Table of Content

15 February 2025, Volume 31 Issue 4

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Medical Education

"Medical + X" talent training mode for development of comprehensive capability of medical imaging graduate students

Liu Weifeng, Guo Yuan, Tang Wenjie, Yang Ruimeng, Fan Hao, Wei Xinhua

2025, 31(4):  530-534.  DOI: 10.3760/cma.j.cn441417-20241119-04001

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With the advancement of the "Healthy China" initiative and the deepening construction of new medical sciences, there is an urgent need for innovation in the education model of medical imaging to meet contemporary healthcare demands. This article examines the cultivation practices for graduate students within the medical imaging discipline at Second Affiliated Hospital of South China University of Technology, and explores a "Medical + X" training paradigm that underscores the significance of interdisciplinary integration. By reconstructing the curriculum framework to merge foundational medical knowledge with information technology, artificial intelligence, big data, and other emerging fields, alongside implementing personalized training programs for graduate students, establishing academic exchange platforms, guiding scientific research endeavors, and creating mentorship mechanisms among peers, we enhance both clinical competencies and research interests among students. The ultimate objective is to elevate overall quality and employ ability competitiveness among graduate students in medical imaging while nurturing exceptional professional talent for the healthcare sector. This model has demonstrably improved scientific research output and innovative capabilities among graduate students, and offers novel perspectives and actionable pathways for advancing medical imaging education.

Application of 3D printing technology and BOPPPS teaching method in urology practice teaching

Lai Dehui, Zhen Xingshu, Dai Xiaoqi, Huang Mei, Zhan Yifei, Du Yuxuan, Li Liuqiang, Bian Jun

2025, 31(4):  534-538.  DOI: 10.3760/cma.j.cn441417-20240909-04002

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Objective　To explore the effect for applying the 3D printing technology and BOPPPS teaching method in urology practice teaching. Methods　One hundred and ten students who practiced at Department of Urology, Fifth Affiliated Hospital of Guangzhou Medical University from September 2023 to May 2024 were selected for the prospective study, and were divided into a control group and an experimental group by the random number table method, with 55 ones in each group. There were 31 males and 24 females in the control group who were 22-25 years old. There were 25 males and 30 females in the experimental group who were 22-24 years old. The control group adopted the 3D printing technology and traditional teaching method. The experimental group adopted the 3D printing technology and BOPPPS teaching method. The Mann-Whitney U test was used for the statistical analysis. Results　There was no statistical difference in the score of theoretical knowledge between the two groups (P>0.05). The scores of the ability on consultation, physical examination, and medical record writing and image reading and diagnosis ability in the experimental group were higher than those in the control group [94.0 (91.5, 97.0) vs. 87.0 (82.5, 91.0) and 91.0 (86.0, 95.0) vs. 75.0 (70.0, 81.5)], with statistical differences (Z=-6.640 and -7.750; both P<0.05). The results of the questionnaire survey showed that 96.4% of the students recognized the 3D printing technology combined with BOPPPS teaching method; 89.1% of the students were satisfied with the teaching arrangement; all the students were satisfied with the participatory learning phase of the BOPPPS approach; 85.5% of the students recognized the examination form of this course; 92.7% of the students believed that 3D printing technology combined with BOPPPS teaching method could improve their understanding of knowledge; 89.1% of the students believed that it could enhance their practical ability; 89.1% of the students thought that it could promote their innovative thinking; 85.5% of the students thought that it could cultivate their teamwork ability. Conclusion　In the clinical probation teaching of urology, it is believed that 3D printing technology combined with BOPPPS can help strengthen students' understanding of urology structure and diseases, and achieve better teaching results.

Application of case and problem teaching model in clinical pharmacy practice teaching under SOAP thinking mode

Hao Huihui, Feng Anhua, Ma Xiaolin, Li Ao, Ding Chuanhu

2025, 31(4):  539-542.  DOI: 10.3760/cma.j.cn441417-20241002-00003

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With the continuous improvement of medical level, the role of clinical pharmacy becomes increasingly prominent. To meet the demand of medical institutions for professional talents in clinical pharmacy, it is imperative to improve the internship teaching mode. This paper deeply discusses the application of the teaching mode of problem-based learning (PBL) combined with case teaching method (CBL) under the SOAP (Subject Objective Assessment Plan) thinking mode in clinical pharmacy internship teaching. This mode focuses on improving students' clinical thinking ability, problem-solving ability, and teamwork ability through steps such as case introduction, independent learning in student groups, group discussion and reporting, evaluation and feedback, etc. The teaching mode can effectively make up the deficiencies of traditional teaching methods and improve students' learning enthusiasm, comprehensive ability, and knowledge mastery.

Effect for applying online-offline mixed teaching mode based on BOPPPS in clinical teaching of gastrooncology department

Huang Yu, Lu Xuerou, Yang Guohai, Li Yongqiang

2025, 31(4):  543-546.  DOI: 10.3760/cma.j.cn441417-20240929-00004

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Objective　To evaluate the effect for applying the online-offline mixed teaching mode based on BOPPPS in clinical teaching of gastrooncology department. Methods　A total of 113 undergraduate interns at Department of Gastrooncology, Affiliated Cancer Hospital of Guangxi Medical University from January 2019 to December 2022 were selected for the prospective study. The 57 interns of 2018 grade were set as a control group, and the 56 interns of 2019 grade an experimental group. There were 23 males and 34 females in the control group; they were (22.37±0.85) years old. There were 26 males and 30 females in the experimental group; they were (22.06±0.79) years old. The control group adopted the traditional mixed teaching mode, and the experimental group the online-offline mixed teaching mode based on BOPPPS. The results of theoretical knowledge, professional skills, medical record writing, and student satisfaction were compared between two groups. t and χ² tests were used for the statistical analysis. Results　The scores of theoretical knowledge, professional skills, and medical record writing in the experimental group were higher than those in the control group (78.50±9.46 vs. 73.06±10.06, 97.09±3.19 vs. 85.35±3.30, and 97.32±0.69 vs. 89.59±6.14), with statistical differences (t=2.960, 19.209, and 9.352; all P<0.05). The students' self-study ability, study interest, operation skills, communication and expression ability, clinical thinking, team work ability, and satisfaction with teachers in the experimental group were higher than those in the control group [94.64% (53/56) vs. 77.68% (46/57), 91.07% (51/56) vs. 75.43% (43/57), 92.85% (52/56) vs. 73.68% (42/57), 89.28% (50/56) vs. 73.68% (42/57), 94.64% (53/56) vs. 77.19% (44/57), 92.85% (52/56) vs. 70.17% (40/57), and 96.42% (54/56) vs. 78.94% (45/57)], with statistical differences (χ²=5.058, 4.936, 7.424, 4.544, 7.077, 9.605, and 7.953; all P<0.05). Conclusion　Applying the online-offline mixed teaching mode based on BOPPPS in clinical teaching of gastrooncology department can improve teaching effect and students' satisfaction.

Application of objective structured clinical examination and simulation teaching in neurological nursing teaching

Guo Jie, Zhu Mingfang

2025, 31(4):  547-551.  DOI: 10.3760/cma.j.cn441417-20241108-00005

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Objective　To explore the effect for applying objective structured clinical examination (OSCE) and simulation teaching in neurological nursing teaching. Methods　One hundred and twenty-eight special nurses at Henan Provincial People's Hospital from December 2022 to January 2024 were selected for the randomized controlled trial, and were divided into a control group and a study group by the random number table method, with 64 ones in each group. There were 5 males and 59 females in the control group; they were (29.35±2.36) years old. There were 3 males and 61 females in the study group; they were (28.73±2.28) years old. The control group used the traditional teaching mode. The study group used the OSCE combined with simulation teaching mode. The theoretical knowledge, operation skills, clinical comprehensive practice ability, core ability, teaching quality, and teaching satisfaction were compared between the two groups. The independent-sample t test and χ² test were used for the statistical analysis. Results　Before the training, there were no statistical differences in the scores of theoretical knowledge, operation skills, clinical comprehensive practice ability, and core ability between the two groups (all P>0.05). After 3 months' training, the scores of theoretical knowledge, operation skills, clinical comprehensive practice ability, treatment communication and relation, professional attitude, critical thinking, general signs, clinical manifestations, and core ability in the study group were higher than those in the control group [89.71±7.74 vs. 76.42±6.53, 88.25±8.12 vs. 74.86±6.89, 86.76±7.64 vs. 75.66±6.48, 88.93±7.15 vs. 73.49±6.18, 48.33±4.67 vs. 43.12±5.29, 55.84±4.69 vs. 47.23±3.24, 51.67±4.36 vs. 48.29±4.12, 32.07±3.73 vs. 22.38±2.43, and 276.84±16.43 vs. 234.51±14.37], with statistical differences (all P<0.05). The study interest, self-learning ability, discovering and solving problem ability, clinical thinking ability, and organization and expression ability in the study group were higher than those in the control group [90.63% (58/64) vs. 73.44% (47/64), 87.50% (56/64) vs. 65.63% (42/64), 96.88% (62/64) vs. 82.81% (53/64), 93.75% (60/64) vs. 70.31% (45/64), and 90.63% (58/64) vs. 65.63% (42/64)], with statistical differences (all P<0.05). The nurses' satisfaction with teaching in the study group was higher than that in the control group [98.44% (63/64) vs. 84.38%(54/64)], with a statistical difference (P<0.05). Conclusion　Applying the OSCE combined with simulation teaching mode in neurological nursing teaching can improve the special nurses' theoretical knowledge and clinical operation skills, their core competence, the teaching quality, and their satisfaction with teaching.

Meta Analysis

Meta-analysis on efficacy of calming internal wind agent combined with acupuncture in treatment of migraine

Zhang Ruihuan, Yang Yaofeng, Hao Tao, Chen Jun

2025, 31(4):  552-558.  DOI: 10.3760/cma.j.cn441417-20240925-04006

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Objective　To systematically evaluate the efficacy of calming internal wind agent combined with acupuncture in the treatment of migraine. Methods　CNKI,Wan Fang, VIP, SinoMed, PubMed,Web of Science, Cochrane Library, and Embase were searched to collect the clinical randomized controlled trials of calming internal wind agent combined with acupuncture in the treatment of migraine from their construction to 30 November 2023. The meta-analysis was performed using the RevMan5.4 software. The GRADE grading system was used to evaluate the evidence level of the observation indicators. The TSA 0.9.5.1 Beta software was used for sequential analysis of the trial. Results　A total of 14 randomized controlled trials involving 1 396 patients were included. The results of the meta-analysis showed that the cured rate in the experimental group was higher than that in the control group (RR=1.69,95%CI 1.43～1.99, P<0.000 01); the score of Visual Analogue Scale (VAS) in the experimental group was lower than that in the control group (MD=-1.22,95%CI -1.56--0.87, P<0.000 01); there were no statistical differences in the duration and frequency of headache between the experimental group and the control group (MD=-1.71,95%CI -4.04-0.62，P=0.15; MD=-1.22, 95%CI -2.54-0.11， P=0.07). The results of GRADE evidence grading showed that the recovery rate was moderate; the total effective rate and score of VAS were low; the duration and frequency of headache were extremely low. The sequential analysis of the trials for total efficacy showed that the sample sizes included had met the requirements needed for the meta-analysis; the false positive possibility was ruled out; the efficacy results after penalization statistics were reliable. Conclusion　The clinical efficacy of the combination of calming internal wind agent and acupuncture for migraine is better than that of western medicines.

