Table of Content

01 April 2025, Volume 31 Issue 7

Previous Issue   

Special Column of Traditional Chinese Medicine

Summary of Professor Tan Guiyun's academic thoughts and clinical experiences in treating polycystic ovary syndrome 

Dong Xiaojing, Tan Guiyun, Yang Junwen, Mo Yingyin

2025, 31(7):  1057-1061.  DOI: 10.3760/cma.j.cn441417-20240822-07001

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Professor Tan Guiyun has been practicing medicine for more than 30 years, with noble medical ethics and rich experiences. In the diagnosis and treatment of gynecological diseases, she emphasizes the regulatory role of the liver and spleen based on the kidney, providing valuable guidance for the treatment of polycystic ovary syndrome. This article clarifies the etiology and pathogenesis of polycystic ovary syndrome, and deeply analyzes Professor Tan Guiyun's academic philosophy and clinical experiences in the treatment of polycystic ovary syndrome from the perspectives of treatment strategies, drug differentiation and application, and actual case analysis.

Inheritance and development of spleen disease theory in Huangdi Neijing from the perspective of infantile malnutrition treatment in Fuxing Jue

Huang Hongkai, Zhu Kaixin, Gu Jihong

2025, 31(7):  1062-1064.  DOI: 10.3760/cma.j.cn441417-20240430-07002

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Applying the theory of "Tangye Jingfa Tu" in Fuxing Jue, we analyze the guiding drugs in the infantile malnutrition syndrome guidelines, and find out that all the combinations follow the principle of drug positioning for treating spleen with pungent flavor for purgation, sweet flavor for tonification, and bitter flavor for drying, which better inherits and enriches the theory of "bitter desire for tonification and purgation" in Huangdi Neijing. It also suggests that infantile malnutrition and its concurrent symptoms can be treated with simplified medications based on the theory of five flavors for tonification and purgation, and provides more objective theoretical basis for the prescription of other pediatric diseases.

Effect of suspension rehabilitation diagnosis and treatment system combined with appropriate Chinese medicine technology on preschool children with autism

Yang Yi, Shao Kang, Li Hanyan, Li Dongcheng

2025, 31(7):  1065-1068.  DOI: 10.3760/cma.j.cn441417-20241017-07003

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Objective　To explore the effect of suspension rehabilitation diagnosis and treatment system combined with appropriate Chinese medicine technology on preschool children with autism. Methods　This study was a randomized controlled trial. From January 2023 to June 2024, a total of 62 preschool children with autism treated in Shenzhen Baoan Women's and Children's Hospital were randomly divided into a control group and an experimental group, with 31 children in each group. In the control group, there were 18 boys and 13 girls, aged (3.97±1.31) years, 20 moderate cases and 11 severe cases. In the experimental group, there were 17 boys and 14 girls, aged (4.02±1.34) years, 22 moderate cases and 9 severe cases. The control group was treated with the suspension rehabilitation diagnosis and treatment system, and the experimental group was treated with the appropriate technology of traditional Chinese medicine on the basis of the control group. Both groups were treated for 8 weeks. The scores of Autism Behavior Checklist (ABC), Autism Treatment Evaluation Checklist (ATEC) before and after treatment and clinical efficacies of the two groups were compared. Statistical methods used were t test and χ² test. Results　After treatment, the scores of language, communication, feeling, self-care, and exercise and total score of the ABC in the experimental group were lower than those in the control group, with statistically significant differences (t=3.345, 5.171, 4.922, 9.017, 7.158, and 6.078, all P<0.05); the scores of social contact, health-body-behavior, speech-language-communication, and sense-cognition-consciousness in the experimental group were all lower than those in the control group [(20.28±2.36) points vs. (26.41±2.75) points, (27.25±3.09) points vs. (34.87±3.63) points, (14.10±2.12) points vs. (18.64±2.59) points, (19.48±2.60) points vs. (25.78±2.91) points], with statistically significant differences (t=9.418, 8.900, 7.552, and 8.989, all P<0.05). The effective rate of the experimental group was higher than that of the control group [93.55% (29/31) vs. 67.74% (21/31)], with a statistically significant difference (χ²=6.613, P<0.05). Conclusion　Suspension rehabilitation diagnosis and treatment system combined with appropriate technology of traditional Chinese medicine has a significant effect on preschool children with autism, which can obviously improve behaviors, symptoms, and prognosis.

Application effect of Jin's Three-Needle combined with Bobath therapy in children with spastic cerebral palsy 

Xu Jingfeng, Wang Lei, Gao Jiyong

2025, 31(7):  1069-1073.  DOI: 10.3760/cma.j.cn441417-20241024-07004

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Objective　To explore the application effect of Jin's Three-Needle combined with Bobath therapy in children with spastic cerebral palsy. Methods　A total of 106 children with spastic cerebral palsy admitted to the First Affiliated Hospital of Shandong First Medical University from September 2022 to April 2024 were prospectively selected for a randomized controlled trial, and they were divided into two groups by the random number table, with 53 cases in each group. There were 30 boys and 23 girls in the control group, aged (3.64±1.03) years, 16 cases of mild disability, 26 cases of moderate disability, and 11 cases of severe disability. There were 31 boys and 22 girls in the observation group, aged (3.87±1.11) years, 17 cases of mild disability, 24 cases of moderate disability, and 12 cases of severe disability. The control group received Bobath therapy (exercise rehabilitation therapy), and the observation group received Jin's Three-Needle combined with Bobath therapy. Both groups were treated for 12 weeks. The limb motor function, cognitive function, and EEG power before and after treatment were compared between the two groups, as well as clinical efficacy. Statistical methods include t test, χ² test, and rank sum test. Results　After treatment, the scores of the Gross Motor Function Scale, Fine Motor Function Scale, and Gesell Developmental Scale in both groups increased compared to before treatment, and those in the observation group were higher than those in the control group [(185.33±41.18) points vs. (152.86±33.97) points, (125.87±27.98) points vs. (107.24±23.85) points, (75.38±16.75) points vs. (62.84±13.97) points], with statistically significant differences (t=4.361, 3.633, and 4.122, all P<0.05); the θ and θ/β waves in the observation group were lower than those in the control group, and the β wave was higher than that in the control group, with statistically significant differences (t=3.671, 7.531, and 3.892, all P<0.05). The total effective rate of the observation group was higher than that of the control group [92.31% (48/52) vs. 76.47% (39/51)], with a statistically significant difference (χ²=4.922, P<0.05). Conclusion　Jin's Three-Needle combined with Bobath therapy has significant therapeutic effect on spastic cerebral palsy in children, which can effectively enhance the limb motor function and cognitive function, improve the EEG power, and is worthy of further clinical promotion and application.

Efficacy and safety of Tiaoshen Shujin acupuncture therapy on post-stroke ankle dorsiflexion dysfunction

Song Qinqin, Song Rui, Shao Di

2025, 31(7):  1074-1078.  DOI: 10.3760/cma.j.cn441417-20241119-07005

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Objective　To observe the efficacy and safety of Tiaoshen Shujin acupuncture therapy on post-stroke ankle dorsiflexion dysfunction. Methods　A total of 90 patients with post-stroke ankle dorsiflexion dysfunction treated in Shaanxi Provincial Hospital of Traditional Chinese Medicine from March 2022 to February 2024 were prospectively selected and were randomly divided into two groups by the envelope method, with 45 cases in each group. In the feedback group, there were 26 males and 19 females, aged 42-78 (62.24±7.44) years, the stroke duration was 3-12 (7.74±1.24) weeks, and the hemiplegia was on the left side in 21 cases and right side in 24 cases. In the acupuncture group, there were 24 males and 21 females, aged 40-76 (61.94±7.57) years, the stroke duration was 3-12 (7.69±1.30) weeks, and the hemiplegia was on the left side in 23 cases and right side in 22 cases. Both groups were given early rehabilitation training intervention, the feedback group was given myoelectric biofeedback intervention, and the acupuncture group was combined with Tiaoshen Shujin acupuncture therapy on the basis of the feedback group. Both groups were treated continuously for 4 weeks. The gait parameters, active range of motion (AROM) and surface electromyographic indexes of the ankle joints, Fugl-Meyer Assessment Scale for Lower Extremity (FMA-LE) score, Holden Functional Ambulation Category (FAC) score, modified Barthel index (MBI), and clinical spasm index (CSI) were compared between the two groups before and after treatment. Statistical methods used were t test and χ² test. Results　After treatment, the step length, step speed, and step frequency in the acupuncture group were higher than those in the feedback group [(37.44±2.91) cm vs. (34.23±2.58) cm, (57.26±5.82) cm/s vs. (52.84±5.16) cm/s, (69.85±7.04) steps/min vs. (64.46±6.89) steps/min], but the support phase time on the affected side was lower than that in the feedback group [(55.25±5.79)% vs. (58.98±6.42)%], with statistically significant differences (t=5.537, 3.812, 3.671, and 2.894, all P<0.05); the integrated electromyography (iEMG) values of the tibialis anterior muscle and the lateral head of the gastrocnemius muscle in the acupuncture group were higher than those in the feedback group, and the co-contraction ratio (CCR) of dorsiflexion of the affected ankle was lower than that in the feedback group, with statistically significant differences (t=11.913, 4.386, and 3.768, all P<0.05); the scores of FMA-LE, FAC, and MBI and ankle AROM in the acupuncture group were higher than those in the feedback group [(18.69±3.02) points vs. (15.27±2.78) points, (3.71±0.96) points vs. (3.21±0.78) points, (52.64±8.16) points vs. (43.59±7.48) points, (7.23±1.74)° vs. (6.06±1.65)°], but the CSI was lower than that in the feedback group [(8.97±1.24) points vs. (10.34±1.55) points], with statistically significant differences (t=5.589, 3.254, 5.484, 3.273, and 5.589, all P<0.05). The total effective rate of the acupuncture group was higher than that of the feedback group [91.11% (41/45) vs. 75.56% (34/45)], with a statistically significant difference (χ²=3.920, P<0.05). Conclusion　Tiaoshen Shujin acupuncture therapy combined with electromyographic biofeedback intervention can improve ankle dorsiflexion function, walking independence, and therapeutic effect in patients with post-stroke ankle dorsiflexion dysfunction.

