Table of Content

15 May 2025, Volume 31 Issue 10

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Special Collumn of Gynecology and Obstetrics

Type 2 diabetes increases the risk of preeclampsia through alterations in gut microbiota

Yang Haiyan, Song Qinwen, Wang Shili, Lyu Shangling, Chen Xiaofang, Qin Ying

2025, 31(10):  1586-1591.  DOI: 10.3760/cma.j.cn441417-20250306-10001

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Objective　To analyze the potential role of gut microbiota in elevating the risk of preeclampsia in individuals with diabetes by Mendelian randomization (MR). Methods　The study was carried out at Yantaishan Hospital from September to November 2024. The data of Genome-Wide Association Studies (GWAS) extracted from the IEU OpenGWAS public database. This study analyzed three large diabetic cohorts (n=461 578, 520 580, and 659 316), along with preeclampsia (n=118 291) and eclampsia (n=11 729) cohorts. The two-step MR method was employed to evaluate the mediating effect of gut microbiota on the relationship between diabetes and preeclampsia. Additionally, the GWAS data for gut microbiota included 211 taxa derived from 14 306 European participants. The MR-Egger regression intercept and Cochran's Q were used to evaluate the pleiotropy and heterogeneity. The sensitivity was analyzed by the leave-one-out method. Results　Types 1 and 2 diabetes were both associated with increased risk of preeclampsia (OR=1.05 and 1.15). Among the 211 gut microbiota taxa analyzed, the effect values of Olsenella for preeclampsia was 0.12 (P=0.003); the effect value of type 2 diabetes for preeclampsia was 0.14 (P=8.23E-05). Olsenella was related to type 2 diabetes and preeclampsia. The MR indicated that Olsenella partially mediated the effect of type 2 diabetes on preeclampsia, accounting for 6% of the total effect. Conclusion　Type 2 diabetes may increase the risk of preeclampsia via gut microbiota.

Construction of a diagnostic model for polycystic ovary syndrome based on necroptosis-related genes and drug screening 

Zhang Huiping, Li Jiao, Ji Kaijie, Zhang Yuanyuan

2025, 31(10):  1591-1598.  DOI: 10.3760/cma.j.cn441417-20241209-10002

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Objective　To collect and analyze the gene expression data of granulosa cells from the polycystic ovary syndrome (PCOS) samples in the GEO database, to construct a PCOS diagnostic model based on necroptosis-related genes, and to further screen potential therapeutic drugs. Methods　Five algorithms, including Lasso, support vector machine (SVM), random forest (RF), gradient boosting algorithm (XGB), and generalized linear model (GLM), were used to select the necroptosis-related feature genes associated with PCOS, and a diagnostic nomogram model was constructed. The model was validated using external datasets. Simultaneously, the sensitive drugs related to the feature genes were screened through the DGIdb database. t test, one-way analysis of variate, and Kruskal-Wallis rank sum test were used for the statistical comparisons. The correlation was analyzed by the Spearman correlation analysis. Results　Two downregulated genes (PANX1 and HSPA4) and three upregulated genes (STAT5B, PYGM, and TRIM11) were identified in the PCOS samples. The nomogram model based on these genes demonstrated an area under the receiver operating characteristic curve of this model was 0.875 in the validation set, indicating good diagnostic reliability. A total of 34 approved drugs related to the feature genes were identified. Conclusions　The PCOS diagnostic model constructed based on the necroptosis-related genes (PANX1, STAT5B, HSPA4, PYGM, and TRIM11) shows good predictive performance. The 34 clinically available drugs identified through the DGIdb database provide new insights for the diagnosis and treatment of PCOS.

Expressions of circDLG1, HIF-1α, PLGF, and MVD in placental tissue of patients with pre-eclampsia and their relationship 

Du Caiyun, Yang Hong

2025, 31(10):  1599-1604.  DOI: 10.3760/cma.j.cn441417-20240722-10003

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Objective　To investigate the expressions of circular RNA DLG1 (circDLG1), hypoxia-inducible factor-1α (HIF-1α), placental growth factor (PLGF), and placental microvascular density (MVD) in placental tissue of patients with pre-eclampsia (PE) and their relationship. Methods　A total of 116 pregnant women with PE who delivered in Department of Obstetrics, The Second Affiliated Hospital of Xi'an Medical University from January 2020 to December 2023 were selected as an observation group; they were (29.15±5.82) years old; there were 72 primiparas, and 44 multiparas; their gestational age was (37.02±2.14) weeks. A total of 116 healthy pregnant women in the same period were selected as a control group; they were (28.72±5.36) years old; there were 78 primiparas and 38 multiparas; their gestational age was (36.68±2.02) weeks. The clinical data, including age, BMI before pregnancy and at delivery, parity, gestational week, diastolic and systolic blood pressures, blood urea nitrogen, lactate dehydrogenase (LDH), creatinine (Cr), urea protein, platelet count (PLT), mean platelet volume (MPV), albumin (ALB), total bilirubin (TBIL), alanine aminotransferase (ALT), and aspartate aminotransferase (AST), in both groups were collected. The real time quantitative-polymerase chain reaction (qRT-PCR) was used to measure the expressions of circDLG1, HIF-1α, and PLGF in the two groups, and the MVD was calculated. The factors influencing PE were analyzed by the multivariate logistic regression analysis. Results　The systolic and diastolic blood pressures and levels of BUN, LDH, Cr, and urinary protein in the observation group were higher than those in the control group, and the levels of MPV and ALB were lower (all P<0.05). There were no statistical differences in age, BMI before pregnancy and at delivery, parity, gestational week, and levels of PLT, TBIL, ALT, and AST between the two groups (all P>0.05). The results of qRT-PCR showed that the HIF-1α mRNA level in the observation group was higher than that in the control group (0.64±0.15 vs. 0.47±0.11, P<0.05), and the expression level of circDLG1 mRNA (0.62±0.24 vs. 1.08±0.47), PLGF mRNA level (1.12±0.18 vs. 1.68±0.23), and MVD count, (45.26±6.58 vs. 75.26±8.11) were lower (all P<0.05). The relative expression of circDLG1 in the patients was negatively correlated with HIF-1α (r=-0.564; P<0.05), and positively with PLGF and MVD (r=0.547 and 0.621; both P<0.05). The logistic regression analysis showed that LDH, urinary protein, and MPV were independent risk factors for PE (all P<0.05), and the high circDLG1, PLGF, and MVD levels and a low HIF-1α level were independent protective factors for PE (all P<0.05). Conclusions　In the placental tissue of patients with PE, the expression levels of circDLG1, HIF-1α, and MVD are low, while the expression level of PLGF is high; the relative expression level of circDLG1 is closely related to HIF-1α, PLGF, and MVD; high levels of circDLG1, PLGF, and MVD and a low level of HIF-1α are independent protective factors for the occurrence of PE.

Quadratus lumborum block combined with general anesthesia for elderly patients undergoing gynecologic laparoscopic surgery 

Deng Xiaoying, Liang Hao, Wen Rou, Zhang Yonggang

2025, 31(10):  1604-1609.  DOI: 10.3760/cma.j.cn441417-20241021-10004

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Objective　To explore the effect of quadratus lumborum block combined with general anesthesia for elderly patients undergoing gynecological laparoscopic surgery. Methods　Ninety-six elderly patients who underwent gynecological laparoscopic surgery at Baoji Maternal and Child Health Hospital from January 2021 to January 2023 were selected for the randomized controlled trial, and were divided into a control group who were (70.86±7.63) years old and an observation group who were (71.14±7.87) years old by the random number table method, with 48 cases in each group. Both groups received general anesthesia during the surgery; the observation group took quadratus lumborum block 30 min before anesthesia induction. The perioperative parameters (remifentanil and propofol dosages, awakening time, and time to recovery of spontaneous breathing) were compared between the two groups. The heart rate and mean arterial pressure were recorded before induction (T0), 5 min after intubation (T1), at skin incision (T2), and after the surgery (T3). The pain scores and comfort scores (BCS) 1 and 24 h after the surgery and the stress indicators before and 24 h after the surgery were compared between the two groups. Before and 1, 3, and 7 d after the surgery, their cognitive function was assessed using the Mini-Mental State Examination (MMSE). The incidence rates of cognitive impairment and adverse reactions were recorded. t test, repeated measurement analysis of variatment, and χ² were used for the statistical comparisons. Results　The dosages of remifentanil and propofol, awakening time, and time to recovery of spontaneous breathing in the control group were (1.35±0.31) mg, (410.25±43.12) mg, (6.49±1.23) min, and (15.07±2.43) min, and those in the observation group (0.72±0.21) mg, (326.78±37.69) mg, (4.06±0.81) min, and (9.55±1.62) min; the intraoperative heart rate and mean arterial pressure in the observation group were more stable than those in the control group; there were statistical differences (all P<0.05). There were statistical differences in the postoperative scores of pain and BCS between the observation group and the control group were (3.54±0.40 vs. 4.13±0.43 and 2.78±0.40 vs. 2.03±0.38), with statistical differences (all P<0.05). The observation group had lower postoperative stress markers and a higher MMSE score than the control group, with statistical differences (all P<0.05). The incidence rates of cognitive impairment and adverse reactions in the observation group were lower than those in the control group [2.08% (1/48) vs. 14.58% (7/48) and 6.25% (3/48) vs. 18.75%(9/48); both P<0.05]. Conclusion Quadratus lumborum block combined with general anesthesia can maintain hemodynamic stable in elderly patients undergoing gynecological laparoscopic surgery and reduce the risk of postoperative cognitive dysfunction and adverse reactions.

