Table of Content

01 March 2025, Volume 31 Issue 5

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Special Column of Urology and Reproduction

Meta-analysis of the application effect of web-based decision aids in treatment decisions for prostate cancer patients

Chen Yuan, Gao Mengxin, Wang Jing, Chen Yunqing, Cai Chao, Sun Hongling

2025, 31(5):  706-712.  DOI: 10.3760/cma.j.cn441417-20241011-05001

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Objective　To systematically evaluate the application effect of web-based decision aids (DA) in prostatic cancer treatment decisions. Methods　Randomized controlled trials on the application effect of web-based DA in prostatic cancer treatment decisions were retrieved from databases such as CNKI, Wanfang, VIP, PubMed, the Cochrane Library, Embase, and Web of Science from the establishment of the databases to August 7, 2024, and the references included in the studies were traced. Subject words combined with free words were used to search. Meta-analysis was performed using RevMan 5.3 software, and publication bias was assessed by funnel plot. Results　Finally, 13 articles were included. The results of the meta-analysis showed that the proportion of the patients who chose conservative treatment in the intervention group was higher than that in the conventional group [RR=1.19, 95%CI:(1.02, 1.39), P=0.03]; the impact of web-based DA on the choice of radical prostatectomy [RR=1.01, 95%CI:(0.92, 1.10), P=0.87] and radiotherapy [RR=0.84, 95%CI:(0.62, 1.15), P=0.28] in patients with localized prostate cancer had no statistical significance; for patients with low-risk prostate cancer, the difference in the choice of radical prostatectomy [RR=0.73, 95%CI:(0.54, 0.98), P=0.04] was statistically significant; there were no statistically significant differences between the intervention group and the conventional group in terms of decision conflict [SMD=-0.03, 95%CI:(-0.11, 0.05), P=0.42], decision regret [SMD=0.01, 95%CI:(-0.24, 0.26), P=0.94], or satisfaction [SMD=-0.11, 95%CI:(-0.44, 0.22), P=0.50]. Conclusion　DA has a certain intervention effect on the treatment decisions in patients with prostate cancer.

Research progress of tubule-derived exosomes in renal fibrosis

Li Xiaotong, Yu Shengqiang

2025, 31(5):  712-718.  DOI: 10.3760/cma.j.cn441417-20241119-05002

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Chronic kidney disease (CKD) patients are increasing rapidly and placing a heavy burden on medical care. CKD is characterized by progressive loss of kidney function and progression of renal fibrosis, and exosome mediated cellular communication has been implicated in various diseases, including renal fibrosis. However, little is known about how exosomes regulate renal fibrosis. This article mainly introduces the key role of tubule-derived exosomes in mediating fibroblast activation and renal fibrosis after ischemic or obstructive injury, and their potential as emerging biological markers, intervention targets and targeted therapy carriers for renal fibrosis. It also summarizes the existing problems and prospects for clinical application.

Analysis of kidney pathology and partial gene results in 449 children from a single center

Liu Yujie, Li Yuliu, Zhang Yaxin, Zhao Gongping, Cao Guanghai, Zhang Shufeng, Tian Ming, Liu Cuihua

2025, 31(5):  719-723.  DOI: 10.3760/cma.j.cn441417-20240914-05003

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Objective　To investigate the pathological features and genetic status of renal disease in children. Methods　The pathological data and partial genetic test results of 449 children with renal disease who received renal biopsy in Department of Nephrology and Rheumatology, Henan Children's Hospital from January 2020 to December 2023 were analyzed retrospectively. Renal puncture biopsy, pathological examination, and gene test were completed within 1 week after admission. Results　Among 449 children with renal disease, there were 308 boys (68.60%) and 141 girls (31.40%), ranging in age from 10 months to 17 years old, with a median age of 5 years old. The most common clinical diagnosis was Henoch-Schonlein purpura nephritis (159 cases), followed by hematuria with/without proteinuria (133 cases), nephrotic syndrome (115 cases), renal insufficiency (15 cases), lupus nephritis (14 cases), and repeated renal biopsy (12 cases). There were 242 children with primary glomerular diseases, accounting for 53.90%, including 97 cases of minimal change disease (MCD), 78 cases of immunoglobulin (Ig) A nephropathy, 24 cases of focal segmental glomerulosclerosis (FSGS), and 13 cases of membranous nephropathy. There were 173 children with secondary glomerular disease, accounting for 38.53%, including 159 cases of purpura nephritis and 14 cases of lupus nephritis. There were 9 cases of renal tubulointerstitial disease, accounting for 2.00%, including 7 cases of acute tubulointerstitial injury, 1 case of subacute tubulointerstitial nephropathy, and 1 case of moderate chronic tubulointerstitial injury. There were 12 children with repeated kidney biopsy, among whom 2 children had changes in the results of repeated renal biopsy: the results of primary renal biopsy and repeated renal biopsy were mild pathological glomerulopathy and Alport syndrome, and the results of primary renal biopsy and repeated renal biopsy were MCD and FSGS. Among 67 children with renal disease, 39 cases (58.21%) were positive, including 15 cases of Alport syndrome, 14 cases of FSGS, 14 cases of minor degenerative nephropathy, and 7 cases of mild mesangial proliferative glomerulonephritis. Conclusions　Primary glomerular disease is still the most common renal disease in children, mainly MCD and IgA nephropathy. The secondary renal disease is mainly purpura nephritis.

Efficacies of different doses of rituximab in the treatment of idiopathic membranous nephropathy and analysis of recurrence-influencing factors

Si Yafang, Liu Yuyu, Cao Li

2025, 31(5):  723-728.  DOI: 10.3760/cma.j.cn441417-20240814-05004

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Objective　To evaluate the efficacies of different doses of rituximab (RTX) in the treatment of idiopathic membranous nephropathy (IMN) and to identify factors influencing its recurrence. Methods　A retrospective analysis was conducted on 100 IMN patients treated at the Yulin Hospital of Xi'an Jiaotong University First Affiliated Hospital from June 2020 to June 2023, and were divided into two groups based on total medication dose. There were 35 males and 15 females in the study group, aged (56.39±10.73) years, with a body mass index of (25.31±2.36) kg/m², and there were 14 cases of hypertension, 12 cases of diabetes, and 11 cases of hyperlipidemia. In the control group, there were 37 males and 13 females, aged (57.21±10.80) years, with a body mass index of (25.74±2.52) kg/m², and there were 13 cases of hypertension, 14 cases of diabetes, and 12 cases of hyperlipidemia. Both the study group and the control group were treated with rituximab injection 375 mg/m² intravenously, once a week for 4 weeks in the control group, once every 2 weeks for 6 weeks in the study group. The clinical efficacies of the two groups were compared, as well as renal function [24 h urinary protein (24 h UP), serum creatinine (Scr), and estimated glomerular filtration rate (eGFR)] and immune function [M-type phospholipase A2 receptor (PLA2R) antibody, CD19 antigen-positive B (CD19+B) cells, and immunoglobulin G (IgG)] before and after treatment and adverse reactions during treatment. Independent sample t test, paired t test, and χ² test were used for statistical analysis. After 1 year of follow-up, the recurrence rate was 22.00% (11/50) in the study group and 18.00% (9/50) in the control group, and the total recurrence rate was 20.00% (20/100). The patients were divided into a recurrence group (20 cases) and a non-recurrence group (80 cases); the influencing factors of recurrence in IMN patients were analyzed by univariate and multivariate logistic regression analysis. Results　The total effective rate was 60.00% (30/50) in the study group and 62.00% (31/50) in the control group, and the difference was not statistically significant (P>0.05). After treatment, there were no statistically significant differences in the 24 h UP, Scr, PLA2R antibody, IgG level, CD19+B cell proportion, and eGFR between the study group and the control group (all P>0.05). During treatment, the total incidence of adverse reactions in the study group was lower than that in the control group [34.00% (17/50) vs. 56.00% (28/50)] (P<0.05). Univariate analysis showed that there were statistically significant differences in the age, 24 h UP, Scr, PLA2R antibody, IgG level, and CD19+B cell proportion between the recurrence group and the non-recurrence group (all P<0.05). Multivariate logistic regression analysis showed that age ≥60 years old (OR: 7.679, 95%CI: 1.973-29.884), 24 h UP (OR: 2.319, 95%CI: 1.505-3.574), Scr (OR: 1.115, 95%CI: 1.016-1.223), PLA2R antibody (OR: 1.033, 95%CI: 1.001-1.065), and CD19+B cell proportion (OR: 1.031, 95%CI: 1.004-1.060) were all independent risk factors for recurrence in IMN patients, and IgG level (OR: 0.499, 95%CI: 0.265-0.941) was an independent protective factor (all P<0.05). Conclusions　Two different dosing regimens of RTX in the treatment of IMN showed no significant differences in overall clinical efficacy, renal function, or immune function indicators. However, the study group was more effective in reducing adverse reactions. Age, 24 h UP, Scr, PLA2R antibody, CD19+B cell proportion, and IgG level were important predictors of recurrence.

Effect of high-flux hemodialysis combined with hemodiafiltration in patients with end-stage renal disease

Quan Jiaojie, Wang Xiaoling, Chen Huijuan

2025, 31(5):  729-733.  DOI: 10.3760/cma.j.cn441417-20240924-05005

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Objective　To evaluate the impacts of high-flux hemodialysis combined with hemodiafiltration on renal function and inflammatory level in patients with end-stage renal disease. Methods　Ninety-four patients with end-stage renal disease admitted to Xi'an Hi-tech Hospital from January 2020 to January 2023 were selected as the study objects, and were divided into a control group (47 cases) and an observation group (47 cases) by the random number table method. The control group included 27 males and 20 females, aged (61.91±7.39) years, with a body mass index (BMI) of (23.21±3.24) kg/m² and a course of disease of (3.85±0.68) years, and the primary diseases were chronic glomerulonephritis in 23 cases, diabetic nephropathy in 14 cases, and hypertensive renal injury in 10 cases. The observation group included 25 males and 22 females, aged (61.75±7.23) years, with a BMI of (23.07±3.19) kg/m² and a course of disease of (3.77±0.59) years, and the primary diseases were chronic glomerulonephritis in 26 cases, diabetic nephropathy in 13 cases, and hypertensive renal injury in 8 cases. The control group was treated with high-flux hemodialysis (4 h/time, 3 times a week), and the observation group was combined with hemodiafiltration (4 h/time, once every 2 weeks). Both groups were treated continuously for 4 months. The levels of inflammatory factors [tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and interleukin-6 (IL-6)], calcium and phosphorus metabolism (serum calcium and phosphorus), renal function [urinary nitrogen (BUN) and creatinine (Scr)], nutritional status [prealbumin (PA), hemoglobin (Hb), and albumin (ALB)] 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　After treatment, the levels of TNF-α, CRP, and IL-6 in the observation group were lower than those in the control group [(23.28±3.49) ng/L vs. (31.39±4.27) ng/L, (6.38±1.09) mg/L vs. (8.23±1.54) mg/L, (8.01±1.49) ng/L vs. (12.04±2.03) ng/L] (all P<0.05); the serum calcium level of the observation group was higher than that of the control group [(2.35±0.34) mmol/L vs. (2.06±0.25) mmol/L], and the serum phosphorus level was lower than that of the control group [(1.30±0.11) mmol/L vs. (1.56±0.15) mmol/L] (both P<0.05); serum BUN and Scr levels in the observation group were lower than those in the control group [(14.85±2.12) mmol/L vs. (17.72±2.35) mmol/L, (301.24±29.89) μmmol/L vs. (440.34±37.78) μmmol/L] (both P<0.05); the levels of PA, Hb, and ALB in the observation group were higher than those in the control group [(274.12±31.47) mg/L vs. (168.24±20.13) mg/L, (117.03±14.23) g/L vs. (99.78±10.16) g/L, (42.14±5.03) g/L vs. (36.02±4.19) g/L] (all P<0.05). Conclusion　The combined treatment of high-flux hemodialysis and hemodiafiltration contributes to reducing inflammation level and improving renal function and nutritional status in patients with end-stage renal disease.

