Table of Content

01 May 2025, Volume 31 Issue 9

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Special Column of Spine

Evaluation of the effect of percutaneous corner vertebroplasty in the treatment of osteoporotic vertebral compression fractures

Zhang Guibin, Deng Yajun, Chen Xinqing, Cao Meng, Xu Yan

2025, 31(9):  1410-1415.  DOI: 10.3760/cma.j.cn441417-20240506-09001

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Objective　To investigate the changes of serum matrix metalloproteinase inhibitory factor-1 (TIMP-1), matrix metalloproteinase-3 (MMP-3), and leptin levels and clinical benefits in patients with osteoporotic vertebral compression fractures (OVCF) treated with percutaneous corner vertebroplasty (PCVP). Methods　The study was designed using a randomized, prospective, single-center clinical study method. A total of 108 patients with OVCF who received treatment in Xi'an Fifth Hospital from October 2020 to January 2023 were selected and were divided into group A and group B according to the random number table method, with 54 patients in each group. There were 30 males and 24 females in group A, aged 45-71 (67.87±3.65) years, injury causes: 18 cases of lifting heavy objects, 13 cases of traffic accidents, and 23 cases of slips and falls; the time from fracture to operation was 0.5-3.0 (1.76±0.54) d. There were 28 males and 26 females in group B, aged 45-72 (68.02±3.70) years, injury causes: 21 cases of lifting heavy objects, 11 cases of traffic accidents, and 22 cases of slips and falls; the time from fracture to operation was 0.7-3.0 (1.79±0.58) d. Group A received unilateral percutaneous vertebroplasty (PVP), while group B received PCVP. Both groups were followed up for 6 months after surgery. The bone cement filling effect after 6 months of follow-up, surgical related indicators, anterior vertebral height, Cobb angle of injured vertebra, and lumbar mobility before and after 6 months of follow-up, levels of MMP-3, TIMP-1, and leptin before and 7 d after surgery, and complications were compared between the two groups. χ² test and t test were used for statistical analysis. Results　After 6 months of follow-up, the excellent and good rate of bone cement filling in group B was higher than that in group A [94.44% (51/54) vs. 81.48% (44/54)], with a statistically significant difference (P<0.05). The operation time and hospital stay of group B were shorter than those of group A [(21.65±2.54) min vs. (33.65±3.43) min, (8.54±2.54) d vs. (12.54±6.43) d], the number of fluoroscopy times and bone cement dosage were less than those in group A [(13.54±1.98) times vs. (21.43±2.03) times, (23.65±0.32) ml vs. (31.65±2.54) ml], and the effective diffusion ratio of bone cement in group B was higher than that in group A (1.87±0.06 vs. 0.99±0.04), with statistically significant differences (all P<0.05). After 6 months of follow-up, the anterior vertebral height was increased in both groups, and that in group B was higher than that in group A [(95.65±3.43)% vs. (92.12±2.43)%], the Oswestry Disability Index (ODI) and Cobb angle of injured vertebra were decreased in both groups, and those in group B were lower than those in group A [(15.43±4.32) min vs. (19.87±4.98) min, (12.76±2.31)° vs. (14.98±2.89)°], with statistically significant differences (all P<0.05). Compared with preoperative levels, serum MMP-3 and leptin levels were decreased in both groups 7 d after surgery, and the serum MMP-3 level in group B was lower than that in group A [(21.76±1.65) mmol/L vs. (24.65±1.87) mmol/L]; serum TIMP-1 level was increased in both groups, and that in group B was higher than that in group A [(144.76±16.54) μg/L vs. (136.65±17.02) μg/L], with statistically significant differences (all P<0.05). The incidence of complications in group B was lower than that in group A during follow-up [5.56% (3/54) vs. 18.52% (10/54)], with a statistically significant difference (P<0.05). Conclusion　Compared with unilateral PVP, PCVP had advantages such as shorter surgical time and less amount of bone cement used, which can reduce the number of fluoroscopy times, improve the filling effect of bone cement, further regulate the levels of serum MMP-3 and TIMP-1 in patients with OVCF, promote the recovery of the anterior edge height, Cobb angle of the injured vertebra, and lumbar function, and shorten the hospital stay, with high safety

Efficacy of modified PVP in the treatment of senile patients with mid-thoracic OVCF complicated with degenerative spinal disease

Zhang Bo, Zhang Bin

2025, 31(9):  1415-1420.  DOI: 10.3760/cma.j.cn441417-20240710-09002

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Objective　To investigate the effect of CT-guided modified unilateral pedicle approach vertebroplasty (PVP) in the treatment of senile patients with osteoporotic vertebral compression fracture (OVCF) of mid-thoracic vertebra (T5-T9) and degenerative spinal disease. Methods　A retrospective analysis was performed on 105 elderly patients with mid-thoracic vertebra (T5-T9) OVCF complicated with degenerative spinal disease admitted to Shaanxi Nuclear Industry 215 Hospital from February 2019 to May 2022. They were divided into a study group (63 cases) and a control group (42 cases) according to different approaches. In the control group, there were 6 males and 36 females, aged (76.81±5.74) years, and the course of disease was (12.51±4.72) d. In the study group, there were 8 males and 55 females, aged (76.27±5.93) years, and the course of disease was (12.93±4.30) d. The study group received modified CT-guided PVP, and the control group received bilateral transpedicle approach vertebroplasty. The perioperative conditions, pain, imaging parameters, biomechanical indexes, and complications were compared between the two groups. Repeated measure ANOVA, independent sample t test, and χ² test were used for statistical analysis. Results　The operation time of the study group was longer than that of the control group [(48.50±6.45) min vs. (37.13±5.32) min], and the intraoperative X-ray exposure times and hospitalization cost were lower than those of the control group [(17.35±2.59) times vs. (21.23±3.68) times, (1.91±0.28) million yuan vs. (2.45±0.37) million yuan] (all P<0.05). There was no statistically significant difference in the amount of blood loss, injection amount of bone cement, distribution of bone cement, postoperative ambulation time, or hospital stay between the two groups (all P>0.05). The Visual Analogue Scale (VAS) scores of the study group and the control group were (1.32±0.28) points and (1.39±0.31) points one year after surgery, which were lower than those before surgery and one month after surgery (all P<0.05); the anterior edge heights of the injured vertebra in the study group and the control group were (22.48±3.76) mm and (22.72±3.98) mm, and the posterior edge heights of the injured vertebra were (37.85±5.73) mm and (37.64±5.30) mm, which were higher than those before surgery and one month after surgery (all P<0.05); the local Cobb angles were (10.14±1.78)° and (10.38±1.70)°, which were lower than those before surgery and one month after surgery (all P<0.05). There was no statistically significant difference in the total incidence of complications between the control group and the study group [28.6% (12/42) vs. 22.2% (14/63)] (P>0.05). Conclusion　In elderly patients with mid-thoracic vertebrae (T5-T9) OVCF complicated with degenerative spinal disease, CT-guided modified PVP can effectively improve the biomechanical function, reduce the degree of pain, and save the hospitalization costs, but it has a certain learning curve.

Correlation analysis between bone cement/vertebral body volume ratio and adjacent vertebral compression fractures after percutaneous vertebroplasty

Yang Yuetai, Jia Benzhi

2025, 31(9):  1421-1425.  DOI: 10.3760/cma.j.cn441417-20241225-09003

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Objective　To analyze the correlation between bone cement/vertebral body volume ratio and adjacent vertebral compression fractures (AVCF) after percutaneous vertebroplasty (PVP). Methods　The clinical data of 202 patients with osteoporotic vertebral compression fracture treated by PVP from June 2018 to June 2022 in the Department of Spinal Surgery of Shaanxi Provincial Rehabilitation Hospital were retrospectively analyzed, including 89 males and 113 females, with an age of 56-78 (67.98±6.93) years old, followed up for 6-12 (8.32±2.31) months. According to whether AVCF occurred after operation, the patients were divided into an AVCF group (31 cases) and a non-AVCF group (171 cases). Univariate and multivariate logistic regression analysis were used to analyze on demographic data, body mass index, bone density, bone cement leakage, bone cement volume (BCV), larger vertebral body volume (LSBCV), vertebral body volume (VBV), BCV/VBV, LSBCV/VBV, and other indicators for two groups. The receiver operator characteristic curve (ROC) was used to analyze the efficacies of influencing factors in predicting AVCF after PVP. Independent sample t test and χ² test were used for statistical analysis. Results　Preoperative bone mineral density T value, LSBCV, LSBCV/VBV, and bone cement leakage had significant effects on AVCF after PVP (all P<0.05). Multivariate logistic regression analysis showed that low preoperative bone mineral density (OR=0.377) and high LSBCV/VBV (OR=2.123) were independent risk factors for AVCF after PVP (both P<0.05). The area under the curve (AUC) of preoperative bone mineral density in predicting the occurrence of AVCF after PVP was 0.638 (0.559-0.746). The AUC of LSBCV/VBV was 0.800 (0.723-0.877), and the optimal diagnostic threshold was 13.859%; the sensitivity, specificity, Youden index, positive predictive value, and negative predictive value of LSBCV/VBV in predicting the occurrence of AVCF after PVP were 83.87%, 66.67%, 0.505, 31.33%, and 95.80%, respectively. Conclusion　Low preoperative bone mineral density T value and high LSBCV/VBV are independent risk factors for AVCF after PVP, and LSBCV/VBV has certain predictive value for AVCF after PVP.

Risk factors analysis of recurrent fracture in elderly patients with osteoporotic thoracolumbar compression fracture after PVP

Chen Xiaoyan, Zhou Guojun, Shi Kui, Li Ziqiang, Sun Feifei

2025, 31(9):  1426-1429.  DOI: 10.3760/cma.j.cn441417-20241031-09004

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Objective　To analyze the influencing factors of recurrent fracture after percutaneous vertebroplasty (PVP) in elderly patients with osteoporotic thoracolumbar compression fracture (OVCF). Methods　Sixty-nine patients with OVCF who were treated in Hanzhong Hospital of Traditional Chinese Medicine from January 1, 2020 to December 31, 2023 were retrospectively analyzed, and were divided into two groups according to whether or not they had a recurrent fracture after PVP. General data such as age, gender, and body mass index were collected and analyzed in the two groups. The influencing factors of recurrent fractures after PVP were analyzed by multivariate logistic regression analysis. Independent sample t test and χ² test were used for statistical analysis. Results　At 6 months of follow-up, 14 of 69 patients with OVCF had recurrent fractures after PVP, with an incidence of 20.29%. Univariate and multivariate analysis showed that age, bone mineral density, and bone cement leakage were the influencing factors for recurrent fractures after PVP in elderly OVCF patients (all P<0.05). Conclusion　Age, bone mineral density lower than normal, and bone cement leakage are risk factors for recurrent fracture after PVP in elderly OVCF patients.