New Medical Advances

Research progress of abnormal lipid metabolism and its intervention in diffuse large B-cell lymphoma

Hong Jinquan, Huang Xiaoling, Huang Zhenyu, Huang Haobo

2025, 31(4):  559-562.  DOI: 10.3760/cma.j.cn441417-20240101-04007

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Abnormal lipid metabolism is an important metabolic change in the occurrence and development of malignant tumors. Lipid reprogramming caused by changes in lipid metabolism-related genes and subsequent abnormal lipid metabolites have important effects on the proliferation, invasion, and metastasis of tumor cells. Clinical and basic studies have shown that there are abnormal expressions of lipid metabolism-related genes and metabolites in patients with diffuse large B-cell lymphoma (DLBCL), and these changes are related to prognosis. Intervention targeting abnormal lipid metabolism can change the biological behaviors of DLBCL cells. Therefore, this article reviews the abnormal lipid metabolism in DLBCL, its mechanism, and the intervention targeting lipid metabolism, so as to provide a useful summary for exploring the potential diagnosis and treatment targets of DLBCL.

Research progress of mesenchymal stem cells in neurodegenerative diseases

Wang Xingxing, Zhang Xiaolin, Wang Yanfei

2025, 31(4):  562-567.  DOI: 10.3760/cma.j.cn441417-20240902-04008

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Stem cells are involved in tissue development, growth, repair, and regenerative therapy, and are the cornerstone of tissue and organ regeneration in the human body, with self-renewal and multidirectional differentiation potential. Mesenchymal stem cells (MSCs), a type of stem cells, are widely found in human umbilical cords, and are also one of the most commonly used stem cells in clinical practice. Neurodegenerative diseases are a class of chronic and progressive neuronal death and loss of function that occur with age, including Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, age-related hearing loss, etc., which seriously affect the quality of life of the elderly. With the increasing trend of global aging, the incidence rate of neurodegenerative diseases is increasing year by year, and has become a major challenge for global public health. In this paper, we searched the literatures through PubMed, OVID, China Knowledge Network, Wanfang Data, and other databases and summarized the relevant studies of MSCs in neurodegenerative diseases.

Treatises

Effects of endovascular interventional embolization on serum inflammatory factors, oxidative stress, and cerebrovascular status in patients with cerebral aneurysm

Ju Yan, Shi Bo, Yang Demin

2025, 31(4):  568-572.  DOI: 10.3760/cma.j.cn441417-20240924-04009

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Objective　To analyze the effects of endovascular interventional embolization on serum inflammatory factors [interleukin-6 (IL-6), interleukin-8 (IL-8), and tumour-necrosis factor-α (TNF- α)], oxidative stress [prostaglandin E2 (PGE2), corticotropin (ACTH), and corticotropin releasing hormone (CRH)], and cerebrovascular status [mean flow velocity (Vm), middle cerebral artery systolic peak velocity (Vs), end-diastolic flow velocity (Vd), and beat index (PI)] in patients with cerebral aneurysm. Methods　This was a retrospective study. Ninety-eight patients with cerebral aneurysm treated at Yangling Demonstration Zone Hospital from July 2021 to December 2023 were selected. The 47 patients treated with craniotomy were set as a control group, including 26 men and 21 women who were (49.20±2.01) years old; the 51 patients treated with endovascular interventional embolization were set as an observation group, including 31 men and 20 women who were (50.98±2.40) years old. The levels of IL-6, IL-8, TNF- α, PGE 2, ACTH, and CRH, Vm, Vs, Vd, PI, clinical efficacies, and incidence rates of complications were compared between the two groups. t test, rank sum test, and χ² test were used for the statistical analysis. Results　On the 14th day after the surgery, the levels of IL-6, IL-8, TNF-α, PGE2, ACTH, and CRH in the observation group were lower than those in the control group [(8.69±1.08) ng/L vs. (10.38±3.74) ng/L, (9.51±0.94) ng/L vs. (12.35±2.70) ng/L, (0.79±0.26) ng/L vs. (1.00±0.35) ng/L, (256.38±21.33) ng/L vs. (271.35±34.89) ng/L, (34.25±14.35) ng/L vs. (41.26±10.78) ng/L, and (28.25±3.08) mg/L vs. (30.24±4.78) mg/L], with statistical differences (all P<0.05). The Vm, Vs, Vd, and PI in the observation group were better than those in the control group [(50.02±4.76) cm/s vs. (47.25±3.99) cm/s, (88.21±3.78) cm/s vs. (85.79±3.02) cm/s, (44.39±5.79) cm/s vs. (47.20±3.17) cm/s, and 0.92±0.04 vs. 0.95±0.03], with statistical differences (all P<0.05). The effective rate in the observation group was higher than that in the control group [98.04% (50/51) vs. 82.98% (39/47)], with a statistical difference (P<0.05). Within 14 d after the surgery, the incidence rate of complications in the observation group was lower than that in the control group [5.88% (3/51) vs. 23.40% (11/47)], with a statistical difference (P<0.05). Conclusion　Endovascular interventional embolization for patients with cerebral aneurysm can reduce their levels of inflammatory factors, effectively relieve their postoperative stress, improve their cerebrovascular status and the clinical treatment effect, and reduce the incidence rate of complications.

Effect of Jiawei Buyang Huanwu Tang combined with western medicine for patients with idiopathic membranous nephropathy

Lu Xiaoqing, Guo Yaping, Bian Jing, Zhao Dongyan, Jing Xuanfeng, Zhao Yafeng

2025, 31(4):  573-577.  DOI: 10.3760/cma.j.cn441417-20240624-04010

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Objective　To explore the efficacy of Jiawei Buyang Huanwu Tang combined with western medicine in the treatment of patients with idiopathic membranous nephropathy. Methods　A total of 120 patients with idiopathic membranous nephropathy treated at Yulin Traditional Chinese Medicine Hospital from September 2020 to September 2023 were selected for the randomized controlled trial, and were divided into a control group and an observation group by the random number table method, with 60 cases in each group. There were 42 males and 18 females in the control group; they were (49.68±5.62) years old. There were 44 males and 16 females in the observation group; they were (49.81±5.54) years old. The control group took tacrolimus, while the observation group took Jiawei Buyang Huanwu Tang and tacrolimus, for 6 months. The clinical efficacies, lipid metabolism levels [total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL)], renal function [24-hour urinary total protein (24 h-UTP), serum creatinine (Scr), and blood urea nitrogen (BUN)], inflammatory markers [transforming growth factor-β1 (TGF-β1), podocyte protein (PCX), and cystatin C (CysC)], and coagulation-fibrinolysis function [tissue plasminogen activator (t-PA) and type Ⅰ plasminogen activator inhibitor [PAI-Ⅰ]) before and after the treatment, and adverse reactions were compared between the two groups. χ² and t tests were used for the statistical analysis. Results　The overall efficacy in the observation group was higher than that in the control group [95.00% (57/60) vs. 80.00% (48/60)], with a statistical difference (χ²=6.171; P<0.05). After the treatment, the levels of TC, TG, LDL, 24 h-UTP, Scr, BUN, TGF-β1, PCX, CysC, t-PA, and PAI-Ⅰ in the observation group were better than those in the control group [(4.31±0.96) mmol/L vs. (6.39±1.24) mmol/L, (1.61±0.46) mmol/L vs. (2.49±0.72) mmol/L, (1.23±0.24) mmol/L vs. (2.59±0.41) mmol/L, (0.56±0.24) g vs. (1.34±0.37) g, (82.57±7.16) μmol/L vs. (88.49±8.64) μmol/L, (6.02±1.03) mmol/L vs. (7.34±1.28) mmol/L, (235.25±14.76) ng/L vs. (301.59±17.64) ng/L, (7.11±1.42) μg/L vs. (12.24±1.78) μg/L, (0.82±0.22) mg/L vs. (1.18±0.34) mg/L, (6.88±1.07) μg/L vs. (5.42±0.97) μg/L, and (22.01±2.08) μg/L vs. (26.78±2.63) μg/L; t=10.274, 7.978, 22.174, 13.700, 4.087, 6.223, 22.341, 17.451, and 6.886, 7.831, and 11.019; all P<0.05]. There was no statistical difference in the incidence rate of adverse reactions between the two groups (P>0.05). Conclusion　Jiawei Buyang Huanwu Tang and tacrolimus in the treatment of patients with idiopathic membranous nephropathy is effective, and can improve their lipid metabolism, renal function, inflammatory status, and coagulation-fibrinolysis function.

