Table of Content

01 September 2025, Volume 31 Issue 17

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Special Topic on Gastrointestinal Diseases

The value of MSCT combined with serum PRSS2 and EFNA1 in diagnosing lymph node metastasis in patients with gastric cancer

Sun Lihui, Li Yajun, Chen Jianting, Wang Junyan, Zhang Ming

2025, 31(17):  2818-2822.  DOI: 10.3760/cma.j.cn441417-20241223-17001

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Objective　To explore the value of multi-slice spiral computed tomography (MSCT) combined with serum serine protease 2 (PRSS2) and ephrin A1 (EFNA1) in diagnosing lymph node metastasis in patients with gastric cancer. Methods　A total of 124 patients with gastric cancer who were admitted to Xi'an Gaoxin Hospital from February 2021 to August 2024 were selected as the research subjects. Among them, 74 were male and 50 were female; the age ranged from 34 to 73 (55.33±5.28) years old. All patients underwent MSCT examination, serum PRSS2 and EFNA1 tests, and pathological examination. Based on the pathological examination results, the patients were divided into the non-metastasis group (59 cases) and the metastasis group (65 cases). The parameters of MSCT [blood volume (BV), blood flow (BF), surface permeability (PS), and mean transit time of contrast agent (MTT)] were compared between the two groups, as well as serum PRSS2 and EFNA1. Independent sample t test, and Mann-Whitney U test were used for statistical analysis. The value of combining MSCT parameters with serum PRSS2 and EFNA1 in diagnosing lymph node metastasis in patients with gastric cancer was analyzed using the receiver operating characteristic curve (ROC). Results　Comparison between the two groups of BV showed no statistically significant difference (P>0.05); in the metastasis group, BF, PS, and MTT were all higher than those in the non-metastasis group [(92.66±27.82) ml/(100 mg·min) vs. (73.42±20.86) ml/(100 mg·min), (9.64±2.78) ml/(100 mg·min) vs. (7.61±1.18) ml/(100 mg·min), (28.54±5.28) s vs. (22.67±3.14) s] (all P<0.05). The serum levels of PRSS2 and EFNA1 in the metastasis group were higher than those in the non-metastasis group [3.65 (2.87, 5.22) vs. 2.12 (1.82, 2.56), 1.63 (1.30, 1.77) vs. 1.15 (0.95, 1.32)] (both P<0.05). The ROC curve showed that the combination of MSCT parameters (BF, PS, MTT) and serum PRSS2, EFNA1 for diagnosing lymph node metastasis in gastric cancer patients had a higher sensitivity than single diagnosis, and the area under the curve was higher than that of single diagnosis (all P<0.05), while the specificity was basically consistent with that of single diagnosis. Conclusion　The MSCT parameters (BF, PS, MTT) and serum PRSS2, EFNA1 are all helpful for the clinical diagnosis of lymph node metastasis in patients with gastric cancer, and their combined diagnosis has a higher value.

Indocyanine green-near infrared imaging technology in laparoscopic radical resection of left-sided colon cancer

Yang Shuang, Pan Jinduo, Wu Peng, Zhu Yuming, Song Jingfang, Huang Jin, Liu Xingguo

2025, 31(17):  2823-2827.  DOI: 10.3760/cma.j.cn441417-20250427-17002

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Objective　To explore the application value of indocyanine green-near infrared (ICG-NIR) imaging technology in laparoscopic radical resection of left-sided colon cancer. Methods　A total of 90 patients who underwent laparoscopic left hemicolectomy at Jiangmen Wuyi Hospital of Chinese Medicine from May 2022 to March 2025 were selected as the research subjects. Using the random number table method, the patients were divided into the control group and the observation group, with 45 cases in each group. There were 31 males and 14 females in the control group, aged (53.21±5.28) years, course of the disease (1.63±0.32) years. There were 32 males and 13 females in the observation group, aged (54.39±5.14) years, course of the disease (1.61±0.28) years. The control group did not use indocyanine green (ICG) solution as the tracer for laparoscopic surgery, while the observation group used ICG solution as the tracer for laparoscopic surgery. The perioperative indicators were compared between the two groups (intraoperative blood loss, operation duration, postoperative exhaust time, and total hospital stay), the postoperative lymph node dissection situation (number of lymph nodes detected, number of positive lymph nodes, and lymph node metastasis), and the postoperative complication occurrence (anastomotic leakage, incision infection, and pulmonary infection). Independent sample t test, and χ² test were used for statistical analysis. Results　The intraoperative blood loss in the observation group was less than that in the control group [(106.45±4.85) ml vs. (150.56±5.23) ml], and the operation duration, postoperative exhaust time, and total hospital stay were all shorter [(101.45±4.81) min vs. (112.56±4.67) min, (2.14±1.12) d vs. (3.56±1.25) d, (8.46±1.64) d vs. (12.15±1.78) d] (all P<0.05). There was no statistically significant difference in the number of positive lymph nodes between the two groups (P>0.05). The number of lymph nodes detected in the observation group was higher than that in the control group [(16.42±2.14) vs. (12.21±2.23)], and the proportion of lymph node metastasis in the observation group was lower than that in the control group [28.89% (13/45) vs. 51.11% (23/45)] (both P<0.05). The total incidence of postoperative complications in the observation group was lower than that in the control group [4.44% (2/45) vs. 17.78% (8/45)] (P<0.05). Conclusions　The ICG-NIR imaging technique can accurately locate the tumor and its boundaries during laparoscopic radical resection of left-sided colon cancer. It can shorten the operation duration, reduce the amount of bleeding, increase the number of lymph nodes detected, decrease the proportion of patients with lymph node metastasis and the incidence of postoperative complications.

Analysis of the occurrence status and influencing factors of intraoperative hypothermia in patients undergoing laparoscopic radical resection of colorectal cancer

Li Na, Yu Li, Chen Yaqi

2025, 31(17):  2828-2834.  DOI: 10.3760/cma.j.cn441417-20250303-17003

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Objective　To analyze the occurrence status and influencing factors of intraoperative hypothermia in patients undergoing laparoscopic radical resection of colorectal cancer (LRRCC), and to propose preventive nursing strategies. Methods　A total of 220 patients with colorectal cancer who underwent LRRCC in the operating room of Tongji Hospital, affiliated with Tongji Medical College of Huazhong University of Science and Technology, from March 2021 to December 2023 were selected as the study subjects, including 123 males and 97 females. Patients were divided into an occurrence group (88 cases) and a non-occurrence group (132 cases) based on the occurrence of intraoperative hypothermia (core body temperature <36 ℃). Clinical data were collected for all patients, including age, gender, body mass index, diabetes, hypertension, American Society of Anesthesiologists (ASA) classification, preoperative heart rate, preoperative body temperature, preoperative albumin levels, operating room temperature, operating room humidity, anesthesia-to-incision time, surgery duration, intraoperative irrigation volume, intraoperative blood loss, presence of adverse nursing procedures, intraoperative fluid administration volume, preoperative Mini-Nutrition Assessment Screening Form (MNA-SF) nutritional score, presence of CO₂ insufflation warming and humidification, and presence of composite warming. Univariate analysis was performed using χ² tests, and multivariate logistic regression analysis was used to identify risk factors for intraoperative hypothermia in LRRCC patients. Results　This study involved 220 patients with LRRCC. During the operation, 88 cases experienced hypothermia, with an incidence rate of 40.00%. Poor control of   diabetes in the occurrence group, preoperative heart rate≤70 beats/min, anesthesia-delivery time>30 min, operation duration>3 h, intraoperative fluid volume>1.6 L, intraoperative blood loss>150 ml, improper operation by the medical staff, intraoperative fluid infusion volume>1 000 ml,     preoperative MNA-SF nutritional score≤12 points, no CO₂ pneumoperitoneum heating or humidification, and no compound heat preservation were all more common in the occurrence group  than in the non-occurrence group (all P<0.05). The results of multivariate logistic regression   analysis showed that poor control of diabetes (OR=6.642), preoperative heart rate≤70 beats/min   (OR=2.865), anesthesia-delivery time>30 min (OR=1.207), operation duration>3 h (OR=2.344),  intraoperative fluid volume>1.6 L (OR=2.711), intraoperative blood loss>150 ml (OR=2.354), improper operation by the medical staff (OR=2.149), intraoperative fluid infusion volume>1 000 ml (OR=2.109), preoperative MNA-SF nutritional score≤12 points (OR=2.192), no CO₂   pneumoperitoneum heating or humidification (OR=2.804), and no compound heat preservation (OR=3.040) were all risk factors for intraoperative hypothermia in patients with LRRCC (all P<0.05). The results of the Omnibus test for the model showed χ²=139.399, P<0.05, indicating that the model as a whole is statistically significant. In terms of model fit, the log-likelihood ratio for the model was 156.726, indicating that the quantitative evaluation model had good fit; the Hosmer-Lemeshow test results were χ²=8.784, P>0.05, indicating that the qualitative evaluation model had good fit. Conclusion　Poor control of diabetes, preoperative heart rate≤70 beats/min, anesthesia-delivery time>30 min, operation duration>3 h, intraoperative fluid volume>1.6 L, intraoperative blood loss>150 ml, improper operation by the medical staff, intraoperative fluid infusion volume>1 000 ml, preoperative MNA-SF nutritional score≤12 points, no CO₂ pneumoperitoneum heating or humidification, and no compound heat preservation were all risk factors for intraoperative hypothermia in patients with LRRCC. Implementing preventive nursing strategies based on the above factors can help reduce the risk of intraoperative hypothermia, and has guiding significance for future clinical practice and nursing management.