Construction and validation of a risk model for adjacent segment disease after lumbar fusion surgery based on preoperative spinal - pelvic parameters and intervertebral disc characteristics

Ren Fei, Zhang Haiping, Gao Shansong

2025, 31(9):  1430-1435.  DOI: 10.3760/cma.j.cn441417-20240914-09005

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Objective　To construct and validate a risk model for adjacent segment disease (ASD) after lumbar fusion surgery by analyzing measurements of the spinal pelvic sagittal plane. Methods　A retrospective analysis was conducted on the data of 197 patients who underwent transforaminal lumbar interbody fusion at the First Affiliated Hospital of Xi'an Jiaotong University Yulin Hospital from October 2020 to October 2023. After one year of follow-up, the patients finally included in the study were divided into an ASD group and a non-ASD group. The general data, surgical data, and preoperative spinal-pelvic sagittal imaging parameters [thoracic kyphosis (TK), lumbar lordosis (LL), segmental lordosis (SL), sacral slope (SS), pelvic tilt (PT), pelvic incident angle (PI), relative height of intervertebral space, etc] of the two groups were compared. Multivariate logistic regression analysis was used to analyze the correlations between preoperative spinal-pelvic sagittal imaging parameters and the occurrence of ASD after lumbar fusion surgery. A risk prediction model was constructed using R software, and the model's discrimination was evaluated through the receiver operating characteristic curve (ROC). The Bootstrap method was used for 1,000 repeated samplings to verify the predictive performance of the model. Statistical analysis was performed using independent sample t test and χ² test. Results　Of the 197 patients, 185 completed the follow-up (93.90%). Among them, 43 patients (23.24%) were in the ASD group, including 26 males and 17 females, with an age of (49.44±10.12) years old; 142 patients (76.75%) were in the non-ASD group, including 88 males and 54 females, with an age of (50.13±10.19) years old. Multivariate logistic regression analysis indicated that PT, SL, TK, PI-LL, and interference from adjacent segments during surgery were the influencing factors for ASD after lumbar fusion surgery (all P<0.05). The ROC analysis of the risk prediction model constructed based on these indicators showed that the area under the curve of the model to predict the postoperative ASD risk was 0.970, with a sensitivity of 97.7% and a specificity of 85.9%, indicating that the model had good discriminative ability. Bootstrap validation showed that the deviation calibration curve of the model was in good agreement with the ideal curve, with a mean absolute error (MAE) of 0.031. Conclusions　Spinal pelvic sagittal balance plays an important role in the growth and development of the spine, and PT, SL, TK, PI-LL, and interference from adjacent segments during surgery are influencing factors for ASD after lumbar fusion surgery. This study provides clinical evidences for predicting the risk of ASD after lumbar fusion surgery.

Clinical effect of Qidong Yixin Granules combined with core muscle group training on patients with spinal cord injury

Yang Li, Jin Xingshan

2025, 31(9):  1435-1439.  DOI: 10.3760/cma.j.cn441417-20241119-09006

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Objective　To investigate the effect of Qidong Yixin Granules combined with core muscle group training on patients with spinal cord injury. Methods　A retrospective analysis was performed on 98 patients with spinal cord injury in Zhumadian Traditional Chinese Medicine Hospital from January 2022 to August 2024, and they were divided into a control group (47 cases) and a combination group (51 cases) according to different treatment methods. In the control group, there were 26 males and 21 females, aged 32-58 (44.03±4.05) years, the course of disease was 3-8 (5.84±1.07) months, the injured segments were thoracic segment in 25 cases, lumbar segment in 17 cases, and cervical segment in 5 cases, and the American Spinal Cord Injury Association (ASIA) classification was grade C in 29 cases and grade D in 18 cases. In the combination group, there were 28 males and 23 females, aged 30-55 (42.95±5.02) years, the course of disease was 3-9 (6.08±1.10) months, the injured segments were thoracic segment in 22 cases, lumbar segment in 19 cases, and cervical segment in 10 cases, and the ASIA classification was grade C in 30 cases and grade D in 21 cases. The control group received core muscle group training on the basis of conventional treatment, twice a day, 5 days a week; the combination group was treated with Qidong Yixin Granules orally on the basis of control group, 5 g/time, 3 times a day. Both groups were treated for 3 months. The clinical efficacies of the two groups were compared, as well as Fugl-Meyer Lower Limb Motor Function Assessment Scale (FMA-LE), Holden Walking Function Classification (FAC), Berg Balance Scale (BBS), ASIA motor score, plasma viscosity (PV), whole blood high shear viscosity (HBV), hematocrit (HCT), whole blood low shear viscosity (LBV), CD3⁺, CD4⁺/CD8⁺, and natural killer (NK) cell levels before treatment and 3 months after treatment. Statistical methods used were t test and χ² test. Results　The total effective rate of the combination group was higher than that of the control group [94.12% (48/51) vs. 76.60% (36/47)] (P=0.013). After 3 months of treatment, the FMA-LE [(26.48±2.56) points], FAC [(4.16±0.29) points], BBS [(36.13±6.41) points], and ASIA motor scores [(80.01±5.03) points] in the combination group were higher than those in the control group [(20.58±2.02) points, (2.68±0.42) points, (30.59±5.14) points, and (67.17±5.17) points] (all P<0.001); the PV [(1.31±0.11) mPa·s], HBV [(4.15±0.32) mPa·s], HCT [(42.10±2.07)%], LBV [(7.49±0.51) mPa·s], and CD8⁺ [(35.84±2.11)%] in the combination group were lower than those in the control group [(1.49±0.15) mPa·s, (4.87±0.39) mPa·s, (45.74±2.68)%, (9.11±0.63) mPa·s, and (41.69±1.87)%], and the CD3⁺ [(68.19±4.22)%], CD4⁺/CD8⁺ (1.67±0.16), and NK cells [(29.10±3.11)%] were higher than those in the control group [(59.69±3.48)%, 1.56±0.09, and (17.69±4.07)%] (all P<0.001). Conclusion　Qidong Yixin Granules combined with core muscle group training can improve the therapeutic effect of spinal cord injury patients, improve exercise and balance function, promote blood circulation, and enhance immune function.

Levels of serum S100A12 and peripheral blood RDW and Mono% and their clinical significance in patients with spinal tuberculosis and their clinical significance

Ma Hang, Zhang Bing

2025, 31(9):  1440-1444.  DOI: 10.3760/cma.j.cn441417-20240703-09007

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 Objective　To investigate the levels of serum S100 calcium-binding protein A12 (S100A12) and peripheral blood red cell distribution width (RDW) and monocyte percentage (Mono%) in patients with spinal tuberculosis and their clinical significance. Methods　A total of 80 patients with spinal tuberculosis admitted to Xianyang Central Hospital from February 2021 to May 2023 were selected as an observation group, including 44 males and 36 females, aged (41.78±8.58) years, and 60 healthy individuals who underwent physical examination during the same period were selected as a control group, including 33 males and 27 females, aged (39.49±9.90) years. The levels of serum S100A12 and peripheral blood RDW and Mono% of the two groups were detected, and the diagnostic efficacies of the three indexes for spinal tuberculosis were analyzed by the receiver operating characteristic curve (ROC). The observation group of 80 patients with spinal tuberculosis were followed up for 1 year, and were divided into a recurrence group (23 cases) and a non-recurrence group (57 cases) based on recurrence. The predictive efficacies of serum S100A12 and peripheral blood RDW and Mono% for spinal tuberculosis recurrence were analyzed. Independent sample t test was used for statistical analysis. Results　The levels of serum S100A12 and peripheral blood RDW and Mono% in the observation group were higher than those in control group [(149.08±43.76) ng/L vs. (88.36±20.26) ng/L, (14.44±1.55)% vs. (12.97±1.31)%, (9.27±1.62)% vs. (8.03±1.38)%], with statistically significant differences (all P<0.05). ROC analysis showed that the sensitivity of S100A12 was 73.8%, the specificity was 98.3%, and the area under the curve (AUC) was 0.894 in the diagnosis of spinal tuberculosis; the sensitivity of RDW was 68.8%, the specificity was 78.3%, and the AUC was 0.767; the sensitivity of Mono% was 68.8%, the specificity was 68.3%, and the AUC was 0.726. However, when S100A12, RDW, and Mono% were combined for diagnosis, the sensitivity and specificity were 87.5% and 95.0%, respectively, with an AUC of 0.948, indicating high diagnostic efficacy with combined testing. The levels of serum S100A12 and peripheral blood RDW and Mono% in the recurrence group were higher than those in the non-recurrence group [(177.36±47.59) ng/L vs. (137.67±36.76) ng/L, (15.40±1.55)% vs. (14.05±1.39)%, (9.91±1.68)% vs. (9.01±1.53)%], with statistically significant differences (all P<0.05). ROC analysis showed that the sensitivity of S100A12 was 56.5%, the specificity was 89.5%, and the AUC was 0.757 in predicting the recurrence of spinal tuberculosis; the sensitivity of RDW was 78.3%, the specificity was 68.4%, and the AUC was 0.755; the sensitivity of Mono% was 82.6%, the specificity was 56.1%, and the AUC was 0.698. However, when S100A12, RDW, and Mono% were combined for prediction, the sensitivity and specificity increased to 82.6% and 84.2%, respectively, with an AUC of 0.863, indicating high predictive efficacy with combined testing. Conclusion　Serum S100A12 and peripheral blood RDW and Mono% can be used to diagnose spinal tuberculosis and have certain value in predicting recurrence.