Experience of prevention and treatment of complications related to disposable circumcision suture in children aged 5-8 years

Yang Yi, Xu Le, Chen Zhijun, Zhang Xin, Huang Zhonghua, Liang Hongyi, Qiu Minjie, Jiang Jiehong

2025, 31(5):  733-737.  DOI: 10.3760/cma.j.cn441417-20241119-05006

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Objective　To investigate strategies for preventing and managing postoperative complications related to disposable circumcision suture, and to improve the implementation of this technique in pediatric surgery. Methods　Clinical data of 1 932 children with phimosis aged 5-8 year admitted to Hexian Memorial Hospital, Panyu District from February 2018 to August 2023 were retrospectively analyzed, with an age of (6.41±0.14) years old. All children underwent sevoflurane inhalation anesthesia and were treated with disposable circumcision suture under the hospital's "completely painless concept". The complications related to the surgery were recorded and analyzed. Results　All the children successfully completed the procedures, and the total operation time was 4.5-6.5 min, with an average of 5.2 min. The postoperative follow-up lasted from 2 to 8 months, with an average of 6.5 months. In 121 (6.26%) children, frenulum active bleeding occurred during operation. The overall incidence of postoperative complications was 5.64% (109/1 932). Among them, the incidence of short-term complications (<7 days) was 3.26% (63/1 932), including 32 cases of delayed hematoma, 8 cases of dysuria, 4 cases of device failure, 15 cases of wound infection, and 1 case of accidental external urethral injury. The incidence of mid-term complications (7-30 days) was 1.55% (30/1 932), including 10 cases of foreskin edema and 20 cases of difficulty with nail removal. The incidence of long-term complications (>30 days) was 0.98% (19/1 932), including 9 cases of secondary scar-related phimosis and 10 cases of skin bridge formation. Despite these complications, all children recovered and returned to normal health. Conclusions　To further reduce postoperative complications, surgical processes should be standardized, technical skills refined, and education for both children and parents strengthened. Additionally, improvements to disposable circumcision suture devices are recommended. The application of disposable circumcision suture devices within the "completely painless concept" enhances satisfaction among children and parents, making it a valuable approach for broader clinical implementation.

Clinical effect of low intensity extracorporeal shock wave therapy for Peyronie's disease

Du Yuxuan, Zhou Chenyu, Chen Xiaofeng, Zhu Shuangju, Bian Jun, Lai Dehui, Liang Yanbing

2025, 31(5):  738-741.  DOI: 10.3760/cma.j.cn441417-20241022-05007

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Objective　To analyze the clinical effect of low intensity extracorporeal shock wave therapy for Peyronie's disease. Methods　A total of 22 patients diagnosed with Peyronie's disease at the Department of Urology, the Fifth Affiliated Hospital of Guangzhou Medical University from May 2019 to March 2024 were treated with low intensity extracorporeal shock wave therapy (once a week for 4-12 weeks). After completing the treatment, the induration size, degree of penile curvature, Visual Analogue Scale (VAS) score, International Index of Erectile Function Questionnaire-5 (IIEF-5) score, and complications were recorded. χ² test or Fisher exact probability method were used for statistical analysis. Results　The patients ranged in age from 32 to 55 years old, with an average of 43.5 years old. Among them, 6 cases (27.3%) were under 40 years old, 12 cases (54.5%) were 40 - 50 years old, and 4 cases (18.2%) were over 50 years old. The average course of disease was 16 months, 10 cases (45.4%) within 1 year, 8 cases (36.4%) of 1 - 2 years, and 4 cases (18.2%) over 2 years; 14 cases (63.6%) had only 1 induration, 6 cases (27.3%) had 2 indurations, and 2 cases (9.1%) had 3 indurations. Most of the indurations were nodules, and were long cords in only 4 cases. The maximum induration was 25 mm × 23 mm, and the minimum was 5 mm × 5 mm. The induration was found on both sides of the penis in 8 cases (36.4%) and on the dorsal side of the penis in 14 cases (63.6%). In 18 patients (81.82%), the size decreased or became soft after treatment. Of the 18 patients experiencing pain during penile erection, 14 cases (77.78%) had pain relief. Of the 8 patients with obvious penile curvature during erection, 6 cases (75.00%) were significantly improved after treatment. Of the 9 patients with erectile dysfunction, 7 cases (77.78%) showed significant improvement. No significant complications were observed in all patients. Conclusions　Low intensity extracorporeal shock wave therapy is helpful to relieve the pain caused by penile induration, and improve the penile curvature and quality of life. The findings advocate for its broader implementation in clinical practice.

Efficacy of neoadjuvant therapy combined with radical cystectomy for myometrial invasive bladder cancer

Guo Guijun, Liu Fulin

2025, 31(5):  742-745.  DOI: 10.3760/cma.j.cn441417-20241010-05008

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Objective　To observe the efficacy and safety of neoadjuvant therapy[gemcitabine + cisplatin (GC) neoadjuvant chemotherapy combined with Tislelizumab immunotherapy] combined with radical cystectomy in the treatment of myometrial invasive bladder cancer (MIBC). Methods　A total of 6 MIBC patients who received neoadjuvant therapy combined with radical cystectomy in the First Affiliated Hospital of Gannan Medical University from June 2021 to January 2023 were selected as the study objects. All 6 cases were male; the age ranged from 53 to 70 years, with a median age of 62 years old; the clinical stage of tumor was T2N0M0 in 3 cases and T3N0M0 in 3 cases. Tislelizumab 200 mg was given intravenously on the 1st day, intravenous drip with 1 000 mg/m² of gemcitabine on the 1st and 8th day, and 70 mg/m² of cisplatin was given intravenously for 1-2 days, with 21 days as a course of treatment, a total of 3-4 courses. Within 6 weeks after neoadjuvant therapy, the patients underwent radical cystectomy and lymph node dissection. Clinical data, including age, smoking history, pathological grade, clinical stage, and incidence, were collected by electronic medical record system. The effect of neoadjuvant therapy was evaluated, including complete response, partial response, stable disease, and progression of disease. During neoadjuvant therapy, the occurrence of adverse reactions (grade 0 to 4) was recorded. The completion of radical cystectomy and lymph node dissection and the number of postoperative pathological downgrades were recorded. The patients were followed up for 8 to 26 months, and the recurrence of tumor was recorded. Fisher exact probability method was used for statistical analysis. Results　All the 6 patients with MIBC completed neoadjuvant therapy, with complete remission in 1 case (16.67%), partial remission in 2 cases (33.33%), stable disease in 3 cases (50.00%), an objective remission rate of 50.00% (3/6), and a disease control rate of 100.00% (6/6). There were no statistically significant differences in the clinical data between effective and ineffective MIBC patients (all P>0.05). During neoadjuvant therapy, the total incidence of adverse reactions was 100.00% (6/6), including 2 cases of grade 3-4 leukopenia, 1 case of grade 3-4 nausea and vomiting, and 1 case of grade 3-4 thrombocytopenia. All the 6 patients with MIBC underwent radical cystectomy plus lymph node dissection, and 1 patient had postoperative pathological decline (<pT2N0M0). None of the patients had tumor recurrence. Conclusion　Neoadjuvant therapy combined with radical cystectomy is effective and safe in the treatment of MIBC.

Construction of an evaluation index system of the health education on chronic kidney disease

Tang Fang, Zou Tao, Luo Shimiao, Wu Xiaona, Jie Xina, Fu Lizhe, Qin Xindong, Deng Lili, Wu Yifan

2025, 31(5):  746-751.  DOI: 10.3760/cma.j.cn441417-20241217-05009

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Objective　To construct an evaluation index system for the effect of health education on chronic kidney disease, and to provide a reference basis for formulating and carrying out health education work. Methods　The relevant literatures on the evaluation index system for the effect of health education on chronic kidney disease established in Cochrane, PubMed, Web of Science, CNKI, Wanfang, and VIP from the establishment of the databases to June 2023 were searched by computer. Finally, 80 literatures were selected, and 6 first-level indicators were obtained (satisfaction effect, education effect, management effect, economic effect, social effect, and sustainable development). On the basis of literature retrieval, with reference to the local standards of Specification for Health Education on Chronic Kidney Disease and the evaluation index system model of "audience-social-economy-sustainability", and combined with the actual work of health education, an evaluation index system for the effect of health education for chronic kidney disease (6 first-level indicators and 20 second-level indicators) was initially developed. The expert letter questionnaire was made, including the foreword, the expert basic information questionnaire, the expert familiarity and judgment basis, and the expert opinion table. From August to September 2023, two rounds of questionnaires were sent to 28 experts with an interval of two weeks. After the end of the first round of expert correspondence, the research team made modifications according to the experts' opinions and the screening principle of indicators, and the second round of expert correspondence questionnaire was formed. χ² test was used for statistical analysis, enthusiasm was represented by questionnaire recovery rate and opinion proposal rate, authority was represented by authority coefficient, coordination degree and consistency were represented by Kendall harmony coefficient and variation coefficient, and analytic hierarchy process was used to determine the weights of the first-level and second-level indicators. Results　A total of 28 experts in the field of chronic kidney disease and science popularization were included in this study, including 8 males and 20 females; age: ≥30 - <35 years old in 14 cases, ≥35 - <40 years old in 5 cases, and ≥40 years old in 9 cases; education: bachelor's degree in 17 cases, master's degree in 5 cases, and doctor's degree in 6 cases; working years: <10 years in 17 cases, ≥10 - <20 years in 5 cases, and ≥20 years in 6 cases; professional titles: intermediate in 9 cases, associate senior in 15 cases, and senior in 4 cases; frequency of health education activities: once or twice a day in 8 cases, once or twice a week in 6 cases, once or twice a month in 8 cases, once or twice a quarter in 4 cases, and once or twice a year in 2 cases. The recovery rates of the two rounds of questionnaires were 100.00%(28/28) and 92.86%(26/28), respectively. In the first round of expert correspondence, 16 experts gave their opinions in written or oral form, accounting for 57.14%. The expert authority coefficients of the two rounds were 0.804 and 0.839, respectively. The Kendall harmony coefficients of the first-level and second-level indicators in the first round of expert correspondence were 0.263 and 0.211, respectively, and 0.316 and 0.272 in the second round, with statistically significant differences between the two rounds (all P<0.05). The variation coefficients of the first-level indicators in the first round of expert correspondence were 0 - 0.196, without addition or deletion; the variation coefficients of the second-level indicators were 0 - 0.286, and 4 items of the second-level indicators were modified. In the second round of expert correspondence, there were no additions or deletions to the first-level or second-level indicators. Finally, an evaluation index system for the effect of health education on chronic kidney disease including 6 first-level indicators and 27 second-level indicators was constructed. The weights of satisfaction and education effect were both 0.173, 0.172 of management effect, 0.170 of economic effect, 0.163 of social effect, and 0.018 of sustainable development effect. Conclusion　The formulation of the evaluation indexes for the effect of health education on chronic kidney disease is scientific, reasonable, comprehensive in content, and highly targeted, which can be used to evaluate health education activities for patients with chronic kidney disease.

