Table of Content

01 February 2025, Volume 31 Issue 3

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Special Column of Cardiovascular Diseases

Mechanism of miR-155/Shh/Gli1 signaling pathway in the immune response mediated by CD4+ T cells in dilated cardiomyopathy

Dong Fuqiang, Teng Guangshuai, Ho Ning, Liu Changle

2025, 31(3):  353-359.  DOI: 10.3760/cma.j.cn441417-20240625-03001

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Objective　To explore the mechanism of the miR-155/Shh/Gli1 signaling pathway in CD4+ T cells in the pathogenesis and development of dilated cardiomyopathy (DCM). Methods　This study was a clinical cohort study. Fifty patients with DCM treated in the Second Hospital of Tianjin Medical University from January 2018 to December 2023 were selected as a DCM group, and 50 healthy subjects of the same age during the same period were selected as a healthy control group (HD group). In the DCM group, there were 26 males and 24 females, aged (49.7±4.9) years. In the HD group, there were 25 males and 25 females, aged (50.8±4.3) years. The expression of CD4+ T cells in DCM patients was analyzed, and next generation sequencing (NGS) was performed on CD4+ T cells of the peripheral blood from different subgroups to verify the expressions of signaling pathway proteins. The role of miR-155 in DCM was investigated by interfering with its expression level in CD4+ T cells. Independent sample t test and Pearson correlation analysis were used for statistical analysis. Results　CD4+ T cells were actively expressed in DCM patients[(45.5±5.9)% vs. (37.1±6.3)%](t=6.862,P<0.001), and the expression of miR-155 in CD4+ T cells was elevated(P<0.05). The increased expression of miR-155 promoted the elevation of endoplasmic reticulum stress (ERS) and the expressions of proteins Shh and Gli1 in the Hedgehog signaling pathway. Treatment with Shhagonists further promoted the ERS response. Conclusion　The miR-155/Shh/Gli1 signaling pathway may be involved in the abnormal expression of CD4+ T cells in DCM.

Predictive value of real-time 3D echocardiographic parameters for in-stent restenosis after percutaneous coronary intervention in patients with acute myocardial infarction

Huang Xinliang, Du Yakun, Ren Hongmei

2025, 31(3):  360-365.  DOI: 10.3760/cma.j.cn441417-20240824-03002

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Objective　To assess the value of real-time 3D echocardiographic parameters in predicting in-stent restenosis after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction. Methods　This study was a retrospective analysis. The clinical data of 100 patients with acute myocardial infarction who underwent PCI in Hanzhong People's Hospital from July 2019 to January 2022 were collected. The patients were divided into a restenosis group (30 cases) and a non-restenosis group (70 cases) according to in-stent restenosis within 6 months after surgery. The left ventricular function and synchronization parameters were compared between the two groups. Lasso regression modeling was used to screen out the key characteristic variables of restenosis, and the clinical value of the variables was evaluated by the receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA). Independent sample t test and χ² test were used for statistical analysis. Results　The left ventricular end-diastolic volume (LVEDV) in the restenosis group was higher than that in the non-restenosis group [(142.07±28.62) ml vs. (113.83±32.55) ml], but the left ventricular ejection fraction (LVEF), peak ejection rate (PER)/end-diastolic volume (EDV), and peak filling rate (PFR)/EDV were all lower than those in the non-stenosis group [(46.77±4.26)% vs. (49.84±4.26)%, (1.89±0.62) L/s vs. (2.47±0.87) L/s, (1.36±0.45) L/s vs. (1.77±0.68) L/s], with statistically significant differences (t=4.335, -3.312, -3.794, and -3.598, all P<0.001). The characteristic variables of in-stent restenosis were screened by Lasso regression analysis, and 5 characteristic variables were obtained, including LVEDV, LVEF, Tmsv12-Dif/R-R, Tmsv12-SD/R-R, and Tmsv16-SD/R-R. The risk score of the restenosis group was lower than that of the non-restenosis group [(0.02±0.99) points vs. (1.54±1.07) points, t=6.653, P<0.001], and the area under the curve of the Lasso risk score was 0.866. Conclusions　In this study, we assessed left ventricular function and synchronization by real-time 3D echocardiography and LASSO regression in patients after PCI, screening key characteristic variables to predict restenosis risk.

Quantitative parametric analysis of coronary CT angiography for predicting myocardial ischemic events in patients with coronary heart disease

Han Xin, Sheng Jiexin, Ren Linzi, Yu Jie

2025, 31(3):  365-370.  DOI: 10.3760/cma.j.cn441417-20240703-03003

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Objective　To investigate the value of quantitative coronary CT angiography (CTA) parameters in predicting myocardial ischemic events in patients with coronary heart disease. Methods　A retrospective analysis of 110 patients with coronary heart disease treated in Hanzhong Central Hospital from November 2021 to June 2022. Based on the results of the blood flow reserve fraction test, the patients were divided into two groups: an ischemic group (75 cases) and a non-ischemic group (35 cases). In the ischemia group, there were 46 males and 29 females, 34 ≥60 years old and 41 <60 years old. In the non-ischemic group, there were 18 males and 17 females, 19 ≥60 years old and 16 <60 years old. Coronary CTA was conducted using a Canon 640-slice CT scanner. The total plaque volume, length, diameter stenosis, and joint prediction coefficient were compared between the two groups. The efficacy of the variables in predicting myocardial ischemia was analyzed using the receiver operating characteristic curve (ROC). The patients were followed up for 1 year, and major adverse cardiovascular events (MACE) were counted. According to the occurrence of MACE, the patients were divided into a MACE group (31 cases) and a non-MACE group (79 cases). The predictive value of the predictive coefficients for MACE was analyzed. Results　In the ischemic group, the total plaque volume, length, diameter stenosis, and joint prediction coefficient were (98.21±9.21) mm³, (4.79±1.67) mm, (19.80±4.47)%, and -3.84±2.33, respectively, and the above indexes in the non-ischemic group were (75.89±13.99) mm³, (3.44±1.10) mm, (13.16±4.09)%, and 2.91±2.81, respectively, with statistically significant differences (t=8.606, 5.011, 7.708, and -12.370, all P<0.001). The areas under the curves (AUCs) of the total plaque volume, length, diameter stenosis, and joint prediction coefficient in predicting myocardial ischemia were 0.898, 0.748, 0.859, and 0.968, respectively, and the AUC of the prediction coefficient was greater than those of the total plaque volume, length, and diameter stenosis, with statistically significant differences (all P<0.05). The prediction coefficient of the MACE group was -3.69[-5.16, -2.27], which was lower than that of the non-MACE group -1.81[-4.11, 2.75], with a statistically significant difference (Z=3.009, P=0.002). ROC analysis showed that the AUC of the predictive coefficient in predicting MACE in patients with coronary heart disease was 0.690. Conclusion　The combination of plaque CTA quantitative parameters with prediction coefficients is an effective method for predicting myocardial ischemic injury in patients with coronary heart disease. This approach is more accurate than relying on a single parameter and provides a valuable reference for clinical practice.

Constructing a risk prediction plan for revascularization in patients with acute myocardial infarction after PCI based on decision tree algorithm

Zhai Xia, Kang Qi, Zhao Xuefei, Li Minjie, Chen Minna, Dong Huanle, Dong Jing

2025, 31(3):  370-376.  DOI: 10.3760/cma.j.cn441417-20240621-03004

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Objective　To construct a risk prediction model for revascularization in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) using decision tree algorithm. Methods　The clinical data of 203 patients with AMI who underwent PCI in the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from January 2021 to January 2023 were retrospectively analyzed, and they were divided into a revascularization group (60 cases) and a non-revascularization group (143 cases) according to whether they underwent revascularization within 1 year after operation. In the revascularization group, there were 41 males and 19 females, aged (62.75±10.32) years. In the non-revascularization group, there were 94 males and 49 females, aged (61.47±10.07) years. Multivariate logistic regression analysis was used to investigate the influencing factors of revascularization in AMI patients after PCI. According to the ratio of 7:3, 203 patients were randomly divided into a training set (142 cases) and a test set (61 cases). The decision tree model was constructed based on the training set data, and the prediction efficiency of the decision tree model was verified based on the test set data. χ² test and t test were used for statistical analysis. Results　In the revascularization group, the proportions of diabetes mellitus, low density lipoprotein cholesterol (LDL-C) ≥3.4 mmol/L, uric acid >420 µmol/L, hypersensitive C-reactive protein (hs-CRP) >10 mg/L, number of lesions ≥2, and number of stents ≥3 before PCI, and residual SYNTAX score (rSS) >5 points after PCI were higher than those in the non-revascularization group [23.33% (14/60) vs. 11.19% (16/143), 36.67% (22/60) vs. 20.98% (30/143), 38.33% (23/60) vs. 20.98% (30/143), 33.33% (20/60) vs. 17.48% (25/143), 70.00% (42/60) vs. 53.85% (77/143), 61.67% (37/60) vs. 45.45% (65/143), 38.33% (23/60) vs. 21.68% (31/143)], with statistically significant differences (all P<0.05). Multivariate logistic regression analysis showed that diabetes mellitus, LDL-C ≥3.4 mmol/L, uric acid >420 µmol/L, hs-CRP >10 mg/L, and number of lesions ≥2 before PCI, and rSS >5 points after PCI were all risk factors for revascularization in AMI patients after PCI (all P<0.05). Based on the training set data, a decision tree risk prediction model for revascularization in AMI patients after PCI was established. The model contained 6 explanatory variables, namely diabetes mellitus, LDL-C level, uric acid level, hs-CRP level, and number of lesions before PCI, and rSS after PCI. A total of 7 classification rules were extracted, among which the uric acid level before PCI was the primary influencing factor of the model. The decision tree model was verified based on the test set data, and the sensitivity, specificity, and accuracy of the decision tree model for predicting revascularization in AMI patients after PCI were 88.89%, 83.72%, and 85.25%, respectively. Conclusion　The decision tree risk model of revascularization in AMI patients after PCI includes 6 variables, namely diabetes mellitus, LDL-C level, uric acid level, hs-CRP level, and number of lesions before PCI, and rSS after PCI, among which the uric acid level before PCI is the primary influencing factor of the model.

Relationships between expression of natriuretic peptide receptor A and serum NT-proBNP and TGF-β1 levels and cardiac function in patients with diabetic cardiomyopathy

Guo Tao, Zhang Jing, Zhang Lingjuan

2025, 31(3):  377-382.  DOI: 10.3760/cma.j.cn441417-20240617-03005

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Objective　To explore the correlations between the expression of natriuretic peptide receptor A and the levels of serum amino terminal brain natriuretic peptide precursor (NT-proBNP) and transforming growth factor (TGF)-β1 and cardiac function in patients with diabetic cardiomyopathy. Methods　A total of 120 patients with diabetic cardiomyopathy admitted to the Second Affiliated Hospital of Xi'an Medical College from May 2020 to May 2023 were retrospectively selected as a diabetic cardiomyopathy group, 70 healthy people during the same period were selected as a control group, and 50 diabetic patients receiving treatment during the same period were selected as a diabetic group. In the control group, there were 41 males and 29 females, aged (47.16±6.24) years. In the diabetic group, there were 29 males and 21 females, aged (47.62±6.56) years. In the diabetic cardiomyopathy group, there were 62 males and 58 females, aged (48.08±6.88) years. The baseline data, natriuretic peptide receptor A, NT-proBNP, TGF-β1, soluble growth stimulation expression gene 2 protein (sST2), matrix metalloproteinase-2 (MMP-2), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), total cholesterol (TC), triacylglycerol (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), left ventricular remodeling index (LVRI), left ventricular posterior wall thickness (LVPW), right ventricular end-systolic volume (RVESV), and cardiac function indicators were compared among the 3 groups. The correlations between the expression of natriuretic peptide receptor A and NT-proBNP, ventricular remodeling, TGF-β1, myocardial fibrosis, cardiac function, and lipid indexes in 120 patients with diabetic cardiomyopathy were analyzed by Pearson correlation analysis. The statistical methods used were F test and χ² test. Results　The levels of natriuretic peptide receptor A, NT-proBNP, and TGF-β1 in the diabetic cardiomyopathy group were higher than those in the control group and the diabetic group [0.72±0.21 vs. 0.32±0.17 and 0.47±0.21, (1 586.23±300.28) ng/L vs. (1 041.06±284.03) ng/L and (1 313.65±292.16) ng/L, (235.44±30.19) ng/L vs. (221.21±31.06) ng/L and (228.33±30.63) ng/L]; the levels of sST2, TIMP-1, TC, TG, LDL-C, LVRI, LVPW, RVESV, and LVEDD were higher than those in the control group and the diabetic group, while the levels of MMP-2, HDL-C, LVEF, E/A, and SV were lower than those in the control group and the diabetic group, with statistically significant differences (all P<0.05); there were statistically significant differences in the above indexes between the control group and the diabetic group (all P<0.05). Pearson correlation analysis showed that natriuretic peptide receptor A was positively correlated with the levels of NT-proBNP, TGF-β1, sST2, TIMP-1, TC, TG, LDL-C, LVRI, LVPW, RVESV, and LVEDD in patients with diabetic cardiomyopathy (r=0.432, 0.415, 0.431, 0.418, 0.441, 0.513, 0.475, 0.526, 0.548, 0.519, and 0.356, all P<0.05), was negatively correlated with the levels of MMP-2, HDL-C, LVEF, E/A, and SV (r=-0.349, -0.482, -0.342, -0.294, and -0.351, all P<0.05). Conclusion　The lower the expression of natriuretic peptide receptor A in patients with diabetic cardiomyopathy, the higher the levels of NT-proBNP and TGF-β1, and the better the cardiac function.

