Table of Content

01 August 2025, Volume 31 Issue 15

Previous Issue   

Special Column of Anesthesia and Analgesia

Research progress of minimally invasive interventional therapy for pain in patients with advanced cancer

Dai Wei , Cui Dongmei , Wang Wenjun , Yang Wenjing , Ma Shigang , Zhang Yanying , Wang Tao , Man Tao

2025, 31(15):  2466-2470.  DOI: 10.3760/cma.j.cn441417-20250609-15001

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Cancer pain is a common and severe symptom that significantly affects the quality of life of cancer patients, particularly those with advanced cancer. Traditional pharmacological treatments have many limitations; therefore, minimally invasive interventional therapies have gradually shown advantages in the management of cancer pain. This article reviews the indications and contraindications for minimally invasive interventional treatment in cancer pain patients, commonly used methods for different anatomical sites, including nerve block and ablation,percutaneous vertebroplasty, radiofrequency ablation, and intrathecal drug delivery system implantation for pain management in advanced cancer. It also discusses the timing of interventional interventions for refractory cancer pain, analyzing their principles, efficacy, advantages, and associated risks. The aim is to provide a reference for better selection and application of minimally invasive interventional therapies for cancer pain in clinical practice to improve patient quality of life.

Research on CT guided percutaneous microwave ablation for relieving cancer-related pain in patients with metastatic non-small cell lung cancer

Yang Wenjing, Dai Wei, Wang Wenjun, Cui Dongmei

2025, 31(15):  2471-2475.  DOI: 10.3760/cma.j.cn441417-20250208-15002

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Objective　To investigate the effects of CT-guided percutaneous microwave ablation on alleviating cancer-related pain in patients with metastatic non-small cell lung cancer (NSCLC). Methods　This study is a randomized controlled trial involving 104 patients diagnosed with metastatic NSCLC and experiencing cancer-related pain symptoms at Zaozhuang Chest Hospital from March 2023 to September 2024. Patients were divided into a conventional group (58 cases) and an observation group (46 cases) based on different analgesic protocols. In the conventional group, there were 32 males and 26 females, aged (62.60±7.74) years; pathological types included 48 cases of adenocarcinoma and 10 cases of squamous cell carcinoma. In the observation group, there were 26 males and 20 females, aged (60.26±7.15) years; pathological types included 38 cases of adenocarcinoma and 8 cases of squamous cell carcinoma. The conventional group received standard analgesic medications, while the observation group underwent CT-guided percutaneous microwave ablation in addition to standard pain relief. The degree of cancer-related pain [visual analogue scale (VAS)] and the incidence of breakthrough pain were compared between the two groups before treatment and at 1, 3, and 10 weeks post-treatment. Functional status [Karnofsky Performance Status (KPS) score] and quality of life [Functional Assessment of Cancer Therapy-Lung (FACT-L) score] were assessed before treatment and one week after treatment. Complications during the treatment period were also observed in both groups. Statistical analysis was performed using Fisher's exact probability method, χ² test, and t test. Results　Before treatment and at 1, 3, and 10 weeks post-treatment, the VAS scores in the observation group were (8.24±1.02, 2.89±0.77, 2.93±0.65, 3.24±0.64) points, while those in the conventional group were (8.33±1.21, 4.57±1.14, 4.10±1.05, 4.12±0.82) points. Both groups showed a significant reduction in VAS scores compared to pre-treatment, with the observation group scores being lower than those of the conventional group, and all differences were statistically significant (all P<0.001). Within one week post-treatment, the observation group experienced fewer instances of breakthrough pain compared to the control group [(3.26±1.08) times/week vs. (6.50±1.41) times/week] (t=12.351, P<0.001). One week after treatment, the KPS and FACT-L scores in the observation group were higher than those in the conventional group [(74.78±5.57) points vs. (68.36±5.23) points and (104.26±5.85) points vs. (96.33±4.39)points] (all P<0.001). The incidence of nausea, vomiting, constipation, excessive sedation, and numbness or atrophy at the puncture site during analgesic treatment showed no statistically significant differences between the two groups (all P>0.05). Conclusion　CT-guided percutaneous microwave ablation is effective in rapidly alleviating cancer-related pain in patients with metastatic NSCLC and positively impacts their functional status and quality of life.

Acupoint injection of lappaconitine combined with acupuncture in the treatment of cancer-related pain in lung cancer chemotherapy patients and its effect on pain mediator levels

Shi Yue, Wang Dan

2025, 31(15):  2476-2481.  DOI: 10.3760/cma.j.cn441417-20250208-15003

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Objective　To explore the effect of acupoint injection of lappaconitine combined with acupuncture in the treatment of cancer-related pain in lung cancer chemotherapy patients and pain mediator levels. Methods　This is a prospective study. A total of 176 lung cancer patients receiving chemotherapy at Yan'an Traditional Chinese Medicine Hospital from June 2021 to June 2024 were selected as study subjects. They were randomly divided into four groups: conventional group, acupuncture group, injection group, and combined group, with 44 cases in each group. In the conventional group, there were 29 males and 15 females, aged (57.52±9.05) years and a pain duration of (21.18±4.14) days; in the acupuncture group, there were 27 males and 17 females, aged (59.02±8.63) years and a pain duration of (21.84±4.03) days; in the injection group, there were 28 males and 16 females, aged (58.48±8.91) years and a pain duration of (21.57±4.25) days; in the combined group, there were 25 males and 19 females, aged (56.91±9.24) years and a pain duration of (20.32±4.09) days. All four groups received a three-step analgesic regimen for cancer pain. Additionally, the acupuncture group received acupuncture treatment, the injection group received acupoint injection of lappaconitine, and the combined group received both acupuncture and acupoint injection of lappaconitine. A total of four treatment cycles were conducted. The levels of cancer-related pain, sleep quality, pain mediator levels, quality of life, and pain relief after treatment were compared. Statistical methods included one-way ANOVA, χ² test, and t test. Results　After treatment, the visual analogue scale (VAS) scores and Pittsburgh Sleep Quality Index (PSQI) scores in the combined group were lower than those in the conventional group, acupuncture group, and injection group [(1.05±0.31) points vs. (2.52±0.44, 1.75±0.41, 1.59±0.39) points and (5.14±1.48) points vs. (9.05±2.29, 6.73±2.06, 6.50±2.03) points], with all differences being statistically significant (all P<0.05). The overall effective rate of pain relief in the combined group was higher than in the conventional group, acupuncture group, and injection group [97.73% (43/44) vs. 75.00% (33/44), 84.09% (37/44), 84.09% (37/44)], with significant differences (all P<0.05). Serum levels of serotonin, prostaglandin E₂, and substance P, as well as symptom scale scores and individual item scores from the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC-QLQ-C30), were lower in the combined group compared to the conventional group, acupuncture group, and injection group, while both the acupuncture and injection groups were lower than the conventional group (all P<0.05). Serum levels of β-endorphin and scores on the functional scale and overall quality of life scale from the EORTC-QLQ-C30 in the combined group were higher than those in the conventional group, acupuncture group, and injection group, with both the acupuncture and injection groups being higher than the conventional group (all P<0.05). Conclusion　Acupoint injection of lappaconitine combined with acupuncture in the treatment of lung cancer chemotherapy patients can significantly alleviate cancer-related pain, reduce pain mediator levels and improve sleep quality and quality of life.

Analysis of the pain control effect of esketamine preemptive analgesia in children undergoing developmental dysplasia of the hip surgery

Huang Jingyuan, Cai Liang, Lyu Haigang, Deng Yanan

2025, 31(15):  2482-2486.  DOI: 10.3760/cma.j.cn441417-20250319-15004

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Objective　To investigate the effects and safety of preemptive analgesia with esketamine for pain control in children undergoing surgery for developmental dysplasia of the hip (DDH). Methods　A retrospective study was conducted involving 120 children who underwent DDH surgery at the Xi'an Jiaotong University Affiliated Honghui Hospital from January 2021 to December 2023. The children were randomly divided into a control group (60 cases) and an observation group (60 cases). In the observation group, there were 10 males and 50 females, aged (3.25±0.73) years; in the control group, there were 9 males and 51 females, aged (3.17±0.86) years. The observation group received intravenous injection of 0.5 mg/kg esketamine for preemptive analgesia 30 min before the end of surgery, while the control group received an equivalent volume of saline. Pain levels were assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) scale and the Wisconsin Children's Hospital Sedation Scale (CHW) at postoperative hours 2, 4, 8, 12, and 24. The occurrence of postoperative adverse reactions was observed and recorded. Statistical significance was evaluated using the χ² test, t test, and repeated measures ANOVA. Results　At postoperative hours 2, 4, 8, 12, and 24, the FLACC scores in the observation group were (2.75±1.53, 2.41±1.22, 2.18±1.05, 1.76±0.61, 1.45±0.42) points, while those in the control group were (4.31±1.82, 3.75±1.43, 3.23±1.21, 2.79±1.08, 2.18±0.73) points, with all differences being statistically significant (all P<0.05). Over time, both groups showed a decreasing trend in FLACC scores. The CHW scores for the observation group at postoperative hours 2, 4, 8, and 12 were lower than those in the control group (all P<0.05), while there was no statistically significant difference at 24 hours postoperatively (P>0.05), with CHW scores showing an increasing trend over time. The overall incidence of adverse reactions between the two groups was not significantly different [20.0% (12/60) vs. 16.7% (10/60)] (χ²=0.223, P=0.637). Conclusion　Esketamine preemptive analgesia has good pain control effect in children with DDH surgery, can significantly reduce the postoperative pain scores of children, and has a low incidence of postoperative adverse reactions.