Effect of multidisciplinary team psychological support combined with mindfulness-based cognitive therapy on negative emotions of elderly patients with uterine prolapse 

Liu Yaqi, Gong Xiaofan, Li Chenyang, Bai Xue

2025, 31(10):  1610-1614.  DOI: 10.3760/cma.j.cn441417-20241022-10005

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Objective　To evaluate the effect of multidisciplinary team psychological support combined with mindfulness-based cognitive therapy on negative emotional stress in elderly patients with uterine prolapse. Methods　Eighty-nine patients with uterine prolapse treated at Henan Provincial People's Hospital from January 2023 to January 2024 were selected for the randomized controlled trial, and were divided into an experimental group (45 cases) who were (68.55±6.25) years old and a control group (44 cases) who were (69.01±6.79) years old by the random number table method. In the experimental group, there were 12 cases of POP-Q stage Ⅱ, 22 cases of stage Ⅲ, and 11 cases of stage Ⅳ. In the control group, there were 14 cases of POP-Q stage Ⅱ, 20 cases of stage Ⅲ, and 10 cases of stage. The experimental group were intervened by multidisciplinary team psychological support and mindfulness-based cognitive therapy, while the control group received routine care, for 12 weeks. The scores of Pelvic Floor Distress Inventory-20 (PFDI-20), Geriatric Depression Scale-Short Form (GDS-15), Hospital Anxiety and Depression Scale Depression subscale (HADS-A), SF-36 Health Survey (SF-36), and Social Dysfunction Screening Schedule (SDSS) were compared between the two groups before and after the intervention. χ² test and t test were used for the statistical comparisons. Results　After 12 weeks' intervention, the scores of PFDI-20, GDS-15, HADS-A, SDSS, and SF-36 in the experimental group were better than those in the control group (32.83±8.72 vs. 41.92±9.02, 7.14±1.92 vs. 9.63±2.27, 8.23±2.47 vs. 10.76±2.63, 8.04±3.58 vs. 10.12±3.61, and 72.45±6.78 vs. 65.41±7.12), with statistical differences (all P<0.05). Conclusion　Application of multidisciplinary team psychological support and mindfulness-based cognitive therapy in negative emotion stress nursing for elderly patients with uterine prolapse can alleviate their symptoms of pelvic floor dysfunction, depression, and anxiety, and improve their quality of life and social function.

Value of transperineal ultrasound combined with shear wave elastography in diagnosis of pelvic floor dysfunction 

Gao Xin, Gao Xiaoting, Chen Xin, Mu Liang, Xue Xiaomei, He Jing

2025, 31(10):  1615-1619.  DOI: 10.3760/cma.j.cn441417-20240805-10006

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Objective　To explore the value of transperineal ultrasound combined with shear wave elastography (SWE) in the diagnosis of pelvic floor dysfunction (PFD). Methods　This was a retrospective study. One hundred and twenty patients with PFD treated at Yulin Hospital, The First Affiliated Hospital of Xi'an Jiaotong University from October 2021 to October 2023 were selected as a study group; 82 healthy women who received physical examination during the same period were selected as a control group. All the subjects took transperineal ultrasound and SWE examinations. The general data (age, body mass index, parity, and education level) and parameters of transperineal ultrasound and SWE examinations under different conditions were collected in both groups. The accuracy rates of different examination methods in the diagnosis of PDF were compared. t and χ² tests were use for the statistical comparisons. The receiver operating characteristic curve (ROC) was applied to evaluate the value of transperineal ultrasound combined with SWE in the diagnosis of PFD. Results　There were no statistical differences in age, body mass index, parity, and education level between the two groups (all P>0.05). Under different conditions, the anteroposterior diameter, left-right diameter, and area of anal levator hiatus in the study group were larger than those in the control group, while the Young' s modulus of puborectal muscle (PR) was lower (all P<0.05). The accurate rates of transperineal ultrasound, SWE, and their combination in the detection of PDF were 86.67% (104/120), 90.83% (109/120) , and 97.50% (117/120), respectively; the accurate rate of the combination was higher than those of transperineal ultrasound and SWE (both P<0.05). The ROC results showed that the areas under the curves (AUC) of the anteroposterior diameter, left-right diameter, and area of anal levator hiatus and the Young' s modulus of PR for PFD were 0.622, 0.569, 0.676, 0.638, 0.643, 0.586, 0.680, and 0.694 (all P<0.05), respectively, and the AUC of the combined diagnosis was 0.846 (P<0.05). Conclusion　Transperineal ultrasound combined with SWE has high diagnostic value fir PFD.

New Medical Advances

Research progress of dual trigger in GnRH antagonist protocol

Yu Hanxu, Fan Yanru, Zhu Mingqing, Liu Xuemei

2025, 31(10):  1620-1623.  DOI: 10.3760/cma.j.cn441417-20241211-10007

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The trigger is a key step in the process of ovarian stimulation. It uses exogenous drugs to simulate or induce the endogenous luteinizing hormone surge, promoting the final maturation of oocytes, resumption of meiosis, and triggering ovulation. It determines the outcomes of in vitro fertilization/intracytoplasmic sperm injection. The dual trigger is to promote the final maturation of the oocyte using gonadotropin-releasing hormone agonist and human chorionic gonadotropin, and is mostly used in the GnRH antagonist protocol. Dual trigger can improve oocyte quality and clinical pregnancy rates in poor and normal ovarian response populations, also reduce the risk of moderate/severe ovarian hyperstimulation syndrome, and offer the possibility of fresh embryo transfer cycle in high ovarian response populations. This article reviews the role of the dual trigger in the GnRH antagonist protocol.

Research progress of dietary inflammatory index and colorectal cancer and its precancerous lesions 

Qin Zhenkun, Deng Dongyan, Feng Xiaoling

2025, 31(10):  1624-1627.  DOI: 10.3760/cma.j.cn441417-20241218-10008

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Colorectal cancer (CRC) is a prevalent malignant tumor of the digestive system and the second leading cause of cancer-related mortality worldwide. Colorectal adenomatous polyps (CAP) serve as precursors to this malignancy. Chronic inflammation significantly contributes to the onset and progression of CRC and CAP inducing DNA damage and gene mutations, as well as disrupting the homeostasis of gut microbiota. Dietary patterns are closely linked to this process; pro-inflammatory diets elevate levels of chronic inflammation, while anti-inflammatory diets mitigate them. Researches conducted both domestically and internationally have demonstrated that a high dietary inflammatory index (DII) correlates with increased risk of CRC; however, the relationship between DII and CAP remains inconsistent. This article reviews the current state of researches on the association between colorectal cancer, its precursors, and DII, with the aim of providing theoretical foundation for simplifying DII to develop personalized dietary intervention strategies, thereby enhancing the prevention and treatment of CRC and its precursors.

Pathogenesis of diabetic foot complicated with osteoporosis 

Feng Deping, Zhang Kaige, Li Ruonan

2025, 31(10):  1628-1631.  DOI: 10.3760/cma.j.cn441417-20241114-10009

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Diabetes is a systemic disease. With the progression of the disease, it will lead to a variety of serious complications, and bone metabolism will also be affected. The onset of diabetic bone changes is insidious, so it is often ignored. Patients with diabetes have higher risk of osteoporosis than ordinary people. Patients with diabetic foot are more likely to suffer from osteoporosis than patients with simple diabetes due to poor blood glucose control, vascular neuropathy, chronic inflammation, and other reasons, resulting in pathological fracture, which increases the difficulty of treatment and treatment cost, and causes heavy family and social burden. This article aims to explore the pathogenesis of osteoporosis in diabetic foot patients and to provide evidences for the early prevention and treatment of osteoporosis in diabetic foot patients.

Treatises

Value of serum levels of NGAL and sdLDL-C in prediction of major cardiovascular and cerebrovascular adverse events in elderly patients with type 2 diabetes mellitus

Zhang Hongyan, Liu Ming, Liu Lili, Suo Dongmei

2025, 31(10):  1632-1636.  DOI: 10.3760/cma.j.cn441417-20240530-10010

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Objective　To investigate the value of serum levels of neutrophil gelatinase-associated lipid carrier protein (NGAL) and small and dense low-density lipoprotein cholesterol (sdLDL-C) in the prediction of major unconscience cerebrovascular events (MACCE) in elderly patients with type 2 diabetes mellitus (T2DM). Methods　A total of 120 elderly patients with T2DM who were over 60 years old and treated in General Hospital of Tianjin Medical University from June 2020 to January 2023 were selected for the case-control study, including 65 males and 55 females who were (73.12±9.33) years old. They were divided into a good prognosis group and a poor prognosis group according to whether MACCE occurred during 12 months' follow-up after discharge. The baseline data and laboratory indicators in both groups were recorded and compared. The risk factors of MACCE in the patients were analyzed by the multivariate logistic regression. The value of the serum levels of NGAL and sdLDL-C in the prediction of MACCE in the patients was analyzed by the receiver operating characteristic curve (ROC). Results　There were statistical differences in the serum levels of HbA1c, LDL-C, sdlDL-C, ApoA-I, ApoB, and NGAL between the poor prognosis group and the good prognosis group (all P<0.05). The multivariate logistic regression analysis showed that elevated serum levels of sdlDL-C (OR=2.880, 95%CI 1.336-6.918) and NGAL (OR=2.052, 95%CI 1.880-4.120) were independent risk factors for MACCE in the patients. The ROC analysis results showed that serum NGAL and sdLDL-C had high predictive value for MACCE in the patients [areas under the curves (AUC)=0.791 and 0.760], and their cut-off values were 131.81 μg/L and 32.38 mg/dl, respectively. The combined diagnostic value was higher (AUC=0.871). Conclusion　Elevated serum levels of NGAL and sdLDL-C both are risk factors for MACCE in elderly patients with T2DM, and have certain predictive value for the occurrence of MACCE.