Study on the effect of acupuncture and moxibustion based on the theory of meridians and tendons on limb spasticity after stroke

Ma Yunxin, Li Jintao, Li Renxinxiu

2025, 31(7):  1079-1083.  DOI: 10.3760/cma.j.cn441417-20241114-07006

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Objective　To explore the effect of acupuncture and moxibustion based on the theory of meridians and tendons on limb spasticity after stroke. Methods　A total of 90 patients with post-stroke limb spasticity were selected from Baoji Traditional Chinese Medicine Hospital from May 2022 to May 2024. They were divided into two groups according to the random number table method. In 45 cases of the control group, the male to female ratio was 28:17, the age was (60.28±4.62) years old, and the Brunnstrom stroke classification included 16 patients with grade II, 20 patients with grade III, and 9 patients with grade IV. In 45 cases of the observation group, the male to female ratio was 26:19, the age was (61.43±4.57) years old, and the Brunnstrom stroke classification included 14 patients with grade II, 21 patients with grade III, and 10 patients with grade IV. The control group received routine rehabilitation therapy, and the observation group received routine rehabilitation therapy + acupuncture and moxibustion based on the theory of meridians and tendons. Both groups were treated for 1 month. The changes of cerebrospinal fluid γ-aminobutyric acid (GABA) and glutamic acid (GLU) levels, traditional Chinese medicine (TCM) syndrome score, free-hand muscle strength, motor function of limbs, neurological deficit, and quality of life were observed in the two groups. t test was used for statistical analysis. Results　After intervention, the GABA level in the observation group was higher than that in the control group [(1.75±0.48) mol/L vs. (1.49±0.43) mol/L], and the levels of GLU and GLU/GABA were lower than those in the control group [(2.07±0.22) mol/L vs. (2.38±0.34) mol/L, 1.38±0.39 vs. 1.65±0.43] (all P<0.05); the scores of TCM syndromes in the observation group were lower than those in the control group (all P<0.05); there were statistically significant differences in the motor function of upper limb [(26.37±3.72) points vs. (21.16±3.54) points], motor function of lower limb [(17.46±2.74) points vs. (14.36±2.62) points], muscle strength of free hand (3.36±0.59 vs. 2.61±0.53), and nerve function defect degree [(9.34±1.74) points vs. (13.83±1.25) points] between the observation group and the control group (all P<0.05); the quality of life scores of the observation group were higher than those of the control group (all P<0.05). Conclusion　Acupuncture and moxibustion based on the theory of meridians and tendons helps the patients with limb spasticity after stroke to improve the spasticity of limbs, improve the muscle strength of limbs, promote the recovery of motor function, improve the neurological deficit, promote the prognosis, and improve the quality of life.

Effect of acupotomy under the guidance of meridian tendon theory combined with scalp acupuncture on lower limb spasm after stroke 

Liu Bin, Li Jintao, Wu Peng

2025, 31(7):  1084-1088.  DOI: 10.3760/cma.j.cn441417-20241113-07007

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Objective　To analyze the effect of acupotomy under the guidance of meridian tendon theory combined with scalp acupuncture in the treatment of lower limb spasm after stroke and its influences on spasm degree and balance function. Methods　A total of 80 patients with lower limb spasm after stroke admitted to Xi'an International Medical Center Hospital from February 2021 to June 2024 were prospectively selected, and were divided into 2 groups with 40 cases in each group according to the random number table method. There were 20 males and 20 females in the control group, aged (49.20±4.17) years, the spasticity time of lower limb was (10.21±2.63) d, and the hemiplegia site was on the left side in 18 cases and right side in 22 cases. There were 23 males and 17 females in the observation group, aged (49.81±4.37) years, the spasticity time of lower limb was (10.65±3.02) d, and the hemiplegia site was on the left side in 20 cases and right side 20 cases. The control group was treated with scalp acupuncture (once a day, 6 times a week), and the observation group was treated with scalp acupuncture combined with acupotomy under the guidance of meridian tendon theory (3 times a week). Both groups were treated for 4 weeks. The therapeutic effect, adverse reactions, spasticity, balance function, activities of daily living, lower limb motor function, and three-dimensional gait analysis were compared between the two groups. χ² test, rank sum test, and t test were used for statistical analysis. Results　The effective rate of the observation group was 95.00% (38/40), which was higher than that of the control group [77.50% (31/40)] (χ²=5.165, P=0.023). After 4 weeks of treatment, the grade of spasticity in the observation group was better than that in the control group (P<0.05); the modified Barthel index (MBI) [(52.63±3.78) points], Fugl-Meyer Lower Limb Motor Function Rating Scale (FMA-LE) score [(23.20±2.98) points], and Berg Balance Scale (BBS) score [(46.25±5.04) points] in the observation group were higher than those in the control group [(46.21±3.42) points, (20.45±2.68) points, and (41.08±4.59) points] (t=7.965, 4.340, and 4.797, all P<0.05); the step frequency [(73.20±4.99) steps/min] and step speed [(0.61±0.07) m/s] in the observation group were higher than those in the control group [(70.02±4.24) steps/min and (0.52±0.06) m/s] (t=3.071 and 6.174, both P<0.05); the maximum dorsiflexion angle of the affected ankle [(14.02±1.62)°] and the maximum plantar flexion angle of the affected ankle [(20.02±2.74)°] in the observation group were higher than those in the control group [(11.84±1.27)° and (17.21±2.27)°] (t=6.698 and 4.995, both P<0.05). No aggravation occurred in both groups during treatment, and no adverse reactions such as needle fainting, subcutaneous hematoma, or congestion occurred. Conclusion　Acupotomy under the guidance of meridian tendon theory combined with scalp acupuncture has significant therapeutic effect in the treatment of lower limb spasm after stroke, which can reduce the degree of spasm, and improve the gait kinematics parameters, step frequency and pace, and lower limb motor function.

Study on the effect of Chinese medicine meridian theory on the recovery of neurological function in patients with cerebral infarction 

Yue Qiuxiang, Cui Xiaocan, Feng Guangda , Chen Tongyao

2025, 31(7):  1089-1093.  DOI: 10.3760/cma.j.cn441417-20240704-07008

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 Objective　To investigate the effect of Chinese medicine meridian theory on the recovery of neurological function in patients with cerebral infarction. Methods　Ninety-eight patients with cerebral infarction during the rehabilitation period from October 2022 to October 2023 in Xinxiang First People's Hospital were selected for a retrospective study, and they were divided into a control group and a study group according to the treatment time with 49 cases in each group. In the control group, there were 25 males and 24 females, aged 52-76 (61.2±2.4) years. In the study group, there were 23 males and 26 females, aged 54-75 (60.5±2.2) years. The control group was given routine nursing, and the study group was combined with comprehensive intervention measures based on Chinese medicine meridian theory. Both groups were intervened and followed up for 6 months. The neurological function recovery, psychological state, quality of life, and nursing satisfaction were compared between the two groups after intervention. χ² test and t test were used for statistical analysis. Results　Compared to those before intervention, the National Institutes of Health Stroke Scale (NIHSS) scores [(4.65±1.39) and (8.84±1.12) points], Barthel indexes [(74.63±3.36) and (58.86±1.08) points], Fugl-Meyer Motor Function Assessment (FMA) scores [(38.59±3.10) and (31.90±6.15) points], optimism scores [(27.06±9.54) and (23.55±7.15) points], toughness scores [(24.84±8.46) and (21.39±6.74) points], self-strengthening scores [(25.69±8.29) and (21.73±7.00) points], physiological function scores [(65.73±12.51) and (60.82±9.30) points], vitality scores [(58.84±9.44) and (53.20±7.37) points], emotional function scores [(58.41±9.20) and (53.04±7.11) points], general health scores [(64.71±11.59) and (58.33±9.14) points], body function scores [(60.84±10.38) and (54.98±8.04) points], somatic pain scores [(52.51±7.16) and (46.71±6.26) points], social function scores [(62.45±8.76) and (56.71±8.87) points], and mental health scores [(64.14±10.15) and (60.35±7.70) points] in the study group and the control group were improved after intervention, and those in the study group were better than those in the control group, with statistically significant differences (all P<0.05). The satisfaction rate of the study group was 87.76% (43/49), which was higher than that of the control group [61.22% (30/49)], with a statistically significant difference (P<0.05). Conclusion　Chinese medicine meridian theory can significantly improve the neurological deficits and the ability of daily life, reduce depression, anxiety, and other emotional disorders, and further improve patient satisfaction through various means such as acupuncture, tui-na massage, traditional Chinese medicine treatment, and functional exercises in patients with cerebral infarction during the rehabilitation period.

Application value of dragon-tiger fighting acupuncture combined with six-meridian syndrome differentiation massage in the treatment of cervical spondylotic radiculopathy with qi stagnation and blood stasis syndrome 

Gao Feng, Li Shuiqin, Wei Wei

2025, 31(7):  1094-1097.  DOI: 10.3760/cma.j.cn441417-20241126-07009

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Objective　To analyze the application value of dragon-tiger fighting acupuncture combined with six-meridian syndrome differentiation massage in the treatment of cervical spondylotic radiculopathy (CSR) with qi stagnation and blood stasis syndrome. Methods　A total of 90 patients with CSR who were treated with six-meridian syndrome differentiation massage in Xi'an Third Hospital from March 2022 to May 2023 were selected as a control group, and another 90 patients with CSR who were treated with dragon-tiger fighting acupuncture combined with six-meridian syndrome differentiation massage from June 2023 to August 2024 were selected as an observation group. There were 48 males and 42 females in the control group, aged (40.86±5.51) years, with a body mass index of (22.66±1.32) kg/m² and a course of disease of (15.33±5.24) months. There were 47 males and 43 females in the observation group, aged (40.12±5.23) years, with a body mass index of (22.54±1.26) kg/m² and a course of disease of (15.57±2.25) months. Dragon-tiger fighting acupuncture and six-meridian syndrome differentiation massage were once a day, and both groups were treated for 2 weeks. The clinical efficacies of the two groups were compared, as well as cervical spine function [Neck Disability Index (NDI)], pain level [Visual Analogue Scale (VAS)], levels of inflammatory factors [interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α (TNF-α)] before and after treatment. χ² test, rank sum test, independent sample t test, and analysis of variance were used for statistical analysis. Results　The total effective rate of the observation group was higher than that of the control group [95.56% (86/90) vs. 86.67% (78/90)] (P<0.05). The NDI, VAS score, and IL-6, IL-1β, and TNF-α levels in both groups showed a decreasing trend with treatment time; after treatment for 1 week and 2 weeks, the NDI [(25.14±3.21)% and (17.55±2.12)%], VAS score [(3.54±0.67) points and (1.96±0.55) points], and IL-6 [(35.44±4.52) ng/L and (25.14±3.54) ng/L], IL-1β [(7.54±1.12) ng/L and (4.86±1.02) ng/L], and TNF-α levels [(12.86±2.65) mg/L and (9.20±1.46) mg/L] in the observation group were lower than those in the control group [(28.25±3.02)%, (20.54±3.11)%, (4.63±0.75) points, (2. 74±0.64) points, (46.23±4.84) ng/L, (34.28±4.54) ng/L, (8.62±1.06) ng/L, (6.52±1.11) ng/L, (15.45±2.04) mg/L, and (12.57±1.22) mg/L] (all P<0.05). Conclusion　The dragon-tiger fighting acupuncture combined with six-meridian syndrome differentiation massage can effectively improve the cervical spine function of CSR patients with qi stagnation and blood stasis syndrome, relieve the pain, reduce the inflammation level, and improve the clinical efficacy.