Effect of methimazole combined with Yangyin Pingjia Decoction for patients with hyperthyroidism characterized by yin deficiency and exuberant fire

Tian Lu, Pei Ruixia, Bai Xiaolin, Zhang Ting, Zhao Meiyun

2025, 31(4):  578-581.  DOI: 10.3760/cma.j.cn441417-20240717-04011

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Objective　To explore the effect of methimazole combined with Yangyin Pingjia Decoction for patients with hyperthyroidism characterized by yin deficiency and exuberant fire. Methods　Ninety patients with hyperthyroidism characterized by yin deficiency and exuberant fire treated at Xi'an Traditional Chinese Medicine Hospital from February 2022 to February 2024 were selected for the randomized controlled trial, and were divided into a control group and an observation group by the random number table method, with 45 cases in each group. There were 18 males and 27 females in the control group; they were (54.69±5.38) years old. There were 19 males and 26 females in the observation group; they were (54.78±5.26) years old. The control group took methimazole, and the observation group methimazole and Yangyin Pingjia Decoction, for 2 months. The clinical efficacies, scores of traditional Chinese medicine (TCM) symptoms and thyroid function [free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH)] before and after the treatment, and incidence rates of adverse reactions were compared between the two groups. χ² and t tests were used for the statistical analysis. Results　The total effective rate in the observation group was higher than that in the control group [93.33% (42/45) vs. 77.78% (35/45)], with a statistical difference (χ²=4.406; P<0.05). After the treatment, the scores of heat sensation, irritability, fatigue, and palpitation and insomnia in the observation group were lower than those in the control group (1.36±0.14 vs. 2.45±0.21, 1.21±0.12 vs. 2.29±0.20, 1.12±0.11 vs. 2.94±0.27, and 1.34±0.15 vs. 3.01±0.32), with statistical differences (t=28.971, 31.062, 41.876, and 31.699; all P<0.05). After the treatment, the levels of FT3, FT4, and TSH in the observation group were better than those in the control group [(7.46±1.59) pmol/L vs. (11.02±2.23) pmol/L, (26.54±2.76) pmol/L vs. (33.57±3.85) pmol/L, and (0.86±0.19) mIU/L vs. (0.41±0.10) mIU/L], with statistical differences (t=8.720, 9.955, and 14.059; all P<0.05). The incidence rate of adverse reactions in the observation group was lower than that in the control grouip [4.44% (2/45) vs. 20.00% (9/45)], with a statistical difference (χ²=5.075; P<0.05). Conclusion　Methimazole combined with Yangyin Pingjia Decoction is more effective and safer than methimazole alone in treating patients with hyperthyroidism characterized by yin deficiency and exuberant fire, and can improve their clinical symptoms, and regulate their thyroid function indicators.

Application of CT three-dimensional reconstruction fusion image in operation of hypertensive cerebral hemorrhage in basal nucleus region

Shang Lihong, Cai Changwen, Zhang Bin, Zhou Yang, Hu Xiaoyu

2025, 31(4):  582-586.  DOI: 10.3760/cma.j.cn441417-20240906-04012

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Objective　To analyze the effect of three-dimensional CT reconstruction fusion image in the operation of hypertensive cerebral hemorrhage in the basal nucleus region. Methods　The clinical data of 95 patients with hypertensive cerebral hemorrhage in the basal nucleus region treated at Department of Neurosurgery, Shangluo Central Hospital from March 202 to February 2023 were retrospectively analyzed. The patients were divided into a control group (50 cases), taking neuroendoscopic surgery, and an observation group (45 cases), taking CT 3D reconstruction fusion image + neuroendoscopic surgery, according to whether CT three-dimensional reconstruction fusion image were performed. There were 32 males and 18 females in the control group; they were (57.34±5.16) years old. There were 30 males and 15 females in the observation group; they were (59.11±4.95) years old. The clinical efficacies, operation conditions (operation time, intraoperative bleeding volume, and hospital stay), complications, serum nerve damage indicators [neuron-specific enolase (NSE), neuropeptide Y (NPY), and brain-derived neurotrophic factor (BDNF)] before and 1 week after the surgery, and neurological function [modified Rankin Scale (mRS)] before and 6 months after the surgery were observed and compared between the two groups. χ² and t tests were used for the statistical analysis. Results　The total effective rate of the observation group was higher than that of the control group [95.56% (43/45) vs. 78.00% (39/50)], with a statistical difference (χ²=6.180; P=0.013). The operation time and hospital stay in the observation group were shorter than those in the control group [(89.46±12.17) min vs. (94.37±11.25) min and (9.25±1.13) d vs. (12.16±1.47) d; the intraoperative bleeding volume in the observation group was lower than that in the control group [(64.38±12.47) ml vs. (86.42±11.35) ml]; there were statistical differences (all P<0.05). One week after the surgery, the serum levels of NSE, NPY, and BDNF in the observation group were better than those in the control group [(13.27±2.52) mg/L vs. (18.35±2.41) mg/L and (121.65±6.39) ng/L vs. (168.27±7.28) ng/L, and (7.43±0.82) μg/L vs. (5.62±0.76) μg/L], with statistical differences (all P<0.05). Six months after the surgery, the score of mRS in the observation group was lower than that in the control group (2.02±0.41 vs. 2.58±0.34), with a statistical difference (P<0.001). The incidence rate of complications in the observation group was slightly lower than that in the control group, with no statistical difference (χ²=1.071; P=0.301). Conclusion　CT three-dimensional reconstruction fusion image is safe and effective in the operation of patients with hypertensive cerebral hemorrhage in the basal nucleus region, and can better improve their nerve function.

Spectral CT combined with ultrasound C-TIRADS grading in differentiation of benign and malignant thyroid nodules

Wang Yutang, Wang Hongxia, Huang Yanan, Huang Junlin, Jiang Xingyue

2025, 31(4):  587-590.  DOI: 10.3760/cma.j.cn441417-20240812-04013

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Objective　To explore the value of spectral CT combined with ultrasound C-TIRADS grading in the differentiation of benign and malignant thyroid nodules. Methods　Seventy patients with thyroid nodules treated at Binzhou Medical University Hospital from May 2023 to May 2024 were selected for the retrospective study, including 26 cases of benign nodules and 44 cases of malignant nodules. All the patients took ultrasound examination and spectral CT scanning. The ages, genders, maximum nodule diameters, and spectral CT parameters were compared between the two groups. The independent predictive factors of spectral CT were selected   through univariate and multivariate analyses, and ultrasound C-TIRADS grading was introduced to construct the nomogram model. The model's stability was internally validated by the Bootstrap method with 1 000 iterations. The independent-sample t test, Mann-Whitney U test, and χ² test were used for the statistical analysis. Results　There were statistical differences in the CT spectral parameters, including iodine concentration (IC) in the arterial and venous phases, normal iodine concentration (NIC), and slope of the energy spectrum curve (λHU), as well as the maximum nodule diameter between the benign group and the malignant group (all P<0.05). The multivariate analysis revealed that arterial phase IC and venous phase NIC were independent predictive factors for determining the benign or malignant thyroid nodules (both P<0.05). A predictive model was constructed based on these variables, and its area under the curve (AUC) was 0.940. Utilizing ultrasound C-TIRADS grading for diagnosing benign or malignant thyroid nodules resulted in an AUC of 0.823. When ultrasound C-TIRADS grading was combined with spectral CT parameters to create a nomogram, its AUC was 0.982. The calibration curve demonstrated excellent calibration performance for the nomogram, with a Brier score of 0.051. The decision curve analysis indicated that the nomograms consistently provided good clinical net benefit across a wide range of threshold probabilities. The internal validation of the nomogram model using the Bootstrap method with 1 000 iterations further confirmed its robustness, yielding an average AUC of 0.961. Conclusions　The AUC of the spectral CT predictive model is higher than that of the ultrasound C-TIRADS grading. The combined model improves the performance of both spectral CT and ultrasound C-TIRADS grading in distinguishing benign and malignant thyroid nodules.

Effect of platelet-rich plasma on IL-1β-induced apoptosis of rat nucleus pulposus cells

Zhang Guoteng, Wang Yi, Zhou Pei, Qiu Shicheng, Zhou Jianpeng

2025, 31(4):  591-596.  DOI: 10.3760/cma.j.cn441417-20241208-04014

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Objective　To observe the effect of platelet-rich plasma (PRP) on the apoptosis of rat nucleus pulposus cells induced by interleukin-1β (IL-1β). Methods　This study was from July 2023 to October 2024. The PRP was extracted from the SD rats' blood by the two-step centrifugation method, and was used for the subsequent experiments. The rat nucleus pulposus cells were routinely cultured in vitro. The nucleus pulposus cells were treated by different concentrations of PRP for different periods of time, and the cell viability test kit was used to detect the nucleus pulposus cells' activity. The degeneration model of the nucleus pulposus cells was established by IL-1β induction. The cells were randomly divided into a control group (without the treatment of IL-1β and PRP), an IL-1β group (adding 10 μg/L lL-1β solution), and a PRP group (adding 10 μg/L IL-1β solution and PRP). After 72 hours' intervention, the expression levels of Bcl-2 associated X protein (Bax), B-cell lymphoma/leukemia 2 (Bcl-2), and cysteine aspartic protease-3 (Caspase-3) were detected by the Western blotting. The expressions of Bax, Bcl-2, and Caspase-3 mRNA were detected by the quantitative real-time polymerase chain reaction (qRT-PCR). One-way analysis of variance and LSD-t test were used to analyze the data. Results　The western blotting test results show that the expressions of Bax and Caspase-3 protein and the ratio of Bax/Bcl-2 in the IL-1β group were higher than those in the control group (2.43±0.22 vs. 1.04±0.07, 1.96±0.09 vs. 1.06±0.12, and 3.76±0.34 vs. 1.00±0.10), while the expression of Bcl-2 protein was lower (0.65±0.05 vs. 1.05±0.17), with statistical differences (all P<0.05). The expressions of Bax and Caspase-3 proteins and the ratio of Bax/Bcl-2 in the PRP group were higher than those in the IL-1β group, while the expression of Bcl-2 protein was lower, with statistical differences (all P<0.05). The results of qRT-PCR showed that the expressions of Bax and Caspase-3 mRNA in the IL-1β group were higher than those in the control group (1.15±0.12 vs. 1.00±0.03 and 1.22±0.09 vs. 1.00±0.11), while the expression of Bcl-2 mRNA was lower (0.51±0.05 vs. 1.00±0.04), with statistical differences (all P<0.05). The expressions of Bax and Caspase-3 mRNA in the PRP group were lower than those in the IL-1β group, while the expression of Bcl-2 mRNA were higher, with statistical differences (all P<0.05). Conclusions　PRP can inhibit the apoptosis and inflammatory response of nucleus pulposus cells induced by IL-1β, enhance cell activity, and effectively delay the progression of intervertebral disc degeneration.