New Medical Advances

Research progress of post-transplantation lymphoproliferative disease in children with adenotonsillar hypertrophy

Zhang Han, Sun Ting, Wang Yanfei, Zhang Xiaolin, Che Juan

2025, 31(5):  752-757.  DOI: 10.3760/cma.j.cn441417-20240724-05010

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Post-transplantation lymphoproliferative disease (PTLD) is a prevalent and diverse form of secondary malignancy observed in pediatric patients. The incidence of PTLD is higher in children than in adults, with a mortality rate reaching up to 20%. PTLD typically originates within the Waldeyer ring of the head and neck, presenting as adenotonsillar hypertrophy, tonsillitis, or cervical lymph node enlargement. Adenotonsillar hypertrophy in children is a common disease in otorhinolaryngology; when adenotonsillar hypertrophy occurs in post-transplant children, the possibility of PTLD should be alerted. Hence, this article comprehensively reviews the current research progress on the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of PTLD in children with adenotonsillar hypertrophy, aiming to enhance early identification, accurate diagnosis, and effective treatment of PTLD in children with adenotonsillar hypertrophy after their first transplantation, and improve the prognosis.

Application status and progress of MRI based radiomics in pituitary adenoma

Mo Jiachan, Fan Wanfeng, Jiang Xingyue

2025, 31(5):  757-760.  DOI: 10.3760/cma.j.cn441417-20240926-05011

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Radiomics is a tool for high-throughput mining of quantitative features from medical images such as computed tomography (CT), magnetic resonance imaging (MRI), and positron emission computed tomography (PET-CT). It has become increasingly valuable in the study of pituitary adenoma (PA). The radiomic features extracted from pituitary MRI can provide relevant information for PA diagnosis and treatment. For example, there are relevant reports on predicting postoperative tumor recurrence, tumor invasiveness, tumor texture, surgical resection rate, drug treatment response, postoperative complications, and preoperative tumor subtypes. This article mainly reviews the application status and progress of radiomics based on MRI images in predicting postoperative tumor recurrence, tumor invasiveness, and tumor texture in PA patients.

Treatises

Postoperative significance of horizontal fissure differentiation and the distance from tumor margin to horizontal fissure in patients with invasive non-small cell lung cancer

Zhao Jinpeng, Gao Chengfei, Lyu Xiaodong

2025, 31(5):  761-765.  DOI: 10.3760/cma.j.cn441417-20240523-05012

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Objective　To assess the postoperative significance of horizontal fissure differentiation and the distance from tumor margin to horizontal fissure in non-small cell lung cancer (NSCLC). Methods　The clinicopathological data and follow-up results of surgical patients with NSCLC were selected in the Department of Cardiothoracic Surgery of Yantai Laiyang Central Hospital between July 2018 and July 2021. The horizontal fissure differentiation was evaluated by chest enhanced thin slice computed tomography (CT) combined with intraoperative direct vision exploration, including 33 good cases and 58 incomplete cases. The distance from tumor margin to horizontal fissure was measured by chest enhanced thin slice CT in 58 patients with incomplete horizontal fissure differentiation. With 4 cm as the critical distance, 25 cases were ≤4 cm and 33 cases were >4 cm. The patients' general data were collected, including gender, age, smoking, histological type, degree of differentiation, and TNM stage. The patients were followed up for 36 months by telephone follow-up or outpatient review, once every 2 months, and the recurrence (lymph node metastasis, in-situ recurrence, and distant metastasis) and disease-free survival were recorded. χ² test was used for statistical analysis, Kaplan-Meier curve was used for survival analysis, Log-rank test was used for single factor analysis, and COX proportional risk regression model was used for multivariate analysis. Results　There were no statistically significant differences in the general data of NSCLC patients with different horizontal fissure differentiation (all P>0.05). The disease-free survival time was 30.5 months in patients with good horizontal fissure differentiation and 24.6 months in patients with incomplete horizontal fissure differentiation, without statistically significant difference (P>0.05). TNM stage (HR=2.592, 95%CI: 1.739-3.865) and differentiation degree (HR=3.199, 95%CI: 1.711-5.982) were independent risk factors for prognosis of NSCLC patients (both P<0.05). There were no statistically significant differences in the general data of NSCLC patients with incomplete horizontal fissure differentiation with different distances from tumor margin to horizontal fissure (all P>0.05). The disease-free survival time was 29.4 months in patients with distance from tumor margin to horizontal fissure >4 cm, and 18.5 months in patients with distance from tumor margin to horizontal fissure ≤4 cm, with a statistically significant difference (P<0.05). Distance from tumor margin to horizontal fissure (HR=2.381, 95%CI: 1.073-5.287), TNM stage (HR=2.609, 95%CI: 1.566-4.347), and differentiation degree (HR=3.384, 95%CI: 1.539-7.441) were independent risk factors for prognosis of NSCLC patients with incomplete horizontal fissure differentiation (all P<0.05). Conclusion　The distance from tumor margin to horizontal fissure is an independent risk factor for the prognosis of NSCLC patients with incomplete horizontal fissure differentiation, and can be used to evaluate the patients' prognosis and guide comprehensive treatment.

Expression of miR-6884-5p in non-small cell lung cancer and its correlations with tumor markers

Liu Zhenzhen, Liu Man, Jia Yongqing, Yang Meiju

2025, 31(5):  766-770.  DOI: 10.3760/cma.j.cn441417-20240515-05013

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Objective　To analyze the expression of miR-6884-5p in non-small cell lung cancer (NSCLC) and its correlations with tumor markers and prognosis. Methods　Samples from 91 NSCLC patients treated in Shangqiu First People's Hospital from January 2017 to January 2019 were collected. Tumor tissues and adjacent non-tumor tissues were collected during surgery. Serum samples from 50 healthy individuals were collected as a control group. NSCLC patients : 55 males and 36 females, aged (60.3±7.4) years ; Control group : 27 males and 23 females, aged (60.1±5.7) years. The relative expression levels of miR-6884-5p in tumor tissues and serum were measured using quantitative real-time PCR (qRT-PCR). The diagnostic value of miR-6884-5p in NSCLC patients was assessed using the receiver operating characteristic curve (ROC). Cox regression analysis was used to identify independent prognostic factors affecting 5-year survival of NSCLC patients. Statistical methods were χ² test and t test. Results　The expression of miR-6884-5p in tumor tissues was lower than that in adjacent non-tumor tissues (P<0.001). The relative expression level of miR-6884-5p in the serum of NSCLC patients was lower than that of the control group (P<0.001). ROC analysis revealed that the area under the curve (AUC) for serum miR-6884-5p in diagnosing NSCLC was 0.863. Serum miR-6884-5p expression was negatively correlated with cancer antigen 125 (CA125) and carcinoembryonic antigen (CEA) levels (both P<0.05). The patients in the miR-6884-5p low expression group had a higher incidence of advanced clinical stages (III+IV) and lymph node metastasis compared to the high expression group (both P<0.01). The 5-year survival rate of the low expression group was lower than that of the high expression group (P<0.05). Multivariate Cox regression analysis showed that miR-6884-5p (HR=0.370, 95%CI 0.206-0.664), age (HR=2.639, 95%CI 1.505-4.627), tumor size (HR=2.415, 95%CI 1.392-4.190), clinical stage (HR=0.339, 95%CI 0.193-0.597), and lymph node metastasis (HR=3.058, 95%CI 1.760-5.311) were independent prognostic factors affecting 5-year survival (all P<0.05). Conclusion　The low expression of miR-6884-5p in NSCLC is closely associated with tumor progression and poor prognosis, suggesting that miR-6884-5p may serve as a potential biomarker and therapeutic target.

Construction and validation of a nomogram for assessing nutritional risk in patients with acute exacerbation of chronic obstructive pulmonary disease

Chen Congling, Wang Ting, Zhang Jinzhao

2025, 31(5):  771-779.  DOI: 10.3760/cma.j.cn441417-20241014-05014

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Objective　To investigate the factors contributing to nutritional risk in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to construct and validate a corresponding nomogram. Methods　A retrospective analysis was conducted on 300 AECOPD patients admitted to Chang'an Hospital between June 2021 and June 2023, who were divided into a training set (210 cases) and a validation set (90 cases) in a 7:3 ratio using random numbers generated by computer. The training set was further categorized into groups with (83 cases) or without (127 cases) nutritional risk. General data of the two groups were compared, and a multivariate logistic regression model was applied to identify the factors influencing nutritional risk in AECOPD patients. A regression equation and a nomogram were subsequently constructed. The model's predictive efficiency was assessed internally using the receiver operating characteristic curve (ROC), and the calibration curve and decision curve analysis (DCA) were used to evaluate the model's calibration accuracy and clinical utility. χ² test, t test, and Mann-Whitney U test were used for statistical analysis. Results　Multivariate logistic regression model showed that diabetes mellitus (OR=2.861, 95%CI 1.407-5.818), dietary imbalance (OR=2.985, 95%CI 1.401-6.358), COPD Assessment Test (CAT) score (OR=2.163, 95%CI 1.436-3.258), and multiple drug resistance (OR=2.051, 95%CI 1.075-3.912) were risk factors for nutritional risk in AECOPD patients (all P<0.05); Perceptive Social Support Scale (PSSS) score (OR=0.496, 95%CI 0.252-0.977) and albumin (Alb, OR=0.524, 95%CI 0.341-0.805) were protective factors (all P<0.05).  Based on the logistic regression analysis of the training set, a nomogram model was constructed to predict nutritional risk in AECOPD patients. The area under the curve (AUC) of the nomogram model for predicting nutritional risk was 0.945  for the training set, with a sensitivity of 91.57% and a specificity of 91.34%; for the validation set, the AUC was 0.909 , with a sensitivity of 86.11% and a specificity of 94.44%. The Hosmer-Lemeshow test revealed no statistically significant difference in the calibration curve for both training set (χ²=0.512, P>0.05) and validation set (χ²=0.633, P>0.05). Internal validation using the Bootstrap method showed that the concordance index (C-index) was 0.932 for the training set and 0.908 for the validation set. The decision curve showed that the training set and the validation set obtained clinical net benefit in the range of risk threshold 0.16-0.80 and 0.45-0.83, respectively. Conclusions　Diabetes mellitus, dietary imbalance, multidrug resistance, and CAT score are risk factors for nutritional risk in AECOPD patients, while PSSS score and Alb level serve as protective factors. The nomogram model based on these factors exhibits robust clinical utility and predictive accuracy.