Effects of different anesthesia methods on surgical efficacy and coagulation function in patients undergoing total hip arthroplasty 

Li Dan, Dai Yanwen, Xue Na

2025, 31(15):  2487-2491.  DOI: 10.3760/cma.j.cn441417-20250114-15005

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Objective　To compare the effects of general anesthesia and epidural anesthesia on the surgical outcomes and coagulation function of elderly patients undergoing total hip replacement surgery. Method　This study utilized a randomized controlled design, selecting 96 elderly patients scheduled for elective total hip arthroplasty at the Yulin Hospital of Xi'an Jiaotong University First Affiliated Hospital from April 2023 to April 2024. Patients were divided into group A (general anesthesia group) and group B (epidural anesthesia group) using a random number table, with 48 cases in each group. Group A comprised 28 males and 20 females, aged (68.41±4.04) years; American Society of Anesthesiologists (ASA) classification included 27 cases of ASA II and 21 cases of ASA III. Group B included 27 males and 21 females, aged (68.55±4.17) years; ASA classification included 28 cases of ASA II and 20 cases of ASA III. Group A was given general anesthesia by tracheal intubation, and group B was given epidural anesthesia. The surgical-related indicators, coagulation function levels, and incidence of lower limb deep venous thrombosis were compared between the two groups. Statistical analysis was performed using χ² test and t test. Result　There were no statistically significant differences between the two groups in terms of surgical time, anesthesia time, intraoperative blood loss, and time to ambulation (all P>0.05). At 72 hours post-anesthesia, the platelet aggregation rate in group B was lower than that in group A [(65.92±8.34)% vs. (75.28±7.39)%,] with a statistically significant difference (t=5.820, P<0.001). At 24 hours post-anesthesia, the prothrombin time, prothrombin activity, fibrinogen, activated partial thromboplastin time, thrombin time, and D-dimer levels in group B were (14.22±1.08) s, (108.54±9.15)%, (4.24±0.83) g/ml, (37.92±1.84) s, (18.79±1.64) s, and (0.84±0.13) mg/L, respectively, while in group A they were (12.91±1.38) s, (97.48±11.26)%, (5.23±0.79) g/ml, (33.96±5.39) s, (14.68±1.41) s, and (1.49±0.58) mg/L, with all differences being statistically significant (all P<0.05). The incidence of lower limb deep venous thrombosis in group B was [2.08% (1/48)], which was lower than that in group A [14.58% (7/48)], with a statistically significant difference (χ²=4.909, P=0.027). Conclusion　In elderly patients undergoing total hip arthroplasty, both general anesthesia and epidural anesthesia interventions effectively ensure the smooth progress of surgery. However, epidural anesthesia better stabilizes postoperative platelet aggregation rates, improves the coagulation status of patients, prevents the occurrence of lower limb deep venous thrombosis, and ensures better prognostic outcomes.

Application of remimazolam combined with propofol in balanced anesthesia for elderly patients with spinal fractures

Zhang Fanfan, Zhang Li, Zhang Zhenhua

2025, 31(15):  2492-2496.  DOI: 10.3760/cma.j.cn441417-20250316-15006

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Objective　This study was to evaluate the perioperative effect of remazolam combined with propofol anesthesia in elderly patients with spinal fracture. Methods　A prospective, randomized controlled trial was conducted to select 104 elderly patients with spinal fractures admitted to the First Hospital of Northwestern University from January 2021 to December 2023. They were divided into remazolam combined with propofol group (group R) and propofol group (group P) according to the way of anesthesia, with 52 cases in each group. In group P, there were 25 males and 27 females, aged (72.18±4.14) years, and the number of cervical, thoracic and lumbar fractures were 12, 22 and 18, respectively. In group R, there were 26 males and 26 females, aged (72.37±4.21) years old. The number of cervical, thoracic and lumbar fractures were 11, 25 and 16, respectively. Group P was given propofol anesthesia, and group R was given remifentanil combined with propofol anesthesia. Hemodynamic parameters [heart rate (HR), mean arterial pressure (MAP), blood oxygen saturation (SpO₂)] and stress levels (epinephrine, cortisol) were monitored and recorded at four time points: upon entry (T0), 5 minutes after anesthesia (T1), 60 minutes after anesthesia (T2), and at the end of the surgery (T3). Pain levels and cognitive function were compared between the two groups preoperatively, 1 day postoperatively, and 3 days postoperatively, as well as the incidence of complications. Statistical analysis was performed using χ² test and t test. Results　(1) At time points T0 to T3, MAP in the P group was (96.23±11.06, 75.38±7.24, 73.35±6.24, 77.42±6.16) mmHg(1 mmHg=0.133 kPa), while in the R group it was (96.74±10.75, 80.34±8.02, 83.24±9.78, 82.34±10.13) mmHg; the HR in the P group were (80.42±9.13, 76.34±9.35, 70.24±10.04, 72.73±8.92) beats/min, and in the R group they were (79.36±9.41, 74.82±7.23, 73.93±7.34, 76.37±9.06) beats/min. Both groups showed a significant decrease in MAP and HR from T1 to T3 compared to T0, with the R group maintaining higher MAP at T1 to T3 and higher heart rates at T2 and T3 than the P group (all P<0.05). There were no statistically significant differences in SpO₂ at different time points between the two groups (all P>0.05).(2) At time points T0 to T3, adrenaline levels in the P group were (12.43±1.63, 18.02±1.45, 18.24±1.44, 14.31±1.12) ng/L, and in the R group they were (12.24±1.84, 15.36±1.38, 15.73±1.27, 13.19±1.33) ng/L; cortisol levels in the P group were (3.26±1.25, 4.62±1.23, 5.78±1.32, 4.31±1.23) nmol/L, and in the R group they were (3.32±1.24, 3.86±0.73, 4.31±1.16, 3.87±0.73) nmol/L. Levels of adrenaline and cortisol significantly increased from T1 to T3 in both groups, with the R group having lower levels of both epinephrine and cortisol at T1 to T3 compared to the P group (all P<0.05). (3) Preoperatively, and on postoperative days 1 and 3, the Visual Analog Scale (VAS) scores in the P group were (5.83±0.93, 3.86±0.74, 2.34±0.58) points, while in the R group they were (5.87±1.01, 2.79±0.82, 1.33±0.45) points; the Mini-Mental State Examination (MMSE) scores in the P group were (27.91±0.42, 28.32±0.46, 28.75±0.63) points, and in the R group they were (27.78±0.45, 28.52±0.51, 29.11±0.45) points. The VAS scores significantly decreased and MMSE scores significantly increased on postoperative days 1 and 3 in both groups, with the R group performing better than the P group (all P<0.05).(4) The total incidence of adverse reactions in the P group was 32.69% (17/52), compared to 26.92% (14/52) in the R group, with no statistically significant difference (χ²=0.414, P=0.520). Conclusion　Remazolam combined with propofol can better maintain hemodynamic stability, reduce stress response, and help improve early postoperative pain and cognitive function recovery in elderly patients with spinal fracture during the perioperative period, and the incidence of complications is not significantly increased. It is a safe and effective anesthesia strategy.

Basic Research

Research on the anti-hepatic fibrosis effect of caffeic acid phenethyl ester via the TGF-β1/Smad3 pathway

Yang Ning, Wang Ruiping, Zhang Yami, Li Yaping, Dang Shuangsuo

2025, 31(15):  2497-2502.  DOI: 10.3760/cma.j.cn441417-20250317-15007

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Objective　To investigate the effects of caffeic acid phenethyl ester (CAPE) on the activation of hepatic stellate cells (HSCs), extracellular matrix deposition, and to explore the anti-hepatic fibrosis effects and molecular mechanisms of CAPE through the TGF-β1/Smad3 pathway. Methods　The experiment was conducted on the innovation platform of Shaanxi University of Traditional Chinese Medicine from September 2021 to September 2022. Based on preliminary animal experiment results, 35 male Sprague-Dawley (SD) rats were selected and divided into a blank control group (10 rats), a carbon tetrachloride (CCl₄) model group(15 rats), and a CAPE intervention group(10 rats), with an average body weight of (254.50±16.22) g. After 10 weeks of intervention, subsequent experiments were conducted. Electron microscopy was used to observe liver tissue, and HE, Masson, elastic fiber, and reticular fiber staining were performed to assess pathological changes in liver tissue. Real-time polymerase chain reaction (real-time PCR), immunohistochemistry, and Western blotting were used to detect the expression levels of α-smooth muscle actin (α-SMA), type I collagen (Collagen I), transforming growth factor β1 (TGF-β1), p-Smad3, tissue inhibitor of metalloproteinases 1 (TIMP1), and matrix metalloproteinase 2 (MMP2) mRNA and protein levels in liver tissue. Statistical analysis was performed using one-way ANOVA and Dunnett's t test. Results　Electron microscopy revealed that in the CAPE intervention group, cell structures were intact, and no clustered proliferative cell myofibrils were observed. Staining results from HE, Masson, elastic fibers, and reticular fibers showed that collagen levels in the liver tissue of the CAPE intervention group were reduced compared to the CCl₄ model group. Immunohistochemical staining results indicated that the expression levels of Collagen I, α-SMA, TGF-β1, and p-Smad3 in liver tissue were significantly increased in the CCl₄ model group compared to the blank control group (all P<0.05), while CAPE intervention significantly reduced their expression levels in liver tissue (all P<0.05). Western-blot and real-time PCR results were consistent. However, MMP2 showed opposite results in mRNA and protein expression. Conclusion　CAPE can significantly improve liver pathological damage caused by CCl₄ combined factors and reverse the progression of liver fibrosis. CAPE may exert its anti-fibrotic effects by inhibiting the activation of HSCs and collagen formation, regulating the TIMP1/MMP2 balance, and downregulating the expression of the TGF-β1/Smad3 signaling pathway.

The effects of Danggui Shaoyao San on the uterine immune microenvironment and Th17/Treg cell balance in mice with recurrent spontaneous abortion

Shao Ying, Ma Yannan, Du Yuxia, Hu Na

2025, 31(15):  2503-2507.  DOI: 10.3760/cma.j.cn441417-20250324-15008

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Objective　To investigate the effects of Danggui Shaoyao San (DSS) on the uterine immune microenvironment and the balance of T helper 17 (Th17) cells and regulatory T (Treg) cells in a mouse model of recurrent abortion (RA). Methods　CBA/J female mice were paired with DBA/2 male mice (8-10 weeks old) to establish the RA model. Successful model mice were divided into the RA group and three treatment groups: L-DSS, M-DSS, and H-DSS , with 10 mice in each group. Another CBA / J female mice were paired with BALB / c male mice ( 8-10 weeks old ) to establish a normal pregnancy model, and 10 were taken as the control group. L-DSS, M-DSS and H-DSS groups were given 6.11, 12.22 and 24.44 g/kg DSS by gavage once a day for 14 consecutive days, respectively. Control group and RA group were given the same amount of distilled water by gavage. Pregnancy outcomes were observed in all groups; organ coefficients of the mice's uteri were calculated; HE staining was performed to observe pathological changes in the uterine tissues; levels of interleukin (IL)-17A and tumor necrosis factor alpha (TNF-α) in the blood were detected using ELISA; and the proportions of Th17 and Treg cells, as well as the Th17/Treg ratio, were analyzed using flow cytometry. Statistical methods included Fisher's exact probability method, one-way ANOVA, and SNK-q test. Results　The control group exhibited intact and normal morphology of the endometrium, the number of decidual cells is large; the RA group showed thinning and rupture of the endometrium, with reduced numbers of decidual cells, abnormal vascularity, and evidence of inflammatory cell infiltration. The L-DSS, M-DSS, and H-DSS groups exhibited sequential thickening of the endometrium, increased numbers of decidual cells, and decreased inflammatory cells. The embryo loss rate, IL-17A, TNF-α, Th17 cell proportion, and Th17/Treg ratio in the RA group were all higher than those in the Control group [48.61% (35/72) vs. 6.90% (6/87), (186.92±19.05) ng/L vs. (74.25±15.40) ng/L, (270.57±28.37) ng/L vs. (153.28±24.29) ng/L, (1.19±0.14)% vs. (0.36±0.10)%, 1.64±0.17 vs. 0.10±0.03], while the uterine organ coefficient and Treg cell proportion were lower than those in the Control group [(5.87±1.44)% vs. (10.74±1.83)%, (0.72±0.19)% vs. (3.25±0.33)%], with all differences being statistically significant (all P<0.05). The embryo loss rate, IL-17A, TNF-α, Th17 cell proportion, and Th17/Treg ratio in the L-DSS, M-DSS, and H-DSS groups were lower than those in the RA group, while the uterine organ coefficients and Treg cell proportions were higher than those in the RA group (all P<0.05). Conclusion　DSS can modulate the uterine immune microenvironment and the Th17/Treg cell balance in RA mice, improving pregnancy outcomes.

