [(2.51±0.62) μg/L vs. (13.74±3.45) μg/L, (41.12±10.58) ng/L vs. (106.24±30.62) ng/L, and (151.54±15.27) ng/L vs. (285.44±34.38) ng/L; t=-32.829, -20.597, and -36.473; all P<0.05]; the levels of serum AMH, INHB, and TGF-β1 were negatively correlated with the occurrence of premature ovarian failure (r=-0.648, -0.623, and -0.659; all P<0.05); the levels of serum AMH (OR=7.306,95%CI 5.983-8.921), INHB(OR=7.680,95%CI 6.387-9.234), and TGF-β1 (OR=8.762,95%CI 7.245-10.597) were independent influencing factors for the occurrence of premature ovarian failure in the patients ( all P<0.05). The areas under the curves (AUC) of AMH, INHB, TGF-β1, and their combination in the diagnosis of premature ovarian failure were 0.631, 0.619, 0.702, and 0.849, respectively (P<0.05). The individuals with high serum levels of AMH, INHB, and TGF-β1 were 0.470, 0.530, and 0.391 times more likely to experience premature ovarian failure compared to those with low levels (all P<0.05). Conclusion　The serum levels of AMH, INHB, and TGF-β1 are closely related to the occurrence of premature ovarian failure, and the combined detection of these indicators can provide references for the clinical diagnosis of premature ovarian failure.

Telmisartan combined with cagreliflozin in treatment of patients with type 2 diabetes and central obesity

Wang Menglin, Qu Wenyan, Wang Yi

2025, 31(6):  1001-1005.  DOI: 10.3760/cma.j.cn441417-20241012-06024

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Objective　To explore the clinical efficacy of telmisartan combined with cagreliflozin for patients with type 2 diabetes mellitus (T2DM) and central obesity. Methods　This was a prospective study. Eighty-eight patients with T2DM and central obesity treated at Xi'an Daxing Hospital between January 2022 and January 2024 were selected as the study objects, and were divided into a reference group and a combination group by the random number table method, with 44 cases in each group. There were 24 males and 20 females in the reference group; they were 41-73 (54.83±9.97) years old; their T2DM course was 4-10 (6.49±1.31) years. There were 26 males and 18 females in the combination group; they were 42-72 (55.18±10.16) years old; their T2DM course was 4-9 (6.36±1.27) years. The reference group received basic treatment and orally took 100 mg of cagreliflozin once per day; in addition, the combination group orally took 80 mg of telmisartan once per day; both groups were treated for 6 months. The obesity-related indicators [body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and visceral fat area (VFA)], glycemic indicators [glycated hemoglobin (HbA1c), fasting blood glucose (FBG), and 2-hour postprandial blood glucose (2 hPBG)], pancreatic islet function [homeostasis model assessment for insulin resistance (HOMA-IR), homeostasis model assessment for beta-cell function (HOMA-β), and fasting insulin (FINS)], and cardiovascular indicators [endothelin-1 (ET-1), vascular endothelial growth factor (VEGF), and flow-mediated dilation (FMD)] before and after the treatment and incidence rates of adverse reactions were compared between the two groups. The statistical analysis was performed using the t and χ² tests. Results　After the treatment, the BMI, WC, WHR, VFA, HbA1c, FBG, 2 hPBG, and HOMA-IR in the combination group were lower than those in the reference group , while the FMD was higher, with statistical differences (t=7.139, 4.869, 2.909, 2.471, 2.743, 24.288, 3.696,26.441, and 7.508; all P0.05); the FMD in the combination group was higher than that in the reference group [(10.93±1.88)% vs. (8.27±1.41)%], while the levels of ET-1 and VEGF were lower [(63.20±7.72) ng/L vs. (69.17±8.88) ng/L and (8.14±1.29) ng/L vs. (9.46±1.57) ng/L], with statistical differences (t=7.508, 3.366, and 4.309; all P0.05). There was no statistical difference in the incidence rate of adverse reactions between the two groups (χ²=1.397; P0.05). Conclusion　Telmisartan combined with cagreliflozin for patients with T2DM and central obesity can improve their blood glucose and body weight indicators and regulate blood lipids, and is safe.