Analysis of risk factors of delayed encephalopathy caused by acute carbon monoxide poisoning

Wu Yanfang, Zhang Yu, Fu Yongwang

2025, 31(4):  596-602.  DOI: 10.3760/cma.j.cn441417-20240924-04015

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Objective　To study the risk factors associated with delayed encephalopathy in patients with acute carbon monoxide poisoning (ACOP). Methods　A retrospective analysis was performed on 365 patients with moderate to severe ACOP treated at Inner Mongolia Autonomous Region People's Hospital from October 2020 to October 2023. There were 154 females and 211 males. They were 18-80 years old. Their clinical data were collected. They were followed up for more than 60 days. According to whether delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) occurred, the patients were divided into a DEACMP group (80 cases) and a non-DEACMP group (285 cases). The univariate analysis was used to compare the general clinical data and the first emergency laboratory indicators between the two groups, and the indicators with statistical differences were selected for the multivariate logistic regression analysis to analyze the risk factors of DEACMP. According to their age, the patients were divided into a 18-45 years old group (92 cases), a >45-60 years old group (142 cases), and a >60-80 years old group (131 cases); the clinical data and the first emergency laboratory indicators were compared between the 3 groups. χ² test and Fisher's precision probability test were used to compared the data between the groups. Results　The results of univariate analysis showed that there were statistical differences between the DEACMP group and the non-DEACMP group in age, previous history (diabetes and hypertension), duration of coma, toxicity degree, myocardial injury, rhabdomyolysis, lung infection, and first hyperbaric oxygen therapy (HBOT) time (all P<0.05). The early abnormal rates of white blood cell count (WBC), C-reaction protein (CRP), D-dimer (D-D), troponin I (cTnI), and creatine kinase (CK) in the DEACMP group were higher than those in the non-DEACMP group [73.8% (59/80) vs. 42.8% (122/285), 47.5% (38/80) vs. 27.1% (77/285), 61.3% (49/80) vs. 20.7% (59/285), 67.5% (54/80) vs. 27.7% (79/285), and 78.8% (63/80) vs. 35.1% (100/285)], with statistical differences (all P<0.05). The results of multivariate logistic regression analysis showed that age increase, long duration of coma, myocardial injury, long first HBOT time, and early abnormal CRP, D-D, cTnI, and CK were independent risk factors for DEACMP (all P<0.05). The elder the patients with ACOP were, the longer the duration of coma, the easier to have rhabdomyolysis, the higher the rates of early abnormal CRP and cTnI, and the more likely they had DEACMP. Conclusion　Age increase, long duration of coma, myocardial injury, long first HBOT time, and early abnormal CRP, D-D, cTnI, and CK may be the independent risk factors for DEACMP.

Correlation of cognitive function with serum biomarkers and pain degree in patients with primary Parkinson's disease

Wang Yu, Hu Xiaohui, Ma Jie, Cui Xin, Li Ting

2025, 31(4):  603-607.  DOI: 10.3760/cma.j.cn441417-20240000-04016

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Objective　To investigate the correlation of cognitive function with the levels of interleukin-1β (IL-1β), α-synuclein, and thioredoxin peroxidase (TPX) and pain in patients with primary Parkinson's disease. Methods　This was a retrospective study. The clinical data of 124 patients with primary Parkinson's disease treated at Xi'an Honghui Hospital between March 2021 and March 2024 were collected. Among them, there were 75 males and 49 females, with an age of 63.84±7.47. According to their cognitive function, they were divided into a PDCI group (51 cases, dementia) and a PDNC group (73 cases, mild cognitive impairment and no cognitive impairment). The serum levels of IL-1β, α-synuclein, and TPX in both groups were measured using the enzyme linked immunosorbent assay. The Montreal Cognitive Assessment (MoCA) and KINGs' Parkinsons' Disease Pain Scale (KPPS) were used to evaluate their cognitive function and pain. The receiver operating characteristic curve (ROC) was used to assess the value of the levels of IL-1β, α-synuclein, and TPX and score of KPPS in the evaluation of incidence of dementia. Paired t and χ² tests were used for the statistical analysis. Results　The patients in the PDCI group were older than the patients in the PDNC group (P<0.05). The serum levels of IL-1β and α-synuclein and score of KPPS in the PDCI group were higher were higher than those in the PDNC group (all P<0.05). The level of TPX in the PDCI group was lower than that in the PDNC group (P<0.05). The scores of all the dimensions and total score of MoCA in the PDCI group were lower than those in the PDNC group (all P<0.05). The total score of MoCA was negatively correlated with serum IL-1β and α-synuclein and score of KPPS (r=-0.413, -0.553, and -0.691; all P<0.05), and positively with serum TPX (r=0.799; P<0.05). The ROC analysis indicated that the combination of IL-1β, α-synuclein, TPX, and score of KPPS had an area under the curve of 0.973, a sensitivity of 98.0%, and a specificity of 97.3%. Conclusion　The abnormal expression of serum IL-1β, α-synuclein, and TPX, as well as pain symptoms, are closely related to cognitive impairment in patients with primary Parkinson's disease.

Clinical Research

Clinical effect of edaravone combined with Xingnaojing injection on neurological function in patients with subarachnoid hemorrhage

Gao Haohao, Li Pengju, Song Hujie

2025, 31(4):  608-612.  DOI: 10.3760/cma.j.cn441417-20240924-04017

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Objective　To investigate the protective effect of edaravone injection combined with Xingnaojing injection on nerve function in patients with subarachnoid hemorrhage and its clinical application value. Methods　A total of 120 patients with subarachnoid hemorrhage treated at Department of Neurology, Xi 'an Daxing Hospital from January 2021 to January 2023 were selected, and were divided into an experimental group and a control group by the random number table method, with 60 cases in each group. There were 38 males and 22 females in the experimental group; they were (67.30±3.13) years old; their disease course was (7.21±0.63) h. There were 33 males and 27 females in the observation group; they were (66.96±2.84) years old; their disease course was (6.49±0.77) h. The control group took routine treatment and intravenously dripped 30 mg of edaravone injection + 100 ml of NaCl injection, twice a day (in the morning and evening); in addition, the experimental group were intravenously dripped 20 ml of Xingnaojing injection + 250 ml of glucose injection, twice a day (in the morning and evening). Both groups were treated for 12 d. The clinical efficacies, inflammatory factors, oxidative stress, and neurological function before and after the treatment, and prognosis were compared between the two groups. χ² and t tests were used for the statistical analysis. Results　The total effective rate of the experimental group was higher than that of the control group [95.00% (57/60) vs. 78.33% (47/60)], with a statistical difference (χ²=7.211; P<0.05). After the treatment, the scores of National Institutes of Health Stroke Scale (NIHSS) and Glasgow Outcome Scale (GOS) in the experimental group were better than those in the control group (8.68±2.21 vs. 14.05±2.27 and 4.30±0.72 vs. 3.07±0.78), with statistical differences (t=13.146 and 9.010; both P<0.05). After the treatment, the levels of hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), superoxide dismutase (SOD), and malondialdehyde (MDA) in the experimental group were better than those in the control group, with statistical differences (t=11.379, 12.099, 38.859, and 15.217; all P<0.05). Conclusion　Edaravone injection combined with Xingnaojing injection for patients with subarachnoid hemorrhage can improve their oxidative stress and neurological function, reduce their inflammatory reaction, and increase the clinical treatment effect.

Ultra wide angle optical coherence tomography in diagnosis of retinal vein occlusion

Jiang Xuguang, Su Zhenghong

2025, 31(4):  612-617.  DOI: 10.3760/cma.j.cn441417-20240528-04018

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Objective　To explore the value of ultra wide angle optical coherence tomography (OCTA) in the diagnosis of patients with retinal vein occlusion (RVO). Methods　Seventy-eight ( 78 eyes ) patients with RVO taking examination and diagnosed at Xi'an Ai'er Ancient City Eye Hospital from January 2023 to January 2024 were selected for the retrospective study, including 43 males and 35 females who were (58.7±9.4) years old. All the patients underwent ultra wide angle OCTA and fluorescein angiography (FFA) within 2 weeks. The FFA results were set as the gold standard for clinical diagnosis. The value of ultra wide angle OCTA in the diagnosis of non-perfusion retinal areas was evaluated. The paired t test was used to analyze the differences in blood flow density characteristic parameters of the optic disc area between the affected and healthy sides of the subjects undergoing ultra wide angle OCTA. The analysis of variance was used to analyze the difference in non-perfusion areas between FFA and ultra wide angle OCTA. Results　There were no statistical differences in the areas of retinal layer, superficial vascular complex, and deep vascular complex between ultra wide angle OCTA and FFA (all P>0.05). The blood flow densities of the entire image of the optic disc area, the peripheral vessels of the optic disc, the capillaries of the entire image, the peripheral capillaries of the optic disc, the nasal side below, the temporal side below, the below temporal side, the above temporal side, the temporal side above, and the temporal side below on the affected sides of the patients with central retinal vein occlusion were lower than those on the healthy sides [(50.61±4.82)% vs. (55.17±5.20)%, (51.40±4.77)% vs. (57.37±5.00)%, (45.68±5.20)% vs. (48.93±4.88)%, (45.48±5.50)% vs. (50.30±6.23)%, (43.83±5.50)% vs. (48.29±7.23)%, (50.90±7.27)% vs. (57.34±7.86)%, (48.65±6.61)% vs. (53.43±6.93)%, (49.50±6.14)% vs. (54.63±7.22)%, (49.33±7.10)% vs. (55.38±7.50)%, (45.52±6.14)% vs. (49.58±6.85)%], with statistical differences (all P<0.05). The blood flow densities of the entire image of the optic disc area, the peripheral vessels of the optic disc, the capillaries of the entire image, the peripheral capillaries of the optic disc, the nasal side below, the temporal side below, the below temporal side, the above temporal side, the temporal side above, and the temporal side below on the affected sides of the patients with branch retinal vein occlusion were lower than those on the healthy sides [(52.33±5.14)% vs. (55.43±4.88)%, (52.30±5.15)% vs. (57.43±4.86)%, (46.77±4.98)% vs. (49.54±5.50)%, (46.13±6.62)% vs. (50.63±5.87)%, (44.18±5.87)% vs. (48.43±6.61)%, (51.39±6.98)% vs. (57.92±6.94)%, (49.66±6.21)% vs. (53.56±6.60)%, (49.50±6.33)% vs. (54.81±6.87)%, (49.89±7.09)% vs. (56.12±7.28)%, and (45.83±5.81)% vs. (50.75±6.43)%], with statistical differences (all P<0.05). The sensitivities of ultra wide angle OCTA for diagnosing non-perfusion areas in the patients with central retinal vein occlusion and branch retinal vein occlusion were 100.0% (35/35) and 81.4% (35/43), respectively; the specificities were 86.0% (37/43) and 100.0% (35/35), respectively. Conclusions　Ultra wide angle OCTA can examine the blood flow density characteristics of the optic disc areas in patients with RVO, and has high diagnostic value for non-perfusion of RVO. Moreover, ultra wide angle OCTA has non-invasive advantages over FFA.