Effect of nicorandil combined with amiodarone on clinical symptoms and serum levels of related cytokines in patients with coronary heart disease and angina pectoris

Liu Gongyan, Wang Lin, Li Chuanbo, Han Keli

2025, 31(3):  382-386.  DOI: 10.3760/cma.j.cn441417-20240910-03006

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Objective　To investigate the efficacy of nicorandil combined with amiodarone in the treatment of coronary heart disease with angina pectoris. Methods　The clinical data of 120 patients with coronary heart disease and angina pectoris admitted to the First People's Hospital of Nanyang City from April 2022 to April 2024 were collected for a retrospective study. They were divided into a reference group (61 cases) and a study group (59 cases) according to different treatment plans. In the reference group, there were 33 males and 28 females, aged (56.02±7.52) years, the course of disease was (3.25±0.63) years, and the grading of cardiac function was as follows: 16 cases of grade I, 35 cases of grade II, and 10 cases of grade III. In the study group, there were 35 males and 24 females, aged (57.96±7.46) years, the course of disease was (3.50±0.82) years, and the grading of cardiac function was as follows: 15 cases of grade I, 33 cases of grade II, and 11 cases of grade III. The reference group was treated with oral nicorandil tablets, 5 mg/time, 3 times/day. The study group was given amiodarone injection intravenously on the basis of the reference group, and 150 mg of amiodarone injection was dissolved in 20 ml of normal saline, amiodarone injection was injected slowly for 20 min, then at the rate of 1 mg/min for 6 h, and then gradually reduced to 0.5 mg/min, with the total amount within 24 h less than 2 000 mg; after the heart rate recovered, amiodarone tablets were taken orally, 0.2 g/time, twice a day. Both groups were treated for 4 weeks. The clinical symptoms, cardiac function indicators, and serum levels of relevant cytokines [hypersensitive C-reactive protein (hs-CRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2)] before and after treatment and the total incidence of adverse reactions were compared between the two groups. χ² test and t test were used for statistical analysis. Results　After treatment, the frequency of angina pectoris in the study group was less than that in the reference group, and the duration of angina pectoris attacks was shorter [(1.02±0.28) times/week vs. (2.37±0.61) times/week, (2.77±0.92) min/time vs. (4.01±0.85) min/time]; the left ventricular end-systolic diameter was smaller than that in the reference group, and the left ventricular ejection fraction was higher than that in the reference group [(32.88±3.41) mm vs. (39.73±3.27) mm, (50.25±3.04)% vs. (48.12±3.15)%]; the levels of hs-CRP and Lp-PLA2 were lower than those in the reference group [(5.32±1.14) mg/L vs. (10.75±1.03) mg/L, (20.76±3.96) µg/L vs. (35.24±4.35) µg/L], with statistically significant differences (t=-15.664, -7.662, -11.225, 3.769, -27.349, and -19.079, all P<0.001). The total incidence of adverse reactions in the study group was slightly higher than that in the reference group [8.20% (5/61) vs. 5.08% (3/59)], but the difference was not statistically significant (χ²=0.467, P=0.494). Conclusion　Nicorandil combined with amiodarone can effectively alleviate the clinical symptoms, inhibit the inflammatory reactions, maintain the plaque stability, improve the cardiac function, and has high safety in patients with coronary heart disease and angina pectoris.

Clinical effect of Qiliqiangxin capsules on heart failure patients with atrial fibrillation Yang deficiency and water-generalized syndrome

Du Yongbo, Ren Yi, Zhang Jingkun, Xu Xinsong

2025, 31(3):  387-391.  DOI: 10.3760/cma.j.cn441417-20240813-03007

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Objective　To analyze the clinical effect of Qiliqiangxin capsules on patients with heart failure complicated with atrial fibrillation with Yang-deficiency and water-generalized syndrome. Methods　This study was a randomized controlled trial. From August 2022 to February 2024, 78 patients with heart failure complicated with atrial fibrillation with Yang-deficiency and water-generalized syndrome in the Internal Medicine Department of Hanzhong Hospital of Traditional Chinese Medicine were divided into a western medicine group and a combined group with 39 cases in each group by the random number table method. In the western medicine group, there were 20 males and 19 females, aged (61.84±4.55) years, the duration of heart failure was (2.95±0.66) years, and the frequency of atrial fibrillation was (4.93±1.33) times/week. In the combined group, there were 22 males and 17 females, aged (62.12±4.23) years, the duration of heart failure was (3.11±0.51) years, and the frequency of atrial fibrillation was (5.13±1.47) times/week. The western medicine group received basic treatment combined with oral sacubactril/valsartan sodium tablets, and the initial dose of sacubactril/valsartan sodium tablets was 50 mg/time, twice a day, whose dosage was increased according to the therapeutic effect (the initial dose as a single increase), but was not more than 4 times of the initial dose. The combined group was supplemented with Qiliqiangxin capsules on the basis of the western medicine group, 1.2 g/time, 3 times/day. Both groups were treated for 8 weeks. The effects of the two groups were compared, as well as the indexes of cardiac function, electrocardiogram, and myocardial injury before and after treatment, and the occurrence of adverse reactions during treatment. Chi-square test and t test were used for statistical analysis. Results　The total effective rate of the combined group was higher than that of the western medicine group [94.87% (37/39) vs. 76.92% (30/39)], with a statistically significant difference (χ2=5.186, P=0.023). After treatment, the left ventricular end-systolic diameter, QT dispersion, maximum P-wave duration, P-wave dispersion, and serum matrix metalloproteinase-9, soluble growth stimulation-expression gene 2 protein, and growth differentiation factor 15 levels in the combined group were lower than those in the western medicine group [(35.34±2.52) mm vs. (39.08±2.50) mm, (62.56±5.41) ms vs. (68.82±5.25) ms, (102.43±12.87) ms vs. (113.96±11.46) ms, (28.20±3.98) ms vs. (32.97±3.26) ms, (37.90±5.46) µg/L vs. (51.02±5.52) µg/L, (15.34±3.48) µg/L vs. (19.91±3.45) µg/L, (143.85±19.32) ng/L vs. (173.14±18.31) ng/L]; the cardiac index and left ventricular ejection fraction were higher than those in the western medicine group [(3.23±0.51) L/min vs. (2.91±0.43) L/min, (44.51±3.52)% vs. (38.72±3.46)%], with statistically significant differences (all P<0.001). During treatment, the treatment was not terminated due to obvious adverse reactions in both groups, and there was no statistically significant difference in the incidence of adverse reactions between the two groups [12.82% (5/39) vs 7.69% (3/39)] (χ²=0.139, P=0.709). Conclusion　On the basis of basic treatment and sacubactril/valsartan sodium tablets, Qiliqiangxin capsules has higher efficacy in patients with heart failure complicated with atrial fibrillation with Yang-deficiency and water-generalized syndrome, which can improve the cardiac function and electrocardiogram indexes, alleviate the myocardial injury, and has higher safety.

Nursing for patients with right ventricular dysfunction during perioperative period of heart transplantation

Zong Xiaona, Ling Yun, Lin Qiongyu, Zhang Yongping, Zhu Sumin

2025, 31(3):  392-395.  DOI: 10.3760/cma.j.cn441417-20241008-03008

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Objective　To summarize the nursing process of right ventricular dysfunction during perioperative heart transplantation and provide reference for clinical nursing. Methods　A retrospective analysis was performed on 19 patients with right ventricular dysfunction who underwent heart transplantation at the Cardiac Surgery Department of Guangdong Provincial People's Hospital from February 2023 to February 2024, including 17 males and 2 females, aged (46.2±11.0) years, 13 patients with dilated cardiomyopathy and 6 patients with ischemic cardiomyopathy. Through perioperative enhancement of right ventricular diastolic and systolic function, nitric oxide inhalation care, strengthening volume management, and improving microcirculatory perfusion, observation and care of rejection reactions, the purpose of maintaining the stability of right heart function and maintaining the effect of surgery was ultimately achieved. Results　The postoperative ventilator assistance time of the 19 patients was [28 (25, 75)]h, and the ICU stay time was (8.0±4.8) d. Conclusion　Full evaluation of patients' right ventricular function during perioperative period and optimization of perioperative right ventricular function can improve the prognosis of heart transplantation patients.

Analysis of thirst current situation and influencing factors after cardiopulmonary bypass

Chen Chen, Wang Yanping

2025, 31(3):  396-400.  DOI: 10.3760/cma.j.cn441417-20240809-03009

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Objective　To investigate the thirst current situation and influencing factors after cardiopulmonary bypass. Methods　This study was a retrospective analysis. Clinical data of 65 patients with cardiopulmonary bypass admitted to Fuwai Central China Cardiovascular Hospital from March 2021 to April 2023 were collected, including 32 males and 33 females, aged (53.25±2.35) years, with a body mass index of (22.65±1.05) kg/m². The Thirst Distress Scale (TDS) was used to evaluate postoperative thirst in patients with cardiopulmonary bypass (CPB) after the removal of tracheal intubation (usually 2 ~ 3 days after surgery). The patients' gender (male/female), age (≥60 years old /<60 years old), education level (high school and below/college and above), underlying diseases (yes/no), duration of cardiopulmonary bypass (≤30 min/>30 min) disease type (coronary artery bypass surgery/tetralogy of Fallot/others), diuretic type (<2 types/≥2 types), serum sodium ion, mechanical ventilation time (≤3 h/>3 h), disease perception (good/poor), Self-Rating Anxiety Scale (SAS) score (≥50 points /<50 points), Self-Rating Depression Scale (SDS) score (≥53 points/<53 points), and attitude and behavior towards sodium restricted diet (good/poor) were collected and compared. Logistic regression analysis was used to examine the influencing factors of postoperative thirst in patients with cardiopulmonary bypass. t test was used for statistical analysis. Results　The TDS score of the 65 patients with cardiopulmonary bypass was (34.62±1.35) points. The TDS scores of the patients with age <60 years old, SAS score ≥50 points, SDS score ≥53 points, poor disease perception, and poor attitude and behavior towards sodium restricted diet were higher than those of the patients with age ≥60 years old, SAS score <50 points, SDS score <53 points, good disease perception, and good attitude and behavior towards sodium restricted diet [(35.71±1.25) points vs. (16.22±1.05) points, (34.88±1.75) points vs. (22.73±1.50) points, (35.56±1.67) points vs.(30.50±1.22) points, (37.50±1.85) points vs. (28.80±1.50) points, (37.67±1.88) points vs. (28.18±1.53) points], with statistically significant differences (t=68.253, 31.885, 14.653, 19.782, and 20.442, all P<0.001). Multiple linear regression analysis showed that age, SAS score, SDS score, disease perception, and attitude and behavior towards sodium restricted diet were all influencing factors of postoperative thirst in patients with cardiopulmonary bypass (all P<0.05). Conclusion　The patients with cardiopulmonary bypass have a higher TDS score after operation. Patients' age, SAS and SDS scores, disease perception, and attitude and behavior towards sodium restricted diet are all important factors affecting the TDS score in patients with cardiopulmonary bypass.

