Table of Content

01 June 2025, Volume 31 Issue 11

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Special Column of Cardiovascular Diseases

Relationships between Lp-PLA2, ET-1, NO levels and major adverse cardiovascular events in patients with acute myocardial infarction after intensive lipid-lowering therapy

Wang Xuewen, Li Guangping, Liu Xing, Yang Lei, Gao Yi, Xu Yanmin, Liu Tong

2025, 31(11):  1762-1769.  DOI: 10.3760/cma.j.cn441417-20241125-11001

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Objective　To investigate the relationships between lipoprotein-associated phospholipase A2 (Lp-PLA2), nitric oxide (NO), and endothelin-1 (ET-1) and major adverse cardiovascular events (MACE) in patients with acute ST-segment elevation myocardial infarction (STEMI) after intensive lipid-lowering therapy after percutaneous coronary intervention (PCI). Methods　A total of 130 STEMI patients who underwent PCI treatment at the Second Hospital of Tianjin Medical University from January 2020 to December 2022 were selected as the research subjects. There were 69 male patients and 61 female patients, aged 18-75 (65.16±5.04) years. All patients received intensive lipid-lowering therapy after PCI. After one-year follow-up, the patients were divided into a MACE group (52 cases) and a non-MACE group (78 cases) based on the occurrence of MACE. Compare the general data of the two groups as well as the levels of serum Lp-PLA2, ET-1, and NO. The levels of serum Lp-PLA2, NO, and ET-1 were examined using the main effect test. The relationship between vascular endothelial function (serum NO and ET-1 levels) and serum Lp-PLA2 levels 4 months after treatment was analyzed using the generalized additive model (GAM). A multivariate logistic regression analysis was conducted to examine the independent correlations between the levels of serum Lp-PLA2, NO, and ET-1 at 4 months after treatment and the occurrence of MACE. The dose-response relationship between serum Lp-PLA2 levels 4 months after treatment and MACE was analyzed using a restricted cubic spline model. Construct an mediation effect model to analyze the influence of serum Lp-PLA2 levels and vascular endothelial function 4 months after treatment on MACE. The log-binomial model was used to analyze the association between the serum Lp-PLA2 level 4 months after treatment and the subtypes of MACE. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　Three and four months after the treatment, the serum Lp-PLA2 levels in the MACE group were higher than those in the non-MACE group (both P<0.05). One month, two months, three months and four months after the treatment, the serum NO levels in the MACE group were all lower than those in the non-MACE group, while the serum ET-1 levels in the MACE group were all higher than those in the non-MACE group (all P<0.05). There were statistically significant differences in the time effects, group effects, and interaction effects of the levels of Lp-PLA2, NO, and ET-1 in the two groups (all P<0.05). The results of the GAM analysis showed that the effect of serum Lp-PLA2 levels 4 months after treatment on the serum NO and ET-1 levels of vascular endothelial function indicators presented a linear relationship. Among them, the negative effect of serum Lp-PLA2 levels on serum NO levels was statistically significant (F=3.618, P=0.011), and the positive effect on serum ET-1 levels was also statistically significant (F=4.205, P=0.007). The results of the multivariate logistic regression analysis showed that the levels of serum Lp-PLA2 (OR=1.334, 95%CI: 1.138-1.629), NO (OR=0.802, 95%CI: 0.723-0.867), and ET-1 (OR=1.877, 95%CI: 1.536-2.187) at 4 months after treatment were independently correlated with MACE (all P<0.05); compared with low serum Lp-PLA2, ET-1 levels and high serum NO levels, high serum Lp-PLA2, ET-1 levels, and low serum NO levels were independently correlated with MACE (all P<0.05). The association strength between the continuous changes in serum Lp-PLA2 levels 4 months after treatment and MACE showed a non-linear dose-response relationship(P<0.05). Serum Lp-PLA2 levels were positively correlated with MACE (P<0.05). The results of the mediation effect model analysis showed that the levels of serum NO and ET-1 played a partial mediating role between serum Lp-PLA2 levels and MACE. The mediating effects were 0.200 (z=11.065, P<0.001) and 0.178 (z=10.746, P<0.001) respectively, and the ratios of the mediating effect to the total effect were 23.84% and 21.26% respectively. The log-binomial analysis results showed that there was a statistically significant difference in the occurrence of MACE among patients with different serum Lp-PLA2 levels 4 months after treatment (P=0.042). Conclusion　The levels of Lp-PLA2 and ET-1 are positively correlated with MACE, and the level of NO is negatively correlated with MACE after intensive lipid-lowering therapy in STEMI patients after PCI.

The efficacy ofHuangqi ZongqiFormula in treating patients with coronary heart disease complicated with heart failure and its impact on vascular endothelial function

Liu Yi, Han Baohua, Zhang Yue

2025, 31(11):  1770-1774.  DOI: 10.3760/cma.j.cn441417-20250123-11002

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Objective　To explore the efficacy of the Huangqi Zongqi Formula in treating patients with coronary heart disease combined with heart failure and its impact on vascular endothelial function. Methods　A total of 98 patients with coronary heart disease and heart failure who were admitted to the Second Affiliated Hospital of Shaanxi University of Chinese Medicine from October 2021 to October 2024 were selected as the research subjects. The patients were divided into the traditional Chinese medicine group and the conventional group using the random number table method, with 49 cases in each group. There were 27 males and 22 females in the traditional Chinese medicine group, aged 45-81 (62.10±8.05) years, course of coronary heart disease 4-13(8.43±2.09) years, course of heart failure 1-5 (2.61±0.70) years, New York Heart Association (NYHA) classification: 13 cases at grade Ⅱ, 25 cases at grade Ⅲ, and 11 cases at grade Ⅳ. There were 25 males and 24 females in the conventional group, aged 44-82 (63.20±8.78) years, course of coronary heart disease 3-12 (8.08±1.96) years, course of heart failure 1-5 (2.67±0.66) years, NYHA classification: 15 cases at grade Ⅱ, 24 cases at grade Ⅲ, and 10 cases at grade Ⅳ. The conventional group received conventional Western medical treatment, while the traditional Chinese medicine group was treated with the Huangqi Zongqi Formula in addition to the treatment provided by the conventional group. Both groups were treated continuously for 8 weeks. Compare the clinical efficacy of the two groups; vascular endothelial function (endothelin-1, nitric oxide), cardiac function [left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), B-type natriuretic peptide (BNP)], heart failure symptoms (Lee's heart failure score), and quality of life [Minnesota heart failure quality of life questionnaire (MLHFQ)] before and after treatment. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　The total effective rate of the traditional Chinese medicine group was higher than that of the conventional group [91.84% (45/49) vs. 73.47% (36/49)] (P<0.05). After treatment, the level of endothelin-1 in the traditional Chinese medicine group was lower than that in the conventional group [(43.98±3.30) ng/L vs. (51.31±3.88) ng/L], and the level of nitric oxide was higher than that in the conventional group [(39.33±2.99) μmol/L vs. (35.15±1.37) μmol/L] (both P<0.05); the LVEF of the traditional Chinese medicine group was higher than that of the conventional group [(58.14±3.57)% vs. (55.06±4.43)%], while the LVESD, LVEDD and BNP levels were all lower in the traditional Chinese medicine group [(46.41±3.96) mm vs. (49.57±2.32) mm, (46.61±3.03) mm vs. (52.92±3.25) mm, (454.36±90.21) ng/L vs. (506.58±76.30) ng/L] (all P<0.05); the Lee's heart failure score and the MLHFQ score in the traditional Chinese medicine group were both lower than those in the conventional group [(7.47±1.60) points vs. (9.29±1.44) points, (38.12±4.60) points vs. (45.27±4.71) points] (both P<0.05). Conclusion　The Huangqi Zongqi Formula combined with other treatments for coronary heart disease complicated with heart failure has a better therapeutic effect. It can improve vascular endothelial function, cardiac function and symptoms of heart failure, and enhance the quality of life.

The value of the uric acid/high-density lipoprotein cholesterol ratio in predicting major cardiovascular adverse events in elderly patients with chronic heart failure 

Hu Renyue, Cao Xiaomei, Xia Xueyan

2025, 31(11):  1775-1779.  DOI: 10.3760/cma.j.cn441417-20250123-11003

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Objective　To explore the value of the uric acid/high-density lipoprotein cholesterol ratio (UHR) in predicting major adverse cardiovascular events (MACE) in elderly patients with chronic heart failure (CHF). Methods　A total of 96 elderly patients with CHF who were admitted to Yantai Laiyang Central Hospital from January 2021 to December 2023 were selected as the study subjects. There were 57 males and 39 females, with ages ranging from 60 to 80 (70.46±8.25) years old. All patients were followed up for one year after discharge. Based on the occurrence of MACE, the patients were divided into the MACE group (27 cases) and the non-MACE group (69 cases). Collect the clinical data of the patients at the time of admission, including age, body mass index, gender, coexisting diseases (hypertension, coronary heart disease, cardiomyopathy, valvular disease), total cholesterol (TC), triglycerides (TG), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), smoking history, drinking history, uric acid (UA), high-density lipoprotein cholesterol (HDL-C), and UHR. Using binary logistic regression analysis, the influencing factors for the occurrence of MACE in elderly patients with CHF were investigated. The predictive efficacy of the receiver operating characteristic curve (ROC) was used to analyze the occurrence of MACE in elderly patients with CHF. Independent sample t test, and χ² test were used for statistical analysis. Results　A total of 96 elderly patients with CHF were included in this study. They were followed up for one year after discharge, and a total of 27 cases developed MACE. The LVEDD and LVESD in the MACE group were longer than those in the non-MACE group [(65.21±8.34) mm vs. (48.57±8.63) mm, (64.97±5.74) mm vs. (48.02±5.28) mm], and the LVEF was lower in the MACE group [(40.83±5.12)% vs. (46.29±6.45)%] (all P<0.05). The levels of UA and UHR in the MACE group were higher than those in the non-MACE group [(467.12±84.08) μmol/L vs. (409.86±73.75) μmol/L, 657.92±118.43 vs. 333.22±66.65], while the level of HDL-C was lower in the MACE group [(0.71±0.13) mmol/L vs. (1.23±0.21) mmol/L] (all P<0.05). The results of the binary logistic regression analysis showed that high UA levels (OR=2.109, 95%CI 1.109-4.010), low HDL-C levels (OR=0.438, 95%CI 0.254-0.756), and high UHR (OR=10.549, 95%CI 3.123-35.629) were all independent risk factors for the occurrence of MACE (all P<0.05). The ROC results showed that the area under the curve (95%CI) of UHR in predicting the occurrence of MACE in elderly patients with CHF was 0.904 (0.859-0.954), the cut-off value was 469.68, the specificity was 86.71%, and the sensitivity was 85.48%. Conclusion　UHR is closely related to MACE in elderly patients with CHF and is expected to become a biomarker for predicting the occurrence of MACE in elderly patients with CHF.