Meta-analysis of the impact of preoperative enteral nutrition on the clinical efficacy of patients with colorectal cancer

Tan Shiyong, Lin Haiyang, Hao Yanping, Zi Qinglan, Li Yumei, Huang Haiqun

2025, 31(17):  2835-2842.  DOI: 10.3760/cma.j.cn441417-20250402-17004

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Objective　To evaluate the impact of preoperative enteral nutrition on the clinical efficacy of patients with colorectal cancer (CRC). Methods　Computerized searches were conducted in PubMed, Web of Science, Cochrane Library, Embase, Ovid, CNKI, Wanfang Database, VIP Database, Chinese Biomedical Literature Database, and Chinese Medical Journal Full-text Database to collect randomized controlled trials on the impact of preoperative enteral nutrition on the clinical efficacy of patients with CRC. The references of the included studies were also traced. Searchs were performed by combining keywords with free words. Search period: from the establishment of the databases to May 2024. A meta-analysis was conducted using RevMan 5.4.1 software. Results  A total of 13 articles were included. The results of the meta-analysis showed that preoperative enteral nutrition increased the albumin level in CRC patients [MD=1.40, 95%CI: (0.46, 2.35), P<0.05]. Preoperative enteral nutrition increased the prealbumin level in CRC patients [MD=0.02, 95%CI: (0.01, 0.03), P<0.05]. Preoperative enteral nutrition increased the transferrin level in CRC patients [MD=0.27, 95%CI: (0.20, 0.35), P<0.05]. Preoperative enteral nutrition improved the total protein level in CRC patients [MD=-14.74, 95%CI: (-27.49, -2.00), P=0.02]. Preoperative enteral nutrition increased the hemoglobin level in CRC patients [MD=6.01, 95%CI: (3.71, 8.32), P<0.05]. Preoperative enteral nutrition increased the level of immunoglobulin A (IgA) in CRC patients [MD=0.13, 95%CI: (0.03, 0.23), P=0.01]. Preoperative enteral nutrition increased the IgG level in CRC patients [MD=1.10, 95%CI: (0.65, 1.54), P<0.05]. Preoperative enteral nutrition increased the IgM level in CRC patients [MD=0.13, 95%CI: (0.07, 0.20), P<0.05]. Preoperative enteral nutrition reduced the level of interleukin-6 (IL-6) in CRC patients [MD=-10.84, 95%CI: (-15.08, -6.59), P<0.05]. Preoperative enteral nutrition improved lymphocyte levels [MD=0.26, 95%CI: (0.20, 0.32), P<0.05]. Preoperative enteral nutrition reduced the C-reactive protein level in CRC patients [MD=-3.91, 95%CI: (-6.78, -1.04), P<0.05]. Preoperative enteral nutrition reduced the overall incidence of complications [OR=0.52, 95%CI: (0.36, 0.76), P<0.05]. Preoperative enteral nutrition reduced the incidence of postoperative infectious complications [OR=0.39, 95%CI: (0.26, 0.58), P<0.05]. Preoperative enteral nutrition shortened the postoperative hospital stay of CRC patients [MD=-3.04, 95%CI: (-3.36, -2.72), P<0.05]. Preoperative enteral nutrition shortened the time to the first postoperative flatus expulsion [MD=-10.58, 95%CI: (-14.00, -7.17), P<0.05]. There were no statistically significant differences in the time of the first bowel movement after the surgery and in the grip strength [MD=-23.41, 95%CI: (-50.28, 3.45), P=0.09; MD=1.97, 95%CI: (-0.34, 4.28), P=0.09]. Conclusion  Preoperative enteral nutrition can improve the nutritional status of CRC patients, regulate immune function, reduce complications and promote postoperative recovery, but its effects on the first postoperative defecation time and grip strength are limited.

New Medical Advances

Research progress on metabolomics of traditional Chinese medicine in the treatment of perimenopausal syndrome

Wang Min, Zhuang Kechuan, Xu Qingtian, Wang Wen

2025, 31(17):  2843-2846.  DOI: 10.3760/cma.j.cn441417-20250326-17005

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Perimenopausal syndrome is a disease that occurs when women enter the perimenopausal stage and experience a decline in estrogen levels. It is characterized by a series of symptoms such as irregular menstruation, hot flashes and night sweats, insomnia, and mood swings, which directly affect their physical and mental health and quality of life. Traditional Chinese medicine has a remarkable therapeutic effect on perimenopausal syndrome. The mechanism involves regulating the biological markers related to metabolism within the body and the corresponding metabolic pathways. This article elaborates on the impact of traditional Chinese medicine therapies on the metabolic regulation of perimenopausal syndrome in recent years, providing more evidence for the mechanism of action in the treatment of this disease.

Research progress on the role of hexokinase 2 in the pathogenesis of hepatocellular carcinoma

Dong Yunhong, Gong Keke, Lan Yongting

2025, 31(17):  2847-2851.  DOI: 10.3760/cma.j.cn441417-20250317-17006

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The mortality rate of hepatocellular carcinoma (HCC) ranks third among all malignant tumors worldwide, and its incidence is increasing year by year. The research on the pathogenesis of HCC has always been of great concern. In recent years, cancer metabolism research has become a new research hotspot in the field of oncology. Among them, the changes in cellular metabolism are not only the cause of cancer occurrence, but also the result of tumor progression. Hexokinase (HK) ２, as a key metabolic enzyme, is closely related to the pathogenesis and progression of HCC. Moreover, HK2 inhibitors play a significant role in regulating the metabolic activities of cancer cells. This reveals the great potential of HK2 inhibitors in combating malignant tumors. This article reviews the biological role of HK2 in HCC, with the aim of providing new ideas for the treatment of HCC.

Research progress on diagnostic strategies and clinical treatment of myasthenia gravis

Gao Yifan, Zhang Wei, Zhang Ziliang, Chen Jinbo

2025, 31(17):  2851-2855.  DOI: 10.3760/cma.j.cn441417-20250424-17007

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Myasthenia gravis (MG), as a rare neuromuscular junction disorder, the advancements in its diagnosis and treatment have a profound impact on the prognosis and quality of life of patients. This article will systematically elaborate on the diagnostic strategies of MG (clinical diagnosis, serum antibody testing, electrophysiological examination, and pharmacological testing), and summarize its treatment plans (pharmacological treatment, surgical treatment, and immunotherapy). By analyzing the current medical treatment situation, the latest research progress and the future research directions, valuable references are provided for clinical practice.

Meta Analysis

Meta-analysis of the efficacy and safety of traditional Chinese medicine in treating pediatric lobar pneumonia

Ye Zhen, Guo Fubin, Hou Hui, Sun Yu

2025, 31(17):  2856-2863.  DOI: 10.3760/cma.j.cn441417-20250213-17008

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Objective　Based on a meta-analysis, the efficacy and safety of integrated traditional Chinese and western medicine in the treatment of pediatric lobar pneumonia were evaluated. Methods　Computerized searches were conducted in Web of Science, PubMed, Embase, CNKI, China Biomedical Literature Database, VIP Database, and Wanfang Database for randomized controlled trials on the integration of traditional Chinese and western medicine in the treatment of pediatric lobar pneumonia. The references of the included studies were also traced. Search by combining key words with free words. Search period: From database establishment to December 2024. Meta-analysis was conducted using RevMan 5.3 software, and funnel plots were used to assess publication bias. Results  A total of 15 articles were included. The results of the meta-analysis showed that there was a statistically significant difference in the efficacy rates between the two groups [RR=1.17, 95%CI (1.10, 1.25), P<0.000 01]. The efficacy rate of the observation group was 1.17 times that of the control group. The incidence of adverse reactions in the observation group was slightly lower than that in the control group [RR=0.73, 95%CI (0.47, 1.16), P=0.18]. The duration of fever reduction in the observation group was shorter than that in the control group [MD=-1.78, 95%CI (-2.14, -1.43), P<0.000 01]. The duration of cough disappearance in the observation group was shorter than that in the control group [MD=-2.74, 95%CI (-3.37, -2.10), P<0.000 01]. The duration of disappearance of lung rales in the observation group was shorter than that in the control group [MD=-3.01, 95%CI (-3.76, -2.25), P<0.000 01]. The level of C-reactive protein after treatment in the observation group was lower than that in the control group [MD=-3.18, 95%CI (-4.72, -1.63), P<0.000 01]. The decrease in the integrated score of traditional Chinese medicine syndromes before and after treatment in the observation group was higher than that in the control group [MD=4.98, 95%CI (0.31, 9.65), P=0.04]. A total of 15 articles were included in this study, covering 7 outcome indicators. After evaluating the publication bias of the overall effective rate, it was found that the funnel plot showed an asymmetrical distribution, suggesting the existence of publication bias risk. Conclusion  The combined treatment of traditional Chinese and western medicine for pediatric lobar pneumonia has a better effect, but more high-quality randomized controlled trials are still needed to further explore this issue.