Risk factors for peritoneal dialysis catheter blockage after operation for complex congenital heart disease

Li Chenchen, Wang Haiyan, Zhang Yuanyuan, Pang Qiuhe

2025, 31(3):  400-405.  DOI: 10.3760/cma.j.cn441417-20240709-03010

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Objective　To analyze the risk factors for peritoneal dialysis (PD) catheter blockage after operation for complex congenital heart disease and construct a prediction model, so as to provide reference for smooth implementation of PD after operation for complex congenital heart disease. Methods　A prospective study was conducted, and 120 children who underwent PD after operation for complex congenital heart disease in Fuwai Central China Cardiovascular Hospital from December 2022 to February 2024 were selected as the research subjects. Among them, there were 82 boys and 38 girls, aged 6 months-3 years. There were 52 cases of tetralogy of Fallot, 37 cases of transposition of the great arteries, 28 cases of ventricular septal defects, and 3 other cases. All the children received PD treatment. The incidence of PD catheter blockage was analyzed, and the children were divided into a catheter blockage group (81 cases) and a non-catheter blockage group (39 cases) according to the presence/absence of catheter blockage. Univariate and multivariate logistic regression analysis were performed to identify the risk factors for PD catheter blockage after operation for complex congenital heart disease. A prediction model was constructed, and the predictive value of the prediction model was evaluated by the receiver operating characteristic curve (ROC). χ² test and t test were used for statistical analysis. Results　In this study, 81 children experienced catheter blockage after the first PD, with an incidence rate of 67.50% (81/120). The proportions of children under 1 year old, children undergoing catheterization at the right rectus abdominis, children with catheter displacement, children with twisted catheter, children without preventive medication during PD, and children with greater omentum wrapping in the catheter blockage group were higher than those in the non-catheter blockage group [85.19% (69/81) vs. 58.97% (23/39), 72.84% (59/81) vs. 25.64% (10/39), 32.10% (26/81) vs. 12.82% (5/39), 35.80% (29/81) vs. 15.38% (6/39), 69.14%(56/81) vs. 23.08%(9/39), 40.74% (33/81) vs. 20.51% (8/39)], with statistically significant differences (all P<0.05). Logistic regression analysis showed that catheter displacement (odds ratio =1.670, 95% confidence interval 1.079-2.586), twisted catheter (odds ratio =1.642, 95% confidence interval 1.219-2.212), and greater omentum wrapping (odds ratio =1.592, 95% confidence interval 1.208-2.099) were the risk factors for PD catheter blockage after operation for complex congenital heart disease, and preventive medication during PD was a protective factor (odds ratio =0.676, 95% confidence interval 0.536-0.852). According to the logistic regression analysis results, a prediction model was constructed. ROC analysis results showed that the sensitivity, specificity, area under the curve (AUC), and Youden index of the model were 84.62%, 79.69%, 0.865, and 0.643. Compared with the actual value, the accordance rate of the model was 95.00% [(78+36)/120]. Conclusions　There are multiple risk factors for PD catheter blockage after operation for complex congenital heart disease, including catheter displacement, twisted catheter, greater omentum wrapping, and preventive medication during PD. The prediction model constructed based on these factors helps to early identify the risk of catheter blockage, which is expected to provide reference for smooth implementation of PD after operation for complex congenital heart disease.

Application of family-empowered peer education model in the transition period of elderly patients with atrial fibrillation

Zhang Mingyan, Ruan Jing, Zhao Lin

2025, 31(3):  406-410.  DOI: 10.3760/cma.j.cn441417-20240419-03011

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Objective　To explore the effect of family-empowered peer education model on the transition period of elderly patients with atrial fibrillation. Methods　This study was a randomized controlled trial. From January to June 2023, 134 elderly patients with atrial fibrillation in the transition period in Luoyang Central Hospital Affiliated to Zhengzhou University were simply randomly divided into an experimental group (67 cases) and a control group (67 cases). There were 39 males and 28 females in the experimental group, aged (70.20±3.06) years. There were 40 males and 27 females in the control group, aged (69.30±3.28) years. The control group was given conventional health education mode of atrial fibrillation, and the experimental group was given family-empowered peer education model based on the control group. Both groups continued the intervention until 3 months after discharge. The classification of main family caregivers and medication compliance [Chinese version of the 8-item Morisky Medication Adherence Scale (MMAS-8)], quality of life [Atrial Fibrillation Effect on Quality-of-Life (AF-QoL-18)], caregiving ability [Family Caregiver Task Inventory (FCTI)], and burden level [Care Burden Index (CBI)] before discharge and 3 months after discharge were compared between the two groups. Independent sample t test and χ² test were used for statistical analysis. Results　In both groups, their spouses were the main caregivers [62.68% (42/67) and 59.70% (40/67)], followed by spouses + children [28.36% (19/67) and 29.85% (20/67)], children [4.48% (3/67) and 5.97% (4/67)], and babysitters [both 4.48% (3/67)]. There was no statistically significant difference between the two groups (P>0.05). Three months after discharge, the scores of MMAS-8, AF-QoL-18, and FCTI in the experimental group were higher than those in the control group [(7.31±0.70) points vs. (6.02±1.22) points, (71.63±8.65) points vs. (65.02±9.24) points, (61.43±5.92) points vs. (51.27±6.97) points], and the CBI score was lower than that in the control group [(54.47±8.99) points vs. (62.63±7.49) points] (all P<0.05). Conclusion　The family-empowered peer education model can improve the medication compliance and quality of life of elderly patients in the transition period of atrial fibrillation, improve the ability of main family caregivers, and reduce the burden of care.

New Medical Advances

Research progress in the field of surgical treatment for hypertension

Zeng Lingguo, Zhao Zhou, Liu Weipeng, Hu Baoguang

2025, 31(3):  411-415.  DOI: 10.3760/cma.j.cn441417-20240904-03012

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Hypertension is a common chronic condition that is usually managed with medical medications. However, in some specific cases, surgical intervention may be required. In recent years, with advances and innovations in medical technology, significant progress has been made in the surgical management of hypertension, providing new treatment options for many patients. The main surgical treatments for hypertension include traditional methods, weight loss metabolic surgery, interdisciplinary treatment, and microvascular decompression. In different situations, surgical interventions for hypertension aim to address the specific cause of the disease, rapidly control the condition, and potentially save the patients' life.

Research progress of scrapping therapy for thyroid nodules

Duan Yuwei, Zhao Pu, Fei Jinglan

2025, 31(3):  415-418.  DOI: 10.3760/cma.j.cn441417-20240826-03013

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Thyroid nodules are the most common disease of the endocrine system, and most of them are benign nodules. However, 5% to 15% of benign nodules can further develop into thyroid cancer. How to effectively treat thyroid nodules and prevent cancer is the focus of research in the field of endocrine system diseases in recent years. Compared with western medicine, external treatment of traditional Chinese medicine focuses on local lesions and emphasizes the principle of holistic nursing. External treatment is carried out on the body surface, and has therapeutic effect by stimulating the transmission of meridians and dredging qi and blood. Non-invasive or minimally invasive features and good curative effect are the reasons why patients favor external treatment of traditional Chinese medicine. In recent years, scrapping therapy has become a popular external treatment of traditional Chinese medicine, which can shrink thyroid nodules, prevent disease recurrence, and reduce adverse reactions. It is of great significance to explore the treatment of thyroid nodules with scrapping therapy, so the author review the literatures on the treatment of thyroid nodules with scrapping therapy, in order to provide reference for medical staff to further improve the clinical efficacy of thyroid nodules.

Basic Research

Effects of laggera herb extract on renal function and NF-κB signaling pathway in myocardial infarction rats

Yang Xiaolin, Fu Huanjie

2025, 31(3):  419-424.  DOI: 10.3760/cma.j.cn441417-20240515-03014

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Objective　To observe the effects of extracts of laggera herb on renal function and nuclear transcription factor κB (NF-κB) signaling pathway in myocardial infarction rats. Methods　Fifty SPF-grade SD rats were selected, half male and half female, aged 4-6 weeks, weighted 200-300 g, a sham surgery group, a myocardial infarction group, and three experimental groups receiving different doses of the extracts of laggera herb, 10 rats in each group. The doses were 6.8 g/kg, 13.6 g/kg, and 27.2 g/kg of the extracts diluted in distilled water, administered via gavage for 14 d. The cardiac function [left ventricular end-diastolic pressure (LVEDP), mean arterial pressure (MAP), left ventricular systolic pressure and (LVSP)], renal function [creatinine (Cr), urea nitrogen (BUN), and 24 h urine protein], inflammatory factors [interleukin (IL) -1β, IL-6, monocyte chemotactic protein-1 (MCP-1), and tumor necrosis factor α (TNF-α)], pathological changes of myocardial and renal tissues, renal histopathological protein levels (NF-κB, p65, p-p65, and IκBβ), and renal mRNA levels (NF-κB and IκBβ) were compared between among all groups after the last gavage. Independent sample t test and one-way analysis of variance were used for statistical analysis. Results　After the last gavage, the LVEDP in the model group was higher than that in the sham surgery group, but the MAP and LVSP were lower than those in the sham surgery group (all P<0.05); the LVEDP in the low, medium, and high dose groups were lower than that in the model group, but the MAP was higher than that in the model group (all P<0.05); the LVEDP in the high dose group was lower than those in the low and medium dose groups [(8.17±0.38) mmHg (1 mmHg=0.133 kPa) vs. (11.59±0.22) mmHg and (9.86±0.41) mmHg], and the MAP and LVSP were higher than those in the low and medium dose groups [(116.33±4.24) mmHg vs. (101.26±4.02) mmHg and (105.86±3.63) mmHg, (140.67±5.65) mmHg vs. (113.59±7.88) mmHg and (129.86±6.02) mmHg] (all P<0.05). The levels of serum Cr, BUN, and 24 h urinary protein in the model group were higher than those in the sham surgery group (all P<0.05); serum Cr and 24 h urinary protein levels in the low, medium, and high dose groups were lower than those in the model group (all P<0.05); serum Cr, BUN, and 24 h urinary protein levels in the high dose group were lower than those in the low and medium dose groups [(14.33±5.33) μmol/L vs. (39.26±6.42) μmol/L and (27.52±5.61) μmol/L, (8.14±0.24) mmol/L vs. (11.59±2.00) mmol/L and (9.86±0.22) mmol/L, (7.00±0.76) mg vs. (11.59±1.78) mg and (9.52±1.02) mg] (all P<0.05). Serum levels of IL-1β, IL-6, MCP-1, and TNF-α in the model group were higher than those in the sham surgery group (all P<0.05); serum levels of IL-6 and MCP-1 in the low, medium, and high dose groups were lower than those in the model group (all P<0.05); serum levels of IL-1β, IL-6, MCP-1, and TNF-α in the high dose group were lower than those in the low dose group [(23.64±0.07) ng/L vs. (28.59±4.87) ng/L, (16.57±0.37) ng/L vs. (21.86±1.89) ng/L, (225.64±20.35) ng/L vs. (321.56±17.36) ng/L, (14.46±0.51) ng/L vs. (21.30±2.78) ng/L] (all P<0.05). The protein levels of NF-κB and p-p65/p65 in the kidney tissue of the model group were higher than those in the sham surgery group, and the protein level of IκBβ was lower than that in the sham surgery group (all P<0.05); the protein levels of NF-κB and p-p65/p65 in the low, medium, and high dose groups were lower than those in the model group, and the protein levels of IκBβ were higher than that in the model group (all P<0.05); the protein levels of NF-κB and p-p65/p65 in the high dose group were lower than those in the low and medium dose groups (0.18±0.02 vs. 0.34±0.02 and 0.25±0.01, 0.34±0.02 vs. 0.67±0.01 and 0.46±0.02), and the protein level of IκBβ was higher than those in the low and medium dose groups (0.42±0.02 vs. 0.26±0.01 and 0.33±0.02) (all P<0.05). The NF-κB mRNA level in the model group was higher than that in the sham surgery group, and the IκBβ mRNA level was lower than that in the sham surgery group (both P<0.05); the NF-κB mRNA levels in the medium and high dose groups were lower than that in the model group, and the IκBβ mRNA levels were higher than that in the model group (all P<0.05); the NF-κB mRNA level in the high-dose group was lower than that in the low-dose group (1.26±0.16 vs. 1.90±0.25), and the IκBβ mRNA level was higher than that in the low-dose group (0.94±0.10 vs. 0.69±0.09) (both P<0.05). Conclusions　The extract of laggera herb can effectively improve the cardiac and renal function and relieve the pathological injury of myocardium and renal tissues in rats with myocardial infarction. The molecular mechanism may be related to inhibiting the activation of NF-κB signaling pathway.