Correlation analysis of quantitative CT parameters of lung lobes, serum HCAR level, and the severity and therapeutic effect in patients with chronic obstructive pulmonary disease

Zhang Pengjuan, Ning Fangwei, Zhang Zhongmian, Fan Linpeng

2025, 31(5):  779-783.  DOI: 10.3760/cma.j.cn441417-20240930-05015

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Objective　To analyze the correlations between quantitative CT parameters of lung lobes, serum high-sensitivity C-reactive protein/albumin ratio (HCAR) levels, and the severity and therapeutic efficacy in patients with chronic obstructive pulmonary disease (COPD). Methods　A retrospective study was conducted on 92 patients with COPD admitted to Second Affiliated Hospital of Zhengzhou University from March 2022 to August 2024. The patients were divided into mild (42 cases), moderate (31 cases), and severe groups (19 cases) based on their disease severity. There was no significant difference in general data among the three groups ( all P>0.05 ).The quantitative CT parameters of lung lobes [CT air trapping index (ATI), low attenuation area percentage (LAA%) of the entire lung volume, and wall area percentage (WA%)] and serum HCAR level were compared among the three groups at admission, and their correlations were analyzed. The levels of each indicator were compared among patients with different treatment effects, and partial regression analysis was used to analyze their correlations with treatment effect and their predictive value for ineffective treatment. One way analysis of variance and t test were used for statistical analysis. Results　The ATI, LAA%, WA%, and serum HCAR levels in the three groups were compared, severe group > moderate group > mild group, with statistically significant differences (F=29.049, 211.037, 95.503, and 26.523, all P<0.05); ATI, LAA%, WA%, and serum HCAR were positively correlated with the severity of disease (r=0.622, 0.671, 0.637, and 0.667, all P<0.001). The ATI, LAA%, WA%, and serum HCAR levels in the ineffective patients were higher than those in the effective patients (t=5.537, 14.983, 3.901, and 5.410, all P<0.05); ATI (OR=3.070, 95%CI 1.541-6.117), LAA% (OR=2.534, 95%CI 1.847-3.477), WA% (OR=3.086, 95%CI 1.416-6.727), and serum HCAR levels (OR=4.085, 95%CI 2.441-6.837) were risk factors for ineffective treatment (all P<0.05). The efficacy of combined prediction for ineffective treatment using the parameters of ATI, LAA%, WA%, and serum HCAR levels was 0.912, which was higher than that of each individual parameter (P<0.05). Conclusions　Both quantitative CT parameters of lung lobes and serum HCAR are associated with the severity of the COPD patients' condition and therapeutic effect. The combined detection of ATI, LAA%, WA%, and serum HCAR levels can improve the sensitivity and specificity in predicting the therapeutic effect, with high clinical application value.

Efficacy of thymic peptide α1 combined with biapenem in the treatment of severe pneumonia

Wu Chenglin, Wang Shaoxia, Ren Lehao

2025, 31(5):  784-787.  DOI: 10.3760/cma.j.cn441417-20241128-05016

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Objective　To investigate the therapeutic effect of thymic peptide α1 combined with biapenem in the treatment of severe pneumonia and its effects on serum CD40L, surfactant associated protein D (SP-D), and interleukin-1β (IL-1β) levels. Methods　In this prospective study, 88 patients with severe pneumonia admitted to Xi'an Fengcheng Hospital from June 2022 to August 2023 were selected as the research objects, and were divided into a study group and a control group according to the random number table method, with 44 cases in each group. In the control group, there were 24 males and 20 females, aged 40-69 (52.34±5.76) years, and the course of disease was 1-3 (2.10±0.24) weeks. In the study group, there were 23 males and 21 females, aged 41-65 (50.83±5.24) years, and the course of disease was 1-4 (2.57±0.84) weeks. The control group was given biapenem on the basis of conventional treatment (intravenous drip with 0.3 g diluted in 100 ml of normal saline, once every 8 h, 3 times a day). The study group was given thymic peptide α1 on the basis of the control group (1.6 mg thymic peptide α1 was dissolved in 1 ml of water for injection and then injected subcutaneously, once a day). Both groups were treated for 2 weeks. The effective rate of treatment, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, and serum levels of CD40L, SP-D, and IL-1β were compared between the two groups. t test and χ² test were used for statistical analysis. Results　The effective rate of treatment in the study group was higher than that in the control group [84.91% (37/44) vs. 70.45% (31/44)], with a statistically significant difference (χ²=4.706, P<0.05). After treatment, the APACHEⅡ score and levels of CD40L, IL-1β, and SP-D in the study group were lower than those in the control group [(12.59±4.35) points vs. (15.40±4.61) points, (1.48±0.63) μg/L vs. (2.64±0.40) μg/L, (19.81±1.57) ng/L vs. (24.30±1.76) ng/L, (145.67±10.69) μg/L vs. (152.31±10.74) μg/L], with statistically significant differences (t=-2.943, -10.361, -12.653, and -2.912, all P<0.05). Conclusion　Thymic peptide α1 combined with biapenem can improve the therapeutic effect and clinical symptoms of severe pneumonia, and reduce serum CD40L, SP-D, and IL-1β levels.

Effect of remifentanil in patients with mechanical ventilation in intensive care unit 

Zhang Lijia, Zhang Ru, Li Ruitao, Chen Ting

2025, 31(5):  787-791.  DOI: 10.3760/cma.j.cn441417-20240820-05017

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Objective　To explore the effect of remifentanil in patients with mechanical ventilation in intensive care unit (ICU). Methods　A total of 120 patients with mechanical ventilation admitted to ICU of Yulin First Hospital from January 2021 to December 2023 were included in this study, and were divided into group A and group B with 60 cases in each group according to the random number table method. The male to female ratios in group A and group B were 33:27 and 34:26; their ages were (47.25±4.39) and (47.36±4.42) years old; their Acute Physiology and Chronic Health Evaluation (APACHEⅡ) scores were (21.07±2.03) and (21.11±2.06) points. In group A, fentanyl was injected intravenously with an initial dose of 0.5 μg/(kg·h), and a load dose of 0.7-1.5 μg/kg was given according to the patients' specific conditions; group B was given remifentanil at 0.05 μg/(kg·min). The Face Pain Scale (FPS) and Ramsay sedation score were used to evaluate the pain degree and sedation state of the two groups every 20 min. For patients whose sedative and analgesic effect did not meet the requirements, 0.25 μg/(kg·h) of fentanyl or 0.025 μg/(kg·min) of remifentanil was added a single time until the analgesic and sedative effect was satisfactory. For patients whose fentanyl dose was increased to 1 μg/(kg·h) or remifentanil dose was increased to 0.1 μg/(kg·min) but the sedative and analgesic effect still did not meet the standard, propofol was given intravenously with the initial dose of 0.5 μg/(kg·h), and the dosage was gradually increased until the sedative and analgesic effect was satisfactory. The relevant indicators of the two groups were compared. χ² test and independent sample t test were used for statistical analysis. Results　There were no statistically significant differences in the Ramsay sedation score, FPS score, mean arterial pressure (MAP), or heart rate (HR) between the two groups before and 90 min after medication (all P>0.05). At 10 and 30 min after medication, the Ramsay sedation score s of both groups were higher than those before medication, and the score in group B was even higher; the FPS scores were lower than those before medication, and the score in group B was even lower; the MAP and HR of both groups were lower than those before medication, but those in group B were higher than those in group A, with statistically significant differences (all P<0.05). The mechanical ventilation time, extubation time, and hospital stay in group B were shorter than those in group A [(63.13±3.63) h vs. (89.26±3.41) h, (93.86±6.33) h vs. (126.35±13.41) h, (12.05±3.27) d vs. (16.52±5.84) d], with statistically significant differences (all P<0.05). The total incidence of adverse reactions in group B was slightly lower than that in group A, with no statistically significant difference (P>0.05). Conclusion　For ICU patients with mechanical ventilation, remifentanil can reduce the FPS score, effectively improve the Ramsay sedation score, and keep the MAP and HR levels relatively stable, which is conducive to the patients' rapid recovery , with high safety.

Research on the relationships between blood adrenocorticotropic hormone and cortisol levels and suicide risk in patients with depressive episodes

Yang Maozeng, Cai Weiling, Lu Xiaobing, Liang Yaoguo, Li Yifan, Liang Yuanshi

2025, 31(5):  792-795.  DOI: 10.3760/cma.j.cn441417-20240619-05018

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Objective　To explore the relationships between the levels of adrenocorticotropic hormone (ACTH) and cortisol (COR) and the suicide risk in patients with depressive episodes, and to provide clinical evidences for early identification and intervention of suicidal behaviors in patients with depressive episodes. Methods　In this study, 80 patients aged 18 - 65 years who were diagnosed with depressive episodes and visited Dongguan Seventh People's Hospital from August 2022 to May 2024 were selected as the research objects. A case-control study design was adopted. The Beck Scale for Suicide Ideation was used to assess the patients' suicide risk, and peripheral blood was collected to measure the levels of ACTH and COR. Among them, 40 patients with positive score on the suicide ideation scale were included in the study group, while 40 patients with negative score on the suicide ideation scale were included in the control group. There were 20 males and 20 females in the study group, aged 19-65 (42.87±2.98) years, and the course of disease was 1-10 (5.87±0.56) years. There were 21 males and 19 females in the control group, aged 19-64 (42.84±2.97) years, and the course of disease was 1-11 (5.89±0.59) years. The two groups received the same treatment. The ACTH level, COR level, Hamilton Depression Rating Scale (HAMD) score, and Beck score were compared between the two groups before and after treatment. t test was used for statistical analysis. Results　Before treatment, the ACTH and COR levels in the study group were higher than those in the control group [(25.41±11.84) ng/L vs. (20.14±7.45) ng/L, (268.41±66.52) nmol/L vs. (239.25±57.41) nmol/L], with statistically significant differences (t=2.38 and 2.10, both P<0.05). After antidepressant treatment, the ACTH level, COR level, HAMD score, and Beck score in the study group were higher than those in the control group (t=6.05,12.88,14.36 , and 38.11, all P<0.05). Conclusions　Among patients with depressive episodes, the higher the levels of ACTH and COR are, the higher the suicide risk is. Moreover, after antidepressant treatment, the levels of ACTH and COR are still higher than those in patients without suicide risk, suggesting that the blood levels of ACTH and COR may be potential biological indicators for assessing the suicide risk in patients with depressive episodes.