Treatises

Clinical characteristics and prognostic analysis of neonatal adrenal neuroblastoma

Huang Yiwen, Chai Chengwei, Li Peng, Huang Baisha, Dong Chou, Cen Long, Xiao Jing, Li Ganglong

2025, 31(17):  2864-2867.  DOI: 10.3760/cma.j.cn441417-20250311-17009

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Objective　To summarize the clinical characteristics of neonatal adrenal neuroblastoma (NB) and explore the diagnosis and treatment of neonatal adrenal NB. Methods　Clinical data were collected from 10 cases of neonatal adrenal NB diagnosed by pathology at Guangdong Provincial Maternal and Child Health Hospital from August 2018 to August 2024, including age, sex, time of discovery, staging, treatment regimens, etc, and a retrospective analysis was conducted. Results　Among the 10 patients, there were 4 males and 6 females, with the time of discovery ranging from prenatal at 31 weeks of gestation to within 1 month after birth. 7 cases were identified by prenatal ultrasound, and 3 cases were found through abdominal ultrasound due to postnatal abdominal distension. All tumors originated from the adrenal gland, with 6 on the right side and 4 on the left. Preoperative ultrasound and CT scans indicated a round solid mass in the adrenal region in 9 cases and a cystic lesion in 1 case, with the shortest diameter ranging from 1.9 to 4.1 cm and the longest diameter from 2.1 to 5.7 cm. According to the International Neuroblastoma Staging System (INSS), there were 3 cases of stage 4S with liver metastasis and 7 cases of stage 1. The age at surgery ranged from 12 to 84 days, with a median of 29 days. Pathological classification revealed 7 cases as poorly differentiated and 3 as undifferentiated. All patients showed no MYCN gene amplification and had no 1p/11q deletions. All patients were classified into the very low-risk group and underwent primary tumor resection. Among them, 2 cases with liver metastasis (1 with multiple cystic lesions in the liver and 1 with diffuse hepatic enlargement) received chemotherapy for 6 cycles according to the low-risk group protocol, while the remaining cases underwent complete resection without postoperative chemotherapy and were followed up. All 10 patients were followed for 9 to 69 months and remained alive, with 7 stage 1 patients achieving complete remission and 3 stage 4S patients living with the tumor. Conclusions　NB has its clinical specificities, mostly stage one and 4S. Currently, the main treatment is complete resection of the primary tumor lesion. In this study, tumor resection in the neonatal period was found to be safe and effective, but individualized chemotherapy was needed for children in the very low-risk group. The overall prognosis of children with NB is good.

Associations of clinical characteristics and risk factors of all-cause mortality in elderly patients with acute myocardial infarction

Ma Honglan, Cao Jinlong, Cai Tianzhi, Xu Suining, Zhang Weihua

2025, 31(17):  2868-2873.  DOI: 10.3760/cma.j.cn441417-20250408-17010

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Objective　To investigate the clinical characteristics and risk factors for all-cause mortality in elderly patients with acute myocardial infarction (AMI). Methods　This study is a retrospective cohort study. A total of 1 554 patients with AMI who were hospitalized in the First Affiliated Hospital of Xi 'an Medical University from January 2020 to September 2024 were selected. Among them, 583 patients aged ≥65 years were in the elderly group, and 971 patients aged <65 years were in the non-elderly group. Baseline data including age, sex, medical history, and smoking status were collected for all study subjects. Clinical symptoms, heart function assessed by Killip classification, whether the patient underwent percutaneous coronary intervention (PCI), intraoperative and postoperative complications, medications during hospitalization, length of stay, and in-hospital mortality were also recorded. Logistic regression analysis was used to identify risk factors for all-cause mortality in AMI patients. Statistical analysis was performed using χ², t tests, and Mann-Whitney U tests. Results　Among the 583 patients in the elderly group, there were 393 males (67.41%) with an average age of (74.31±7.39) years. In the non-elderly group of 971 patients, there were 867 males (89.29%) with an average age of (51.46±9.17) years. The proportions of males, smokers, obese patients, those with a family history of early coronary heart disease, and patients with hyperlipidemia, as well as pulse, heart rate, and diastolic pressure in the elderly group, were all lower than those in the non-elderly group (all P<0.001). The proportions of patients with a history of hypertension, PCI, chronic obstructive pulmonary disease (COPD), and cerebrovascular disease in the elderly group were higher than in the non-elderly group. Laboratory tests showed that the elderly group had lower levels of triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-sensitivity cardiac troponin, and left ventricular ejection fraction compared to the non-elderly group (all P<0.05), while high-density lipoprotein cholesterol (HDL-C) and NT-proBNP levels were higher in the elderly group (both P<0.001). The main symptoms in both groups were chest tightness or chest pain. The revascularization rate in the elderly group was lower than in the non-elderly group [93.32% (544/583) vs. 99.18% (963/971)], with a longer length of hospitalization [10 (7, 12) days vs. 9 (7, 11) days] and a higher in-hospital mortality rate [6.87% (40/583) vs. 1.13% (11/971)], with all differences being statistically significant (all P<0.05). Univariate and multivariate logistic regression analyses revealed that age [odds ratio (OR)=1.040, 95% confidence interval (CI) 1.009-1.073, P=0.011], Killip class Ⅳ heart function (OR=2.533, 95%CI 1.053-6.095, P=0.038), no revascularization measures (OR=0.250, 95%CI 0.090-0.695, P=0.008), heart failure (OR=3.684, 95%CI 1.771-7.662, P<0.001), shock (OR=4.005, 95%CI 1.744-9.196, P=0.001), and mechanical complications (OR=46.340, 95%CI 6.809-315.385, P<0.001) were identified as independent risk factors for mortality in patients with acute myocardial infarction. Conclusions　Elderly patients with acute myocardial infarction have low reperfusion therapy rate and high mortality rate. Shock, heart failure, age, no revascularization measures, and cardiac function Killip class Ⅳ were independent risk factors for all-cause mortality in patients with acute myocardial infarction.

Therapeutic efficacy of Yiqi Jiedu compound on myasthenia gravis patients

Liang Lili, Zeng Xiaocui, Zhao Siyu

2025, 31(17):  2874-2878.  DOI: 10.3760/cma.j.cn441417-20241031-17011

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Objective　To investigate the therapeutic efficacy of Yiqi Jiedu Compound in patients with myasthenia gravis (MG) and its effects on interleukin-6 (IL-6) and IL-17 levels. Methods　A prospective study was conducted with 100 children diagnosed with myasthenia gravis at Xi'an Children's Hospital from January 2021 to August 2024. Subjects were randomly assigned to a conventional group (50 cases) and a compound group (50 cases) using an envelope drawing method. In the conventional group, there were 28 males and 22 females, with an average age of (6.5±2.3) years and a disease duration of (1.2±0.8) years; clinical classification included 20 cases of type I, 18 cases of type IIa, and 12 cases of type IIb. In the compound group, there were 26 males and 24 females, with an average age of (6.8±2.5) years and a disease duration of (1.3±0.9) years; clinical classification included 19 cases of type I, 19 cases of type IIa, and 12 cases of type IIb. The conventional group received standard treatment. The compound group received Yiqi Jiedu compound in addition to the standard treatment, administered as one dose per day, with 300 ml of decoction taken in three warm doses. The treatment duration for both groups was 3 months. Clinical efficacy, quantitative myasthenia gravis score (QMG) before and after treatment, traditional Chinese medicine syndrome scores, immune indicators, and levels of retinoic acid receptor-related orphan receptor γt (RORγt) and forkhead box protein P3 (FoxP3) mRNA were compared between the two groups. Statistical analysis was performed using χ², t, and F tests. Results　After treatment, the overall effective rate in the compound group was higher than that in the conventional group [96.0% (48/50) vs. 82.0% (41/50)], with a statistically significant difference (χ²=5.005, P=0.025). At 1 and 3 months post-treatment, the QMG scores and traditional Chinese medicine syndrome scores in the compound group were lower than those in the conventional group [(9.94±0.96, 7.92±0.70) points vs. (12.32±1.27, 11.04±1.24) points; (7.90±0.74, 5.74±0.63) points vs. (11.52±0.91, 9.70±1.15) points] (all P<0.05). After 3 months of treatment, levels of helper T cell 17 (Th17), IL-6, and IL-17 in the compound group were lower than those in the conventional group [(1.64±0.18)% vs. (3.75±0.31)%; (5.36±0.52) ng/L vs. (9.15±0.91) ng/L; (7.78±0.71) ng/L vs. (11.12±0.95) ng/L], with all differences being statistically significant (t=41.621, 25.570, 19.912; all P<0.001). The RORγt mRNA levels in the compound group were lower than those in the conventional group, while the Foxp3 mRNA levels were higher in the compound group (all P<0.05). Conclusion　Yiqi Jiedu compound can improve the symptoms of weakness in children with myasthenia gravis, enhance clinical efficacy, and effectively regulate the immune function of these children by inhibiting the excessive expression of inflammatory factors.

Study on the prediction of cardiomyopathy in patients with septic shock based on shock index and FT-CMR cardiac functional assessment parameters