Treatises

Correlation analysis and prediction model construction of depression with psychotic symptoms and childhood abuse

Fu Rui, Shu Mangqiao, Wang Wendong, Guo Xinqiang, Wang Xinrong, Kang Xiaogang

2025, 31(3):  425-429.  DOI: 10.3760/cma.j.cn441417-20240929-03015

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Objective　To analyze the correlation between depression with psychotic symptoms and childhood abuse and construct a prediction model. Methods　A total of 600 patients with depression admitted to Chang'an Hospital and Dali Shanda Psychiatric Hospital from February 2021 to February 2024 were selected as the study objects, including 208 males and 392 females, aged 21 to 50 (35.11±4.88) years. The patients were divided into a psychotic symptom group (65 cases) and a non-psychotic symptom group (535 cases) according to the 90-item Symptom Check List (SCL-90) score. General data of the patients were collected and compared through the electronic medical record system, including demographic characteristics (gender, age, body mass index, duration of depression, marital status, education, employment, family history of depression, and childhood abuse) and clinical characteristics (age of onset of depression, depression with anxiety, and depression with suicidal tendency). Independent sample t test and χ² test were used for statistical analysis. Multivariate logistic regression analysis was used to analyze the influencing factors of depression patients with psychotic symptoms, and a prediction model was constructed. The receiver operating characteristic curve (ROC) was drawn by MedCalc software, and the Hosmer-Lemeshow goodness of fit test was used to verify the difference between the prediction model and the actual observation results. Results　The age of onset of depression in the psychotic symptom group was lower than that in the non-psychotic symptom group [(27.11±3.94) years old vs. (31.19±4.01) years old]; the proportions of family history of depression, childhood abuse, depression accompanied by suicide tendency were higher than those in the non-psychotic symptom group [20.00% (13/65) vs. 6.73% (36/535), 41.54% (27/65) vs. 24.30% (130/535), 46.15% (30/65) vs. 29.35% (157/535)] (all P<0.05). Multivariate logistic regression analysis showed that family history of depression (OR: 2.483, 95%CI: 1.133-5.445), childhood abuse (OR: 2.234, 95%CI: 1.250-3.995), low age of onset of depression (OR: 0.794, 95%CI: 0.740-0.853), and depression with suicidal tendency (OR: 1.935, 95%CI: 1.093-3.428) were risk factors for psychotic symptoms in patients with depression (all P<0.05). ROC results showed that the area under the curve of the prediction model was 0.780 (95%CI: 0.744-0.812), the sensitivity was 80.00%, and the specificity was 64.11%. Conclusions　Depression patients with psychotic symptoms are closely related to family history of depression, childhood abuse, age of onset of depression, and depression with suicidal tendency. The predictive model is effective and can help medical staff identify psychotic symptoms early.

Application of ultrasound-guided thoracic paravertebral nerve block in patients undergoing thoracoscopic lobectomy

Han Bing, Wang Xing, Zhao Bin, Deng Chuanjun, Liu Kuan

2025, 31(3):  429-434.  DOI: 10.3760/cma.j.cn441417-20240905-03016

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Objective　To explore the application effect of ultrasound-guided thoracic paravertebral nerve block (TPVB) in patients undergoing thoracoscopic lobectomy. Methods　A total of 100 patients with lung cancer who underwent single-hole thoracoscopic lobectomy in Weihai Municipal Hospital from March 2021 to March 2023 were selected as the study objects and were divided into a control group and a study group with 50 cases in each group by the random number table method. There were 29 males and 21 females in the control group, aged (58.71±7.53) years; the body mass index was (22.13±1.69) kg/m²; the tumor length was (2.35±1.06) cm; the pathological types were: 22 cases of squamous cell carcinoma, 26 cases of adenocarcinoma, and 2 cases of adeno-squamous cell carcinoma. There were 31 males and 19 females in the study group, aged (59.54±7.81) years; the body mass index was (22.06±1.83) kg/m²; the tumor length was (2.39±1.17) cm; the pathological types were: 25 cases of squamous cell carcinoma, 22 cases of adenocarcinoma, and 3 cases of adeno-squamous cell carcinoma. The control group underwent thoracic epidural anesthesia, and the study group underwent ultrasound-guided TPVB. The basic conditions (operation time, anesthesia time, intraoperative fluid infusion volume, intraoperative sufentanil dosage, use of vasoactive drugs, urine volume, and blood loss), static (quiet state) and dynamic (deep breathing) pain degrees [Visual Analogue Scale (VAS)] 6, 12, 24, 36, 48, and 72 h after surgery, and serum cytokine levels [monocyte chemotactic protein-1 (MCP-1), prostaglandin E2 (PGE2), and tumor necrosis factor-α (TNF-α)] and pulmonary function indicators [forced expiratory volume in the first second (FEV1), vital capacity (VC), maximum mid-expiratory flow (MMF), and maximum ventilatory volume (MVV)] after entry and 24 and 48 h after surgery were compared between the two groups. Repeated measure ANOVA, independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　The duration of anesthesia in the study group was shorter than that in the control group [(96.09±17.42) min vs. (141.42±19.51) min], and the proportion of use of vasoactive drugs was lower than that in the control group [2.00% (1/50) vs. 18.00% (9/50)] (both P<0.05). At 6, 12, 24, 36, 48, and 72 h after surgery, the static and dynamic VAS scores of the study group were lower than those of the control group (all P<0.05). At 24 and 48 h after surgery, serum levels of MCP-1, PGE2, and TNF-α in the study group were lower than those in the control group [(60.34±7.01) ng/L vs. (69.50±7.54) ng/L, (49.41±7.63) ng/L vs. (58.65±7.22) ng/L, (372.40±36.74) ng/L vs. (388.52±39.08) ng/L, (293.96±35.80) ng/L vs. (322.85±33.78) ng/L, (37.80±5.02) ng/L vs. (55.23±6.45) ng/L, (36.81±4.88) ng/L vs. (45.73±5.24) ng/L] (all P<0.05); the FEV1, VC, MMF, and MVV in the study group were higher than those in the control group [(2.05±0.62) L vs. (1.57±0.71) L, (2.74±0.52) L vs. (1.99±0.38) L, (2.24±0.63) L vs. (1.85±0.52) L, (2.84±0.45) L vs. (2.21±0.40) L, (1.57±0.73) L/s vs. (0.96±0.51) L/s, (2.10±0.32) L/s vs. (1.81±0.27) L/s, (62.29±8.23) L vs. (58.77±8.09) L, (69.31±5.45) L vs. (66.74±6.03) L] (all P<0.05). Within 3 d after surgery, there was no statistically significant difference in the total incidence of adverse reactions between the two groups (P>0.05). Conclusion　Ultrasound-guided TPVB can effectively reduce the pain degree and the levels of serum MCP-1, PGE2, and TNF-α of lung cancer patients undergoing single-port thoracoscopic lobectomy, which is conducive to the rapid recovery of lung function and has certain safety.

Expressions and clinical significance of chemokine ligand 12 and its receptor 4 (CXCL12/CXCR4) in children with biliary atresia liver fibrosis

Zhang Pan, Xu Ke, Liu Ying, Fu Nina, Wang Sha

2025, 31(3):  435-440.  DOI: 10.3760/cma.j.cn441417-20240806-03017

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Objective　To analyze the expressions and clinical significance of chemokine ligand 12 and its receptor 4 (CXCL12/CXCR4) in children with biliary atresia liver fibrosis. Methods　A total of 100 children with biliary atresia liver fibrosis admitted to Baoji Maternal and Child Health Hospital from May 2019 to May 2024 were selected as the study group, and the fibrosis grades were performed, including 36 cases of grade Ⅰ-Ⅱ and 64 cases of grade Ⅲ-Ⅳ. Forty-five children with common bile duct cysts admitted for surgery during the same period were selected as the control group. There were 47 males and 53 females in the study group, aged (59.41±5.23) d. There were 22 males and 23 females in the control group, aged (60.33±5.48) d. The general data [gender, age, white blood cell count (WBC), platelet count (PLT), and neutrophil to lymphocyte ratio (NLR)], expression levels of CXCL12 and CXCR4 protein, and liver function indexes [alanine aminotransferase (ALT), total bilirubin (TBil), and glutamyl transpeptidase (GGT)] of the two groups were compared. And the expression levels of CXCL12 and CXCR4 protein in children with biliary atresia liver fibrosis of different fibrosis grades. Independent sample t test and χ² test were used for statistical analysis. Multivariate logistic regression analysis was used to analyze the influencing factors of biliary atresia liver fibrosis. The receiver operating characteristic curve (ROC) was used to analyze the diagnostic efficiency of each index for biliary atresia liver fibrosis, and the area under the curve (AUC) was calculated. The correlations between the expression levels of CXCL12 and CXCR4 protein and the grade of fibrosis in children with biliary atresia liver fibrosis were analyzed by scatter plot. Results　The expression levels of CXCL12 and CXCR4 protein in the study group were higher than those in the control group [(1.09±0.26) μg/L vs. (0.89±0.18) μg/L, (1.04±0.22) μg/L vs. (0.87±0.19) μg/L] (both P<0.05). Serum ALT, TBil, and GGT levels in the study group were higher than those in the control group [(75.47±23.12) U/L vs. (62.15±10.33) U/L, (148.26±30.14) μmol/L vs. (125.27±28.59) μmol/L, (321.87±43.26) U/L vs. (285.49±38.15) U/L] (all P<0.05). Multiple logistic regression analysis showed that CXCL12 and CXCR4 protein expression levels and serum ALT, TBil, and GGT levels were independent risk factors for biliary atresia liver fibrosis (all P<0.05). ROC results showed that the AUC of CXCL12 and CXCR4 protein expression levels combined with serum ALT, TBil, and GGT in the diagnosis of biliary atresia liver fibrosis was greater than those of single index (0.874 vs. 0.670, 0.642, 0.693, 0.677, and 0.720) (all P<0.05). The expression levels of CXCL12 and CXCR4 protein in children with biliary atresia liver fibrosis in grade Ⅲ-Ⅳ were higher than those in grade Ⅰ-Ⅱ [(1.54±0.20) μg/L vs. (1.07±0.17) μg/L, (1.14±0.10) μg/L vs. (0.91±0.07) μg/L] (both P<0.05). Correlation analysis showed that the expression levels of CXCL12 and CXCR4 protein were positively correlated with fibrosis grade in children with biliary atresia liver fibrosis (both P<0.05). Conclusions　The combined diagnosis of CXCL12, CXCR4, ALT, TBil, and GGT has good diagnostic value for biliary atresia liver fibrosis. CXCL12 and CXCR4 are positively correlated with fibrosis grading, and clinical studies can use CXCL12 and CXCR4 as specific indicators for liver fibrosis in children with biliary atresia.