Different restoration methods for extensive anterior maxillary tooth defects

Fu Haifeng, Ju Yang, Li Yinglou

2025, 31(6):  1006-1011.  DOI: 10.3760/cma.j.cn441417-20240620-06025

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Objective　To explore the effects of different restoration methods for extensive anterior maxillary tooth defects. Methods　This was a prospective study. Ninety children undergoing anterior maxillary primary tooth restoration at Yangling Demonstration District Hospital from September 2021 to June 2023 were selected as the study objects. The children were divided into three groups (A, B, and C) according to the restoration methods, with 30 cases in each group. Group A had 17 boys and 13 girls who were (3.76±0.78) years old. Group B had 15 boys and 15 girls who were (3.21±0.89) years old. group C had 19 boys and 11 girls who were (3.58±0.67) years old. Group A received direct resin filling restoration; group B underwent fiber post combined with translucent crown resin restoration; group C received fiber post CAD/CAM resin crown restoration. The periodontal indicators [plaque index (PLI) and bleeding index (BI)], restoration success rates, fracture resistance indexes, and levels of inflammatory factors [tumor necrosis factor-α (TNF-α) and interleukin-8 (IL-8)] in the gingival crevicular fluid before and after the treatment were compared between the three groups by one-way analysis of variance and χ² test. Results　Before the restoration, there were no statistical differences in the periodontal indicators, fracture resistance index, and levels of inflammatory factors between the 3 groups (all P>0.05). After the restoration, the PLI, BI, and levels of TNF-α and IL-8 in group C [0.40±0.25, 0.67±0.35, (613.18±48.18) ng/L, and (525.08±29.97) ng/L] were lower than those in group A [0.87±0.31, 1.10±0.50, (702.49±62.08) ng/L, and (578.37±30.48) ng/L] and group B [0.73±0.38, 0.70±0.45, (650.76±59.13) ng/L, and (552.41±35.15) ng/L], with statistical differences (F=17.297, 9.021, 18.711, 20.867; all P<0.05); the fracture resistance index in group C was higher than those in group A and group B [(0.61±0.08) kN vs. (0.50±0.09) kN and (0.51±0.01) kN], with a statistical difference (F=22.808; P<0.05). The restoration success rate in group C was higher than those in group A and group B [96.23% (102/106) vs. 74.79% (89/119) and 84.69% (83/98)], with a statistical difference (χ²=20.021; P<0.001). Conclusion　The fiber post CAD/CAM resin crown restoration method for extensive anterior maxillary tooth defects can improve the restoration success rate, periodontal health, and fracture resistance of the restoration structure, and reduce the levels of inflammatory factors.

Effect of Chinese medicine acupressure massage on delivery quality of primiparae of Qi stagnation and blood stasis type