Correlations between inflammation index, blood lipid index and severity of coronary artery disease in patients with acute coronary syndrome

Xu Ling, Wu Hongyan, Xu Yao, Yin Delu

2025, 31(11):  1780-1784.  DOI: 10.3760/cma.j.cn441417-20241230-11004

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Objective　To investigate the correlations between inflammation index (SII), blood lipid index and the severity of coronary artery disease in patients with acute coronary syndrome (ACS). Methods　A total of 100 patients with ACS who were admitted to the First People's Hospital of Lianyungang from March 2021 to March 2024 were selected as the research subjects. There were 58 males and 42 females; aged 38-82 (62.50±10.81) years; body mass index 18.20-32.60 (25.31±3.52) kg/m². According to the number of affected blood vessels, the patients were divided into the single-vessel disease group (25 cases) and the multiple-vessel disease group (75 cases). According to the Gensini score, the patients were divided into the mild disease group (32 cases) and the moderate and severe disease group (68 cases). Compare the SII and lipid indicators[total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C)] between the single-vessel disease group and the multi-vessel disease group, as well as between the mild disease group and the moderate and severe disease group. The Spearman rank correlation analysis method was used to analyze the correlation between the changes in SII and blood lipid index in ACS patients and the severity of coronary artery lesions. Independent sample t test was used for statistical analysis. Results　The levels of TC, TG, LDL-C and SII in the multi-vessel disease group were all higher than those in the single-vessel disease group, while the level of HDL-C was lower than that in the single-vessel disease group (all P<0.05). The levels of TC, TG, LDL-C and SII in the moderate and severe disease group were all higher than those in the mild disease group, while the level of HDL-C was lower than that in the mild disease group (all P<0.05). The Spearman rank correlation analysis results showed that the levels of  TC, TG, LDL-C and SII were positively correlated with the severity of coronary artery lesions, while the level of HDL-C was negatively correlated with the severity of coronary artery lesions(r=0.272, 0.450, 0.484, 0.374, and -0.479, all P<0.05). Conclusion　The elevated SII level and lipid metabolism disorders in ACS patients are closely related to the severity of coronary artery lesions. The detection of these indicators is helpful for assessing the patient's condition and formulating treatment plans

Expressions and clinical significance of serum TSP-1 and Apela levels in patients with chronic heart failure secondary to coronary atherosclerotic heart disease 

Liu Xinyu, Shi Yongpeng, Gao Yuan

2025, 31(11):  1784-1790.  DOI: 10.3760/cma.j.cn441417-20241014-11005

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Objective　To detect the expressions of serum thrombospondin-1 (TSP-1) and Apela in patients with coronary atherosclerotic heart disease (CHD) and chronic heart failure (CHF), and to analyze their clinical significance. Methods　129 patients with CHD combined with CHF who were admitted to the First Affiliated Hospital of Xi'an Jiaotong University from January 2023 to January 2024 were selected and included in the CHD+CHF group; 129 patients with only CHD without CHF who were admitted during the same period were selected and included in the CHD group; 129 healthy subjects who underwent physical examinations during the same period were selected and included in the healthy group. There were 65 males and 64 females in the CHD+CHF group, aged 54-78 (66.38±9.10) years, body mass index (BMI) 18.09-32.16 (23.47±2.97) kg/m². There were 68 males and 61 females in the CHD group, aged 56-76 (67.41±8.67) years, BMI 18.17-31.15 (23.39±3.06) kg/m². There were 63 males and 66 females in the healthy group, aged 54-76 (66.95±8.96) years, BMI 18.23-30.96 (23.34±3.11) kg/m². Compare the levels of serum TSP-1 and Apela in 387 subjects; compare the levels of serum TSP-1 and Apela in patients with CHD combined with CHF of different New York Heart Association (NYHA) cardiac function grades; use Pearson correlation analysis method to analyze the correlation between serum TSP-1 and Apela levels and the cardiac function indicators of patients with CHD combined with CHF; follow-up and statistically analyze the prognosis of patients with CHD combined with CHF, divide them into the poor prognosis group (28 cases) and the good prognosis group (91 cases), compare the general data and serum TSP-1 and Apela levels of the two groups; use multivariate logistic regression analysis to analyze the influencing factors of poor prognosis in patients with CHD combined with CHF. Independent sample t test, analysis of variance, LSD-t test, Mann-Whitney U test, and χ² test were used for statistical analysis. Results　The serum TSP-1 levels in the CHD group and the CHD+CHF group were both higher than those in the healthy group, while the serum Apela levels were both lower than those in the healthy group (all P<0.05); the serum TSP-1 level in the CHD+CHF group was higher than that in the CHD group, while the serum Apela level was lower than that in the CHD group (both P<0.05). The serum TSP-1 levels of patients with grades Ⅲ and grade Ⅳ CHD combined with CHF were higher than those of patients with grade Ⅱ, and the serum Apela levels were lower than those of patients with grade Ⅱ (all P<0.05); the serum TSP-1 level of patients with grade Ⅳ CHD combined with CHF was higher than that of patients with grade Ⅲ, while the serum Apela level was lower than that of patients with grade Ⅲ (both P<0.05). The Pearson correlation analysis showed that the serum TSP-1 level was positively correlated with the left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV) in patients with CHD combined with CHF, and negatively correlated with the left ventricular ejection fraction (LVEF) (all P<0.05). The follow-up period was 6 to 18 months, with a median follow-up time of 12 months. Among the 129 patients with CHD and CHF, 10 were lost to follow-up, leaving 119 patients. Among them, 28 had a poor prognosis (23.53%). The poor prognosis group had higher proportions of smoking, more than 3 diseased blood vessels, irregular medication outside the hospital, as well as higher serum TSP-1 level and Gensini score compared to the good prognosis group [46.43% (13/28) vs. 24.18% (22/91), 32.14% (9/28) vs. 13.19% (12/91), 25.00% (7/28) vs. 9.89% (9/91), (9.14±2.16) μg/L vs. (7.47±2.02) μg/L, 45 (31,62) points vs. 41 (26,58) points](all P<0.05). The serum Apela level was lower in the poor prognosis group than in the good prognosis group [(2.65±0.68) μg/L vs. (3.48±0.54) μg/L](P<0.05). The results of multivariate logistic regression analysis showed that smoking (OR=1.687, 95%CI 1.007-2.826), high Gensini score (OR=1.864, 95%CI 1.200-2.894), high serum TSP-1 level (OR=2.087, 95%CI 1.209-3.602), and irregular medication outside the hospital (OR=1.830, 95%CI 1.268-2.641) were all independent risk factors for poor prognosis, while high serum Apela level (OR=0.556, 95%CI 0.369-0.837) was an independent protective factor (all P<0.05). Conclusion　The serum levels of TSP-1 and Apela in patients with CHD combined with CHF are closely related to cardiac function, and both are influencing factors for the prognosis of patients with CHD combined with CHF.

Analysis of the effects of Di'ao Xinxuekang Capsules combined with diltiazem on clinical symptoms and serum cytokine levels in patients with angina pectoris of coronary heart disease 

Jin Xingshan, Yang Li

2025, 31(11):  1791-1795.  DOI: 10.3760/cma.j.cn441417-20241128-11006

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Objective　To analyze the efficacy of Di'ao Xinxuekang Capsules combined with diltiazem in the treatment of angina pectoris of coronary heart disease. Methods　A total of 96 patients with angina pectoris of coronary heart disease who were admitted to the First People's Hospital of Zhumadian from March 2022 to July 2024 were selected as the study subjects. According to the treatment plan, the patients were divided into the control group (49 cases) and the study group (47 cases). There were 20 males and 29 females in the control group, aged 54-70 (61.97±3.35) years, course of the disease 5-15 (10.24±1.96) months. There were 19 males and 28 females in the study group, aged 53-70 (62.08±3.46) years, course of the disease 5-16 (10.31±1.89) months. The control group was treated with diltiazem, while the study group was treated with Di'ao Xinxuekang capsules in addition to the treatment of the control group. Both groups received continuous treatment for 3 months. Compare the therapeutic effects and adverse reactions of the two groups, as well as the clinical symptoms (frequency and duration of angina pectoris attacks), cardiac function [left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD)], and levels of serum-related cytokines [serum N-terminal pro-B-type natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), high-sensitivity C-reactive protein (hs-CRP) levels, and the ratio of neutrophils to lymphocytes (NLR)] before and after treatment. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　The total effective rate of the study group was higher than that of the control group [95.75% (45/47) vs. 77.55% (38/49)] (P<0.05). After treatment, the frequency of angina pectoris attacks in the study group was lower than that in the control group [(2.30±0.49) times/week vs. (3.22±0.51) times/week], and the duration was shorter than that in the control group [(3.22±0.71) min/time vs. (4.61±0.85) min/time] (both P<0.05); the LVEF of the study group was higher than that of the control group [(48.02±0.61)% vs. (45.91±0.52)%], and the LVESD was lower than that of the control group [(40.15±2.98) mm vs. (44.05±3.07) mm] (both P<0.05); the levels of serum NT-proBNP, cTnI, hs-CRP and NLR in the study group were all lower than those in the control group [(246.51±29.52) ng/L vs. (378.54±31.74) ng/L, (0.20±0.04) μg/L vs. (0.39±0.05) μg/L, (3.05±0.74) mg/L vs. (4.65±0.92) mg/L, 1.98±0.35 vs. 2.61±0.39] (all P<0.05). The comparison of the total incidence rates of adverse reactions between the two groups showed no statistically significant difference (P>0.05). Conclusion　The combination of Di'ao Xinxuekang Capsules and diltiazem is effective in treating angina pectoris of coronary heart disease. It can inhibit the occurrence of angina pectoris, reduce inflammatory responses, improve cardiac function, and alleviate the degree of myocardial damage. It also has good safety.

Application of "Internet +" exercise rehabilitation nursing in patients with chronic heart failure 

Ye Xiaohui, Han Jintao, Wang Mairui

2025, 31(11):  1796-1800.  DOI: 10.3760/cma.j.cn441417-20241121-11007

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Objective　To explore the application value of "Internet +" exercise rehabilitation nursing in patients with chronic heart failure (CHF). Methods　A total of 78 patients with CHF who were admitted to the Seventh People's Hospital of Zhengzhou from May 2022 to May 2024 were selected as the research subjects. According to the nursing methods, the patients were divided into the control group (39 cases) and the observation group (39 cases). There were 22 males and 17 females in the control group, aged 50-68 (61.94±2.25) years, course of the disease 2-16 (9.94±3.63) years, cardiac function classification: 10 cases at grade Ⅰ, 15 cases at grade Ⅱ, and 14 cases at grade Ⅲ. There were 23 males and 16 females in the observation group, aged 52-70 (61.98±2.22) years, course of the disease 1-17 (9.52±3.82) years, cardiac function classification: 12 cases at grade Ⅰ, 16 cases at grade Ⅱ, and 11 cases at grade Ⅲ. The control group took routine nursing, the observation group took "Internet +" exercise rehabilitation nursing, both groups were continuously nursing observation for 12 weeks. Compare the two groups in terms of exercise compliance (the self-developed exercise compliance questionnaire of the 7th People's Hospital of Zhengzhou), 6 min walking distance, cardiac function [left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF)], quality of life [Minnesota living with heart failure questionnaire (MLHFQ)], and nursing satisfaction (Newcastle satisfaction with nursing scale). Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　After the nursing intervention, the scores of each dimension (timely exercise, exercise frequency, exercise duration) in the exercise compliance questionnaire of the observation group were all higher than those of the control group [(85.53±3.62) points vs. (79.98±3.54) points, (86.26±4.24) points vs. (78.86±3.93) points, (85.57±2.64) points vs. (79.69±2.53) points] (all P<0.05); The 6 min walking distance of the observation group was longer than that of the control group [(546.63±20.94) m vs. (489.75±20.56) m] (P<0.05); the LVEDD and LVESD values in the observation group were lower than those in the control group, while the LVEF was higher than that in the control group (all P<0.05); the scores of each dimension (emotional domain, physical domain, and other domains) of the MLHFQ in the observation group were all lower than those in the control group [(9.39±1.18) points vs. (12.54±1.22) points, (19.89±2.26) points vs. (22.35±2.28) points, (15.54±1.35) points vs. (19.93±1.76) points] (all P<0.05); the overall satisfaction rate of nursing in the observation group was higher than that in the control group [94.87% (37/39) vs. 79.49% (31/39)] (P<0.05). Conclusion　Exercise rehabilitation nursing based on "Internet +" can enhance the exercise compliance of patients with CHF, increase exercise endurance, promote the recovery of cardiac function, improve the quality of life, and increase the satisfaction of nursing.