Effects of iontophoresis of Duhuo Xuduan decoction on knee swelling and pain in patients with knee osteoarthritis 

Liu Jie, Wang Yu, Niu Yongqiang

2025, 31(7):  1098-1102.  DOI: 10.3760/cma.j.cn441417-20241120-07010

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Objective　To investigate the effects of iontophoresis of Duhuo Xuduan decoction on knee swelling and pain in patients with knee osteoarthritis. Methods　A total of 200 patients with knee osteoarthritis admitted to Yulin Traditional Chinese Medicine Hospital from June 2022 to December 2023 were divided into two groups by touching ball method, with odd numbers as a control group (100 cases) and even numbers as an observation group (100 cases). In the control group, there were 58 males and 42 females, aged (59.57±4.69) years, with a course of disease of (3.24±0.67) years, and the location of disease was left knee in 46 cases and right knee in 54 cases. In the observation group, there were 60 males and 40 females, aged (59.68±4.75) years, with a course of disease of (3.36±0.69) years, and the location of disease was left knee in 48 cases and right knee in 52 cases. The control group was treated with glucosamine sulfate capsules (0.5 g each time, twice a day), and the observation group was additionally treated with iontophoresis of Duhuo Xuduan decoction (30 min a day) for 1 month. The clinical effects of the two groups were compared, as well as the degree of knee swelling, pain level [Visual Analogue Scale (VAS)], osteoarthritis index [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)], arthritis biomarkers [stromal cell-derived factor 1 (SDF-1), matrix metalloproteinase 3 (MMP-3), and CXC chemokine receptor 4 (CXCR4)], levels of inflammatory factors [prostaglandin E₂ (PGE₂) and cyclooxygenase-2 (COX-2)] before and after treatment. χ² test and independent sample t test were used for statistical analysis. Results　After treatment, the total effective rate of the observation group was higher than that of the control group [95.00% (95/100) vs. 81.00% (81/100)], with a statistically significant difference (χ²=9.280, P=0.002); the knee swelling score and VAS score in the observation group were lower than those in the control group [(0.60±0.05) points vs. (0.81±0.08) points, (3.49±0.52) points vs. (4.81±0.76) points], with statistically significant differences (t=22.260 and 14.334, both P<0.05); the scores of pain, stiffness, and difficulty of daily living of the WOMAC in the observation group were lower than those in the control group [(4.58±0.96) points vs. (6.21±1.27) points, (0.70±0.21) points vs. (1.30±0.49) points, (10.03±1.68) points vs. (15.54±2.57) points], with statistically significant differences (t=10.239, 11.255, and 17.946, all P<0.05); the levels of SDF-1, MMP-3, and CXCR4 in the observation group were lower than those in the control group [(103.25±8.93) pg/L vs. (119.16±10.37) pg/L, (1.79±0.31) μg/L vs. (2.41±0.68) μg/L, (37.52±3.54) pg/L vs. (49.87±4.76) pg/L], with statistically significant differences (t=11.626, 8.296, and 20.819, all P<0.05); the levels of PGE₂ and COX-2 in the observation group were lower than those in the control group [(116.54±9.43) ng/L vs. (152.34±13.27) ng/L, (6.20±1.47) ng/L vs. (9.21±2.34) ng/L], with statistically significant differences (t=21.991 and 10.892, both P<0.05). Conclusion　Iontophoresis of Duhuo Xuduan decoction can enhance clinical efficacy in patients with knee osteoarthritis, reduce knee swelling and pain, and decrease inflammation level.

Clinical efficacy and safety observation of small-needle knife loosening combined with traditional Chinese medicine hot compress in the treatment of adhesive frozen shoulder syndrome 

Yang Baohua, Dong Bo, Gou Wei

2025, 31(7):  1103-1107.  DOI: 10.3760/cma.j.cn441417-20240816-07011

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Objective　To observe the clinical efficacy and safety of small-needle knife loosening combined with traditional Chinese medicine hot compress in the treatment of adhesive frozen shoulder syndrome. Methods　A total of 80 patients with adhesive frozen shoulder syndrome admitted to Baoji Second Hospital of Traditional Chinese Medicine from August 2023 to May 2024 were prospectively selected and were divided into two groups with 40 cases in each group by drawing lots. Group A included 12 males and 28 females, aged (57.74±7.88) years, the course of disease was (5.25±1.33) months, and there were 24 cases on the left shoulder and 16 cases on the right shoulder. Group B included 14 males and 26 females, aged (58.01±7.16) years, the course of disease was (5.21±1.42) months, and there were 21 cases on the left shoulder and 19 cases on the right shoulder. Group A was treated with small-needle knife loosening alone, once every two weeks, twice in total. Group B was treated with small-needle knife loosening combined with hot compress of traditional Chinese medicine: hot compress of traditional Chinese medicine was started 1 day after small-needle knife loosening, once a day, 30 min each time, continuous treatment for 4 weeks, and hot compress was suspended once in case of small-needle knife treatment day. The McGill pain questionnaire score, interleukin-10 (IL-10), IL-6, periarticular shoulder muscle strength, shoulder range of motion, and total clinical effective rate were compared between the two groups. t test and χ² test were used for statistical analysis. Results　After treatment, The Present Pain Intensity (PPI) scores [(1.45±0.34) and (0.85±0.22) points], Visual Analogue Scale (VAS) scores [(2.45±0.74) and (1.60±0.48) points], Pain Rating Index (PRI) scores [(10.10±1.78) and (6.75±1.26) points] in group A and B were lower than those before treatment, and those in group B were lower than those in group A (all P<0.05). After treatment, the levels of IL-10 in group A and B were higher than those before treatment, and the levels of IL-6 were lower than those before treatment; the level of IL-10 in group B was higher than that in group A, and the level of IL-6 was lower than that in group A (all P<0.05). After treatment, the peak anterior flexion moments [(42.63±4.22) and (51.04±4.89) N/m], average power of anterior flexion [(45.52±5.11) and (56.65±6.02) W], peak abduction moments [(44.15±4.29) and (52.05±5.21) N/m], and average power of abduction [(44.12±5.27) and (51.77±4.82) W] in group A and B were higher than those before treatment, and those in group B were higher than those in group A (all P<0.05). After treatment, the ranges of motion of shoulder anterior flexion, posterior extension, internal rotation, external rotation, and abduction in group A and B were higher than those before treatment, and those in group B were higher than those in group A (all P<0.05). The total effective rate of group B [95.00% (38/40)] was higher than that of group A [80.00% (32/40)], with a statistically significant difference (P<0.05). Conclusion Small-needle knife loosening combined with traditional Chinese medicine hot compresses in the treatment of adhesive frozen shoulder syndrome can reduce the pain, improve the degree of shoulder joint restriction, regulate the expressions of inflammatory factors, and improve the treatment efficacy.

Clinical effect of ultrasound-guided acupotomy combined with Qinxitong in the treatment of rheumatoid shoulder arthritis 

Zhang Tingting, Niu Xiaoqing, Li Juan, Li Rui, Song Jia

2025, 31(7):  1108-1113.  DOI: 10.3760/cma.j.cn441417-20240806-07012

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Objective　To analyze the clinical effect of ultrasound-guided acupotomy combined with Qinxitong in the treatment of rheumatoid shoulder arthritis. Methods　This study was a randomized controlled trial. A total of 120 patients with rheumatoid shoulder arthritis treated in Xi'an Fifth Hospital from September 2021 to March 2023 were selected and were divided into group A, B, and C by the random number table method, with 40 cases in each group. Group A included 8 males and 32 females, aged (52.43±11.77) years, with a course of disease of (55.40±33.89） months. Group B included 11 males and 29 females， aged （51.48±11.91） years， with a course of disease of (56.25±40.41) months. Group C included 10 males and 30 females, aged (53.18±10.47) years, with a course of disease of (55.88±41.52) months. All the three groups took methotrexate tablet 10.0-12.5 mg/time, once a week, and leflunomide tablet 10-20 mg/time, once a day. Group A was treated with ultrasound-guided acupotomy once a week for 3 consecutive weeks. Group B took Qinxitong orally, 1.08-1.80 g/time, twice a day. Group C was treated with ultrasound-guided acupotomy combined with Qinxitong, and the treatment plan was consistent with group A and B. All the three groups were treated for 12 weeks. The Visual Analogue Scale (VAS) score, Constant-Murley Shoulder Joint Function Score (CMS), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), 28 joint disease activity score-erythrocyte sedimentation rate (DAS28-ESR), and 28 joint disease activity score-C reactive protein (DAS28-CRP) were compared among the three groups before treatment, 4 weeks after treatment, and 12 weeks after treatment, as well as clinical efficacy and adverse effects. χ² test, analysis of variance, and generalized estimation equation were used for statistical analysis. Results　The effective rate of group C was 97.50% (39/40), higher than those of group A [77.50% (31/40)] and B [77.50% (31/40)], with a statistically significant difference (χ²=8.004, P=0.018). After 4 weeks and 12 weeks of treatment, the VAS, ESR, CRP, DAS28-ESR, and DAS28-CRP of the three groups showed a decreasing trend compared to before treatment, and those in group C were lower than those in group A and B; the CMS showed an upward trend, and that in group C was higher than those in group A and B (all P<0.05). The incidences of adverse reactions in group A, B, and C were 12.50% (5/40), 17.50% (7/40), and 20.00% (8/40), respectively, with no statistically significant difference (P>0.05). Conclusion　The combination of ultrasound-guided acupotomy and Qinxitong in the treatment of rheumatoid arthritis can relieve shoulder joint pain, improve shoulder joint function, reduce inflammation level and disease activity, and improve clinical efficacy, with relatively high safety in clinical application.

Application value of Chinese medicine sealing package combined with 5E rehabilitation nursing model in patients with lumbar disc herniation of cold-damp paralytic obstruction type

Wang Lina, Yang Yang, He Dingding

2025, 31(7):  1113-1117.  DOI: 10.3760/cma.j.cn441417-20241104-07013

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Objective　To explore the application value of traditional Chinese medicine sealing package combined with 5E (Encouragement-Education-Exercise-Employment-Evaluation) rehabilitation nursing model in patients with lumbar disc herniation (LDH) of cold-damp paralytic obstruction type. Methods　Sixty-eight LDH patients of cold-damp paralytic obstruction type in Kaifeng People's Hospital from January 2021 to December 2023 were retrospectively analyzed: 33 patients took traditional rehabilitation nursing as a traditional group, and 35 patients took traditional Chinese medicine sealing package combined with 5E rehabilitation nursing model as a combined group. There were 19 males and 16 females in the combined group, aged (59.43±2.28) years, with a course of disease of (3.02±0.27) years, 21 cases in acute stage and 14 cases in remission stage. In the traditional group, there were 17 males and 16 females, aged (59.48±2.32) years, with a course of disease of (2.97±0.25) years, 23 cases in acute stage and 10 cases in remission stage. Both groups received continuous nursing intervention for 2 months. The Visual Analogue Scale (VAS) score, lumbar function [Oswestry Disability Index (ODI) and Japanese Orthopaedic Association Assessment Scale (JOA)], degree of straight leg raising, and quality of life [World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) and Roland-Morris Disability Questionnaire (RMDQ)] were compared between the two groups before and after intervention. Independent sample t test was used for statistical analysis. Results　Compared with those in the traditional group [(4.38±0.34) and (2.77±0.18) points], the VAS scores [(3.96±0.28) and (1.25±0.09) points] in the combined group after 1 and 2 months of intervention were lower (t=5.574 and 44.428, both P<0.05). Compared with those in the traditional group [(28.32±1.46) and (15.87±1.14) points], the ODI score [(13.61±1.07) points] in the combined group after intervention was lower, and the JOA score [(24.04±1.85) points] was higher (t=47.583 and 21.766, both P<0.05). Compared with that in the traditional group [(69.98±4.92)°], the degree of straight leg raising [(77.05±5.14)°] in the combined group after intervention was higher (t=5.788, P<0.05). Compared with those in the traditional group [(18.74±1.02) and (71.82±4.94) points], the RMDQ and WHOQOL-BREF scores [(20.97±1.37) and (80.83±5.59) points] in the combined group after intervention were higher (t=7.577 and 7.026, both P<0.05). Conclusion　Traditional Chinese medicine sealing package combined with 5E rehabilitation nursing model in patients with cold-damp paralytic obstruction type LDH can rapidly relieve the pain, and improve the body's lumbar spine function, quality of life, and degree of straight leg raising.