Zhao Aimei, Wang Xiaoli, Wang Mei, Cao Ningning, Zhang Fang, Zhu Yanong

2025, 31(6):  1011-1015.  DOI: 10.3760/cma.j.cn441417-20241114-06026

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Objectives　To observe the effect of Chinese medicine acupressure massage on delivery quality of primiparae of the Qi stagnation and blood stasis type. Methods　Eighty-two full-term primiparae of the Qi stagnation and blood stasis type were selected for the randomized controlled trial. They underwent regular prenatal check ups and were awaiting delivery at Dongchangfu District Maternal and Child Health Care Hospital from October 2022 to September 2023. They were divided into a study group and a control group by the random number table method, with 41 cases in each group. The control group received routine prenatal intervention, while the study group applied the Chinese medicine acupressure massage. The general data, scores of traditional Chinese medicine symptoms, traditional Chinese medicine treatment effects, labor durations, oxytocin usage, vaginal midwifery rates, postpartum hemorrhage, incidence rates for transferring to cesarean section, neonatal asphyxia rates, and incidence rates of adverse reactions were compared between the two groups. χ² test or Fisher's exact probability test, t test, and non-parameter test were used for the statistical comparisons. Results　There were no statistical differences in the general data between the two groups (all P>0.05). The score of traditional Chinese medicine symptoms in the control group was higher than that in the study group [7.00 (6.00, 7.00) vs. 5.00 (5.00, 5.00)], with a statistical difference (P<0.05). In the control group, 5 patients (12.19%) were effective, and 36 (87.81%) ineffective; in the study group, 38 patients (92.68%) were effective, and 3 (7.32%) ineffective; there was statistical difference between the two groups (P<0.05). The first and second stages of labor and total duration of labor in the control group were longer than those in the study group [(503.97±172.19) min vs. (254.34±91.09) min, (78.15±35.05) min vs. (29.73±14.04) min, and (587.74±182.93) min vs. (284.41±102.82) min], with statistical differences between the two groups (all P<0.05). The oxytocin use rate, vaginal midwifery rate, postpartum hemorrhage rate, incidence rate for transferring to cesarean section, and neonatal asphyxia rate in the control group were higher than those in the study group [14.634% (6/41) vs. 0, 17.073% (7/41) vs. 0, 14.634% (6/41) vs. 4.878% (2/41), 4.878% (2/41) vs. 0, and 4.878% (2/41) vs. 0], with statistical differences between the two groups (all P<0.05). No case had allergic reaction, skin irritation, etc. in the study group during the Chinese medicine acupressure massage. Conclusions　The Chinese medicine acupressure massage for primiparae of the Qi stagnation and blood stasis type can shorten their second stage of labor, reduce the use of oxytocin and the vaginal delivery rate, and improve their overall delivery quality.

Clinical application of detection of red blood cell irregular antibodies

Liang Juan, Huang Haobo, Xue Tingling, Lin Shou, Ren Benchun

2025, 31(6):  1016-1020.  DOI: 10.3760/cma.j.cn441417-20240918-06027

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Objective　To investigate the clinical significance for detecting red blood cell (RBC) irregular antibodies. Methods　The irregular antibodies in the 352 samples from the patients with positive blood type antibody screening, crossmatching incompatibility, and hemolytic disease of newborn (151 males and 201 females who were 18-90 years old) at the hospitals were detected by the salt water agglutination, indirect anti-human globulin test, and direct anti-human globulin test to determine the specificity from January 2001 to December 2023. Two hundred and fifty-eight patients' diagnoses were confirmed, including 87 males and 171 females. The autoantibody distribution difference between the males and females was analyzed by the Poisson distribution probability method. Results　The distribution of RBC irregular antibodies: the Rh system antibodies were the most common (33.8%, 124/368), followed by autoantibodies, the MNSs system, the Lewis system, the P system, and the Kidd system. The relationship between RBC irregular antibodies in the 258 clinically confirmed specimens and clinical diseases: blood system diseases were the most common (32.9%, 85/258), followed by tumor (17.4%, 45/258), digestive system diseases (11.6%, 30/258), gynecological diseases (8.5%, 22/258), autoimmune diseases (6.2%, 16/258), urinary system diseases (5.8%, 15/258), bone and joint diseases (5.1%, 13/258), pediatric diseases (4.3%, 11/258), cardiovascular diseases (3.5%, 9/258), respiratory system diseases (2.3%,6/258), endocrine system diseases (0.8%, 2/258), nervous system diseases (0.8%, 2/258), and other diseases (fever, infection, etc.) (0.8%, 2/258). Two hundred and thirteen cases of RBC irregular antibodies were detected in the females, and 155 cases in the males; 43 cases (11.7%) had RBC irregular antibodies produced simply by pregnancy; 119 cases (32.3%) had autoantibodies; there was no statistical difference in the distribution of autoantibodies between the males and the females (u=1.191; P>0.05). Conclusion　RBC irregular antibody body detection has some clinical significance for patients who have blood transfusion history and women who had pregnancy.