Literature Analysis

Expression of autophagy-related genes in synovial tissues of patients with osteoarthritis and establishment of regulatory network

Dong Qiang, Yu Hongchao, Feng Wei

2025, 31(15):  2508-2514.  DOI: 10.3760/cma.j.cn441417-20250311-15009

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Objective　This study aims to analyze the potential mechanisms of autophagy-related genes (ATGs) in osteoarthritis using genomics and bioinformatics methods, providing a reference for its prevention and treatment. Methods　Public datasets GSE55457, GSE55235, and GSE1919 submitted between November 2, 2004, and February 28, 2014, were retrieved. Data preprocessing was conducted using the online software Network Analyst, followed by the selection of differentially expressed genes (Log₂Fold Change>2, Adjusted P-value<0.05) to identify common differentially expressed genes between ATGs and osteoarthritis. Biological function and pathway enrichment analysis were performed using the online analysis software String. Cytoscape 3.7.2 was employed to establish protein-protein interaction (PPI) networks, specific ATG PPI networks, ATG-microRNA regulatory networks, transcription factor (TF)-ATG regulatory networks, and environmental chemical-ATG regulatory networks. Results　ATGs in osteoarthritis (OA) showed significant changes, with a total of 106 differentially expressed autophagy-related genes identified (OA-AT-DEGs), including 43 upregulated (40.57%) and 63 downregulated (59.43%). Enrichment analysis indicated that ATGs are mainly involved in biological processes related to defense responses against viral infections. The OA-AT-DEGs and specific PPI networks revealed that UBC, MAPK1, and RPS6KB1 are important core nodes in the OA-AT-DEGs-related PPI network. The microRNA-OA-AT-DEGs interaction network showed that 21 microRNAs have regulatory interactions with OA-AT-DEGs. Among these, hsa-miR-16-5P has a targeting interaction with 8 OA-AT-DEGs, indicating that genes such as BCL2 and CDKN1A are regulated by TF. Additionally, ATGs interact with environmental chemicals such as estradiol and valproate. Conclusion　The gene expression pattern of patients with osteoarthritis has changed significantly, and proteins or genes such as UBC and RPS6KB1 may play an important role in the defense immune mechanism. Micro-RNA, TF, signaling pathway molecules, environmental chemicals and specific genes also play a role in the above process, providing new insights for studying the impact of autophagy genes on osteoarthritis and for developing clinical prevention, diagnosis, and treatment strategies.

Treatises

Analysis of the current status of cardiac function and influencing factors among inpatients in the coronary care unit of a tertiary hospital

Hao Chaofan, Ye Famin

2025, 31(15):  2515-2519.  DOI: 10.3760/cma.j.cn441417-20241021-15010

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Objective　To investigate the current status of cardiac function among inpatients in the coronary care unit (CCU) of a tertiary hospital, and to analyze the influencing factors of cardiac function recovery. Methods　A retrospective analysis was conducted on 200 inpatients admitted to the CCU of Fuwai Central China Cardiovascular Hospital from June 2022 to June 2024. According to the New York cardiac function classification, patients with grade I to II were classified as a good cardiac function group, a total of 56 cases (28.00%); patients with grade III to IV were classified as a poor cardiac function group, a total of 144 cases (72.00%). The general information, laboratory indicators, and cardiac function indicators of the two groups were compared. Logistic regression analysis was used to explore the influencing factors of cardiac function recovery in patients with coronary heart disease. Statistical analysis was conducted using independent sample t test and χ² test. Results　In the good cardiac function group, there were 27 males and 29 females, with an age of (62.42±5.46) years old; in the poor cardiac function group, there were 75 males and 69 females, with an age of (62.58±5.32) years old. There were statistically significant differences between the two groups in terms of the proportions of hypertension, hyperlipidemia, diabetes, and cerebrovascular diseases, the length of stay in CCU, the number of hospitalizations in the last 1 year, the presence of heart failure, and the Eastern Cooperative Oncology Group (ECOG) performance status score (all P<0.05); while there was no statistically significant difference in terms of gender, age, or body mass index (all P>0.05). There were statistically significant differences in the levels of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), free triiodothyronine (FT3), and thyroid-stimulating hormone (TSH) between the two groups (all P<0.05); while there was no statistically significant difference in the level of total cholesterol (TC), triglycerides (TG), red blood count (RBC), white blood count (WBC), platelet count (PLT), or free thyroxine (FT4) (all P>0.05). There were statistically significant differences in the left atrial diameter (LAD), left ventricular diameter (LVD), right atrial diameter (RAD), and right ventricular diameter (RVD) between the two groups (all P<0.05). Logistic regression analysis indicated that hypertension, length of stay in CCU, number of hospitalizations in the last 1 year, presence of heart failure, LAD, LVD, RAD, and RVD were independent risk factors for cardiac function recovery (all P<0.05). Conclusions　Hypertension, length of stay in CCU, number of hospitalizations in the last 1 year, presence of heart failure, LAD, LVD, RAD, and RVD are positively correlated with the cardiac function among patients hospitalized in the CCU, which are independent risk factors affecting the recovery of cardiac function. The mastery of the independent risk factors of coronary heart disease has an important guiding role in the treatment of this disease.

Value of total cholesterol/high-density lipoprotein cholesterol ratio in predicting the prognosis of elderly patients with acute myocardial infarction after PCI

You Yuwei, Cao Xiaomei, Liu Zhongli

2025, 31(15):  2520-2525.  DOI: 10.3760/cma.j.cn441417-20250331-15011

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Objective　To investigate the predictive efficacy of total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) ratios on the prognosis of elderly patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods　A retrospective analysis was conducted on the clinical data of 231 AMI patients admitted to Laiyang Central Hospital from January 2020 to January 2024. Patients were divided into the major adverse cardiovascular events (MACE) group (48 cases) and the non-MACE group (183 cases) based on the occurrence of MACE one year after PCI. In the MACE group, there were 37 males and 11 females, aged 63 (63, 68) years; in the non-MACE group, there were 156 males and 27 females, aged 65 (62, 67) years. Baseline data for the patients were collected, and receiver operating characteristic (ROC) curves and Kaplan-Meier curves were drawn to analyze the application value of the TC/HDL-C ratio in predicting MACE after PCI in AMI patients. A Cox regression model was established to analyze the influencing factors for MACE occurrence after PCI. Statistical analyses were performed using the Mann-Whitney U test, χ² test, and t test. Results　The TC/HDL-C ratio in the MACE group was higher than that in the non-MACE group (4.65±0.99 vs. 3.43±0.84), with a statistically significant difference (t=8.579, P<0.001). The area under the curve (AUC) for the TC/HDL-C ratio in predicting MACE after PCI in AMI patients was 0.823 (95% confidence interval 0.768–0.870), with a cutoff value of 3.96, sensitivity of 79.17%, and specificity of 71.58%. Elevated fibrinogen and TC/HDL-C ratios were identified as independent risk factors for MACE after PCI in AMI patients, while an increased left ventricular ejection fraction was a protective factor (all P<0.05). Based on the ROC cutoff value (3.96), patients were divided into a high TC/HDL-C group (>3.96, 90 cases) and a low TC/HDL-C group (≤3.96, 141 cases). The incidence of MACE in the high TC/HDL-C group was significantly higher than that in the low TC/HDL-C group [42.22% (38/90) vs. 7.09% (10/141)] (χ²=41.185, P<0.001). Conclusion　The TC/HDL-C ratio is significantly increased in patients with MACE after PCI, which is an independent risk factor for MACE in AMI patients after PCI. Our finding provides new ideas for the clinical diagnosis and treatment of AMI.

Effect of atorvastatin combined with Alirocumab injection on blood lipid indexes in patients with coronary heart disease

Du Xiaoyan, Yan Huili, Han Jianlun, Yu Mengmeng

2025, 31(15):  2525-2529.  DOI: 10.3760/cma.j.cn441417-20250306-15012

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Objective　To investigate the effect of atorvastatin combined with PCSK9 inhibitor Alirocumab injection on blood lipid metabolism in patients with coronary heart disease. Methods　A total of 102 patients with coronary heart disease admitted to the Cardiology Department of the First Hospital of Yulin from November 2023 to October 2024 were collected. They were divided into two groups according to the random number table method: a control group and a combined group, with 51 cases in each group. In the control group, there were 25 males and 26 females, with an age of (56.37±6.08) years old, 11 cases of cardiac function grade II, 31 cases of grade III, and 9 cases of grade IV. In the combined group, there were 22 males and 29 females, with an age of (57.81±6.71) years old, 12 cases of cardiac function grade II, 28 cases of grade III, and 11 cases of grade IV. The control group received atorvastatin intervention, 20 mg per night, for 3 months. The combined group received Alirocumab injection intervention on the basis of the control group, subcutaneous injection, 75 mg per dose, once every 2 weeks, for a total of 3 months. Serum lipid metabolism indexes [high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglyceride (TG), and total cholesterol (TC)], carotid atherosclerosis plaques [carotid intima-media thickness (IMT) and plaque Crouse score], levels of inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and high mobility group protein (HMGB1)] before and after intervention, and the occurrence of adverse reactions were compared between the two groups. Statistical analysis was conducted using independent sample t test, paired t test, and χ² test. Results　After intervention, the level of HDL-C [(1.82±0.26) mmol/L] in the combined group was higher than that in the control group (P<0.05); the levels of LDL-C [(1.57±0.20) mmol/L], TG [(1.31±0.15) mmol/L], and TC [(2.43±0.42) mmol/L] were all lower than those in the control group (all P<0.05). After intervention, the IMT [(0.89±0.04) mm], plaque Crouse score [(1.84±0.35) points], TNF-α [(3.21±0.73) μg/L], HMGB1 [(2.09±0.68) mg/L], and IL-6 [(16.52±2.30) ng/L] in the combined group were all lower than those in the control group (all P<0.05). The incidence of adverse reactions in the combined group [3.92% (2/51)] was lower than that in the control group (P<0.05). Conclusion　Atorvastatin combined with PCSK9 inhibitor Alirocumab injection in the treatment of coronary heart disease can effectively improve the blood lipid metabolism, eliminate the carotid atherosclerotic plaques, alleviate the inflammatory reaction, and reduce the complications.