Application of elective ear acupoint pressing bean + Taijiquan round the tail of the bird in patients with prolapse lumbar disc herniation

Zhang Ping, Ge Haiying

2025, 31(7):  1118-1122.  DOI: 10.3760/cma.j.cn441417-20240903-07014

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Objective　To explore the application effect of elective ear acupoint pressing bean + Taijiquan round the tail of the bird in the postoperative rehabilitation period of prolapse lumbar disc herniation (LDH) patients. Methods　A total of 168 patients with prolapse LDH from January to December 2023 in Ward 4, Spine Center, Baoji Hospital of Traditional Chinese Medicine were prospectively selected and were divided into a control group and a study group with 84 cases in each group according to the random number table method. In the study group, there were 51 males and 33 females, aged (58.79±6.53) years, with a body mass index of (23.52±2.24) kg/m² and a disease course of (4.79±1.53) years, protruding segments: L_3-4 in 26 cases, L_4-5 in 31 cases, and L₅-S₁ in 27 cases. In the control group, there were 54 males and 30 females, aged (59.21±6.44) years, with a body mass index of (23.43±2.35) kg/m² and a course of disease of (4.61±1.44) years, protruding segments: L_3-4 in 29 cases, L_4-5 in 32 cases, and L₅-S₁ in 23 cases. Both groups underwent endoscopic discectomy through percutaneous foraminal approach, the control group received regular care after surgery, and the study group received elective ear acupoint pressing bean + Taijiquan round the tail of the bird for 12 weeks. The pain degree [Numeric Rating Scale (NRS) score], lumbar function [Oswestry Disability Index (ODI)], and quality of life [Generic Quality of Life Inventory-74 (GQOLI-74)] were compared between the two groups at different time points. Independent sample t test and χ² test were used for statistical analysis. Results　The NRS scores of the study group 6 and 12 weeks after surgery were lower than those of the control group [(4.04±0.86) points vs. (5.67±1.18) points, (1.71±0.60) points vs. (2.94±0.91) points] (both P<0.05); the ODI scores were lower than those of the control group [(15.92±2.40) points vs. (21.71±3.15) points, (7.20±1.43) points vs. (13.61±2.19) points] (both P<0.05); the scores of psychological function, somatic function, social function, and material life status were higher than those of the control group (all P<0.05). Conclusion　Elective ear acupoint pressing bean + Taijiquan round the tail of the bird can effectively relieve the degree of pain in postoperative rehabilitation of prolapse LDH patients, improve the patients' lumbar function and quality of life.

Effects of fumigation with traditional Chinese medicine combined with external application of golden yellow paste on postoperative pain and wound healing in patients with perianal abscess 

Lu Yifang, Yi Hongmei, Zeng Yaling

2025, 31(7):  1123-1126.  DOI: 10.3760/cma.j.cn441417-20240719-07015

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Objective　To investigate the effects of fumigation with traditional Chinese medicine combined with external application of golden yellow paste on postoperative pain and wound healing in patients with perianal abscess. Methods　A total of 92 patients with perianal abscess who underwent surgical treatment in Yichun Hospital of Traditional Chinese Medicine from January 2023 to January 2024 were prospectively selected and were divided into a control group (46 cases) and an intervention group (46 cases) by drawing lots. In the control group, there were 26 males and 20 females, aged (35.62±5.69) years. In the intervention group, there were 28 males and 18 females, aged (35.79±5.84) years. The control group received routine intervention, and the intervention group received traditional Chinese medicine fumigation and washing (once in the morning and once in the evening) combined with external application of golden yellow paste (once a day) on the basis. The intervention period of both groups was 14 days. The degree of postoperative pain and wound healing were compared between the two groups. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　On day 7 and 14 after surgery, the Visual Analogue Scale (VAS) scores in the intervention group [(3.21±0.85) and (2.03±0.42) points] were lower than those in the control group [(4.32±0.94) and (3.41±0.52) points] (t=5.940 and 14.002, both P<0.05). The time of wound edema [(5.69±1.23) d], fluid leakage [(7.41±1.53) d], flesh-shedding [(4.05±1.01) d], and healing [(15.63±4.52) d] in the intervention group were shorter than those in the control group [(7.85±1.65) d, (9.66±1.86) d, (5.66±1.12) d, and (22.63±5.69) d] (t=7.119, 6.336, 7.240, and 6.533, all P<0.05). Conclusion　The combination of traditional Chinese medicine fumigation and external application of golden yellow paste can alleviate postoperative pain and shorten wound healing time in patients with perianal abscess.

Legal cooperative guarantee strategies for value remining of TCM achievements under the background of new-quality productive forces

Li Tong

2025, 31(7):  1126-1129.  DOI: 10.3760/cma.j.cn441417-20250303-07016

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New Medical Advances

Application of ultrasound in the diagnosis of psoriatic arthritis and its comorbidities

Wang Xiaonan, Jiao Yuting, Fang Yaqi, Duan Huantong, Yang Zhi

2025, 31(7):  1130-1134.  DOI: 10.3760/cma.j.cn441417-20240729-07017

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Psoriatic arthritis (PsA) is a chronic inflammatory joint disease, as a subtype of psoriasis, often presents as involvement of joints, tendons, enthesitis, nails, and skin. It is also associated with multisystem diseases such as cardiovascular diseases, diabetes, hypertension, and metabolic syndrome. Ultrasound is a safe, sensitive, and convenient imaging method that has been widely used for disease monitoring, treatment efficacy evaluating, and complication diagnosing of PsA. This article reviews the application of ultrasound in the diagnosis and management of PsA and its comorbidities.

Literature Analysis

Bibliometric analysis of machine learning algorithms based on Web of Science core set applied to nursing field

Hu Meilan, Hu Tingting

2025, 31(7):  1135-1140.  DOI: 10.3760/cma.j.cn441417-20240827-07018

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Objective　To analyze the research status and hotspots of machine learning algorithms applied to nursing field in foreign countries, so as to provide a reference path for related researches in China. Methods　Based on the literature analysis software CiteSpace 6.2 R6, we searched the relevant literatures on the application of machine learning algorithms in nursing in the core set of Web of Science from January 2010 to May 2024, and carried out a visual analysis in terms of the number of articles per year, authors, countries, journals, total citations, and keyword clustering, etc. Results　A total of 842 documents were included, with an overall increasing trend in annual publications, with the most publications in the journal Nursing (139), the United States being the country with the most publications (295), and the country with the strongest centrality (centrality=0.62). Research hotspots show that the top three sudden keywords are machine learning, deep learning, and predictive models, among them, machine learning (strength=7.16) has the highest burst intensity and has been sustained until now. Conclusions  The research hotness of machine learning algorithms applied to the nursing field has continued to increase in recent years, and there is still a certain gap between the current state of China's research in this field and the international cutting-edge level. In the future, on the basis of grasping the international hotspot, we should deepen the cooperation between nursing and machine learning algorithms.

Mechanism of Xinkeshu in treatment of coronary heart disease based on network pharmacology and molecular docking technology

Shi Hanjin, Ma Huixuan, Wang Yuanping

2025, 31(7):  1140-1148.  DOI: 10.3760/cma.j.cn441417-20240106-07019

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Objective　To investigate the mechanism of Xinkeshu in the treatment of coronary heart disease (CHD) based on network pharmacology and molecular docking technology. Methods　The active components and targets of Xinkeshu were obtained through the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) and HERB databases. The OMIM and GeneCards databases were used to acquire targets related to CHD. Time: Unlimited-December 2024. The common targets of drugs and diseases were obtained by drawing Venn diagram. The common targets were imported into the STRING database for protein interrelationship analysis. The Cytoscape 3.10.2 was applied to construct the protein-protein interaction (PPI) network and the "Chinese medicine-active component-target" network. The Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were performed via the DAVID database. The key active components and core targets screened from the network data were validated using AutoDock Tools for molecular docking. Results　Through the screening process, 77 main active components and 378 targets were identified for Xinkeshu, with 194 common targets shared between Xinkeshu and CHD. Following molecular docking validation, the core targets determined were interleukin-6 (IL-6), serine/threonine protein kinase B (AKT1), tumor necrosis factor (TNF), tumor protein p53 (TP53), cysteine aspartate protease 3 (CASP3), and epidermal growth factor receptor (EGFR). The key active components included β-sitosterol, luteolin, formononetin, Stigmasterol, 1,2,5,6-tetrahydrotanshinone, and DFV. GO and KEGG enrichment analysis suggested that the core targets were primarily enriched in pathways regulating lipid metabolism and atherosclerosis, AGE/RAGE signaling pathway, PI3K-AKT signaling pathway, fluid shear stress, and insulin resistance. These pathways were involved in biological processes such as response to external stimuli, positive regulation of cell migration, phosphorylation, negative regulation of apoptotic process, and positive regulation of the ERK1 and ERK2 cascade. Conclusion　The main active components of Xinkeshu may treat CHD by regulating core targets such as IL-6, AKT1, TNF, and multiple pathways including lipid metabolism and atherosclerosis, the AGE/RAGE signaling pathway, and the PI3K-Akt signaling pathway. These effects are likely achieved through anti-inflammatory actions, regulation of cell proliferation, and apoptosis.