Association of uric acid to albumin ratio with cardiovascular and cerebrovascular events in patients with chronic kidney disease taking peritoneal dialysis

Gu Yunyun, Gu Jin, Sun Dunpo, Wang Yisong, Li Jing

2025, 31(6):  1020-1026.  DOI: 10.3760/cma.j.cn441417-20241017-06028

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Objective　To investigate the association of uric acid to albumin ratio (UA / Alb, UAR) with cardiovascular and cerebrovascular events in patients with chronic kidney disease taking peritoneal dialysis. Methods　The clinical data of 533 patients with stage 5 chronic kidney disease taking peritoneal catheterization at Affiliated Lianyungang Hospital, Nanjing University of Chinese Medicine from October 2017 to May 2024 were retrospectively collected. According to the optimal cut-off value of UAR obtained by the receiver operating characteristic curve (ROC), the patients were divided into a low UAR group (321 cases), including 175 males and 146 females who were 53 (45, 61) years old, and a high UAR group (212 cases), including 122 males and 90 females who were 59 (48, 66) years old. The t test, Mann-Whitney U test, and χ² test were used to compare the data between the two groups. The survival curves of cardiovascular and cerebrovascular events in the patients were drawn by the Kaplan-Meier method. The patients' survival rate was analyzed by the Log-Rank method. The independent risk factors were analyzed by the Cox regression. Results　The area under the ROC (AUC) of UAR was 0.726 (95%CI 0.681-0.772); the sensitivity was 49.10%; the specificity was 88.00%; the optimal cut-off value was 14.77. Taking UAR 14.77 as the optimal cut-off value, the patients were divided into a low UAR group (UAR<14.77, 321 patients) and a high UAR group (UAR≥14.77, 212 patients). The age, white blood cell (WBC), neutrophils (Neu), red blood cell (RBC), standard deviation of red blood cell distribution width (RDW-SD), alkaline phosphatase (ALP), uric acid (UA), and neutrophil / lymphocyte ratio (Neu/Lym, NLR) in the high UAR group were higher than those in the low UAR group, with statistical differences (all Ρ<0.05). The levels of lymphocyte (Lym), mean erythrocyte hemoglobin concentration (MCHC), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and albumin (Alb) in the high UAR group were lower than those in the low UAR group, with statistical differences (all Ρ<0.05). The Kaplan-Meier survival curve analysis showed that the incidence rate of cardiovascular and cerebrovascular events in the high UAR group was higher in than that in the low UAR group (Log-Rank χ²=11.498, Ρ<0.001). The incidence rates at 12, 24, 36, 48, and 60 months in the high UAR group were 21.4%, 39.1%, 56.2%, 74.7%, and 86.5%, respectively. The Cox regression analysis showed that high level of UAR (HR=1.042,95%CI 1.021-1.063, Ρ<0.05) and low level of ALP (HR= 0.998, 95%CI 0.997-0.999, Ρ<0.05) were the independent risk factors for cardiovascular and cerebrovascular events in the patients. Conclusions　UAR and ALP have certain value for predicting the occurrence of cardiovascular and cerebrovascular events in patients taking peritoneal dialysis. UAR can be used as a good predictor of cardiovascular and cerebrovascular events in patients taking peritoneal dialysis.

Risk factors of acute kidney injury in patients with cirrhosis and establishment of a nomogram prediction model