Efficacy of escitalopram combined with repetitive transcranial magnetic stimulation for patients with post-stroke depression 

Geng Lin, Luo Fenyang, Ma Xiangcang

2025, 31(10):  1637-1640.  DOI: 10.3760/cma.j.cn441417-20241127-10011

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Objective　To observe the therapeutic effect of escitalopram and repetitive transcranial magnetic stimulation for patients with post-stroke depression and the effect on their neurotransmitters. Methods　This was a prospective study. Ninety patients with post-stroke depression who were admitted to Department of Neurology, Shenmu Hospital, Northwest University from February 2023 to March 2024 were selected as the study objects, and were divided into a study group and a control group by the random number table method, with 49 cases in each group. There were 21 males and 18 females in the study group; they were (58.31±4.26) years old. There were 22 males and 17 females in the control group; they were (58.82±4.17) years old. The control group took escitalopram once per day, 10 mg per time; the study group took escitalopram and repetitive transcranial magnetic stimulation. Both groups were treated for 1 month. The treatment effective rates, scores of Hamilton Depression Rating Scale-17 (HAMD-17) and modified Barthel index, and levels of neurotransmitter and were compared between the two groups. The independent-sample t and χ² tests were used for the statistical analysis. Results　After one month's treatment, the total effective rate in the study group was higher than that in the control group [93.88% (46/49) vs. 79.59% (39/49)]; the scores of HAMD-17 and modified Barthel index in the study group were better than those in the control group (8.64±3.28 vs. 11.13±3.37 and 63.81±3.27 vs. 55.76±5.64); the levels of serotonin and norepinephrine in the study group were higher than those in the control group [(110.53±10.24) μg/L vs. (90.79±10.33) μg/L and (10.27±1.05) μg/L vs. (8.14±1.13) μg/L]; there were statistical differences in the above indicators between the two groups (all P<0.05). Conclusion　Escitalopram combined with repetitive transcranial magnetic stimulation for patients with post-stroke depression can improve the treatment effective rate and their depression, daily life ability, and levels of neurotransmitters.

Remote ischemic conditioning combined with edaravone and dexamethasone for patients with acute cerebral infarction 

Zhou Meining, Zhang Lingru

2025, 31(10):  1641-1645.  DOI: 10.3760/cma.j.cn441417-20240827-10012

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Objective　To explore the effect of remote ischemic conditioning (RIC) combined with edaravone and dexamethasone for patients with acute cerebral infarction. Methods　One hundred and sixty patients with acute cerebral infarction treated at The Third Affiliated Hospital of Xi'an Medical University between July 2021 and July 2023 were selected for the randomized controlled trial. The patients were divided into a control group and a study group by the random number table method, with 80 cases in each group. There were 41 males and 39 females in the control group; they were (63.37±7.48) years old. There were 46 males and 34 females in the study group; they were (62.59±6.97) years old. The control group were treated with edaravone and dexamethasone; in addition, the study group were treated with RIC. The total effective rates, incidence rates of adverse reactions, and levels of pro-inflammatory factors [tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1β), and interleukin 6 (IL-6)], levels of S100 calcium-binding protein B (S100B), neurological function [scores of the Modified Rankin Scale (MRS) and the National Institutes of Health Stroke Scale (NIHSS)], and levels of neuroprotective factors [vascular endothelial growth factor (VEGF) and brain-derived neurotrophic factor (BDNF)] before and 2, 4, 12 weeks after the treatment were compared between the two groups. t and χ² tests were used for the statistical analysis. Results　There was a statistical difference in the total effective rate between the study group and the control group [92.50% (74/80) vs. 80.00% (64/80); P<0.05]. There was no statistical difference in the total effective rate between the study group and the control group [12.50% (10/80) and 10.00% (8/80); P>0.05]. After the treatment, the levels of TNF-α, IL-1β, S100B, and IL-6 were lower than those before the treatment in both groups, and the levels in the study group were lower than those in the control group (all P<0.05). After the treatment, the levels of VEGF and BDNF were higher than those before the treatment in both groups, and the levels in the study group were higher than those in the control group (all P<0.05). Conclusion　RIC combined with edaravone and dexamethasone for patients with acute cerebral infarction is effective, and can improve their neurological function and prognosis.

Value of CEUS and two-dimensional ultrasound in prediction of recurrence of hepatocellular carcinoma after US-PMMA 

Yang Shangyun, She Wen, Xu Cheng

2025, 31(10):  1646-1650.  DOI: 10.3760/cma.j.cn441417-20241104-10013

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Objective　To explore the value of contrast-enhanced ultrasound imaging (CEUS) and two-dimensional ultrasound in the prediction of recurrence of hepatocellular carcinoma after percutaneous microwave ablation with ultrasonic guidance and polymerization of methyl methacrylate (US-PMMA). Methods　Eighty-two patients with early hepatocellular carcinoma who received US-PMMA treatment in Xi'an International Medical Center Hospital from March 2022 to March 2023 were selected as the study objects, including 64 males and 18 females who were 32-78 (55.43±10.35) years old. All the patients underwent preoperative two-dimensional ultrasound and CEUS examinations. They were divided into a recurrence group (21 cases) and a non-recurrence group (61 cases) according to whether they recurred within 1 year after the surgery. The CEUS and two-dimensional ultrasound characteristics (maximum tumor diameter, tumor boundary, macrovascular invasion, blood flow grade, envelope type, enhanced delay period, clearance time, etc) were compared between the two groups. The multivariate logistic regression analysis was conducted to analyze the risk factors for the recurrence of hepatocellular carcinoma after US-PMMA. The receiver operating characteristic curve (ROC) was drawn, and the area under the curve (AUC) was calculated to evaluate the predictive value of CEUS and two-dimensional ultrasound features for the recurrence of early hepatocellular carcinoma after US-PMMA. t and χ² tests were used for the statistical analysis. Results　There were statistical differences between the recurrence group and the non-recurrence group in maximum tumor diameter, tumor boundary, macrovascular invasion, blood flow grade, envelope type, enhanced delay period, clearance time, and other characteristics (χ²=9.277, 5.178, 8.433, 5.763, 20.038, and 32.382; t=6.578; all P<0.05). The multivariate logistic regression analysis showed that the maximum tumor diameter ≥ 5 cm (OR=3.916), unsmooth tumor boundary (OR=4.371), macrovascular invasion (OR=4.003), blood flow grade Ⅱ～Ⅲ (OR=3.959), incomplete envelope (OR=4.233), low enhancement in delay period (OR=3.873), and clearance time < 70 s (OR=4.212) were the independent risk factors for the recurrence of early hepatocellular carcinoma after US-PMMA (all P<0.05). The ROC showed that the combination of maximum tumor diameter ≥5 cm, unsmooth tumor boundary, macrovascular invasion, blood flow grade Ⅱ～Ⅲ, incomplete envelope, low enhancement in delay period, and clearance time <70 s in the prediction of early hepatocellular carcinoma recurrence after US-PMMA had an AUC of 0.836, a specificity of 86.89% (53/61), and a sensitivity of 85.71% (18/21). Conclusion　CEUS and two-dimensional ultrasound can effectively predict the risk of recurrence of hepatocellular carcinoma after US-PMMA through maximum tumor diameter, boundary, macrovascular invasion, capsule morphology, and blood supply.

Relationship of serum levels of pNF-H and Prdx6 with stability of carotid atherosclerotic plaques in patients with acute cerebral infarction 

Hui Yuhang, Zhou Haojun

2025, 31(10):  1651-1656.  DOI: 10.3760/cma.j.cn441417-20241108-10014

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 Objective　To analyze the relationship of the serum levels of phosphorylated neurofilament protein H (pNF-H) and peroxidoreductin 6 (Prdx6) with the stability of carotid atherosclerotic plaques in patients with acute cerebral infarction (ACI) and its clinical significance. Methods　A total of 110 patients with ACI treated at Xianyang First People's Hospital from April 2022 to March 2024 were selected as a study group, including 54 males and 56 females. They were (63.04±7.76) years old. There were 39 mild cases, 48 moderate cases, and 23 severe cases. There were 36 cases without plaques, 44 cases with stable plaques, and 30 cases with unstable plaques. Fifty healthy subjects in the same period were selected as a control group. The patients' clinical data were collected. The serum levels of pNF-H and Prdx6 in each group were detected. The Spearman correlation analysis was used to analyze the relationship of serum levels of pNF-H and Prdx6 with the infarction degree and plaque stability. The risk factors of plaque instability were analyzed by the logistic regression. The receiver operating characteristic curve (ROC) was used to analyze the efficacies of both methods in the prediction of ACI plaque instability. Results　The serum levels of pNF-H and Prdx6 in the study group were (0.57±0.07) μg/L and (46.57±5.64) ng/L, and those in the control group (0.31±0.03) μg/L and (81.25±7.34) ng/L, with statistical differences (both P<0.05); with the aggravation of ACI infarction, the levels of PNF-H and PrDX6 gradually increased or decreased, with statistical differences (all P<0.05). Compared with those in the non-plaque group, the levels of hyperlipidemia, hypertension, low density lipoprotein cholesterol (LDL-C), apolipoprotein (ApoB), cystatin C (Cys-C), homocysteine (Hcy), and pNF-H in the plaque stable group and the plaque unstable group were higher, and the levels of Prdx6 were lower; those in the unstable group were higher or lower than those in the stable group; there were statistical differences (all P<0.05). Hyperlipidemia and the levels of ApoB, Hcy, Cys-C, pNF-H, and Prdx6 were independent factors affecting the stability of carotid atherosclerotic plaques in the patients (all P<0.05). The stability of carotid atherosclerotic plaques and the infarction degree in the patients were positively correlated with serum pNF-H level (r=0.556 and 0.571; both P<0.05), and negatively with serum Prdx6 level (r=-0.534 and -0.515; both P<0.05). When the cut-off values of serum pNF-H and Prdx6 were 0.63 μg/L and 43.77 ng/L, respectively, the area under the curve of the combination for predicting the instability of carotid atherosclerotic plaques was 0.910 (95%CI 0.853-0.968), with a sensitivity of 92.30% and a specificity of 81.20%; the diagnostic efficacy was better than that of single indicator. Conclusion　The increase of serum pNF-H level and the decrease of Prdx6 level are closely related to the degree of ACI and the stability of carotid atherosclerotic plaques, which have high predictive efficacy in evaluating the incidence of ACI and judging the stability of carotid atherosclerotic plaques.