Yang Xiaolong, Zhao Wei

2025, 31(17):  2879-2884.  DOI: 10.3760/cma.j.cn441417-20250327-17012

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Objective　To establish and validate a predictive model for septic shock cardiomyopathy based on the shock index (SI) and cardiac magnetic resonance feature tracking (FT-CMR) parameters, aiming to provide clinical guidance for reducing the incidence of cardiomyopathy in patients with septic shock. Methods　A retrospective analysis was conducted on the clinical data of 137 patients with septic shock admitted to Xi'an Ninth Hospital from May 2020 to October 2023. Patients were divided into a cardiomyopathy group (42 cases) and a non-cardiomyopathy group (95 cases) based on the presence of cardiomyopathy within 72 hours of enrollment. In the cardiomyopathy group, there were 23 males and 19 females, aged (66.52±5.54) years and a body mass index (BMI) of (22.77±1.18) kg/m². In the non-cardiomyopathy group, there were 48 males and 47 females, aged (58.74±4.89) years and a BMI of (22.48±1.16) kg/m². All patients underwent FT-CMR examination and SI assessment at enrollment. Factors influencing the occurrence of cardiomyopathy were analyzed, and a nomogram was constructed to predict the risk of cardiomyopathy. The predictive efficacy of the model for the occurrence of cardiomyopathy was analyzed using receiver operating characteristic (ROC) curves. Statistical analyses were performed using the χ² test and t test. Results　Univariate analysis showed that the age, cardiac troponin (cTnI), lactic acid, N-terminal pro-brain natriuretic peptide (NTpro-BNP) and SI levels in the cardiomyopathy group were higher than those in the non-cardiomyopathy group, while the total left atrial strain (Es), overall longitudinal strain of the left atrium (PLAS), and peak positive strain rate (SRs) were lower in the cardiomyopathy group (all P<0.05). Binary logistic regression analysis revealed that age [odds ratio (OR)=2.769, 95% confidence interval (CI) 1.151-6.663], lactate (OR=4.661, 95% CI 2.645-8.212), cTnI (OR=6.234, 95% CI 3.096-12.550), and SI (OR=4.165, 95% CI 1.526-11.361) were independent risk factors for the development of cardiomyopathy in patients with septic shock, while PLAS (OR=0.186, 95% CI 0.081-0.423) was an independent protective factor. The nomogram prediction model constructed based on these influencing factors showed a C-index of 0.821 (95% CI 0.743-0.925) upon internal validation using the Bootstrap method, with the calibration curve for predicting the occurrence of cardiomyopathy approaching the ideal curve (P>0.05). ROC analysis indicated that the nomogram model had a sensitivity of 85.70% and specificity of 86.60%, with an area under the curve (AUC) of 0.872 (95% CI 0.783-0.960). Conclusion　SI is an independent risk factor for the development of cardiomyopathy in patients with septic shock, and PLAS is an independent protective factor. The nomogram prediction model based on SI and PLAS can better evaluate the risk of cardiomyopathy in patients with septic shock.

Effects of bone cement dispersion on clinical curative effect in patients with osteoporotic vertebral compression fracture after percutaneous vertebroplasty

Zhang Hao, Yao Zhensong, Guo Jianbang, Lai Weihua, Yue Wenfeng

2025, 31(17):  2885-2890.  DOI: 10.3760/cma.j.cn441417-20241122-17013

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Objective　To explore the correlation between different cement distribution types and the efficacy of percutaneous vertebroplasty (PVP) in treating osteoporotic vertebral compressibility fractures (OVCF). Methods　This study is a retrospective analysis. A total of 198 patients with OVCF treated with PVP at Meizhou Traditional Chinese Medicine Hospital from July 2022 to January 2024 were selected. Based on the anatomical characteristics of the vertebrae and the imaging features of cement diffusion, patients were divided into four groups: type Ⅰ (87 cases), type Ⅱ (17 cases), type Ⅲ (70 cases), and type Ⅳ (24 cases). In type Ⅰ, there were 26 males and 61 females, aged (69.80±7.64) years old and a bone mineral density T-score of -2.50±1.01; in type Ⅱ, there were 6 males and 11 females, aged (70.10±8.03) years old and a T-score of -2.45±0.98; in type Ⅲ, there were 21 males and 49 females, aged (69.80±7.95) years and a T-score of -2.61±1.23; in type Ⅳ, there were 7 males and 17 females, with an average age of (69.10±8.04) years old and a T-score of -2.70±1.16. Preoperative pain levels were assessed using the Visual Analog Scale (VAS) at baseline, 1 day postoperatively, and 3 months postoperatively. The Oswestry Disability Index (ODI) was used to evaluate lumbar function, and the ratio of the affected vertebral area to the cement area was measured using Image-J software to calculate the cement diffusion effect. Statistical analyses were conducted using the χ² test and one-way ANOVA. Results　Before treatment, 1 day postoperatively, and 3 months postoperatively, the VAS scores and ODI scores for type Ⅰ patients were (7.68±1.01, 2.93±1.12, 1.80±0.78) points and (38.13±2.80, 21.11±2.37, 15.74±2.86) points, respectively. For type Ⅱ patients, the scores were (7.75±0.99, 2.76±0.98, 1.76±0.81) points and (38.00±3.10, 20.24±2.40, 15.94±3.01) points, respectively. For type Ⅲpatients, the scores were (7.53±1.31, 2.67±1.17, 1.83±0.69) points and (37.56±2.92, 20.06±2.70, 15.61±3.16) points, respectively. For type Ⅳ patients, the scores were (7.88±1.12, 2.96±1.05, 2.29±0.76) points and (37.88±2.79, 21.04±2.81, 19.58±2.96) points, respectively. Within-group comparisons showed significant differences in VAS and ODI scores among all groups before treatment, 1 day postoperatively, and 3 months postoperatively (all P<0.05). Between-group comparisons indicated that type Ⅳ patients had significantly higher VAS and ODI scores at 3 months postoperatively compared to the other three types (all P<0.05). The cement diffusion ratios on anteroposterior and lateral X-rays for type Ⅰ patients were (0.93±0.16, 0.94±0.14)%, which were better than those of type Ⅱ [(0.82±0.12, 0.82±0.08)%], type Ⅲ[(0.84±0.06, 0.81±0.12)%], and type Ⅳ [(0.80±0.06, 0.79±0.05)%], showing statistically significant differences (all P<0.05). The volume of cement infusion, operative time, and C-arm exposure counts for type Ⅳ were (5.07±0.27) ml, (35.18±3.71) min, and (16.50±2.12) times, respectively, which were better than those for type Ⅰ [(6.14±0.36) ml, (43.62±3.13) min, (25.76±1.34) times], type Ⅱ [(5.12±0.43) ml, (42.38±3.03) min, (26.53±1.28) times], and type Ⅲ [(5.10±0.29) ml, (43.31±2.93) min, (25.81±1.37) times], with statistically significant differences (all P<0.05). There were no statistically significant differences in the incidence of adverse reactions among the four groups (χ²=2.949, P=0.400). Conclusion　PVP can significantly relieve pain and improve lumbar function in OVCF patients. The wide distribution and uniform perfusion of bone cement in vertebra has better effect.

Effect of ciprofol combined with different doses of dexmedetomidine on elderly diabetic patients undergoing painless gastrointestinal endoscopy

Liu Hui, Liang Jiao, Zhang Ce

2025, 31(17):  2891-2897.  DOI: 10.3760/cma.j.cn441417-20250318-17014

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Objective　To investigate the effects of remifentanil combined with different doses of dexmedetomidine on cognitive function, plasma insulin, and blood glucose in elderly diabetic patients undergoing painless gastrointestinal endoscopy. Methods　This prospective study selected 179 elderly diabetic patients who underwent painless gastrointestinal endoscopy at Xidian Group Hospital from January 2020 to January 2024. Patients were randomly divided into a low-dose group (89 cases) and a high-dose group (90 cases) using a random number table method. In the low-dose group, there were 48 males and 41 females, with an average age of (68.64±7.35) years and a diabetes duration of (8.35±1.46) years. In the high-dose group, there were 46 males and 44 females, with an average age of (67.46±8.23) years and a diabetes duration of (8.74±1.35) years. The low-dose group received intravenous remifentanil at 0.2 mg/kg + dexmedetomidine at 0.5 µg/kg, while the high-dose group received intravenous remifentanil at 0.2 mg/kg + dexmedetomidine at 1.0 µg/kg. General data for both groups were collected. Hemodynamic parameters, blood glucose, plasma cortisol, and adrenaline levels were statistically analyzed and compared at five time points: after admission (T₀), at the start of anesthesia induction (T₁), upon completion of anesthetic drug administration (T₂), 2 minutes after endoscopy (T₃), and 2 minutes after recovery (T₄). Additionally, the time to disappearance of the eyelash reflex, Ciprofol dosage, recovery time after anesthesia, and gastrointestinal function were compared between the two groups. The cognitive function (Mini-Cog score), recovery quality [ Richmond sedation-agitation scale (RASS), visual analogue scale (VAS) score ] and adverse reactions during the examination were statistically compared between the two groups before and after the examination. Statistical analyses were conducted using χ², t, and F tests. Results　The mean arterial pressure (MAP), heart rate (HR), peripheral blood oxygen saturation (SpO₂), and respiratory rate (RR) at T₀, T₁, T₂, T₃, and T₄ showed statistically significant differences (all P<0.05). There were significant differences in MAP, HR, SpO₂ and RR between the two groups at T₁, T₂, T₃ and T₄(F=76.565, 31.402, 11.852, 24.236, all P<0.001). The trends in changes of MAP, HR, SpO₂, and RR between the two groups were statistically significant (all P<0.05). Comparisons of blood glucose, insulin, plasma cortisol, and adrenaline levels at different time points also showed statistically significant differences (all P<0.05). The levels of blood glucose, insulin, plasma cortisol, and adrenaline at T₁, T₂, T₃ and T₄ in the high-dose group were lower than those in the low-dose group (F=156.364, 1 208.490, 91.566, 46.861, all P<0.001), with smaller fluctuations. The trends in changes of blood glucose, insulin, plasma cortisol, and adrenaline levels between the two groups were statistically significant (all P<0.05). The disappearance time of eyelash reflex in the high-dose group was shorter than that in the low-dose group [(2.60±0.45) min vs. (2.78±0.55) min], and the dosage of propofol in the high-dose group was less than that in the low-dose group [(81.35 ±13.24) mg vs. (122.45±23.13) mg]. The time to call for eye-opening and the time to regain orientation in the high-dose group were (10.76±1.21, 19.67±1.23) min, both longer than those in the control group [(7.56±1.68, 17.12±0.98) min], with statistically significant differences (all P<0.05). The recovery time of bowel sounds, time to pass gas, and time to defecate in the high-dose group were (2.01±0.77) d (16.75±5.31) h, and (2.12±0.44) d, respectively, all longer than those in the low-dose group [(1.26±0.43) d, (7.13±4.11) h, (1.21±0.57) d] (all P<0.05). The Mini-Cog scores in the high-dose group were lower than those in the low-dose group [(2.68±0.96) points vs. (3.03±0.67) points]. The Ramsay sedation scores in the high-dose group were higher than those in the low-dose group [(1.73±0.13) points vs. (1.60±0.12) points], while the RASS and VAS scores were lower in the high-dose group [(1.66±0.12)points vs. (1.82±0.11) points, (1.85±0.21) points vs. (1.96±0.27) points)], with statistically significant differences (t=2.826, 6.950, 9.296, 3.044, all P<0.05). Conclusion　Ciprofol combined with different doses of dexmedetomidine in painless gastrointestinal endoscopy for elderly diabetic patients shows that the high-dose group has advantages in maintaining stable hemodynamic indices, lower blood sugar and insulin levels, and quicker functional recovery without increasing the risk of adverse reactions. This indicates that the dosage can be adjusted according to the specific clinical situation of patients to optimize treatment effects and patient safety.