Special Topic on Kawasaki Disease

Analysis of 20 cases of Kawasaki disease complicated with coronary artery lesions undergoing percutaneous coronary angiography

Lei Xi, Wang Tao, Xu Xiaoyan, Liu Meiqi, Wang Juanli, Wang Jie, Jiang Congshan, Zhang Yanmin

2025, 31(9):  1445-1450.  DOI: 10.3760/cma.j.cn441417-20240903-09008

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Influencing factors of intravenous immunoglobulin resistance and coronary artery damage in children with Kawasaki disease 

Liu Qing, Ren Wenjuan, Zhong Hongping

2025, 31(9):  1451-1456.  DOI: 10.3760/cma.j.cn441417-20241114-09009

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Objective　To investigate the influencing factors of intravenous immunoglobulin (IVIG) resistance and coronary artery damage in children with Kawasaki disease (KD). Methods　A retrospective cohort study was conducted to analyze the clinical data of 205 KD children who received treatment in Yan'an University Affiliated Hospital from May 2021 to June 2024. They were all treated with IVIG. The children were divided into a drug-resistant group and a sensitive group according to whether drug resistance occurred, and the coronary artery damage after IVIG was recorded. Independent sample t test and χ² test were used for between-group comparison, and logistic regression analysis was used to analyze the influencing factors of IVIG resistance in KD children. Results　Among the 47 children in the drug-resistant group, there were 21 boys and 26 girls, 34 cases ≥2 years old and 13 cases <2 years old. Among the 158 children in the sensitive group, there were 71 boys and 87 girls, 58 cases ≥2 years old and 100 cases <2 years old. There were statistically significant differences in the proportion of central nervous system damage, age of onset, platelet count (PLT), white blood cell count (WBC), peripheral blood neutrophil percentage (N), C-reactive protein (CRP), hemoglobin (Hb), albumin (ALB), serum ferritin (SF), and sedimentation rate between the two groups (all P<0.05). Multivariate logistic regression analysis showed that age of onset ≥2 years old, low PLT, high CRP, low Hb, low ALB, high SF, and high sedimentation rate were independent risk factors for IVIG resistance in KD children (all P<0.05). There was no statistically significant difference in the coronary artery damage between the two groups at the onset [42.55% (20/47) vs. 41.14% (65/158)] (P>0.05). However, the coronary artery damage rate in the drug-resistant group was higher than that in the sensitive group at 1 week and 3 months after treatment [36.17% (17/47) vs. 21.52% (34/158), 29.79% (14/47) vs. 15.82% (25/158)] (both P<0.05). Conclusions　Age of onset ≥2 years old, low PLT, high CRP, low Hb, low ALB, high SF, and high sedimentation rate are independent risk factors for IVIG resistance in KD children. It is necessary to perform clinical management on the above factors to reduce the risk of IVIG resistance. In addition, the rate of coronary artery damage in the drug-resistant group is higher than that in the sensitive group at 1 week and 3 months after treatment. These findings provide an important reference for clinical identification of risk factors for IVIG resistance in KD children and prevention of coronary artery damage.

Effect of infliximab combined with tacrolimus on children with Kawasaki disease resistant to initial immunoglobulin therapy and its impact on immune function

Jiang Hong, Xue Dongqing

2025, 31(9):  1456-1460.  DOI: 10.3760/cma.j.cn441417-20240724-09010

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Objective　To explore the effect of infliximab (IFX) combined with tacrolimus in treating children with Kawasaki disease resistant to initial immunoglobulin therapy and its impact on immune function. Methods　Eighty children with Kawasaki disease resistant to initial immunoglobulin therapy were selected from the Department of Pediatrics of Weinan First Hospital from March 2020 to March 2024, and were divided into an IFX group (38 cases) and a combination group (42 cases) according to the treatment methods. In the IFX group, there were 22 boys and 16 girls, with an age of (4.27±0.82) years old, a weight of (14.38±1.76) kg, and a duration of fever of (5.57±2.24) d. In the combination group, there were 27 boys and 15 girls, with an age of (4.35±0.89) years old, a weight of (14.43±1.64) kg, and a duration of fever of (5.49±2.31) d. The IFX group was given IFX treatment, and the combination group was given IFX combined with tacrolimus treatment. The clinical symptom relief time, coronary artery lesions, immune function, laboratory indicators, and adverse reactions were compared between the two groups. χ² test, independent sample t test, and paired t test were used for statistical analysis. Results　The relief time of conjunctival hyperemia [(2.57±0.27) d], fever [(2.17±0.22) d], and cervical lymph enlargement [(3.12±0.41) d] in the combination group were shorter than those in the IFX group [(3.76±0.43) d, (3.21±0.34) d, and (4.43±0.56) d] (all P<0.05). Two months after treatment, there was no statistically significant difference in the total incidence of coronary artery lesions between the combination group and the IFX group [21.4% (9/42) vs. 18.4% (7/38)] (P>0.05). One week after treatment, the levels of immunoglobulin A (IgA) [(2.63±0.26) g/L], IgG [(12.33±1.20) g/L], and CD4⁺ [(39.22±4.07)%] in the combination group were higher than those in the IFX group [(1.80±0.17) g/L, (9.60±1.10) g/L, and (35.41±3.70)%], but the CD8⁺ [(22.33±2.46)%] was lower than that in the IFX group [(26.41±2.77)%] (all P<0.05); the levels of albumin (ALB), direct bilirubin (DBIL), and total bilirubin (TBIL) in the combination group and the IFX group were lower than those before treatment (all P<0.05), but there was no statistically significant difference in the level of ALB, DBIL, or TBIL between the two groups (all P>0.05). There was no statistically significant difference in the incidence of adverse reactions between the combination group and the IFX group [16.7% (7/42) vs. 13.2% (5/38)] (P>0.05). Conclusion　The combination of IFX and tacrolimus significantly affects the treatment efficacy and immune function in children with Kawasaki disease resistant to initial immunoglobulin therapy.

New Medical Advances

Advances in intraocular lens refractive power calculation for cataract surgery following radial keratotomy 

Zhi Danlin, Huo Chaokui Lu, Jianmei, Xia Ruiqing, Cheng Hao, Cao Danmin

2025, 31(9):  1461-1465.  DOI: 10.3760/cma.j.cn441417-20241114-09011

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Radial keratotomy (RK) is a procedure in which a number of 4-24 non-penetrating radial release incisions (80%-90% depth) are made in the paracentral periphery outside the optical zone of the cornea, indirectly altering the curvature of the central cornea, resulting in a relative flattening of the central anterior surface of the cornea and a reduction in refractive power under intraocular pressure, and by varying the number and depth of the incisions, it is possible to correct myopia from 0-12 D. RK became a widely adopted surgical solution for myopia and astigmatism from the 1970s to the 1990s. However, refractive outcomes after RK are highly variable and are associated with many short- and long-term complications. Over time, the majority of patients undergoing RK have aged to the point of needing cataract surgery, and this group of patients is relatively young compared to conventional age-related cataract patients with relatively high expectations of post-cataract refractive accuracy. However, the change in corneal curvature after RK and the often irregular corneal surface make it difficult to measure preoperative cataract ocular biology and calculate intraocular lens (IOL) degrees. The proportion of refractive error ±0.5D after conventional cataract surgery is higher than that after RK. In this section, the reasons for the difficulty in calculating IOL after RK and the methods for calculating IOL after RK are discussed.

Research status of hypertensive rat model 

Zhao Zhou, Liu Weipeng, Li Zongrui, Wang Ruizhi, Hu Baoguang

2025, 31(9):  1465-1470.  DOI: 10.3760/cma.j.cn441417-20241010-09012

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The study of hypertension in rat models is currently active. Rats have a similar genome, cardiovascular system structure, and physiological characteristics to humans, making them a preferred animal model for studying hypertension. In order to gain a deep understanding of the pathogenesis of this disease and to explore new treatment methods, various experimental models of hypertension have been constructed. These models can be mainly divided into spontaneous and secondary hypertension models. The former includes spontaneously hypertensive rats (SHR), N-nitro-L-arginine methyl ester (L-NAME) model, Dahl salt-sensitive model, Milan hypertensive strain (MHS) model, and Sabra hypertension-prone (SBH) model, and the latter includes renal hypertension model, endocrine hypertension model, arterial hypertension model, and other secondary hypertension model (such as hypertension model induced by sleep apnea syndrome, hypertension model induced by diabetes, etc). This article provides a comprehensive overview of the different model production methods, advantages, and disadvantages, aiming to provide a more convenient and accurate solution for the clinical treatment of hypertension.

Research progress and prospects of Tongdu Tiaoshen acupuncture in the treatment of post-stroke dysphagia 

Zan Xingchun

2025, 31(9):  1470-1474.  DOI: 10.3760/cma.j.cn441417-20241025-09013

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Reviewing the research progress of Tongdu Tiaoshen acupuncture in the treatment of post-stroke dysphagia (PSD), this article systematically elaborates on the acupoint selection and techniques of Tongdu Tiaoshen acupuncture, the analysis of clinical trial data on Tongdu Tiaoshen acupuncture in the treatment of dysphagia, the promotion of neuromuscular function recovery and neuroplasticity by Tongdu Tiaoshen acupuncture, the neuroendocrine regulatory network of Tongdu Tiaoshen acupuncture in the treatment of dysphagia after stroke, and the related signal pathways of Tongdu Tiaoshen acupuncture in the treatment of PSD, and the future research direction and clinical application prospects of Tongdu Tiaoshen acupuncture in the treatment of PSD. This article aim is to systematically analyze relevant literature, reveal the mechanism of action of acupuncture therapy and its potential in clinical application, and provide more evidence-based medicine for the application of acupuncture therapy in the treatment of PSD.

Meta Analysis

Application of enhanced recovery after surgery principles in the perioperative management of lung cancer: a systematic review and meta-analysis based on randomized controlled trials 

Lyu Xiaodong, Gao Chengfei, Zhao Jinpeng

2025, 31(9):  1475-1481.  DOI: 10.3760/cma.j.cn441417-20241113-09014

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Objective　This study aimed to systematically evaluate the impact of enhanced recovery after surgery (ERAS) principles on perioperative outcomes in patients undergoing lung cancer surgery. Methods　Randomized controlled trials on the application effect of ERAS concept in the perioperative period of lung cancer were retrieved from databases such as PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, and VIP from the establishment of the databases to July 2024, and the references included in the studies were traced. Medical subject headings and keywords were used to search. Meta-analysis was performed using STATA 16.0 software, and publication bias was assessed by funnel plot and Egger test. Results  Finally, 13 articles (1 719 patients) were included. The results of the meta-analysis showed that the incidence of postoperative complications in the ERAS group was lower than that in the control group (OR=0.33, 95%CI: 0.26-0.41, P<0.01); the postoperative pain score of the ERAS group was lower than that of the control group(WMD=-1.04, 95%CI: -1.46--0.61, P<0.01); the retention time of the drainage tube in the ERAS group was shorter than that in the control group(WMD=-2.40, 95%CI: -3.08--1.72, P<0.01); the hospitalization time of the ERAS group was shorter than that of the control group(WMD=-3.51, 95%CI: -4.33--2.68, P<0.01). Conclusion  Implementing ERAS principles in the perioperative management of lung cancer patients significantly reduces postoperative complication rates and pain levels and shortens both chest tube duration and hospital stay.