Observation on effect of low frequency electrical stimulation on back combined with Ruyi Jinhuang Powder for patients with acute mastitis during lactation period

Zhong Yimin, Li Wenfang, Huang Huanrong, Zheng jieru, Xian Haiyan

2025, 31(4):  618-622.  DOI: 10.3760/cma.j.cn441417-20240628-04019

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Objective　To observe the effect of manual massage combined with low frequency electrical stimulation on the back and external application of Ruyi Jinhuang Powder in the treatment of patients with acute mastitis during lactation period. Methods　A total of 70 patients with acute mastitis during lactation period diagnosed at Panyu Maternal and Child Care Service Center from March to December 2023 were selected as the study objects. According to the treatment methods, they were divided into a control group and an observation group, with 35 cases in each group. The control group were (27.46±3.36) years old; 19 cases had pain on one side, and 16 cases on both sides. The observation group were (27.16±3.52) years old; 17 cases had pain on one side, and 18 cases on both sides. The control group were treated with manual massage and external application of Ruyi Jinhuang Powder; in addition, the observation group were treated with low-frequency electrical stimulation on the back. Both groups were treated for 3 d. The therapeutic effects, inflammation levels before and after the treatment, and the incidence rates of adverse reactions were compared between the two groups. t test was used for the statistical analysis. Results　The recovery time of body temperature, time for disappearance of breast swelling pain, milk clearing time, and swelling disappearance time in the observation group were shorter than those in the control group [(1.02±1.02) d vs. (2.89±1.25) d, (2.01±1.30) d vs. (3.89±1.45) d, (1.00±0.31) d vs. (2.89±0.78) d, and (2.03±1.04) d vs. (4.78±1.36) d], with statistical differences (t=6.163, 8.415, 6.487, and 7.102; all P<0.05). The levels of C-reaction protein (CRP), white blood cell count (WBC), and percentage of neutropils (NEUT%) in the observation group were lower than those in the control group [(3.00±1.03) mg/L vs. (8.23±1.25) mg/L, (6.10±1.22)×10⁹/L vs. (9.85±1.45)×10⁹/L, and (23.11±9.42)% vs. (35.15±10.02)%], with statistical differences (t=8.664, 8.265, and 9.184; all P<0.05). No complications occurred in both groups. Conclusion　Low frequency electrical stimulation on back combined with Ruyi Jinhuang Powder for patients with acute mastitis during lactation period is effective and safe, and has positive effect on inflammatory changes.

Effects of hyperbaric oxygen on proliferation, apoptosis, and HIF-1α/VEGF signaling pathway of endometrial cancer cells

Wang Wei, Ding Boyong

2025, 31(4):  622-626.  DOI: 10.3760/cma.j.cn441417-20240628-04020

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Objective　To investigate the effects of hyperbaric oxygen (HBO) on the proliferation and apoptosis of endometrial cancer (EC) cells, and to analyze the possible mechanism. Methods　From April 2022 to January 2023, the EC cell line RL95-2 was cultured in vitro and divided into a blank control group, an HBO group, a pathway activator group [100 μmol/L dimethylacetoylglycine (DMOG)], and an HBO + pathway activator group (HBO + 100 μmol/L DMOG). The MTT assay and flow cytometry were used to detect the cell proliferation and apoptosis. Western blot was used to detect the expressions of cell proliferation associated nuclear antigen (Ki-67), Bcl-2, Bax, and hypoxia inducible factor-1α/vascular endothelial growth factor (HIF-1α/VEGF) pathway related proteins. One-way analysis of variance was used for the statistical analysis. Results　The proliferation inhibition rates of the blank control group, the HBO group, the pathway activator group, and the HBO + pathway activator group were 0, (33.85±5.07)%, (-4.89±0.73)%, and (9.82±1.47)%, respectively, with a statistical difference between the 4 groups (F=244.919,P<0.001). The apoptosis rates of the four groups were (16.79±2.51)%, (34.65±5.18)%, (5.73±0.86)%, and (9.69±1.45)%, respectively, with a statistical difference (F=109.342; P<0.001). The proliferation inhibition rate, apoptosis rate, and Bax protein in the HBO group were higher than those in the blank control group, the HIF-1α/VEGF pathway protein was lower (all P<0.05). The proliferation inhibition rate, apoptosis rate, and Bax protein in the pathway activator group were lower than those in the blank control group, while the HIF-1α/VEGF pathway protein was higher (all P<0.05). Conclusions　HBO can inhibit EC cell proliferation and induce apoptosis. Its mechanism is related to the inhibition of the HIF-1α/VEGF pathway.

Influencing factors of hypotension after anesthesia in women taking cesarean section and construction of nomagram model

Nie Qinghua, Li Xiaolong, Zhu Bo, Dai Zhiming

2025, 31(4):  627-632.  DOI: 10.3760/cma.j.cn441417-20241008-04021

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Objective　To explore the influencing factors of hypotension after anesthesia in women taking cesarean section, and to construct a nomagram model. Methods　The clinical data of 269 women who underwent cesarean section at Xianyang First People's Hospital from April 2022 to June 2024 were retrospectively analyzed. According to whether they had hypotension after anesthesia, they were divided into a hypotension group (119 cases) and a non-hypotension group (150 cases). The hypotension group were (31.56±4.28) years old; their gestational weeks was (39.05±1.23) weeks; there were 80 cases of grade Ⅰ and 39 cases of grade Ⅱ of American Society of Anesthesiologists (ASA). The non-hypotension group were (30.69±4.03) years old; their gestational weeks was (38.84±0.96) weeks; there were 115 cases of grade Ⅰ and 35 cases of grade Ⅱ of ASA. The clinical data were compared between the two groups. The influencing factors of hypotension in the women after anesthesia were screened using the multiple Logistic regression analysis. A risk prediction nomagram model for hypotension after anesthesia was constructed by the R software and rms package. The clinical application value of the model was validated using the calibration curves, receiver operating characteristic curves (ROC), and decision analysis curves. t and χ² tests were used for the statistical analysis. Results　The proportions of the women with maternal abdominal circumference >100 cm, uterine height >36 cm, and anesthesia level >T4 and the intraoperative bleeding volume in the hypotension group were higher than those in the non-hypotension group [89.08% (106/119) vs. 80.00% (120/150), 11.76% (14/119) vs. 4.00% (6/150), 20.17% (24/119) vs. 8.67% (13/150), and (326.52±65.39) ml vs. (301.43±62.68) ml], with statistical differences (χ²=4.070, 5.813, and 7.399; t=3.199; all P<0.05). The prenatal hemoglobin level and the proportions of the women with left lateral tilt of position and prophylactic medication in the hypotension group were lower than those in the non-hypotension group [(125.95±13.46) g/L vs. (132.53±12.68) g/L, 71.43% (85/119) vs. 88.67% (133/150), and 56.30% (67/119) vs. 76.67% (115/150)], with statistical differences (t=4.113; χ²=12.833 and 12.576; all P<0.05). The multivariate logistic regression analysis showed that uterine height > 36 cm, low prenatal hemoglobin level, big intraoperative bleeding volume, and anesthesia level > T4 were the risk factors for hypotension after cesarean section (OR=1.808, 1.906, 1.866, and 2.268; all P<0.05), while left lateral tilt of position and prophylactic medication were the protective factors for it (OR=0.510 and 0.490; both P<0.05). The internal validation showed that the model's consistency index was 0.868; the calibration curve showed that the calibration curve was close to the ideal curve; the ROC showed that its sensitivity, specificity, and area under the curve were 86.67%, 80.71%, and 0.867%, respectively; the decision curve analysis showed that when the threshold probability was between 0.52 and 0.80, the model could obtain a good net profit value. Conclusions　Uterine height >36 cm, low prenatal hemoglobin level, big intraoperative bleeding volume, anesthesia level >T4, left lateral tilt of position, and prophylactic medication are all the factors affecting the occurrence of hypotension in women taking cesarean section after anesthesia. The nomagram model constructed based on this has high clinical application value, and can help clinicians screen high-risk cesarean section women who experience hypotension after anesthesia in the early stage and guide clinical work.

Effect of lncRNA GAS6-AS1 on malignant biological behaviors of cervical cancer cells regulating miR-330-5p/PTBP1 axis

Wang Cancan, Li Fei, Wang Jinglong, Pan Ke

2025, 31(4):  633-640.  DOI: 10.3760/cma.j.cn441417-20240820-04022

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Objective　To investigate the effect of long chain non-coding RNA (lncRNA) GAS6-AS1 on the malignant biological behaviors of cervical cancer cells regulating the miR-330-5p/polypyrimidine string binding protein 1 (PTBP1) axis. Methods　The experiment was conducted from February to December 2023. The cancer tissue and adjacent tissue of 26 patients with cervical cancer treated at Affiliated Hospital of Shaanxi University of Chinese Medicine from July 2021 to June 2023 were collected. The cervical cancer MS751 cells were divided into a control group, an sh-NC group, an sh-GAS6-AS1 group, an sh-GAS6-AS1+inhibitor NC, group, an sh-GAS6-AS1+miR-330-5p inhibitor group, an sh-GAS6-AS1+oe-NC group, and an sh-GAS6-AS1+oe-PTBP1 group. The expression levels of GAS6-AS1, miR-330-5p, and PTBP1 mRNA in the cells and tissues were detected by the real-time fluorescence quantitative polymerase chain reaction (RT-PCR). The cell proliferation was detected by the cell counting kit 8 (CCK-8 method). The cell migration and invasion were detected by the transwell experiment. The cell apoptosis rate was detected by the flow cytometry. Western blot was applied to detect the expression levels of tumor proliferation antigen (Ki67), Bcl-2 associated X protein (Bax), B lymphoblastoma-2 gene (Bcl-2), matrix metalloproteinase 2 (MMP-2) and PTBP1 proteins in the cells. The targeted relationship of miR-330-5p with GAS6-AS1 and PTBP1 was verified. t test, one-way ANOVA, and SNK-q test were used for the statistical analysis. Results　There were statistical differences in the expression levels of GAS6-AS1, miR-330-5p, and PTBP1 mRNA between the cervical cancer tissue and adjacent tissue (1.84±0.17 vs. 1.03±0.09, 0.34±0.03 vs. 0.98±0.07, 2.13±0.22 vs. 1.06±0.10; all P<0.05). The PTBP1 positive expression rate in the cancer tissue was higher than that in the adjacent tissue [(68.46±7.82)% vs. (21.83±2.79)%; P<0.05]. Compared with those in the normal human cervical epithelial cells H8, the expressions of GAS6-AS1 and PTBP1 mRNA were increased, and the expression of miR-330-5p was decreased in the cervical cancer cells (all P<0.05). The expressions of GAS6-AS1 and PTBP1 mRNA, the value of A₄₅₀ (24 and 48 h), the numbers of cell migration and invasion, and the expressions of Ki67, Bcl-2, MMP-2, and PTBP1 protein in the MS751 cells in the sh-GAS6-AS1 group were lower than those in the sh-NC group. The expression of miR-330-5p, apoptosis rate, and Bax protein expression in the sh-GAS6-AS1 group were higher than those in the sh-NC group (all P<0.05). Knocking down miR-330-5p expression or upregulating ANXA2 expression while downregulating GAS6-AS1 was able to weaken the inhibitory effect of downregulating GAS6-AS1 on the behaviors of the MS751 cells (both P<0.05). Conclusion　Interference with GAS6-AS1 expression can regulate the miR-330-5p/PTBP1 axis, thereby inhibiting the proliferation, migration, and invasion of cervical cancer cells and promoting apoptosis.