Application of modified sacral anesthesia combined with quadratus lumborum block in pediatric hip dislocation surgery

Zhang Hui, Lyu Haigang, Xue Yuting

2025, 31(17):  2897-2902.  DOI: 10.3760/cma.j.cn441417-20250416-17015

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Objective　To analyze the application effect of improved sacral anesthesia combined with lumbar muscle block on pediatric hip dislocation surgery and its impact on postoperative agitation and stress response. Methods　A total of 120 children undergoing hip dislocation surgery at Xi'an Jiaotong University Affiliated Honghui Hospital from March 2022 to March 2025 were prospectively selected and randomly assigned to three groups: the sacral anesthesia group, the lumbar muscle block group, and the combined group, with 40 cases in each group. In the sacral anesthesia group, there were 23 males and 17 females, with an average age of (2.23±0.54) years; American Society of Anesthesiologists (ASA) classification: 21 cases of grade I and 19 cases of grade II. In the lumbar muscle block group, there were 21 males and 19 females, with an average age of (2.30±0.25) years; ASA classification: 25 cases of grade I and 15 cases of grade II. In the combined group, there were 24 males and 16 females, with an average age of (2.35±0.41) years; ASA classification: 24 cases of grade I and 16 cases of grade II. All children received sevoflurane inhalation for general anesthesia. After induction, the sacral anesthesia group, lumbar muscle block group, and combined group underwent improved sacral anesthesia, lumbar muscle block, and improved sacral anesthesia combined with lumbar muscle block, respectively. The anesthesia efficacy rates were compared among the three groups, and pain levels were evaluated at 2, 6, and 12 hours postoperative using the Visual Analogue Scale (VAS). The agitation of children was assessed at 5, 10, and 20 minutes postoperative using the Pediatric Anesthesia Emergence Delirium (PAED) scale. Cortisol and norepinephrine (NE) levels were measured before surgery and at 1 and 3 days postoperative. Statistical analysis was performed using χ² and F tests. Results　The anesthesia efficacy rates were 90.00% (36/40) for the sacral anesthesia group, 85.00% (34/40) for the lumbar muscle block group, and 100.00% (40/40) for the combined group, with the combined group being significantly higher than both the sacral anesthesia group and the lumbar muscle block group (both P<0.05). There was no statistically significant difference between the sacral anesthesia group and the lumbar muscle block group (P>0.05). VAS scores increased at 6 hours postoperative in all three groups and decreased at 12 hours postoperative. The VAS scores at 2, 6, and 12 hours postoperative in the combined group [(4.11±1.25, 5.45±1.24, 3.24±0.82) points] were all lower than those in the sacral anesthesia group [(5.45±1.24, 6.20±1.27, 4.28±0.95) points] and the lumbar muscle block group [(5.21±1.22, 6.34±2.01, 5.02±1.11) points] (P<0.05). At 12 hours postoperative, the VAS score in the sacral anesthesia group was lower than that in the lumbar muscle block group (P<0.05). The PAED scores at 10 and 20 minutes postoperative decreased in all three groups; at 5, 10, and 20 minutes postoperative, the combined group [(5.25±0.88, 4.45±0.36, 2.22±0.23) points] had lower scores than the sacral anesthesia group [(7.11±1.94, 5.60±0.92, 3.31±0.36) points] and the lumbar muscle block group [(7.61±1.33, 5.83±0.70, 3.35±0.47) points], with all differences being statistically significant (all P<0.05); there was no significant difference between the sacral anesthesia group and the lumbar muscle block group (P>0.05). The levels of NE and cortisol in the three groups increased at 1 day after operation and decreased at 3 days after operation. The NE and cortisol levels at 1 and 3 days postoperative in the combined group were (243.34±41.46, 223.56±36.83) ng/L and (60.26±9.32, 51.46±6.36) µg/L, respectively; in the sacral anesthesia group, they were (281.93±38.78, 252.53±36.54) ng/L and (67.62±5.44, 58.83±7.54) µg/L, respectively; and in the lumbar muscle block group, they were (315.84±37.67, 274.53±31.54) ng/L and (85.43±7.68, 65.52±9.52) µg/L, respectively. The combined group values were lower than those in both the sacral anesthesia group and the lumbar muscle block group, and the sacral anesthesia group values were lower than those in the lumbar muscle block group, with all differences being statistically significant (all P<0.05). Conclusion　The application of modified sacral anesthesia combined with quadratus lumborum block in pediatric hip dislocation surgery can improve the excellent and good rate of anesthesia, reduce postoperative pain and agitation, and reduce postoperative stress response.

Investigation and analysis of iron overload and bone metabolism in children with transfusion-dependent thalassemia

Zou Xian, Li Ensi, Wan Jingjing, Xie Mingyu, Zeng Haisheng

2025, 31(17):  2903-2907.  DOI: 10.3760/cma.j.cn441417-20250625-17016

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Objective　To investigate and analyze the iron overload and bone metabolism in children with transfusion-dependent thalassemia (TDT). Methods　A total of 93 children with TDT admitted to Dongguan Eighth People's Hospital from January 2021 to August 2023 were selected as the research subjects. The severity of iron overload was determined based on the serum ferritin (SF) level and the children were divided into three groups: children without iron overload (SF ≤1 000 μg/L, 14 cases), children with mild to moderate iron overload (1 000 μg/L < SF < 2 500 μg/L, 32 cases), and children with severe iron overload (SF ≥2 500 μg/L, 47 cases). There were 7 boys and 7 girls in the non-iron overload group, with an age of (7.14±1.29) years old. In the mild to moderate iron overload group, there were 17 boys and 15 girls, with an age of (7.10±1.12) years old. In the severe iron overload group, there were 19 boys and 28 girls, with an age of (7.44±1.45) years old. All children with iron overload received iron removal treatment. The levels of SF, bone metabolism indicators {parathyroid hormone (PTH) and serum 25-hydroxyvitamin D₃ [25(OH)D₃]}, and liver function indicators [alanine aminotransferase (ALT) and aspartate aminotransferase (AST)] in children with mild to moderate and severe iron overload were compared before and 3 months after medication. Pearson correlation analysis was used to investigate the correlations between the SF level and bone metabolism indicators in children with iron overload. Multivariate logistic regression analysis was conducted to identify the independent risk factors for severe iron overload in children with TDT. Statistical analysis was conducted using the χ² test, Fisher's exact probability method, independent sample t test, and one-way analysis of variance. Results　The levels of SF, PTH, ALT, and AST before medication and SF after medication in the severe iron overload group were (5 410.74±930.15) μg/L, (9.57±1.79) pmol/L, (45.50±8.47) U/L, (65.88±8.19) U/L, and (3 197.13±629.49) μg/L, which were all higher than those in the mild to moderate iron overload group [(1 801.53±388.21) μg/L, (6.17±1.23) pmol/L, (37.45±8.80) U/L, (54.74±6.75) U/L, and (1 225.62±199.48) μg/L] (all P<0.05); the level of 25(OH)D₃ before medication in the severe iron overload group was (18.22±4.48) μg/L, which was lower than that in the mild to moderate iron overload group [(24.86±5.48) μg/L] (P<0.05). The Pearson correlation analysis results showed that before treatment, the SF level was negatively correlated with the 25(OH)D₃ level (r = -0.561, P<0.05), and positively correlated with the PTH, ALT, and AST levels (r = 0.646, 0.392, and 0.544, all P<0.05); after treatment, the SF level was negatively correlated with the 25(OH)D₃ level (r = -0.484, P<0.05), and positively correlated with the PTH, ALT, and AST levels (r = 0.623, 0.342, and 0.448, all P<0.05). The logistic regression analysis results showed that pre-medication high PTH (OR = 3.914, 95%CI = 2.168 - 7.065), low 25(OH)D₃ (OR = 0.755, 95%CI = 0.659 - 0.864), high ALT (OR = 1.114, 95%CI = 1.048 - 1.184), and high AST (OR = 1.203, 95%CI = 1.108 - 1.307) were all independent risk factors for severe iron overload in children with TDT (all P<0.05). Conclusions　Iron overload is common in children with TDT in Dongguan, and the severity of iron overload is correlated with bone metabolism disorders. It is recommended to include bone metabolism markers in routine monitoring of TDT children and initiate early combined iron removal therapy for those with SF >2 500 μg/L.