Basic Research

Study on the mechanism of CD147 in regulating airway remodeling in asthma rats based on Akt-FoxO3-NF-κB signaling axis 

Sang Yang, Han Xinpeng, Yan Yuling, Zhang Shaoyi

2025, 31(9):  1482-1488.  DOI: 10.3760/cma.j.cn441417-20241202-09015

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Objective　To investigate the mechanism of CD147 in regulating airway remodeling in asthma rats based on the protein kinase B/forkhead box protein O3/nuclear factor-κB (Akt-FoxO3-NF-κB) signaling axis. Methods　Seventy SPF-grade SD rats were selected, aged 7-8 weeks, weight (200±20) g. Control group, model group, IgG group, anti-CD147 group and anti-CD147+SC-79 group, 12 rats in each group. In the anti-CD147+SC-79 group, 7 mg/kg of CD147 antibody was intraperitoneally injected and 0.04 μg/kg of SC-79 was injected through the tail vein. In the anti-CD147 group, 7 mg/kg of CD147 antibody was intraperitoneally injected and the same amount of normal saline was injected through the tail vein. In the IgG group, 7 mg/kg of IgG was intraperitoneally injected and the same amount of normal saline was injected through the tail vein. Both the control group and the model group were intraperitoneally injected and tail vein injected with the same amount of normal saline. Once a day, with continuous intervention for 4 weeks. The airway resistance (nebulized inhalation of different concentrations of acetylcholine), the number of inflammatory cells, the levels of inflammatory factors, the pathological changes of lung tissue, the expressions of transforming growth factor -β1 (TGF-β1) and α -smooth muscle actin (α-SMA), and the expressions of Akt-FoxO3-NF-κB signal axis-related proteins were compared 24 hours after the last administration in each group. One-way analysis of variance and SNK-q test were used for statistical analysis. Results　After aerosol inhalation of different concentrations of acetylcholine, the airway resistance of the model group was higher than that of the control group (P<0.05). The airway resistance of anti-CD147 group was lower than that of IgG group (P<0.05). The airway resistance of anti-CD147+SC-79 group was higher than that of anti-CD147 group (P<0.05). The numbers of macrophages, lymphocytes, neutrophils and eosinophils in the model group were higher than those in the control group (all P<0.05). The numbers of macrophages, lymphocytes, neutrophils and eosinophils in anti-CD147 group were lower than those in IgG group (all P<0.05). The numbers of macrophages, lymphocytes, neutrophils and eosinophils in anti-CD147+SC-79 group were higher than those in anti-CD147 group (all P<0.05). The levels of IL-4, IL-5 and IL-13 in the model group were higher than those in the control group (all P<0.05). The levels of IL-4, IL-5 and IL-13 in anti-CD147 group were lower than those in IgG group (all P<0.05). The levels of IL-4, IL-5 and IL-13 in anti-CD147+SC-79 group were higher than those in anti-CD147 group (all P<0.05). The expressions of TGF-β1 and α-SMA in the model group were higher than those in the control group (0.89±0.09 vs. 0.36±0.04, 0.80±0.09 vs. 0.27±0.03) (both P<0.05). The expressions of TGF-β1 and α-SMA in anti-CD147 group were lower than those in IgG group (0.47±0.05 vs. 0.85±0.09, 0.34±0.04 vs. 0.77±0.08) (both P<0.05). The expressions of TGF-β1 and α-SMA in anti-CD147+SC-79 group were higher than those in anti-CD147 group (0.80±0.09 vs. 0.47±0.05, 0.72±0.08 vs. 0.34±0.04) (both P<0.05). The expression of p-Akt/Akt, p-FoxO3a/FoxO3a, p-NF-κB p65/NF-κB p65 in model group were higher than those in the control group (0.93±0.10 vs. 0.44±0.05, 0.86±0.09 vs. 0.37±0.04, 0.76±0.08 vs. 0.33±0.04) (all P<0.05). The expression of p-Akt/Akt, p-FoxO3a/FoxO3a, p-NF-κB p65/NF-κB p65 in anti-CD147 group were lower than those in the IgG group (0.48±0.05 vs. 0.90±0.10, 0.41±0.05 vs. 0.82±0.09, 0.38±0.04 vs. 0.74±0.08) (all P<0.05). The expression of p-Akt/Akt, p-FoxO3a/FoxO3a, p-NF-κB p65/NF-κB p65 in anti-CD147+SC-79 group were higher than those in the anti-CD147 group (0.87±0.09 vs. 0.48±0.05, 0.79±0.08 vs. 0.41±0.05, 0.70±0.08 vs. 0.38±0.04) (all P<0.05). Conclusion　CD147 antibody can alleviate airway remodeling in asthma rats and is associated with inhibition of the Akt-FoxO3-NF-κB signaling axis.

Treatises

Risk factors related to children attention deficit hyperactivity disorder and construction of prediction model

Wu Yali, Fu Xiaoping, Ding Dawei, Xu Ning'an, Zhou Yuanyuan

2025, 31(9):  1489-1494.  DOI: 10.3760/cma.j.cn441417-20241101-09016

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Objective　To explore risk factors of childhood attention deficit hyperactivity disorder (ADHD) and construct a risk prediction model. Methods　From July 2023 to May 2024, 78 children with ADHD who were admitted to Hunan Children's Hospital were selected as the ADHD group. Meanwhile, 312 children who were admitted for treatment during the same period but did not have ADHD were selected as the non-ADHD group at a ratio of 1:4. In the ADHD group, there were 41 boys and 37 girls, aged (8.42±1.35) years.In the non-ADHD group, there were 169 boys and 143 girls, aged (8.57±1.29) years. A uniformly designed data collection form combined with electronic medical records was used to collect the relevant information of the children including age, gender, educational level of parents, mode of delivery, etc. Independent sample t test and χ² test were used for statistical analysis. Multivariate logistic regression analysis was used to analyze the influencing factors of the diagnosis of children with ADHD,and a risk prediction model was constructed. The diagnostic efficacy of the model on children with ADHD was analyzed by using receiver operating characteristic curve (ROC). The calibration curve and Hosmer-Lemeshow test were used to test the calibration degree and goodness of fit of the model. Results　From July 2023 to May 2024, Hunan Provincial Children's Hospital admitted a total of 1 391 children, among whom 78 cases were ADHD patients, with an incidence rate of 5.61%. The proportions of fetal distress in utero, prolonged labor, broken parent-child relationship in the family, and educational types of crude and excessive indulgence in the ADHD group were higher than those in the non-ADHD group [69.23% (54/78) vs. 12.82% (40/312), 70.51% (55/78) vs. 16.35% (51/312), 76.92% (60/78) vs. 16.67% (52/312), 73.08% (57/78) vs. 10.58% (33/312)] (all P<0.05). The results of logistic regression analysis indicated that fetal distress in utero, prolonged labor, broken parent-child relationship in the family, and educational types of crude and excessive indulgence were independent risk factors influencing the diagnosis of children with ADHD (all P<0.05). The area under the ROC of the risk prediction model for ADHD in children was 0.803 (95%CI: 0.706-0.951), the Youden index was 0.877, the critical value was 0.301, the sensitivity was 81.42%, and the specificity was 87.51%. The Hosmer-Lemeshow test results showed that χ²=16.889,P=0.302. Conclusion　The risk prediction model for childhood ADHD constructed in this study has considerable clinical value. Medical staff can take targeted preventive measures based on the risk factors of childhood ADHD.

Analysis of diagnosis and treatment of secondary intestinal stenosis after conservative treatment of neonatal necrotizing enterocolitis 

Wang Qingyuan, Fang Yuanlong, Wang Zhiqin, Huang Rong, Tian Song, Yuan Like, Ge Wuping, Zhu Xiaochun, Xiao Shangjie, Zhou Jialiang

2025, 31(9):  1495-1498.  DOI: 10.3760/cma.j.cn441417-20241017-09017

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Objective　To explore the early diagnosis and treatment experience of secondary intestinal stricture in medically treated neonatal necrotizing enterocolitis (NEC) patients. Methods　A total of 105 patients with secondary intestinal stenosis admitted to Guangdong Women and Children Hospital from January 2016 to June 2024 were selected as the study objects.There were 53 boys and 52 girls, gestational aged 32(30, 36) weeks, birth weight 1.77(1.32, 2.25) kg. All children in the acute stage of NEC were given conservative treatments such as fasting, gastrointestinal decompression, and anti-infection for a course of more than one week. After the improvement of clinical signs, milk feeding was initiated at a later date. Abdominal plain films or laboratory tests were reexamined when necessary. Medical records of the children patients were collected, including general conditions (gender, gestational age, birth weight), acute stage conditions of NEC, conditions when intestinal stenosis occurs (age of onset, weight, clinical manifestations, comorbidities), imaging manifestations, treatment conditions (age of operation, surgical methods, prognosis), etc. χ² test was used for statistical analysis. Results　A total of 105 children met the research criteria. The age of onset in the acute phase was 14(4, 28) days; after re-eating, the symptoms of intestinal stenosis occurred 27(13, 36) days after the acute onset. All children were diagnosed with intestinal stenosis at 18(10, 26) days after the onset of intestinal stenosis. 35 children were first diagnosed in our hospital after intestinal stenosis or symptoms occurred during hospitalization, and 70 children were transferred to our hospital after suspected surgical conditions in other hospitals. A total of 100 children underwent enema radiography examination. Five children were not subjected to enema radiography examination due to their severe conditions or the need for emergency laparotomy exploration. Children with intestinal stenosis in the colon ( including multiple stenosis of the colon and small intestine ) were included in the colon group, and children with lesions only in the small intestine were included in the small intestine group. The overall diagnostic sensitivity was 77.00% (77/100). The diagnostic sensitivity of colonic stenosis was higher than that of intestinal stenosis [89.74% (70/78) vs. 31.82% (7/22) ] (P<0.05). 92 children underwent one-stage intestinal resection and intestinal anastomosis, and 13 children underwent staged fistula closure. 103 children were cured, and 2 children gave up treatment due to systemic infection and neurological sequelae after operation. Conclusion　Intestinal stricture after conservative treatment of NEC is a common cause of feeding intolerance in neonates, and surgical treatment is effective. Enema contrast has low sensitivity for the diagnosis of small intestinal stricture, and clinicians should combine medical history, clinical manifestations and enema contrast to promote early diagnosis. Early diagnosis and intervention, shorten the hospitalization time, reduce the pain of children.