Effect of multimodal digital health education on life control in patients with atrial fibrillation during the "gap period" after radiofrequency ablation 

Du Yingying, Zhang Lijun, Sun Junhua, Li Jiangbo

2025, 31(11):  1801-1805.  DOI: 10.3760/cma.j.cn441417-20241024-11008

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Objective　To study the effect of multimodal digital health education on life control in patients with atrial fibrillation during the "gap period" after radiofrequency ablation. Methods　Eighty patients who underwent atrial fibrillation surgery and were admitted to Luoyang Central Hospital from January 2022 to October 2023 were selected as the research subjects. Using the random number table method, the patients were divided into the conventional group (40 cases) and the research group (40 cases). There were 20 males and 20 females in the conventional group, aged 32-68 (48.45±6.83) years, course of the disease 3-13 (7.95±2.43) months. There were 22 males and 18 females in the research group, aged 33-69 (49.33±7.30) years, course of the disease 3-14 (8.23±2.57) months. The conventional group received conventional health education intervention, while the research group received multimodal digital health education intervention. Both groups were subjected to continuous intervention for 12 weeks. Compare the levels of motion fear [tampa scale for kinesiophobia heart (TSK-SV Heart)], sleep quality [pittsburgh sleep quality index (PSQI)], self-management ability [adult health self-management scale (AHSMSRS)], and life control sense [personal mastery scale (PMS)] between the two groups. Independent sample t test, and paired t test were used for statistical analysis. Results　After the intervention, the scores of each dimension (danger perception, fear of exercise, avoidance of exercise, functional disorder) in the TSK-SV Heart of the research group were all lower than those of the conventional group [(6.45±1.57) points vs. (7.31±1.88) points, (7.12±1.38) points vs. (8.94±1.95) points, (6.55±1.27) points vs. (8.12±1.48) points, (6.05±1.22) points vs. (7.84±1.35) points] (all P<0.05); the scores of each dimension (sleep disorders, daytime function, sleep efficiency, hypnotic drugs, sleep onset time, sleep duration, sleep quality) in the research group were all lower than those in the conventional group (all P<0.05); the scores of each dimension (self-management environment, health self-management cognition, health self-management behavior) in the AHSMSRS of the research group were all higher than those of the conventional group [(35.71±4.83) points vs. (32.75±5.22) points, (46.62±4.90) points vs. (43.52±4.51) points, (45.71±4.53) points vs. (42.75±4.42) points] (all P<0.05); the PMS score of the research group was higher than that of the control group [(28.31±3.53) points vs. (24.75±3.22) points] (P<0.05). Conclusion　Multimodal digital health education can effectively enhance the self-management ability of patients with atrial fibrillation during the "gap period" after radiofrequency ablation, improve sleep quality, alleviate exercise fear, and enhance the sense of life control.

Application progress of left atrial and right ventricular strains in cardiovascular diseases 

Wu Jianbo, Liu Qian

2025, 31(11):  1806-1811.  DOI: 10.3760/cma.j.cn441417-20250113-11009

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 Left atrium (LA) and right ventricle (RV) function are closely related to the occurrence, development and prognosis of cardiovascular diseases. With the continuous development of ultrasound instruments and software, ultrasound imaging technology has gradually matured. The cardiac magnetic resonance feature tracking (CMR-FT) and speckle tracking echocardiography (STE) can perform non-invasive comprehensive analysis of LA and RV myocardial strains in a variety of cardiovascular diseases. It can improve the single limitations in measuring the volumes and structures of the LA and RV, and provide early reflection of the cardiac function disorders and prognosis of the LA and RV. This article reviews the application progress of STE and CMR-FT in evaluating the early structural and functional changes, risk stratification, and prognosis assessment of LA and RV strain in various cardiovascular diseases, providing a basis for further exploration of the application of LA and RV strain in cardiovascular diseases.

Research progress of P13K/AKT/KDM5A pathway in atrial fibrillation 

Zhao Ke, Liu Zhenxing, Shi Dayu, Xu Huipu

2025, 31(11):  1812-1815.  DOI: 10.3760/cma.j.cn441417-20250106-11010

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Cardiac remodeling is the pathological manifestation in the end stages of diseases such as hypertension, myocardial infarction, and heart failure, with myocardial fibrosis being a core component. Numerous studies have confirmed that atrial remodeling is one of the important mechanisms that trigger atrial fibrillation. Among these, the phosphatidylinositol 3-kinase (PI3K)/Serine/Threonine kinase (Akt) signaling pathway regulates the progression of myocardial fibrosis and is closely related to atrial remodeling. However, research on how lysine-specific demethylase 5A (KDM5A) regulates the occurrence of myocardial fibrosis is still in its early stages. Further investigation into the mechanisms of KDM5A in myocardial fibrosis may become one of the effective strategies for treating atrial fibrillation in the future.

Research progress of circRNA in heart failure

Ji Zenghui, Qu Fuzheng, Han Jiaqi, Zhang Juan, Yu Yangsheng, Cheng Haoran

2025, 31(11):  1816-1819.  DOI: 10.3760/cma.j.cn441417-20241212-11011

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Heart failure is an increasingly serious public health issue and represents the end stage of many cardiovascular diseases. Despite the widespread adoption of evidence-based medications and mechanical circulatory support, an unacceptable number of patients continue to suffer from functional impairment, poor quality of life, and early mortality due to heart failure. Circular RNA (circRNA) is a novel class of endogenous non-coding RNA that has been shown in recent studies to be closely associated with the diagnosis of heart failure, the formation of coronary atherosclerotic plaques, and the development of myocardial infarction and heart failure. This paper reviews the role and mechanisms of circRNA structure in heart failure, providing new insights for the diagnosis and treatment of heart failure.

New Medical Advances

Research progress on the application of nasal high flow oxygen therapy combined with pulmonary rehabilitation training in the treatment of pulmonary tuberculosis with respiratory failure 

Luo Meiyi, Yu Chaoxian, Li Hongxia, Huang Su

2025, 31(11):  1820-1825.  DOI: 10.3760/cma.j.cn441417-20241101-11012

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High-flow nasal cannula oxygen therapy (HFNC) has shown potential in the treatment of pulmonary tuberculosis complicated by respiratory failure. HFNC can provide a stable oxygen concentration and high-flow gas, which helps improve the patient's oxygenation index and reduce respiratory rate, while also decreasing dead space and increasing alveolar ventilation. Additionally, the combination of HFNC and pulmonary rehabilitation training can better enhance respiratory function and prognosis in patients. This paper reviews the physiological and pathological characteristics of pulmonary tuberculosis complicated by respiratory failure, the mechanisms and methods of HFNC and pulmonary rehabilitation, and the application effects and limitations of HFNC combined with pulmonary rehabilitation in patients with this condition, aiming to provide a reference for clinical nursing.

Meta Analysis

Meta-analysis of the efficacy of Kuanxiong Lifei decoction with western medicine in AECOPD 

Kou Yule, Li Xiangwen, Tan Xishu, Lyu Changrui

2025, 31(11):  1826-1834.  DOI: 10.3760/cma.j.cn441417-20240923-11013

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Objective　To perform a meta-analysis to systematically evaluate the clinical efficacy and safety of Kuanxiong Lifei decoction combined with conventional western medicine in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), providing evidence-based medical support for traditional Chinese medicine (TCM) treatment of AECOPD. Methods　Randomized controlled trials on the treatment of AECOPD with Kuanxiong Lifei decoction combined with western medicine were retrieved from databases including CNKI, VIP Chinese Science and Technology Journal Database, Wanfang Database, China Biomedical Literature Database, PubMed, The Cochrane Library, and Web of Science, with the search period limited from database inception to July 23, 2024. Meta-analysis was conducted using Review Manager 5.4 and Stata 18.0. Results　A total of 14 studies involving 1,217 participants were included, with 611 in the observation group and 606 in the control group. The meta-analysis results showed that the clinical effective rate in the observation group was higher than that in the control group [relative risk (RR)=1.18 (1.08, 1.29)], as were FEV1/FVC [mean difference (MD)=5.64 (3.84, 7.44)], FEV1/Pred% [MD=5.14 (3.96, 6.31)], FEV1 [MD=0.26 (0.16, 0.36)], PO₂ [MD=6.25 (4.94, 7.55)], and quality of life scores [MD=7.12 (4.76, 9.48)], all showing statistically significant differences (all P<0.05). The incidence of adverse reactions in the observation group was higher than that in the control group [RR=1.50 (0.27, 8.34)], but the difference was not statistically significant (P>0.05). The TCM syndrome scores after treatment in the observation group [MD=-2.44 (-2.81 ,-2.07)], PCO₂ [MD=-6.09 (-7.89, -4.28)], CRP [MD=-2.21 (-2.48, -1.94)], WBC [MD=-1.40 (-2.24, -0.56)], IL-6 [MD=-1.21 (-2.31, -0.11)], and TNF-α [MD=-1.87 (-3.29, -0.45)] were all lower than those in the control group, with statistically significant differences (all P<0.05). The N% after treatment in the observation group was lower than in the control group [MD=-2.01 (-5.30, 1.27)], but the difference was not statistically significant (P>0.05). The results of subgroup analysis showed that there was no significant difference in clinical effective rate, TCM syndrome score and FEV1/FVC between AECOPD patients with phlegm turbidity obstructing lung syndrome and phlegm heat obstructing lung syndrome after treatment (all P>0.05). Conclusion　The combination of Kuanxiong Lifei decoction and conventional western therapy is more effective for AECOPD, improving lung function, inflammatory markers, and quality of life, and is applicable to patients with phlegm obstructing lung syndrome and phlegm heat obstructing lung syndrome.