Short-term clinical efficacy of unilateral biportal endoscopic nerve root release surgery in the treatment of lumbar spinal stenosis

Li Yifeng, Liu Chen

2025, 31(15):  2529-2533.  DOI: 10.3760/cma.j.cn441417-20250217-15013

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Objective　To investigate the short-term clinical efficacy of unilateral biportal endoscopic (UBE) nerve root release surgery in the treatment of lumbar spinal stenosis. Methods　A total of 18 patients with lumbar spinal stenosis who were admitted to the First Affiliated Hospital of Wannan Medical College from May to November 2023 were included. Among them, there were 9 males and 9 females, with ages ranging from 36 to 76 (52.78±8.98) years old, and the affected segments were L3/4 in 1 case, L4/5 in 9 cases, and L5/S1 in 8 cases. All the patients underwent UBE nerve root release surgery. The Visual Analogue Scale (VAS) scores of low back pain and leg pain and Oswestry Disability Index (ODI) before surgery, on the first day after surgery, and at the last follow-up were compared; the clinical efficacy at the last follow-up was evaluated using the MacNab scoring system. Statistical analysis was conducted using analysis of variance and Dunnett's T3 multiple comparison method. Results　All 18 patients successfully completed the surgery without any complication during or after surgery. The surgical duration ranged from 35 to 130 (75.17±24.21) minutes, the postoperative hospital stay was 1 to 8 (2.22±1.59) days, and the follow-up period was 13 to 18 (16.00±1.81) months. On the first day after surgery, there was no statistically significant difference in the VAS score of lower back pain compared to the preoperative score (P>0.05); the VAS score of lower back pain at the last follow-up was lower than that before surgery and on the first day after surgery, with statistically significant differences (both P<0.05). The VAS scores of leg pain and ODIs on the first day after surgery and at the last follow-up were all improved compared to those before surgery (all P<0.05). At the last follow-up, the clinical efficacy was evaluated using the MacNab score: excellent in 15 cases, good in 1 case, and fair in 2 cases, with an excellent and good rate of 88.89% (16/18). Conclusion　UBE nerve root release surgery for lumbar spinal stenosis can achieve satisfactory clinical efficacy, providing another minimally invasive surgical option for lumbar spinal stenosis, and is conducive to the patients' rapid rehabilitation.

Clinical risk assessment of prognosis after decompression surgery for T10-L2 incomplete burst thoracolumbar vertebral fractures with spinal canal invasion

Shi Liang, Zhao Junfeng, Zhou Hailong, Duan Liang, Chang Yanhai, Hao Yuanyuan

2025, 31(15):  2534-2539.  DOI: 10.3760/cma.j.cn441417-20240906-15014

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Objective　To explore the influencing factors of prognosis after decompression surgery for T10-L2 incomplete burst thoracolumbar vertebral fractures with spinal canal invasion. Methods　A total of 122 patients with spinal canal invasion type T10-L2 incomplete burst thoracolumbar vertebral fractures who were treated in Shaanxi Provincial People's Hospital from January 2021 to January 2024 were selected. Among them, there were 67 males and 55 females; 73 cases were under 60 years old and 49 cases were 60 years old or above. All patients were followed up for 6 months after surgery to analyze the prognosis. The differences in clinical data between poor prognosis and good prognosis patients were compared by independent sample t test or χ² test. Logistic regression analysis was used to identify the influencing factors of poor prognosis. A nomogram model was constructed and its value in predicting poor prognosis was analyzed. Results　All 122 patients successfully completed the surgery and were followed up for 6 months after surgery, including 28 patients with poor prognosis and 94 patients with good prognosis. The proportions of age ≥60 years old, osteoporosis, and Thoracolumbar Injury Classification and Severity Score (TLICS) ≥8 points in the poor prognosis group were 64.29% (18/28), 46.43% (13/28), and 71.43% (20/28), which were higher than those in the good prognosis group (all P<0.05); there was no statistically significant difference in the gender, body mass index, hypertension, diabetes, injured vertebra position, time from injury to admission, compression rate of the injured vertebra, or Cobb angle between the poor prognosis group and the good prognosis group (all P>0.05). Logistic regression analysis showed that age, osteoporosis, and TLICS were risk factors for poor prognosis in patients (all P<0.05). A nomogram model for predicting poor prognosis was constructed based on age, osteoporosis, and TLICS. The area under the curve of the nomogram model for predicting poor prognosis was 0.917 (95%CI: 0.866 - 0.969), P<0.05, with a sensitivity of 90.00% and a specificity of 77.50%. Conclusions　The prognosis of T10-L2 incomplete burst thoracolumbar vertebral fractures with spinal canal invasion after decompression surgery is influenced by the patients' age, osteoporosis, and TLICS. The constructed nomogram model based on these factors has a good predictive value for the patients' prognosis.

Clinical efficacy of vertebroplasty and pedicle screw fixation combined with microwave ablation in the treatment of spinal metastases

Huang Yunfei, Du Jinpeng, Yang Xiaobin, He Baorong, Li Xiaoju, Zhang Nan

2025, 31(15):  2539-2543.  DOI: 10.3760/cma.j.cn441417-20250217-15015

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Objective　To investigate the clinical efficacy of vertebroplasty and pedicle screw fixation combined with microwave ablation in the treatment of spinal metastases. Methods　A retrospective analysis was conducted on the clinical data of 80 patients with spinal metastases who were admitted to Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2022 to December 2023. The patients were divided into a control group (38 cases) and an observation group (42 cases) based on the different surgical methods. In the control group, there were 25 males and 13 females, with an age of (64.78±7.90) years old and a disease duration of (5.32±1.60) months; in the observation group, there were 28 males and 14 females, with an age of (65.71±9.55) years old and a disease duration of (5.51±1.24) months. The control group was treated with percutaneous vertebroplasty, and the observation group was treated with vertebroplasty and pedicle screw fixation combined with microwave ablation. The general data, perioperative indicators, follow-up results, and postoperative complications of the two groups were statistically analyzed. Statistical analysis was conducted using independent sample t test and χ² test. Results　The operation time [(125.69±16.48) minutes], ambulation time [(1.83±0.42) days], and hospitalization time [(11.33±2.70) days] in the observation group were all longer than those in the control group, and the intraoperative blood loss [(271.87±31.56) ml] and the amount of bone cement [(4.55±1.13) ml] were also greater than those in the control group (all P<0.05). The Visual Analogue Scale (VAS) score [(1.18±0.34) points] and the Eastern Cooperative Oncology Group (ECOG) score [(1.07±0.53) points] in the observation group at 6 months after surgery were both lower than those in the control group (both P<0.05). Conclusion　Vertebroplasty and pedicle screw fixation combined with microwave ablation for the treatment of spinal metastases can effectively improve the long-term pain and functional status, which is worthy of clinical promotion.

Efficacy of sofosbuvir/velpatasvir with or without glecaprevir in the treatment of genotype 3 chronic hepatitis C

Gao Ni, Cao Dan, Gao Yunfei

2025, 31(15):  2544-2548.  DOI: 10.3760/cma.j.cn441417-20250319-15016

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Objective　To evaluate the efficacy of sofosbuvir/velpatasvir (SOF/VEL) with or without glecaprevir in the treatment of genotype 3 chronic hepatitis C (CHC). Methods　A total of 236 patients with genotype 3 CHC who were treated at the First Hospital of Yulin from June 2019 to December 2021 were selected, including 121 males and 115 females, with an age of (56.93±19.11) years old, 155 cases of CHC and 81 cases of hepatitis C virus compensated cirrhosis (HCV-CLC). All patients were treated with SOF/VEL (400 mg SOF/100 mg VEL once daily) with or without glecaprevir (100 mg once daily) for 12 consecutive weeks. The changes in the examination indicators were compared between the two groups at baseline, the 4th week of treatment, the 12th week of treatment, and the 12th week after drug withdrawal. Statistical analysis was conducted using independent sample t test, paired t test, Mann-Whitney U test, and χ² test. Results　The response rates of the CHC group at the 4th week of treatment, the 12th week of treatment, and the 12th week after drug withdrawal were 36.13% (56/155), 87.10% (135/155), and 94.84% (147/155), and those of the HCV-CLC group were 13.58% (11/81), 44.44% (36/81), and 67.90% (55/81), with statistically significant differences (all P<0.05). In the CHC group, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) at the 4th week of treatment, the 12th week of treatment, and the 12th week after drug withdrawal were 35 (31, 55) U/L, 57 (30, 78) U/L, 123 (109, 166) U/L, 27 (23, 50) U/L, 37 (25, 45) U/L, 84 (50, 115) U/L, 15 (11, 33) U/L, 18 (10, 36) U/L, and 43 (45, 76) U/L, and there were statistically significant differences compared with those at baseline [75 (40, 100) U/L, 84 (63, 111) U/L, and 196 (144, 238) U/L] (all P<0.05). In the HCV-CLC group, the levels of ALT, AST, and ALP at the 4th week of treatment, the 12th week of treatment, and the 12th week after drug withdrawal were 42 (22, 50) U/L, 56 (46, 67) U/L, 147 (120, 160) U/L, 27 (20, 41) U/L, 33 (16, 40) U/L, 82 (70, 125) U/L, 21 (15, 23) U/L, 18 (13, 25) U/L, and 60 (44, 77) U/L, and there were statistically significant differences compared with those at baseline [73 (42, 110) U/L, 87 (57, 106) U/L, and 196 (155, 257) U/L] (all P<0.05). The liver stiffness values of the CHC group at the 4th week of treatment, the 12th week of treatment, and the 12th week after drug withdrawal were (8.87±1.52) kPa, (5.52±1.72) kPa, and (5.10±1.64) kPa, and there were statistically significant differences compared with that at baseline [(12.70±2.94) kPa] (all P<0.05). The liver stiffness values of the HCV-CLC group at the 4th week of treatment, the 12th week of treatment, and the 12th week after drug withdrawal were (14.62±4.57) kPa, (8.86±2.75) kPa, and (5.46±1.81) kPa, and there were statistically significant differences compared with that at baseline [(25.61±6.46) kPa] (all P<0.05). The liver stiffness value in the CHC group was lower than that in the HCV-CLC group at baseline, the 4th week of treatment, and the 12th week of treatment (all P<0.05), but there was no statistically significant difference in the liver stiffness value between the two groups at the 12th week after drug withdrawal (P>0.05). Conclusion　SOF/VEL with or without glecaprevir has significant efficacy in the treatment of CHC patients.