Construction of early warning model for mechanical ventilation weaning failure in neonatal respiratory distress syndrome

Deng Qiaoni, Chang Ya'na, Zhou Xiaoyu, Kang Hua

2025, 31(9):  1499-1505.  DOI: 10.3760/cma.j.cn441417-20241120-09018

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 Objective　To explore the influencing factors of mechanical ventilation weaning failure in neonatal respiratory distress syndrome and constructing a risk prediction model. Methods　A total of 185 children with respiratory distress syndrome admitted to Baoji High-Tech Hospital from December 2021 to July 2024, who underwent mechanical ventilation within 72 hours after birth, were selected as the study objects, including 79 boys and 106 girls. The children were randomly divided into a training set (148 cases) and a validation set (37 cases) in a ratio of 4∶1. The children were categorized into a weaning failure group (22 cases) and a weaning success group (126 cases) according to whether they required reintubation within 72 hours after the initial weaning, the success rate of weaning was 85.14% (126/148).In the weaning failure group, there were 8 boys and 14 girls, gestation aged (29.41±0.63) weeks. In the weaning success group, there were 51 boys and 75 girls, gestation aged (30.15±0.48) weeks. Clinical data of the patients was collected, including gestational age, gender, weight, birth weight, 5-minute Apgar score after birth, intubation in the delivery room, etc. Independent sample t test and χ² test were used for statistical analysis. Multivariate logistic regression analysis was used to analyze the influencing factors of ventilation weaning failure in neonatal respiratory distress syndrome. A Nomogram model was established, and C-index was used to evaluate the discrimination. The predictive efficacy of the model for the failure of weaning from mechanical ventilation in children with respiratory distress syndrome was analyzed by using the receiver operating characteristic curve (ROC). Results　The gestational age of the weaning failed group was lower than that of the weaning success group, the FiO₂ and PCO₂ before weaning were higher than that of the weaning success group, the proportion of using high-dose caffeine was lower than that of the weaning success group, and the proportions of patent ductus arteriosus and ventilator-associated pneumonia were higher than that of the weaning success group (all P<0.05). Logistic regression analysis revealed that gestational age (OR=0.223, 95%CI: 0.067-0.737), high-dose caffeine use (OR=0.249, 95%CI: 0.075-0.825), FiO₂ before weaning (OR=3.766, 95%CI: 1.135-12.487), PCO₂ before weaning (OR=3.473, 95%CI: 1.047-11.516), patent ductus arteriosus (OR=3.951, 95%CI: 1.192-13.101), and ventilator-associated pneumonia (OR=5.038, 95%CI: 1.519-16.705) were independent risk factors for weaning failure in children with respiratory distress syndrome (all P<0.05). The nomogram model demonstrated a sensitivity of 0.784 and specificity of 0.877 in predicting weaning failure in the training set, with an area under the curve (AUC) of 0.851. In the validation set, the model achieved a sensitivity of 0.759 and specificity of 0.867, with an AUC of 0.844. Conclusions　Gestational age, caffeine dosage, FiO₂ and PCO₂ before weaning, patent ductus arteriosus, and ventilator-associated pneumonia are significantly associated with weaning failure in children with respiratory distress syndrome. The nomogram model developed in this study provides a valuable tool for early assessment of weaning failure risk in this population.

Predictive value of total bilirubin, umbilical cord bilirubin level, and reticulocyte count in neonatal ABO hemolytic disease to neurological damage 

Zhang Senshan, Cai Mei, Sun Feng

2025, 31(9):  1506-1510.  DOI: 10.3760/cma.j.cn441417-20241125-09019

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Objective　To investigate the abnormal expression of serum total bilirubin (TBil) level, umbilical cord bilirubin level, and reticulocyte (RET) count in neonatal ABO hemolytic disease and their predictive value for neurological damage. Methods　A total of 87 neonates with ABO hemolytic disease admitted to Ankang Central Hospital from May 2021 to May 2024 were selected as the study subjects. At the seventh day after birth, the neonates were divided into neurological damage group (35 cases) and neurological non-damage group (52 cases) according to the neonatal behavioral neurological assessment (NBNA) score. There were 20 boys and 15 girls in the neurological damage group, gestational aged (38.53±0.36) weeks. There were 28 boys and 24 girls in the neurological non-damage group, gestational aged (38.49±0.39) weeks. Clinical data of the patients was collected (gestational age, gender, weight, etc.). The serum TBil levels, umbilical cord bilirubin levels, and RET counts were compared between the two groups. Independent sample t test and χ² test were used for statistical analysis. Multivariate logistic regression analysis was used to analyze the influencing factors of neurological damage in neonates. The receiver operating characteristic curve (ROC) was used to verify the predictive value of serum TBil level, umbilical cord bilirubin level, and RET count for neurological damage in neonates with ABO hemolytic disease, and the area under the curve (AUC) was calculated. Results　There were no statistically significant differences in the clinical data between the two groups (all P>0.05). The serum TBil levels, umbilical cord bilirubin levels, and RET counts of the neurological damage group were higher than those of the non-damage group [(192.53±25.17) μmol/L vs. (169.46±21.42) μmol/L, (47.33±12.06) μmol/L vs. (31.16±8.95) μmol/L, (4.92±1.74)% vs. (3.36±0.98)%](all P<0.05). Multivariate logistic regression analysis showed that serum TBil level (OR=1.041, 95%CI: 1.008-1.074, P=0.013), umbilical cord bilirubin level (OR=1.141, 95%CI: 1.059-1.230, P=0.001) and RET count (OR=2.675, 95%CI: 1.437-4.977, P=0.002) were independent risk factors for neurological damage in neonates with ABO hemolytic disease (all P<0.05). ROC results showed that the AUC of the combined prediction of serum TBil level, umbilical cord bilirubin level and RET count for neurological damage in neonates with ABO hemolytic disease was 0.922 (95%CI: 0.853-0.991), the sensitivity was 91.43%, the specificity was 96.15%, and the Youden index was 0.779. Conclusion　Abnormal expression of serum TBil level, umbilical cord bilirubin level, and RET count are closely associated with neurological damage in neonates with ABO hemolytic disease. Combined detection of these indicators holds significant clinical value for predicting neurological damage.

Efficacy of meropenem combined with continuous renal replacement therapy in the treatment of sepsis-associated acute kidney injury and its impact on renal function recovery

Hao Xin, Guo Wei, Tan Dandan, Guo Jinyan, Ma Ning, Lan Yuhuai

2025, 31(9):  1511-1515.  DOI: 10.3760/cma.j.cn441417-20241030-09020

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Objective　To investigate the efficacy of meropenem combined with continuous renal replacement therapy (CRRT) in the treatment of sepsis-associated acute kidney injury (S-AKI) and its impact on renal function recovery. Methods　A total of 60 patients with S-AKI admitted to Heilongjiang Provincial Hospital from June 2023 to May 2024 were selected as the study subjects. Using a random number table, patients were divided into an observation group and a control group, with 30 patients in each group. There were 12 males and 18 females in the control group, aged (38.50±2.75) years, acute kidney injury staging: stage Ⅰ (17 cases), stage Ⅱ (7 cases), and stage Ⅲ (6 cases). There were 14 males and 16 females in the observation group, aged (38.17±2.63) years, acute kidney injury staging: stage Ⅰ (15 cases), stage Ⅱ (8 cases), and stage Ⅲ (7 cases). The control group received CRRT, while the observation group received meropenem combined with CRRT. Therapeutic outcomes [intensive care unit (ICU) stay duration, urine output recovery time, and cardiovascular events], survival rates; infectious indicators [white blood cell count (WBC), neutrophil ratio (NEUR), and procalcitonin (PCT)], inflammatory factors [interleukin (IL)-6, IL-1β, and tumor necrosis factor-α (TNF-α)], and renal function indicators [blood urea nitrogen (BUN), urinary protein, and creatinine] were compared before and 3 d after treatment. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　The ICU hospitalization time and the time for urine output recovery in the observation group were shorter than those in the control group [(8.67±1.49) d vs. (12.23±3.67) d, (7.63±4.48) d vs. (11.27±8.28) d], and the total incidence rate of cardiovascular events was lower than that of the control group [13.33% (4/30) vs. 40.00% (12/30)] (all P<0.05). After 3 d of treatment, the levels of WBC, NEUR and PCT in the observation group were lower than those in the control group [(8.91±3.08)×10⁹/L vs. (11.57±5.59)×10⁹/L, (71.10±2.30)% vs. (76.54±3.13)%, (0.39±0.09) μg/L vs. (0.45±0.09) μg/L] (all P<0.05); the levels of IL-6, IL-1β and TNF-α in the observation group were lower than those in the control group [(87.58±9.07) ng/L vs. (185.32±23.23) ng/L, (14.58±3.26) μg/L vs. (24.06±3.61) μg/L, (45.37±8.29) ng/L vs. (74.09±9.27) ng/L] (all P<0.05); the levels of BUN, urine protein and creatinine in the observation group were lower than those in the control group [(7.12±0.93) mmol/L vs. (9.71±1.13) mmol/L, (6.18±1.18) mg/24 h vs. (10.97±2.35) mg/24 h, (49.51±2.18) μmol/L vs. (57.05±5.28) μmol/L] (all P<0.05). After 28 d of follow-up, the survival rate in the observation group was higher than that in the control group [93.33% (28/30) vs. 73.33% (22/30)] (P<0.05). Conclusion　Meropenem combined with CRRT can reduce ICU stay duration, urine output recovery time, and the incidence of cardiovascular events in patients with S-AKI. It also lowers infectious indicators and inflammatory factor levels, aids in renal function recovery, and improves survival rates.

The application value of topical sodium citrate combined with low-dose heparin sodium anticoagulation in CRRT for patients with sepsis and acute kidney injury 

Zhang Ke, Liu Jinggang, Wu Ruirong, Feng Hui

2025, 31(9):  1516-1520.  DOI: 10.3760/cma.j.cn441417-20240828-09021

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Objective　To explore the application value of topical sodium citrate combined with low-dose heparin sodium anticoagulation in the treatment of continuous blood purification (CRRT) in patients with sepsis and acute kidney injury. Methods　This research is a randomized controlled trial. Seventy-one patients with sepsis and acute kidney injury (AKI) who were admitted to Shangxian Central Hospital from January 2021 to January 2024 were selected as the research subjects. The patients were divided into the control group (35 cases) and the treatment group (36 cases) by using the random number table method. There were 18 males and 17 females in the control group, aged (53.40±12.03) years. There were 18 males and 18 females in the treatment group, aged (57.97±10.66) years. The control group was treated with CRRT under topical sodium citrate, and the treatment group was treated with CRRT under topical sodium citrate combined with low-dose heparin sodium anticoagulation. Compare the transmembrane pressure (TMP), pressure drop (PFU) and platelet count (PLT) of the two groups before and after treatment at 12 h, 24 h and 48 h; the coagulation grade of the filter and venous reservoir at 24 h after treatment; and the bleeding conditions (skin and mucous membranes, digestive tract, urinary tract, etc.). Independent sample t test, paired t test, χ² test, fisher exact probability and rank sum test were used for statistical analysis. Results　At 12 h, 24 h and 48 h after treatment, the TMP of the treatment group were lower than those of the control group [(114.97±22.65) mmHg (1 mmHg=0.133 kPa) vs. (126.91±22.88) mmHg, (133.28±20.04) mmHg vs. (143.17±20.30) mmHg, (151.14±17.43) mmHg vs. (159.80±17.68) mmHg] (all P<0.05); and the PFU were lower than those of the control group [(97.58±15.22) mmHg vs. (105.71±15.85) mmHg, (118.81±13.72) mmHg vs. (126.51±13.25) mmHg, (140.39±14.19) mmHg vs. (147.43±12.02) mmHg] (all P<0.05); there were no statistically significant difference in the PLT between the two groups (all P>0.05). At 24 hours after treatment, the coagulation grades of the filters and venous reservoirs of the treatment group were better than those of the control group (P<0.05).There was no statistically significant difference in the total incidence of bleeding between the two groups (P>0.05). Conclusion　The treatment of CRRT under topical sodium citrate combined with low-dose heparin sodium anticoagulation can extend the service life of the filter, improve the efficiency of the filter in removing inflammatory mediators, and the therapeutic effect is good without increasing the treatment risk.