Treatises

Analysis of sensory integration ability and behavior in children with autism spectrum disorder with enuresis

Huang Jiahui, Li Shuidi, Zhou Dalong, Zeng Liuyuan, Huang Wenmin, Zhang Yina, Zhang Pengcheng

2025, 31(11):  1835-1838.  DOI: 10.3760/cma.j.cn441417-20240926-11014

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Objective　To explore the relationship between sensory integration abilities and behavior in children with autism spectrum disorder (ASD) who have comorbid enuresis. Methods　This study was a cross-sectional analysis. Using purposive sampling, 72 children with ASD hospitalized within 2 weeks at the Rehabilitation Department of Guangdong Women and Children Hospital were consecutively selected from March to September 2023. They were divided into a non-comorbid group (43 cases) and a comorbid group (29 cases) based on the presence of enuresis. Among the 72 ASD children, there were 59 males and 13 females, with ages of 4, 5, 6, and 8 years accounting for 40, 20, 11, and 1 case, respectively. The sensory integration assessment scale and autism behavior assessment scale scores were analyzed and compared between the two groups. Statistical analysis was conducted using Fisher's exact probability method and t tests. Results　There were no statistically significant differences in age and gender between the two groups of ASD children aged 4 to 6 years (P>0.05). The comorbid group had lower scores on the vestibular sense subscale of the sensory integration scale compared to the non-comorbid group, and higher scores on the self-care ability subscale of the autism behavior assessment scale [(43.21±5.93) points vs. (48.33±5.78) points, (9.66±4.70) points vs. (7.35±4.50) points], with statistically significant differences (t=3.647, -2.096, both P<0.05). Conclusion　Children with autism spectrum disorder and comorbid enuresis exhibit more severe vestibular dysfunction and poorer self-care abilities. Sensory integration training combined with life skills intervention may improve their prognosis. 

The impact of EIT and ARDSnet titration PEEP method on the short-term prognosis of moderate to severe ARDS

Wang Xudong, Zhang Xiangcheng, Sun Yanhu, Liu Yawen, Liu Yan, Shi Weitao, Wu Suming, Li Yue, Wang Runzhu, Zhang Jing

2025, 31(11):  1838-1844.  DOI: 10.3760/cma.j.cn441417-20241017-11015

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Objective　To investigate the impact of electrical impedance tomography (EIT) and the ARDSnet titration method for positive end-expiratory pressure (PEEP) on the short-term prognosis of moderate to severe acute respiratory distress syndrome (ARDS). Method　This study was a prospective investigation. A total of 100 patients with severe ARDS admitted to Xuzhou First People's Hospital from January 2022 to December 2023 were selected as study subjects. Patients were randomly assigned to the EIT group and the ARDSnet group using a computer-generated random number table, with 50 cases in each group. The EIT group included 30 males and 20 females, with an average age of (55.62±8.45) years and a body mass index (BMI) of (26.51±3.64) kg/m². The ARDSnet group included 28 males and 22 females, with an average age of (55.93±8.61) years and a BMI of (27.06±3.73) kg/m². Both groups received continuous invasive mechanical ventilation. The ARDSnet group set the PEEP value according to the oxygenation methods recommended by ARDSnet, aiming to maintain oxygen saturation (SpO₂) between 88%-95% and arterial oxygen partial pressure (PaO₂) between 55-80 mmHg. The EIT group underwent EIT measurements during the supine PEEP titration process, with EIT data recorded. Starting from an initial pressure of 5 cmH₂O, PEEP was gradually increased using an incremental method, raising it by 2 cmH₂O every 2 minutes until a plateau pressure of 30 cmH₂O was reached, ensuring it did not exceed this upper limit. Compare the levels of hemodynamics, pulmonary edema, arterial blood gas analysis, respiratory mechanics parameters, and treatment efficacy between two groups treated for 12 hours and on days 1, 2, 3, and 5. Statistical analysis was performed using χ² tests and t tests. Result　On day 5, the heart rate in the EIT group was lower, while the mean arterial pressure on days 3 and 5, and cardiac index, arterial oxygen partial pressure, oxygenation index, tidal volume, and compliance on days 2, 3, and 5 were higher than those in the ARDSnet group. At all-time points, extravascular lung water and the permeability index, flow rate, peak airway pressure, plateau airway pressure, transpulmonary pressure, and driving pressure on days 2, 3, and 5 were lower in the EIT group compared to the ARDSnet group, with statistically significant differences for all intergroup comparisons, time points, and interactions (all P<0.05). The 28-day mortality rate in the EIT group was 20.0% (10/50), while in the ARDSnet group it was 38.0% (19/50), with a statistically significant difference (χ²=3.934, P=0.047). The duration of invasive mechanical ventilation and the length of stay in the intensive care unit (ICU) were both shorter in the EIT group compared to the ARDSnet group [(14.25±5.63) d vs. (16.83±6.41) d, (21.52±8.76) d vs. (25.39±9.26) d], with statistically significant differences (all P<0.05). Conclusion　Severe ARDS patients are treated with EIT therapy, which effectively reduces mortality, shortens mechanical ventilation time, and ICU stay by improving lung compliance, reducing airway resistance, optimizing ventilation strategies, and implementing fine fluid management.

The effect of modified Guizhi Gancao decoction on the induction of cardiomyocyte pyroptosis by osimertinib in EGFR mutant NSCLC patients

Long Huidong, Guo Ruoyue, Zhou Jinyu, Lin Yunen, Chen Hanrui

2025, 31(11):  1845-1849.  DOI: 10.3760/cma.j.cn441417-20241010-11016

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Objective　This study aims to assess the intervention effects of modified Guizhi Gancao decoction on cardiomyocyte pyroptosis induced by osimertinib treatment in patients with epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer (NSCLC). Methods　This is a case-control study. Selecting 100 patients with advanced EGFR mutant NSCLC admitted to the Affiliated Cancer Hospital of Guangzhou Medical University from January 2019 to January 2022, the patients were divided into a control group and a traditional Chinese medicine group based on whether they were treated with modified Guizhi Gancao decoction in combination, with 50 patients in each group. There were 13 males and 37 females in the control group, aged (69.16 ± 4.61) years, who were orally administered 80 mg of Axitinib Mesylate tablets once daily. There were 12 males and 38 females in the traditional Chinese medicine group, with an age of (69.02 ± 4.13) years, receiving osimertinib combined with modified Guizhi Gancao decoction. The modified Guizhi Gancao decoction was administered once daily in two doses (morning and evening), with each treatment cycle lasting 21 days. Both groups underwent treatment for 3 months. The cardiac function indicators and serum pyroptosis-related protein levels before and after treatment were compared between the two groups to evaluate the effects of TCM intervention. Statistical analysis was performed using χ² tests and t tests. Results　After treatment, the E/A ratio in the TCM group was higher than that in the control group [(1.13±0.49) points vs. (0.84±0.25) points], with a statistically significant difference (t=3.728, P<0.001). The serum levels of Caspase-1, interleukin-1β (IL-1β), and IL-18 in the TCM group were lower than those in the control group [(52.67±6.02) pg/L vs. (60.75±6.05) pg/L, (42.35±2.43) pg/L vs. (58.55±3.01) pg/L, (37.22±3.32) ng/L vs. (50.44±4.11) ng/L], with statistically significant differences (t=6.694, 29.611, 17.693, P<0.001). There were no statistically significant differences in recent efficacy between the two groups (all P>0.05). Conclusion　The combination of osimertinib and modified Guizhi Gancao decoction in treating EGFR mutant NSCLC patients effectively reduces the pyroptosis response induced by osimertinib, improves cardiac function, enhances the tolerance to targeted therapy, and improves prognosis.

Etiological investigation and risk prediction of multidrug resistant organism infection in NICU neonates 

Zhang Suhong, Ren Hongjuan, Wang Weihua, Li Ting, Lyu Juying

2025, 31(11):  1850-1858.  DOI: 10.3760/cma.j.cn441417-20250208-11017

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Objective　To investigate the microbiological characteristics of multidrug-resistant organism (MDRO) infections in the Neonatal Intensive Care Unit (NICU) and to explore a risk prediction scheme for MDRO infections in NICU neonates. Methods　A retrospective analysis was conducted on the clinical data of 387 neonates with infections admitted to the NICU of Xianyang First People's Hospital from March 2020 to September 2024. The microbiological status of MDRO infections was analyzed, and the cases were divided into a modeling group (258 cases) and a validation group (129 cases) in a 2:1 ratio. The modeling group included 156 males and 102 females, with 65 cases born at a gestational age of <37 weeks and 193 cases born at ≥37 weeks; the validation group included 82 males and 47 females, with 36 cases born at <37 weeks and 93 cases born at ≥37 weeks. The modeling group was further divided into an MDRO infection group (83 cases) and a non-MDRO infection group (175 cases). Factors influencing MDRO infections in NICU neonates were analyzed, and a nomogram risk prediction model was constructed based on these factors. The model was validated using the Bootstrap method, and calibration curves and receiver operating characteristic (ROC) curves were plotted to evaluate the model's calibration and predictive performance, along with decision curves to assess the clinical net benefit of the model. Statistical analysis was performed using χ² tests and t tests. Results　The MDRO infection rate in NICU newborns was 32.56% (126/387). A total of 187 MDRO strains were detected in 126 newborns with MDRO infection, of which Gram-negative bacteria accounted for 68.45% (128/187), Gram-positive bacteria accounted for 31.55% (59/187). The resistance rates of Escherichia coli and Klebsiella pneumoniae to ceftriaxone were the highest, which were 77.14% and 82.35%, respectively, and the resistance rate to meropenem was the lowest, which was 0.00%. The resistance rates of Staphylococcus aureus and Staphylococcus haemolyticus to penicillin were the highest, which were 100.00% and 95.00%, respectively, and the resistance rate to vancomycin was the lowest, which was 0.00%. There was no statistically significant difference in clinical data between the modeling group and the verification group (all P>0.05). Risk factors for MDRO infections in NICU neonates included maternal antibiotic use within one week prior to delivery, gestational age <37 weeks, birth weight <2,500 g, hypoalbuminemia, invasive mechanical ventilation, use of three or more types of antimicrobial agents, and duration of antimicrobial use ≥7 days (all P<0.05). Based on the above influencing factors, the nomogram model was constructed. The consistency index of the nomogram model in the modeling group and the verification group was 0.853 and 0.841, respectively, with good fit between the calibration curves and the ideal curve. ROC analysis revealed area under the curve (AUC) values for predicting MDRO infections in NICU neonates of 0.893 (95% confidence interval 0.851-0.947) for the modeling group and 0.865 (95% confidence interval 0.795-0.936) for the validation group. Decision curve analysis indicated that the risk threshold probabilities for the modeling group were 0.4%-70.0% and 85.0%-100.0%, while for the validation group, they were 0.4%-52.0%, 56.0%-73.0%, and 84.0%-100.0%, all showing high net benefit values. Conclusion　The main pathogens of MDRO infections in NICU neonates are Escherichia coli and Staphylococcus aureus. Factors influencing MDRO infections in NICU neonates include maternal antibiotic use within one week prior to delivery, gestational age, birth weight, hypoalbuminemia, invasive mechanical ventilation, types of antimicrobial agents used, and duration of antimicrobial use. The nomogram model constructed based on these factors demonstrates good calibration and predictive performance, indicating high clinical application value.