Clinical Research

Analysis of the curative effect of modified ligation of intersphincteric fistula tract in the treatment of transsphincteric anal fistula

Yang Qin, Li Weihua, Wang Jichang

2025, 31(17):  2908-2912.  DOI: 10.3760/cma.j.cn441417-20250408-17017

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Objective　To explore the clinical efficacy and application value of modified ligation of intersphincteric fistula tract (LIFT) in the treatment of transsphincteric anal fistula. Methods　A retrospective controlled study was conducted. A total of 121 patients with transsphincteric anal fistula who underwent surgical treatment in the Department of Anorectal Surgery at Shangluo Traditional Chinese Medicine Hospital from January 2020 to December 2022 were selected as the study subjects. According to different surgical methods, patients were divided into an observation group (61 cases, receiving modified LIFT) and a control group (60 cases, receiving traditional LIFT). The observation group included 39 males and 22 females, with an average age of (42.65±8.27) years; the control group included 40 males and 20 females, with an average age of (43.12±7.96) years. Surgical-related indicators (operation time, intraoperative blood loss, length of hospital stay, wound healing time), postoperative pain scores [Visual Analog Scale (VAS)], postoperative complications, anal function assessment, and recurrence rates were compared between the two groups. Statistical analysis was conducted using χ² ,t and F tests and Fisher exact probability method. Results　The observation group had an operation time, intraoperative blood loss, length of hospital stay, and wound healing time of (45.37±8.62) minutes, (16.24±3.58) ml, (5.12±1.03) days, and (16.43±3.25) days, respectively, while the control group had (58.64±10.15) minutes, (25.37±4.76) ml, (7.38±1.42) days, and (21.87±4.19) days. All differences were statistically significant (t=7.84, 12.45, 10.23, 8.33, all P<0.001). Postoperative VAS scores at 24, 48, and 72 hours for the observation group were (4.25±0.83, 3.18±0.67, 2.04±0.52) points, which were all lower than those of the control group [(5.67±1.04, 4.52±0.89, 3.26±0.75) points], with all differences being statistically significant (all P<0.001). The total incidence of postoperative complications in the observation group was lower than that in the control group [6.56% (4/61) vs. 18.33% (11/60)] (χ²=4.13, P=0.042). At 3 months postoperatively, the Wexner anal function score in the observation group was (1.24±0.58) points, compared to (1.38±0.67) points in the control group, with no statistically significant difference (t=1.24, P=0.216). After 12 months of follow-up, there was no significant difference in the recurrence rate between the two groups(P>0.05). Conclusions　Modified LIFT in the treatment of transsphincteric anal fistula has the advantages of less surgical trauma, faster postoperative recovery, less pain and fewer complications. The recurrence rate has a decreasing trend, which can protect the function of anal sphincter and has high clinical application value.

Application of targeted approach repair in patients with primary or incisional lateral abdominal wall hernia

Hong Haobin, Zhang Bo, Zhou Zhangpeng, Huang Changyu, Ma Ping

2025, 31(17):  2912-2916.  DOI: 10.3760/cma.j.cn441417-20241210-17018

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Objective　To analyze the application value of targeted approach repair and conventional intraperitoneal repair in patients with primary or incisional abdominal wall hernia. Methods　Retrospective analysis was used to select 125 patients with lateral abdominal incisional hernia who underwent surgical treatment in Xianyang First People 's Hospital from March 2021 to March 2024. All patients underwent laparoscopic repair.According to the different surgical methods, they were divided into control group (60 cases) and study group (65 cases).The control group underwent routine intraperitoneal repair, and the study group underwent targeted approach repair.Control group: 30 males and 30 females, aged 45-69 (53.45±5.67) years ;There were 15 cases of primary abdominal wall hernia and 45 cases of incisional abdominal wall hernia.Study group : 33 males and 22 females, aged 40-68 (53.68±5.71) years ;There were 18 cases of primary abdominal wall hernia and 47 cases of incisional abdominal wall hernia.The intraoperative blood loss, operation time, transverse diameter of hernia ring, postoperative Visual Analogue Scale (VAS) score, postoperative hospital stay, postoperative complications and postoperative recurrence were compared between the two groups.Statistical analysis was conducted using t test and χ² test. Results　The intraoperative blood loss, operation time and transverse diameter of hernia ring were compared between the two groups [(10.95±3.33) ml vs. (12.24±5.28) ml, (161.25±52.18) min vs.(145.27±41.06) min, (6.71±2.02) cm vs. (6.85±2.19) cm], the differences were not statistically significant (t=1.647,1.892,0.372; all P>0.05). The VAS score at rest on the first day after operation in the study group was lower than that in the control group [(2.45±0.53) points vs. (2.82±0.85) points], and the hospitalization time was shorter than that in the control group [ (4.80±1.32) d vs. (8.32±2.06) d], the differences were statistically significant (t=2.944,11.463; all P<0.05). After 6 months of follow-up, the incidence of postoperative complications and recurrence rates were compared between the study group and the control group [6.15%(4/65) vs. 0%(0/60), 0%(0/65) vs. 5.00%(3/60)], the differences were not statistically significant (χ²=2.086,1.537; both P>0.05). Conclusion　Compared with conventional intraperitoneal repair, targeted approach repair for patients with primary or incisional abdominal wall hernia has lower postoperative pain, shorter postoperative recovery time and better prognosis.

Application of laparoscopic three-hole subxiphoid 3 cm incision approach and intercostal space approach in patients with primary mediastinal tumors

Jia Yong, Wang Rong, Fan Yanting

2025, 31(17):  2917-2921.  DOI: 10.3760/cma.j.cn441417-20241212-17019

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Objective　To explore the impact of the three-port laparoscopic approach through the subxiphoid 3 cm incision and the intercostal space approach on the clinical intervention effects of patients with primary mediastinal tumors. Methods　A total of 98 patients with primary mediastinal tumors who were admitted to Baoji Central Hospital from December 2019 to December 2022 were selected. They were numbered in sequence from 01 to 98, and were divided into the control group and the intervention group according to the odd-even number grouping method.The control group consisted of odd numbers (49 cases) and was treated with the traditional intercostal space approach. The intervention group consisted of an even number (49 cases), and they were all treated with the laparoscopic three-port approach via a 3 cm incision under the xiphoid process.The preoperative and postoperative levels of serum pain stress factors, lung function, and survival conditions of the two groups of patients were observed and compared.Statistical methods employed t-test and χ² test. Results　Seven days after the operation, the levels of bradykinin (BK), 5-hydroxytryptamine (5-HT), and neuropeptide Y (NPY) in the intervention group were all lower than those in the control group [(3.86±0.06) μg/L vs.(3.93±0.05) μg/L,(340.48±14.54) μg/L vs.(353.59±12.61) μg/L,(119.36±3.42) ng/L vs.(126.55±4.23) ng/L], the differences were all statistically significant (t=6.274,4.768,9.253; all P<0.05). Three months after the operation, the forced vital capacity (FVC), vital capacity (VC), maximal ventilation volume (MVV), and total lung capacity (TLC) of the intervention group were all higher than those of the control group, and the differences were statistically significant (t=2.048,2.283,2.813,2.646; all P<0.05). After a 24-month follow-up, 3 patients (6.12%) in the intervention group died, while 46 patients (93.88%) survived. The median overall survival (OS) was 16 months. n the control group, 9 patients (18.37%) died and 40 patients (81.63%) survived. The overall survival (OS) time was 12 months, and the difference was statistically significant (χ²=5.089,P<0.05). Conclusion　For patients with primary mediastinal tumors, adopting the laparoscopic three-port approach via a 3 cm incision under the xiphoid process can alleviate the pain stress level of the patients, enhance their lung function, and improve their quality of life.

Clinical efficacy observation of low-frequency pulsed electrical stimulation combined with warm acupuncture in the treatment of elderly refractory facial paralysis

Li Xiling, Jiang Jing, Meng Wenwen, Wang Haitao

2025, 31(17):  2921-2925.  DOI: 10.3760/cma.j.cn441417-20250226-17020

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Objective　To investigate the clinical efficacy of low-frequency pulse electrical stimulation combined with warm acupuncture in the treatment of refractory facial paralysis (RBFP) in the elderly and its effect on oxidative stress indicators. Methods　A prospective study was conducted to select 84 elderly patients with RBFP admitted to Weihai Central Hospital Affiliated to Qingdao University from January 2021 to December 2023. They were divided into two groups according to the random number method, with 42 cases in each group.Control group : 23 males and 19 females, aged (69.74±7.85) years, course of disease (98.43±22.79) d ; give warm acupuncture treatment.Observation group : 20 males and 22 females, aged (69.50±7.74) years, course of disease (100.15±21.34) d ; on the basis of the control group, low frequency pulse electrical stimulation was given.Both groups were treated once a day, 10 days as a course of treatment, a total of 2 courses of treatment.The clinical efficacy and Sunnybrook (Toronto) facial nerve assessment system score, facial disability index (FDI), oxidative stress index [ superoxide dismutase (SOD), malondialdehyde (MDA)] before and after treatment were compared between the two groups.The statistical methods were χ² test and t test. Results　After treatment, the curative effect of the observation group was better than that of the control group [78.57%(33/42) vs. 95.24%(40/42)], and the Sunnybrook facial nerve assessment system score was higher than that of the control group [(70.36±8.44) points vs. (62.89±7.02) points], the differences were statistically significant (χ²=5.126, t=4.410; both P<0.05);The physical function ( FDIP ) score of the observation group was higher than that of the control group, and the social function (FDIS) score was lower than that of the control group, the differences were statistically significant (t=8.887,9.799; both P<0.05);The serum SOD level in the observation group was higher than that in the control group [(113.97±10.25) nU/ml vs. (95.24±8.57) nU/ml], and the serum MDA level was lower than that in the control group [(3.28±0.39) nmol/L vs. (4.93±0.64) nmol/L], the differences were statistically significant (t=9.085,14.268; both P<0.05). Conclusion　Low-frequency pulse electrical stimulation combined with warm acupuncture can improve the clinical efficacy of elderly patients with RBFP, improve the facial nerve function score and FDIP/FDIS score, and synergistically optimize the balance of oxidative stress, which is more advantageous than single warm acupuncture.