Clinical Research

A study on the relationships between maternal-infant factors and neonatal hyperbilirubinemia using Lasso regression model and preventive strategies

Zhang Yu, Yuan Xue, Yang Yunfan, Zhou Zhizhao

2025, 31(15):  2544-2548.  DOI: 10.3760/cma.j.cn441417-20250319-15016

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Objective　To investigate the relationships between maternal-infant factors and neonatal hyperbilirubinemia by Lasso regression model, and explore its preventive measures. Methods　A retrospective analysis was conducted on the medical records of 200 pregnant women and their newborns in Yangling Demonstration Zone Hospital from January to December 2023. Among the pregnant women, there were 113 primiparas and 87 multiparas, the age ranged from 23 to 40 (31.42±5.64) years old. Among the newborns, there were 105 boys and 95 girls; the birth weight ranged from 1 511 to 4 035 (2 506.50±1 019) g. All newborns were divided into an occurrence group (108 cases) and a non-occurrence group (92 cases) by the results of hyperbilirubinemia. The baseline data of pregnant women and newborns (such as number of deliveries, delivery methods, gestational age, birth weight, etc.) of two groups were collected. Lasso regression was used to select variables, and then logistic regression analysis was used to identify the risk factors influencing the occurrence of hyperbilirubinemia in newborns. R language was used to establish a nomogram prediction model and the efficiency of the prediction model was analyzed. Statistical analysis was conducted using the χ² test and independent sample t test. Results　After conducting a single-factor screening of the 22 most representative risk factors that affected the occurrence of hyperbilirubinemia in newborns, and analyzing 22 variables using Lasso regression and completing ten-fold cross-validation, it was found that a total of 11 variables were selected when λ = 0.035 090. The obtained variables were included in the multivariate logistic regression analysis. The results showed that cesarean section (OR = 2.217), blood type incompatibility of mother and infant (OR = 2.863), gestational age < 34 weeks (OR = 1.842), and onset time of neonatal jaundice < 24 h (OR = 1.799) were risk factors for neonatal hyperbilirubinemia (all P<0.05). In addition, Bootstrap method (B=1000) was used to verify the model. The area under the curve (AUC) of the predicted model was 0.833, 95%CI 0.779 - 0.887. The mean absolute error and mean square error of the calibration curve were 0.033 and 0.001 42. There was no statistically significant difference between the actual and predicted values (χ²= 5.407, P=0.713). The net benefit rate of the decision curve analysis (DCA) curve was good. Conclusions　Maternal and infant factors such as delivery modes, incompatibility of blood group, gestational age, and onset time of neonatal jaundice may increase the risk of neonatal hyperbilirubinemia. Clinical intervention can be strengthened to reduce the risk of neonatal hyperbilirubinemia.

A comparative study on visual quality after SMILE and FS-LASIK

Du Qingwei, Zhong Wenjin, Li Mei, Yang Linsheng, Ma Tian

2025, 31(15):  2556-2561.  DOI: 10.3760/cma.j.cn441417-20241218-15018

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Objective　To explore the differences in visual quality, dry eye parameters, and corneal biomechanics after femtosecond laser keratomileusis (FS-LASIK) and femtosecond laser small incision stroma lens extraction (SMILE). Methods　This study retrospectively selected 50 patients (100 eyes) with myopia and astigmatism who visited the Ophthalmology Refractive Center of the First Affiliated Hospital of Xi'an Medical University from January 2021 to January 2024. These patients were divided into a SMILE group and a FS-LASIK group, with 25 cases (50 eyes) in each group according to the surgical methods. In the SMILE group, there were 11 males and 14 females; the age ranged from 18 to 49 (26.84±7.57) years old; the preoperative spherical equivalent (SE) was (-5.42±1.51) D; the preoperative corneal resistance factor (CRF) was (9.56±1.67) mmHg (1 mmHg = 0.133 kPa); the preoperative corneal hysteresis (CH) was (9.61±1.42) mmHg. In the FS-LASIK group, there were 10 males and 15 females; the age ranged from 19 to 47 (26.56±7.68) years old; the preoperative SE was (-5.51±1.62) D; the preoperative CRF was (9.54±1.64) mmHg; the preoperative CH was (9.59±1.45) mmHg. The follow-up time points were 1 week, 1 month, 3 months, and 6 months after surgery. The visual quality (naked vision, SE, total high-order aberrations, and visual quality scale score), dry eye parameters [tear meniscus height and tear film break-up time (TBUT)], and corneal biomechanics [change in corneal resistance factor (ΔCRF) and change in corneal hysteresis (ΔCH)] were compared between the two groups at different time points. Statistical analysis was conducted using the χ² test, t test, and repeated measures analysis of variance. Results　①Repeated measures analysis of variance showed that the differences in time point effects of the comparison of naked eyesight, SE, and total high-order aberration between the two groups were statistically significant (F _{time point} =261.094, 221.946, and 35.371, all P<0.05); one week after surgery, the naked eye visual acuity (-0.01±0.03) and SE [(-0.24±0.29) D] in the FS-LASIK group were better than those in the SMILE group [0.03±0.01 and (-0.33±0.31) D] (both P<0.05). ②Repeated measures analysis of variance showed that the differences in time point effects of the comparison of the two groups of tear meniscus height and TBUT (F _{time point} = 27.699 and 5.251), between group effects (F _{between groups} = 21.767 and 9.314), and interaction effects (F _interaction = 3.832 and 3.651) were statistically significant (all P<0.05); the tear meniscus height [(0.27±0.04) mm and (0.28±0.03) mm] and TBUT [(12.81±3.51) s and (13.15±4.06) s] of the SMILE group were higher than those of the FS-LASIK group at 3 and 6 months after surgery [tear meniscus height: (0.23±0.05) mm and (0.24±0.03) mm, and TBUT: (10.95±3.69) s and (11.13±3.78) s], with statistically significant differences (all P<0.05). ③Repeated measures analysis of variance showed that ΔCH and ΔCRF of the two groups had an inter-group effect (F _{between groups} =92.007 and 37.760, both P<0.05); the ΔCH [(1.39±0.42), (1.25±0.38), (1.29±0.35), and (1.32±0.31) mmHg] and ΔCRF [(2.58±0.87), (2.37±0.91), (2.41±0.88), and (2.39±0.79) mmHg] in the SMILE group at 1 week, 1 month, 3 months, and 6 months after surgery were all smaller than those in the FS-LASIK group [ΔCH: (1.76±0.61), (1.73±0.58), (1.87±0.56), and (1.89±0.61) mmHg, ΔCRF: (2.94±0.89), (2.93±0.84), (3.01±0.95), and (2.98±0.81) mmHg] (all P<0.05). Conclusions　The visual quality recovery of SMILE and FS-LASIK is equivalent, and the dry eye parameters have different degrees of decline compared with preoperatively, which affect the corneal biomechanical stability; while the early visual quality recovery of SMILE is slower than that of FS-LASIK. However, 3 months and 6 months after SMILE, the dry eye parameters are better than FS-LASIK, and SMILE has a smaller effect on corneal biomechanics.

Predictive values of cardiac MRI-derived left atrial strain parameters for HFpEF in patients with CKD

Li Li, Zheng Jianmin, Li Jian, Xiang Xinglin, Zhang Ying

2025, 31(15):  2562-2567.  DOI: 10.3760/cma.j.cn441417-20240621-15019

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Objective　To investigate the predictive values of cardiac MRI-derived left atrial strain parameters for heart failure with preserved ejection fraction (HFpEF) in patients with chronic kidney disease (CKD). Methods　A retrospective analysis was conducted on 130 patients with CKD and HFpEF admitted to Xi'an Fengcheng Hospital from May 2020 to January 2024, who were included in the observation group, including 82 males and 48 females, with an age of (46.97±10.21) years old. Another 100 patients with CKD during the same period were selected and included in the control group, including 60 males and 40 females, with an age of (48.02±11.67) years old. Both groups underwent cardiac MRI and MRI speckle tracking analysis to obtain indicators such as left atrial stiffness index (LASI) and left atrial filling index (LAFI). The general data of both groups were collected. Pearson correlation analysis was used to evaluate the correlations between LASI, LAFI and the levels of cardiac troponin T (cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). The predictive values of LASI and LAFI for HFpEF in CKD patients were assessed through the receiver operating characteristic curve (ROC). Statistical analysis was conducted using the χ² test, independent sample t test, and rank sum test. Results　There were statistically significant differences between the two groups in terms of systolic blood pressure, diastolic blood pressure, hypertension, diabetes, cTnT, NT-proBNP, urea, creatinine, and estimated glomerular filtration rate (eGFR) (all P<0.05). The LASI and LAFI values in the observation group were higher than those in the control group [0.66 (0.44, 0.94) vs. 0.21 (0.16, 0.31), 2.95 (1.89, 4.78) vs. 1.75 (1.32, 2.10)], with statistically significant differences (Z = 11.615 and 7.326, both P<0.05). The correlation analysis results showed that LASI and LAFI were positively correlated with the levels of cTnT and NT-proBNP (all P<0.05). The ROC analysis results showed that the areas under the curves of LASI and LAFI in predicting the presence of HFpEF in CKD patients were 0.947 and 0.782, respectively. Conclusion　Cardiac MRI-derived left atrial strain parameters, LASI and LAFI, have predictive values in assessing HFpEF in CKD patients.