Effect of intravitreal injection of Ranibizumab combined with panretinal photocoagulation for neovascular glaucoma

Wang Yan, Jiang Chunhui, Jing Yongfeng, Cui Lijun

2025, 31(3):  440-444.  DOI: 10.3760/cma.j.cn441417-20241017-03018

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Objective　To investigate the curative effect of intravitreal injection of Ranibizumab combined with panretinal photocoagulation for neovascular glaucoma (NVG). Methods　A total of 90 patients with NVG admitted to Xianyang Central Hospital from June 2020 to June 2023 were selected as the study objects, all of whom were monocular lesions. The patients were divided into an observation group and a control group with 45 cases in each group by the random number table method. There were 28 males and 17 females in the observation group, aged 24-76 (50.62±4.01) years; the affected eye was right eye in 23 cases and left eye in 22 cases; the disease stages were stage Ⅱ in 25 cases and stage Ⅲ in 20 cases; the causes were retinal vein obstruction in 12 cases, diabetic retinopathy in 25 cases, and carotid artery stenosis of eye ischemia syndrome in 8 cases. There were 26 males and 19 females in the control group, aged 25-78 (51.24±4.32) years; the affected eye was right eye in 21 cases and left eye in 24 cases; the disease stages were stage Ⅱ in 23 cases and stage Ⅲ in 22 cases; the causes were retinal vein obstruction in 14 cases, diabetic retinopathy in 24 cases, and carotid artery stenosis of eye ischemia syndrome in 7 cases. The control group was treated with panretinal photocoagulation (a total of 4 times, interval of 2 d), and the observation group was treated with intravitreal injection of Ranibizumab 3 d before surgery on the basis. The clinical efficacy 1 week after surgery, intraocular pressure (IOP) and serum long non-coding RNA- lung adenocarcinoma metastasation-related transcription factor 1 (lncRNA MALAT1) levels before surgery and 1 week, 1 month, and 6 months after surgery, visual acuity improvement 6 months after surgery, and complications within 1 month after surgery were compared between the two groups. Repeated measure ANOVA, independent sample t test, paired t test, χ² test, and rank sum test were used for statistical analysis. Results　One week after surgery, the total treatment success rate of the observation group was higher than that of the control group [95.56% (43/45) vs. 77.78% (35/45)] (P<0.05). One week, one month, and six months after surgery, the IOP of the observation group was lower than that of the control group [(25.47±4.19) mmHg (1 mmHg=0.133 kPa) vs. (29.59±4.92) mmHg, (20.15±3.42) mmHg vs. (23.82±4.06) mmHg, (13.01±2.11) mmHg vs. (17.27±2.65) mmHg] (all P<0.05); the serum lncRNA MALAT1 level in the observation group was lower than that of the control group [(105.14±11.59) ng/L vs. (123.26±12.01) ng/L, (84.31±10.89) ng/L vs. (101.69±11.22) ng/L, (77.26±10.32) ng/L vs. (91.48±9.53) ng/L] (all P<0.05). Six months after surgery, the visual acuity improvement of the observation group was better than that of the control group (P<0.05). There was no statistically significant difference in the total incidence of complications between the two groups within 1 month after surgery (P>0.05). Conclusion　Intravitreal injection of Ranibizumab combined with panretinal photocoagulation is effective in the treatment of NVG, which can improve the patients' IOP and visual acuity, reduce the serum lncRNA MALAT1 level, and has good safety.

Value of combined serum levels of Amphiregulin and cyclophilin A in predicting adverse pregnancy outcomes in preeclampsia patients

Zhao Bei, Zhang Xianping

2025, 31(3):  445-448.  DOI: 10.3760/cma.j.cn441417-20240328-03019

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Objective　To explore the value of combined serum levels of Amphiregulin and cyclophilin A (CYPA) in predicting adverse pregnancy outcomes in preeclampsia patients. Methods　Ninety-six preeclampsia patients [aged (28.96±5.24) years, with a gestational age of (29.36±3.58) weeks and a body mass index (BMI) of (22.94±2.03) kg/m²] admitted to Northwest Women's and Children's Hospital from March 2020 to March 2023 were included. According to the pregnancy outcomes, the preeclampsia patients were divided into a normal outcome group (73 cases) and an adverse outcome group (23 cases). Another 50 healthy pregnant women during the same period were selected as a control group, aged (29.01±5.21) years, with a gestational age of (29.47±3.52) weeks and a BMI of (22.99±2.11) kg/m². Enzyme linked immunosorbent assay (ELISA) was used to detect the serum Amphiregulin and CYPA levels at 34-36 weeks of gestation in the three groups, and Spearman correlation analysis was used to analyze the correlations between serum Amphiregulin and CYPA levels and adverse pregnancy outcomes in preeclampsia patients. The receiver operating characteristic curve (ROC) was used to analyze the value of combined serum Amphiregulin and CYPA levels in predicting adverse pregnancy outcomes in preeclampsia patients. One-way analysis of variance and LSD-t test were used for statistical analysis. Results　Serum levels of Amphiregulin [(970.21±31.36) ng/L] and CYPA [(96.21±9.71) ng/L] in the adverse outcome group were higher than those in the normal outcome group [(862.25±27.25) ng/L and (79.58±7.22) ng/L] and the control group [(792.32±23.36) ng/L and (59.14±5.36) ng/L], with statistically significant differences (all P<0.05). Correlation analysis showed that serum levels of Amphiregulin and CYPA were positively correlated with adverse pregnancy outcomes in preeclampsia patients (r=0.855 and 0.673, both P<0.05). ROC analysis results showed that the sensitivity and specificity of serum Amphiregulin and CYPA levels combined to predict adverse pregnancy outcomes in preeclampsia patients were 91.3% and 84.9%, respectively, and the area under the curve was 0.920, which was higher than that of any single test. Conclusions　The serum levels of Amphiregulin and CYPA in preeclampsia patients are higher than those in normal pregnant women. The levels of the two indicators are positively correlated with adverse pregnancy outcomes. Their combined use can effectively predict adverse pregnancy outcomes in preeclampsia patients, showing high sensitivity and specificity.

Application effect of different concentrations of platelet-rich plasma combined with quadricep muscle training in cartilage repair of knee osteoarthritis

Zhang Jiyang, Jiang Peng, Li Pengfei, Song Yuxuan, Yang Yanhui

2025, 31(3):  449-453.  DOI: 10.3760/cma.j.cn441417-20240802-03020

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Objective　To investigate the effect of different concentrations of platelet-rich plasma combined with quadricep muscle training in cartilage repair of knee osteoarthritis. Methods　A total of 114 patients with cartilage repair of knee osteoarthritis treated in Shaanxi Rehabilitation Hospital from June 2022 to December 2023 were retrospectively selected as the study objects. According to different platelet-rich plasma concentrations, the patients were divided into three groups, 38 cases in each group. There were 23 males and 15 females in group A, aged (59.38±3.61) years, with a course of disease of (4.15±0.59) years, 22 cases of left knee and 16 cases of right knee, Kellgren-Lawrence (K-L) classification: 27 cases of grade Ⅱ and 11 cases of grade Ⅲ. There were 24 males and 14 females in group B, aged (60.11±3.64) years, with a course of disease of (4.18±0.62) years, 23 cases of left knee and 15 cases of right knee, K-L classification: 29 cases of grade Ⅱ and 9 cases of grade Ⅲ. There were 21 males and 17 females in group C, aged (59.94±3.62) years, with a course of disease of (4.17±0.60) years, 30 cases of left knee and 8 cases of right knee, K-L classification: 30 cases of grade Ⅱ and 8 cases of grade Ⅲ. All the three groups were treated with quadricep muscle training, and on the basis of this, different concentrations of platelet-rich plasma were injected into the knee joint. The platelet-rich plasma concentration in group A was 900 to 1 500×10⁹/L, 1 500 to 1 800×10⁹/L in group B, and 1 800 to 2 100×10⁹/L in group C. All the three groups were treated for 6 weeks. The knee function [Western Ontario and McMaster University Osteoarthritis Index (WMOAC)] and inflammatory factors and oxidative stress indexes [interleukin-17 (IL-17), Toll-like receptor 4 (TLR4), nitric oxide (NO), oxidized low density lipoprotein (ox-LDL), and glutathione peroxidase (GSH-Px)] before and after treatment and the occurrence of adverse reactions during treatment were compared among the 3 groups. Independent sample t test, paired t test, ANOVA, and χ² test were used. Results　After treatment, the scores of pain, limitation of daily living, and stiffness of the WMOAC in the 3 groups were lower than those before treatment (all P<0.05); the above scores of group B were lower than those of groups A and C [(6.39±1.52) points vs. (18.52±2.61) points and (18.54±2.63) points, (60.23±5.21) points vs. (79.46±7.12) points and (79.48±7.10) points. (4.32±0.61) points vs. (7.82±1.12) points and (7.85±1.14) points] (all P<0.05). After treatment, the levels of IL-17, TLR4, NO, and ox-LDL in the 3 groups were lower than those before treatment, and the GSH-Px level was higher than that before treatment (all P<0.05); the levels of IL-17, TLR4, NO, and ox-LDL in group B were lower than those in groups A and C [(3.22±0.43) ng/L vs. (4.51±0.57) ng/L and (4.53±0.59) ng/L, (9.78±1.21) μg/L vs. (13.25±1.95) μg/L and (13.27±1.97) μg/L, (83.52±6.72) μmol/L vs. (102.14±8.74) μmol/L and (102.18±8.79) μmol/L, (10.62±0.87) nmol/L vs. (12.15±1.34) nmol/L and (12.17±1.36) nmol/L], and the GSH-Px level was higher than those in groups A and C [(247.39±18.72) mg/L vs. (195.37±15.41) mg/L and (196.11±15.43) mg/L] (all P<0.05). During the treatment period, there was no statistically significant difference in the total incidence of adverse reactions among the 3 groups (P>0.05). Conclusion　Different concentrations of platelet-rich plasma combined with quadricep muscle training for cartilage repair of knee osteoarthritis can achieve good repair effects, and the treatment effect of platelet-rich plasma concentration of 1 500-1 800×10⁹/L is the best, which can reduce the patients' pain, improve the function of knee joint, reduce the levels of inflammatory factors and oxidative stress in the body, and is safe.

Clinical Research

Effect of azithromycin sequential therapy combined with low dose methylprednisolone on mycoplasma pneumonia in children

Zhang Songlin, Shi Yang, Guo Yanjun

2025, 31(3):  454-457.  DOI: 10.3760/cma.j.cn441417-20240805-03021

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Objective　To observe the effect of azithromycin sequential therapy combined with low dose methylprednisolone on mycoplasma pneumonia (MPP) in children, and its effects on serum inflammatory factors. Methods　A total of 78 children with MPP admitted to the Children's Hospital Affiliated to Zhengzhou University from January 2023 to March 2024 were selected as the study objects. According to different medication regimens, the children were divided into a control group (39 cases) and an experimental group (39 cases). There were 21 boys and 18 girls in the control group, aged 2-11 (5.68±1.03) years old; the body mass index (BMI) was 14.36-17.62 (15.25±0.57) kg/m²; the course of disease was 2-10 (4.12±0.62) d. There were 23 boys and 16 girls in the experimental group, aged 2-12 (5.65±1.02) years; the BMI was 14.30-17.39 (15.30±0.55) kg/m²; the course of disease was 1-9 (4.15±0.59) d. The control group was given azithromycin sequential therapy (continuous treatment for 5 d followed by withdrawal for 3 d and continued treatment for 3 d), and the experimental group was combined with 1-2 mg/kg of methylprednisolone (continuous treatment for 11 d) on the basis of the control group. The clinical efficacy, occurrence of adverse reactions during treatment, and serum levels of inflammatory factors [interleukin-4 (IL-4), interleukin-6 (IL-6), hypersensitive C-reactive protein (hs-CRP), and tumor necrosis factor-α (TNF-α)] before and after treatment were compared between the two groups. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　The total effective rate of the experimental group was higher than that of the control group [92.31% (36/39) vs. 74.36% (29/39)] (P<0.05). After treatment, the levels of serum IL-4, IL-6, hs-CRP, and TNF-α in the experimental group were lower than those in the control group [(9.29±2.18) mg/L vs. (16.93±3.25) mg/L, (13.09±2.68) ng/L vs. (18.53±3.75) ng/L, (4.02±0.96) mg/L vs. (6.78±1.21) mg/L, (15.84±2.56) ng/L vs. (22.11±3.07) ng/L] (all P<0.05). During treatment, there was no statistically significant difference in the total incidence of adverse reactions between the two groups (P>0.05). Conclusion　Low-dose methylprednone combined with azithromycin sequential therapy is effective in the treatment of MPP in children, which can reduce the levels of serum inflammatory factors, with good safety.