Intervention study of butylphthalide capsules on cognitive functional network connectivity in patients with cognitive dysfunction after cerebral infarction

Niu Yali, Cai Chunqian, Wu Rui, Wang Xue, Zhang Fuqing, Wang Chunxiao

2025, 31(5):  796-800.  DOI: 10.3760/cma.j.cn441417-20241104-05019

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Objective　To investigate the effect of butylphthalide capsules on cognitive functional network connectivity in patients with cognitive dysfunction after cerebral infarction. Methods　A total of 70 patients with cognitive dysfunction after cerebral infarction who received treatment in Tianjin Medical University General Hospital from January 2022 to April 2024 were selected as the research subjects, and were randomly divided into a placebo group and a butylphthalide capsule group, with 35 cases in each group. In the placebo group, there were 19 males and 16 females, aged (54.59±6.22) years, and there were 9 cases of hypertension, 6 cases of hyperlipidemia, 4 cases of diabetes, and 2 cases of coronary heart disease. There were 21 males and 14 females in the butylphthalide capsule group, aged (55.07±6.32) years, and there were 10 cases of hypertension, 7 cases of hyperlipidemia, 5 cases of diabetes, and 1 case of coronary heart disease. The placebo group received oral placebo based on conventional antiplatelet therapy, 0.2 g each time, three times a day; on the basis of conventional antiplatelet therapy, the butylphthalide capsule group was combined with butylphthalide soft capsules, which was taken fasting orally, 0.2 g each time, three times a day. Both groups were treated continuously for 6 months.The observation indicators included disconnection index, functional network connection index, cognitive function score, and quality of life score before treatment and 3 and 6 months after treatment in both groups, as well as incidence of adverse reactions. Independent sample t test and χ² test were used for statistical analysis. Results　Before treatment, there were no statistically significant differences in the disconnection index, functional network connection index, or cognitive function score between the two groups (all P0.05); 3 and 6 months after treatment, the disconnection index of the butylphthalide capsule group was lower than that of the placebo group [(0.18±0.02) points vs. (0.23±0.03) points, (0.15±0.01) points vs. (0.21±0.02) points], the functional network connectivity index of the butylphthalide capsule group was higher than that of the placebo group [(0.69±0.05) points vs. (0.66±0.07) points, (0.75±0.06) points vs. (0.69±0.07) points], and the cognitive function score of the butylphthalide capsule group was higher than that of the placebo group [(23.39±5.14) points vs. (20.97±4.96) points, (26.17±6.89) points vs. (22.31±5.27) points] (all P0.05). Before treatment, there were no statistically significant differences in the quality of life scores between the two groups (all P0.05); after treatment, the quality of life scores of the two groups were increased, and the scores of all dimensions in the butylphthalide capsule group were higher than those in the placebo group (all P0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P0.05). Conclusions　Butylphthalide capsules effectively enhance the cognitive functional network connectivity in patients with cognitive dysfunction after cerebral infarction and improve their quality of life through multiple pathways, including regulating cerebral blood circulation, antioxidant stress, inhibiting inflammatory reactions, promoting nerve regeneration, and regulating neurotransmitters. Due to their good safety characteristics, they demonstrate broad clinical application potential.

Clinical Research

Effect of continuous thoracic paravertebral block with ropivacaine on patients undergoing video-assisted thoracoscopic lobectomy

Li Nan, Sun Shuangchun, Yan Yuqiang, Zhang Qin

2025, 31(5):  801-805.  DOI: 10.3760/cma.j.cn441417-20240425-05020

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Objective　To evaluate the effects of continuous thoracic paravertebral block (CTPVB) with ropivacaine on cognitive function, analgesia, and inflammatory factors in patients undergoing video-assisted thoracoscopic lobectomy. Methods　This study was a randomized controlled trial. A total of 80 patients with non-small cell lung cancer who underwent video-assisted thoracoscopic lobectomy in Xi'an Central Hospital from January to December 2023 were selected as the study objects, and were divided into a control group (40 cases) and a study group (40 cases) according to the envelope method. There were 24 males and 16 females in the control group, aged (43.24±5.79) years, American Society of Anesthesiologists (ASA) grade Ⅰ in 16 cases and grade Ⅱ in 24 cases, and the pathological stages of Ⅰa, Ⅰb, Ⅱa, Ⅱb, and Ⅲa were 15, 11, 6, 5, and 3 cases, respectively. There were 22 males and 18 females in the study group, aged (44.13±5.62) years, ASA grade Ⅰ in 17 cases and grade Ⅱ in 23 cases, and the pathological stages of Ⅰa, Ⅰb, Ⅱa, Ⅱb, and Ⅲa were 14, 13, 5, 6, and 2 cases, respectively. The control group was given general anesthesia, and the study group was given CTPVB with ropivacaine (before anesthesia induction, CTPVB on the affected side was guided by ultrasound, the probe was located parallel to the intercostal space for puncture points, the intraplane puncture method was used to reach T4 - T8 segments, 5 ml of 0.5% ropivacaine was injected into each paravertebral space, and the nerve block effect was determined by the method of skin pain attenuation by acupuncture. General anesthesia was performed 15 min after CTPVB took effect) combined with general anesthesia. Postoperative recovery, cognitive function [Mini-Mental State Examination (MMSE)], pain levels at rest and during coughing [Visual Analogue Scale (VAS)], analgesia, levels of inflammatory factors [interleukin (IL-6), IL-8, and tumor necrosis factor-α (TNF-α)], and occurrence of adverse reactions were compared between the two groups. χ² and t tests were used for statistical analysis. Results　The postoperative recovery of the study group was superior to the control group [extubation time: (19.95±7.83) min vs. (26.36±8.02) min, awakening time: (10.96±6.78) min vs. (21.53±9.24) min, postoperative ICU stay: (52.85±10.23) min vs. (61.31±10.13) min], with statistically significant differences (all P<0.05). At 24 h after surgery, the MMSE score of the study group was (26.55±2.42) points, which was higher than that of the control group [(24.30±2.52) points], with a statistically significant difference (P<0.05). At 1 h, 6 h, and 12 h after surgery, the VAS scores of the study group at rest and during coughing were lower than those of the control group (all P<0.05). The analgesia of the study group was superior to the control group [propofol dosage: (582.68±75.31) mg vs. (674.74±80.95) mg, fentanyl dosage: (209.86±28.74) µg vs. (347.43±30.58) µg, first analgesic pump press time: (11.13±4.86) h vs. (7.94±5.38) h, number of analgesic pump presses: (2.35±0.86) times vs. (4.25±1.35) times] (all P<0.05). The levels of IL-6, IL-8, and TNF-α in the study group were lower than those in the control group 24 h and 48 h after surgery (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the study group and the control group [32.50% (13/40) vs. 47.50% (19/40)] (P>0.05). Conclusion　CTPVB with ropivacaine significantly improves postoperative cognitive function and analgesic effect, and reduces systemic inflammatory responses induced by surgery, indicating that this anesthetic method positively impacts postoperative recovery.

Clinical study of Sintilimab combined with thalidomide in the treatment of advanced esophageal cancer

Song Qunli, Guan Wei, Chen Yaoli

2025, 31(5):  806-810.  DOI: 10.3760/cma.j.cn441417-20240425-05021

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Objective　To investigate the effect of Sintilimab combined with thalidomide in the treatment of advanced esophageal cancer. Methods　This study was a randomized controlled trial. According to the random number table method, 155 patients with advanced esophageal cancer treated in People's Hospital of Tongchuan from January 2020 to January 2023 were divided into a study group (77 cases) and a control group (78 cases). In the control group, there were 41 males and 37 females, aged (60.41±8.21) years, with a body mass index (BMI) of (22.86±1.24) kg/m², and the tumor stages were as follows: stage Ⅱ in 10 cases, stage Ⅲ in 30 cases, and stage Ⅳ in 38 cases. In the study group, there were 44 males and 33 females, aged (59.32±8.06) years, with a BMI of (22.91±1.28) kg/m², and the tumor stages were as follows: stage Ⅱ in 8 cases, stage Ⅲ in 27 cases, and stage Ⅳ in 42 cases. The control group was given thalidomide orally, 200 mg/time, once a day, on the basis of conventional chemotherapy. The study group was given 200 mg of Sintilimab intravenously every 21 days on the basis of the control group. With 21 days as one chemotherapy cycle, and the efficacy was evaluated in both groups after 4 cycles of treatment. The anti-tumor efficacy, levels of tumor markers, immune function, and adverse drug reactions of the two groups were compared, and the survival status was followed up for 1 year. Independent sample t test, paired t test, χ² test, and Log-rank test were used for statistical analysis. Results　The objective response rate [33.77% (26/77)] and disease control rate [85.71% (66/77)] of the study group were higher than those of the control group [19.23% (15/78) and 71.79% (56/78)], with statistically significant differences (both P<0.05). After treatment, the levels of carcinoembryonic antigen, squamous cell carcinoma antigen, and cytokeratin 19 fragment antigen in the study group were lower than those in the control group [(26.27±4.18) ng/L vs. (35.19±5.12) ng/L, (20.03±3.27) ng/L vs. (24.25±4.01) ng/L, (14.92±2.73) ng/L vs. (18.23±3.14) ng/L], with statistically significant differences (all P<0.05). After treatment, helper T cell 1/helper T cell 2 in the study group was higher than that in the control group [(6.37±0.98)% vs. (6.01±1.02)%], and helper T cell 17/regulatory T cells was lower than that in the control group [(1.02±0.15)% vs. (1.23±0.19)%], with statistically significant differences (both P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups (P>0.05). After 1 year of follow-up, 48 and 36 patients survived in the study group and the control group, respectively, and the total survival of the study group was better than that of the control group (P<0.05). Conclusion　Sintilimab combined with thalidomide in the treatment of advanced esophageal cancer can enhance the anti-tumor effect, improve the patients' immune function, and is safe and reliable.

Accuracy of MSCT combined with serum CA125, SCC, ProGRP, and NSE in the diagnosis of lung cancer

Ge Qiang, Li Jianyi, Yan Xiaohong

2025, 31(5):  810-814.  DOI: 10.3760/cma.j.cn441417-20240103-05022

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Objective　To analyze the accuracy of multi-slice spiral computed tomography (MSCT) combined with serum carbohydrate antigen 125 (CA125), squamous cell carcinoma antigen (SCC), gastrin-releasing peptide precursor (ProGRP), and neuron-specific enolase (NSE) in the diagnosis of lung cancer. Methods　A total of 92 patients with lung cancer admitted to Longxian Hospital of Traditional Chinese Medicine from December 2018 to September 2023 were selected as a malignant group, and 110 patients with benign lung lesions were selected as a benign group. All patients were confirmed by surgical pathological examination. MSCT and serum CA125, SCC, ProGRP, and NSE levels were detected on the next day after admission. The MSCT signs and serum levels of CA125, SCC, ProGRP, and NSE were compared between the two groups. The results of MSCT examination were counted. The diagnostic value of MSCT combined with serum tumor markers in lung cancer was analyzed by the receiver operating characteristic curve (ROC). χ² test and independent sample t test were used for statistical analysis. Results　In the benign group, there were 78 males and 32 females, aged (67.37±6.71) years, with a body mass index of (22.36±2.16) kg/m²; in the malignant group, there were 73 males and 19 females, aged (67.78±6.49) years, with a body mass index of (22.49±2.51) kg/m²; there were no statistically significant differences (all P>0.05). The proportions of malignant component lobe sign, bronchial inflation sign, burr sign, pleural indentation sign, vacuole sign, and ground glass nodule in the malignant group were higher than those in the benign group (all P<0.05). Seventy-five of 92 patients with lung cancer were detected by MSCT, with a detection rate of 81.52%; 69 of 110 patients with benign lung lesions were detected by MSCT, with a detection rate of 62.73%. Serum levels of CA125, SCC, ProGRP, and NSE in the malignant group were higher than those in the benign group (all P<0.05). The area under the curve (AUC) of MSCT combined with serum CA125, SCC, ProGRP, and NSE in the diagnosis of lung cancer was 0.873, higher than that of the five alone (all P<0.05). Conclusions　There are obvious differences in MSCT signs and serum levels of CA125, SCC, ProGRP, and NSE between patients with lung cancer and patients with benign lung lesions. MSCT combined with serum CA125, SCC, ProGRP, and NSE can effectively improve the diagnostic efficiency for lung cancer.