The effect of Xiangdan injection combined with metoprolol tartrate on clinical symptoms and oxidative stress response in patients with coronary heart disease and angina pectoris

Zang Keliang, Ban Fang, Zhang Qiumei, Zhang Hengliang

2025, 31(9):  1520-1524.  DOI: 10.3760/cma.j.cn441417-20240808-09022

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Objective　To analyze the efficacy of Xiangdan injection combined with metoprolol tartrate in patients with coronary heart disease and angina pectoris, as well as its impact on clinical symptoms and oxidative stress response. Methods　A total of 92 patients with angina pectoris of coronary heart disease who were admitted to Shangqiu Municipal Hospital from April 2021 to April 2024 were selected as the research subjects. The patients were divided into the control group (46 cases) and the research group (46 cases) by using the random number table method. There were 25 males and 21 females in the control group, aged 51-78(64.29±7.08) years, course of coronary heart disease 2-10(6.24±1.66) years. There were 22 males and 24 females in the research group, aged 52-79(65.36±7.17) years, course of coronary heart disease 2-11(6.51±1.84) years. The control group was treated with metoprolol tartrate, and the research group was treated with Xiangdan injection combined with metoprolol tartrate. Compare the clinical efficacy of the two groups; clinical symptoms (frequency and duration of angina pectoris attacks), levels of myocardial injury markers [creatine kinase MB (CK-MB), brain natriuretic peptide (BNP), cardiac troponin Ⅰ (cTnⅠ)], and oxidative stress indicators [superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA)] before and after treatment; and adverse reactions (vertigo, nausea, fatigue, etc.). Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　The total effective rate of treatment in the research group was higher than that in the control group[89.13% (41/46) vs. 71.74% (33/46)](P<0.05). After the treatment, the frequency of angina pectoris attacks in the research group was lower than that in the control group[(2.49±0.62) times/week vs. (3.25±0.68) times/week] and the duration of angina pectoris was shorter than that of the control group[(5.05±0.97) min vs. (6.54±0.39) min] (both P<0.05); the levels of BNP, CK-MB and cTnⅠ in the research group were lower than those in the control group [(114.72±16.87) ng/L vs. (143.59±18.04) ng/L, (15.27±2.21) U/L vs. (18.67±2.16) U/L, (1.21±0.27) μg/L vs. (1.46±0.26) μg/L] (all P<0.05); the MDA level in the research group was lower than that in the control group [(6.24±1.29) mol/L vs. (8.27±1.46) mol/L] and the levels of CAT and SOD were higher than those of the control group [(34.97±4.38) U/ml vs. (30.67±4.21) U/ml, (98.46±7.64) U/L vs. (90.37±7.92) U/L](all P<0.05). There were no statistically significant difference in the total incidence rate of adverse reactions between the two groups (P>0.05). Conclusion　Xiangdan injection combined with metoprolol tartrate has significant effect in treating angina pectoris in coronary heart disease, which helps to improve the symptoms of angina pectoris, reduce oxidative stress damage, improve myocardial damage, and has high safety.

Study on risk factors of target vessel restenosis after drug-coated balloon angioplasty in patients with coronary artery disease and predictive model analysis

Jiang Zhengfa, Wang Liyou, Zhang Xiao, Xu Hongyong

2025, 31(9):  1525-1531.  DOI: 10.3760/cma.j.cn441417-20241120-09023

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Objective　To approach the risk factors of target vessel restenosis after drug-coated balloon (DCB) angioplasty in patients with coronary artery disease, and develop a predictive model. Methods　A total of 108 CAD patients admitted to Ankang Central Hospital from January 2020 to March 2024 was selected as the study objects. All patients had underwent DCB angioplasty. Coronary angiography was used to evaluate restenosis of the target vessel six months after the operation. The patients were divided into a stenosis group (30 cases)and a non-stenosis group (78 cases). In the stenosis group, there were 18 males and 12 females, aged (64.30±6.10) years. In the non-stenosis group, there were 42 males and 36 females, aged (63.15±6.58) years. Clinical data, preoperative laboratory results, echocardiography findings and intraoperative coronary angiography characteristics were compared between the two groups. Independent sample t test and χ² test were used for statistical analysis. Multivariate logistic regression analysis was performed to explore independent risk factors for target vessel restenosis. R software and rms packages were used to construct the nomogram model. The predictive efficacy of the model for target vessel restenosis in patients with coronary heart disease after DCB formation was analyzed by using calibration curve, receiver operating characteristic curve (ROC) and decision analysis curve. Results　The proportions of smoking and diabetes in the stenosis group were higher than those in the non-stenosis group, the proportion of using pre-dilated balloons was lower than that in the non-stenosis group, the length of target vascular lesions was longer than that in the non-stenosis group, the postoperative residual stenosis rate and the levels of low-density lipoprotein cholesterol (LDL-C) and cystatin C (CysC) were higher than those in the non-stenosis group, the levels of matrix metalloproteinase inhibitor-1 (TIMP-1) and secreted frizzled-related protein 5 (SFRP-5) were lower than those in the non-stenosis group (all P<0.05). The results of multivariate logistic regression analysis indicated that smoking (OR=5.697, 95%CI: 1.332-24.359), diabetes (OR=5.169, 95%CI: 1.241-21.532), preoperative high LDL-C levels (OR=5.163, 95%CI: 1.271-20.976), low TIMP-1 levels (OR=0.151, 95%CI: 0.023-0.990), low SFRP-5 levels (OR=0.149, 95%CI: 0.025-0.892), no use of pre-dilated balloons during the operation (OR=0.308, 95%CI: 0.104-0.910), and high residual stenosis rate after the operation (OR=4.901, 95%CI: 1.014-23.673) were all independent risk factors for target vessel restenosis (all P<0.05). Based on the results of multivariate logistic regression analysis, a nomogram model influencing target vessel restenosis in patients with coronary heart disease after DCB angioplasty was constructed. The results showed that coronary heart disease patients who smoked, had diabetes, had high preoperative LDL-C levels, low TIMP-1 levels, low SFRP-5 levels, did not use pre-dilated balloons during the operation, and had a high postoperative residual stenosis rate had a higher risk of target vessel restenosis after DCB angioplasty. The area under the curve of the nomogram model was 0.981, with a sensitivity of 96.67% and a specificity of 92.31%. Conclusion　Smoking, diabetes, high preoperative LDL-C levels, low TIMP-1 levels, SFRP-5 levels, no use of pre-dilated balloons during the operation, and high postoperative residual stenosis rate are independent risk factors for target vessel restenosis after drug-coated balloon angioplasty.

Application of AI technology in preplanning of unicompartmental knee arthroplasty 

Pan Xi'an, Zhang Yuanjin, Zhang Guofu, Li Jun, Sun Farui, Liu Bingxia

2025, 31(9):  1532-1537.  DOI: 10.3760/cma.j.cn441417-20241008-09024

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Objective　To explore the clinical application value of Artificial Intelligence (AI) technology in preoperative planning of unicompartmental knee arthroplasty. Methods　This study is a retrospective controlled analysis. A total of 35 patients who underwent unicompartmental knee arthroplasty at Huangshi Central Hospital from July 2021 to July 2023 were selected and divided into an experimental group and a control group based on the preoperative planning method used. Among the 14 patients in the experimental group, 6 were male and 8 were female, the age was (62.43±3.55) years old, AI technology was used for preoperative planning. In the control group, there were 7 males and 14 females in 21 patients, the age was (62.10±2.86) years old, Preoperative planning was performed according to the traditional X-ray method. The surgical time, intraoperative blood loss, postoperative drainage volume, prosthesis conformity rate (the preoperatively predicted sizes and models of the prosthesis and spacer matching exactly with those used intraoperatively), as well as the American Hospital Specialty (HHS) knee scores, Visual Analog Scale (VAS) scores, and improvement in knee range of motion at 3 months and 1 year postoperatively were recorded and compared. The χ² test and t test were used for statistical analysis. Results　The surgical time, intraoperative blood loss, and postoperative drainage volume in the experimental group were (59.07±3.36) minutes, (107.29±10.16) ml, and (78.93±10.95) ml, The control group were (69.57±2.11) minutes, (123.38±7.65) ml, and (95.19±12.49) ml, with all differences being statistically significant (t=11.378, 5.347,and 3.958, all P<0.001). At 3 months and 1 year postoperatively, the HHS knee scores and the range of motion of the knee was greater in the experimental group[(79.93±1.14) points vs. (76.81±1.54) points,(119.57±4.62)° vs. (111.76±6.25)°,(92.36±1.87) points vs. (90.48±1.25) points,(130.29±4.60)° vs. (120.57±4.98)°], and VAS scores in the experimental group were lower than those in the control group [(1.71±0.47) points vs. (2.43±0.68) points, (1.14±0.36) points vs. (1.86±0.48) points], with all differences being statistically significant (all P<0.05). The conformity rates for the femoral side, tibial side, and spacer in the experimental group were higher than those in the control group [92.86% (13/14) vs. 42.86% (9/21), 92.86% (13/14) vs. 38.10% (8/21), 85.71% (12/14) vs. 33.33% (7/21), all P<0.05]. Conclusion　The application of AI technology in preoperative planning for unicompartmental knee arthroplasty can accurately predict the model of the femoral and tibial prostheses as well as the size of the spacer, improve prosthesis conformity rates, reduce intraoperative blood loss and postoperative drainage volume, alleviate postoperative knee pain symptoms, and enhance knee range of motion, demonstrating significant clinical guidance value.