Diagnostic value of CT texture analysis and morphological features in benign and malignant pulmonary ground glass nodules

Ma Xuyang, Jiang Xiaofeng, Su Meijun, Zheng Qi, Li Zhenghe, Huang Yan, Yang Ningli, Tang Minli, Yang Quanxin

2025, 31(3):  458-462.  DOI: 10.3760/cma.j.cn441417-20240111-03022

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Objective　To explore the diagnostic value of computerized tomography (CT) texture analysis and morphological features in benign and malignant pulmonary ground glass nodules. Methods　A retrospective study was conducted on the clinical data of 80 patients with pulmonary ground glass nodules admitted to Yan'an University Xianyang Hospital from January 2021 to January 2023. All the patients received surgical resection and pathological findings were obtained, according to the pathological findings, all patients were divided into a benign group (34 cases) and a malignant group (46 cases). In the benign group, there were 20 males and 14 females, aged 35-83 (58.32±11.25) years. In the malignant group, there were 26 males and 20 females, aged 34-85 (58.93±12.48) years. Preoperative CT image data of all the patients were collected, and the CT texture parameters and morphological characteristics of pulmonary nodules in the two groups were compared and analyzed. The receiver operating characteristic curve (ROC) was drawn, and the area under the curve (AUC) was calculated to analyze the diagnostic efficacy of CT texture parameters and morphological characteristics in the diagnosis of benign and malignant pulmonary ground glass nodules. The statistical methods used were t test, H test, and χ² test. Results　The mean sum, entropy, entropy sum, and entropy difference of the benign group were lower than those of the malignant group (63.93±5.32 vs. 68.93±12.36, 1.53±0.28 vs. 1.94±0.37, 1.03±0.22 vs. 1.33±0.58, 0.90±0.08 vs. 1.23±0.11), with statistically significant differences (t=2.209, 5.413, 2.863, and 14.823, all P<0.05). The long diameter, short diameter, volume, solid partial space, average CT value, lobular sign, burr sign, vacuolar sign, air bronchial sign, pleural depression, vascular bunching, and bronchial truncation in the malignant group were higher than those in the benign group, with statistically significant differences (all P<0.05). Multivariate logistic regression analysis showed that the mean sum, entropy, entropy sum, and entropy difference had statistical significance in the detection of benign and malignant pulmonary ground glass nodules (all P<0.05). According to ROC analysis, the AUC for benign and malignant pulmonary ground glass nodules were 0.757, 0.690, 0.734, and 0.763, the specificities were 88.24%, 79.38%, 67.29%, and 76.37%, and the sensitivities were 58.25%, 59.34%, 68.27%, and 79.36%; CT texture combined with morphological features had higher specificity and sensitivity for the diagnosis of benign and malignant pulmonary ground glass nodules, which were 81.34% and 95.68%, respectively. Conclusion　CT texture and morphological features are of great value in the differential diagnosis of benign and malignant pulmonary ground glass nodules, and can provide certain guidance and reference for the formulation of precancerous lesions and clinical treatment of pulmonary ground glass nodules.

Efficacy of scalp acupuncture combined with virtual reality technology in treating post-stroke mild cognitive impairment

Yang Kun, Wang Xiaoli, Wu Jun, Wang Yali

2025, 31(3):  462-468.  DOI: 10.3760/cma.j.cn441417-20240927-03023

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Application of progressive rehabilitation therapy in patients after hip replacement surgery

Sun Qi, Guo Jianping, Ren Yi

2025, 31(3):  469-473.  DOI: 10.3760/cma.j.cn441417-20240711-03024

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Objective　To analyze the impacts of progressive rehabilitation treatment on hip joint function and walking function in patients after hip replacement surgery. Methods　A prospective randomized controlled trial was used to select 84 patients who underwent hip replacement treatment in Shaanxi Provincial Nuclear Industry 215 Hospital and Xianyang First People's Hospital from February 2022 to February 2024. They were randomly divided into a control group and a study group by the computer numbering, with 42 cases in each group. In the control group, there were 24 males and 18 females, aged 36-73 (51.21±5.45) years, 17 cases on the left side and 25 cases on the right side. In the study group, there were 23 males and 19 females, aged 38-76 (51.45±5.29) years, 19 cases on the left side and 23 cases on the right side. The control group received routine muscle strength and joint movement training. The study group was given a progressive rehabilitation program. Both groups were treated for 12 weeks. The hip joint function and walking function were compared between the two groups before and after treatment. t test was used for statistical analysis. Results　After treatment, the scores of pain, function, and range of motion of the Harris score table in the study group were higher than those in the control group [(39.45±3.41) points vs. (34.18±3.20) points, (44.12±3.85) points vs. (38.65±3.57) points, (4.18±0.33) points vs. (3.27±0.85) points], with statistically significant differences (t=7.303, 6.752, and 6.468, all P<0.05). The step length, step width, walking speed, step frequency, and rating of the Holden Functional Ambulation Scale in the study group were all better than those in the control group [(0.45±0.10) m vs. (0.40±0.09) m, (11.09±1.09) cm vs. (13.18±1.12) cm, (0.80±0.20) m/s vs. (0.71±0.18) m/s, (1.51±0.26) steps/s vs. (1.31±0.25) steps/s, 3.85±0.48 vs. 3.35±0.69], with statistically significant differences (t=2.409, 8.667, 2.168, 3.593, and 3.855, all P<0.05). Conclusion　Progressive rehabilitation therapy can improve the hip joint function and walking function in patients after hip replacement surgery.

Analysis on the data of tumor patients treated in a Class II, Grade A general hospital in western Guangdong from 2020 to 2023

Liu Wenliang, Li Zhong, Chen Hui, Su Shan, Liu Zhihui, Li Li, Lin Jihong, Ruan Shaohuan, Pang Huidan

2025, 31(3):  473-477.  DOI: 10.3760/cma.j.cn441417-20240801-03025

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Objective　To investigate the prevalence of tumor in local area based on real-world data from hospitals, and further provide the basis for the scientific formulation of comprehensive strategy of regional tumor prevention and treatment and the clinical speciality development of hospital. Methods　The data of 869 tumor patients treated in Agricultural Reclamation Hospital of Maoming Guangdong from 2020 to 2023 were retrospectively analyzed. Among them, there were 459 males and 410 females, aged 5 to 95 years. Based on ages, genders, and given year, the epidemic characteristics of tumor diseases in this region were initially discussed. Results　Grouped by age of ≤20 years old, >20-30 years old, >30-40 years old, >40-50 years old, >50-60 years old, >60-70 years old, and >70 years old, the proportions of tumor patients were 0.23%, 1.04%, 4.03%, 15.42%, 26.01%, 23.82%, and 29.46%, respectively. The ratio of male to female was 1.31:1 in 2020, 0.88:1 in 2021, 1.25:1 in 2022, 1.08:1 in 2023, and 1.12:1 from 2020 to 2023, respectively. From 2020 to 2023, the top 5 tumor sites from high to low were: nasopharynx - lung - liver - esophagus - mammary gland (2020), lung - nasopharynx - mammary gland - uterus - liver (2021), lung - nasopharynx - liver - uterus - mammary gland (2022), lung - nasopharynx - liver - uterus - mammary gland (2023). In males and females, the top 5 tumor sites from high to low were lung - nasopharyngeal - liver - esophagus – rectum and lung - uterus - mammary gland - nasopharynx - colon, and the overall sequence was lung - nasopharynx - liver - uterus - mammary gland. Conclusions　The individuals above 40 years old are high tumor incidence population. Lung, nasopharynx, liver, esophagus, rectum, uterus, and mammary gland are frequent sites.

Efficacy of chiglitazar sodium and recombinant human insulin in patients with type 2 diabetes mellitus

Guan Wei, Jiao Jianhu, Chen Juan, Li Qiuyun, Wei Dang

2025, 31(3):  478-482.  DOI: 10.3760/cma.j.cn441417-20240702-03026

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Objective　To investigate the efficacy of chiglitazar sodium combined with recombinant human insulin in the treatment of type 2 diabetes mellitus (T2DM). Methods　A prospective study was carried out on 90 patients with T2DM who were treated in Tongchuan People's Hospital from February 2022 to February 2024. The patients were divided into two groups according to the random number table method. In the control group, there were 26 males and 19 females, aged (65.46±3.53) years, and the course of disease was (7.78±1.24) years. In the observation group, there were 27 males and 18 females, aged (66.13±3.42) years, and the course of disease was (8.14±1.37) years. The control group was treated with recombinant human insulin (recombinant human insulin injection 0.4-0.6 U/kg, subcutaneous injection into the abdomen 30 min before breakfast and dinner, twice a day). The observation group was combined with chiglitazar sodium on the basis of the control group (oral chiglitazar sodium tablets, 2 tablets/time, once a day). Both groups were treated for 3 months. The levels of blood glucose, fasting insulin, blood lipid indexes, and inflammatory factors before and after treatment, adverse reactions, and clinical efficacy of both groups were observed. t test and χ² test were used for statistical analysis. Results　After treatment, the levels of fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2hPG), glycated hemoglobin (HbA1c), fasting insulin, total cholesterol (TC), triglyceride (TG), and low density lipoprotein cholesterol (LDL-C) in the observation group were lower than those in the control group [(6.63±1.28) mmol/L vs. (7.95±1.56) mmol/L, (8.24±1.23) mmol/L vs. (10.16±1.65) mmol/L, (6.49±0.54) % vs. (7.36±0.87) %, (10.69±1.72) mU/L vs. (16.33±1.43) mU/L, (4.12±0.18) mmol/L vs. (4.95±0.63) mmol/L, (1.23±0.24) mmol/L vs. (1.76±0.38) mmol/L, (3.04±0.23) mmol/L vs. (3.86±0.75) mmol/L], while the level of high density lipoprotein cholesterol (HDL-C) was higher than that in the control group [(1.68±0.16) mmol/L vs. (1.23±0.19) mmol/L], with statistically significant differences (t=4.388, 6.258, 5.699, 16.914, 8.497, 7.910, 7.011, and 12.152, all P<0.05). The levels of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) in the observation group were lower than those in the control group, with statistically significant differences (t=6.489, 4.124, and 14.999, all P<0.05). The total effective rate of the observation group was higher than that of the control group [95.55% (43/45) vs. 77.77% (35/45)], the difference was statistically significant (χ²=6.153, P<0.05). Conclusion　In T2DM patients, chiglitazar sodium combined with recombinant human insulin can reduce the blood glucose level, improve the level of blood lipids, reduce the inflammatory reaction, and improve the clinical efficacy.

Comparative analysis of pathogenic bacteria between the department of infectious diseases and other departments in a 3A hospital in recent 5 years

Lin Yiru, Ji Bing, Ding Guofeng

2025, 31(3):  483-487.  DOI: 10.3760/cma.j.cn441417-20240708-03027

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Objective　To understand the distribution of pathogenic bacteria and drug resistance in the department of infectious diseases and other departments in a 3A hospital in recent 5 years, so as to provide a basis for rational clinical application of antimicrobial drugs. Methods　All pathogenic bacteria sent for clinical examination in Binzhou Medical University Hospital from January 2017 to December 2021 were collected, and the distribution of strains, specimen sources, and drug resistance rate from the department of infectious diseases and other departments were analyzed. χ² test was used for statistical analysis. Results　A total of 25 433 non-repeated pathogenic strains were isolated, including 826 strains from the department of infectious diseases and 24 607 strains from other departments. The top three pathogenic bacteria in the department of infectious diseases were Escherichia coli [27.72% (229/826)], Klebsiella pneumoniae [11.50% (95/826)], and Brucella [7.51% (62/826)], and the main sources of specimens were blood [42.86% (354/826)], sputum [24.70% (204/826)], and urine [17.80% (147/826)]. The top three pathogenic bacteria in other departments were Escherichia coli [15.43% (3 797/24 607)], Klebsiella pneumoniae [12.08% (2 973/24 607)], and Staphylococcus aureus [11.19% (2 753/24 607)], and the main sources of specimens were sputum [28.41% (6 991/24 607)], urine [10.29% (2 531/24 607)], and blood [9.82% (2 417/24 607)]. The resistance rates of Escherichia coli isolated from the department of infectious diseases and other departments to ampicillin were the highest [85.15% (195/229) and 83.09% (3 155/3 797)], the resistance rates to levofloxacin were greater than 50%, and the resistance rates to amikacin, furantoin, carbapenems, piperacillin/tazobactam, and cefoperazone/sulbactam were all less than 10%. The resistance rates of Klebsiella pneumoniae isolated from the department of infectious diseases and other departments to cefazolin were the highest [23.16% (22/95) and 32.59% (969/2 973)], the resistance rates to carbapenems were less than 5%, and the resistance rates to third-generation cephalosporins were about 25%. Conclusions　Clinical isolation of pathogenic bacteria is mainly Gram-negative bacteria. Blood specimens and sputum specimens are the main sources of pathogenic bacteria detection, and standardization of specimen extraction and delivery is of great significance to the detection of pathogenic bacteria. The monitoring of pathogenic bacteria and the rational use of antimicrobial drugs should be given high priority by all clinical departments.