Efficacy of colon dialysis with nitrogen-lowering detoxification solution combined with retention enema of uremic clear granules for early and middle-stage chronic renal failure patients

Feng Xiaoyan, Chen Shunhe, Zhang Yan

2025, 31(17):  2926-2930.  DOI: 10.3760/cma.j.cn441417-20250327-17021

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Objective　To explore the clinical efficacy of the colon dialysis with nitrogen-lowering detoxification solution combined with urine toxin-clearing granules retention enema in the treatment of patients with early to mid-stage chronic renal failure (CRF). Methods　Carry out a prospective study.Using the simple random sampling method, 98 patients with CRF who received treatment at Xi'an Hospital of Traditional Chinese Medicine from June 2021 to August 2023 were divided into two groups, with 49 patients in each group.Control group: 27 males and 22 females, with an average age of (42.56±9.38) years and a disease duration of (6.48±2.50) years.In the early stage, there were 25 cases of CRF; in the middle stage, there were 24 cases of CRF. The treatment method was to use the Yutuzhen Granules for direct retention enema.Observation group: 29 males and 20 females, with an average age of (42.41±9.18) years and a disease duration of (6.75±2.34) years.Early cases of CRF: 23; Mid-term cases of CRF: 26.First, perform colon dialysis with the nitrogen-lowering detoxification solution, and then use the Yutuqing Granules for retention enema.The patients in both groups were treated with urine toxin-clearing granule retention enema three times a week for a total of four weeks.The clinical efficacy, occurrence of adverse reactions, and levels of blood urea nitrogen (BUN), serum creatinine (Scr), glomerular filtration rate (GFR), uric acid (UA), blood calcium (Ca), and blood phosphorus (P) before and after treatment were compared between the two groups of patients. Statistical analysis was conducted using t-test and χ² test. Results　After treatment, the total effective rate of the observation group was higher than that of the control group [93.88%(46/49) vs.63.27%(31/49)], and the difference was statistically significant (χ²=13.636; P<0.05).The BUN and Scr levels in the observation group were lower than those in the control group [(18.98±4.19) mmol/L vs.(22.37±5.71) mmol/L,(334.16±32.29) μmol/L vs.(352.05±43.01) μmol/L], and the GFR was higher than that in the control group [(44.39±6.21) mL/(min·1.73 m²) vs.(37.05±5.57) mL/(min·1.73 m²)], and the differences were statistically significant (t=3.351,2.017,6.159; all P<0.05).After treatment, the levels of UA and P in the observation group were lower than those in the control group [(382.67±57.40) μmol/L vs.(437.22±65.58) μmol/L, (1.31±0.19) mmol/L vs.(1.42±0.23) mmol/L], while the level of Ca was higher in the observation group [(2.54±0.23) mmol/L vs. (2.27±0.21) mmol/L], and the differences were statistically significant (t=4.381,2.581,6.068; all P<0.05).The comparison of adverse reaction rates between the two groups of patients [8.16%(4/49) vs.14.29%(7/49)] showed no statistically significant difference (χ²=0.922; P>0.05). Conclusion　The combined treatment of nitrogen-lowering detoxification liquid colon dialysis and urine toxin-clearing granules retention enema for patients with early to middle-stage chronic renal failure can effectively improve the renal function and metabolic indicators of the patients, and the clinical efficacy is excellent.

Application effect of acupoint massage combined with lumbar orthopaedic fixative in postoperative rehabilitation of patients with lumbar disc herniation

Zhao Liang, Wang Jing, Li Jintao, Deng Baofeng

2025, 31(17):  2931-2935.  DOI: 10.3760/cma.j.cn441417-20250207-17022

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Objective　To explore the application effect of acupoint massage along meridians combined with lumbar orthopedic fixation support in the postoperative rehabilitation of patients with lumbar disc herniation (LDH). Methods　A retrospective study was conducted. 82 patients with LDH who underwent surgical treatment at Baoji Hospital of Traditional Chinese Medicine from January 2021 to December 2023 were selected. They were divided into two groups according to the postoperative adjuvant treatment methods, with 41 cases in each group.Control group: 17 males and 24 females, with an average age of (44.36±7.39) years, and a disease duration of (24.52±8.11) months. They were treated with lumbar orthopedic fixation stent assistance.Observation group: 21 males and 20 females, with an average age of (42.31±7.05) years, and a disease duration of (26.84±8.94) months. They were treated with acupoint massage along the meridians combined with a lumbar orthopedic fixation brace as an auxiliary therapy.Compare the Visual Analogue Scale (VAS) scores, lumbar range of motion, lumbar function, quality of life, and adverse reactions of the two groups of patients before treatment, at 2 weeks and 4 weeks after treatment.Statistical methods employed were the χ² test, F test, and t test. Results　At 2 weeks and 4 weeks of treatment, the VAS scores for the waist [(4.34±0.86) points,(2.11±0.42) points], the VAS scores for the legs [(3.42±0.68) points,(2.23±0.45) points] and the ODI scores [(35.42±4.43) points,(19.64±2.46) points] in the observation group were significantly lower than those before treatment.Comparisons between the two groups before and after treatment showed statistically significant differences (F_groups=26.875, F_time= 31.624, F_interaction=24.728; F_groups=24.615, F_time=29.653, F_interaction=23.511; F_groups=21.932, F_time=25.441, F_interaction=20.125; all P<0.001_groups, all P<0.001_time, all P<0.001_interaction).The flexion and extension activities of the lumbar spine, as well as the JOA score, in the observation group all showed significant increases compared to those before treatment. When comparing the two groups before and after treatment, the differences were statistically significant(F_groups=22.506, F_time=27.491, F_interaction=21.631; F_groups=23.726, F_time=30.745, F_interaction=21.223; F_groups=18.417, F_time=22.586, F_interaction=15.745; P_groups<0.001, P_time<0.001, P_interaction<0.001).After 2 weeks of treatment, the SF-36 score of the observation group was higher than that of the control group [(83.11±6.39) points vs.(79.42±6.10) points], and the difference was statistically significant (t=2.675, P=0.009). Conclusion　Acupoint massage along the meridians combined with a spinal orthopedic fixation brace for LDH patients during postoperative rehabilitation can effectively reduce pain levels, improve lumbar spine function and joint mobility, and enhance the quality of life.

Clinical observation of Orff music therapy combined with scalp acupuncture on language impairment in autistic children

Mu Baoni, Luo Ting, Liu Rui

2025, 31(17):  2935-2940.  DOI: 10.3760/cma.j.cn441417-20250117-17023

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Objective　Exploring the efficacy of Orff music therapy combined with scalp acupuncture in treating language disorders in children with autism. Methods　Conduct a retrospective study.A total of 96 children diagnosed with autism who were admitted to Xi'an Union Hospital and treated from January 2021 to August 2024 were selected. They were divided into the control group (52 cases) and the experimental group (44 cases) according to the treatment methods.Experimental group: 23 males and 21 females, aged 3 to 5 (4.37±0.89) years, with a disease duration of 1 to 3(1.66±0.62) years, with a developmental quotient ranging from 75 to 93(84.25±6.53) points. They were treated with the Orff musical drama therapy combined with scalp acupuncture.Control group: 33 males and 19 females, aged 3 to 5(4.61±0.32) years, with a disease duration of 1 to 3(1.54±0.49) years, developmental quotient ranging from 73 to 92(86.13±5.22) points, treated with scalp acupuncture.Both groups were treated for 24 weeks.Compare the scores of the two groups in terms of TCM syndrome indices, the Psychological Education Scale for Children with Autism Spectrum Disorders and Related Developmental Disorders (CPEP-3), the Autism Treatment Evaluation Checklist (ATEC), and the Autism Behavior Checklist for Children (ABC).The statistical methods employed were t-test and χ² test. Results　After the treatment, the scores of the traditional Chinese medicine syndromes in both groups decreased compared to before the treatment, especially for language retardation, mental lethargy, intellectual disability and loss of appetite. Moreover, the scores in the experimental group were lower than those in the control group[(0.26±0.12) points vs.(0.86±0.20) points, (0.18±0.08) points vs.(0.67±0.13) points, (0.21±0.14) points vs.(0.58±0.22) points, (0.16±0.05) points vs.(0.63±0.11) points], all the differences were statistically significant (t=17.415,21.75,9.624,26.134; all P<0.05).The ATEC and ABC scores of the experimental group were both lower than those of the control group [(69.17±5.64) points vs.(88.73±7.66) points, (69.09±5.98) points vs.(87.35±6.31) points], and the differences were statistically significant (t=14.021,14.469; both P<0.05).After the treatment, the CPEP-3 scores showed that in terms of cognition, language expression, language comprehension, imitation, fine motor skills, gross motor skills, social interaction, emotional expression, non-verbal behavioral characteristics and language behavioral characteristics, they were all higher than those before the treatment, and the scores of the experimental group were higher than those of the control group (all P<0.05).The comparison of the total incidence rates of adverse reactions between the two groups showed no statistically significant difference (9.61%(5/52) vs.13.63%(6/44); χ²=0.380, P>0.05). Conclusion　Orff music therapy combined with scalp acupuncture can improve language ability disorders such as cognition, imitation, expression and comprehension in children with autism, and promote their recovery.