Effectiveness of bronchoalveolar lavage in adult severe pneumonia and its impacts on sICAM-1 and IL-6 levels

Chen Xueqian, Lei Lianlian, Zhou Guizhi

2025, 31(15):  2568-2573.  DOI: 10.3760/cma.j.cn441417-20240722-15020

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Objective　To evaluate the efficacy of bronchoalveolar lavage for adult severe pneumonia and its effects on serum levels of soluble intercellular adhesion molecule-1 (sICAM-1) and interleukin-6 (IL-6). Methods　A total of 102 adult patients with severe pneumonia who were admitted to Ankang Hospital of Traditional Chinese Medicine from January 2020 to December 2023 were included. The patients were divided into a control group and a study group using the stratified random sampling method. In the control group, there were 28 males and 23 females; the age ranged from 45 to 70 (58.24±6.53) years old; the body mass index was (24.56±3.21) kg/m²; the disease duration was 7 to 20 (12.48 ± 3.67) days. In the study group, there were 27 males and 24 females; the age ranged from 46 to 69 (57.92±6.28) years old; the body mass index was (24.78±3.15) kg/m²; the disease duration was 8 to 19 (12.35±3.54) days. The control group received treatment with ambroxol hydrochloride injection: 15 mg of ambroxol hydrochloride was mixed with 50 ml of 5% glucose injection and then administered intravenously, lasting for about 30 minutes, twice a day. The study group received additional electronic bronchoalveolar lavage, 1 to 2 times per week. Both groups received treatment for 14 days. The resolution time of clinical symptoms (cough, expectoration, and fever) were compared between the two groups, as well as the serum markers (sICAM-1 and IL-6), respiratory mechanics parameters [airway resistance (RAW), dynamic lung compliance (Cdyn), and work of breathing (WOB)], Clinical Pulmonary Infection Score (CPIS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and the occurrence of adverse reactions (nausea, skin itching, airway bleeding, airway spasm, and diarrhea). Statistical methods used were t test and χ² test. Results　The resolution time for cough, fever, and expectoration in the study group were (2.22±1.11) days, (1.46±0.38) days, and (2.41±0.34) days, which were shorter than those in the control group [(6.45±1.06) days, (2.51±0.57) days, and (5.77±0.82) days], with statistically significant differences (t = 19.682, 10.946, and 27.031; all P<0.05). After 14 days of treatment, the levels of sICAM-1 and IL-6 in the study group were (134.51±28.17) μg/L and (17.41±1.53) μg/L, which were lower than those in the control group [(168.25±35.44) μg/L and (23.20±1.86) μg/L], with statistically significant differences (t = 5.322 and 17.168; both P<0.05). The RAW and WOB values of the study group were (9.71±2.15) cmH₂O/(L·s) (1 cmH₂O = 0.098 kPa) and (0.53±0.09) J/L, which were lower than those of the control group [(11.87±2.68) cmH₂O/(L·s) and (0.65±0.14) J/L]; the Cdyn value was (36.84±4.99) ml/cmH₂O, which was higher than that of the control group [(32.63±4.85) ml/cmH₂O], with statistically significant differences (t = 4.490, 5.149, and 4.321, all P<0.05). The CPIS and APACHE II score of the study group were (3.41±0.83) points and (11.65±2.74) points, which were lower than those of the control group [(4.76±1.21) points and (14.55±3.19) points], with statistically significant differences (t = 6.570 and 4.925; both P<0.05). The incidence of adverse reactions in the study group was 3.92% (2/51), which was lower than that in the control group [13.73% (7/51)], but the difference was not statistically significant (χ²=3.047, P=0.081). Conclusion　Bronchoalveolar lavage can effectively alleviate the clinical symptoms of adult patients with severe pneumonia, reduce the levels of sICAM-1 and IL-6, improve the respiratory mechanics indicators, and lower the CPIS and APACHE II score, demonstrating high safety and tolerance.

Clinical study on the treatment of mild cognitive impairment in elderly patients with type 2 diabetes mellitus with lixisenatide combined with donepezil hydrochloride

Wang Yanchuan, Mi Lan

2025, 31(15):  2573-2577.  DOI: 10.3760/cma.j.cn441417-20250314-15021

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Research on Traditional Chinese Medicine

The effect of Xuefu Zhuyu decoction and Si Junzi decoction combined with nilotinib in the treatment of postoperative patients with non-small cell lung cancer

Ma Xiaohong, Zhang Chen, Wu Anhong

2025, 31(15):  2578-2582.  DOI: 10.3760/cma.j.cn441417-20240927-15022

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Objective　To analyze the effect of Xuefu Zhuyu decoction and Si Junzi decoction combined with nilotinib in the treatment of postoperative patients with non-small cell lung cancer (NSCLC). Methods　A total of 118 postoperative patients with NSCLC who were admitted to Ankang Hospital of Traditional Chinese Medicine from September 2020 to August 2022 were selected as the research subjects. According to the different treatment methods, the patients were divided into the control group (57 cases) and the observation group (61 cases). There were 33 males and 24 females in the control group, aged 19-78 (48.56±4.58) years. There were 34 males and 27 females in the observation group, aged 20-77 (46.84±4.86) years. The control group was treated with nilotinib capsules, while the observation group was treated with the combination of Xuefu Zhuyu decoction and Si Junzi decoction in addition to the treatment of the control group. Both groups were treated continuously for 8 weeks. The therapeutic effects, adverse reactions and long-term outcomes were compared between the two groups, as well as the traditional Chinese medicine symptom scores, quality of life [Karnofsky Performance Status Score (KPS), Functional Assessment of Cancer Therapy-Lung cancer (FACT-L)], immune indicators (CD3+, CD4+, CD8+) before and after treatment. Independent sample t test, paired t test, and χ² test were used for statistical analysis. The survival rate was estimated using the Kaplan-Meier method, and the survival analysis was conducted using the Log-rank χ² test. Results　The disease remission rate and disease control rate in the observation group were both higher than those in the control group [75.41% (46/61) vs. 43.86% (32/57), 88.52% (54/61) vs. 73.68% (42/57)] (both P<0.05). After treatment, the traditional Chinese medicine symptom scores (main symptoms and secondary symptoms) of the observation group were lower than those of the control group (both P<0.05); the KPS score and FACT-L score of the observation group were higher than those of the control group [(79.85±4.58) points vs. (76.52±3.89) points, (83.24±5.63) points vs. (78.29±5.24) points] (both P<0.05); the levels of CD3+ and CD4+ in the observation group were higher than those in the control group [(68.45±4.85)% vs. (64.15±4.28)%, (42.63±4.15)% vs. (40.25±3.89)%], while the level of CD8+ was lower than that in the control group [(20.36±2.47)% vs. (25.03±2.95)%] (all P<0.05). During the treatment period, there was no statistically significant difference in the total incidence of adverse reactions between the two groups (P>0.05). After a 2-year follow-up, 14 patients were lost (5 in the control group and 9 in the observation group) due to lost contact information or changes in their home addresses. The mortality rate in the observation group was lower than that in the control group [11.54% (6/52) vs. 19.23% (10/52)], and the difference was not statistically significant (P>0.05). Conclusion　Xuefu Zhuyu decoction and Si junzi decoction combined with nilotinib has a better therapeutic effect on postoperative NSCLC patients. It can effectively reduce the traditional Chinese medicine syndrome score, improve the quality of life, enhance the immune status of the body, and reduce the mortality rate.

Clinical observation of modified Qingre Jiedu decoction in the treatment of elderly patients with pneumonia

Wang Xuee, Li Chaoran, Tang Huanxin, Huang Jintian, Zhao Yani, Wang Weizu

2025, 31(15):  2583-2587.  DOI: 10.3760/cma.j.cn441417-20240530-15023

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Objective　To investigate the effect of modified Qingre Jiedu decoction in the treatment of elderly patients with pneumonia and the influence on serum soluble interleukin-2 receptor (sIL-2R) and nuclear factor-κB (NF-κB) levels. Methods　From September 2020 to September 2023, 116 elderly patients with pneumonia admitted to Xi'an International Medical Center Hospital were selected for the study. According to the random number table method, they were allocated to the control group (58 cases) and the treatment group (58 cases). In the control group, there were 31 males and 27 females, with an age of (62.35±6.58) years old and a disease duration of (5.75±1.14) days. In the treatment group, there were 33 males and 25 females, with an age of (61.98±6.63) years old and a disease duration of (5.81±1.07) days. The control group was given conventional treatment and the treatment group was treated with modified Qingre Jiedu decoction on the basis (400 ml of the decoction was taken daily, in two divided doses, taken warm in the morning and evening). All the patients were treated for 14 days. The clinical efficacy, traditional Chinese medicine (TCM) syndrome scores, levels of inflammatory factors, sIL-2R, and NF-κB were compared between the two groups. The occurrence of adverse reactions was recorded. Statistical analysis was conducted using χ² test and t test. Results　The clinical response rate of the treatment group was higher than that of the control group [91.38% (53/58) vs. 70.69% (41/58)], with a statistically significant difference (P<0.05). Before treatment, there was no statistically significant difference in the score of cough, expectoration, fever, or chest tightness between the two groups (all P>0.05); after treatment, the scores of the above-mentioned TCM syndromes in both groups decreased, and which were lower in the treatment group than in the control group (all P<0.05). Before treatment, there was no statistically significant difference in the levels of inflammatory factors [C-reactive protein (CRP), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α)], sIL-2R, or NF-κB between the two groups (all P>0.05); after treatment, the levels of these indicators in both groups decreased, and which were lower in the treatment group than in the control group (all P<0.05). No obvious adverse reactions were observed in the two groups. Conclusion　Modified Qingre Jiedu decoction is effective in the treatment of elderly patients with pneumonia, which can significantly improve the clinical symptoms, and lower the levels of inflammatory factors, sIL-2R, and NF-κB, with high safety.

The effect of Shenling Yihua Zhuanggu prescription in treating patients with femoral neck fractures after total hip arthroplasty

Wang Jianwen, Ma Xiaofan

2025, 31(15):  2587-2591.  DOI: 10.3760/cma.j.cn441417-20240709-15024

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Objective　To observe the therapeutic effect of the Shenling Yihua Zhuanggu prescription on patients with femoral neck fractures who underwent total hip arthroplasty. Methods　Eighty patients with femoral neck fractures who underwent total hip replacement surgery at Xi'an International Medical Center Hospital from January 2017 to December 2020 were selected as the research subjects. Using the simple randomization method, the patients were divided into the control group (40 cases) and the observation group (40 cases). There were 24 males and 16 females in the control group, aged (57.85±9.22) years. There were 21 males and 19 females in the observation group, aged (58.47±10.05) years. The control group received conventional treatment, while the observation group was treated with the Shenling Yihua Zhuanggu prescription in addition to the treatment of the control group. Both groups were treated continuously for 14 days. The occurrence of deep vein thrombosis (DVT) in the lower limbs, complications and adverse reactions were compared between the two groups, as well as the traditional Chinese medicine syndrome scores, Harris scores, pain factors [β-endorphin (β-EP), substance P (SP), prostaglandin E2 (PGE2)], and blood rheological indicators [plasma viscosity, whole blood viscosity (high, medium, low shear), D-dimer] before and after treatment. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　After treatment, the traditional Chinese medicine syndrome score of the observation group was lower than that of the control group [(6.89±1.04) points vs. (9.25±1.14) points], and the Harris score was higher than that of the control group [(68.96±6.41) points vs. (56.85±5.89) points] (both P<0.05); the levels of β-EP, SP, and PGE2 in the observation group were all lower than those in the control group [(97.52±11.08) ng/L vs. (131.54±13.42) ng/L, (137.48±23.51) ng/L vs. (187.85±26.33) ng/L, (114.58±18.53) μg/L vs. (194.55±26.43) μg/L] (all P<0.05); the plasma viscosity, whole blood viscosity (high, medium, and low shear), and D-dimer levels in the observation group were all lower than those in the control group (all P<0.05). The incidence of lower limb DVT after surgery in the observation group was lower than that in the control group [2.50% (1/40) vs. 15.00% (6/40)] (P<0.05). During the treatment period, no complications or adverse reactions occurred in either group. Conclusion　The Shenling Yihua Zhuanggu prescription is used to treat patients with spleen deficiency with dampness syndrome after total hip arthroplasty for femoral neck fractures. It can improve the hypercoagulable state of the blood, reduce postoperative lower limb DVT, alleviate pain, and promote the recovery of hip joint function.