Research on Traditional Chinese Medicine

Analysis of Chinese herbal medicine treatment for adenoid hypertrophy

Qiu Ting, Wu Xiujun, Li Meifen, Guo Liangfen

2025, 31(5):  815-817.  DOI: 10.3760/cma.j.cn441417-20240925-05023

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Objective　To explore the drug features and formula rules of Chinese medicine in the treatment of adenoid hypertrophy, and to guide and promote rational clinical drug use. Methods　A total of 559 Chinese medicine prescriptions for children diagnosed with adenoid hypertrophy in Panyu Branch of Guangdong Women and Children Hospital from January 1 to December 31, 2022 were collected, and the data were statistically analyzed using Excel statistical software. Results　Among them, there were 357 (63.86%) boys and 202 (36.14%) girls, and there were 60 cases (10.73%) aged 1 to 3, 343 cases (61.36%) aged 4 to 6, 134 cases (23.97%) aged 7 to 9, and 22 cases (3.94%) aged over 10. The six syndrome types were: lung and spleen deficiency (22.54%, 126 cases), phlegm-dampness intertwined (20.04%, 112 cases), phlegm-heat obstructing the lung (18.78%, 105 cases), pathogenic stagnation in the nose (15.92%, 89 cases), spleen and stomach deficiency (13.95%, 78 cases), and diet stagnation (8.77%, 49 cases). A total of 201 Chinese herbs were selected for analysis, with the main channels being lung, spleen, and stomach; the most frequently used Chinese medicines were poria, pinellia, licorice, Fritillaria thunbergii, and Xinyi. The co-prescription of two herbs with the highest frequency was pinellia + poria (244); the co-prescription of three herbs with the highest frequency was pinellia + poria + dried orange peel (184). Conclusion　The drug use for the treatment of adenoid hypertrophy in children is mainly focused on expelling pathogens, opening orifices, strengthening qi and promoting digestion, and eliminating phlegm and dampness, which provides reference for clinical drug use.

Effect of adalimumab combined with Guanzhong Li's bone injury school decompression and pain relief method on hip joint function in patients with ankylosing spondylitis

Zhang Yiyi, Zheng Zhou, Liu Qian

2025, 31(5):  818-822.  DOI: 10.3760/cma.j.cn441417-20241022-05024

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Objective　To assess the efficacy and safety of combining adalimumab with Guanzhong Li's bone injury school decompression and pain relief method in improving hip joint function in patients with ankylosing spondylitis (AS). Methods　This study was a randomized controlled trial. A total of 90 AS patients in Xi'an Fifth Hospital from May 2021 to May 2024 were selected and were divided into a control group and a treatment group with 45 cases in each group according to the random number table method. The ratios of male to female in the treatment group and the control group were 30:15 and 33:12; their ages were (32.6±7.4) and (33.1±7.8) years old; their body mass indexes were (24.3±3.5) and (24.1±3.3) kg/m²; their courses of disease were (2.83±0.42) and (2.86±0.51) years. The control group was treated with adalimumab by subcutaneous injection of 40 mg every two weeks for 4 weeks. The treatment group was combined with Guanzhong Li's bone injury school decompression and pain relief method once a week for 4 weeks on the basis of control group. The therapeutic effects of the two groups were observed, including Harris score, total range of passive motion, Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Function Index (BASFI) scores, and serum inflammatory factors before and after treatment, and the degree of difficulty in wearing shoes and socks after treatment. χ² test, rank sum test, and independent sample t test were used for statistical analysis. Results　The total effective rate of the treatment group was higher than that of the control group [95.56% (43/45) vs. 71.11% (32/45)] (P<0.05). After treatment, the Harris score and total range of passive motion in the treatment group were (86.29±1.43) points and (225.39±8.57)°, which were higher than those in the control group [(78.96±1.09) points and (204.23±7.32)°] (both P<0.05); the BASDAI and BASFI scores in the treatment group were (3.25±0.67) and (1.93±0.43) points, which were lower than those in the control group [(3.92±0.74) and (2.44±0.38) points] (both P<0.05); the levels of serum inflammatory factors and the degree of difficulty in wearing shoes and socks in the treatment group were also lower than those in the control group (all P<0.05). Conclusion　The combined treatment of adalimumab and Guanzhong Li's bone injury school decompression and pain relief method significantly enhances the hip joint function in patients with AS, underscoring its effectiveness and potential as a superior treatment modality.

Clinical efficacy and safety of Tongdu Yisui acupuncture combined with Ningshen Zhichou decoction in the treatment of pediatric Tourette syndrome with internal stirring of liver wind

He Jiani, Liu Yanguan, Feng Weixing, Hao Tao

2025, 31(5):  823-827.  DOI: 10.3760/cma.j.cn441417-20241022-05025

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Objective　To explore the clinical efficacy and safety of Tongdu Yisui acupuncture combined with Ningshen Zhichou decoction in treating pediatric Tourette syndrome characterized by internal stirring of liver wind. Methods　This study was a randomized controlled trial. A total of 102 children with Tourette syndrome with internal stirring of liver wind admitted to Yulin Traditional Chinese Medicine Hospital from December 2021 to April 2024 were enrolled and were randomly divided into a treatment group and a control group, with 51 cases in each group. In the treatment group, 29 boys and 22 girls were (8.03±2.21) years old, and the course of disease was (3.86±0.62) months. In the control group, 27 boys and 24 girls were (7.89±2.15) years old, and the course of disease was (3.80±0.59) months. The control group was given tiapride hydrochloride tablets orally, the initial dose was 0.05 g/time, twice a day, and the dose was increased to 0.10 g/time, twice a day after the 3rd week, continuous treatment for 1 month. On the basis of the control group, the treatment group was given Tongdu Yisui acupuncture (3 times a week, with an interval of 1-2 days, a total of 1 month) combined with Ningshen Zhichou decoction (1 dose a day, 3 to 10 years old, 100 ml each time, twice a day; 11-12 years old, 200 ml each time, twice a day, taken warmly in the morning and evening, a total of 1 month). After treatment, the traditional Chinese medicine (TCM) syndrome score, Yale Global Tic Severity Scale (YGTSS) score, frequency and interval of tic occurrence, neurotransmitter balance, and humoral immunity level in the two groups were observed, and the safety was recorded. Independent sample t test and χ² test were used for statistical analysis. Results　After treatment, the TCM syndrome score of the treatment group was lower than that of the control group [(2.08±0.53) points vs. (3.31±0.88) points], and the scores of motor tics, vocal tics, and overall impairment and total YGTSS score of the treatment group were lower than those of the control group, with statistically significant differences (all P<0.05). After treatment, the daily frequency of the treatment group was lower than that of the control group (1.80±0.24 vs. 4.16±0.66), and the interval duration was longer than that of the control group [(10.48±1.53) h vs. (4.48±1.48) h] (both P<0.05). After treatment, the levels of neurotransmitters in the treatment group were higher than those in the control group, and the immune function was better than that in the control group, with statistically significant differences (all P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups (P>0.05). Conclusion　The use of Tongdu Yisui acupuncture combined with Ningshen Zhichou decoction in treating pediatric Tourette syndrome with internal stirring of liver wind significantly outperforms conventional drug treatment in terms of improving TCM syndromes, YGTSS score, tic frequency and interval, neurotransmitter balance, and humoral immune level, while maintaining a high level of safety.

Observation of therapeutic effect of Fu's subcutaneous needling combined with kinesiology tape on shoulder pain after stroke with hemiplegia

Jing Bowen, Zhao Pengfei, Sun Ying, Ma Yonghua, Luo Ping

2025, 31(5):  828-832.  DOI: 10.3760/cma.j.cn441417-20240730-05026

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Objective　To observe the clinical effect of Fu's subcutaneous needling (FSN) combined with kinesiology tape on shoulder pain after stroke with hemiplegia. Methods　This study was a randomized controlled trial. Sixty patients with shoulder pain after stroke with hemiplegia who received treatment in the Rehabilitation Medicine Department of the Ninth People's Hospital of Zibo from August 2023 to May 2024 were selected and were divided into a FSN treatment group and a control group with 30 cases in each group according to the random number table method. The FSN treatment group included 19 males and 11 females, aged (58.67±8.68) years. The control group included 20 males and 10 females, aged (58.63±7.07) years. The control group received kinesiology tape and routine rehabilitation training, rehabilitation training once a day, a total of 7 times, and kinesiology tape treatment was given on the 4th day and was maintained for 3 days; the FSN treatment group received FSN combined with kinesiology tape and routine rehabilitation training, FSN treatment was given once a day for 3 times in total, kinesiology tape was given on the 4th day and was maintained for 3 days, and FSN treatment was given again on the 7th day. After 7 days of treatment, the Visual Analogue Scale (VAS) was used to evaluate the pain situation, and the Fugl-Meyer Assessment Upper Extremity (FMA-UE) was used to evaluate the recovery of upper limb function, and the modified Barthel index (MBI) was used to evaluate the activities of daily living. t test and χ² test were used for statistical analysis. Results　Before treatment, there was no statistically significant difference in the VAS score between the two groups (P>0.05). After 3 days of treatment, the VAS score of the FSN treatment group was lower than that before treatment [(2.23±1.10) points vs. (5.43±0.73) points] (P<0.05); after 7 days of treatment, the VAS score of the FSN treatment group was lower than those after 3 days of treatment and before treatment [(2.03±1.25) points vs. (2.23±1.10) points and (5.43±0.73) points] (both P<0.05), and the VAS score of the control group was lower than that before treatment [(4.00±1.66) points vs. (5.40±0.72) points] (P<0.05). After 7 days of treatment, the VAS score of the FSN treatment group was lower than that of the control group [(2.03±1.25) points vs. (4.00±1.66) points] (P<0.05). Before treatment and after 7 days of treatment, there were no statistically significant differences in the FMA-UE or MBI score between the two groups (all P>0.05). The total effective rate of the FSN treatment group was higher than that of the control group [63.33% (19/30) vs. 36.67% (11/30)], with a statistically significant difference (χ²=4.267, P=0.039). Conclusion　FSN combined with kinesiology tape and routine rehabilitation training can improve shoulder pain in stroke patients with hemiplegia, which is superior to kinesiology tape combined with routine rehabilitation training.