Bushen Huoxue Formula combined with western medicine in treatment of patients with ovulation disorder infertility of Shenxu Xueyu type

Hu Ting, Zhang Jia, Liu Na

2025, 31(4):  641-644.  DOI: 10.3760/cma.j.cn441417-20240809-04023

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Objective　To observe the therapeutic effect of Bushen Huoxue Formula combined with western medicine in the treatment of patients with ovulation disorder infertility of Shenxu Xueyu type. Methods　Eighty patients with ovulation disorder infertility of Shenxu Xueyu type treated at Yan'an Hospital of Traditional Chinese Medicine from January 2020 to May 2023 were selected for the randomized controlled trial, and were divided into an experimental group and a control group, with 40 cases in each group. The patients in the control group were (26.87±9.55) years old; their disease course was (1.95±0.63) years; their body mass index was (24.87±3.58) kg/m²; their basic body temperature was (36.12±1.32) ℃; their menstruation volume was (17.12±2.67) ml. The patients in the experimental group were (27.62±8.79) years old; their disease course was (2.04±0.50) years; their body mass index was (25.62±2.59) kg/m²; their basic body temperature was (36.25±0.97) ℃; their menstruation volume was (16.27±3.85) ml. The control group took clomiphene citrate, while the experimental group took clomiphene citrate and Bushen Huoxue Formula. Each treatment course lasted 5 days; both groups were treated 8 courses. The endometrial thicknesses, follicle counts, maximum follicle diameters, and serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E₂) before and after the treatment, treatment efficacies, and adverse reactions in both groups were recorded. t and χ² tests were used for the statistical analysis. Results　After the treatment, the endometrial thickness, follicle count, maximum follicle diameter, and serum levels of FSH, LH, and E₂ in the experimental group were higher than those in the control group [(9.17±3.62) mm vs. (7.07±2.06) mm, 6.80±2.57 vs. 4.19±2.66, (16.81±3.42) mm vs. (15.29±3.19) mm, (9.91±2.56) IU/L vs. (8.82±1.69) IU/L, (10.61±2.39) IU/L vs. (7.62±3.31) IU/L, and (89.12±13.46) ng/L vs. (65.14±15.56) ng/L; t=3.189, 4.463, 2.056, 2.247, 4.623, and 7.372; all P<0.05]. The total effective rate in the experimental group was higher than that in the control group [85.00% (34/40) vs. 57.50% (23/40); χ²=6.102; P=0.014]. The overall incidence rate of adverse reactions in the experimental group was lower than that in the control group [5.00% (2/40) vs. 27.50% (11/40); χ²=5.878; P=0.015]. Conclusion　Bushen Huoxue Formula combined with western medicine in the treatment of patients with ovulation disorder infertility of Shenxu Xueyu type is effective.

Influencing factors of secondary hypothyroidism in patients with differentiated thyroid cancer after secondary surgery

Zhao Li, Ma Juli, Su Yanjin, Yuan Xiuli

2025, 31(4):  645-649.  DOI: 10.3760/cma.j.cn441417-20240702-04024

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Objective　To explore the factors influencing secondary hypothyroidism in patients with differentiated thyroid cancer after secondary surgery, and to develop a risk prediction model to guide clinical practice. Methods　One hundred and twenty patients who underwent secondary thyroid surgery at Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from January 2022 to January 2024 were selected for the retrospective study. According to whether they had secondary hypothyroidism after the surgery, the patients were divided into a hypothyroidism group (43 cases) and a non-hypothyroidism group (77 cases). The ages, genders, surgical types, lesion location and nature, clinical stages, and lymph node dissection were compared between the two groups. The multivariate logistic regression analysis was used to identify the risk factors of hypothyroidism. A risk prediction model was developed using the R software; its sensitivity and specificity were evaluated by the receiver operating characteristic curve (ROC), and was validated through 1 000 Bootstrap sampling. t and χ² tests were used for the statistical analysis. Results　There were statistical differences in age, gender, lesion location and nature, surgical type, lymph node dissection, and family history of thyroid disease between the two groups (all P<0.05). The multivariate logistic regression analysis showed that older age, female, bilateral lesions, malignant tumor, total thyroidectomy, and family history of thyroid disease were the risk factors of hypothyroidism. The ROC revealed that the area under the curve of the this model was 0.941, with a sensitivity of 95.3% and a specificity of 77.9%. The Bootstrap validation confirmed the model's accuracy, with a mean absolute error of 0.037. Conclusion　The construction of a risk prediction model for secondary hypothyroidism in patients with differentiated thyroid cancer after secondary surgery is not only feasible but also clinically valuable.

Effect of physical activity on arteriovenous fistula thrombosis in patients taking maintenance hemodialysis

Zhao Yina, Huang Huigen, Li Caixia, Song Li, Zhou Lifang, Du Zhenping, Cai Shaona, Fu Xia

2025, 31(4):  650-657.  DOI: 10.3760/cma.j.cn441417-20240801-04025

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Objective　To determine the impact of physical activity on the arteriovenous fistula (AVF) thrombosis in patients taking maintenance hemodialysis (MHD), and to provide new strategies for the management of fistula. Methods　The convenient sampling method was used. The physical activity of 274 patients taking MHD at Guangdong Provincial People's Hospital from October to December 2021 were investigated. According to whether the patients had AVF thrombosis, they were divided into a thrombosis group (31 cases) and a non-thrombosis group (243 cases). There were 20 males and 11 females in the thrombosis group; they were (56.19±12.77) years old. There were 157 males and 86 females in the non-thrombosis group; they were (57.55±14.04) years old. The patients were followed up with AVF thrombosis as the primary endpoint until December 31, 2022. t test, χ² test, and analysis of variance were used to compare the differences between the two groups. The Cox proportional hazard regression model and restricted cubic splines were used to assess the effect of physical activity on AVF thrombosis. Results　There were no statistical differences in the basic data between the two groups (all P>0.05).The proportion of the patients with dysfunction history in the thrombosis group was higher than that in the non-thrombosis group [58.1% (18/31) vs. 26.3% (64/243)], with a statistical difference (χ²=13.197, P<0.01). Among the 274 patients, 85 (31.0%) had insufficient physical activity, 116 (42.4%) moderate physical activity, and 73 (26.6%) active physical activity. The Cox proportional risk model showed that physical activity was a factor affecting AVF thrombosis (HR=0.274, 95%CI 0.097-0.711, P=0.014). The limited cubic spline showed that the nonlinear relationship between physical activity and thrombosis was not significant (χ²=4.960, P_nonlinear=0.084). Conclusion　Compared with insufficient physical activity, active physical activity can reduce AVF thrombosis, suggesting that medical personnel can reduce the formation of AVF thrombosis increasing patients' physical activity.

Value of conventional inflammatory markers and novel inflammation indicators in prediction of urinary tract infections in patients with diabetic nephropathy and uremia

Zhang Shijie, Kang Yunhui, Zhang Yanzi, Zhang Kaige, Wang Jingyuan

2025, 31(4):  658-663.  DOI: 10.3760/cma.j.cn441417-20240729-04026

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Objective　To explore the value of conventional inflammatory markers and novel inflammation indicators in the prediction of urinary tract infections in patients with diabetic nephropathy and uremia. Methods　One hundred and twenty-two patients with diabetic nephropathy and uremia treated at First Affiliated Hospital of Xi'an Jiaotong University from January to December 2022 were selected for the randomized controlled trial, and were divided into an infected group (45) and an uninfected group (77 cases) according to whether they had urinary tract infections. The basic data and levels of conventional inflammatory markers and novel inflammation indicators [systemic immune-inflammation index (SII), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR)] were compared between the two groups. The logistic regression analysis was used to identify the factors influencing urinary tract infections in the patients. A nomogram model was constructed, and its fit was assessed. χ² and t tests were used for the statistical analysis. Results　The levels of interleukin-6, C-reaction protein, and tumor necrosis factor-α in the infected group were (17.70±2.31) ng/L, (15.49±2.23) mg/L, and (6.98±1.25) ng/L, which were higher than those in the uninfected group (all P<0.05). The SII, NLR, PLR, and LMR in the infected group were 1 569.54±362.82, 3.13±0.71, 165.25±24.26, and 3.48±0.66, which were higher than those in the uninfected group (all P<0.05). The blood glucose levels, inflammatory marker levels, SII, NLR, PLR, and MLR were factors influencing the occurrence of urinary tract infections in the patients with diabetic nephropathy undergoing dialysis (all P<0.05). The calibration curve showed an average absolute error of 0.018, indicating high predictive accuracy. Conclusion　Inflammatory levels in patients with diabetic nephropathy and uremia can affect the occurrence of urinary tract infections.