Clinical Research

Analysis of changes of blood lipid levels in adolescents with bipolar disorder and their relationship with regional brain structure in imaging examination 

Zhang Ting, Guo Lin, Zhang Chi, Fu Rui, Cui Zhiquan, Kang Xiaogang

2025, 31(9):  1538-1543.  DOI: 10.3760/cma.j.cn441417-20241018-09025

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Objective　To investigate the changes in blood lipid levels in adolescents with bipolar disorder and their relationship with regional brain structure as assessed by imaging studies. Method　A retrospective study was conducted involving 72 adolescents with bipolar disorder treated at the Department of Psychiatry, Chang'an Hospital, from May 2022 to May 2024. The observation group consisted of 45 males and 27 females, the age was (13.26±1.51) years old. Patients were divided into a depressive episode group (31 cases) and a manic episode group (41 cases) based on the cause of onset. Treatment effects were assessed after 3 months of therapy. According to the Young Mania Rating Scale (YMRS) and the Montgomery-Asberg Depression Rating Scale (MADRS), patients were classified into a good prognosis group (YMRS score < 13 points, MADRS < 22 points, 45 cases) and a poor prognosis group (YMRS score ≥ 13 points, MADRS ≥ 22 points, 27 cases). A control group of 52 healthy individuals was selected during the same period, comprising 34 males and 18 females, the age was (13.31±1.54) years old. Blood lipid levels [total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C)] were measured using an automatic biochemical analyzer on the second day after admission for the observation group and on the day of health examination for the control group. All patients underwent resting-state functional magnetic resonance imaging (fMRI) to collect imaging parameters. Correlation analysis was performed using Pearson correlation, and statistical analysis was conducted using t tests. Results　The TC, TG, LDL-C, and HDL-C levels in the observation group were (5.89±0.94, 2.12±0.31, 3.75±0.86, 1.53±0.35) mmol/L, compared to (5.03±0.78, 1.34±0.26, 3.11±0.58, 1.74±0.29) mmol/L in the control group, with all differences being statistically significant (t=5.555, 15.196, 4.946, and 3.645, all P<0.001). No statistically significant differences were found between the depressive episode group and the manic episode group regarding TC, TG, LDL-C, and HDL-C levels (all P>0.05). The TC, TG, and LDL-C levels in the poor prognosis group were higher than those in the good prognosis group, while HDL-C levels were lower in the poor prognosis group (all P<0.05). Regional brain structure regional homogeneity (ReHo) values: the ReHo values for the left cerebellum, right cerebellum, left cuneus, right cuneus, and right superior temporal gyrus in the observation group were 0.23±0.04, -0.21±0.06, 0.12±0.05, -0.05±0.01, and 0.21±0.06, respectively, while the control group had values of 0.51±0.15, -0.42±0.12, -0.28±0.09, -0.19±0.04, and 0.39±0.09, with all differences being statistically significant (t=11.427, 9.714, 23.982, 21.538, and 10.163, all P<0.001). In the depressive episode group, the ReHo values for the left cerebellum, left cuneus, right cuneus, and right superior temporal gyrus were lower than those in the manic episode group, while the ReHo value for the right cerebellum was higher than in the manic episode group (all P<0.05). The ReHo values for the left cerebellum and right superior temporal gyrus in the poor prognosis group were lower than those in the good prognosis group, while the ReHo values for the right cerebellum, left cuneus, and right cuneus were higher than in the good prognosis group (all P<0.05). Pearson correlation results indicated that TC, TG, and LDL-C levels in adolescents with bipolar disorder were positively correlated with the ReHo values of the right cerebellum, left cuneus, and right cuneus, and negatively correlated with the ReHo values of the left cerebellum and right superior temporal gyrus (all P<0.05); HDL-C was negatively correlated with the ReHo values of the right cerebellum, left cuneus, and right cuneus, and positively correlated with the ReHo values of the left cerebellum and right superior temporal gyrus (all P<0.05). Conclusion　The changes of blood lipid levels in patients with adolescent bipolar disorder are obvious, which are correlated with the ReHo value of regional brain structure, which can reflect the neuropathological changes of patients. Strengthening the magnetic resonance imaging examination of patients can evaluate the prognosis of patients.

Effects of paroxetine combined with aniracetam on glycolipid metabolism in elderly patients with depression

Li Yan, Zhao Limin, Qu Shanshan

2025, 31(9):  1544-1548.  DOI: 10.3760/cma.j.cn441417-20241025-09026

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Objective　To observe the effects of paroxetine combined with aniracetam on cognitive function and glucose and lipid metabolism disorders in elderly patients with depression. Methods　A retrospective analysis was conducted on the clinical data of 85 elderly patients with depression treated at Ankang Central Hospital from March 2020 to February 2024. Patients were divided into a control group (41 cases) and an observation group (44 cases) based on different treatment methods. The control group included 23 males and 18 females, the age was (71.43±4.26) years old; they received paroxetine orally, starting at a dose of 10 mg/d, which was increased to 20 mg/d after 3 days, with optional dosage adjustments up to a maximum of 40 mg/d. The observation group included 27 males and 17 females, the age was (72.58±4.87) years old; they received aniracetam orally at a dose of 100 mg once daily, in addition to paroxetine treatment. Both groups were treated for 8 weeks. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) scale, depression severity was evaluated using the Hamilton Depression Scale (HAMD), and clinical efficacy, serological indicators, glucose-lipid metabolism indicators, and adverse reactions were compared. Statistical methods included t tests and χ² tests. Results　After 8 weeks of treatment, the MoCA and HAMD scores in the observation group were (27.10±0.45) and (6.37±1.02) points, respectively, compared to (25.51±0.83) and (12.18±2.54) points in the control group, with statistically significant differences (t=11.082, and 14.013, both P<0.001). Serum levels of glial cell-derived neurotrophic factor, serotonin, and norepinephrine were (631.49±65.87, 135.84±17.20, 141.29±15.94) ng/L in the observation group, compared to (527.86±58.30, 118.25±13.76, 128.46±13.52) ng/L in the control group, with statistically significant differences (t=7.659, 5.182, and 3.987, all P<0.05). There were no statistically significant differences between the two groups in terms of hemoglobin A1c, low-density lipoprotein cholesterol, postprandial 2-hour blood glucose, and triglyceride levels (all P>0.05). The total effective rate in the observation group was 93.18% (41/44), higher than the control group's 75.61% (31/41), with a statistically significant difference (χ²=5.059, P=0.025). The overall incidence of adverse reactions was not statistically significant between the two groups (P>0.05). Conclusion　The combination of paroxetine and aniracetam is effective in treating elderly depression, improving cognitive function, regulating glucose-lipid metabolism disorders and neurotransmitter levels, and demonstrating reliable safety.

Effect of escitalopram combined with Shugan Jieyu capsule on senile depression with insomnia

Yang Yufeng, Lu Lijun, Deng Qian, Chen Shidong, Wang Huiying

2025, 31(9):  1549-1553.  DOI: 10.3760/cma.j.cn441417-20241125-09027

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Objective　To analyze the efficacy of escitalopram combined with Shugan Jieyu capsule in the treatment of senile depression with insomnia. Methods　A total of 58 outpatients with senile depression and insomnia admitted to the First Affiliated Hospital of Nanyang Medical College from May 2021 to May 2023 were retrospectively selected and divided into control group and observation group according to different treatment methods, with 29 cases in each group. In the control group, there were 12 males and 17 females, aged (68.79±3.26) years old, and the course of disease was (12.57±2.45) months. The patients were treated with escitalopram orally, with an initial dose of 10 mg/d, and the dose was adjusted to 20 mg/d within 2 weeks. There were 14 males and 15 females in the observation group, aged (69.52±3.35) years old, and the course of disease was (12.82±2.34) months. Patients in the control group were po administered with Shugan Jieyu Capsules on the basis of the control group, 0.72 g/d, 2 times/d. All patients were treated continuously for 2 months.Clinical efficacy, psychological status [Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS) scores], sleep indicators (sleep onset time, total sleep time), Montreal Cognitive Assessment (MoCA) scores, neurochemical indicators [serotonin (5-HT), dopamine (DA), norepinephrine (NE)], Pittsburgh Sleep Quality Index (PSQI) scores, General Quality of Life Inventory (GQOLI-74) scores, and adverse reactions were compared between the two groups. Statistical analyses were performed using Fisher's exact test and t tests. Results　The total effective rate in the observation group was higher than that in the control group [96.55% (28/29) vs. 72.41% (21/29)], with a statistically significant difference (P=0.025). After 2 months of treatment, the SDS and SAS scores in the observation group were lower than those in the control group [(32.45±2.12) points vs. (38.26±2.43) points, (31.64±1.93) points vs. (37.58±2.12) points]. The observation group had a shorter sleep onset time compared to the control group [(30.58±3.24) min vs. (54.62±4.35) min] and a longer total sleep time [(6.71±1.35) h vs. (5.26±1.21) h]. The MoCA score in the observation group was higher than that in the control group [(28.23±1.04) points vs. (25.76±1.15) points]. The levels of 5-HT, DA, and NE in the observation group were (108.51±6.35) µg/L, (78.26±4.18) ng/L, and (10.12±0.64) mg/L, respectively, compared to (98.76±5.02) µg/L, (66.58±3.75) ng/L, and (9.35±0.58) mg/L in the control group. The PSQI score in the observation group was lower than that in the control group [(4.72±0.53) points vs. (7.25±0.62) points], while the GQOLI-74 score was higher in the observation group [(78.29±4.38) points vs. (70.35±4.12) points], with all differences being statistically significant (all P<0.05). The overall incidence of adverse reactions between the two groups was not statistically significant (P=1.000). Conclusion　Escitalopram combined with Shugan Jieyu capsule in the treatment of senile depression with insomnia can improve the clinical efficacy and reduce depression, Prolong sleep time, improve cognitive function, regulate neurotransmitter levels, Improve sleep quality, improve quality of life, and better safety.

Study on the effect of cast porcelain inlay crown on the restoration of short abutment teeth 

Pan Qi, Yu Li, Zhang Ansheng

2025, 31(9):  1554-1558.  DOI: 10.3760/cma.j.cn441417-20241014-09028

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Objective　To explore the application effects of cast porcelain inlay crowns in the restoration of short abutments and their impact on patients' chewing function, gingival status, and inflammatory markers in gingival crevicular fluid. Methods　A prospective study was conducted selecting 94 patients with short abutment posterior teeth restorations treated at the Department of Stomatology, Xi'an Third Hospital, from May 2021 to January 2023. Patients were randomly divided into a control group and an observation group, with 47 patients in each group using the envelope method. The control group included 25 males and 22 females, the age was (34.39±5.41) years old. The observation group included 29 males and 18 females, the age was (34.43±5.46) years old. The control group received all-ceramic crowns after root canal treatment, while the observation group received cast ceramic inlay crowns. The effectiveness of the restorations was evaluated 3 months after completion, followed by a 12 month outpatient follow-up. Chewing function, gingival status, aesthetics, and complication rates were compared between the two groups. Statistical analysis was conducted using χ² tests and t tests. Results　Three months after restoration, the chewing efficiency and occlusal force in the observation group were higher than those in the control group [(95.89±9.35) % vs. (78.51±6.78) %, (125.32±7.51) lbs vs. (112.59±6.29) lbs]. The plaque index and gingival index scores were lower in the observation group [(0.82±0.17) points vs. (1.41±0.25) points, (1.41±0.28) points vs. (1.85±0.34) points], with all differences being statistically significant (t=10.317, 8.909, 13.379, and 6.849, all P<0.001). After 12 months, the anatomical morphology of the interproximal surfaces, fracture and retention of the prosthesis, marginal fit, and surface and margin discoloration scores in the observation group were (0.85±0.12, 0.92±0.15, 0.88±0.14, 0.99±0.18) points, compared to (2.59±0.34, 2.63±0.42, 2.43±0.31, 2.49±0.36) points in the control group, with all differences being statistically significant (t=33.085, 26.286, 31.240, and 25.550, all P<0.001). During the 12 month outpatient follow-up, the total complication rates in the observation and control groups were 4.26% (2/47) and 10.64% (5/47), respectively, with no statistically significant difference (χ²=1.389, P=0.239). Conclusion　The application of cast porcelain inlay crown in the repair of posterior teeth of short abutment teeth has a good effect. It can improve the chewing function of patients, improve the gingival condition, help to improve the long-term beauty of patients, and has high safety. It is worthy of popularization and application.