The effect of Taohong Siwu decoction combined with electroacupuncture and exercise therapy in the treatment of acute ankle sprain with qi stagnation and blood stasis syndrome

Liu Qing, Jiang Yu, Hao Long

2025, 31(15):  2592-2597.  DOI: 10.3760/cma.j.cn441417-20250211-15025

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Objective　To explore the efficacy of Taohong Siwu decoction combined with electroacupuncture and exercise therapy in the treatment of acute ankle sprain with qi stagnation and blood stasis syndrome. Methods　A total of 120 patients with acute ankle sprains who were admitted to Yan'an Traditional Chinese Medicine Hospital from January 2023 to September 2024 were selected as the research subjects. The patients were divided into the observation group and the control group by using the random number table method, with 60 cases in each group. There were 35 males and 25 females in the observation group, aged (40.32±7.65) years, sprain classification: grade Ⅰ in 31 cases, grade Ⅱ in 29 cases. There were 31 males and 29 females in the control group, aged (39.87±8.49) years, sprain classification: grade Ⅰ in 30 cases, grade Ⅱ in 30 cases. The control group received conventional exercise therapy, while the observation group received Taohong Siwu decoction combined with electroacupuncture in addition to the treatment methods of the control group. Both groups were treated continuously for 2 weeks. The clinical efficacy and occurrence of adverse reactions were compared between the two groups, as well as the ankle joint circumference and flexion/extension degree, foot-ankle function and ankle-hindfoot function [Foot and Ankle Ability Measure-Activities of Daily Living (FAAM-ADL), Foot and Ankle Ability Measure-Sports (FAAM-S), American Orthopedic Foot and Ankle Society Rating System (AOFAS)], traditional Chinese medicine syndrome scores, pain mediators [neuropeptide Y (NPY), nerve growth factor (NGF), prostaglandin E2 (PGE2)] 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 treatment in the observation group was higher than that in the control group [96.67%(58/60) vs. 86.67%(52/60)] (P<0.05). After treatment, the ankle joint circumference of the observation group was smaller than that of the control group [(31.27±2.03) cm vs. (34.65±2.39) cm], and the ankle joint flexion/extension degree was greater than that of the control group [(85.75±6.29)° vs. (76.38±6.43)°] (both P<0.05); the scores of FAAM-ADL, FAAM-S, and AOFAS in the observation group were all higher than those in the control group [(67.73±5.01) points vs. (62.18±5.24) points, (25.05±2.33) points vs. (21.57±1.84) points, (87.34±5.06) points vs. (83.23±5.37) points] (all P<0.05); the scores of traditional Chinese medicine syndromes (pain, swelling, ecchymosis, and limited movement) in the observation group were all lower than those in the control group (all P<0.05); the levels of serum NPY, NGF, and PGE2 in the observation group were all lower than those in the control group (all P<0.05). During the treatment period, no adverse reactions occurred in either group. Conclusion　Taohong Siwu decoction combined with electroacupuncture and exercise therapy has a better effect in treating the syndrome of qi stagnation and blood stasis in acute ankle sprain. It can promote the recovery of joint function and reduce the levels of pain mediators.




Case Report

A case of acute angle-closure glaucoma combined with incomplete retinal vein occlusion 

Wei Jia, Kang Jianguo, Zhu Runzhi, Zhang Xiao, Hu Xuejun

2025, 31(15):  2598-2601.  DOI: 10.3760/cma.j.cn441417-20241230-15026

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At present, various specialties in ophthalmology are developing rapidly, leading to more precise diagnosis and treatment of diseases. However, in clinical practice, medical staff often focus only on specific diseases while neglecting other accompanying conditions. Primary angle-closure glaucoma (PACG) combined with retinal vein occlusion (RVO) is not uncommon in clinical practice, but it is often overlooked. This article reports a case of PACG combined with RVO, and discusses the mechanism of PACG's angle closure as well as the correlation between PACG and RVO. The aim is to provide clinical doctors with diagnostic and treatment ideas, and enhance their understanding of such diseases.

Corynebacterium striatum caused infective endocarditis: a case report

Li Dan, Bi Yanni, Xue Ming

2025, 31(15):  2602-2604.  DOI: 10.3760/cma.j.cn441417-20250314-15027

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This article reports a case of infective endocarditis caused by Corynebacterium striatum and reviews relevant literature. The patient was a 52-year-old male diagnosed with infective endocarditis, from whom Corynebacterium striatum was isolated multiple times from peripheral blood cultures. Following a detailed clinical and laboratory evaluation, a definitive diagnosis of infective endocarditis due to Corynebacterium striatum was made. During treatment, the patient received a combined antibiotic regimen of meropenem and vancomycin, resulting in a favorable outcome. This article emphasizes that Corynebacterium striatum, as an opportunistic pathogen, is increasingly associated with infections in immunocompromised individuals (those with prolonged use of antibiotics, long-term hemodialysis, organ transplantation, interventional procedures such as catheterization, diabetes, and malignancies), and this should alert clinicians to its rising incidence.

Nursing Research

Summary of evidence on gastric lavage techniques for acute poisoning in children through the digestive tract

Wu Chanfeng, Wang Xiaoqin, Zeng Qiuhong, Pan Huiyi, Chen Hao, Xu Wenting, Ling Donglan

2025, 31(15):  2605-2610.  DOI: 10.3760/cma.j.cn441417-20250310-15028

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Objective　Search, evaluate and integrate the relevant evidence on the gastric lavage techniques for acute poisoning in children through the digestive tract, in order to provide reference materials for the clinical practice of emergency medical staff. Methods　Clinical questions were constructed using the PIPOST model, and the "6S" evidence model was followed to conduct a top-down search of domestic and foreign databases and related professional websites from the establishment of the database to February 5, 2024, for clinical decisions, best practices, evidence summaries, guidelines, industry standards, expert consensus, and systematic reviews regarding the operation of gastric lavage techniques for acute poisoning in children through the digestive tract. After the literature quality was independently evaluated by two researchers, the members of the research team extracted and synthesized the evidence based on the themes. Results　A total of 1 327 documents were retrieved, and finally 6 documents were included, among which 2 were guidelines, 3 were clinical decisions, and 1 was an expert consensus. After classification, the evidence was divided into 4 themes: preoperative assessment and management for gastric lavage, selection of gastric tube, key points for gastric lavage operation, and health education on gastric lavage. A total of 27 pieces of evidence were summarized. Conclusion　Medical staff should select appropriate evidence based on the clinical situation and apply it in the process of pediatric gastric lavage to ensure the safety of the procedure and reduce the occurrence of related complications.

Analysis of health status and glycated hemoglobin levels in elderly patients with type 2 diabetes mellitus 

Li Xiaoyu, Wang Xiaoxia, Liang Nahong, Gao Ying, Yuan Lili, Tan Yun

2025, 31(15):  2611-2616.  DOI: 10.3760/cma.j.cn441417-20250317-15029

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Objective　The study aimed to analyze the health status and the achievement of glycated hemoglobin (HbA1c) stratification attainment in elderly patients with type 2 diabetes mellitus (T2DM), providing a reference for the stratified management and individualized blood glucose control of elderly T2DM patients. Methods　A total of 187 elderly patients with T2DM who were hospitalized at Guangdong Provincial People's Hospital from October 2022 to August 2024 were selected as the study subjects. Among them, there were 102 males and 85 females; the age was (80.94±8.28) years; the duration of T2DM was (17.25±9.30) years. The clinical data (general information, laboratory indicators, and the use of hypoglycemic drugs before admission), the comprehensive health assessment [comorbid conditions, activity of daily living (ADL), etc.], and the HbA1c stratification attainment were compared in the patients. Results　The proportions of elderly patients with T2DM with good (Group 1), moderate (Group 2), and poor (Group 3) health status were 3.74% (7/187), 47.59% (89/187), and 48.66% (91/187), respectively. 96.26% (180/187) of the patients had a total of 3 or more chronic diseases other than diabetes; 81 patients in Group 3 had ≥2 ADL impairments, accounting for 43.32% (81/187) of the total and 89.01% (81/91) of Group 3. The attainment rate of the patients who did not use the drugs with a higher risk of hypoglycemia was 76.67% (23/30), while the attainment rate of the patients who used the drugs with a higher risk of hypoglycemia was 13.38% (21/157). The HbA1c attainment rate for Group 1 patients was 28.57% (2/7); for Group 2 patients, it was 22.47% (20/89); for Group 3 patients, it was 24.18% (22/91); and the overall attainment rate was 23.53% (44/187). Conclusion　The total number of chronic diseases other than diabetes exceeding 3 is the main reason for the elderly T2DM patients to be classified into Group 2 in terms of their health status. The impairment of ADL ≥ 2 items is the main reason for the elderly T2DM patients to be classified into Group 3. The low rate of achieving HbA1c target is related to the coexistence of multiple chronic diseases, ADL impairment, and the use of drugs with a higher risk of hypoglycemia.

Application of the health education model based on the five moments for medication safety in the adherence to inhaled medication of patients with COPD 

Huang Ping, Zeng Qiuxuan, Chen Wenli, Yang Xu, Lin Xiaohong, Huang Huixin, Dong Huan

2025, 31(15):  2616-2621.  DOI: 10.3760/cma.j.cn441417-20250102-15030

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Objective　To explore the application effect of the "five moments for medication safety" concept in the adherence to inhaled medication of patients with chronic obstructive pulmonary disease (COPD). Methods　This study is a randomized controlled trial. A total of 320 patients with acute COPD who were hospitalized at the First Affiliated Hospital of Guangzhou Medical University from June 2024 to December 2024 were selected as the study subjects. Using the random number table method, the patients were divided into the experimental group and the control group, with 160 cases in each group. There were 140 males and 20 females in the control group, aged (67.67±9.94) years, course of the disease (10.91±9.14) years. In the experimental group, 2 cases were lost to follow-up and 2 cases withdrew from the study due to worsening conditions. There were 126 males and 30 females in the experimental group, aged (68.96±9.16) years, course of the disease (11.72±9.12) years. The control group received conventional nursing intervention, while the experimental group was given the health education model based on the five moments for medication safety on top of the intervention provided by the control group. Both groups were subjected to continuous intervention for 3 months. The general data were compared between the two groups, as well as the scores of the medication knowledge questionnaire, medication belief questionnaire, and the Chinese version of the adherence to inhaled medication test (TAI) after 3 months of intervention. One-way analysis of variance, and χ² test were used for statistical analysis. Results　After 3 months of intervention, the scores of the medication knowledge questionnaire, medication belief questionnaire and the Chinese version of TAI in the experimental group were all higher than those in the control group [(27.23±8.73) points vs. (21.86±9.86) points, (51.46±9.40) points vs. (42.91±10.39) points, (46.00±6.48) points vs. (38.58±10.33) points] (all P<0.05). Conclusion　Applying the five moments for medication safety to guide the inhalation medication treatment for COPD patients can enhance their understanding and adherence to inhaled medication, and optimize the long-term management model of inhalation medication.