Analysis of influencing factors of severe Mycoplasma pneumoniae pneumonia in children and construction of a nomogram model

Li Xiaoze, Wang Duan, Wang Ce

2025, 31(11):  1859-1864.  DOI: 10.3760/cma.j.cn441417-20241119-11018

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Objective　To analyze the influencing factors of severe Mycoplasma pneumoniae pneumonia (MPP) in children and to construct a nomogram model based on these factors. Method　A retrospective analysis was conducted on the clinical data of 246 children with MPP admitted to Xi'an Children's Hospital from February 2022 to May 2024. Based on the progression of the disease, the children were divided into a severe group (54 cases) and a non-severe group (192 cases). The severe group included 34 males and 20 females, with an average age of (7.56±2.32) years and a disease duration of (8.11±1.42) days; the non-severe group included 110 males and 82 females, with an average age of (8.11±2.74) years and a disease duration of (7.85±1.35) days. General data were compared between the two groups, and multivariate logistic regression analysis was used to identify the influencing factors for the severe progression of MPP. Additionally, the R 3.4.3 software was used to create a nomogram model for predicting severe MPP. The internal validation of the model was primarily conducted using the Bootstrap method, while the calibration and predictive performance were assessed using calibration curves and the receiver operating characteristic (ROC) curve. Statistical analysis was performed using χ² tests and t tests. Results　The levels of C-reactive protein (CRP), interleukin-2 (IL-2), procalcitonin (PCT), lactate dehydrogenase (LDH), D-dimer (D-D), and erythrocyte sedimentation rate (ESR) in the severe group were higher than those in the non-severe group [ (10.81±3.22) mg/L vs. (7.73±2.54) mg/L, (3.98±0.83) ng/L vs. (3.55±0.72) ng/L, (0.58±0.11) µg/L vs. (0.26±0.06) µg/L, (365.65±115.52) U/L vs. (252.36±75.36) U/L, (3.25±1.02) mg/L vs. (2.62±0.87) mg/L, (46.32±13.65) mm/h vs. (33.25±11.01) mm/h], with statistically significant differences (t=7.399, 3.746, 28.150, 8.582, 4.521, 7.293, all P<0.001). Multivariate logistic regression analysis indicated that elevated levels of CRP, IL-2, PCT, LDH, D-D, and ESR were all risk factors for severe MPP in children (all P<0.05). The consistency index (C-index) of the nomogram prediction model constructed based on these factors, validated by the Bootstrap method, was 0.934, and the calibration curve showed good fit with the ideal curve. The ROC analysis indicated that the area under the curve (AUC), sensitivity, and specificity of the nomogram model for predicting severe MPP were 0.911, 93.75%, and 85.94%, respectively. Conclusion　The elevated levels of CRP, IL-2, PCT, LDH, D-D and ESR are all risk factors of severity of MPP in children, and the nomogram model constructed based on the above influence factors has good predictive efficacy, and it can provide reference for clinical prevention and treatment to improve the prognosis of children.

Effect of stellate ganglion catgut embedding on weight control and serum leptin regulation in patients with simple obesity 

Sun Lingli, Wang Xiaoxia, Yang Shunzhu, Ru Yanlong

2025, 31(11):  1864-1868.  DOI: 10.3760/cma.j.cn441417-20241118-11019

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Objective　This study aims to explore the application effects of stellate ganglion catgut embedding in the treatment of simple obesity patients. Methods　This is a prospective study. A total of 80 patients with simple obesity admitted to Shaanxi Provincial Hospital of Traditional Chinese Medicine from January 2023 to June 2024 were selected and randomly divided into two groups using a random number table. The control group consisted of 18 males and 22 females, with an average age of (31.32±4.60) years, a body mass index (BMI) of (30.87±2.63) kg/m², receiving conventional diet, exercise, and Western medication. The study group included 20 males and 20 females, with an average age of (32.03±5.12) years, a BMI of (31.02±3.04) kg/m², receiving stellate ganglion catgut embedding in addition to the control group's treatment. Both groups were treated for 4 weeks. Clinical efficacy was assessed, and changes in weight control effects (BMI, waist circumference), blood lipid levels (triglycerides, total cholesterol), serum leptin levels, and body fat percentage were compared between the two groups. Statistical analysis was performed using t tests, χ² tests, and rank-sum tests. Results　The total effective rate in the study group was 95.5% (37/40), higher than the control group's 75.0% (30/40), with a statistically significant difference (χ²=4.501, P=0.034). After treatment, the study group had a BMI of (27.23±2.19) kg/m², waist circumference of (92.26±3.50) cm, triglycerides of (1.75±0.40) mmol/L, total cholesterol of (5.54±1.09) mmol/L, serum leptin of (12.03±2.24) µg/L, and body fat percentage of (27.51±2.31)%, all lower than the control group's (28.62±2.03) kg/m², (94.54±3.88) cm, (2.03±0.3) mmol/L, (6.13±1.16) mmol/L, (15.34±2.13) µg/L, and (29.62±2.05)%, with statistically significant differences (t=2.944, 2.760, 3.250, 2.344, 6.773, and 4.321, all P<0.05). Conclusion　The application of stellate ganglion catgut embedding in patients with simple obesity demonstrates clear clinical efficacy, improves weight control effects, and helps regulate patients' blood lipid and serum leptin levels, reducing body fat percentage.

Application of acupuncture combined with Tongluo Mingmu decoction after laser surgery for diabetes retinopathy

Yang Yi, Wang Li, Huang Hui, Xu Lihui

2025, 31(11):  1869-1874.  DOI: 10.3760/cma.j.cn441417-20241008-11020

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Objective　To investigate the effects of acupuncture using the Tongyang Kaiqiao method combined with Tongluo Mingmu decoction on visual function and microvascular parameters in the macular region after laser surgery for diabetic retinopathy. Methods　A total of 172 patients who underwent laser surgery for diabetic retinopathy at Jinan Second People's Hospital from January 2022 to May 2024 were selected for a prospective randomized controlled trial, divided into four groups using a random number table. The control group comprised 20 males and 23 females, with an average age of (65.77±8.10) years and a diabetes duration of (10.07±2.15) years, involving 78 affected eyes. Group A consisted of 22 males and 21 females, with an average age of (66.05±8.26) years and a diabetes duration of (10.12±2.10) years, involving 76 affected eyes. Group B included 21 males and 22 females, with an average age of (65.53±8.07) years and a diabetes duration of (10.16±2.08) years, involving 75 affected eyes. Group C comprised 19 males and 24 females, with an average age of (65.44±8.12) years and a diabetes duration of (10.21±2.18) years, involving 76 affected eyes. The control group received basic supportive treatment, while Group A received acupuncture using the Tongyang Kaiqiao method plus basic supportive treatment, Group B received Tongluo Mingmu decoction plus basic supportive treatment, and Group C received acupuncture using the Tongyang Kaiqiao method plus Tongluo Mingmu decoction plus basic supportive treatment. All groups were treated for 2 weeks. The changes in Traditional Chinese Medicine (TCM) symptom scores, visual function, and microvascular parameters in the macular region before and after treatment were compared, along with adverse reactions. Statistical analysis was performed using One-way ANOVA and χ² tests. Results　After 2 weeks of treatment, the main symptom scores, secondary symptom scores, total scores, retinal neovascularization (RNV) leakage area, and central macular thickness (CMT) in Group C were lower than those in Groups A, B, and the control group [(3.15±0.75) points vs. (5.12±1.01) points, (5.02±1.00) points, (7.35±1.20) points; (2.24±0.41) points vs. (3.45±0.71) points, (3.26±0.68) points, (4.09±0.81) points; (5.39±1.05)points vs. (8.57±1.75) points, (8.29±1.69) points, (10.95±2.01) points; (221.04±19.60) mm² vs. (261.20±21.32) mm², (259.74±20.53) mm², (281.75±25.66) mm²; (422.17±35.88) µm vs. (455.86±37.64) µm, (451.33±38.76) µm, (474.82±39.41) µm], with statistically significant differences (all P<0.05). Groups A and B also had lower scores compared to the control group, with significant differences (all P<0.05). The best corrected visual acuity (BCVA) and deep capillary plexus blood flow density (DCP-BD) in Group C were higher than those in Groups A, B, and the control group [(0.78±0.14)° vs. (0.62±0.11)°, (0.64±0.12)°, (0.55±0.10)°; (45.07±2.04)% vs. (43.10±2.05)%, (43.12±2.07)%, (41.03±2.01)%], with significant differences (all P<0.05). The incidence of adverse reactions in the control, A, B, and C groups was 4.65% (2/43), 9.52% (4/42), 11.90% (5/42), and 14.63% (6/41), respectively, with no statistically significant difference (corrected χ²=0.448, P=0.569). Conclusion　Both acupuncture using the Tongyang Kaiqiao method and Tongluo Mingmu decoction can alleviate symptoms after laser surgery for diabetic retinopathy, improve visual function, and enhance DCP-BD in the macular region. Their combined application yields even better results and is safe and reliable.

Clinical Research

Application of Osteoset XR medical calcium sulfate combined with concentrated growth factor fibrin membrane in the prevention of alveolar bone resorption after tooth extraction 

Wang Yujia, Sun Jialu, Gou Jianzhong

2025, 31(11):  1875-1879.  DOI: 10.3760/cma.j.cn441417-20241206-11021

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Objective　To analyze the application effect of Osteoset XR medical calcium sulfate combined with concentrated growth factor fibrin (CGF) membrane in the prevention of alveolar bone resorption after tooth extraction. Methods　A total of 63 patients requiring tooth extraction admitted to Baoji Stomatological Hospital from May 2021 to September 2023 were selected and were divided into 2 groups according to the envelope method. There were 31 cases in the control group, including 20 males and 11 females, with an age of (42.86±4.85) years old, tooth extraction sites: 18 cases of maxillary molars and 13 cases of mandibular molars. There were 32 cases in the observation group, including 18 males and 14 females, with an age of (44.06±4.03) years old, tooth extraction sites: 20 cases of maxillary molars and 12 cases of mandibular molars. In the control group, the wound surface was covered with double layers of CGF membrane after tooth extraction, and Osteoset XR medical calcium sulfate was used in addition in the observation group. The wound healing status was evaluated 7 days after treatment. The alveolar bone height, width, and density, pain degree, periodontal indicators, and incidence of complications were analyzed. Statistical analysis was performed using the χ² test, rank sum test, and t test. Results　In the observation group, the grade A [97.50% (28/32)], grade B [12.50% (4/32)], and grade C wound healing [0% (0/32)] 7 days after treatment was superior to the control group {grade A [58.06% (18/31)], grade B [35.48% (11/31)], and grade C wound healing [6.45% (2/31)]} (Z=7.427, P=0.024). Three months after treatment, the alveolar bone height [(6.23±1.21) mm] and width [(4.28±0.81) mm] in the observation group were both higher than those in the control group [(5.46±1.17) mm and (3.71±0.75) mm] (t=2.567, P=0.013; t=2.896, P=0.005). Three months after treatment, the alveolar bone mineral density in the observation group was higher than that in the control group [(1.34±0.25) g/cm² vs. (1.15±0.22) g/cm²] (t=3.168, P=0.002); three days after treatment, the pain score of the observation group was lower than that of the control group [(2.36±0.38) points vs. (4.04±0.39) points] (t=17.318, P<0.001). Three months after treatment, the gingival index (GI) [(0.78±0.12) points], plaque index (PLI) [(1.36±0.27) points], and clinical attachment loss (CAL) [(1.63±0.21) mm] in the observation group were lower than those in the control group [(0.92±0.14) points, (1.85±0.29) points, and (2.36±0.24) mm] (t=4.267, P<0.001; t=6.944, P<0.001; t=12.860, P<0.001). There was no statistically significant difference in the total incidence of complications between the two groups (P>0.05). Conclusion　In patients with alveolar bone defect after tooth extraction, CGF membrane combined with Osteoset XR medical calcium sulfate can effectively accelerate wound healing, improve the height, width, and bone density of alveolar bone, improve the periodontal indexes, and reduce the degree of pain, with good clinical application safety.