Traditional Chinese Medicine

Effects of Yinao decoction combined with embedded acupuncture on sleep quality and traditional Chinese medicine syndrome score in children with enuresis due to lung and spleen deficiency

Wan Lu, Mi Xinjing, Zhang Mintao

2025, 31(3):  488-492.  DOI: 10.3760/cma.j.cn441417-20240801-03028

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Objective　To explore the effects of Yinao decoction combined with embedded acupuncture on sleep quality and traditional Chinese medicine (TCM) syndrome score in children with enuresis due to lung and spleen deficiency. Methods　A total of 80 children with enuresis due to lung and spleen deficiency from Xi'an Traditional Chinese Medicine Hospital from January 2023 to January 2024 were randomly divided into a single group (40 cases) and a combined group (40 cases) according to the envelope drawing method. There were 21 boys and 19 girls in the single group, the age was (6.32±0.58) years old, and the course of disease was (2.33±0.17) years. In the combined group, there were 23 boys and 17 girls, the age was (6.36±0.52) years old, and the course of disease was (2.37±0.22) years. On the basis of conventional western medicine treatment, the single group received embedded acupuncture every other day, retaining the needle for 24 h each time. The combined group was treated with Yinao decoction on the basis of the single group, one dose a day, 200 ml of medicine juice was taken twice in the morning and evening. The treatment period of both groups was two months. The clinical efficacy, recurrence rate, and urodynamic parameters, TCM syndrome scores, sleep qualities, qualities of life, and monthly enuresis episodes before and after treatment were compared between the two groups. t test and χ² test were used for statistical analysis. Results　After treatment, the total effective rate of the combined group [97.5% (39/40)] was higher than that of the single group [80.0% (32/40)] (P<0.05); the bladder capacity [(302.31±28.33) ml], maximum urine flow rate [(16.13±1.58) ml/s], internal bladder pressure [(22.40±1.96) cmH₂O (1 cmH₂O=0.098 kPa)] were higher than those of the single group [(245.57±21.68) ml, (13.17±1.23) ml/s, and (16.18±1.47) cmH₂O], and the residual urine volume [(20.36±1.91) ml] was lower than that of the single group [(37.33±3.32) ml] (all P<0.05); the TCM syndrome scores of nocturnal enuresis, difficult to wake up during sleep, fatigue, cold limbs, and restless sleep were all lower than those of the single group (all P<0.05); the Pittsburgh Sleep Quality Index (PSQI) [(9.41±1.12) points] was lower than that of the single group [(12.38±1.47) points], and the Infant Subjective Life Quality Questionnaire (ISLQ) score [(182.33±20.46) points] was higher than that of the single group [(156.41±18.77) points] (all P<0.05); the monthly enuresis episodes [(3.22±0.37) times] and recurrence rate [2.5% (1/40)] were lower than those of the single group [(5.41±0.57) times and 15.0% (6/40)] (both P<0.05). Conclusion　Yinao decoction combined with embedded acupuncture significantly improves the sleep quality and TCM syndrome score in children with enuresis due to lung and spleen deficiency.

Effects of transcutaneous acupoint electrical stimulation on coma score and brain electrophysiological activity level in patients with disturbance of consciousness due to craniocerebral trauma

Zhang Lihua, Ma Rulong, Wang Zhaoxin, Chen Xiao

2025, 31(3):  492-497.  DOI: 10.3760/cma.j.cn441417-20240821-03029

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Objective　To observe the effects of transcutaneous acupoint electrical stimulation (TEAS) on coma score and brain electrophysiological activity level in patients with disturbance of consciousness due to craniocerebral trauma. Methods　This study was a randomized controlled trial. A total of 90 patients with disturbance of consciousness due to craniocerebral trauma admitted to Shaanxi Provincial Hospital of Traditional Chinese Medicine and Xi'an Encephalopathy Hospital of Traditional Chinese Medicine from December 2021 to October 2023 were selected and were divided into two groups by the random number table method. In the conventional group, there were 28 males and 17 females, aged (47.86±10.59) years; the Glasgow Coma Scale (GCS) score was (5.74±1.46) points; the injury types were open injury in 31 cases and closed injury in 14 cases; the causes of injury were traffic injury in 19 cases, falling injury in 14 cases, head injury in 9 cases, and other in 3 cases. In the TEAS group, there were 25 males and 20 females, aged (48.11±10.13) years; the GCS score was (5.69±1.52) points; the injury types were open injury in 28 cases and closed injury in 17 cases; the causes of injury were traffic injury in 18 cases, falling injury in 15 cases, head injury in 10 cases, and other in 2 cases. The conventional group was treated with conventional treatment regimen, and the TEAS group was treated with conventional treatment regimen combined with TEAS (30 min/time, once a day, resting for 1 d after 6 d of continuous treatment). Both groups were treated for 4 weeks. The Coma Recovery Scale-Revised (CRS-R) scores, electroencephalogram (EEG) scores, GCS scores, latent periods and amplitudes of the P300 wave, nerve cytokines, and radionuclide count values of the regions of interest in different brain regions were compared between the two groups before and after treatment, and the time to restore pupillary reflex to the light and rates of wakefulness, cerebral vasospasm, pulmonary infection, and deep vein thrombosis within 4 weeks were analyzed. t test and χ² test were used for statistical analysis. Results　The CRS-R scores [(8.41±1.23) and (9.83±1.09) points], EEG scores [(1.51±0.26) and (1.93±0.31) points], and GCS scores [(9.52±1.36) and (11.14±1.51) points] in the conventional group and the TEAS group after treatment were higher than those before treatment, and those in the TEAS group were higher than those in the conventional group (all P<0.05). The amplitudes of the P300 wave [(5.74±0.54) µV and (6.31±0.61) µV] in the conventional group and the TEAS group after treatment were higher than those before treatment, and that in the TEAS group was higher than that in the conventional group (all P<0.05). The latent periods of the P300 wave [(321.43±19.87) ms and (313.04±17.44) ms] in the conventional group and the TEAS group after treatment were shorter than those before treatment, and that in the TEAS group was shorter than that in the conventional group (all P<0.05). The levels of glial cell progenitor fibrillary acidic protein (GFAP) [(14.04±2.06) ng/L and (8.12±1.25) ng/L], neuropeptide Y (NPY) [(232.85±40.51) ng/L and (195.25±35.06) ng/L], S100β [(1.48±0.36) ng/L and (1.07±0.31) ng/L], ubiquitin completion terminal hydrolase-L1 (UCH-L1) [(1.11±0.27) μg/L and (0.82±0.23) μg/L] in the conventional group and the TEAS group after treatment were lower than those before treatment, and those in the TEAS group were lower than those in the conventional group (all P<0.05). The radionuclide count values of the regions of interest in the cortex (13.54±1.96 and 14.93±2.21) and thalamus (10.04±1.36 and 12.01±1.42) in the conventional group and the TEAS group after treatment were higher than those before treatment, and those in the TEAS group were higher than those in the conventional group (all P<0.05). The time to restore pupillary reflex to the light in the TEAS group was shorter than that in the conventional group [(5.41±1.06) d vs. (6.89±1.31) d], the rate of wakefulness within 4 weeks was higher than that in the conventional group [66.67% (30/45) vs. 44.45% (20/45)], and the rate of cerebral vasospasm was lower than that in the conventional group [2.22% (1/45) vs. 15.56% (7/45)] (all P<0.05). Conclusion　TEAS can increase the coma score, improve the electrophysiological activity, increase the blood perfusion volume in the cortex and thalamus, promote wakefulness, and reduce cerebral vasospasm in patients with disturbance of consciousness due to craniocerebral trauma.

Case Report

A case of Fabry disease in children

Liu Yujie, Jin Yunfeng, Zhao Gongping, Wei Lei, Cao Guanghai, Zhang Shufeng, Tian Ming, Liu Cuihua

2025, 31(3):  498-500.  DOI: 10.3760/cma.j.cn441417-20240704-03030

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The patient, a girl who was born in October 2011, began experiencing pain in her hands and feet toes since December 2020, with the pain worsening with activity and fever. The course was interrupted by tinnitus, which could resolve spontaneously. She was hospitalized at Henan Children's Hospital in January 2024 for treatment. Her mother had an intermittent hand and foot pain history during her school-age years; her uncle passed away at the age of 32 due to dilated cardiomyopathy; her grandmother had a long-term history of abdominal pain and diarrhea; one of her cousins also had symptoms of pain with fever. Considering the specific symptoms and positive family history, the biomarkers of Fabry disease, α-galactosidase A, and related genes of the girl and her mother were tested to confirm Fabry disease. The girl received enzyme replacement therapy, and her mother underwent gene therapy preparation. At present, the girl's pain symptoms and tinnitus were relieved, and she was undergoing long-term follow-up.

Nursing Research

Application of active cycle of breathing techniques combined with multifunctional breath valve exercise in school-aged children with bronchiectasis

Liu Weijuan, Liu Lijuan, Tang Xinmian, Huang Hailan, Wang Dehua, Ouyang Jianting, Zhai Yingying

2025, 31(3):  501-505.  DOI: 10.3760/cma.j.cn441417-20240908-03031

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Objective　To investigate the effect of active cycle of breathing techniques (ACBT) combined with multifunctional breath valve exercise in airway clearance of school-aged children with bronchiectasis. Methods　Seventy school-aged children with bronchiectasis who were hospitalized in the department of pediatrics, the First Affiliated Hospital of Guangzhou Medical University from August 2019 to October 2023 were selected. A total of 35 children treated from August 2019 to December 2021 were included in the control group, including 21 boys and 14 girls, aged (8.74±2.62) years. A total of 35 children treated from January 2022 to October 2023 were included in the observation group, including 23 boys and 12 girls, aged (9.54±2.43) years. The control group received routine airway clearance treatment after admission until the day before discharge. On the basis of routine airway clearance treatment, the observation group received ACBT and multifunctional breath valve exercise (twice a day, 10-15 min each time) from the second day after admission to the day before discharge. The 24 h sputum volume, cough symptom score, and length of hospital stay were compared between two groups. Independent sample t test and Mann-Whitney U test were used for statistical analysis. Results　After intervention, the 24 h sputum volumes in the control group and the observation group were (33.60±4.34) ml and (37.80±5.49) ml, respectively, with a statistically significant difference (t=-3.545, P=0.001). The daytime cough score, nighttime cough score, and total cough symptom score in the observation group were lower than those in the control group, with statistically significant differences (all P<0.001). The length of hospital stay in the observation group was (10.39±3.41) d, which was shorter than that in the control group [(12.62±2.36) d], with a statistically significant difference (t=3.133, P=0.003). Conclusions　ACBT combined with multifunctional breath valve exercise can effectively promote the removal of respiratory secretions in school-aged children with bronchiectasis, improve their symptoms of cough and sputum, and improve their condition.