Basic Research

Effect of Klotho on renal injury in spontaneous hypertensive rats by inhibiting NLRP3 inflammasome

Li Wei, Wang Yan, Zhao Wei

2025, 31(7):  1149-1156.  DOI: 10.3760/cma.j.cn441417-20241029-07020

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Objective　To investigate the effects of Klotho protein on renal injury and nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome in spontaneous hypertensive rats (SHR). Methods　The experiment was conducted from January 10 to March 25, 2024. The 14-week-old SPF male spontaneously hypertensive rats with body mass of 220-260 g were selected, and the other SPF male WKY rats with the same body mass were selected. All rats were fed alone in a 12 h/12 h light-dark cycle at 25 ℃ and 60% humidity, and after 7 days of adaptive feeding, the rats were treated in groups at the same time in the morning during the following 21 days. The spontaneously hypertensive rats were divided into a model group (gavage with equal volume of normal saline), a positive control group (gavage with 0.67 mg/kg of enalapril), low and high dose Klotho groups (gavage with 50 and 100 mg/kg of Klotho), and a high dose Klotho+NLRP3 inflammasome activator group (gavage with 100 mg/kg of Klotho protein followed by 5 mg/kg of nigericin sodium), 12 rats in each group; another 12 WKY rats were selected as a control group (gavage with equal volume of normal saline). The rats in each group were given gavage once a day for 21 days, and other treatment methods were the same. The systolic and diastolic blood pressure of the tail artery, renal function (serum creatinine, blood urea nitrogen, and urinary microalbumin), pathological morphology of renal tissue, content of collagen fibers, levels of inflammatory factors [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and IL-1β], Klotho protein, NLRP3, apoptosis-associated speck-like protein (ASC), Caspase-1, Collagen Ⅲ, and Collagen Ⅰ protein contents of each group were detected. One-way analysis of variance and LSD-t test were used for statistical analysis. Results　Compared with the control group, the model group had severe renal tissue damage, with increased tail artery systolic and diastolic blood pressure, serum creatinine, urea nitrogen, and urinary microalbumin contents, levels of inflammatory factors in renal tissue (IL-6, TNF-α, and IL-1β), Collagen volume fraction, and NLRP3, ASC, Caspase-1, Collagen Ⅲ, and Collagen Ⅰ protein expressions in renal tissue, and reduced Klotho protein expression level (0.24±0.01 vs. 0.60±0.02), with statistically significant differences (all P<0.05). Compared with the model group, the positive control group and low and high dose Klotho groups had reduced kidney tissue lesions, with reduced tail artery systolic and diastolic blood pressure, serum creatinine, urea nitrogen, and urinary microalbumin contents, levels of inflammatory factors in renal tissue (IL-6, TNF-α, and IL-1β), Collagen volume fraction, and NLRP3, ASC, Caspase-1, Collagen Ⅲ, and Collagen Ⅰ protein expressions in renal tissue, and increased Klotho protein expression level (0.53±0.03, 0.36±0.03, 0.51±0.04 vs. 0.24±0.01), with statistically significant differences (all P<0.05). Compared with the high dose Klotho group, the high-dose Klotho+NLRP3 inflammasome activator group had severe renal tissue damage, intensified renal fibrosis and inflammatory response, and decreased renal function (all P<0.05). Conclusion　Supplementing with Klotho protein can alleviate the renal tissue inflammation and fibrosis in spontaneously hypertensive rats by inhibiting the NLRP3 inflammasome pathway, thereby improving the renal injury and enhancing the renal function.

Treatises

Analysis of influencing factors of prolonged length of hospital stay in patients with acute intracerebral hemorrhage 

Ren Changqing, Li Huiping, Du Zhenping, Wang Lixin, Wu Shibiao

2025, 31(7):  1157-1161.  DOI: 10.3760/cma.j.cn441417-20240912-07021

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Objective　To investigate the influencing factors of prolonged length of hospital stay (LOS) in patients with acute intracerebral hemorrhage (ICH). Methods　This retrospective study included 310 patients with ICH in three branches of Guangdong Hospital of Traditional Chinese Medicine from May 2019 to May 2021. We recorded baseline data and laboratory data within 24 hours after admission. According to the LOS, the patients were divided into a prolonged group (>14 days) and a non-prolonged group (≤14 days). Among the 211 cases in the non-prolonged group, there were 142 males, aged (61.62±15.51) years. Among the 99 patients in the prolonged group, there were 64 males, aged (63.39±15.12) years. Independent sample t test, Mann-Whitney U test, χ² test, and multivariate logistic regression analysis were used to analyze the independent influencing factors of prolonged LOS in ICH patients. Results　Among the 310 ICH patients enrolled, the average LOS was 12 days. The hospitalization cost in the prolonged group was higher than that in the non-prolonged group [22 613.48 (15 343.92, 38 598.77) yuan vs. 98 618.66 (60 511.49, 152 027.37) yuan, Z=-11.194, P<0.001], accounting for 63.1% of the total hospitalization medical cost. Multivariate logistic regression analysis showed that surgery (OR=2.477, 95%CI 1.286-4.770), stroke-associated pneumonia (SAP) (OR=2.189, 95%CI 1.033-4.641), in-hospital death (OR=0.073, 95%CI 0.021-0.249), and discharge from hospital with non-severe disability [modified Rankin scale (mRS) score ≤2 points] (OR=0.244, 95%CI 0.110-0.539) were independent influencing factors for prolonged LOS in ICH patients (all P<0.05). Conclusions　Surgery, in-hospital death, SAP, and discharge from hospital with non-severe disability are closely related to prolonged LOS in patients with ICH. To achieve the purpose of reducing invalid LOS, reducing the waste of medical resources, and reducing the burden on patients and society, we suggest optimizing the surgical procedure, preventing and treating SAP at an early stage, and using antibacterial drugs rationally. In addition, we should pay attention to early rehabilitation management and establish a stable two-way referral channel with rehabilitation hospitals.

Correlation between femoral neck anteversion angle and internal fixation failure of intertrochanteric fracture analyzed by machine learning algorithm

Chen Bo, Guo Yifan, Tu Fan, Yang Weizhou

2025, 31(7):  1161-1167.  DOI: 10.3760/cma.j.cn441417-20241111-07022

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Objective　To analyze the correlation between femoral neck anteversion angle and internal fixation failure of intertrochanteric fracture, and to construct a prediction model of internal fixation failure of intertrochanteric fracture based on machine learning algorithm. Methods　A total of 206 patients with intertrochanteric fracture who received internal fixation surgery in Shangluo Central Hospital from January 2022 to September 2023 were retrospectively selected. Among them, there were 103 males and 103 females, aged (69.75±6.90) years, with a body mass index of (22.63±2.31) kg/m², 152 cases of stable fracture and 54 cases of unstable fracture. According to the follow-up results 12 months after surgery, the patients were divided into two groups: an internal fixation failure group (22 cases) and a normal group (184 cases). The clinical data of the patients were collected, factors of internal fixation failure in patients were analyzed by univariate analysis (independent sample t test and χ² test), and machine learning algorithms including logistic regression, categorical regression tree (CRT), and backpropagation neural network (BPNN) were used to construct a prediction model of internal fixation failure of intertrochanteric fracture. The receiver operating characteristic curve (ROC) was used to compare the predictive values of internal fixation failure models constructed by the three methods. Results　Univariate analysis showed that there were statistically significant differences in the body mass index, osteoporosis, fracture reduction quality, lateral wall thickness, and femoral neck anteversion angle between the two groups (t=3.624, P<0.001; χ²=5.016, P=0.025; χ²=7.529, P=0.023; t=4.464, P<0.001; t=7.602, P<0.001). Multivariate logistic regression analysis showed that body mass index, poor fracture reduction quality, lateral wall thickness, and femoral neck anteversion angle were independent influencing factors for internal fixation failure (OR=1.570, P=0.002; OR=22.315, P=0.009; OR=0.589, P=0.001; OR=2.378, P<0.001). The prediction model constructed by CRT method showed that femoral neck anteversion angle, lateral wall thickness, fracture reduction quality, and body mass index were all classification factors for internal fixation failure. The results of BPNN model showed that the most important influencing factors were femoral neck anteversion angle, lateral wall thickness, body mass index, fracture reduction quality, and osteoporosis. The areas under the curves (AUCs) of logistic regression model, CRT model, and BPNN model were 0.952, 0.919, and 0.950, respectively; the results of non-parametric DeLong test showed that there was no statistically significant difference in the prediction performance among the three models (P_{logistic regression model-CRT model} =0.158, P_{logistic regression model-BPNN model} =0.782, P_{CRT model-BPNN model} =0.219). Conclusions　The internal fixation failure of intertrochanteric fracture is correlated with femoral neck anteversion angle, lateral wall thickness, body mass index, and fracture reduction quality, etc. The three prediction models constructed in this study all show good prediction ability and can be further applied.

Utilization of 3D-printed surgical guide plate derived from digital orthopedic application in thoracolumbar fracture surgery and its impact on doctor-patient communication

Ma Hui, Wu Wenjun, Zhang Zhihai, Yu Sihao, Tantai Mengxiao, Lu Zhidong

2025, 31(7):  1168-1173.  DOI: 10.3760/cma.j.cn441417-20240924-07023

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Objective　To explore the application of 3D printing technology combined with E3D software digital design and printing thoracolumbar fracture model and personalized guide plate in the thoracolumbar fracture internal fixation and the effect on doctor-patient communication. Methods　This study was a randomized controlled trial. Fifty-one patients with thoracolumbar fracture and dislocation admitted to the General Hospital of Ningxia Medical University from February to November 2023 were selected as the study objects. The patients were divided into a control group (25 cases) and an experimental group (26 cases) by the random number table method. There were 13 males and 12 females in the control group, aged (43.27±14.36) years, vertebral body fracture site: T10 in 2 cases, T11 in 4 cases, T12 in 6 cases, L1 in 8 cases, L2 in 8 cases, and L3 in 1 case, AO fracture type: type A in 14 cases, type B in 8 cases, and type C in 3 cases, and 5 cases with other fractures. There were 13 males and 13 females in the experimental group, aged (45.32±12.31) years, vertebral body fracture site: T10 in 1 case, T11 in 2 cases, T12 in 6 cases, L1 in 12 cases, L2 in 5 cases, and L3 in 3 cases; AO fracture type: type A in 19 cases, type B in 6 cases, and type C in 1 case, and 8 cases with other fractures. The control group was treated with traditional pedicle screw fixation, and the experimental group was treated with 3D printing model and surgical guide plate. Both groups completed preoperative doctor-patient communication questionnaire survey within 24 h after admission. The doctor-patient communication [self-made questionnaire (preoperative conversation time, understanding degree on the condition and operation, and satisfaction with communication], operation situation (operation time, intraoperative blood loss, and intraoperative fluoroscopy times), and screw placement (total number of screw placement, number of screws inserted at one time, and number of screws successfully inserted into the pedicle) were compared between the two groups. Independent sample t test was used for statistical analysis. Results　The preoperative conversation time of the experimental group was shorter than that of the control group [(17.81±3.66) min vs. (20.80±3.27) min], and the understanding degree on the condition and operation and satisfaction with communication were higher than those of the control group [(8.65±0.85) points vs. (7.76±0.83) points, (8.69±1.05) points vs. (7.84±0.85) points] (all P<0.05). The operation time of the experimental group was shorter than that of the control group [(128.96±7.35) min vs. (144.08±9.03) min], and the intraoperative blood loss and fluoroscopy times were lower than those of the control group [(123.08±9.99) ml vs. (151.28±22.76) ml, (8.00±1.48) times vs. (12.28±2.41) times] (all P<0.05). There was no statistically significant difference in the total number of screws between the two groups (P>0.05); the number of screws inserted at one time and the number of screws successfully inserted into the pedicle in the experimental group were higher than those in the control group (5.58±0.86 vs. 3.76±0.97, 5.96±0.96 vs. 4.40±1.04) (both P<0.05) Conclusion　The application of 3D printing technology in spinal orthopedics can improve the effect of doctor-patient communication, shorten the operation time, reduce the intraoperative blood loss and fluoroscopy times, and improve the accuracy of screw placement.