Zhang Haimei, Yu Guoying, Hu Hanjun

2025, 31(6):  1027-1032.  DOI: 10.3760/cma.j.cn441417-20241012-06029

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Objective　To analyze the risk factors of acute kidney injury in patients with cirrhosis and establish a nomogram prediction model. Methods　A total of 135 patients with cirrhosis treated at the Fifth People's Hospital of Qinghai Province and the Fourth People's Hospital of Qinghai Province from January to May 2024 were selected as the modeling set, and were divided into an acute kidney injury group (50 cases) and a non-acute kidney injury group (85 cases) according to whether they had acute kidney injury. Another 45 patients with cirrhosis from June to July 2024 were selected as the validation set. The patients' clinical data were collected. The multivariate logistic regression analysis was performed on the variates with statistical differences in the univariate analysis to obtain the risk factors of acute kidney injury in the patients, and a nomogram risk warning model for acute kidney injury in the patients was constructed. t and χ² tests were used for the statistical analysis. Results　The univariate analysis results showed that age, hypertension, ascites, hyperuricemia (HUA), infection, diabetes, and Child-Pugh grade were the influencing factors for acute kidney injury in the patients with cirrhosis, with statistical differences (all P<0.05). The results of multiple factors showed that age, HUA, ascites, infection, and Child-Pugh grade were independent risk factors for acute kidney injury in the patients with cirrhosis, with statistical differences (all P<0.05). The area under the curve was 0.877 (95%CI 0.818-0.936); the differentiation was good; the maximum approximate entry index was 0.587; the sensitivity was 0.740; the specificity was 0.847. The external verification results showed that the area under the curve was 0.921 (95%CI 0.844-0.998); the maximum approximate entry index was 0.647; the sensitivity was 0.647; the specificity was 1.000. The theoretical value and the actual value of the calibration curve were in good agreement. Conclusion　Age, HUA, ascites, infection, and Child-Pugh grade are independent risk factors for acute kidney injury in cirrhotic patients, and this model has high predictive value.

Theory of "seeking Yang Qi at Dazhui" by Professor Guo Yi and its clinical application

Liu Xixian, Ma Liang, Geng Lianqi, Guo Yi

2025, 31(6):  1032-1036.  DOI: 10.3760/cma.j.cn441417-20250118-06030

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Professor Guo Yi has been engaged in scientific research, teaching, and clinical work of traditional Chinese medicine and acupuncture for more than 20 years. By combining the clinical applications by medical experts in past dynasties, modern research achievements, and his own years of clinical experience, he has sorted out and reviewed the specificity of commonly used acupoints in clinical practice. Considering the application rules, and under the guidance of the concept of "strictly adhering to the pathogenesis and addressing each aspect appropriately", he put forward the idea of acupoint application, which is "retaining the needle at Fengchi for head and face problems, seeking solutions at Zhongwan for Zhongjiao issues, seeking Yang Qi at Dazhui, and treating encephalopathy with Jingxue". Now, based on the clinical practice and study guided by Guo, this article focuses on the clinical thinking of "seeking Yang Qi at Dazhui", and shares the characteristics and experience of Guo's clinical application of Dazhui acupoint in treating diseases related to Yang deficiency and Yang stagnation, so as to provide references for the ones working in the same field to learn, apply, and promote.

Predictive value of serum CXCL10 and CXCL12 for prognosis of patients with acute pancreatitis