Effect of protein A immunoadsorption nursing process on the efficacy in patients with anti-NMDAR encephalitis

Zhang Kanghua, Liu Zhihong, Li Dandan, Luo Liting, Xiang Lingmei, Kuang Zuying, Xi Lingru, Wang Zhanghang

2025, 31(3):  505-510.  DOI: 10.3760/cma.j.cn441417-20240806-03032

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Objective　To investigate the effect of protein A immunoadsorption (IA) on anti-N‑methyl‑D‑aspartate receptor (NMDAR) encephalitis and the significance of nursing intervention measures. Methods　A total of 10 adult patients with anti-NMDAR encephalitis who underwent IA treatment in the Department of Neurology, Guangdong Sanjiu Brain Hospital from April 2021 to August 2022 were collected. The key points of nursing were the patients' evaluation before IA treatment, the prescription of IA treatment, and the prevention and response of events during treatment. The anti-NMDAR antibodies in serum and cerebrospinal fluid were tested on the day before IA treatment and the next day after treatment, and the changes in symptoms and scores of Activity of Daily Living Scale (ADL), Brief Psychiatric Rating Scale (BPRS), and Mini Mental Status Examination (MMSE) were evaluated on the day before IA treatment and the day before discharge, as well as adverse reactions during treatment. Wilcoxon signed rank test was used for statistical analysis. Results　Among the 10 patients, there were 6 males and 4 females, aged (34.40±11.22) years. Before treatment, the serum anti-NMDAR antibody was positive in 10 patients [antibody titer ranged 1: (30-320)], and cerebrospinal fluid anti-NMDAR antibody was positive in 9 patients (antibody titer ranged from negative to 1:100). Each patient underwent a course of IA treatment, a total of 5 times, once every other day. Ten patients completed a total of 50 treatments, and 1 hypotension and 1 skin allergic reaction occurred, without other discomfort. Compared with those before IA treatment, the serum anti-NMDAR antibody titer of the 10 patients decreased by 1:n on the next day after treatment [10.0 (7.5, 10.0) vs. 30.0 (30.0, 100.0), Z=-2.869, P=0.004], and the cerebrospinal fluid anti-NMDAR antibody titer of the 9 patients also decreased by 1:n [10 (0,10) vs. 30 (10,100), Z=-2.539, P=0.011]. In some patients, the antibody turned negative. Compared with those before IA treatment, the BPRS score decreased on the day before discharge, and the ADL and MMSE scores increased (all P<0.001). Conclusion　IA is safe and effective in the treatment of anti-NMDAR encephalitis.

Clinical value of quantitative assessment model combined with interactive health education intervention for children with Mycoplasma pneumoniae pneumonia

Yan Ruoyuan, Liang Jinling, Liang Shuang, Zhang Songlin

2025, 31(3):  511-515.  DOI: 10.3760/cma.j.cn441417-20240829-03033

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Objective　To explore the clinical effect of quantitative assessment model combined with interactive health education intervention for children with Mycoplasma pneumoniae pneumonia (MPP). Methods　A total of 76 MPP children in Nanyang First People's Hospital from March 2021 to March 2023 were selected and were divided into an experimental group (38 cases) and a control group (38 cases) according to the admission time. There were 23 boys and 15 girls in the control group, the age was (7.81±2.33) years old, and the course of disease was (4.48±1.23) d. There were 22 boys and 16 girls in the experimental group, the age was (7.58±2.19) years old, and the course of disease was (4.55±1.22) d. The control group received interactive health education intervention, and the experimental group was combined with quantitative assessment model based on the control group. Both groups were cared for 2 weeks. The treatment compliance rate, fever reduction time, cough disappearance time, shortness of breath disappearance time, pulmonary rale disappearance time, hospital stay, complication rate, and Pediatric Survival Quality Measurement Scale (PedsQL) score were compared between the two groups. Independent sample t test and χ² test were used for statistical analysis. Results　The treatment compliance rate of the experimental group [97.37% (37/38)] was higher than that of the control group [78.95% (30/38)] (P<0.05). The duration of fever reduction [(4.28±1.74) d], cough disappearance [(5.13±0.96) d], pulmonary rale disappearance [(5.54±1.10) d], shortness of breath disappearance [(1.68±0.52) d], and hospital stay [(6.25±2.04) d] in the experimental group were shorter than those in the control group [(5.81±2.01) d, (6.78±1.34) d, (7.66±1.76) d, (2.56±0.73) d, and (9.78±2.53) d] (all P<0.05). The incidence of complications in the experimental group [7.89% (3/38)] was lower than that in the control group [26.32% (10/38)] (P<0.05). After intervention, the scores of social role [(17.48±1.15) points], physical function [(29.89±1.02) points], psychological state [(17.41±1.28) points], and emotional function [(18.05±0.96) points] of the experimental group were higher than those of the control group [(14.11±2.07) points, (26.48±2.15) points, (18.05±0.96) points, (13.87±3.04) points, and (14.97±1.19) points] (all P<0.001). Conclusion　The quantitative assessment model combined with interactive health education intervention can improve the treatment compliance rate, shorten the improvement time of clinical symptoms, reduce the incidence of complications, and improve the quality of life in MPP children.

Effect of integrated medical care management on gestational diabetes mellitus

Chen Lanfang, Qian Yanling, Chen Hefen, He Minqing, He Yuhuan

2025, 31(3):  515-519.  DOI: 10.3760/cma.j.cn441417-20240826-03034

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Objective　To explore the effect of integrated medical care management on gestational diabetes mellitus. Methods　A total of 103 patients with gestational diabetes mellitus treated in Sanshui District Maternal and Child Health Hospital, Foshan City from January 2020 to December 2022 were divided into two groups by the random number table method. In the 51 cases of the control group, the age was (27.32±2.12) years old, the gestational week was (26.53±2.09) weeks, and the times of pregnancy was 1.39±0.31. In the 52 cases of the experimental group, the age was (28.36±2.14) years old, the gestational week was (26.35±3.11) weeks, and the times of pregnancy was 1.21±0.25. The control group was given conventional management, and the experimental group was given integrated medical care management. The intervention time was 8 weeks. The self-health management ability, blood glucose control, mood improvement, nursing satisfaction, and clinical outcomes were compared between the two groups. Independent sample t test, χ² test, and Fisher exact probability method were used for statistical analysis. Results　After intervention, the scores of blood glucose monitoring and management [(8.51±0.53) points vs. (6.49±0.49) points], exercise management [(8.23±0.56) points vs. (6.98±0.52) points], and diet management [(22.69±0.76) points vs. (16.48±0.71) points] of the experimental group were higher than those of the control group (all P<0.05); the fasting blood glucose [(5.38±0.28) mmol/L vs. (6.42±0.31) mmol/L] and 2 h postprandial blood glucose [(5.99±0.35) mmol/L vs. (9.23±0.38) mmol/L] were lower than those of the control group (both P<0.05); the depression score [(45.92±3.92) points vs. (50.55±4.23) points] and anxiety score [(45.33±4.45) points vs. (50.32±5.11) points] were lower than those of the control group (both P<0.05). The nursing satisfaction of the experimental group was higher than that of the control group [100.00% (52/52) vs. 84.31% (44/51), P=0.006]. The cesarean section rate of the experimental group was lower than that of the control group [23.08% (12/52) vs. 43.14% (22/51), χ²=4.456, P=0.035], and the incidence of total adverse pregnancy outcomes was lower than that of the control group [3.85% (2/52) vs. 19.61% (10/51), χ²=6.061. P=0.014]. Conclusion　Integrated medical care management improves the self-health management ability in patients with gestational diabetes mellitus, effectively controls their blood glucose, relieves their anxiety and depression, and improves their satisfaction with management.

Intervention effect of nutritional management during pregnancy combined with smart App in weight management for pregnant women

Li Mei, Liu Shujun

2025, 31(3):  520-524.  DOI: 10.3760/cma.j.cn441417-20240807-03035

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Objective　To study the intervention effect of nutritional management during pregnancy combined with smart App in weight management for pregnant women. Methods　A total of 92 pregnant women from Zhumadian Central Hospital from January 2022 to December 2023 were selected as the study objects. All the selected pregnant women were divided into a control group (46 cases) and an experimental group (46 cases) according to the random number table method. The experimental group was (28.03±3.12) years old; the gestational age was (9.35±1.06) weeks; there were 28 primipara and 18 parturients; the education level was junior high school and below in 8 cases, secondary school or high school in 12 cases, and college and above in 26 cases. The control group was (28.15±3.04) years old; the gestational age was (9.23±1.09) weeks; there were 30 primipara and 16 parturients; the education level was junior high school and below in 7 cases, secondary school or high school in 15 cases, and college and above in 24 cases. The control group received conventional weight management, and the experimental group received prenatal nutrition management combined with smart App weight management on the basis of conventional weight management. Both groups were intervened till delivery. The Self-rating Questionnaire of Healthcare (SQHMP) score, body mass index, delivery mode, and complication rate were compared between the two groups. Independent sample t test and χ² test were used for statistical analysis. Results　The SQHMP scores [(89.32±3.18) points and (105.37±4.13) points] in the experimental groups at 20 weeks of pregnancy and delivery were higher than those in the control group [(78.57±3.25) points and (92.15±3.27) points] (t=16.035 and 17.021, both P<0.05); the body mass indexes [(22.32±1.05) kg/m² and (25.86±1.15) kg/m²] were lower than those in the control group [(23.58±1.12) kg/m² and (27.64±1.18) kg/m²] (t=5.567 and 7.327, both P<0.05). The cesarean section rate [19.57% (9/46)] in the experimental group was lower than that in the control group [39.13% (18/46)] (χ²=4.246, P=0.039), and the natural delivery rate [78.26% (36/46)] was higher than that in the control group [54.35% (25/46)] (χ²=5.886, P=0.015). The incidences of gestational diabetes mellitus [2.17% (1/46)], gestational hypertension [4.35% (2/46)], macrosomia [4.35% (2/46)], and low-birth-weight infants [2.17% (1/46)] in the experimental group were lower than those in the control group [17.39% (8/46), 19.57% (9/46), 21.74% (10/46), and 19.57% (9/46)] (χ²=4.434, 5.060, 6.133, and 7.181, P=0.035, 0.025, 0.013, and 0.007). Conclusion　Nutritional management during pregnancy combined with smart App for maternal weight management can strengthen the self-care management of pregnant women, improve the rate of natural delivery, and reduce the incidences of maternal and infant complications such as gestational hypertension, diabetes mellitus, macrosomia, and low-birth-weight infants.

Factors influencing self-transcendence in patients with knee osteoarthritis after knee joint replacement surgery

Pang Meifang, Wang Shaohua, Li Zheng

2025, 31(3):  525-528.  DOI: 10.3760/cma.j.cn441417-20240829-03036

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Objective　To analyze the current status of self-transcendence level in patients with knee osteoarthritis after knee joint replacement surgery, and explore the influencing factors of patients' self-transcendence level. Methods　A total of 133 patients who were diagnosed with knee osteoarthritis and planned to undergo knee joint replacement surgery in Zhengzhou Orthopaedic Hospital from May 2021 to February 2024 were included as the study subjects, including 56 males and 77 females, aged (63.56±5.12) years, with a body mass index of (24.51±3.27) kg/m² and a course of disease of (55.58±12.12) months, 82 cases of single knee and 51 cases of both knees. The score of Self-Transcendence Scale (STS) on the 7th day after surgery was recorded, and the factors influencing the level of patients' postoperative self-transcendence were analyzed. Independent sample t test, one-way analysis of variance, and multiple linear regression analysis were used for statistical analysis. Results　The STS score of the 133 patients with knee osteoarthritis after knee joint replacement surgery was (38.04±5.26) points, among them 123 patients were at a low level, accounting for 92.48% (123/133). The STS score of the patients with >55 months of disease course was lower than that of the patients with ≤55 months of disease course [(35.06±4.12) points vs. (42.39±3.37) points] (t=10.816, P<0.001); the STS score of the patients with acute pain after surgery was lower than that of the patients without acute pain [(36.17±5.61) points vs. (39.02±4.81) points] (t=3.066, P=0.003); the STS score of the patients with self-perceived burden after surgery was lower than that of the patients without self-perceived burden [(36.68±5.17) points vs. (38.71±5.20) points] (t=2.118, P=0.036); the STS score of the patients with low social support was lower than that of the patients with good social support [(35.66±4.97) points vs. (39.77±4.79) points] (t=4.804, P<0.001). Linear regression analysis found that disease course, postoperative acute pain, self-perceived burden, and social support were all influencing factors of self-transcendence in patients with knee osteoarthritis after knee joint replacement surgery (all P<0.05), and the linear regression equation was obtained: Y_{STS score} = 43.588 -6.558X_{disease course} -1.377X_{postoperative acute pain} -1.541X_{self-perceived burden} -1.589X_{social support}. Conclusions　The self-transcendence in patients with knee osteoarthritis after knee joint replacement surgery is generally at a low level, which may be related to the patients' disease course, postoperative acute pain, self-perceived burden, and social support level. For patients with long disease course, postoperative acute pain, heavy self-perceived burden, and low social support level, clinical attention should be paid to and reasonable interventions should be carried out.