The application effect of the rehabilitation nursing decision scheme based on case management model in patients with coronary heart disease and heart failure

Meng Fangfang, Yu Liya, Kang Yingying, Wu Ruixin, Zhu Qingchun, Wang Ningbo

2025, 31(15):  2621-2625.  DOI: 10.3760/cma.j.cn441417-20250228-15031

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Objective　To explore the application effect of rehabilitation nursing decision scheme based on case management model in patients with coronary heart disease and heart failure. Methods　A total of 96 patients with coronary heart disease and heart failure who were admitted to the 7th People's Hospital of Zhengzhou from July 2022 to July 2024 were selected as the research subjects. Using the random number table method, the patients were divided into the observation group and the control group, with 48 cases in each group. There were 31 males and 17 females in the observation group, aged 44-77 (62.48±9.13) years, New York Heart Association (NYHA) classification: 25 cases at grade Ⅱ, 14 cases at grade Ⅲ, and 9 cases at grade Ⅳ. There were 28 males and 20 females in the control group, aged 42-80 (63.08±9.63) years, NYHA classification: 23 cases at grade Ⅱ, 18 cases at grade Ⅲ, and 7 cases at grade Ⅳ. The control group received conventional nursing intervention, while the observation group was given the rehabilitation nursing decision scheme based on case management model in addition to the intervention of the control group. Both groups were subjected to continuous intervention for 3 months. The cardiac function [left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF)], adverse psychological states [Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS)], and quality of life [36-Item Short-Form Health Survey (SF-36)] were compared before and after the intervention between the two groups. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　After the intervention, the LVESD of the observation group was lower than that of the control group [(35.83±2.88) mm vs. (39.23±3.39) mm], and the LVEF was higher than that of the control group [(49.70±5.44)% vs. (44.12±5.08)%] (both P<0.05); the SAS and SDS scores of the observation group were both lower than those of the control group [(40.92±5.31) points vs. (46.26±5.30) points, (42.11±5.23) points vs. (47.05±5.05) points] (both P<0.05); the scores of each dimension of SF-36 (physiological function, social function, emotional function, overall health) of the observation group were all higher than those of the control group (all P<0.05). Conclusion　The application of a case management model for rehabilitation nursing decision scheme in patients with coronary heart disease and heart failure can effectively promote the recovery of cardiac function, improve negative psychological states, and enhance the quality of life.

The application effect of traditional Chinese medicine rubbing combined with rehabilitation training intervention in stroke patients

Yan Meilin, Tian Ye, Zhang Xue

2025, 31(15):  2626-2629.  DOI: 10.3760/cma.j.cn441417-20250326-15032

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Objective　To explore the effects of traditional Chinese medicine rubbing combined with rehabilitation training intervention on the degree of pain, upper limb motor ability and self-care ability of life of stroke patients. Methods　A total of 128 stroke patients admitted to Yan'an University Xianyang Hospital from January 2023 to December 2024 were selected as the study subjects. Using the computer randomization method, the patients were divided into the control group and the study group, with 64 cases in each group. There were 39 males and 25 females in the control group, aged (58.64±7.49) years, course of the disease (29.46±4.97) days. There were 37 males and 27 females in the study group, aged (58.27±7.31) years, course of the disease (29.13±4.52) days. The control group received rehabilitation training intervention, while the study group received combined intervention of traditional Chinese medicine rubbing in addition to the intervention of the control group. Both groups were subjected to continuous intervention for 3 months. The neurological function [National Institutes of Health Stroke Scale (NIHSS)], degree of pain [Visual Analogue Scale for Pain (VAS)], upper limb motor ability [Fugl-Meyer Motor Assessment for Upper Limbs (FMA-UE), Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT)], and self-care ability of life [Modified Barthel Index (MBI)] were compared before and after the intervention between the two groups. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　After the intervention, the NIHSS score of the study group was lower than that of the control group [(10.01±2.43) points vs. (13.85±3.27) points] (P<0.05); the VAS score of the study group was lower than that of the control group [(2.05±0.42) points vs. (3.64±0.83) points] (P<0.05); the FMA-UE, ARAT, and WMFT scores of the study group were all higher than those of the control group [(45.75±6.29) points vs. (34.64±5.04) points, (30.21±5.82) points vs. (22.45±4.56) points, (50.87±5.25) points vs. (36.42±5.24) points] (all P<0.05); the MBI score of the study group was higher than that of the control group [(81.35±7.96) points vs. (70.18±7.64) points] (P<0.05). Conclusion　The combination of traditional Chinese medicine rubbing and rehabilitation training can effectively improve the neurological function of stroke patients, reduce the degree of pain, enhance the upper limb motor ability, and promote the recovery of self-care ability of life.

Mediating effect and nursing plan of postoperative health behavior of coronary heart disease patients on mindfulness level and quality of life based on structural equation analysis

Li Hongyan

2025, 31(15):  2630-2635.  DOI: 10.3760/cma.j.cn441417-20250114-15033

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Objective　To analyze the mediating effect of postoperative health behavior on mindfulness level and quality of life in patients with coronary heart disease, as well as nursing plans. Methods　This study is a cross-sectional study. A total of 96 patients with coronary heart disease who were admitted to Fuwai Central China Cardiovascular Hospital from May 2022 to June 2023 were selected as the study subjects. Among them, 61 were male and 35 were female; the age ranged from 37 to 64 (53.59±4.86) years; the disease duration was 2 to 4 (3.48±0.61) years; educational level: 46 had a junior high school education or below, 35 had a high school education, and 15 had a college degree or above. The patients' mindfulness level [Mindful Attention Awareness Scale (MAAS)] was compared at 24 hours and 1 month after surgery, as well as their quality of life [World Health Organization quality of life-BREF (WHOQOL-BREF)] and postoperative health behavior (Active Health Behavior Scale for Patients with Chronic Diseases). Paired t test, Wilcoxon signed-rank test, and χ² test were used for statistical analysis. The relationship between postoperative health behavior and mindfulness level, as well as quality of life in patients with coronary heart disease, was analyzed using bivariate correlation Person method. The mediating effect of postoperative health behavior on the relationship between mindfulness level and quality of life was analyzed using the structural equation model. Results　The MAAS score of patients with coronary heart disease one month after surgery was higher than that 24 hours after surgery [(58.74±6.49) points vs. (45.63±5.01) points] (P<0.05). The scores of each dimension of the WHOQOL-BREF, the overall quality of life score and the total score of the patients with coronary heart disease one month after surgery were all higher than those at 24 hours after surgery (all P<0.05). The scores of each dimension and the total score of the Active Health Behavior Scale for Patients with Chronic Diseases of the patients with coronary heart disease one month after surgery were all higher than those at 24 hours after surgery (all P<0.05). The total score of the Active Health Behavior Scale for Patients with Chronic Diseases for coronary heart disease patients was positively correlated with the MAAS score (r=0.890, P<0.001), and the total score of the Active Health Behavior Scale for Patients with Chronic Diseases was positively correlated with the total score of the WHOQOL-BREF (r=0.885, P<0.001). The MAAS score was positively correlated with the total score of the WHOQOL-BREF (r=0.892, P<0.001). The results of the structural equation analysis show that the regression effect of equation Y=cX+e₁ is significant, with c=0.885, P<0.001. The regression effect of equation M=aX+e₂ is also significant, with a=0.890, P<0.001. The regression effect of equation Y=c'X+bM+e₃ is also significant, with b=0.504, P<0.001; c'=0.436, P<0.001, representing a partial mediation effect model. The contribution rate of the mediating effect to the total effect is: ab/c×100%=50.68%. Conclusion　The postoperative health behavior of patients with coronary heart disease has a certain correlation with the level of mindfulness and quality of life. Moreover, the postoperative health behavior has a mediating effect between the level of mindfulness and the quality of life. Clinically, improving the postoperative health behavior of patients can enhance the level of mindfulness and the quality of life.

Epidemiology

Epidemiological characteristics and treatment outcomes of drug-resistant pulmonary tuberculosis patients in Baoji city during six years

Li Li, Wang Kewen, Liu Li, Ren Wanliang

2025, 31(15):  2636-2640.  DOI: 10.3760/cma.j.cn441417-20240511-15034

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Objective　Analyze the epidemiological characteristics and treatment outcomes of drug-resistant pulmonary tuberculosis patients in Baoji city during six years. Methods　The general data of 211 patients with drug-resistant pulmonary tuberculosis in Baoji city from January 1, 2016 to December 31, 2021 were collected, including age, gender, occupation, previous history of anti-tuberculosis treatment, patient diagnosis type, registration classification, treatment classification, whether receiving anti-tuberculosis treatment, reasons for stopping treatment, drug sensitivity results, and treatment outcome. Chi-square trend test and χ² test were used for statistical analysis. Results　From 2016 to 2021, a total of 211 cases of drug-resistant pulmonary tuberculosis were reported in Baoji city. The average annual incidence rate was 1.02 per 100,000 people, and the incidence rate showed an overall upward trend (P<0.05). There were 144 male cases (68.25%) and 67 female cases (31.75%), with a male-to-female ratio of 2.15:1; the age range was 15 to 85 years old, with 153 cases (72.51%) aged 25 to 64 years old; 149 cases (70.62%) were farmers. The highest average incidence rate was in the mountainous county of Long county (1.83 per 100,000), followed by the urban district of Jintai district (1.35 per 100,000) and the mountainous county of Linyou county (1.17 per 100,000). Comparisons of the average incidence rates among different counties showed statistically significant differences (P<0.05). The top three drugs with drug resistance were rifampicin [93.36% (197/211)], isoniazid [74.88% (158/211)], and ethambutol [31.28% (66/211)], and the resistance rate of fluoroquinolone drugs was relatively low (P<0.05). 158 cases (74.88%) were successfully treated (including cure and completion of treatment course), and 53 cases (25.12%) were not successfully treated. The top three reasons for unsuccessful treatment were drug intolerance [41.51% (22/53)], poor treatment compliance [22.64% (12/53)], and refusal of treatment (including excessive economic burden) [13.21% (7/53)]. Conclusion　From 2016 to 2021, the incidence of drug-resistant pulmonary tuberculosis in Baoji city was relatively high. The patients were mainly male, middle-aged and young adults, and farmers. The drug resistance was mainly composed of rifampicin, isoniazid and ethambutol. The treatment success rate was relatively high. The reasons for unsuccessful treatment were mainly drug intolerance, poor treatment compliance and refusal to treat (including excessive economic burden).