Relationships between serum Syndecan-1, Endocan-1, and GRP78 levels and disease severity and prognosis in elderly patients with severe pneumonia complicated by ARDS

Li Yongping, Wu Shuimiao, Jiao Qin, Ren Jiahui, Zhang Xiao

2025, 31(7):  1173-1178.  DOI: 10.3760/cma.j.cn441417-20241025-07024

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Objective　To analyze the relationships between serum Syndecan-1 (multiligand proteoglycan-1), Endocan-1 (endothelial cell-specific molecule-1), and GRP78 (glucose-regulated protein 78) levels and the disease severity and prognosis in elderly patients with severe pneumonia complicated by acute respiratory distress syndrome (ARDS). Methods　This retrospective study included 120 elderly patients with severe pneumonia complicated by ARDS (ARDS group) admitted to Weinan First Hospital from January 2023 to May 2024, consisting of 71 males and 49 females, with an age of (73.35±7.60) years old. Additionally, 84 elderly patients with severe pneumonia without ARDS (non-ARDS group) were included, consisting of 50 males and 34 females, with an age of (72.68±6.54) years old. According to the oxygenation index, the ARDS group was subdivided into a mild group [33 cases, oxygenation index > 200-300 mmHg (1 mmHg=0.133 kPa)], a moderate group (39 cases, oxygenation index of 100-200 mmHg), and a severe group (48 cases, oxygenation index ≤100 mmHg). According to the 28-day prognosis of the ARDS group, the patients were subdivided into a death group (36 cases) and a survival group (84 cases). A total of 80 healthy volunteers, including 45 males and 35 females, with an age of (71.29±7.20) years old, were selected as a control group. Serum levels of Syndecan-1, Endocan-1, and GRP78 were measured. Multivariate logistic regression analysis was conducted to identify factors affecting prognosis in elderly patients with severe pneumonia complicated by ARDS, and the receiver operating characteristic curve (ROC) was performed to assess the predictive values of serum biomarkers for mortality risk. t test and χ² test were used for statistical analysis. Results　Serum levels of Syndecan-1, Endocan-1, and GRP78 in the control group, non-ARDS group, and ARDS group increased sequentially (all P<0.05). In the mild, moderate, and severe groups, serum levels of Syndecan-1, Endocan-1, and GRP78 showed a gradual increasing trend (all P<0.05). The age, mechanical ventilation time, C-reactive protein, Syndecan-1, Endocan-1, and GRP78 levels in the death group were higher than those in the survival group [(76.72±8.20) years old vs. (71.90±7.42) years old, (4.78±1.12) d vs. (3.29±0.83) d, (113.97±42.98) mg/L vs. (85.74±33.03) mg/L, (97.45±10.48) g/L vs. (80.35±8.58) g/L, (4.80±0.88) ng/L vs. (3.40±0.52) ng/L, (30.37±5.57) µg/L vs. (23.84±4.40) µg/L], but the oxygenation index was lower than that in the survival group [(74.92±27.60) mmHg vs. (164.27±48.50) mmHg], with statistically significant differences (t=3.159, 8.081, 3.907, 9.346, 8.903, 6.862, and 12.743, all P<0.05). Age, mechanical ventilation time, Syndecan-1, Endocan-1, and GRP78 were independent risk factors for prognosis in elderly severe pneumonia patients complicated by ARDS (all P<0.05). The sensitivities of Syndecan-1, Endocan-1, and GRP78 for predicting poor prognosis in elderly severe pneumonia patients complicated by ARDS were 88.9%, 88.9%, and 72.2%, the specificities were 75.0%, 89.9%, and 85.7%, and the areas under the curves were 0.896, 0.921, and 0.823. When Syndecan-1, Endocan-1, and GRP78 were combined, the sensitivity and specificity were 94.4% and 92.9%, respectively, and the area under the curve was 0.987. Conclusion　Serum Syndecan-1, Endocan-1, and GRP78 are closely related to the severity and prognosis of elderly patients with severe pneumonia complicated by ARDS and serve as independent risk factors that significantly impact patient prognosis.

Serum level of interleukin-6 and its prognostic significance in patients with newly diagnosed diffuse large B-cell lymphoma

Zhang Jinping, Chen Ling, Huang Zhenyu, Wang Ying, Huang Xiaoling, Huang Haobo

2025, 31(7):  1179-1183.  DOI: 10.3760/cma.j.cn441417-20240924-07025

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Objective　To explore the serum level of interleukin-6 (IL-6) in patients with newly diagnosed diffuse large B-cell lymphoma (ND-DLBCL) and its clinical significance. Methods　A total of 66 patients with ND-DLBCL who were admitted to Fuzhou Second General Hospital and Fujian Medical University Union Hospital and 35 cases of healthy control individuals from Oct 2017 to Dec 2021 were selected for the retrospective analysis. Among the patients with ND-DLBCL, there were 39 males and 27 females with a median age of 59 years old. Among the healthy control individuals, there were 10 males and 25 females with a median age of 39 years old. The serum IL-6 levels were compared between the two groups. Of the 66 ND-DLBCL patients, 4 were lost to follow-up and 62 were included for further analysis. The optimal cut-off value of serum IL-6 level to predict prognosis was obtained by the receiver operating characteristic curve. The patients were divided into a high level group (IL-6 ≥15.6 ng/L, 39 cases) and a low level group (IL-6 <15.6 ng/L, 23 cases) according to the cut-off value. The clinical and laboratory characteristics, 3-year overall survival (OS) and progression-free survival (PFS) of the two groups were compared. χ² test and t test were used for statistical analysis. Results　The serum level of IL-6 in the patients with ND-DLBCL [(35.95±33.66) ng/L] was higher than that in the healthy control individuals [(1.66±0.77) ng/L] (t=6.012, P<0.001). The optimal cut-off value of serum level of IL-6 for prognosis in patients with ND-DLBCL was 15.6 ng/L, and the area under curve was 0.705 (0.558-0.852) (P<0.05). Compared with the group with low level of serum IL-6, the proportions of the patients with presence of B symptoms [58.97% (23/39) vs. 13.04% (3/23)] and high National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI) (≥4 points) [79.49% (31/39) vs. 43.48% (10/23)] were higher in the high level group, but the OS rate of 3-year [71.79% (28/39) vs. 100.00% (23/23)] and the PFS rate of 3-year [56.41% (22/39) vs. 82.61% (19/23)] were lower in the high level group (all P<0.05). Conclusions　There was an abnormal elevation of serum IL-6 level in patients with ND-DLBCL. Meanwhile, high level of serum IL-6 was associated with poor prognosis in patients with ND-DLBCL.

Analysis of the correlations between LPCAT1, CRP, PLT, and therapeutic efficacy in adult acute myeloid leukemia patients with FAB-M2 subtype

Ren Yu, He Aijun, Ge Fanmei

2025, 31(7):  1183-1189.  DOI: 10.3760/cma.j.cn441417-20240924-07026

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Objective　To investigate the expression levels of lysophosphatidylcholine acyltransferase 1 (LPCAT1), C-reactive protein (CRP), and platelet count (PLT) in adult patients with acute myeloid leukemia (AML) FAB-M2 subtype, and their correlations with therapeutic efficacy, aiming to provide more targeted biomarkers for the clinical treatment of AML. Methods　This was a retrospective study. A total of 162 AML patients in Yan'an University Affiliated Hospital from January 2020 to January 2022 were selected as an AML group, and 25 healthy volunteers during the same period served as a control group. In the AML group, there were 67 males and 95 females, aged (45.82±4.79) years, 76 patients with partial differentiation of acute myeloid leukemia (M2 type), 25 patients with acute promyelocytic leukemia (M3 type), and 61 patients with acute monocytic leukemia (M5 type). In the control group, there were 11 males and 14 females, aged (45.67±5.43) years. The expression level of LPCAT1 in bone marrow tissue of the subjects were measured using real-time quantitative fluorescence. All AML patients received treatment and had complete follow-up data. The M2 subtype AML patients were categorized based on treatment efficacy into a complete remission (CR) group (32 cases) and a non-CR group (44 cases). Clinical data such as CD68, CRP, and PLT were statistically compared between the two groups. χ², Z, and t tests were used for statistical analysis. Spearman correlation analysis was used to analyze the correlations between the expression levels of LPCAT1, CRP, and PLT and therapeutic  efficacy of AML patients. Kaplan-Meier survival curves for overall survival (OS) and progression-free survival (PFS) were plotted for AML patients. Results　The expression level of LPCAT1 in the control group was 35.16% (37.99%, 313.57%), which was lower than that in the AML group [93.31% (29.69%, 63.20%)], with a statistically significant difference (Z=-3.452, P<0.05). The expression level of LPCAT1 was 36.39% (28.08%, 59.68%) in the M2 group, 22.68% (14.32%, 35.74%) in the M3 group, and 53.57% (33.53%, 95.96%) in the M5 group. The levels of CD68 and CRP in the non-CR group were higher than those in the CR group [(2.39±0.35) ng/L vs. (1.73±0.16) ng/L, (19.79±4.31) mg/L vs. (6.89±0.63) mg/L], but the PLT level was lower than that in the CR group [(77.34±27.92) ×10⁹/L vs. (213.97±39.65) ×10⁹/L], with statistically significant differences (all P<0.05). LPCAT1, CD68, and CRP were negatively correlated with the clinical efficacy of AML patients (r=-0.420, -0.794, and -0.855, all P<0.05), but the PLT level was positively correlated with the clinical efficacy of AML patients (r=0.854, P<0.05). A 2-year follow-up of AML patients showed that 16 patients survived and 16 died in the CR group, while 27 patients survived and 17 died in the non-CR group; there were statistically significant differences in the OS and PFS between the two groups (χ²=-3.982 and 4.173, both P<0.05). Conclusions　LPCAT1, CD68, CRP, and PLTlevels can serve as effective indicators for predicting the therapeutic response in AML treatment. LPCAT1 gene may play a significant role in the pathological process of AML. Analysis of K-M survival curve further verifies the correlations between biomarkers and patients' OS and PFS.

Clinical Research

Effects of functional rehabilitation training based on the MOHO on limb function and quality of survival in patients with ischaemic stroke with hemiparesis

Wang Minfen, Dong Yuanyuan, Zhao Sha, Liu Chao, Dong Yixuan, Yang Yanhui

2025, 31(7):  1190-1194.  DOI: 10.3760/cma.j.cn441417-20241012-07027

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Objective　To study the effect of functional rehabilitation training based on the model of human occupation (MOHO) on limb function and quality of survival in patients with ischaemic stroke with hemiparesis. Methods　This study was a prospective single-blind trial. A total of 60 patients with ischaemic stroke with hemiparesis treated in Chang'an Hospital from February 2022 to February 2024 were selected as the study objects. They were divided into a control group and a study group according to the random number table method. In the control group, there were 14 males and 16 females, aged (68.12±4.26) years, and the course of disease was (3.80±1.20) months. In the study group, there were 12 males and 18 females, aged (68.16±4.30) years, and the course of disease was (3.89±1.24) months. The control group received routine rehabilitation training, and the study group received MOHO-based functional rehabilitation training on the basis of the control group, about 40 min each time. The intervention duration of both groups was 6 months. Exercise compliance and motor function and activity of daily living on the next day after admission and 6 months after intervention were compared between the two groups. χ² test and t test were used for statistical analysis. Results　The scores of physical participation, effect monitoring, and advice seeking and total score of the Functional Exercise Compliance Scale for Stroke Patients in the study group were (15.02±1.26), (9.82±1.12), (4.52±0.62) and (24.29±1.60) points, and those in the control group were (14.16±1.22), (9.20±1.10), (4.10±0.56), and (23.19±1.52) points, with statistically significant differences (all P<0.05). After 6 months of intervention, the upper limb and lower limb motor function scores of the study group were higher than those of the control group [(25.37±3.61) points vs. (22.93±3.04) points, (20.16±2.24) points vs. (18.95±2.16) points], with statistically significant differences (t=2.831 and 2.130, both P<0.05); the scores of exercise, self-care, mobility, and sphincter control and total score of the modified Barthel index were higher than those of the control group (all P<0.05). Conclusion　Functional rehabilitation training based on the MOHO can effectively improve the exercise compliance in patients with ischaemic stroke with hemiparesis, and enhance the function of the upper and lower limbs and the ability of daily activities.