Molecular mechanism of PPP1R1A in rat pancreatic INS-1 cells 

Xian Hengbiao, Lin Dejian, Xu Mingying, Chen Peihai, Jiang Hongqun, Chen Liqiang

2025, 31(10):  1656-1659.  DOI: 10.3760/cma.j.cn441417-20240318-10015

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Objective　To investigate the molecular mechanism of protein phosphatase 1 regulatory subunit 1A (PPP1R1A) of rat pancreatic INS-1 cells. Methods　The pLenti-PPP1R1A-sgRNA plasmid was transfected in the rat pancreatic INS-1 cells. The expression levels of PPP1R1A, MafA, Pdx1, and Pax6PPP1R1A, Fox01, NKX6.1, and MAFA were detected by Western blotting. The cell activity was detected by the CCK-8 assay. The concentration of insulin in the cell culture fluid was detected by the enzyme linked immunosorbent assay. Analysis of variance and t test were used for the statistical analysis. Results　After transfecting with pLenti-PPP1R1A-sgRNA plasmid, the expression levels of PPP1R1A, Fox01, NKX6.1, and MAFA in the control group were 0.382±0.187, 0.311±0.151, 0.224±0.053, and 0.317±0.184, and those in the experimental group were 0.156±0.032, 0.203±0.099, 0.104±0.022, and 0.193±0.081 (all P<0.05). The results of the CCK-8 assay showed that after transfecting with pLenti-PPP1R1A-sgRNA plasmid, the proliferation of the INS-1 cells was inhibited (P<0.05), and the insulin secretion function was decreased in the INS-1 cells (P<0.05). Conclusion　Inhibition of the PPP1R1A gene may affect the insulin synthesis and secretion function in INS-1 cells, which may be one of the abnormal and depolarization mechanisms of pancreatic β cells in patients with type 2 diabetes.

Clinical Research

Short-term efficacy of PD-1 inhibitor combined with SOX chemotherapy regimen for patients with locally advanced gastric adenocarcinoma and its influencing factors 

Li Fei, Du Jing, Sun Li, Cai Cheng

2025, 31(10):  1660-1664.  DOI: 10.3760/cma.j.cn441417-20241118-10016

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Objective　To investigate the short-term efficacy of programmed death protein-1 (PD-1) inhibitor combined with oxaliplatin + tiggio (SOX) chemotherapy regimen in the neoadjuvant treatment of patients with locally advanced gastric adenocarcinoma and its influencing factors. Methods　One hundred and twenty-eight patients with locally advanced gastric adenocarcinoma treated at Xi'an Third Hospital from May 2022 to May 2024 were selected for the randomized controlled trial, and were divided into a control group and a study group by the random number table method, with 64 cases in each group. The control group took the SOX chemotherapy regimen, while the study group PD-1 inhibitor and the SOX chemotherapy regimen; both groups completed three cycles of chemotherapy. The short-term clinical efficacies, age, gender, maximum tumor diameters, tumor sites, TNM stages, pathological types, degrees of differentiation, bile acid levels, neutrophil to lymphocyte count ratios (NLR), and expressions of programmed death receptor ligand 1 (PD-L1) were compared between the two groups. The occurrences of adverse reactions during the treatment in the two groups were analyzed. The logistic regression analysis was used to assess the factors influencing the short-term efficacy of PD-1 inhibitor combined with the SOX chemotherapy regimen for the patients with locally advanced gastric adenocarcinoma. χ² and t tests were used for the statistical analysis. Results　The short-term efficacy in the study group was higher than that in the control group [75.00% (48/64) vs. 57.81% (37/64)], with a statistical difference (P<0.05); There were no statistical differences in age, gender, tumor site, pathological type, and differentiation degree between the two groups (all P>0.05). The proportions of the patients with a maximum tumor diameter <6 cm, TNM stage Ⅱ, and PD-L1 expression ≥1% in the study group were higher than those in the control group [78.13% (50/64) vs. 51.56% (33/64), 68.75% (44/64) vs. 28.13% (18/64), and 76.56% (49/64) vs. 48.44% (31/64)], and the bile acid level and proportion of the patients with NLR≥3.7 were lower [(4.64±1.42) μmol/L vs. (5.87±1.78) μmol/L and 23.44% (15/64) vs. 68.75% (44/64)], with statistical differences (all P<0.05). During the treatment, there were 4 cases of nausea, 5 cases of vomiting, and 7 cases of anorexia in the study group; there were 6 cases of nausea, 4 cases of vomiting, and 8 cases of anorexia in the control group; there was no statistical differences (χ²=0.160, P>0.05). The logistic regression analysis showed that maximum tumor diameter <6 cm, TNM stage Ⅱ, low bile acid level, NLR≥3.7, and PD-L1 expression ≥1% were all protective factors for the short-term efficacy of PD-1 inhibitor combined with SOX chemotherapy regimen for the patients with locally advanced gastric adenocarcinoma (all P<0.05). Conclusions　PD-1 inhibitor combined with SOX chemotherapy regimen for patients with locally advanced gastric adenocarcinoma has good short-term efficacy. PD-L1 expression ≥1%, the maximum tumor diameter < 6 cm, and TNM stage Ⅱ are protective factors of clinical efficacy. The appropriate treatment regimen should be selected clinically based on these factors.

VR technology combined with vestibular function rehabilitation for patients with peripheral vertigo 

Yan Juan, Shi Hao, An Li, Tuo Mingxiang, Wang Hong, Zhang Caifeng, He Wenjuan, Li Erle

2025, 31(10):  1665-1669.  DOI: 10.3760/cma.j.cn441417-20241104-10017

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Objective　To explore the effect of virtual reality (VR) technology combined with vestibular function rehabilitation for patients with peripheral vertigo. Methods　This was a prospective study. One hundred patients with peripheral vertigo treated at Yan'an People's Hospital from January 2023 and April 2024 were divided into a single group and a combined group by envelope lottery, with 50 cases in each group. There were 29 males and 21 females in the single group; they were (52.33±6.42) years old; there were 13 cases of hypertension and 15 cases of coronary heart disease. There were 27 males and 23 females in the combined group; they were (52.28±6.47) years old; there were 16 cases of hypertension and 13 cases of coronary heart disease. The single group received vestibular function rehabilitation therapy, while the combined group received the same therapy augmented with VR technology. The clinical efficacies, improvement in vertigo symptoms, balance abilities, vestibular symptom index (VSI), and anxiety levels before and after the treatment were compared between the two groups. t and χ² tests were used for the statistical comparisons. Results　After the treatment, the clinical efficacy of the combined group was higher than that of the single group [96.0% (48/50) vs. 82.0% (41/50)]; the scores of emotional, functional, and physical domains of the Dizziness Handicap Inventory (DHI) in the combined group were lower than those in the single group (8.04±0.71 vs. 12.51±1.38, 10.85±1.11 vs. 14.12±1.53, and 9.44±0.82 vs. 13.03±1.21); the maximum oscillation length and oscillation envelope area of the combined group were lower than those of the single group [(95.72±13.08) mm vs. (121.88±15.17) mm and (425.38±53.37) mm² vs. (622.55±72.56) mm²]; the scores of dizziness, nausea, headache, balance, vertigo, and visual sensitivity of VSI in the combined group were lower than those in the single group (1.14±0.27 vs. 3.45±0.45, 1.08±0.21 vs. 3.15±0.46, 1.21±0.27 vs. 2.86±0.32, 1.22±0.27 vs. 3.41±0.40, 1.33±0.26 vs. 2.81±0.47, and 1.37±0.26 vs. 2.90±0.42); the scores of the Hamilton Anxiety Scale and Hamilton Depression Scale (HAMD) in the combined group were lower than those in the single group (5.85±0.62 vs. 10.63±1.04 and 6.37±0.67 vs. 11.87±1.21); there were statistical differences in the above indicators between the two groups (all P<0.05). Conclusion　VR technology combined with vestibular function rehabilitation for patients with peripheral vertigo is effective.

Correlation between multimodal MRI and carotid ultrasound indicators of cerebral small vessel disease and cognitive impairment 

Qin Jiangyan, Wang Tao, Gao Ren, Fan Zheng

2025, 31(10):  1670-1675.  DOI: 10.3760/cma.j.cn441417-20240311-10018

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Objective　To explore of the diagnostic efficacy of multimodal magnetic resonance imaging (MRI) indicators and carotid ultrasound indicators for patients with cerebral small vessel disease and their correlation with cognitive impairment. Methods　One hundred and ninety-five patients diagnosed with cerebral small vessel disease at Cardiovascular and Cerebrovascular Disease Hospital, Affiliated Hospital of Yan'an University from May 2020 to May 2023 were selected as the study objects. Based on the scores of the Montreal Cognitive Assessment Scale (MoCA), the patients were divided into a cognitive impairment (CL) group (106 cases) and a non-cognitive impairment (NCL) group (89 cases). If the MoCA score < 23, there is cognitive impairment. There were 56 males and 50 females in the CL group; they were (70.73±9.42) years old. There were 48 males and 41 females in the NCL group; they were (65.58±9.29) years old. The multimodal MRI parameters [white matter hyperintensities (WMH), lacunar infarcts (LI), cerebral microbleeds (CMBs), perivascular spaces (PVS), and brain atrophy] and carotid ultrasound markers (score of extracranial carotid atherosclerosis) were detected. The correlation of the multimodal MRI parameters and carotid ultrasound marker with cognitive impairment was analyzed by the Spearman correlation analysis. The diagnostic efficacy of these indicators for cerebral small vessel disease -related cognitive impairment was assessed using the receiver operating characteristic curve (ROC). t, χ², and Mann-Whitney U tests were used for the statistical analysis. Results　All the neuroimaging indicators in the NCL group were lower than those in the CL group (all P<0.05), including Fazekas score [2.00 (1.00, 2.00) vs. 3.50 (2.00, 4.00)], number of LI [1.00 (0.00, 1.00) vs. 2.00 (1.00, 3.00)], number of CMBs [1.00 (0.00, 1.00) vs. 1.00(0.00, 2.00)], CSO-PVS score [1.00 (0.00, 2.00) vs. 1.00 (1.00, 2.00)], BG-PVS score [1.00 (1.00, 2.00) vs. 1.00 (1.00, 2.00)], GCA score [1.00 (1.00, 2.00) vs. 2.00 (1.00, 2.00)], and extracranial carotid atherosclerosis score [2.00 (1.00, 3.50) vs. 4.00 (3.00, 4.00)]. The correlation analysis showed that the Fazekas score, number of LI, number of CMBs, CSO-PVS score, BG-PVS score, GCA score, and score of extracranial carotid atherosclerosis were negatively correlated with the MoCA score (r=-0.372, -0.320, -0.241, -0.163, -0.182, -0.374, and -0.191; all P<0.05). The area under the curve of the multimodal MRI parameters combined with the carotid ultrasound marker for diagnosing cognitive impairment in the patients with cerebral small vessel disease was 0.826 (95%CI 0.764-0.888), with a sensitivity of 82.1% and a specificity of 83.1%. Conclusion　There is a significant correlation of multimodal MRI and carotid ultrasound indicators with cognitive impairment in patients with cerebral small vessel disease.