Zu Weidong, Xu Bo, Hu Xiaohong

2025, 31(6):  1036-1040.  DOI: 10.3760/cma.j.cn441417-20240914-06031

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Objective　To investigate the predictive value of serum CXC chemokine ligand 10 (CXCL10) and CXC chemokine ligand 12 (CXCL12) for prognosis of patients with acute pancreatitis (AP). Methods　A total of 120 patients with AP treated at Weinan Second Hospital from March 2021 to May 2024 were selected as an AP group, including 69 males and 51 females who were (54.47±7.12) years old. Additionally, 120 healthy individuals undergoing physical examinations at Weinan Second Hospital during the same period were selected as a control group, including 66 males and 54 females who were (53.48±6.26) years. The patients were categorized by severity into a mild group (78 cases) and a severe group (42 cases), and were divided into a good prognosis group (99 cases) and a poor prognosis group (21 cases) based on the 1-month treatment outcomes. The serum CXCL10 and CXCL12 levels were measured by the enzyme linked immunosorbent assay. The multivariate logistic regression analysis was performed to assess the factors influencing the patients' prognosis. The predictive performance of CXCL10 and CXCL12 for the patients' prognosis was analyzed using the receiver operating characteristic curves (ROC). Statistical analysis was conducted using t and χ² tests or Fisher's precision probability test. Results　The serum levels of CXCL10 and CXCL12 in the AP group were higher than those in the control group [(178.80±34.71) μg/L vs. (90.29±10.14) μg/L and (2.71±0.65) μg/L vs. (1.65±0.23) μg/L], with statistical differences (t=26.813 and 16.841; both P<0.05). The serum levels of CXCL10 and CXCL12 in the severe group were higher than those in the mild group [(201.20±38.83) μg/L vs. (166.74±31.90) μg/L and (2.98±0.74) μg/L vs. (2.56±0.62) μg/L], with statistical differences (t=5.224 and 3.304; both P<0.05). The serum levels of CXCL10 and CXCL12 in the poor prognosis group were higher than those in the good prognosis group [(216.42±41.10) μg/L vs. (170.82±33.55) μg/L and (3.13±0.78) μg/L vs. (2.62±0.60) μg/L], with statistical differences (t=5.432 and 3.348; both P<0.05). The multivariate logistic regression analysis showed that serum CXCL10 and CXCL12 were independent risk factors affecting the patients' prognosis (both P<0.05). The ROC results revealed that the sensitivity and specificity of CXCL10 combined with CXCL12 for predicting the poor prognosis in the patients were 90.5% and 88.9%, with an AUC of 0.944, which were higher than those of each one (all P<0.05). Conclusion　The combined detection of serum CXCL10 and CXCL12 has significant clinical value for predicting the prognosis of patients with AP.

Recurrence of patients with otitis media after otoendoscopic surgery and construction of a prediction model

Xue Yuan, Wang Dong, Zhang Jie , Yan Juan, Li Erle, Tuo Mingxiang

2025, 31(6):  1041-1046.  DOI: 10.3760/cma.j.cn441417-20240724-06032

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Objective　To analyze the recurrence of patients with otitis media after otoendoscopic surgery and its influencing factors, and to construct and verify a prediction model. Methods　A retrospective analysis was performed on 220 patients with otitis media who underwent otoendoscopic treatment in Yan'an People's Hospital from June 2020 to August 2022, including 108 males and 112 females. They were 30-80 years old. Their disease course was 14-35 months. The patients were followed up for 1 year to observe their postoperative recurrence, and they were divided into a recurrence group (36 cases) and a non-recurrence group (184 cases). The patients' clinical data were collected. Univariate analysis and multivariate logistic analysis were used to analyze the factors affecting their postoperative recurrence, and a nomogram model was constructed. The receiver operating characteristic curve (ROC) was used to analyze the model's prediction efficiency.t and χ² tests were used for the statistical analysis. Results　The patients' recurrence rate within 1 year after the surgery was 16.36% (36/220). The results of univariate analysis showed that the proportion of the patients with ventilation tube retention for 6-12 months in the recurrence group was lower than that in the non-recurrence group, and the proportions of the patients with smoking history, upper respiratory tract infection ≥4 times/year, chronic sinusitis, adenoid hypertrophy, mastoid dysplasia, and eustacia tube dysfunction in the recurrence group were higher than those in the non-recurrence group [58.33% (21/36) vs. 39.13% (72/184), 83.33% (30/36) vs. 62.50% (115/184), 80.56% (29/36) vs. 53.26% (98/184), 63.89% (23/36) vs. 35.87% (66/184), 61.11% (22/36) vs. 38.59% (71/184), and 69.44% (25/36) vs. 35.87% (66/184)], with statistical differences (all P0.05). The binary logistic regression analysis showed that ventilation tube retention time (OR=0.294, 95%CI 0.107-0.806) was an independent protective factor for the patients' postoperative recurrence, and chronic sinusitis (OR=4.226, 95%CI 1.794-9.952), adenoid hypertrophy (OR=5.336, 95%CI 1.805-15.773), and eustachian tube function (OR=4.851, 95%CI 2.535-9.280) were independent risk factors for their postoperative recurrence (all P0.05). The internal verification of the nomogram prediction model built based on the above influencing factors showed that the C-index index was 0.832 (95%CI 0.785-0.926), and the correction curve for predicting their postoperative recurrence was close to the ideal curve (P0.05). The ROC results showed that the sensitivity and specificity of the nomogram model for predicting their postoperative recurrence were 83.30% and 84.80%, and the AUC was 0.878 (95%CI 0.804-0.952;P0.05). Conclusions　Ventilation tube retention time is an independent protective factor for recurrence after otitis media endoscopic surgery, while chronic sinusitis, adenoid hypertrophy, and eustachian tube function are independent risk factors. The nomogram risk prediction model based on the above factors can evaluate the risk of postoperative recurrence well.