Changes of TCB, ALB, and B/A levels in neonates with hyperbilirubinemia and their correlations with long-term neurodevelopmental outcomes

Yang Dong, Yang Yunfan, Mu Qing, Luo Liqian

2025, 31(7):  1194-1198.  DOI: 10.3760/cma.j.cn441417-20240806-07028

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Objective　To investigate the changes of transcutaneous bilirubin (TCB), albumin (ALB), and total bilirubin/albumin (B/A) levels in neonates with hyperbilirubinemia and their correlations with long-term neurodevelopmental outcomes. Methods　Ninety-eight neonates with hyperbilirubinemia admitted to Northwest Women and Children's Hospital from January 2021 to January 2023 were selected as an observation group, and 90 normal neonates born in our hospital during the same period were selected as a control group. There were 53 boys and 45 girls in the observation group, with gestational age of (40.04±1.32) weeks, age of (3.57±0.36) d, and birth weight of (3.40±0.53) kg, and the delivery methods were cesarean section in 17 cases and vaginal delivery in 81 cases. In the control group, there were 55 boys and 35 girls, with gestational age of (39.99±1.41) weeks, age of (3.63±0.34) d, and birth weight of (3.47±0.51) kg, and the delivery methods were cesarean section in 18 cases and vaginal delivery in 72 cases. The TCB and ALB levels were detected in the observation group (before treatment and after 7 days of treatment) and the control group (the next day after inclusion in the study), and the B/A level was calculated. After 12 months of follow-up, the children were divided into a poor outcome group (12 cases) and a good outcome group (86 cases) according to the neurodevelopmental outcomes. Multivariate logistic regression analysis was used to analyze the influencing factors of adverse neurodevelopmental outcomes of neonatal hyperbilirubinemia. The receiver operating characteristic curve (ROC) was used to analyze the predictive efficacies of TCB, ALB, and B/A for adverse neurodevelopmental outcomes of neonatal hyperbilirubinemia. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　The TCB and B/A levels in the observation group before treatment were higher than those in the control group [(360.23±35.82) μmol/L vs. (202.38±21.45) μmol/L, 9.87±1.90 vs. 4.60±1.84], but the ALB was lower than that in the control group [(30.48±4.23) g/L vs. (35.04±2.42) g/L] (all P<0.05). Before and after 7 days of treatment, the TCB and B/A levels in the poor outcome group were higher than those in the good outcome group [(383.23±39.74) μmol/L vs. (342.31±23.86) μmol/L, (182.23±22.10) μmol/L vs. (172.34±9.84) μmol/L, 11.92±2.11 vs. 8.78±1.49, 9.20±1.56 vs. 4.84±1.17], but the ALB was lower than that in the good outcome group [(27.92±2.19) g/L vs. (32.84±2.78) g/L, (31.80±1.62) g/L vs. (35.13±2.12) g/L] (all P<0.05). Multivariate logistic regression analysis showed that pre-treatment TCB, ALB, and B/A levels were independent risk factors for adverse neurodevelopmental outcomes of neonatal hyperbilirubinemia (all P<0.05). ROC results showed that the area under the curve of pre-treatment TCB, ALB, and B/A combined detection was larger than that predicted by TCB, ALB, or B/A alone (all P<0.05). Conclusions　The TCB and B/A levels of neonatal hyperbilirubinemia increased significantly, and the ALB level decreased. The combined detection of TCB, ALB, and B/A had high predictive value for adverse neurodevelopmental outcomes, which should be paid close attention to clinically.

Preventive effects of dexmedetomidine on delirium and cognitive impairment after total hip arthroplasty in the elderly 

Xue Na, Zhao Yuan, Wang Dezhi, Zhang Hui, Song Lei

2025, 31(7):  1199-1203.  DOI: 10.3760/cma.j.cn441417-20240903-07029

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Objective　To analyze the effects of dexmedetomidine on postoperative delirium and cognitive impairment in elderly frailty patients undergoing total hip arthroplasty (THA). Methods　A randomized controlled trial was conducted on 213 elderly frailty patients undergoing elective THA in Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2022 to December 2023, and the patients were divided into 107 cases in the experimental group and 106 cases in the control group using the random number table method. There were 61 males and 46 females in the experimental group, aged (73.11±6.40) years, with a body mass index (BMI) of (23.43±1.43) kg/m², 51 cases on the left side and 56 cases on the right side, American Society of Anesthesiologists (ASA) grade Ⅰ in 35 cases, grade Ⅱ in 47 cases, and grade Ⅲ in 25 cases. There were 64 males and 42 females in the control group, aged (72.91±5.94) years, with a BMI of (23.72±1.20) kg/m², 56 cases on the left side and 50 cases on the right side, ASA grade Ⅰ in 30 cases, grade Ⅱ in 46 cases, and grade Ⅲ in 30 cases. The experimental group was given dexmedetomidine hydrochloride before anesthesia induction, injected with 0.4 μg/kg of load dose within 10 min. After anesthesia induction, dexmedetomidine hydrochloride was injected with 0.4 μg/(kg·h) continuously until the end of the operation. The control group was given the same amount of normal saline before and after anesthesia induction to the end of operation. The incidences of delirium 1-5 d after operation were compared between the two groups (3D-CAM), as well as cognitive function before and 1 d after operation [Mini-Mental State Examination (MMSE)], serum C-reactive protein (CRP) levels before and 1 and 2 d after operation, and incidences of intraoperative bradycardia and hypotension. Independent sample t test, χ² test, and Fisher exact probability method were used for statistical analysis. Results　The total incidence of delirium in the experimental group was lower than that in the control group [9.35% (10/107) vs. 22.64% (24/106)] within 1-5 d after operation (P<0.05). On the first day after operation, the MMSE score of the experimental group was higher than that of the control group [(25.37±2.12) points vs. (24.16±2.33) points] (P<0.05), and the incidence of cognitive dysfunction in the experimental group was lower than that in the control group [9.35% (10/107) vs. 22.64% (24/106)] (P<0.05). One and 2 d after operation, the serum CRP levels in the experimental group were lower than those in the control group [(7.63±1.65) mg/dl vs. (9.45±2.73) mg/dl, (11.85±2.74) mg/dl vs. (14.62±3.15) mg/dl] (both P<0.05). There was no statistically significant difference in the incidence of bradycardia or hypotension between the two groups [24.30% (26/107) vs. 17.92% (19/106), 17.76% (19/107) vs. 15.09% (16/106)] (both P>0.05). Conclusion　Use of dexmedetomidine in elderly frailty patients undergoing THA can reduce the risk of postoperative delirium and cognitive impairment and the level of postoperative CRP, and does not increase the risk of adverse events.

Non-inferiority of water laser pre-treatment against Er:YAG laser pre-treatment of all-ceramic inlay dental restorations

Wang Lei, Li Ying, Bai Qingxia

2025, 31(7):  1204-1208.  DOI: 10.3760/cma.j.cn441417-20241024-07030

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Objective　To investigate the clinical results of water laser pretreatment of all-ceramic inlay dental restorations and to analyze the factors influencing the long-term prognosis. Methods　Convenience sampling method was used to select 136 patients with dental defects admitted to The Third Affiliated Hospital of Air Force Medical University from May 2022 to January 2023 as the study subjects, and they were divided into two groups by the random number table method with 68 cases in each group. After excluding patients with detachment, there were 65 cases in the control group, 33 males and 32 females, aged 22-63 (46.06±8.50) years, with the number of dental defects being 1 in 45 cases, 2 in 16 cases, and 3 in 4 cases, and Er:YAG laser pretreatment was carried out; there were 64 cases in the observation group, 34 males and 30 females, aged 23-66 (44.22±9.83) years, with the number of dental defects being 1 in 48 cases, 2 in 14 cases, and 3 in 2 cases, and water laser pretreatment was carried out. On the basis, both groups were given all-ceramic inlay dental restoration. The results of the two groups were compared at 12 months after dental restoration [United States Public Health Service (USPHS) revised evaluation criteria], as well as oral health before and 12 months after restoration [probing depth (PD), gingival index (GI), and plaque index (PI)], amount of blood loss during dental restoration, pain and discomfort disappeared time after dental restoration, and survival rate of all-ceramic inlays at 18 months after dental restoration. Independent sample t test, paired t test, Mann-Whitney U test, and χ² test were used for statistical analysis. COX regression analysis was used to analyze the factors affecting the survival rate of all ceramic inlays. Results　At 12 months after dental restoration, there was no statistically significant difference in the grading of the dental restoration effect (restoration integrity, edge fitness, color matching, edge staining, retention, sensitivity, gingival health, and secondary caries) between the two groups (all P>0.05). At 12 months after dental restoration, there was no statistically significant difference in the PD, GI, or PI between the two groups (all P>0.05). The amount of blood loss in the observation group was less than that in the control group [(1.23±0.41) ml vs. (1.57±0.47) ml] (P<0.05). The pain and discomfort disappeared time after dental restoration in the observation group were shorter than those in the control group [(7.53±3.03) d vs. (8.69±2.77) d, (9.33±3.04) d vs. (10.51±3.18) d] (both P<0.05). There was no statistically significant difference in the survival rate of all ceramic inlays between the two groups (P>0.05). COX regression analysis showed that PD (HR=44.349, 95%CI= 7.519-261.594) and GI (HR=5.036, 95%CI= 1.232-20.594) were independent risk factors for the survival rate of all ceramic inlays after dental restoration (both P<0.05). Conclusions　The use of water laser pretreatment before dental restoration of all-ceramic inlays can obtain the same effect of Er:YAG laser pretreatment, and at the same time, it can reduce the amount of bleeding in the restoration process to a certain extent, and shorten the disappearance time of pain and discomfort after restoration. It is necessary to strengthen the oral health management after dental restoration, in order to improve the survival rate of all-ceramic inlays.