Nursing Research

Qualitative study on influencing factors of inadequate prevention and treatment of autologous arteriovenous fistula-like dilation in maintenance hemodialysis patients 

Chen Chuntao, Ou Xiuli, Li Caixia, Liu Cailing, Zeng Nafen, Du Zhenping, Cai Shaona, Mi Qian, Fu Xia

2025, 31(9):  1559-1564.  DOI: 10.3760/cma.j.cn441417-20241114-09029

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Objective　To explore the influencing factors of insufficient prevention and treatment of aneurysmal dilatation of arteriovenous fistula in maintenance hemodialysis patients. Methods　This study is a phenomenological research method of qualitative research. Objective sampling method was used, from May to June 2024,18 medical staff from 8 medical institutions and 10 maintenance hemodialysis patients from 1 medical institution were selected for semi-structured interviews. The interview data were collated and analyzed according to Colaizzi 's seven-step analysis method. Results　A total of 28 one-on-one interviews were conducted. The length of each interview was 20-60 min, and no second interview was conducted. Three themes and six sub-themes were extracted. The three themes were insufficient medical support, lack of knowledge of patients ' home self-management, insufficient family support, and insufficient organizational system. Conclusions　There are three major obstacles to the prevention and treatment of aneurysmal dilatation of arteriovenous fistula in maintenance hemodialysis patients. It is suggested to strengthen medical guidance and puncture norms, improve patient self-management, optimize management system and increase human resource investment to improve the prevention and treatment of aneurysmal dilatation of arteriovenous fistula.

The current application status of central venous catheters in intravenous therapy for inpatients in the hospital wards 

Chen Juanjuan

2025, 31(9):  1565-1568.  DOI: 10.3760/cma.j.cn441417-20241008-09030

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This article reviews the definition, placement method, tip position, indications, application in special population and complications of midline catheter, so as to provide help for the placement and clinical use of midline catheter.

Application effect of health education based on empowerment theory in patients with rheumatoid arthritis

Wei Xinyan, Wei Wenjuan, Ke Yihong, Qian Haibing

2025, 31(9):  1569-1573.  DOI: 10.3760/cma.j.cn441417-20240807-09031

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Objective　To explore the effect of health education based on empowerment theory on pain degree, coping style and quality of life in patients with rheumatoid arthritis (RA). Methods　83 RA patients admitted to Gansu Provincial Hospital of Traditional Chinese Medicine from March 2020 to March 2023 were prospectively selected as subjects for the study. They were randomly divided into study group (n=41) and reference group (n=42) using the envelope method. There were 26 males and 15 females in the research group, the age was (51.34±6.20)years old, and a disease duration of (5.42±1.06) years. Disease stage: 17 cases in low activity stage and 24 cases in the moderate to high activity stage. In the reference group, there were 28 males and 14 females, the age was (51.46±6.25) years old, a disease duration of (5.49±1.04) years. Disease stage: 16 cases in the low activity stage and 28 cases in the moderate to high activity stage. The reference group received routine care, while the research group was given health education based on the empowerment theory of authorization on the basis of the care provided to the reference group. Both groups received continuous intervention for 30 days.Pain degree, coping style, quality of life and ability of daily living activities were compared between the two groups. χ² test, and t test were used for statistical analysis. Results　After the intervention, The scores of the physiological, emotional, sensory discrimination and cognitive aspects of the pain assessment scale of the research group were (6.20±1.05, 7.49±1.36, 6.84±1.09, 8.41±1.22) points, all lower than the reference group scores of (8.44±1.42, 9.11±1.54, 8.52±1.50, 10.50±1.59) points, with statistically significant differences (t=8.156, 5.075, 5.825, and 6.707, all P<0.001). The positive coping score of the research group was higher than that of the reference group [(27.44±3.60) points vs. (23.68±2.47) points], while the negative coping score was lower than that of the reference group [(10.77±2.05) points vs. (13.42±3.11) points], with statistically significant differences(t=5.560, and 4.572, all P<0.001). The general health status, social function, emotional function and physiological function scores of the health survey summary table of the study group were (86.21±9.33, 85.37±8.56, 83.74±8.86, 84.01±8.29) points, which were higher than those of the reference group (75.10±8.04, 74.25±7.03, 72.89±6.62, 73.15±7.06) points, the differences were statistically significant ( t=5.805, 6.459, 6.308,and 6.418, all P<0.001). The scores of the research group on the Daily Living Ability Scale were higher than those of the reference group [(60.30±7.22) points vs. (54.69±6.88) points], with statistically significant differences(t=3.626, P<0.001). Conclusions　Health education based on empowerment theory can significantly reduce the degree of pain in RA patients, and can improve coping style, quality of life and activities of daily living, which is worthy of promotion.

Analysis of the effect of the application of tripartite role-matching guided care model in patients with pulmonary tuberculosis 

Lin Zhaojun, Yang Yang, Gao Yu

2025, 31(9):  1574-1578.  DOI: 10.3760/cma.j.cn441417-20240924-09032

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Objective　To analyze the impact of the tripartite role-matching guided care model in patients with pulmonary tuberculosis (PTB). Methods　This study is prospective ,involving 142 patients with pulmonary tuberculosis admitted to the Shaanxi Tuberculosis Control Hospital from December 2022 to December 2023. Random sampling was used to divide the patients into a control group and an observation group, with 71 patients in each group. The control group consisted of 36 males and 35 females, the age was (49.68±6.21) years old, the course of disease was (1.30±0.46) months, receiving routine nursing care. The observation group included 39 males and 32 females, the age was (49.11±6.80) years old, the course of disease was (1.24±0.49) months, On the basis of the control group, the nursing mode was guided by the three-party role standard of nurses, patients and family members of patients. The nursing intervention period for both groups was 7 days. The emotional state, self-care ability, and quality of life of the patients were compared on the day of enrollment and after 7 days of intervention. Statistical methods included t tests and χ² tests. Results　Seven days after the intervention, the observation group scored lower than the control group on the Mood States Scale for tension, fatigue, anger, depression, panic, energy, and self-esteem [(11.11±2.11) points vs. (12.90±2.80) points, (7.77±2.29) points vs. (9.83±2.25) points, (13.89±1.67) points vs. (15.17±2.55) points, (10.76±2.52) points vs. (12.08±4.01) points, (8.96±2.55) points vs. (10.28±3.91) points, (9.89±2.72) points vs. (11.85±2.49) points, (12.89±2.87) points vs. (14.58±2.03) points], with all differences being statistically significant (t=4.302, 5.407, 3.538, 2.348, 2.383, 4.479, and 4.051, all P<0.05). The self-care ability scale scores for self-concept, sense of self-responsibility, self-care skills, and health knowledge level in the observation group were higher than those in the control group [(27.24±3.46) points vs. (25.93±4.32) points, (16.62±2.39) points vs. (15.24±2.02) points, (34.39±2.92) points vs. (32.08±2.47) points, (46.82±2.92) points vs. (45.30±2.86) points], with all differences being statistically significant (t=1.994, 3.716, 5.089, and 3.134, all P<0.05). The World Health Organization Quality of Life Assessment (WHOQOL-BREF) scores for physical health, psychological domain, social relationships, environmental domain, and overall quality of life in the observation group were higher than those in the control group [(22.13±2.08) points vs. (20.70±2.15) points, (25.48±1.47) points vs. (23.85±1.15) points, (8.72±1.04) points vs. (7.28±1.14) points, (30.17±3.79) points vs. (28.21±3.21) points, (7.30±1.16) points vs. (6.24±1.02) points], with all differences being statistically significant (t=4.028, 7.359, 7.863, 3.325, and 5.782, all P<0.05). Conclusion　In PTB patients, the application of tripartite role labeling guided care model can significantly improve their emotional state, effectively improve their self-care ability and quality of life, and holds significant potential for broader application.

Medical Education

Application of situational teaching based on Thorndike's law of learning combined with real-case-based test in teaching for nurses in NICU 

Chen Yu, Duanmu Yanyan, Liu Yanyan, Jiang Mingli

2025, 31(9):  1579-1584.  DOI: 10.3760/cma.j.cn441417-20240611-09033

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Objective　To explore the effects of the situational teaching method based on Thorndike's learning theory combined with real-case assessment training on the core competencies and teaching satisfaction of newly hired nurses in the Neonatal Intensive Care Unit (NICU). Methods　A prospective study was conducted involving newly hired nurses in the NICU at Henan Children's Hospital, Zhengzhou Children's Hospital, from January 2021 to December 2022. 51 nurses who joined the NICU from January to December 2021 were included in the control group, while 51 nurses who joined from January to December 2022 were included in the experimental group. The control group comprised 2 males and 49 females, the age was (20.14±1.03) years old. There were 20 nurses with a junior college education, 21 with a bachelor's degree, and 10 with a graduate degree, all receiving traditional teaching methods. The experimental group consisted of 1 male and 50 females, the age was (20.07±1.11) years old. This group included 18 nurses with a junior college education, 24 with a bachelor's degree, and 9 with a graduate degree, who received situational teaching methods based on Thorndike's learning theory combined with real-case assessment training. The teaching period for both groups was one month. Assessment scores (theoretical tests and practical operation tests), core competencies, psychological states, and teaching satisfaction were compared between the two groups. χ² test and t test were used for statistical analysis. Results　After the intervention, the theoretical and practical operation scores of the experimental group were higher than those of the control group [(81.52±8.66) points vs. (72.78±7.85) points , (82.11±8.36) points vs. (70.62±7.25) points], with statistically significant differences (t=5.340, 7.415, both P<0.001). The core competency assessment scores in the experimental group for assessment and intervention, communication, critical thinking, interpersonal skills, management, leadership, teaching, and comprehensive knowledge were (3.02±0.31, 4.02±0.43, 2.78±0.33, 4.68±0.31, 2.78±0.30, 2.81±0.29, 2.78±0.30, 3.54±0.36) points, compared to the control group scores of (2.25±0.29, 3.58±0.37, 2.11±0.23, 4.02±0.43, 2.21±0.23, 2.17±0.23, 2.31±0.24, 3.01±0.33) points, showing statistically significant differences (all P<0.05). In the experimental group, the scores on the burnout scale for personal accomplishment, depersonalization tendency, and emotional exhaustion were (40.11±4.42, 22.47±2.36, 47.89±5.32) points, while the control group scores were (32.14±3.56, 16.21±1.87, 42.18±4.52) points, with significant differences (t=10.029, 14.847, 5.841, all P<0.001). The overall teaching satisfaction rate in the experimental group was higher than that of the control group [98.04% (50/51) vs. 86.27% (44/51)] (χ²=4.883, P=0.027). Conclusion　The situational teaching method based on Thorndike's learning theory combined with real-case assessment training can improve the theoretical and practical operation levels, core competencies, and psychological states of newly hired nurses in the NICU, thereby enhancing teaching satisfaction.