Predictive value of GGT level for efficacy of TACE combined with sorafenib in treatment of patients with hepatocellular carcinoma 

Shen Yong, Zheng Chunmei

2025, 31(10):  1675-1680.  DOI: 10.3760/cma.j.cn441417-20240730-10019

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Objective　To assess the predictive value of serum gamma-glutamyl transferase (GGT) level for the clinical efficacy and survival outcomes of patients with primary hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) and sorafenib. Methods　One hundred and ten patients with HCC treated at Hanzhong Central Hospital from June 2020 to June 2022 were selected as the study objects. The patients were divided into a high-expression group (65 cases) and a low-expression group (45 cases) according to their serum GGT level before the treatment using a threshold of 50 U/L. The high-expression group had 34 males and 31 females, with 33 cases >60 years old and 32 cases ≤60 years old. The low-expression group had 29 males and 16 females, with 24 cases >60 years old and 21 cases ≤60 years old. The objective response rates (ORR) and local control rates (LCR) after three months' treatment were compared between the two groups. The clinical data were compared between the two groups. The patient survival was assessed using the Kaplan-Meier method to estimate their overall survival (OS) and progression-free survival (PFS). The Cox regression models were used to analyze the impact of GGT and clinical characteristics on their survival outcomes. χ² and t tests were used for the statistical analysis. Results　After 3 months' treatment, the ORR and LCR in the low expression group were higher than those in the high-expression group [51.11% (23/45) vs. 32.31% (21/65) and 80.00% (36/45) vs. 32.31% (55/65); χ²=11.690 and 7.948; both P<0.05]. The proportions of the patients with portal vein tumor thrombus, higher ECOG score, lower tumor differentiation, maximum tumor diameter > 5 cm, and higher AFP level in the high-expression group were higher than those in the low-expression group (all P<0.05). After the 2-year follow-up, the survival rates of the low-expression group and the high-expression group were 75.56% (34/45) and 53.84% (35/65), respectively; the median PFS's were 11.0 months and 5.0 months; the median OS's were 21.0 months and 13.0 months; there were statistical differences between the two groups (all P<0.05). The univariate and multivariate Cox regression analyses showed that serum GGT level, portal vein tumor thrombus, ECOG score, tumor differentiation, maximum tumor diameter, tumor morphology, and AFP level were the independent factors influencing PFS and OS in the patients (all P<0.05). Conclusion　The low GGT expression group demonstrates superior treatment response and survival outcomes compared to the high GGT expression group.

Relationship of Hcy, APOH, and ROS with intestinal flora and clinical characteristics in patients with colorectal cancer 

Zhang Pengyu, Zhang Rong

2025, 31(10):  1681-1686.  DOI: 10.3760/cma.j.cn441417-20241024-10020

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Objective　To investigate the relationship of the serum levels of homocysteine (Hcy), apolipoprotein H (APOH), and reactive oxygen species (ROS) with intestinal flora imbalance and clinical characteristics in patients with colorectal cancer. Methods　Eighty-nine patients with colorectal cancer treated at Daxing Hospital from April 2021 to February 2024 were selected as a study group, including 50 males and 39 females who were (61.45±5.55) years old; 89 healthy people in the same period were selected as a control group, including 52 males and 37 females who were (61.33±5.22) years old. The serum levels of Hcy, APOH, and ROS were detected and compared. The fecal samples of the subjects were collected for bacterial culture, and the number of flora was counted. The numbers of intestinal flora between the study group and the control group were compared. The relationship of the serum levels of Hcy, APOH, and ROS with intestinal flora was analyzed by the Pearson correlation analysis. The clinical characteristics of the patients in the study group were sorted out, and the serum levels of Hcy, APOH, and ROS in the patients with different clinical characteristics were compared. χ² and t tests were used for the statistical analysis. Results　The serum levels of Hcy, APOH, and ROS in the study group were higher than those in the control group [(16.88±5.36) μmol/L vs. (10.54±3.02) μmol/L, (9.66±2.31) mg/L vs. (3.21±1.01) mg/L, and (1 332.58±302.52) U/ml vs. (542.35±30.25) U/ml], with statistical differences (t=9.700, 24.135, and 24.521; all P<0.05). The numbers of Fusobacterium nucleatum, Enterococcus faecalis, and Escherichia coli in the study group were higher than those in the control group [(15.36±2.55) CFU/g vs. (5.06±2.11) CFU/g, (11.13±2.09) CFU/g vs. (4.12±0.99) CFU/g, and (17.16±3.24) CFU/g vs. (5.24±2.11) CFU/g], and the numbers of Bacteroides, Lactobacillus, and Bifidobacterium were lower [(6.87±3.06) CFU/g vs. (16.56±2.44) CFU/g, (8.35±2.41) CFU/g vs. (17.65±4.74) CFU/g, and (6.33±2.05) CFU/g vs. (15.22±4.13) CFU/g], with statistical differences (t=29.539, 28.596, 29.084, 23.358, 16.500, and 18.190; all P<0.05]. The Pearson correlation analysis showed that the serum levels of Hcy, APOH, and ROS were positively correlated with the numbers of Fusobacterium nucleatum, Enterococcus faecalis, and Escherichia coli in the patients (r=0.755, 0.702, and 0.488; r=0.822, 0.733, and 0.577; r=0.801, 0.782, and 0.587; all P<0.05), and negatively with the numbers of Bacteroides, Lactobacillus, and Bifidobacterium (r=-0.632, -0.422, and -0.722; r=-0.664, -0.471, and -0.763; r=-0.678, -0.511, and -0.799; all P<0.05). The serum levels of Hcy, APOH, and ROS in the patients with lymph node metastasis, distant metastasis of tumor, tumor stage III-IV, and poor differentiation were higher than those in the patients without lymph node metastasis, without distant metastasis of tumor, with tumor stage I-II, and with moderate to high differentiation, with statistical differences (all P<0.05). Conclusions　The serum levels of Hcy, APOH, and ROS in patients with colorectal cancer are higher than those in healthy people. All the three are related to the intestinal flora imbalance in patients with tumor metastasis, stage, and differentiation.

Preoperative frailty and its association with postoperative cognitive dysfunction and prognosis in elderly patients with colorectal cancer 

Ding Xijin, Wang Nengping

2025, 31(10):  1686-1691.  DOI: 10.3760/cma.j.cn441417-20240718-10021

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Objective　To analyze the relationship of preoperative frailty with postoperative cognitive impairment and prognosis in elderly patients with colorectal cancer. Methods　Ninety-one elderly patients with colorectal cancer treated at Ankang Traditional Chinese Medicine Hospital from January 2019 to January 2023 were selected as the study objects. All the patients were assessed using the Montreal Cognitive Assessment (MoCA) after operation; the patients scoring ≥26 were set as a cognitively normal group (69 cases), and those scoring <26 as a cognitively impaired group (22 cases). There were 48 males and 21 females who were (73.07±7.41) years old in the cognitively normal group. There were 15 males and 7 females who were (74.81±7.64) years old in the cognitively impaired group. The basic data, pathological features, and basic biochemical indicators were compared between the two groups. The patients' frailty before operation was evaluated using the Tilburg Frailty Indicator (TFI). The serum levels of albumin, tumor necrosis factor-α (TNF-α), brain-derived neurotrophic factor (BDNF), and carcinoembryonic antigen (CEA) were measured. Pearson correlation analysis was used to evaluate the relationship between the preoperative TFI score and postoperative MoCA score. All the patients were followed up for one year; the patients who had tumor recurrence, lesion metastasis, and new lesion detection or died were categorized as a poor prognosis group (36 cases), while the remaining patients were set as a good prognosis group (55 cases). The TFI scores before operation and levels of TNF-α, BDNF, CEA, and albumin were compared between these two groups. The logistic multivariate analysis was used to explore the risk factors of poor prognosis. The predictive value of frailty status for postoperative cognitive impairment and prognosis was assessed using the receiver operating characteristic curve (ROC). t and χ² tests were used for the statistical analysis. Results　The cognitively impaired group had higher TFI score and TNF-α level, and lower levels of albumin and BDNF than the cognitively normal group [7.26±1.53 vs. 4.61±1.22, (34.18±4.34) ng/L vs. (27.97±3.59) ng/L, (31.60±3.78) g/L vs. (40.42±4.61) g/L, and (3.48±0.72) μg/L vs. (5.22±0.91) μg/L], with statistical differences (t=8.327, 6.709, 8.135, and 8.179; all P<0.05). The Pearson correlation analysis showed a negative correlation between the preoperative TFI score and postoperative MoCA score (r=-0.543; P<0.05). The TFI score and levels of TNF-α and CEA in the poor prognosis group were higher than those in the good prognosis group [7.56±1.71 vs. 3.74±1.32, (33.55±4.42) ng/L vs. (26.80±3.60) ng/L, and (181.13±24.16) μg/L vs. (148.20±13.55) μg/L]; the level of albumin in the poor prognosis group was lower than that in the good prognosis group [(34.48±3.69) g/L vs. (40.78±4.36) g/L]; there were statistical differences (t=11.994, 7.986, 8.319, and 7.151; all P<0.05). The multivariate analysis indicated that the TFI score and levels of TNF-α, CEA, and albumin were predictors of poor prognosis (all P<0.05). The accuracies of preoperative TFI score in the prediction of postoperative cognitive dysfunction and poor prognosis was 90.3% and 94.7%, respectively. Conclusion　Preoperative frailty in elderly patients with colorectal cancer affects postoperative cognitive function and may increase the risk of poor prognosis.