Case Report

Amlodipine induced severe gingival hyperplasia in a child with Alport syndrome

Liu Yujie, Wang Xiangli, Zhao Gongping, Cao Guanghai, Zhang Shufeng, Tian Ming, Liu Cuihua

2025, 31(7):  1209-1211.  DOI: 10.3760/cma.j.cn441417-20240914-07031

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This article analyzed a boy with Alport syndrome who has been taking amlodipine besylate for a long time . The 15-year-old boy was diagnosed with Alport syndrome at 7 years and 7 months old (May 2016), and progressed to chronic kidney disease stage 5 at 10 years and 4 months old (February 2019). He started peritoneal dialysis in March 2019, and had been taking various antihypertensive drugs for many years due to the existence of malignant hypertension. However, his blood pressure was not well controlled, mostly in the 130-150/90-110 mmHg (1 mmHg= 0.133 kPa) range. Gingival hyperplasia occurred in February 2023 and gradually worsened. CT examination, bone marrow cell blood examination, physical examination, and medication history were performed to diagnose the gingival hyperplasia associated with calcium channel blockers (CCB). Gingival hyperplasia improved significantly after amlodipine reduction. The exact mechanism of drug-induced gingival hyperplasia is not fully understood. Whether the severe gingival hyperplasia manifestation is related to the gene mutation causing collagen synthesis abnormality or increased drug susceptibility in the patient's underlying disease of Alport syndrome needs further research.

Nursing Research

Perioperative care for 4 patients with infectious endocarditis associated superior mesenteric artery aneurysm

Qin Wenfeng, Wang Wei, Ma Danying, Qing Hongkun, Li Li

2025, 31(7):  1212-1216.  DOI: 10.3760/cma.j.cn441417-20240926-07032

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Objective　To explore the perioperative nursing experiences for superior mesenteric artery aneurysm (SMAA) associated with infective endocarditis (IE). Methods　Four patients diagnosed with SMAA associated with IE were admitted to Guangdong Provincial People's Hospital from March 2022 to June 2024. There were 2 males and 2 females, aged 27-53 (37.25±11.27) years, with a body mass index of 14.18-18.14 (16.75±1.76) kg/m², preoperative cardiac function classification of the New York Heart Association (NYHA): 1 case of grade Ⅱ, 1 case of grade Ⅲ, and 2 cases of grade Ⅳ. The key aspects and measures of perioperative nursing were analyzed, including pre-procedural observation prior to SMAA endovascular treatment, post-embolization nursing care for the mesentery, parenteral nutrition support, anti-infective medication nursing, maintenance of cardiac function, pain nursing, and monitoring for bleeding complications after cardiac surgery. Paired t test was used for statistical analysis. Results　All four patients successfully completed both cardiac surgery and mesenteric embolization procedures. The duration of mechanical ventilation was 6-19 (13.25±6.29) h, the ICU stay was 1-4 (2.50±1.30) d, and the total hospital stay was 9-31 (16.75±9.81) d. Complications included one case each of perioperative SMAA rupture with local hematoma formation, distal occlusion of the superior mesenteric artery, mural thrombosis, arrhythmia, and postoperative hemorrhage. All four patients were discharged after comprehensive nursing care; notably, their albumin and hemoglobin levels improved compared to admission values [(37.30±5.96) g/L vs. (28.80±3.90) g/L, (104.50±10.08) g/L vs. (86.50±14.93) g/L] (both P>0.05). The nursing satisfaction score ranged from 96 to 99 (97.75±1.26) points, all of which were satisfactory. No recurrence of IE or SMAA was observed during 3-12 months of follow-up. Conclusion　The proactive implementation of preventive measures alongside individualized nursing strategies during the perioperative period can significantly reduce complication rate while promoting early recovery in patients and enhancing overall patient satisfaction on nursing care.

Constructing a quality indicator system for ophthalmic outpatient nursing care: a Delphi-based approach

Luo Chunyan, Wu Jiaqi, Fang Xiaomin, Huang Yanyi, Xiao Huiming

2025, 31(7):  1217-1222.  DOI: 10.3760/cma.j.cn441417-20240815-07033

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Objective　To construct a localized, scientific, and reliable quality evaluation index system for ophthalmic outpatient care, and to provide a standardized tool for quality control of ophthalmic outpatient care. Method Using the literature evidence-based approach, relevant literature on ophthalmic outpatient nursing quality indicators was retrieved from databases such as China National Knowledge Infrastructure, Wanfang, PubMed, EmBase, and CINAHL. The search period was from the establishment of the database until August 2023, and 11 relevant articles were ultimately selected. Based on the Structure Process Outcome (SPO) indicator system framework, develop specific interview content items. Using purposive sampling method, interviews were conducted with ophthalmic nursing managers and clinical nurses from five tertiary hospitals in Guangdong Province. Colaizzi analysis method was used to summarize and organize the interview content. Based on literature evidence and interview results, a preliminary indicator system for the quality of ophthalmic outpatient nursing was constructed, including 3 primary indicators, 9 secondary indicators, and 41 tertiary indicators. Create an expert inquiry questionnaire and use the Delphi method to conduct two rounds of expert inquiries via email from December 2023 to May 2024. Based on the results of the first round of inquiry, a second round of inquiry questionnaire will be formed through discussion. Using the recovery rate to indicate the level of expert engagement; The authority coefficient represents the level of expert authority, which is equal to (familiarity+judgment basis)/2; The Kendall harmony coefficient represents the coordination situation among experts. Using Analytic Hierarchy Process (AHP), construct a judgment matrix, calculate the weights, weight ranking, and combination weights of each indicator, and obtain the consistency coefficient (CR value). When the CR value is ≤ 0.100, the judgment matrix has consistency. Results　This study included 17 ophthalmic nursing experts, including 9 with 15 to 30 years of work experience and 8 with over 30 years of work experience; Among them, 7 experts have less than 10 years of experience in outpatient work, 9 experts have 10 to 20 years of working experience, and 1 expert has 20 years or more of working experience; 5 candidates hold senior professional titles, and 12 candidates hold deputy senior titles or below; The distribution areas of expert work units are 10 in South China, 1 in North China, 2 in East China, 1 in Central China, and 3 in Southwest China. In the first round, a total of 18 inquiry questionnaires were distributed and 17 were collected. In the second round, a total of 17 inquiry questionnaires were distributed and 17 were collected. The positive coefficients for the two rounds of expert inquiry were 0.944 and 1.000, the authoritative coefficients were 0.885 and 0.977, and the Kendall harmony coefficients were 0.221 and 0.239, respectively (both P<0.001). In the first round of inquiry, 10 experts proposed 74 revision suggestions. In the second round of inquiry, 9 experts proposed 14 revision suggestions. The final system of ophthalmic outpatient nursing quality indicators includes 3 primary indicators, 8 secondary indicators, and 36 tertiary indicators. Conclusion　The quality evaluation index system of ophthalmic outpatient care constructed in this study has specialized characteristics on the basis of ensuring the scientificity and reliability of the research results, which is in line with the characteristics of clinical practice and nursing management of ophthalmology outpatient clinics, and can provide a reference for the scientific, refined, and standardized management of ophthalmic clinical nursing quality.

Effect of Omaha system-based extended care intervention in post-hospital care for premature infants with low birth weight

Cao Shanmian, Zheng Xiaoying, Zhu Hongrui

2025, 31(7):  1223-1227.  DOI: 10.3760/cma.j.cn441417-20240927-07034

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Objective　To explore the effect of Omaha system-based extended care intervention in post-hospital care for premature infants with low birth weight. Methods　A retrospective analysis was conducted on the clinical data of 98 premature infants with low birth weight admitted to Children's Hospital Affiliated to Zhengzhou University from June 2022 to May 2024. They were divided into two groups based on different nursing methods, with 49 cases in each group. In the control group, the gestational age of preterm infants was (30.14±0.25) weeks, with 29 boys and 20 girls; the family members were (29.95±1.20) years old, and their education level was as follows: 7 cases of junior high school or below, 16 cases of senior high school, and 26 cases of associate degree or above. In the observation group, the gestational age of preterm infants was (30.12±0.24) weeks, with 27 boys and 22 girls; the family members were (29.98±1.23) years old, and their education level was as follows: 6 cases of junior high school or below, 15 cases of senior high school, and 28 cases associate degree or above. The control group received routine nursing after discharge, and the observation group received Omaha system-based extended nursing. Both groups were continuously observed for 3 months. Parental stress, growth and development of preterm infants, neurodevelopment, and family satisfaction were compared between the two groups before nursing (at discharge) and 3 months after nursing. χ² test and t test were used for statistical analysis. Results　After 3 months of nursing, the scores of parent-child interaction disorder, parental distress, and difficult children and total score in the observation group were (19.57±2.04) points, (24.43±3.23) points, (23.38±2.09) points, and (66.12±3.29) points, which were lower than those in the control group [(22.18±2.16) points, (29.89±3.37) points, (27.25±2.14) points, and (78.86±3.31) points], with statistically significant differences (t=6.149, 8.188, 9.056, and 19.109, all P<0.001); the body length, head circumference, and body mass of preterm infants in the observation group were (53.39±3.46) cm, (40.02±3.48) cm, and (4.34±0.28) kg, and those in the control group were (50.19±3.32) cm, (37.89±3.46) cm, and (3.89±0.22) kg, with statistically significant differences (t=4.671, 3.038, and 8.846, all P<0.05); the scores of fine motor, gross motor, adaptive behavior, personal social behavior, and language ability and total score of Gesell Child Development Scale in the observation group were higher than those in the control group (all P<0.05); the satisfaction of family members in the observation group was 95.92% (47/49), which was higher than that in the control group [83.67% (41/49)] (χ²=4.009, P=0.045). Conclusion　The Omaha system-based continuous nursing intervention for low birth weight preterm infants can improve the level of parental stress, contribute to the physical and neurological development of preterm infants, and make their families more satisfied with nursing services.

Application of visualization system and whole process management in CT enhanced examination

Zhang Chun, Li Zhiying, Zhao Jun, Chen Jing, Liao Liangjun, Tian Li

2025, 31(7):  1228-1232.  DOI: 10.3760/cma.j.cn441417-20241226-07035

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Objective　To evaluate the application effect of visualization system and whole process management in CT enhanced examination. Methods　A total of 5 197 patients who underwent enhanced CT examination in the Department of Radiology of the Third People's Hospital of Hubei Province from June 2022 to July 2023 were selected by the convenience sampling method as the study objects. From June 2022 to November 2022, 2 249 patients were selected a control group, including 1 349 males and 900 females, aged (58.32±1.25) years. From February 2023 to July 2023, 2 948 patients were selected an intervention group, including 1 713 males and 1 235 females, aged (54.08±2.47) years. The control group received routine nursing procedures, while the intervention group received visualization system and whole process management. The incidence of contrast agent extravasation, extravasation degree, edema remission time, image quality score (Likert score scale), and patient satisfaction (self-made questionnaire) were compared between the two groups. Independent sample t test, χ² test, and rank sum test were used for statistical analysis. Results　The incidence of contrast agent extravasation in the intervention group was lower than that in the control group [0.37% (11/2 948) vs. 0.89% (20/2 249)] (P<0.05). The degree of contrast agent extravasation in the intervention group was better than that in the control group (P<0.05). The complete remission time of edema in the intervention group was shorter than that in the control group [(31.56±1.74) h vs. (49.83±5.12) h] (P<0.05). The scores of image quality and patient satisfaction in the intervention group were higher than those in the control group [(4.81±0.33) points vs. (4.25±0.53) points, (9.12±0.29) points vs. (8.32±0.46) points] (both P<0.05). Conclusion　The combination of visualization system and whole process management can effectively improve the safety and quality of CT enhanced examination, provide a new reference mode for clinical nursing management, and has positive significance for improving patient experience and radiation nursing quality.