Effect of Xingnao Kaiqiao acupuncture combined with Jiawei Ditan decoction on post-stroke aphasia patients with wind phlegm obstruction syndrome

Han Zhao, Zhang Wei, Zhang Xulong

2025, 31(5):  833-838.  DOI: 10.3760/cma.j.cn441417-20241010-05027

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Objective　To investigate the effect of Xingnao Kaiqiao acupuncture combined with Jiawei Ditan decoction on post-stroke aphasia patients with wind phlegm obstruction syndrome. Methods　A total of 94 post-stroke aphasia patients with wind phlegm obstruction syndrome admitted to Shaanxi Rehabilitation Hospital from January 2022 to March 2024 were prospectively selected and were divided into a control group and a study group with 47 patients in each group by the random number table method. In the control group, there were 28 males and 19 females, aged (65.83±7.24) years, 33 cases of cerebral infarction and 14 cases of cerebral hemorrhage. In the study group, there were 30 males and 17 females, aged (63.29±8.15) years, 35 cases of cerebral infarction and 12 cases of cerebral hemorrhage. All patients were given routine speech rehabilitation therapy for stroke. On this basis, the control group was treated with Jiawei Ditan decoction, and the study group was treated with Xingnao Kaiqiao acupuncture combined with Jiawei Ditan decoction. Both groups were treated continuously for 3 months. The clinical efficacy, aphasia quotient (AQ), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) score, National Institutes of Health Stroke Scale (NIHSS) score, traditional Chinese medicine (TCM) syndrome score, and levels of serum inflammatory factors were compared between the two groups. Repeated measures ANOVA, t test, and χ² test were used for statistical analysis. Results　After 3 months of treatment, the total effective rate of the study group was higher than that of the control group [93.62% (44/47) vs. 72.34% (34/47)], with a statistically significant difference (χ²=7.532, P=0.006). After 1, 2 and 3 months of treatment, the AQ and LOTCA scores of the study group were higher than those of the control group, and the NIHSS and TCM syndrome scores were lower than those of the control group (all P<0.05). After 3 months of treatment, serum levels of hypersensitive C-reactive protein, interleukin-6, interleukin-1β, tumor necrosis factor-α, and cell adhesion molecule-1 in the study group were lower than those in the control group [(0.73±0.18) mg/L vs. (0.96±0.22) mg/L, (8.52±2.14) ng/L vs. (10.36±2.59) ng/L, (5.13±1.28) ng/L vs. (6.24±1.52) ng/L, (1.33±0.29) ng/L vs. (1.68±0.42) ng/L, (137.25±28.89) µg/L vs. (155.41±32.06) µg/L], the level of brain-derived neurotrophic factor was higher than that in the control group [(8.39±2.02) µg/L vs. (7.23±1.56) µg/L], and the differences were statistically significant (t=5.547, 3.755, 3.829, 4.701, 2.885, and 3.116, all P<0.05). Conclusion　Applying Xingnao Kaiqiao acupuncture combined with Jiawei Ditan decoction in the treatment of post-stroke aphasia patients with wind phlegm obstruction syndrome can significantly improve their language function, enhance their cognitive level, and alleviate brain injury related inflammatory reactions, with significant effect.

Effect of standardized chemotherapy regimen combined with Baihe Dihuang decoction on elderly patients with pulmonary tuberculosis

Cao Dongdong, Nie Juanli

2025, 31(5):  839-843.  DOI: 10.3760/cma.j.cn441417-20240820-05028

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Objective　To investigate the effects of Baihe Dihuang decoction combined with standardized chemotherapy regimen on the sputum negative conversion rate and the levels of serum T lymphocyte subsets in elderly patients with pulmonary tuberculosis. Methods　This study was a randomized controlled trial. A total of 106 elderly patients with pulmonary tuberculosis who were treated in the Third Hospital of Yulin from January 2022 to January 2024 were selected and were divided into a control group and a study group by the random number table method. In the control group, 26 males and 27 females, aged (65.83±3.75) years, with a body mass index of (21.26±1.19) kg/m², received standardized chemotherapy regimen (2HRZE/4HR, H: isoniazid, R: rifampicin, Z: pyrazinamide, E: Ethambutol), oral isoniazid, rifampicin, pyrazinamide, and ethambutol for 2 months; after that, oral isoniazid tablets and rifampicin capsules were continued for 4 months. In the study group, 28 males and 25 females, aged (66.19±3.59) years, with a body mass index of (21.23±1.20) kg/m², were treated with Baihe Dihuang decoction on the basis of the control group, one dose per day, divided into two times before morning and evening meals, and continued to be administered during the treatment of standardized chemotherapy regimen for 6 months. The observation indicators included the sputum negative conversion rate, traditional Chinese medicine (TCM) syndrome score, lung function indices [forced expiratory volume in the first second (FEV₁), forced vital capacity (FVC), and peak expiratory flow (PEF)], blood gas indices [arterial oxygen pressure (PaO₂), arterial carbon dioxide pressure (PaCO₂), and oxygenation index (OI)], and changes in levels of serum T lymphocyte subsets (CD3+, CD4+, and CD4+/CD8+), and the occurrence of adverse reactions during treatment was recorded. χ² test and t test were used for statistical analysis. Results　After treatment, the sputum negative conversion rate in the study group was higher than that in the control group [86.79% (46/53) vs. 66.04% (35/53)], with a statistically significant difference (χ²=6.334, P=0.012); the scores of dry cough and fatigue, hot flusher and night sweats, hot hands and heart, and fine and rapid pulse were lower than those in the control group [(0.65±0.16) points vs. (0.78±0.15) points, (0.58±0.13) points vs. (0.66±0.19) points, (0.59±0.17) points vs. (0.71±0.16) points, (0.58±0.18) points vs. (0.69±0.20) points]; the levels of FEV₁, FVC, PEF, PaO₂, OI, CD3+, CD4+, and CD4+/CD8+ were higher than those in the control group [(1.23±0.26) L vs. (1.02±0.11) L, (2.06±0.28) L vs. (1.87±0.31) L, (1.29±0.22) L/s vs. (1.14±0.20) L/s, (63.28±5.88) mmHg (1 mmHg=0.133 kPa) vs. (60.17±6.24) mmHg, 400.65±30.90 vs. 387.16±29.42, (68.78±6.53) ×10⁹/L vs. (65.01±6.41) ×10⁹/L, (41.59±3.46) ×10⁹/L vs. (38.97±3.51) ×10⁹/L, 1.58±0.22 vs. 1.36±0.19], but the PaCO₂ was lower than that in the control group [(45.02±4.47) mmHg vs. (47.79±4.16) mmHg], with statistically significant differences (all P<0.05). The incidence of adverse reactions in the study group was 9.43% (5/53), which was lower than that in the control group [24.53% (13/53)], with a statistically significant difference (χ²=4.283, P=0.038). Conclusion　Baihe Dihuang decoction combined with standardized chemotherapy regimen significantly enhances the sputum negative conversion rate and may improve immune function via elevated CD4+ T cell level, offering a potential adjunct therapy for treating elderly patients with pulmonary tuberculosis.

Nursing Research

Relationship between coping style and hope level in patients with bronchial asthma: mediating effect of family function

Liu Na, Li Saisai, Li Qiuju, Li Ying

2025, 31(5):  844-848.  DOI: 10.3760/cma.j.cn441417-20241014-05029

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Objective　To explore the relationship among family function, coping style, and hope level in patients with bronchial asthma, and to test the mediating effect of family function between coping style and hope level. Methods　A cross-sectional study was conducted on 120 patients with bronchial asthma who received treatment in Henan Provincial People's Hospital from April 2022 to April 2024. Among them, there were 66 males and 54 females, 71 patients ≤50 years old and 49 patients >50 years old. The patients' data were collected by means of questionnaire survey, including general information (gender, age, education level, course of disease, etc.) and scores of Herth Hope Index (HHI), Medical Coping Modes Questionnaire (MCMQ), and APGAR Family Care Index. The correlation analysis was conducted by Pearson correlation analysis method, and the structural equation model was constructed by AMOS 26.0 statistical software. t test and F test were used for statistical analysis. Results　There were statistically significant differences in the hope level among patients with bronchial asthma in terms of gender, age, education level, family income, and main place of residence (all P<0.05). Multiple layered regression analysis showed that the submissive coping style had a negative predictive effect on the hope level in patients with bronchial asthma (β=-0.526, P<0.05); family function had a positive predictive effect on the hope level (β=0.343, P<0.05), while the direct effect of submissive coping style on the hope level was weakened (β=-0.307, P<0.05). Pearson correlation analysis showed that the hope level score was negatively correlated with the submissive coping style score (r=-0.647, P<0.05), and positively correlated with the family function score (r=0.625, P<0.05); the family function score was negatively correlated with the submissive coping style score (r=-0.633, P<0.05). Further analysis showed that family function played a partial mediating role between submissive coping style and hope level, and the effect of submissive coping style on hope level was weakened with the addition of family function. The Bootstrap method verified this mediating effect, with the mediating effect of anxiety on pain behavior being -0.321, accounting for 35.04% of the total effect. Conclusions　The family function in patients with bronchial asthma has a partial mediating effect between submissive coping style and hope level. Future interventions should focus on improving the patients' family function in order to enhance their psychological state and quality of life.

Establishment of a risk warning model for respiratory failure in patients with acute exacerbation of chronic obstructive pulmonary disease and analysis of response strategies

Fan Yuanyuan, Pang Xiaoqian, Guo Zhen

2025, 31(5):  849-854.  DOI: 10.3760/cma.j.cn441417-20241012-05030

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Application effect of therapeutic nursing process based on continuous blood purification risk control in PICU children with severe sepsis

Zhang Chi, Shao Tong, Xu Congrui

2025, 31(5):  855-859.  DOI: 10.3760/cma.j.cn441417-20240820-05031

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Objective　To explore the effect of therapeutic nursing process based on continuous blood purification (CBP) risk control in children with severe sepsis in pediatric intensive care unit (PICU). Methods　A retrospective analysis was performed on 78 children with severe sepsis admitted to the PICU of Henan Children's Hospital from January 2022 to January 2024, who were divided into two groups with 39 cases in each group according to different nursing methods. In the control group, 20 boys and 19 girls, aged (9.95±0.54) years, received routine nursing. In the observation group, 22 boys and 17 girls, aged (9.98±0.57) years, received therapeutic nursing process based on CBP risk control. Both groups received continued nursing until the children were discharged from hospital. The severity of disease, levels of inflammatory factors, quality of life, family satisfaction, and incidence of complications were compared between the two groups. χ² test and t test were used for statistical analysis. Results　After nursing, the Acute Physiology and Chronic Health Evaluation Ⅱ score and levels of C-reactive protein, tumor necrosis factor-α, and procalcitonin in the observation group were lower than those in the control group [(21.15±3.07) points vs. (28.64±3.12) points, (20.03±4.46) mg/L vs. (25.99±5.31) mg/L, (45.33±22.65) µg/L vs. (66.39±25.15) µg/L, (0.95±0.22) mg/L vs. (1.47±0.45) mg/L], with statistically significant differences (t=10.686, 5.367, 3.886, and 6.483, all P<0.001); the scores of physiological function, emotional function, social function, and role function of the Children's Quality of Life Universal Core Scale (PedsQL 4.0) and nursing satisfaction were higher than those in the control group (all P<0.05). The total complication rate of the observation group was lower than that of the control group [5.13% (2/39) vs. 20.51% (8/39)] (χ²=4.129, P=0.042). Conclusion　Therapeutic nursing process based on CBP risk control can improve the illness and inflammatory factor levels in PICU children with severe sepsis, reduce the incidence of complications, effectively ensure the safety, improve their quality of life, to gain higher satisfaction with family members.