Application of standing balance dynamic enhancement and high-precision transcranial direct current stimulation in post-stroke hemiplegia 

Zhang Dawei, Wang Lifeng, Zhang Yanming, Zhu Yiping, Zhang Zhili

2025, 31(11):  1880-1886.  DOI: 10.3760/cma.j.cn441417-20241217-11022

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Objective　To evaluate the therapeutic effect of standing balance dynamic enhancement training combined with high-precision transcranial direct current stimulation on post-stroke hemiplegic patients. Methods　This study was a randomized controlled trial. A total of 92 post-stroke hemiplegic patients in Shaanxi Rehabilitation Hospital from January 2021 to December 2023 were included and were divided into an experimental group and a control group according to the coin-tossing method, with 46 cases in each group. In the experimental group, there were 24 males and 22 females, aged (60.21±5.18) years, with a body mass index (BMI) of (23.89±2.41) kg/m², 29 cases of ischemic stroke and 17 cases of hemorrhagic stroke, 23 cases of left hemiplegia and 23 cases of right hemiplegia, 11 cases of grade I standing balance, 18 cases of grade II, and 17 cases of grade III. In the control group, there were 23 males and 23 females, aged (59.37±5.23) years, with a BMI of (23.56±2.34) kg/m², 28 cases of ischemic stroke and 18 cases of hemorrhagic stroke, 22 cases of left hemiplegia and 24 cases of right hemiplegia, 12 cases of grade Ⅰ standing balance, 17 cases of grade Ⅱ, and 17 cases of grade Ⅲ. The control group received high-precision transcranial direct current stimulation treatment, and the experimental group received standing balance dynamic enhancement training on the basis. Both groups were treated for 8 weeks. The walking ability [Functional Ambulation Classification (FAC)], balance function [Brunel Balance Assessment (BBA)], muscle strength, upper limb motor function [Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment for Upper Extremity (UE-FMA)], serum factors [nerve growth factor (NGF), S100-β protein, and neurotrophin-3 (NT-3)], neurological function [Chinese Stroke Scale (CSS)], and quality of life [Stroke Specific Quality of Life Scale (SS-QOL)] were compared between the two groups. Statistical methods included t-test and rank sum test. Results　After 8 weeks of treatment, the FAC grade of the experimental group was better than that of the control group (Z=2.189, P=0.029). After 8 weeks of treatment, the scores of sitting balance, standing balance, and walking function in the experimental group were (2.41±0.34) points, (2.53±0.36) points, and (3.56±0.51) points, which were higher than those in the control group [(1.17±0.17) points, (1.20±0.17) points, and (2.89±0.49) points], with statistically significant differences (t=22.124, 22.658, and 6.425, all P<0.05). The peak flexion moment, peak extension moment, and flexion-extension moment ratio in the experimental group were (32.72±3.68) J, (67.65±7.30) J, and 0.55±0.12, which were higher than those in the control group [(22.24±3.16) J, (51.40±6.64) J, and 0.40±0.08], with statistically significant differences (t=14.654, 11.169, and 7.054, all P<0.05). The WMFT score and UE-FMA score of the experimental group were (25.55±3.72) points and (35.29±5.04) points, which were higher than those of the control group [(19.60±2.87) points and (21.77±3.11) points], with statistically significant differences (t=8.589 and 15.483, both P<0.05). The level of S100-β in the experimental group was (0.66±0.23) μg/L, which was lower than that in the control group [(0.92±0.27) μg/L]; the levels of NGF and NT-3 were (147.94±17.53) ng/L and (11.22±1.96) ng/L, which were higher than those in the control group [(139.78±15.39) ng/L and (9.63±1.53) ng/L], with statistically significant differences (t=4.972, 2.373, and 4.337, all P<0.05). The CSS score of the experimental group was (7.19±1.76) points, which was lower than that of the control group [(9.45±2.13) points]; the SS-QOL score was (129.56±14.36) points, which was higher than that of the control group [(119.52±12.51) points], with statistically significant differences (t=5.548 and 3.575, both P<0.05). Conclusion　Standing balance dynamic enhancement training combined with high-precision transcranial direct current stimulation significantly improved the walking ability, balance function, muscle strength, upper limb motor function, and quality of life in post-stroke hemiplegic patients, also optimized the neurological function and regulated the key serum factors, providing an effective rehabilitation strategy for post-stroke hemiplegia.

Therapeutic effect of upper limb robot combined with muscle activation technology on the upper limbs in patients with flaccid paralysis after stroke 

Chang Fawang, Wan Cailing, Wang Futao, Lyu Yunliang, Wu Shuhui, Cui Maofeng

2025, 31(11):  1886-1890.  DOI: 10.3760/cma.j.cn441417-20250117-11023

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Objective　To study the therapeutic effect of upper limb robot combined with muscle activation technology on the upper limbs in patients with flaccid paralysis after stroke. Methods　A total of 74 patients with flaccid paralysis after stroke who were admitted to the Department of Rehabilitation Medicine of Liaocheng Third People's Hospital from October 2023 to October 2024 were included. The patients were divided into a treatment group and a control group by the random number table method, with 37 cases in each group. In the treatment group, there were 27 males and 10 females, with an age of (55.78±11.85) years old, 17 cases on the left side and 20 cases on the right side. In the control group, there were 25 males and 12 females, with an age of (59.83±12.69) years old, 19 cases on the left side and 18 cases on the right side. The control group received muscle activation technology (20 minutes each time, 5 days per week), and the treatment group received upper limb robot combined with muscle activation technology (20 minutes each time, 5 days per week) for 4 weeks. Before and after treatment, the Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE), modified Barthel index (MBI), Brunnstrom stage of upper limbs, and Functional Independence Measure (FIM) were used to evaluate the upper limb function and activities of daily living of the two groups. Statistical analysis was performed using t-test and χ² test. Results　Before treatment, there was no statistically significant difference in the score of FMA-UE, MBI, Brunnstrom, or FIM between the two groups (all P>0.05). After 4 weeks of treatment, the scores of FMA-UE, MBI, Brunnstrom, and FIM in both groups were higher than those before treatment; the scores of FMA-UE, MBI, Brunnstrom, and FIM in the treatment group were all higher than those in the control group [(42.89±3.13) points vs. (38.76±2.96) points, (46.08±5.29) points vs. (42.16±3.82) points, (4.05±0.81) points vs. (2.57±0.60) points, (50.57±3.82) points vs. (45.86±3.54) points], with statistically significant differences (t=5.846, 3.654, 8.922, and 5.495, all P<0.05). Conclusions　Upper limb robot combined with muscle activation technology can effectively improve the upper limb motor function in patients with flaccid paralysis after stroke, which is worthy of promotion.

Effect of yin-yang penetrating acupuncture combined with continuous passive motion on the stability of knee joint in patients with knee hyperextension after stroke 

Zhang Rui, Sheng Gang, Zhang Tao, Zhang Min

2025, 31(11):  1891-1895.  DOI: 10.3760/cma.j.cn441417-20241223-11024

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Objective　To study the effect of yin-yang penetrating acupuncture combined with continuous passive motion (CPM) on the stability of knee joint in patients with knee hyperextension after stroke. Methods　The clinical data of 80 patients with knee hyperextension after stroke admitted to Shaanxi Hospital of Traditional Chinese Medicine from February 2021 to May 2024 were retrospectively analyzed, and they were divided into a study group (44 cases) and a control group (36 cases) according to different treatment methods. There were 30 males and 14 females in the study group, with an age of (57.03±4.79) years old and a disease course of (1.45±0.27) months. In the control group, there were 29 males and 7 females, with an age of (55.81±4.52) years old and a disease course of (1.39±0.21) months. The control group received CPM on the basis of routine rehabilitation exercises (10 to 15 minutes each time, 3 to 4 times a week, and the frequency and duration could be gradually increased as the rehabilitation progressed), and the study group received yin-yang penetrating acupuncture on the basis of the control group (once a day, 5 days a week). Both groups were treated continuously for 2 weeks. The χ² test was used to compare the clinical efficacies of the two groups. The t test was used to compare the times of knee hyperextension, 10 m walk time tests (10 MWT), Fugl-Meyer Motor Function Assessment of Lower Extremity (FMA-LE) scores, and Berg Balance Scale (BBS) scores of the two groups before treatment and 2 weeks after treatment. Results　The effective rate of the study group was higher than that of the control group [88.64% (39/44) vs. 69.44% (25/36)], with a statistically significant difference (χ²=4.558, P=0.033). After 2 weeks of treatment, the times of knee hyperextension and 10MWT decreased in both groups; the times of knee hyperextension and 10MWT in the study group were (14.27±2.19) times and (27.15±2.19) s, which were lower than those in the control group [(17.86±2.46) times and (32.12±3.28) s], with statistically significant differences (all P<0.05). The FMA-LE and BBS scores increased in both groups; the FMA-LE and BBS scores of the study group were (22.19±2.82) points and (23.01±1.75) points, which were higher than those of the control group [(19.42±2.70) points and (20.63±2.14) points], with statistically significant differences (all P<0.05). Conclusion　Yin-yang penetrating acupuncture combined with CPM can reduce the times of knee hyperextension in patients with knee hyperextension after stroke, and improve the walking speed, motor function, and balance ability of lower limbs.