Association of levels of CCK, L-γ-GGT, and CBD before and after benign laparoscopic cholecystectomy with post cholecystectomy syndrome 

Zhang Huidong, Su Jinsong, Lin Rongwu

2025, 31(10):  1692-1695.  DOI: 10.3760/cma.j.cn441417-20241129-10022

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Objective　To explore the association of the levels of cholecystokinin (CCK), L-γ-glutamyltransferase (L-γ-GGT), and common bile duct diameter (CBD) before and after laparoscopic cholecystectomy (LC) with post cholecystectomy syndrome (PCS). Methods　This was a retrospective cohort study. Eighty patients who conformed with the observation criteria after LC due to benign gallbladder lesions in Traditional Chinese Medicine Hospital Affiliated to Guangzhou Medical University from January 2021 to June 2023 were selected as the study objects, including 43 males and 37 females who were (56.0±7.8) years old. The patients were followed up 12 months. According to whether they had PCS, the patients were divided into a non-PCS group and a PCS group. The incidence rates in the males and females were observed. The CBD's and serum levels of CCK and L-γ-GGT before and 1, 6, and 12 months after the operation were recorded. One-way analysis of variance and χ² and t tests were used for the statistical comparisons. Results　During the 12 months' follow up, 17 cases had PCS after LC, including 11 females and 6 females; the incidence rate of PCS in the females was higher than that in the males (P<0.05). The levels of CCK and L-γ-GGT and CBD were higher after than before the operation, with statistical differences (all P<0.05), and increased with time (P<0.05). The CCK level in the PCS group was lower than that in the non-PCS group [(0.65±0.14) pmol/L vs. (0.89±0.22) pmol/L], and the L-γ-GGT level and CBD were higher [(82.00±16.00) U/L vs. (41.00±12.00) U/L and (8.70±1.80) mm vs. (4.80±1.40) mm], with statistical differences (all P<0.05). Conclusion　PCS after LC may correlate with changes of gut hormones and increased common bile duct pressure after gallbladder loss, indicating that gallbladder preservation is of great significance in the treatment of benign gallbladder lesions, and removing the gallbladder requires strict adherence to surgical indications.

Establishment and verification of re-examination rules for ORIENTER FA280S fully automatic feces analyzer 

Ou Caiwen, Ke Peifeng, Zhong Yusheng, Yu Jinqi, Su Si'En, Lin Fujia

2025, 31(10):  1696-1701.  DOI: 10.3760/cma.j.cn441417-20241218-10023

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Objective　To establish and validate the re-examination rules for the ORIENTER FA280S fully automatic feces analyzer at the Dadelu Main Hospital of The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, and to improve the efficacy of routine and occult blood testing in feces samples. Methods　A total of 500 routine feces samples were randomly collected from the Dadelu Main Hospital of The Second Affiliated Hospital of Guangzhou University of Chinese Medicine between March 1 and May 31, 2024. These samples were tested using the ORIENTER FA280S fully automatic feces analyzer, with manual microscopic examination as the gold standard. χ² test was conducted to compare the results of instrumental analysis and manual smear microscopic examination, allowing for the screening of re-examination rules for the fully automatic feces analyzer. To validate the re-examination rules, 248 true-positive feces samples for any test item were collected between June 1 and August 31, 2024, and the missed detection rate was calculated. The re-examination rules were evaluated against internationally accepted criteria (false negative rate <5%). Results　For the group used to establish re-examination rules, the positive rates for red blood cells, white blood cells, fungi, parasite eggs, and occult blood test were 5.6% (28/500) , 5.6% (28/500), 4.4% (22/500), 7.2% (36/500), and 24.8% (124/500), respectively. For the validation group, the positive rates for red blood cells, white blood cells, fungi, parasite eggs, and occult blood test were 18.55% (46/248), 29.03% (72/248), 9.27% (23/248), 22.18% (55/248), and 67.34% (167/248), respectively. Five re-examination rules formulated were as below: ⑴ microscopic examination was taken when feces were loose/watery, and red/white blood cells or fungi were negative; ⑵ high-power microscopic review was done when parasites or eggs were reported by the instrument and confirmed by the analyzer's high power field and if the analyzer's field was blur; ⑶ microscopic examination for suspected red/white blood cells or fungi; ⑷ chemical re-test for occult blood was done when feces were dark, brown, or black, and the occult blood test was negative; ⑸ gold standard re-test for occult blood was done when red blood cells were positive, but the occult blood test was negative. The false negative rate for the validated re-examination rules was 4.03% (10/248), lower than 5.00%. Conclusion These rules effectively control the false negative rate, meet international standards, and satisfy testing requirements.

Postoperative closed negative pressure wound therapy for wound healing in chest wall tuberculosis 

Jiang Tao, Xiao Zelin

2025, 31(10):  1701-1705.  DOI: 10.3760/cma.j.cn441417-20250220-10024

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Objective　To investigate the efficacy of postoperative closed negative pressure wound therapy for wound healing in chest wall tuberculosis. Methods　A total of 60 patients with chest wall tuberculosis who underwent surgery at Guangzhou Chest Hospital between February 2022 and March 2024 were selected for the randomized controlled trial, and were divided into a control group and an observation group by the random number table method, with 30 cases in each group. There were 21 males and 9 females in the control group; they were (43.19±0.89) years old. There were 22 males and 8 females in the observation group; they were (45.79±0.15) years old. The control group received conventional dressing drainage and dressing change. The observation group took closed negative pressure wound therapy to treat their postoperative wounds. The clinical inflammation-related indicators, efficacy-related time indicators, and scores of life quality day 7 after the operation and incidence rates of complications were compared between the two groups by t and χ² tests. Results　After the treatment, the white blood cell count, erythrocyte sedimentation rate, and level of C-reactive protein in the observation group were lower than those in the control group [(7.15±1.24)×10⁹/L vs. (9.63±1.15)×10⁹/L, (18.24±2.25) mm/h vs. (25.07±2.23) mm/h, and (38.15±3.03) mg/L vs. (46.17±2.89) mg/L]; the wound red-stage, wound healing time, dressing maintenance time, and postoperative hospital stay in the observation group were shorter than those in the control group [(4.15±1.02) d vs. (8.39±2.15), (14.79±2.48) d vs. (27.34±3.36) d, (8.16±2.07) d vs. (23.76±3.89), and (8.59±2.18) d vs. (16.54±3.57) d]; the total incidence rate of complications in the observation group was lower than that in the control group [6.67% (2/30) vs. 33.3% (10/30)]; the scores of general conditions, mental health, and social function in the observation group were higher than those in the control group (85.27±3.42 vs. 80.15±3.65, 89.35±5.13 vs. 84.20±5.40, and 91.15±5.93 vs. 86.90±6.10); there were statistical differences in the above indicators between the two groups (all P<0.001). Conclusion　Postoperative closed negative pressure wound therapy for patients with chest wall tuberculosis can improve their clinical inflammation-related indicators, alleviate their pain, and reduce their negative emotions, and shorten wound healing time.

Relationship of serum levels of nonestesterified fatty acid and adiponectin with diabetic retinopathy 

Si Yanyan, Liu Shengxun

2025, 31(10):  1706-1708.  DOI: 10.3760/cma.j.cn441417-20240319-10025

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Objective　To investigate the relationship of serum levels of adiponectin (ADPN) and nonestesterified fatty acid (NEFA) with diabetic retinopathy (DR). Methods　Thirty-four patients with type 2 diabetes mellitus (T2DM) treated at Binzhou Medical University Hospital from November 2021 to May 2022 were selected as the study objects, including 18 males and 16 females who were 36-75 years old. According to whether they had DR, the patients were divided into a non-DR group (18 cases) and a DR group (16 cases). Sixteen healthy examinees taking physical examination at Binzhou Medical University Hospital during the same period were selected as a health control group, including 9 males and 7 females who were 33-74 years old. The levels of NEFA, ADPN, blood glucose, cholesterol (CHO), low-density lipoprotein (LDL), triglyceride (TG), and high-density lipoprotein (HDL) in all the subjects were detected. t test was used for the statistical analysis. Results　The levels of NEFA and ADPN in the DR group were (1.03±0.38) mmol/L and (5.64±1.57) mg/L, the levels in the non-DR group (0.47±0.13) mmol/L and (7.99±1.98) mg/L, and the levels in the healthy control group （0.47±0.13） mmol/L and （7.99±1.98） mg/L， with statistical differences (both P<0.05). Conclusion　Serum levels of SNEFA and ADPN are associated with DR in patients with T2DM.

Research on Traditional Chinese Medicine

Occurrence and development mode of intestinal gastric cancer in traditional Chinese medicine 

Zhang Chengming, Li Fang, Yu Tao

2025, 31(10):  1709-1713.  DOI: 10.3760/cma.j.cn441417-20241225-10026

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The classic development mode of intestinal gastric cancer in western medicine is recognized as the Correa mode. At present, there is no theory on the occurrence and development mode of intestinal gastric cancer in traditional Chinese medicine, so it is worthy of further study and excavation. Based on many years' clinical practice, Director Yu found that the pathogenesis of gastric cancer is based on deficiency and excess, spleen deficiency, and damp-heat and blood stasis. Spleen deficiency is mostly caused by the long-term effects of internal injury in diet and emotional disorder. Spleen deficiency is endogenous to dampness, and dampness stagnation turns into heat for a long time, which is unfavorable to qi movement. Coupled with long-term illness and excessive blood stasis, blood stasis stops, and heat stagnation and blood stasis turn into toxic evil for a long time, leading to cancer. Director Yu innovatively put forward the development mode of intestinal gastric cancer——spleen deficiency→damp heat→blood stasis→toxin; the clinical treatment according to the theory was satisfactory. The core pathogenesis of this disease is spleen deficiency, damp-heat, and blood stasis, and the essence is deficiency-based excess syndrome; spleen deficiency is the fundamental pathogenesis; excess is the connotation of damp-heat and blood stasis; the pathogenesis of deficiency of the essence and excess of the essence is primary and secondary; spleen is strengthened, and the root cause is cured from beginning to end; the excess of the essence should be treated according to different stages. Clinical treatment should be based on strengthening the spleen and strengthening the body resistance, clearing away damp-heat, and removing toxin and removing blood stasis. Heat is easy to clear, but dampness and blood stasis are difficult to remove. Strengthening the spleen and strengthening the body resistance is especially important. Strengthening the spleen throughout the treatment, spleen will transport normally; dampness and heat will be clear; blood stasis and toxin will be easily removed; atrophy and intestinal metaplasia can delay the progress and reverse; precancerous lesion and cancer can be prevented and treated.