Case Report

Cup-like AML-M1 with NPM1 and GATA2 mutations in one patient

Xu Daojing, Zhu Haiyan, Yu Jie

2025, 31(6):  1047-1049.  DOI: 10.3760/cma.j.cn441417-20240914-06033

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Acute leukemia (AL) is classified into acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL). AML undifferentiated (AML-M1) is a subtype of AML. The undifferentiated myeloblasts in the marrow are more than 90% in AML-M1 patients, and the response rate of chemotherapy is low.

Nursing Research

Effect of cluster nursing for patients undergoing autologous scalp tissue transplantation

Qu Yaoping, Cao Dayong, Zheng Maosha, Sun Yinping, Yu Kai

2025, 31(6):  1050-1056.  DOI: 10.3760/cma.j.cn441417-20241008-06034

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Objective　To explore the effect of cluster nursing for patients undergoing autologous scalp tissue transplantation. Methods　This was a prospective study. According to the random number table method, 68 patients with large area burn and with scar skin as the medium thick skin donor areas treated in Zhengzhou First People's Hospital from January 2021 to December 2023 were divided into a control group and an observation group, with 34 cases in each group. There were 16 males and 18 females in the control group; they were (31.53±1.48) years old. There were 20 males and 14 females in the observation group; they were (32.12±1.32) years old. All the patients underwent autologous scalp tissue transplantation. The control group received routine nursing, and the observation group cluster nursing. The wound healing times, scores of Visual Analogue Scale (VAS) , Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), and life quality (vitality, physiological function, and social function) before and after the intervention, repair effects, and incidence rates of complications were compared between the two groups. t and χ² tests were used for the statistical analysis. Results　The wound healing time of the observation group was shorter than that of the control group [(8.17±2.28) d vs. (12.56±2.34) d], with a statistical difference (t=7.835; P<0.05). The scores of VAS 1, 3, and 7 d after the intervention in the observation group were lower than those in the control group (4.54±1.14 vs. 5.95±1.25, 3.15±0.61 vs. 3.52±0.75, and 2.03±0.34 vs. 2.86±0.42), with statistical differences (t=4.860, 2.232, and 8.956; all P<0.05). After the intervention, the scores of SDS and SAS in the observation group were lower than those in the control group (31.25±3.05 vs. 39.56±2.21 and 33.23±3.72 vs. 41.56±2.35); the scores of vitality, physiological function, and social function in the observation group were higher than those in the control group (85.62±3.03 vs. 76.25±3.56, 82.14±3.76 vs. 75.65±4.15, and 85.45±2.72 vs. 80.65±2.44); there were statistical differences (t=12.865, 11.039, 11.687, 6.758, and 7.660; all P<0.05). There was no statistical difference in the incidence rate of complications between the observation group and the control group [8.82% (3/34) vs. 17.65% (6/34); χ²=0.512, P>0.05]. Six months after the intervention, the scores of itch and Vancouver Scar Evaluation Scale and scar hyperplasia rate in the observation group were lower than those in the control group [1.37±0.35 vs. 1.84±0.47, 2.05±0.71 vs. 4.31±1.53, and (20.45±4.16)% vs. (42.23±3.52)%], with statistical differences (t=4.677, 7.813, and 23.305; all P<0.05). Conclusion　Cluster nursing can promote wound healing in the middle and thick donor area of scar skin repaired by autologous scalp tissue transplantation, relieve pain, eliminate adverse emotions, improve quality of life, and reduce long-term itching and scar hyperplasia.