Establishing a risk prediction model for adverse outcomes of bacterial meningitis using clinical features and biochemical indicators

Li Bo, Chi Jie, Gao Meng

2025, 31(4):  663-668.  DOI: 10.3760/cma.j.cn441417-20240913-04027

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Objective　To analyze the clinical characteristics and biochemical indicators of children with bacterial meningitis, and to construct a risk prediction model for poor outcomes. Methods　A retrospective analysis was conducted on the clinical data of 274 children with bacterial meningitis treated at Shaanxi Provincial People's Hospital from September 2020 to May 2024. There were 156 boys and 118 girls. They were 0-18 years old. The children were divided into a poor outcome group and a good outcome group based on the in-hospital treatment outcomes. The clinical characteristics and biochemical indicators of the two groups were compared, and the risk factors for poor outcomes were analyzed. A nomogram model for predicting the risk of adverse outcomes in the children with bacterial meningitis was established using the clinical features and biochemical indicators. The model's discrimination, predictive performance, and practicality were evaluated. Mann-Whitney U test, t test, band χ² test were used for the statistical comparisons. The model's discriminability was evaluated by the receiver operating characteristic curve and the area under the curve. The model's performance was assessed by the calibration curve and Hosmer-Lemeshow test. The model's practicality was evaluated by the decision curve analysis. Results　Among the 274 children, 65 cases had poor outcomes, with a poor outcome rate of 23.72%. Repeated convulsive seizures, cerebrospinal fluid protein > 1 g/L, decreased cerebrospinal fluid glucose/blood glucose, and positive blood/cerebrospinal fluid bacterial culture were risk factors for the childrens poor outcomes  (all P<0.05). A nomogram model was established to predict the risk of adverse outcomes in the children with bacterial meningitis based on the four risk factors mentioned above. The receiver operating characteristic curve showed that the area under the curve predicted by the model was 0.855 (95%CI 0.808-0.895). The calibration curve showed that the predicted curve of the model had the same and close direction as the ideal curve; the Hosmer-Lemeshow test showed that the predicted probability of poor outcomes was close to the actual probability of poor outcomes (P=0.394). The decision analysis curve showed that the application of the model prediction had good value when the high-risk threshold was between 0.06 and 0.77. Conclusions　A nomogram model for predicting poor outcomes of children with bacterial meningitis is constructed based on the four risk factors, including repeated convulsive seizure, cerebrospinal fluid protein, cerebrospinal fluid glucose/blood glucose, and blood/CSF bacterial culture; it is confirmed that the model has good application value for predicting poor outcomes.

Clinical effect of targeted therapy with rituximab for patients with locally advanced nasopharyngeal carcinoma

Zhang Yu, Zhang Kaishuo, Cao Hongyou, Gao Shan

2025, 31(4):  669-673.  DOI: 10.3760/cma.j.cn441417-20240727-04028

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Objective　To explore the clinical effect of targeted therapy with rituximab combined with nedaplatin chemotherapy and concurrent radiotherapy for patients with locally advanced nasopharyngeal carcinoma. Methods　Sixty-five patients with locally advanced nasopharyngeal carcinoma treated at Hanzhong Central Hospital and Ankang People's Hospital from August 2016 to December 2020 were selected for the randomized controlled trial, and were divided into a control group (33 cases) and an observation group (32 cases) by the random number table method. Three cases in the control group and 2 in the observation group lost to the follow up, with 30 cases in each group. There were 16 males and 14 females in the control group; they were (45.54±5.43) years old. There were 17 males and 13 females in the observation group; they were (46.02±5.47) years old. The control group took radiotherapy and nedaplatin chemotherapy. The observation group took radiotherapy, nedaplatin chemotherapy, and targeted treatment with nituzumab. The clinical efficacies, levels of biochemical indicators [white blood cell count (WBC), platelet count (PLT), and alanine transaminase (ALT)], serum epidermal growth factor like domain 7 (EGFL7), vascular endothelial growth factor (VEGF), and transforming growth factor β 1 (TGF - β 1) before the treatment and after 3 months' follow-up, adverse reactions during the follow-up period, recurrence rates, and survival status (3 years' follow-up) were compared between the two groups. χ² and t tests were used for the statistical analysis. Results　The total effective rate in the observation group was higher than that in the control group [70.0%(21/30) vs. 43.3%(13/30)], with a statistical difference (χ²=4.344; P=0.037). Before the treatment, there were no statistical differences in the levels of biochemical indicators and serum EGFL7, VEGF, and TGF-β1 between the two groups (all P>0.05). After 3 months' follow up, the levels of ALT, EGFL7, VEGF, and TGF-β1 in the observation group were lower than those in the control group [(44.65±6.54) U/L vs. (73.87±6.87) U/L, (48.65±7.54) μg/L vs. (60.98±1.98) μg/L, (188.65±18.54) ng/L vs. (209.09±27.65) ng/L, and (18.65±1.43) mg/L vs. (35.76±4.32) mg/L], with statistical differences (t=16.873, 8.663, 3.363, and 20.594; all P<0.05). During the follow up, the incidence rates of WBC decrease and nausea and vomiting in the observation group were lower than those in the control group [10.0% (3/30) vs. 63.3% (19/30) and 6.7% (2/30) vs. 30.0% (9/30)], with statistical differences (χ²=18.373 and 5.455; both P<0.05). There were no statistical differences in the recurrence rate and survival rate during the 3-year follow-up between the two groups (both P>0.05). Conclusion　Targeted therapy with rituximab combined with nedaplatin chemotherapy and concurrent radiotherapy for patients with locally advanced nasopharyngeal carcinoma can effectively regulate their serum levels of EGFL7, VEGF, and TGF-β1, control disease progress, improve treatment effect, and decrease the incidence of adverse reactions, and has minimal impact on their liver function.

Correlation of TyG index, Hcy, and folate metabolism genes with stroke

Yi Wenhui, Wang Kaiyue, Chen Xiao

2025, 31(4):  674-679.  DOI: 10.3760/cma.j.cn441417-20240929-04029

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Objective　To investigate the correlation of peripheral blood triglyceride glucose (TyG) index, serum homocysteine (Hcy), and folate metabolism genes with stroke. Methods　This was a case control study. Ninety-five patients with stroke treated at Xi'an Hospital of Traditional Chinese Medicine and Cerebral Diseases from February 2022 to February 2024 were selected as a study group, including 49 males and 46 females who were (59.96±4.92) years old. Ninety-five healthy examinees at Xi'an Hospital of Traditional Chinese Medicine and Cerebral Diseases in the same period were selected as a control group according to the ratio of 1:1, including 51 males and 44 females who were (59.95±4.85) years old. The clinical data of the two groups were collected. The peripheral blood TyG index, serum level of Hcy, and folate metabolism gene polymorphisms were detected. The risk factors for the development of stroke were analyzed. The statistical methods used were independent samples t test, χ² test, one-way analysis of variance, logistic regression analysis, and Hardy-Weinburg balance test. Results　The proportions of the patients with body mass index (BMI) ≥ 28 kg/m², hyperlipidemia, diabetes mellitus, hypertension, history of alcohol consumption, and smoking history, peripheral blood TyG index, and serum level of Hcy in the study group were higher than those in the control group [24.21% (23/95) vs. 7.37% (7/95), 25.26% (24/95) vs. 9.47% (9/95), 21.05% (20/95) vs. 8.42% (8/95), 48.42% (46/95) vs. 16.84% (16/95), 23.16% (22/95) vs. 9.47% (9/95), 28.42% (27/95) vs. 11.58% (11/95), 1.67±0.44 vs. 1.03±0.25, and (25.54±6.79) μmol/L vs. (10.22±2.16) μmol/L], with statistical differences (all P<0.05). The frequencies of TT genotype at MTHFR C677T locus and GG genotype at MTRR A66G locus in the study group were higher than those in the control group [42.11% (40/95) vs. 14.74% (14/95) and 38.95% (37/95) vs. 18.95% (18/95)], with statistical differences (both P<0.05). The logistic regression analysis showed that hyperlipidemia (OR=1.627), diabetes mellitus (OR=1.659), hypertension (OR=1.706), history of alcohol consumption (OR=1.637), history of smoking (OR=1.455), high peripheral blood TyG index (OR=1.510), high serum Hcy level (OR=1.820), and the TT genotype of the MTHFR C677T locus (OR=1.799) were the independent risk factors for the development of stroke (all P<0.05). Conclusion　Stroke is strongly associated with peripheral blood TyG index, high serum level of Hcy, and TT genotype at the MTHFR C677T locus.

Effect of lithotripsy assisted by physical vibration stone removal machine in treatment of elderly patients with complex renal calculi 

Wu Lifeng, Yuan Wenbing, Xiong Haijun

2025, 31(4):  679-683.  DOI: 10.3760/cma.j.cn441417-20240723-04030

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Objective　To explore the the clinical effect of lithotripsy assisted by a physical vibration stone removal machine in the treatment of elderly patients with complex renal calculi. Methods　One hundred and twenty elderly patients with complex renal calculi treated at Baoji People's Hospital from January 2021 to January 2024 were selected for the randomized controlled trial, and were divided into a control group and a study group by the random number table method, with 60 cases in each group. There were 38 males and 22 females in the control group; they were (71.8±4.8) years old. There were 35 males and 25 females in the study group; they were (72.3±4.5) years old. The control group underwent conventional lithotripsy; in addition, the study group were treated by the physical vibration stone expulsion machine. The one-time stone clearance rates, operation times, lithotripsy times, times for off-bed activity, hospitalization times, and bleeding volumes during the operation, levels of oxidative stress markers [malonaldehyde (MDA), cortisol (Cor), and superoxide dismutase (SOD)] and inflammatory cytokines [C-reaction protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α)], and the incidence rates of complications were compared between the two groups by t and χ² tests. Results　There was no statistical difference in the one-time stone clearance rate between the study group and the control group [100.0% (60/60) vs. 96.7% (58/60); χ²=2.033; P=0.153]. There was no statistical difference in the operation time between the two groups (P>0.05). The lithotripsy time, time for off-bed activity, hospitalization time, and bleeding volume during the operation in the study group were lower than those in the control group [(80.12±10.05) min vs. (85.33±11.02) min, (31.51±4.02) h vs. (42.26±6.11) h, (5.41±0.24) d vs. (6.95±0.36) d, and (82.44±11.14) ml vs. (101.34±20.33) ml], with statistical differences (t=2.705, 11.385, 27.570, and 6.315; all P<0.05). There were no statistical differences in the the levels of oxidative stress markers and inflammatory cytokines between the two groups before the treatment. After the treatment, the levels of MDA, Cor, CRP, IL-6, TNF-α, and SOD in the study group were better than those in the control group [(7.90±1.25) nmol/L vs. (10.11±1.03) nmol/L, (241.20±10.34) μg/L vs. (280.84±12.25) μg/L, (18.52±2.17) mg/L vs. (25.03±3.14) mg/L, (5.41±0.14) ng/L vs. (8.01±0.13) ng/L, (60.46±5.12) nmol/ml vs. (81.03±6.31) nmol/ml, and (68.82±6.61) NU/ml vs. (63.26±6.55) NU/ml], with statistical differences (t=10.569, 19.154, 13.211, 105.415, 4.186, and 4.628; all P<0.05). There was no statistical difference in the incidence rate of postoperative complications between the control group and the study group [6.67%(4/60) vs. 3.33%(2/60); P>0.05]. Conclusion　Lithotripsy assisted by a physical vibration stone removal machine in the treatment of elderly patients with complex renal calculi can improve the operation efficacy and the success rate of stone removal, shorten the operation time, and decrease the risk of complications.