Daochi San combined with narrow-spectrum intense pulsed light for patients with acne vulgaris of heart meridian heat accumulation syndrome

Wang Shaobo, Li Wei, Zhao Chan, Liu Yan

2025, 31(10):  1713-1718.  DOI: 10.3760/cma.j.cn441417-20241220-10027

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Objective　To explore the effect of Daochi San combined with narrow-spectrum intense pulsed light for patients with acne vulgaris of heart meridian heat accumulation syndrome. Method　A total of 126 patients with acne vulgaris admitted to Chang 'an Hospital from January 2022 to July 2024 were selected as the prospective research subjects, and  were divided into a Daochi San group, narrow-spectrum intense pulsed light group, and a combination group by  lottery, with 42 patients in each group. There were 15 males and 27 females in the Daochi San group, with an age of (23.67±4.66) years and a disease course of (1.48±0.31) years. There were 18 males and 24 females in the narrow-spectrum intense pulsed light group, with an age of (22.19±3.52) years and a disease course of (1.43±0.36) years. There were 16 males and 26 females in the combination group, with an age of (22.52±3.49) years and a disease course of (1.57±0.38) years. The Daochi San group were treated with the Daochi San, the narrow-spectrum intense pulsed light group narrow-spectrum intense pulsed light, and the combination group with Daochi San and narrow-spectrum intense pulsed light, for 3 months. The study evaluated traditional Chinese medicine symptom scores, skin lesion severity, serum inflammatory factor levels [tumor necrosis factor-α (TNF-α), interleukin-12 (IL-12), and interleukin-17 (IL-17)] before and after treatment, clinical efficacy, and adverse reaction incidence.One-way analysis of variance, t test, and χ² test were used for the statistical analysis. Results　Before the treatment, there were no statistical differences in the scores of traditional Chinese medicine symptoms and skin lesions and levels of TNF-α, IL-12, and IL-17 between the 3 groups (all P>0.05). After the treatment, the scores of traditional Chinese medicine symptoms (7.88±1.57,      7.36±1.44, and 4.81±0.98) and skin lesion (10.38±2.34, 9.52±2.08, and 6.05±0.98) and levels of TNF-α [(33.16±4.41) μg/L, (34.53±4.78) μg/L, and (27.84±3.66) μg/L], IL-12 [(30.34±3.85) μg/L, (29.22±3.34) μg/L, and (23.65±3.09) μg/L], and IL-17 [(1.42±0.26) μg/L, (1.37±0.25) μg/L, and (0.92±0.18) μg/L] decreased in the three groups (all P<0.001), and there were statistical differences between the 3 groups ( all P<0.001); those in the combination group were lower than those in the Daochi San group (all P<0.001) and those in the narrow-spectrum intense pulsed light group (all P<0.001). The total effective rates of the Daochi San group, the narrow-spectrum intense pulsed light group, and the combination group were 69.05% (29/42), 73.81% (31/42), and 92.86% (39/42), the combination group  was higher than those in the Daochi San group and the narrow-spectrum intense pulsed light group (χ²=7.919，P=0.0219). The incidence rates of adverse reactions in the Daochi San group, the narrow-spectrum intense pulsed light group, and the combination group were 2.38% (1/42), 7.14% (3/42), and 9.52% (4/42), respectively, with no statistical difference (χ²=1.869, P>0.05). Conclusion　Daochi San combined with narrow-spectrum intense pulsed light for patients with acne vulgaris of heart meridian heat accumulation syndrome can promote symptom relief and skin lesion regression, inhibit inflammatory reactions, with high efficacy and good safety.

Effect of Taibao Tang combined with dydrogesterone for patients with with threatened miscarriage due to luteal insufficiency

Dou Na, Liu Xiaomao, Li Chunchun, Zhang Yuan, Huo Yanning, Feng Yanxia

2025, 31(10):  1724-1728.  DOI: 10.3760/cma.j.cn441417-20240605-10029

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Objective　To investigate the effect of Taibao Tang combined with dydrogesterone for patients with threatened miscarriage due to luteal insufficiency and its impact on their endocrine and immune parameters. Methods　This study was a prospective clinical controlled trial. Eighty-six patients with threatened miscarriage due to luteal insufficiency treated at Yulin Traditional Chinese Medicine Hospital from April 2021 to March 2023 were selected, and were divided into a control group and a study group by the random number table method, with 43 cases in each group. The study group were (29.39±4.48) years old and (8.93±2.11) weeks pregnant. The control group were (28.89±4.35) years old and (9.10±2.12) weeks pregnant. The control group took dydrogesterone, and the treatment group dydrogesterone and Taibao Tang. The scores of traditional Chinese medicine (TCM) syndrome, pregnancy maintenance rates, endocrine levels [serum progesterone (P), estradiol (E2), and human chorionic gonadotropin (β-hCG)], immune parameters  ( CD4+, CD8+, and CD4+/CD8+ ratio), and pregnancy outcomes were compared between the two groups. t andχ² tests were used for the statistical analysis. Results　After the treatment, the time for the disappearance of abdominal pain, time for vaginal hemostasis, and score of TCM syndromes in the study group were lower than those in the control group [(2.17±0.51) d vs.(2.53±0.49) d,         (2.19±0.40) d vs. (2.48±0.47) d, 5.32±1.13 vs. 6.23±1.07], with statistical differences (t=3.338, 3.081, and 3.834; all P<0.05). After the treatment, the scores of P, E2, and β-hCG in the study group were higher than those in the control group [(48.67±6.30) μg/L vs.(45.16±6.23) μg/L, (638.23±39.18) ng/L vs. (616.06±43.28) ng/L, and (8 536.88±365.02) IU/L vs. (8 343.15±371.29) IU/L], with statistical differences (all P<0.05). After the treatment, the levels of CD4+, CD4+/CD8+, CD8+ in the study group were better than those in the control group (35.55±3.61 vs. 37.27±4.10，1.26±0.33 vs. 1.48±0.32，28.24±3.82 vs.26.16±4.01), with statistical differences (t=2.065, 3.138, and 2.463; all P<0.05). There was no statistical differencein the incidence rate of adverse reactions between the study group and the control group [9.30%(4/43) vs. 13.95%(6/43); χ²=0.453; P>0.05]. The newborns' body weight in the study group was higher than that in the control group [(2 530.32±268.41) g vs. (2 423.31±223.26) g], with a statistical difference (t=2.010; P<0.05). Conclusion　Taibao Tang combined with dydrogesterone in the treatment of patients with with threatened miscarriage due to luteal insufficiency can improve their endocrine levels, immune function, and treatment effect, and reduce the risk of miscarriage.

Case Report

One case of intrauterine fetal death caused by spontaneous rupture of umbilical cord blood vessels

Zhao Aimei, Cao Ningning, Wang Mei, Fan Yanchun

2025, 31(10):  1729-1732.  DOI: 10.3760/cma.j.cn441417-20241115-10030

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Spontaneous rupture of umbilical cord blood vessels is rare in clinical practice, and is atypical, with no specific clinical symptoms, which greatly increases the difficulty of diagnosis. It is a rare obstetric complication with serious consequences and hidden conditions. It is often diagnosed by postpartum examination of the umbilical cord. We report a case of intrauterine fetal death caused by spontaneous rupture and bleeding of umbilical cord blood vessels treated at Department of Obstetrics, Dongchangfu District Maternal and Child Health Hospital in 2024, so as to improve our understanding of and ability to diagnose this disease.

Nursing Research

Mindfulness-based stress reduction therapy combined with graded nutritional status nursing for patients with colon cancer 

Leng Meiting, Zheng Jinqing

2025, 31(10):  1733-1737.  DOI: 10.3760/cma.j.cn441417-20240911-10031

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Objective　To investigate the effect of mindfulness-based stress reduction therapy combined with graded nutritional status nursing for patients with colon cancer. Methods　A prospective study was conducted on 100 patients with colon cancer treated at The Second Affiliated Hospital of Nanchang University from June 2022 to June 2024. They were divided into a control group and an observation group by the the random number table method. In the control group, there were 31 males and 19 females; they were 39-75 (46.75±4.65) years old; there were 14 cases of stage Ⅰ, 26 cases of stage Ⅱ, and 10 cases of stage Ⅲ. In the observation group, there were 32 males and 18 females; they were 40-75 (46.65±4.63) years old; there were 13 cases of stage Ⅰ, 28 cases of stage Ⅱ, and 9 cases of stage Ⅲ. The control group took conventional nursing; in addition, the observation group took mindfulness-based stress reduction therapy combined with graded nutritional status nursing. The psychological status, nutritional indicators, and scores of Colorectal Cancer Quality of Life Dedicated Scale (QLQ-CR38) were compared between the two groups. χ², rank sum, independent-sample t, and paired t tests were used for the statistical analysis. Results　After 8 weeks' intervention, the scores of the Depression Self-assessment Scale (SDS), Anxiety Self-assessment Scale (SAS) , and Patient Subjective Global Assessment Scale (PG-SGA) in the observation group were lower than those in the control group (43.55±4.36 vs. 47.18±4.70, 42.15±4.22 vs. 46.25±4.63, and 5.11±0.52 vs. 7.25±0.73), with statistical differences (t=4.004, 4.628, and 16.883; all P<0.05). After 8 weeks' intervention, the levels of albumin (ALB) and prealbumin (PA) in the observation group were higher than those in the control group [(42.35±4.25) g/L vs. (39.58±3.55) g/L and (0.32±0.03) g/L vs. (0.26±0.02) g/L], (t=3.537 and 11.767; both P<0.05). After                8 weeks' intervention, the observation group had lower score in the symptom domain and higher score in the functional domain than the control group (50.15±5.02 vs. 75.36±7.54 and 21.25±2.13 vs. 17.38±1.74), with statistical differences (t=19.680 and 9.950; both P<0.05). Conclusion　Mindfulness-based stress reduction therapy combined with graded nutritional status nursing for patients with colon cancer can relieve their negative emotions, and improve their nutritional status and quality of life after surgery.