Application of health education model based on motivational protection theory in the whole process management of cancer pain patients

Zeng Yayan, Chen Xuna, Lin Tongtong, Xie Man, Zheng Zhiqiang, Cai Yingying

2025, 31(5):  860-864.  DOI: 10.3760/cma.j.cn441417-20240724-05032

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Objective　To explore the application effect of health education model based on motivational protection theory in the whole process management of cancer pain patients. Methods　This study was a randomized controlled trial. A total of 90 patients with cancer pain admitted to the First Department of Oncology of Jieyang People's Hospital from October 2021 to January 2023 were selected and were divided into a control group and an observation group using the random number table method, with 45 patients in each group. In the control group, there were 22 males and 23 females, aged (59±1) years. In the observation group, there were 22 males and 23 females, aged (55±1) years. The control group adopted the conventional health education model, and the observation group adopted the health education model based on the motivational protection theory. The pain score, degree of pain control disorder, medication compliance, self-management ability, and quality of life were compared between the two groups before intervention (at admission) and after intervention (at discharge). χ² test and t test were used for statistical analysis. Results　After intervention, the pain degree of the observation group was lower than that of the control group (χ²=13.856, P<0.001), and the score of pain control disorder was lower than that of the control group [(6.71±4.12) points vs. (20.07±8.38) points] (t=9.590, P<0.001); the scores of medication compliance, self-management ability, and quality of life were higher than those of the control group [(7.53±0.76) points vs. (5.57±1.64) points, (87.87±12.73) points vs. (69.44±16.69) points, (71.78±9.82) points vs. (65.80±7.32) points], with statistically significant differences (t=7.296, 5.859, and 3.275, all P<0.05). Conclusions　The health education model based on motivational protection theory can effectively reduce the patients' pain degree, and improve the medication compliance, self-management ability, and quality of life, which can provide reference for pain management of cancer pain patients.

Value of trans-theoretical model-based early cardiac rehabilitation nursing in patients with acute myocardial infarction undergoing percutaneous coronary intervention

Tong Jing

2025, 31(5):  865-869.  DOI: 10.3760/cma.j.cn441417-20240411-05033

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Objective　To study the value of trans-theoretical model (TTM)-based early cardiac rehabilitation nursing in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Methods　This study was a randomized controlled trial. A total of 82 patients with AMI who underwent PCI in Shangqiu First People's Hospital from March 2021 to March 2023 were selected as the study objects, and the patients were divided into a routine group (41 cases) and a TTM group (41 cases) by the random number table method. There were 18 males and 23 females in the TTM group, aged 48-85 (60.23±3.86) years, the time from onset to operation was 2-12 (6.41±1.26) h, and the diseased vessels were left anterior descending branch in 19 cases, right circumflex branch in 5 cases, and right coronary artery in 17 cases. In the routine group, there were 16 males and 25 females, aged 47-85 (59.98±3.72) years, the time from onset to operation was 2-12 (6.38±1.32) h, and the diseased vessels were left anterior descending branch in 16 cases, right circumflex branch in 7 cases, and right coronary artery in 18 cases. The routine group received routine early cardiac rehabilitation nursing, and the TTM group received TTM-based early cardiac rehabilitation nursing based on the routine group. Both groups were intervened until 6 months after discharge. The compliance, cardiac function [left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), and left ventricular end-diastolic diameter (LVEDD)], health belief level [Coronary Artery Disease Health Belief Scale (CADHBS)], self-management ability [Coronary Heart Disease Self-management Scale (CSMS)] before and after intervention, and incidence of cardiac adverse events were compared between the two groups. Independent sample t test and χ² test were used. Results　The total compliance rate in the TTM group [97.56% (40/41)] was higher than that in the routine group [80.49% (33/41)] (P<0.05). After intervention, the LVEF in the TTM group was higher than that in the routine group [(61.69±3.58)% vs. (55.06±3.15)%], but the LVESD and LVEDD were lower than those in the routine group [(34.16±2.13) mm vs. (39.74±2.61) mm, (52.47±2.35) mm vs. (61.85±3.27) mm] (all P<0.05). The scores of CADHBS and CSMS in the TTM group were higher than those in the routine group [(69.85±4.59) points vs. (51.38±4.12) points, (98.76±6.89) points vs. (87.41±5.02) points] (both P<0.05). During the intervention period, the total incidence of cardiac adverse events in the TTM group [4.88% (2/41)] was lower than that in the routine group [24.39% (10/41)] (P<0.05). Conclusion　TTM-based early cardiac rehabilitation nursing in AMI patients undergoing PCI can improve the patients' compliance and self-management ability, improve their cardiac function, and reduce the incidence of cardiac adverse events.

Application of self-management model guided by empowerment theory in patients with acute myeloid leukemia undergoing chemotherapy

Du Lulu, Zhu Chenhong, Liu Ruiying, Sun Jing

2025, 31(5):  870-874.  DOI: 10.3760/cma.j.cn441417-20240822-05034

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Objective　To explore the application effect of self-management model guided by empowerment theory in patients with acute myeloid leukemia (AML) undergoing chemotherapy. Methods　The clinical data of 70 patients with AML admitted to Zhengzhou Third People's Hospital from August 2021 to August 2023 were retrospectively analyzed. According to different nursing methods, the patients were divided into a control group and an observation group, with 35 cases in each group. The control group consisted of 18 males and 17 females, aged (40.53±2.36) years, and the course of disease was (13.59±3.54) months. The observation group consisted of 17 males and 18 females, aged (40.59±2.42) years, and the course of disease was (13.62±3.61) months. The control group received routine nursing care, and the observation group received self-management intervention guided by the empowerment theory. Both groups received continuous nursing for 1 month. The psychological state, self-efficacy level, self-management ability, and quality of life before and after nursing and incidence of adverse reactions were compared between the two groups. χ² test and t test were used for statistical analysis. Results　After nursing, the positive emotion level score of the Positive and Negative Emotion Scale in the observation group was higher than that in the control group, and the negative emotion level score was lower than that in the control group [(28.87±2.14) points vs. (19.82±2.01) points, (13.51±1.37) points vs. (18.82±1.46) points] (t=18.236 and 15.691, both P<0.05); the scores of self-stress reduction, positive attitude, and self-decision making of the Health Promotion Strategy Scale were (28.98±1.62), (41.18±2.37), and (11.24±1.15) points, which were higher than those in the control group [(24.72±1.51), (34.84±2.26), and (8.91±1.13) points] (t=11.380, 11.453, and 8.550, all P<0.05); the scores of health knowledge level, self-concept, self-care skills, and self-responsibility in the self-care ability scale were (26.73±1.51), (15.95±1.27), (26.64±1.42), and (16.84±1.52) points, which were higher than those in the control group [(19.98±1.46), (10.31±1.14), (21.41±1.37), and (13.93±1.46) points] (t=19.012, 19.552, 15.681, and 8.168, all P<0.05); the scores of mental health, surrounding environment, physical health, and social relations of the WHOQOL-BREF were (79.84±3.52), (82.29±4.62), (80.19±3.80), and (81.75±4.38) points, which were higher than those in the control group [(70.76±3.47), (75.56±4.04), (71.80±3.67), and (72.27±4.14) points] (t=10.868, 6.488, 9.396, and 9.306, all P<0.05). The incidence of adverse reactions in the observation group was lower than that in the control group [5.71% (2/35) vs. 22.86% (8/35)], with a statistically significant difference (χ²=4.200, P=0.040). Conclusion　The self-management model guided by the empowerment theory can alleviate the negative psychological state of AML patients undergoing chemotherapy, effectively improve their level of self-efficacy and self-management ability, and reduce the occurrence of adverse reactions, thus improving the quality of life.

Effect of trinity chronic disease management model on patients with non-proliferative diabetic retinopathy

Chao Yuanyuan, Chen Xiaodong, Liang Le, Wang Lina

2025, 31(5):  875-880.  DOI: 10.3760/cma.j.cn441417-20240829-05035

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Objective　To study the effect of hospital-community-family trinity chronic disease management model in the health management of non-proliferative diabetic retinopathy (NPDR). Methods　A total of 136 patients with NPDR who received their first treatment in Xi'an First Hospital from October 2021 to May 2023 were prospectively selected and were randomly divided into a control group and an observation group. In the control group, there were 42 males and 26 females, aged (59.7±9.1) years, 48 patients with ≥5 years of disease course. In the observation group, there were 35 males and 33 females, aged (60.5±8.6) years, 41 patients with ≥5 years of disease course. The control group received routine management, and the observation group received hospital-community-family trinity chronic disease management model for 3 months. Visual acuity, blood glucose indexes [fasting blood glucose (FPG), 2 h postprandial blood glucose (2hPG), and glycated hemoglobin (HbA1c)], and blood glucose control rate of the two groups were observed. The scores of Brief Illness Perception Questionnaire (BIPQ), Diabetic Retinopathy Patient Self-management Scale, and Diabetes Specific Quality of Life Scale (DSQL) and economic burden were compared between the two groups before and after intervention. Independent sample t test, χ² test, and rank sum test were used for statistical analysis. Results　After 3 months of intervention, the effective rate of visual acuity improvement in the observation group was higher than that in the control group [61.77% (42/68) vs. 30.88% (21/68)], and the rate of visual acuity decline was lower than that in the control group [4.42% (3/68) vs. 20.59% (14/68)], with a statistically significant difference (χ²=15.956, P=0.001); the levels of FPG, 2hPG, and HbA1c in the observation group were lower than those in the control group [(7.95±1.29) mmol/L vs. (9.08±1.31) mmol/L, (10.27±1.25) mmol/L vs. (11.39±1.28) mmol/L, (6.94±0.36)% vs. (8.48±0.39)%], the control rates of FPG, 2hPG, and HbA1c were higher than those in the control group [27.94% (19/68) vs. 2.94% (2/68), 39.71% (27/68) vs. 20.59% (14/68), 57.35% (39/68) vs. 22.06% (15/68)], with statistically significant differences (all P<0.05); the BIPQ score, DSQL score, and economic burden were lower than those in the control group [(44.59±3.24) points vs. (57.57±4.63) points, (41.34±3.07) points vs. (52.37±3.41) points, (1.98±0.51) thousand yuan vs. (2.37±0.64) thousand yuan], and the score of self-management ability was higher than that in the control group [(95.52±6.64) points vs. (83.71±4.58) points], with statistically significant differences (t=18.941, 19.823, 4.683, and 12.073, all P<0.05). Conclusion　The implementation of hospital-community-family trinity chronic disease management model is beneficial to improve the vision of NPDR patients, control the blood glucose level, improve the disease perception ability, self-management ability, and quality of life, and reduce the economic burden in patients and their families, which has good clinical application value.