Human-like collagen repair dressings combined with dupilumab for children with moderate to severe atopic dermatitis

Yang Lijuan, Ma Fang

2025, 31(4):  684-688.  DOI: 10.3760/cma.j.cn441417-20240723-04031

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Objective　To explore the effect of human-like collagen repair dressings combined with dupilumab for children with moderate to severe atopic dermatitis. Methods　One hundred and sixteen children with moderate to severe atopic dermatitis treated at Northwest Women's and Children's Hospital from February 2021 to August 2023 were selected for the randomized controlled trial, and were divided into a control group and an experimental group by lottery, with 58 cases in each group. There were 29 males and 29 females in the control group; they were (5.78±2.34) years old. There were 29 males and 29 females in the experimental group; they were (5.82±2.28) years old. The control group were treated with dupilumab, while the experimental group with human-like collagen repair dressings and dupilumab. The treatment efficacies, symptom improvement (skin dryness, itching, and skin lesions), skin barrier function [sebum content, moisture content, and transepidermal water loss (TEWL)], scores of Scoring Atopic Dermatitis (SCORAD), scores of Investigator's Global Assessment (IGA), scores of Eczema Area and Severity Index (EASI), and quality of life [Children's Dermatology Life Quality Index (CDLQI) and Infant Dermatitis Quality of Life Index (IDQOL)] were compared between the two groups using t and χ² tests. Results　The overall treatment efficacy in the experimental group was higher than that in the control group [96.55% (56/58) vs. 81.03% (47/58)], with a statistical difference (χ²=7.017; P=0.008). The improvement times for skin dryness, itchiness, and lesions in the experimental group were shorter than those in the control group [(5.56±1.77) d vs. (7.06±2.16) d, (10.56±2.73) d vs. (12.09±2.16) d, and (7.58±2.06) d vs. (10.73±2.27) d], with statistical differences (t=4.091, 3.347, and 7.826; all P<0.05).After the treatment, the sebum content, hydration level, and TEWL in the experimental group were better than those in the control group [(84.22±12.24) μg/cm² vs. (65.47±10.31) μg/cm², (46.35±8.17)% vs. (37.40±7.75)%, (15.87±2.14) g/(h·cm²) vs. (19.76±2.94) g/(h·cm²)], with statistical differences (t=8.923, 6.053, and 8.147; all P<0.05). After the treatment, the scores of SCORAD, IGA, EASI, CDLQI, and IDQOL in the experimental group were lower than those in the control group (18.52±7.98 vs. 23.12±8.49, 1.53±0.74 vs. 2.02±0.61, 5.75±0.94 vs. 7.92±1.26, 3.92±0.53 vs. 9.19±1.31, and 4.68±0.37 vs. 8.83±1.26), with statistical differences (t=3.007, 3.891, 10.513, 28.401, and 24.067; all P<0.05). Conclusion　Human-like collagen repair dressings combined with dupilumab for children with moderate to severe atopic dermatitis can improve their skin symptoms, barrier function, and life quality, and reduce relevant scores.

Effect of PDCA cycle method on rational application of antibiotics in pediatric inpatients with infections

Wu Mingyu

2025, 31(4):  689-691.  DOI: 10.3760/cma.j.cn441417-20240823-04032

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Objective　To explore the effect of the PDCA (plan, do, check, and act) cycle method on rational application of antibiotics in pediatric inpatients with infections. Methods　This was a cohort study. One hundred and fifty-six inpatients with infections treated at Department of Pediatrics, Hongyang Town Health Center from January to June 2023 were selected as a control group, and 164 inpatients with infections from July to December 2023 an experimental group. In the control group, there were 82 boys and 74 girls; they were (2.40±0.82) years old; there were 79 cases of respiratory tract infections, 38 cases of digestive tract infections, and 39 cases of other infections. In the experimental group, there were 89 boys and 75 girls; they were (2.35±0.93) years old; there were 85 cases of respiratory tract infections, 33 cases of digestive tract infections, and 46 cases of other infections. The control group used antibiotics according to the routine pediatric process. The experimental group improved the application of antibiotics for the children by the PDCA cycle method. The antibiotic use rates, the rates for using ≥2 antibiotics, hospitalization times, proportions of antibiotic cost to hospitalization cost, and incidence rates of antibiotic complications (rash and antibiotics-associated diarrhea) were compared between the two groups. t and χ² tests were used for the statistical analysis. Results　The antibiotic use rate, the rate for using ≥2 antibiotics, and proportion of antibiotic cost to hospitalization cost in the experimental group were lower than those in the control group [44.51% (73/164) vs. 66.03% (103/156), 34.14% (56/164) vs. 57.05% (89/156), and 18.19% vs. 40.17%; χ²=14.95, 20.64, and 19.52; all P<0.05]. The hospitalization time in the experimental group was shorter than that in the control group [(6.98±2.76) d vs. (13.01±4.35) d; t=14.06; P<0.05]. The incidence rates of rash and antibiotics-associated diarrhea in the experimental group were lower than those in the control group [27.43% (45/164) vs. 48.71% (76/156) and 19.51% (32/164) vs. 43.58% (68/156); χ²=18.50 and 24.73; both P<0.05]. Conclusion　The PDCA cycle method can improve the the rational use of antibiotics for pediatric inpatients with infections.

Case Report

One case of methylmalonic acidemia with constipation and weight loss as first symptoms and literature analysis

Jiang Meng, Zhao Jingru, Liu Hui, Liu Qingxin

2025, 31(4):  692-695.  DOI: 10.3760/cma.j.cn441417-20240726-04033

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Methylmalonic acidemia is an autosomal recessive genetic disease with abnormal methylmalonyl-CoA mutase metabolism. At present, neuropathy or metabolic acidosis have been reported as the first symptoms of the disease. This article reports and analyzes one case of methylmalonic acidemia with constipation as the first symptoms treated at Binzhou Medical University Hospital on September 18, 2023, hoping to provide help for early detection and treatment of methylmalonic acidemia.

Effect of enhanced recovery after surgery for women after cesarean section

Shi Yanhong, Liu Yanpei, Zhao Songwei

2025, 31(4):  696-700.  DOI: 10.3760/cma.j.cn441417-20240914-04034

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Objective　To explore the effect of enhanced recovery after surgery (ERAS) for women after cesarean section. Methods　Ninety-two women who underwent cesarean section in Qinling Hospital, Zhengzhou Maternal and Child Health Hospital from April 2022 to June 2024 were selected for the randomized controlled trial, and were divided into a traditional management group and an ERAS group by lottery, with 46 cases in each group. The traditional management group were (27.93±3.76) years old and 37-41 (38.72±1.52) weeks pregnant, and received traditional obstetric postoperative management. The ERAS group were (28.07±3.23) years old and (39.02±1.36) weeks pregnant, and took ERAS. The operation outcomes, early off-bed activity, breastfeeding, uterine recovery, and postoperative complications were compared between the two groups. t test, χ² test, and Fisher exact probability test were used for the statistical analysis. Results　The score of the Visual Analogue Scale and vaginal bleeding volume 24 h after the surgery in the ERAS group were lower than those in the traditional management group (both P<0.05). The first exhaust time and time for first off-bed activity in the ERAS group were shorter than those in the traditional management group (both P<0.05). The rate of departure from bed 24 h after the surgery in the ERAS group was higher than that in the traditional management group [54.35% (25/46) vs. 28.26% (13/46); P<0.05]. The lactation initiation time and uterine recovery time in the ERAS group were shorter than those in the traditional management group (both P<0.05). The lactation adequacy rate and exclusive breastfeeding rate 3 d after delivery in the ERAS group were higher than those in the traditional management group [76.09% (35/46) vs. 52.17% (24/46) and 67.39% (31/46) vs. 43.48% (20/46); both P<0.05]. The incidence rate of postoperative complications in the ERAS group was 2.17% (1/46), and that in the traditional management group 6.52% (3/46), with no statistical difference (P>0.05). Conclusion　ERAS can promote the early off-bed activity of women after cesarean section, increase the breastfeeding rate, promote their uterine recovery, and improve their surgical outcomes, and is safe.

Nursing Research

Effect of Chinese medicine characteristic nursing care combined with multi-pathway special continuous management for patients taking amputated finger replantation

Wang Lina, Yang Yang, He Dingding

2025, 31(4):  700-704.  DOI: 10.3760/cma.j.cn441417-20240920-04035

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Objective　To explore the intervention effect of Chinese medicine characteristic nursing care combined with multi-pathway special continuous management for patients taking amputated finger replantation. Methods　Sixty-four patients who underwent amputated finger replantation at Kaifeng People's Hospital from April 2021 to March 2023 were selected for the randomized controlled trial, and were divided into a combined group and a conventional group by the random number table method, with 32 cases in each group. There were 16 males and 16 females in the combined group; they were (40.58±1.15) years old. There were 18 males and 14 females in the conventional group; they were (40.63±1.18) years old. The conventional group took the traditional routine care. The combined group took the traditional Chinese medicine characteristic nursing care and multi-pathway special continuous management. The pain levels [Numerical Rating Scale (NRS)], functional recovery status of fingers, quality of life [Quality of Life Index (QOL)], and incidence rates of complications were compared between the two groups. t and χ² tests were used for the statistical analysis. Results　One, three, and six months after the surgery, the scores of NRS in the combined group were lower than those in the conventional group (3.87±0.24 vs. 4.76±0.31, 3.05±0.21 vs. 4.19±0.27, and 2.96±0.18 vs. 3.85±0.23; t=12.842, 18.853, and 17.238; all P<0.001). One, three, and six months after the surgery, the scores of functional recovery status of fingers in the combined group were higher than those in the conventional group (83.15±4.52 vs. 79.03±4.08, 91.15±3.18 vs. 87.47±2.92, and 96.51±1.26 vs. 90.62±1.21; t=3.828, 4.822, and 19.073; all P<0.001). After the nursing care, the scores of exercise, daily living, support, and general conditions in the combined group were higher than those in the conventional group (8.76±0.58 vs. 7.08±0.49, 8.62±0.55 vs. 6.94±0.43, 7.86±0.53 vs. 6.77±0.42, and 8.67±0.56 vs. 7.24±0.52; t=12.517, 13.613, 9.118, and 10.585; all P<0.001). The incidence rate of complications in the combined group was lower than that in the conventional group [9.38% (3/32) vs. 34.38% (11/32); χ²=5.851; P=0.016]. Conclusion　Traditional Chinese medicine characteristic nursing care combined with multi-pathway special continuous management for patients taking amputated finger replantation can alleviate their postoperative pain, accelerate their recovery of finger function, and improve their quality of life, and reduce the occurrence of complications.