Impact of multi-track specialized nursing mode based on motivation-behavior transformation on postoperative scar treatment with mesenchymal stem cells 

Zhang Shixin, Li Gang, Li Yinghui, Cheng Ding, Ren Yongyuan, Zhao Yujia, Bai Yang, Wang Kun

2025, 31(10):  1737-1742.  DOI: 10.3760/cma.j.cn441417-20241208-100032

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Objective　To analyze the effect of the multi-track specialized nursing mode based on motivation-behavior transformation for scar patients treated with mesenchymal stem cells. Methods　This was a random, prospective, and single-center clinical study. Eighty patients with scar treated at The Second Hospital of Tianjin Medical University from May 2021 to April 2024 were selected for this study. All the patients were treated with mesenchymal stem cells. The patients were divided into a control group and an observation group by lottery, with 40 cases in each group. There were 23 males and 17 females in the control group; they were  (57.78±5.45) years old. There were 21 males and 19 females in the observation group; they were  (57.56±5.39) years old. The control group took conventional nursing, and the observation group were intervened by the multi-track specialized nursing mode based on motivation-behavior transformation. The scores of psychological status, life quality, and hope level before and after the intervention were compared between the two groups. χ² test and t test were used for statistical analysis . Results　After 2 months of intervention, the observation group showed significantly lower negative emotion score compared to the control group (11.31±2.12 vs. 16.18±3.18, P<0.001, and significantly higher positive emotion score (25.34±5.12 vs. 20.23±5.03, P<0.001. Additionally, the observation group demonstrated significantly higher score across all quality-of-life dimensions, including physical function (86.45±8.1 vs. 80.34±8.45), psychological function (87.58±8.07 vs. 80.13±7.45), social function (85.21±8.18 vs. 80.23±7.34)], and material living conditions (75.82±7.36 vs. 70.57±7.26) (all P<0.001). Furthermore, the observation group exhibited significantly higher hope levels than the control group (38.32±5.12 vs. 30.18±5.18, P<0.001). Conclusion　The effect of the multi-track specialized nursing mode based on motivation-behavior transformation for scar patients treated with mesenchymal stem cells can not only regulate their psychological status, but also improve their hope level and life quality.

Operation room nursing guided by enhanced recovery after surgery concept for patients taking laparoscopic cholecystectomy 

Sun Bei, Sun Fei, Wan Xinjian

2025, 31(10):  1742-1747.  DOI: 10.3760/cma.j.cn441417-20241104-10033

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Objective　To evaluate the effect of operating room nursing guided by the enhanced recovery after surgery (ERAS) concept for patients undergoing laparoscopic cholecystectomy. Methods　one hundred patients who underwent laparoscopic cholecystectomy at Hanzhong Central Hospital from January 2022 to January 2023 were selected for the randomized controlled trial, and were divided into an observation group and a control group by the random number table method, with 50 cases in each group. There 25 males and 25 females in the observation group; they were 35-65 (50.34±7.45) years old. There 25 males and 25 females in the control group; they were 34-66 (49.87±7.58) years old. The control group took routine nursing; in addition, the observation group took operation nursing guided by the ERAS concept. The body temperatures and scores of Visual Analogue Scale (VAS) at different time points, recovery indicators (time to tracheal extubation, anesthesia recovery room stay, time for first off-bed activity, time for first anal exhaust, time for recovery to oral intake, and hospital stay), social function [Social Disability Screening Schedule (SDSS)], psychological stress [Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD), and quality of life [World Health Organization Quality of Life Scale (WHO-QOL)] were compared between the two groups. χ² and t tests were used for the statistical analysis. Results　The body temperatures 1 h after anesthesia and when they entered and left the anesthesia recovery room in the observation group were higher than those in the control group [(36.23±0.18) ℃ vs. (35.21±0.23) ℃, (36.40±0.31) ℃ vs. (35.57±0.54) ℃, (36.62±0.18) ℃ vs. (36.12±0.14) ℃], with statistical differences (all P<0.05). The scores of VAS 6, 12, 24, and 72 h after the operation in the observation group were lower than those in the control group ( 7.76±1.56 vs  7.80±1.51 ., 4.48±0.71 vs. 6.57±0.87, 3.71±0.61 vs. 4.55±0.61, and 2.86±0.82 vs. 4.55±0.61), with statistical differences (all P<0.05). The time to tracheal extubation, anesthesia recovery room stay, time for first off-bed activity, time for first anal exhaust, time for recovery to oral intake, and hospital stay in the observation group were shorter than those in the control group [(55.48±7.93) min vs. (75.30±10.76) min,(115.37±16.48) min vs. (166.26±23.75) min, (14.68±2.13) h vs. (18.95±2.71) h, (23.28±3.33) h vs. (36.59±5.23) h, (18.50±2.64) h vs. (30.57±4.37) h, and (5.31±0.75) d vs. (6.58±0.96) d], with statistical differences (all P<0.05). After the intervention, the scores of SDSS, HAMA, and HAMD in the observation group were lower than those in the control group (6.96±0.99 vs. 11.17±0.09, 16.06±2.29 vs. 22.05±3.15, and 17.26±2.47 vs. 20.89±2.98), with statistical differences (all P<0.05). After the intervention, the total score of WHO-QOL in the observation group was higher than that in the control group (81.18±6.36 vs. 71.80±6.15), with a statistical difference (P<0.05). Conclusion　ERAS-guided operating room nursing for patients undergoing laparoscopic cholecystectomy can reduce their perioperative temperature fluctuation and postoperative pain, shorten recovery time, and improve their social function, psychological stress, and quality of life.

Effect of stage-based rehabilitation combined with therapeutic communication on psychological function after gallbladder cancer surgery 

Liu Xinying, Dong Bei

2025, 31(10):  1748-1752.  DOI: 10.3760/cma.j.cn441417-20241106-10034

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Objective　To retrospectively analyze the effect of stage-based rehabilitation combined with therapeutic communication on postoperative psychological function in patients with gallbladder cancer. Methods　Eighty-six patients with gallbladder cancer treated at Henan Cancer Hospital from December 2021 to December 2023 were selected for the randomized controlled trial, and were divided into an observation group and a control group by the random number table method, with 43 cases in each group. In the control group, there were 24 males and 19 females; they were  (56.71±8.45) years old; they did stage-based rehabilitation. In the observation group, there were 27 males and 16 females; they were  (57.23±8.36) years old; they did stage-based rehabilitation and therapeutic communication. The perioperative conditions (exhaustion, off-bed activities, and hospitalization), psychological status [scores of Self-assessment Scale for Anxiety (SAS) and Self-assessment Scale for Depression (SDS)], scores of Psychological Resilience Inventory Connor-Davidson Resilience Scale (CD-RISC), complications, and scores of Short Form-36 of the Health Survey (SF-36) were compared between the two groups. Independent sample t test and χ² test were used for the statistical analysis. Results　The time to exhaustion, time to first off-bed activity, and hospitalization time in the observation group were shorter than those in the control group [(24.16±1.84) h vs. (36.29±2.13) h, (3.25±0.92) h vs. (6.02±1.09) h, and (7.56±1.27) d vs. (11.13±1.85) d], with statistical differences (t=28.260, 12.735, and 10.432; all P<0.05). The score of SAS and SDS in the observation group were lower than those in the control group (49.63±3.15 vs. 55.37±4.09 and 52.14±4.26 vs. 58.31±5.03], with statistical differences (t=7.291 and 6.138; both P<0.05). The score of resilience, self-improvement, and optimism in the observation group were higher than those in the control group (24.53±2.08 vs. 16.85±1.42, 22.68±1.56 vs. 17.27±1.34, and 11.24±0.76 vs. 7.73±0.54], with statistical differences (t=19.997, 17.251, and 24.688; all P<0.05). The incidence rate of complications in the observation group was lower than that in the control group [6.98% (3/43) vs. 23.26% (10/43); χ²=4.441, P=0.035]. The score of physiological function, somatic pain, and general health in the observation group were higher than those in the control group (69.52±5.63 vs. 60.27±5.18, 72.34±6.19 vs. 62.35±5.86, and 71.64±6.12 vs. 62.73±5.79], with statistical differences (t=7.929, 7.685, and 6.935, all P<0.05). Conclusion　Stage-based rehabilitation combined with therapeutic communication for patients with gallbladder cancer can improve their psychological state, accelerate their postoperative rehabilitation, reduce complications, and improve their quality of life.

Personalized skin care management in a cachectic peritoneal dialysis patient with chronic diarrhea: a clinical case study 

Yang pei, Wang Yuquan, Wang Qi

2025, 31(10):  1753-1756.  DOI: 10.3760/cma.j.cn441417-20240924-10035

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Objective  To summarize the skin care measures and experience of patients with long hospitalization periods, high risk of pressure injuries, and susceptibility to pressure ulcers by a case study. Methods  One long-term bedridden patient with impaired active nutrient intake, diarrhea, and intraperitoneal infection who took peritoneal dialysis received pressure ulcer prevention and personalized perianal skin care interventions. Results  During the 15-day hospitalization, there was no perianal skin damage during episodes of diarrhea. The patient's skin remained intact until        discharge. Conclusions  Timely personalized nursing interventions, such as the use of                     foam dressings for pressure ulcer prevention and management, should be implemented for patients at high risk of pressure injuries. For patients with diarrhea, rectal tampon insertion can keep the skin around the anus and buttocks dry, preventing stool contamination from irritating the skin and pressure ulcers and improving their comfort and satisfaction with the care.