Application of an appliance for delivering continuous passive motion to the joint in the postoperative rehabilitation of ankle fracture patients 

Cheng Kang, Zhang Youbo

2025, 31(11):  1895-1899.  DOI: 10.3760/cma.j.cn441417-20241127-11025

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Objective　To analyze the application value of an appliance for delivering continuous passive motion to the joint in the postoperative rehabilitation of ankle fracture patients. Methods　Ninety patients with ankle fractures admitted to Ankang Central Hospital from September 2023 to September 2024 were selected and were divided into two groups according to the stratified sampling method, with 45 cases in each group. In the control group, there were 27 males and 18 females, aged 34-55 (45.19±4.16) years, Lange-Hansen classification: 17 cases of supination-external rotation, 7 cases of supination-adduction, 13 cases of pronation-external rotation, and 8 cases of pronation-abduction. In the observation group, there were 29 males and 16 females, aged 32-54 (44.72±4.27) years, Lange-Hansen classification: 19 cases of supination-external rotation, 5 cases of supination-adduction, 11 cases of pronation-external rotation, and 10 cases of pronation-abduction. Both groups underwent open reduction and internal fixation. The control group received routine rehabilitation training after surgery, and the observation group received intervention with an appliance for delivering continuous passive motion to the ankle joint on the basis of the control group. Both groups were intervened until 3 months after surgery. The ankle joint functions [ankle-hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and Olerud Molander Ankle Score (OMAS)], ranges of motion of ankle dorsiflexion and plantar flexion, walking parameters (standardized single support period duration, step speed, step width, and step length), and incidence of complications were compared between the two groups. Statistical analysis was performed using the χ² test and the t test. Results　After intervention, the AOFAS ankle-hindfoot score and OMAS in the observation group were higher than those in the control group [(83.15±7.43) points vs. (77.52±6.85) points, (80.46±6.12) points vs. (74.18±5.65) points] (t=3.737 and 5.058; both P<0.05); the ranges of motion of ankle dorsiflexion and plantar flexion in the observation group were greater than those in the control group [(15.95±1.08)° vs. (10.42±0.87)°, (41.84±1.96)° vs. (37.12±1.27)°] (t=26.749 and 13.557; both P<0.05); the standardized single support period duration, step speed, and step length in the observation group were all greater than those in the control group [(26.18±4.15)% vs. (21.69±3.77)%, (1.18±0.23) m/s vs. (0.94±0.17) m/s, (0.64±0.21) m vs. (0.53±0.18) m] (t=5.372, 5.629, and 2.668, all P<0.05). The incidence of complications in the observation group was lower than that in the control group [4.44% (2/45) vs. 20.00% (9/45)] (χ²=5.075, P=0.024). Conclusion　Applying an appliance for delivering continuous passive motion to the joint in the postoperative rehabilitation of ankle fracture patients can improve the ankle joint function, increase the ranges of ankle dorsiflexion and plantar flexion, promote the improvement in walking ability, and reduce the incidence of complications.

Exploring the effect of catgut implantation at acupoint on knee osteoarthritis based on the concept of "regulating bone with tendons" 

Feng Xin, Ma Ning, Wang Fei

2025, 31(11):  1900-1905.  DOI: 10.3760/cma.j.cn441417-20241129-11026

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Objective　To explore the effect of catgut implantation at acupoint in the treatment of knee osteoarthritis based on the concept of "regulating bone with tendons". Methods　This study was a randomized controlled trial. A total of 150 patients with knee osteoarthritis admitted to the Department of Rehabilitation Medicine of Xi'an Jiaotong University First Affiliated Hospital Yulin Hospital from March 2021 to March 2024 were selected as the research subjects and were divided into a control group and an observation group, with 75 cases in each group, by the random number table method. In the control group, there were 42 males and 33 females, aged (63.35±8.42) years, the disease duration was (20.36±5.17) months, and there were 26 cases on the left knee, 32 cases on the right knee, and 17 cases on both knees. In the observation group, there were 40 males and 35 females, aged (62.08±9.13) years, the disease course was (21.52±4.86) months, and there were 28 cases on the left knee, 31 cases on the right knee, and 16 cases on both knees. The control group received conventional western medicine treatment: oral celecoxib capsules, 0.2 g each time, once a day, for 4 consecutive weeks; the observation group received catgut implantation at acupoint on the basis of the control group: catgut implantation was done once on the 1st, 7th, 14th, 21st, and 28th days of the treatment, for a total of 5 times. The pain, knee joint function, severity of knee osteoarthritis, and levels of serum inflammatory factors and pain mediators were compared between the two groups before and after treatment, as well as the clinical efficacy and safety. Statistical analysis was performed using t-test and χ² test. Results　After treatment, the Visual Analogue Scale (VAS) score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were decreased in both groups (all P<0.05), and those in the observation group were lower than those in the control group [(1.48±0.19) points vs. (2.97±0.41) points, (20.52±4.03) points vs. (30.65±5.29) points] (t=28.555 and 13.192; both P<0.05). After treatment, the Lysholm knee joint score was increased in both groups (both P<0.05), and the score of the observation group was higher than that of the control group [(79.95±8.13) points vs. (64.83±8.26) points] (t=11.298, P<0.05). After treatment, the levels of serum interleukin-1 (IL-1), IL-6, tumor necrosis factor-α (TNF-α), matrix metalloproteinase-3 (MMP-3), substance P (SP), dopamine (DA), and prostaglandin E₂ (PGE₂) were all decreased in both groups (all P<0.05), and those in the observation group were lower than those in the control group [(101.59±10.17) ng/L vs. (132.88±11.64) ng/L, (113.68±16.71) ng/L vs. (147.95±18.56) ng/L, (4.36±0.92) ng/L vs. (6.41±1.55) ng/L, (90.36±14.76) μg/L vs. (125.42±18.61) μg/L, (139.53±20.32) μg/L vs. (176.41±25.84) μg/L, (7.85±1.16) μg/L vs. (11.92±1.59) μg/L, (121.86±21.95) μg/L vs. (179.63±28.77) μg/L (t=17.531, 11.884, 9.850, 12.783, 9.716, 17.909, and 13.825, all P<0.05). The total clinical effective rate of the observation group was higher than that of the control group [96.00% (72/75) vs. 84.00% (63/75)] (χ²=6.000, P=0.014). Both groups did not experience any serious adverse reactions. Conclusion　Based on the concept of "regulating bone with tendons", catgut implantation at acupoint for patients with knee osteoarthritis can effectively reduce the pain and severity of the condition, improve the knee joint function, reduce the levels of inflammatory factors and pain mediators, and has good clinical efficacy and safety.

Efficacy and safety of gefitinib in the treatment of EGFR-positive advanced NSCLC patients

Zhang Yang, Wang Jingjing, Wang Bo, Li Xiaojun

2025, 31(11):  1905-1910.  DOI: 10.3760/cma.j.cn441417-20240704-11027

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Objective　To study the efficacy and safety of gefitinib in the treatment of advanced non-small cell lung cancer (NSCLC) patients with positive epidermal growth factor receptor (EGFR). Methods　A prospective study was conducted on 102 patients with EGFR-positive NSCLC who were treated in No.215 Hospital of Shaanxi Nuclear Industry from March 2019 to February 2021, and they were divided into a control group (51 cases) and a study group (51 cases) according to the random number table method. In the control group, there were 30 males and 21 females, aged (57.38±5.19) years, 20 cases in stage ⅢB and 31 cases in stage Ⅳ, 11 cases of squamous cell carcinoma and 40 cases of adenocarcinoma. In the study group, there were 28 males and 23 females, aged (56.99±5.32) years, 25 cases in stage ⅢB and 26 cases in stage Ⅳ, 8 cases of squamous cell carcinoma and 43 cases of adenocarcinoma. The control group received docetaxel treatment, intravenous infusion with 75 mg/m² of docetaxel, 3 weeks as a cycle, and the treatment lasted for at least 2 cycles. The study group received gefitinib orally, 250 mg each time, once a day, until the disease progressed or the patient could not tolerate it and the drug was discontinued. The χ² test was used to compare the clinical efficacies and adverse reactions of the two groups. The t-test was used to compare the changes of EGFR, secretory protein Dikkopf-1 (DKK1), pre-gradient protein 2 (AGR2), and tumor markers [squamous cell carcinoma antigen (SCC), non-small cell lung cancer antigen 21-1 (CYFRA21-1), and carcinoembryonic antigen (CEA)] before treatment and one month after treatment in the two groups. The Log-rank test was used to compare the 3-year survival rates of the two groups. Results　The disease control rate of the study group was 82.35% (42/51), which was higher than 54.90% (28/51) of the control group, with a statistically significant difference (P<0.05). One month after treatment, the levels of EGFR, DKK1, and AGR2 in both groups decreased; the levels of EGFR, DKK1, and AGR2 in the study group were (37.94±4.22) μg/L, (3.59±0.85) μg/L, and (8.04±1.68) ng/L, which were lower than those in the control group [(50.11±5.83) μg/L, (5.04±1.02) μg/L, and (12.45±2.59) ng/L], with statistically significant differences (all P<0.05). One month after treatment, the levels of SCC, CYFRA21-1, and CEA in both groups decreased; the levels of SCC, CYFRA21-1, and CEA in the study group were (1.23±0.27) μg/L, (7.76±1.03) μg/L, and (46.19±5.83) μg/L, which were lower than those in the control group [(1.76±0.28) μg/L, (10.24±1.25) μg/L, and (53.17±6.84) μg/L], with statistically significant differences (all P<0.05). The total incidence of adverse reactions in the study group was 21.57% (11/51), which was lower than 41.18% (21/51) in the control group, with a statistically significant difference (P<0.05). The overall survival period of the study group was (29.71±3.61) months, which was longer than that of the control group [(23.21±3.28) months], with a statistically significant difference (P<0.05). Conclusion　Gefitinib can improve the curative effect of EGFR-positive advanced NSCLC patients, down-regulate the expressions of EGFR, DKK1, and AGR2, reduce the levels of tumor markers, has high safety, and is beneficial to the improvement of prognosis.

Effect of apatinib combined with gemcitabine plus oxaliplatin regimen on serum tumor markers and prognosis in patients with advanced ovarian cancer 

Liu Zilong, Fu Xiaoling, Zhang Xin

2025, 31(11):  1911-1915.  DOI: 10.3760/cma.j.cn441417-20241225-11028

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Objective　To retrospectively analyze the effects of apatinib combined with gemcitabine plus oxaliplatin regimen on serum tumor markers and prognosis of patients with advanced ovarian cancer. Methods　A total of 76 patients with advanced ovarian cancer admitted to Nanyang Central Hospital from February 2022 to February 2024 were retrospectively selected and divided into control group and observation group according to different treatment methods, with 38 cases in each group. The age of control group was (51.27±3.28) years old, with pathological staging of 16 cases in stage III and 22 cases in stage IV; they received treatment with gemcitabine and oxaliplatin, with gemcitabine administered intravenously at a dose of 1,000 mg/m² on days 1 and 8, and oxaliplatin at a dose of 130 mg/m² on day 1. Continuous treatment for 3 weeks constituted one cycle. The age of the observation group was ((50.92±3.35) years old, with 18 cases in stage III and 20 cases in stage IV; they received apatinib in addition to the treatment in the control group, orally at a dose of 500 mg once daily. After 14 days of continuous use without severe adverse reactions, the dose was adjusted to 750 mg once daily until disease progression or intolerance occurred. Both groups underwent a total of 3 treatment cycles. Clinical efficacy, tumor markers [carbohydrate antigen (CA125), carcinoembryonic antigen (CEA), cytokeratin 19 fragment antigen 21-1 (CYFRA21-1)], vascular endothelial growth factor receptor (VEGFR), platelet-derived growth factor receptor (PDGFR), inflammatory factors [interleukin-6 (IL-6), IL-10, interferon-γ (INF-γ)] levels, the Chinese Cancer Patient Chemotherapy Quality of Life Scale (QLQ-CCC) scores, and adverse reactions were compared between the two groups. Statistical analysis was performed using χ² tests and t tests. Results　The disease control rate in the observation group was higher than that in the control group [84.21% (32/38) vs. 63.16% (24/38)], with a statistically significant difference (χ²=4.343, P=0.037). After three treatment cycles, the levels of CA125, CEA, CYFRA21-1, VEGFR, PDGFR, IL-6, IL-10, and INF-γ in the observation group were (31.54±2.05) U/ml, (2.46±0.52) ng/L, (15.87±1.26) g/L, (408.56±70.45) ng/L, (64.62±4.28) ng/L, (1.24±0.25) mg/L, and (1.38±0.27) mg/L, (13.48±1.54)mg/L, respectively, compared to (52.68±2.37) U/ml, (4.57±0.76) ng/L, (26.84±1.45) g/L, (495.27±80.23) ng/L, (72.51±5.17) ng/L, (3.27±0.43) mg/L, (3.45±0.38) mg/L, and(7.02±0.92)mg/L in the control group, with all differences being statistically significant (all P<0.05). The QLQ-CCC scores for physiological, social, psychological, and overall sensation in the observation group were all higher than those in the control group (all P<0.05). The overall incidence of adverse reactions between the two groups was not statistically significant (P>0.05). Conclusion　Apatinib combined with gemcitabine plus oxaliplatin regimen in patients with advanced ovarian cancer can improve the disease control rate, reduce tumor marker levels, inhibit the release of inflammatory factors, improve prognosis, and enhance quality of life in patients with advanced ovarian cancer.

Nursing Research

Clinical efficacy of thunder-fire moxibustion based on the Ziwuliuzhu theory on diabetes arthralgia 

Chen Yun, Qi Yanhuan, Mao Jiahui, Zhong Yinqin, Wang Yuqi, Zhou Fengming

2025, 31(11):  1916-1920.  DOI: 10.3760/cma.j.cn441417-20241122-11029

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Objective　To observe the clinical effect of thunder-fire moxibustion under the guidance of Ziwuliuzhu theory in the treatment of diabetes arthralgia. Methods　This study was a randomized controlled trial. A total of 210 patients with diabetes arthralgia who were hospitalized in the Department of Endocrinology of Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian) from January 2023 to June 2024 were selected and were divided into a control group and a treatment group, with 105 cases in each group, according to the random number table method. In the treatment group, there were 47 males and 58 females, the age was 49 (36,59) years old, and the disease duration was 10.0 (7.5, 15.5) years. In the control group, there were 51 males and 54 females, the age was 49 (35,59) years old, and the disease duration was 10.0 (8.0, 15.5) years. The control group received conventional thunder-fire moxibustion, and the treatment group adopted the selection of time and acupoints under the guidance of Ziwuliuzhu theory on the basis of the control group. Each moxibustion lasted for 30 minutes, once a day, for a total of 2 weeks. The traditional Chinese medicine (TCM) syndrome scores, Visual Analogue Scale (VAS) scores, and Diabetes-Specific Quality of Life Scale (DSQL) scores were compared between the two groups before and after treatment. Statistical analysis was performed using the paired design signed rank sum test (Wilcoxon test), two independent sample rank sum test (Mann-Whitney U test), and χ² test. Results　After 2 weeks of treatment, the TCM syndrome score, VAS score, and DSQL score of the treatment group were all lower than those of the control group [5.0 (3.0, 7.5) points vs. 6.0 (3.5, 10.5) points, 0 (0, 2) points vs. 1 (0, 2) points, 42.0 (39.0, 47.0) points vs. 47.0 (39.5) 56.0) points] (all P<0.05). Conclusion　Thunder-fire moxibustion under the guidance of Ziwuliuzhu theory in the treatment of diabetes arthralgia patients can effectively reduce the TCM syndrome score, relieve the pain, and improve the quality of life.

Effect of continuous nursing intervention based on the Omaha system on postoperative recovery in children with supracondylar fracture of humerus 

Zhang Junlan, Jia Mengmeng

2025, 31(11):  1920-1924.  DOI: 10.3760/cma.j.cn441417-20241024-11030

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Objective　To investigate the effect of continuous nursing intervention based on the Omaha system on children with supracondylar fracture of humerus. Methods　The clinical data of 88 children with supracondylar fracture of humerus admitted to the Children's Hospital Affiliated to Zhengzhou University from May 2022 to May 2024 were retrospectively selected. They were divided into a control group and an observation group, with 44 cases in each group, according to different nursing methods. In the control group, there were 24 boys and 20 girls, aged 6-12 (9.95±0.53) years; fracture sites: 19 cases on the left side and 25 cases on the right side; fracture classification: 10 cases of type II, 19 cases of type III, and 15 cases of type IV. In the observation group, there were 23 boys and 21 girls, aged 6-12 (9.92±0.56) years; fracture sites: 21 cases on the left side and 23 cases on the right side; fracture classification: 11 cases of type II, 20 cases of type III, and 13 cases of type IV. The control group received conventional nursing, while the observation group received continuous nursing intervention based on the Omaha system. Both groups were continuously followed up for 3 months. The exercise compliance, elbow joint range of motion, elbow joint recovery, and incidence of complications were compared between the two groups. Statistical analysis was performed using t-test and χ² test. Results　After nursing, the scores of the integrity of the exercise content, whether to master exercise methods, the frequency and duration of daily exercise, and the initiative of exercise of the exercise compliance in the observation group were (86.06±4.30) points, (84.42±3.94) points, (85.51±3.62) points, and (84.64±3.95) points, which were higher than those of the control group [(81.17±4.22) points, (78.83±3.35) points, (79.49±3.54) points, and (78.38±3.91) points] (t=5.384, 7.170, 7.887, and 7.471, all P<0.05); the flexion, extension, pronation, and supination ranges of motion of the elbow joint in the observation group were (132.87±6.69)°, (5.00±1.12)°, (82.57±3.71)°, and (81.18±3.92)°, which were greater than those in the control group [(126.87±6.61)°, (2.54±0.61)°, (74.99±3.68)°, and (76.64±3.53)°] (t=4.232, 12.795, 9.622, and 5.709; all P<0.05); the scores of motor function, pain, daily activity ability, and joint stability of the Mayo Elbow Function Scale (MEPS) in the observation group were (14.04±1.85) points, (28.53±1.79) points, (18.98±1.86) points, and (8.08±0.53) points, which were higher than those in the control group [(11.53±1.80) points, (22.92±1.65) points, (14.94±1.78) points, and (6.16±0.51) points] (t=6.450, 15.286, 10.409, and 17.315, all P<0.05). The total incidence of complications in the observation group was 4.55% (2/44), which was lower than 18.18% (8/44) in the control group (χ²=4.062, P=0.044). Conclusion　Continuous nursing intervention based on the Omaha system can improve the exercise compliance and elbow joint range of motion in children with supracondylar fracture of humerus, facilitate the recovery of elbow joint function, and also reduce the risk of complications.

Analysis of application effect of traditional Chinese medicine stain collapse therapy combined with septum moxibustion in the perioperative period of tibiofibular fracture patients 

Zhang Weina

2025, 31(11):  1925-1929.  DOI: 10.3760/cma.j.cn441417-20241230-11031

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Objective　To explore the application effect of traditional Chinese medicine stain collapse therapy combined with septum moxibustion in the perioperative period of tibiofibular fracture patients. Methods　A total of 86 patients with tibiofibular fractures treated in Henan Provincial Hospital of Traditional Chinese Medicine from July 2023 to July 2024 were selected as the research subjects. According to the admission time, 43 patients who were admitted before December 2023 were taken as a control group, and 43 patients who were admitted after December 2023 were taken as an observation group. In the control group, there were 21 males and 22 females, with an age of (39.62±8.26) years old, 25 cases of stable tibiofibular fractures and 18 cases of unstable tibiofibular fractures. In the observation group, there were 18 males and 25 females, with an age of (41.27±10.08) years old, 23 cases of stable tibiofibular fractures and 20 cases of unstable tibiofibular fractures. The control group received routine nursing, while the observation group received nursing intervention of traditional Chinese medicine stain collapse therapy combined with septum moxibustion until the patients were discharged from the hospital. The time of limb swelling regression, time of getting out of bed, fracture healing time, quality of life, and nursing satisfaction were compared between the two groups. Statistical analysis was performed using the χ² test and the independent sample t-test. Results　The time of limb swelling regression, time of getting out of bed, and fracture healing time in the observation group were all shorter than those in the control group [(11.07±2.81) d vs. (13.66±3.59) d, (14.22±3.15) d vs. (16.48±3.26) d, (17.53±4.27) d vs. (22.01±5.69) d], with statistically significant differences (all P<0.05). After intervention, the scores of each dimension of quality of life in the observation group were all higher than those in the control group, with statistically significant differences (all P<0.05). The score of nursing satisfaction in the observation group was higher than that in the control group [(86.25±9.12) points vs. (77.19±8.46) points], with a statistically significant difference (t=4.776, P<0.001). Conclusions　The combination of traditional Chinese medicine stain collapse therapy and septum moxibustion can effectively promote the disease recovery in patients with tibiofibular fractures during the perioperative period, and improve their quality of life and nursing satisfaction.

Correlation between the degree of early neurological deficit and quality of life in patients with hypertensive cerebral hemorrhage after surgery 

Cheng Jingjing, Shang Lihong, Geng Jin

2025, 31(11):  1930-1933.  DOI: 10.3760/cma.j.cn441417-20240425-11032

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Objective　To analyze the relationship between the degree of early neurological deficit and quality of life in patients with hypertensive cerebral hemorrhage after surgery, which is convenient to carry out clinical nursing measures. Methods　A cross-sectional study was conducted to select 295 patients with hypertensive intracerebral hemorrhage admitted to Shangluo Central Hospital from April 2021 to September 2022 as the study objects. The modified Edinburgh Scandinavia Stroke Scale (MESSS) and Stroke Impact Scale (SIS) were used to evaluate the neurological deficit and quality of life 72 h after surgery. The obtained data were entered into the SPSS 26.0 software for χ² test, ANOVA, and Pearson correlation analysis. Results　A total of 289 valid questionnaires (97.97%) were collected, including 154 males and 135 females, aged (50.37±6.43) years. The MESSS evaluation results showed that there were 131 cases of mild neurological deficit (45.33%), 103 moderate cases (35.64%), and 55 severe cases (19.03%), respectively. Except for the mild group being at a moderate level of the total SIS score, the total SIS score in both moderate and severe groups were at a low level, and there were statistically significant differences in the SIS score among the mild, moderate, and severe groups (all P<0.05). Correlation analysis results showed that the scores of memory and thinking, body, emotion, communication, life ability, behavioral ability, hand function, and social function and total SIS score were negatively correlated with the degree of neurological deficit in 289 patients with hypertensive cerebral hemorrhage (all P<0.05). Conclusions　In patients with hypertensive cerebral hemorrhage after surgery, the more severe the recent neurological deficit, the lower the quality of life. In order to improve the quality of life in patients with hypertensive cerebral hemorrhage after surgery, we can achieve the long-term quality of life from the perspective of various nursing points for promoting neurological recovery.

Medical Education

Exploration and practice of early clinical practice in optometry specialty

Lian Lihua, Yu Xiaoyi

2025, 31(11):  1934-1936.  DOI: 10.3760/cma.j.cn441417-20241112-11033

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The purpose of this paper is to explore the construction of internship before the study of professional courses and before graduation practice for college students majoring in optometry. By analyzing the current situation and challenges of optometry education, the necessity and important value of early clinical practice are put forward. This paper expounds the construction, specific implementation measures and achievements of the practice base of optometry specialty, aiming to provide some reference for the education of optometry specialty in China.