Effect analysis of music therapy combined with cognitive behavioral intervention in benign epilepsy with central temporal spines

Hu Xiaoli, Li Tingting, Wang Yanli, Yang Bo, Cao Yidan

2025, 31(17):  2940-2944.  DOI: 10.3760/cma.j.cn441417-20250321-17024

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Objective　To observe the clinical effect of music therapy combined with cognitive behavioral intervention in children with benign epilepsy with centro-temporal spikes (BECT). Methods　Carry out a prospective study.A total of 86 children with BECT who were admitted to the Pediatrics Department of Henan Provincial People's Hospital from March 2021 to September 2024 were selected as the research subjects. They were divided into two groups by convenience sampling method, with 43 cases in each group.Control group: 22 males and 21 females, aged 6 to 13 (9.24±1.21) years, with a disease duration of 3 to 12 (7.57±1.42) months;Carry out routine intervention;Observation group: 23 males and 20 females, aged 6 to 14 (9.33±1.17) years, with a disease duration of 3 to 13 (7.65±1.39) months;On the basis of the control group, music therapy combined with cognitive behavioral intervention was implemented, and the intervention lasted for 3 months continuously.Both groups received continuous intervention for 3 months.The cognitive functions, negative emotions, medication compliance and developmental quotient of the two groups of BECT patients were compared before and after the intervention.The statistical method employed was the t-test. Results　After the intervention, the verbal comprehension index, working memory index, perceptual reasoning index, and processing speed index of the children in the observation group all increased compared to those before the intervention, while those in the control group were lower than those in the observation group (t=-3.577,-3.607,-5.276,-2.513;all P<0.05).The scores of the Screening Scale for Anxiety-Related Emotional Disorders in Children (SCARED) and the Depression Self-Rating Scale for Children (DSRSC) in the control group were both higher than those in the observation group [(26.51±3.62) points vs. (20.32±2.53) points, (16.58±1.58)points vs.(12.62±1.37)points ], and the differences were statistically significant (t=9.191,12.417; both P<0.05).After the intervention, the scores of the medication compliance scale, fine motor skills, gross motor skills, adaptability, language, and personal-social aspects in the control group were all lower than those in the observation group, and the differences were statistically significant (t=-5.451,-2.872,-4.016,-4.564,-3.095,-2.329; all P<0.05). Conclusion　For children with BECT, the application of music therapy combined with cognitive behavioral intervention can effectively improve their cognitive levels and negative emotions, as well as enhance their medication compliance and developmental quotient.

Case Report

Postmenopause recurrent pyometra complicated with endometrioid adenocarcinoma: a case report and literature review

Liu Xiangyu, Long Ruling

2025, 31(17):  2945-2950.  DOI: 10.3760/cma.j.cn441417-20250417-17025

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Objective　To explore the proportion of endometrial cancer in postmenopausal patients with pyometra and the causes of missed diagnosis, enhance clinicians' understanding and attention to postmenopausal pyometra, improve the diagnosis and treatment level for such patients, and reduce missed diagnosis. Methods　A patient with endometrioid adenocarcinoma, whose initial symptom was recurrent massive pyometra in the uterine cavity after menopause, was admitted to Renhua County People's Hospital, which was supported by the stationed medical team from Zhujiang Hospital of Southern Medical University in March 2024. A retrospective analysis method was used to study the patient's clinical case data, including medical history, clinical manifestations, laboratory tests, molecular typing test results, and the diagnosis and treatment process. Using "postmenopausal uterine cavity effusion" "recurrent pyometra in the uterine cavity" "postmenopausal endometrioid adenocarcinoma" as Chinese and English keywords, the relevant literatures on postmenopausal uterine cavity effusion and pyometra combined with endometrial cancer included in Chinese databases such as Wanfang Data Knowledge Service Platform and China National Knowledge Infrastructure (CNKI), as well as English databases such as PubMed from January 2015 to January 2025 were retrieved. The incidence proportion of endometrial cancer in postmenopausal patients with pyometra was summarized, and the causes of missed diagnosis were analyzed. Results  (1) The patient was a 79-year-old woman who was admitted to the Department of Gynecology of Renhua County People's Hospital on March 23, 2024 due to "28 years of menopause and recurrent vaginal purulent discharge for 1 year". The patient had recurrent intermittent lower abdominal pain and irregular vaginal purulent discharge in the past year. Both gynecological ultrasound and pelvic MRI suggested a large amount of effusion in the uterine cavity. Enterococcus faecalis was cultured from the drained pus, and the carbohydrate antigen (CA) 19-9 was 287.15 U/ml. The admission diagnosis was pyometra, and conservative treatment was tried but ineffective. After communication with the patient and her family members, laparoscopic total hysterectomy + bilateral adnexectomy was performed on May 15, 2024. The patient's family members refused intraoperative frozen pathology and refused to expand the scope of the surgery before and during operation. The postoperative pathology suggested endometrioid adenocarcinoma, and the diagnosis was: endometrioid adenocarcinoma stage IB_NSMP. The patient's general condition was good after operation, and it was recommended to start supplementary vaginal brachytherapy 8 weeks after operation. As of December 14, 2024, the patient had completed radiotherapy for half a year, and the reexamination indicators and imaging examinations were all normal. (2) Results of literature review: there were 9 relevant research literatures on postmenopausal pyometra, involving 251 postmenopausal patients with pyometra, among whom 71 (28.3%) had gynecological malignancies [43 cases of endometrial cancer (17.1%), 27 cases of cervical cancer (10.7%), and 1 case of uterine leiomyosarcoma (0.4%)]. Endometrial cancer ranked the first, and as many as 11 patients were missed diagnosed during the first visit, accounting for 4.3%. Conclusions  Gynecological malignancies are one of the causes of pyometra, mainly endometrial cancer and cervical cancer. Great attention should be paid to postmenopausal patients with pyometra to avoid missed diagnosis. When the cause of the disease cannot be determined and conservative treatment is ineffective, active surgical treatment is recommended to relieve the symptoms and clarify the causes of the disease.

Nursing Research

Risk prediction model construction for chemotherapy-associated infections in childhood acute leukemia

Yang Yanlan, Zhong Jiawen, Liu Wenji, Zhang Yuan, Mai Huirong, Liu Hongyan

2025, 31(17):  2951-2956.  DOI: 10.3760/cma.j.cn441417-20250303-17026

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Objective　To explore the risk factors for chemotherapy-associated infections in childhood acute leukemia and to construct a predictive model. Methods　By using the convenience sampling method, 213 children with acute leukemia who were hospitalized at Shenzhen Children's Hospital from March 2021 to October 2024 were selected as the research subjects. According to whether the children had chemotherapy-associated infections, they were divided into an infection group (69 cases) and a non-infection group (144 cases). In the infection group, there were 35 boys and 34 girls, 30 cases aged <6 years and 39 cases aged 6-14 years. In the non-infection group, there were 78 boys and 66 girls, 65 cases aged <6 years and 79 cases aged 6-14 years. Univariate analysis (χ² test and independent sample t test) and multivariate logistic regression analysis were used to identify the influencing factors of chemotherapy-associated infections in childhood acute leukemia. Based on the results of regression analysis, a nomogram was drawn using R language, a risk prediction model was constructed, and its predictive value was analyzed using the receiver operating characteristic curve (ROC). Results　The incidence of chemotherapy-associated infections in childhood acute leukemia was 32.39% (69/213). The results of univariate analysis showed that there were statistically significant differences between the infection group and the non-infection group in terms of glucocorticoid treatment, prophylactic antibiotics, induction remission period, length of hospital stay, minimum neutrophil count, duration of neutrophil deficiency, and number of chemotherapy (all P<0.05), while there was no statistically significant difference in terms of gender, age, minimum hemoglobin level, or hospitalization season (all P>0.05). The results of logistic regression analysis showed that prophylactic antibiotics, length of hospital stay, duration of neutrophil deficiency, and number of chemotherapy were the influencing factors for chemotherapy-associated infections in children with acute leukemia (all P<0.05). Based on the results of logistic regression analysis, a nomogram model was constructed. The area under the curve of this model was 0.875 (95%CI: 0.713 - 0.946), with a sensitivity of 89.2% and a specificity of 90.7%, which indicated that the model had a high discriminatory ability. The Hosmer-Lemeshow test was conducted, with χ²=0.769 and P=0.993, indicating that the model fit well. Conclusion　The constructed risk prediction model has a high degree of discrimination and helps clinical medical staff quickly identify children with high risk of chemotherapy-associated infections in acute leukemia.

Analysis of reasons for the cancellation of day surgery in cataract patients and management countermeasures

Yao Liyan, Ye Xiufang, Cai Li, Tang Jinzhu, Xia Kong

2025, 31(17):  2957-2961.  DOI: 10.3760/cma.j.cn441417-20250106-17027

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Objective　To analyze the reasons for the cancellation of day surgery in cataract patients and explore feasible management countermeasures to reduce the surgery cancellation rate. Methods　A retrospective study was conducted on 784 patients whose day surgeries were canceled in the Cataract Department of Zhongshan Ophthalmic Center between January and December 2022. Among them, there were 404 males and 380 females, with an age of (66.09±15.63) years old. The causes of cancellation were analyzed, and the corresponding management countermeasures were formulated and implemented. Statistical analysis was conducted using the χ² test. Results　The cancellation rate of cataract day surgery was 4.83% (784/16 233). There were 758 cases (96.68%) of patient-related factors and 26 cases (3.32%) of medical and administrative factors; the most common reasons for cancellation included abnormal preoperative examination results (552 cases, 70.41%), changes in systemic conditions (81 cases, 10.33%), and ocular condition changes (53 cases, 6.76%). There was a statistically significant difference in the cancellation rate of day surgery over the four seasons (P<0.01). After implementing targeted management countermeasures, the cancellation rate decreased from 4.83% in 2022 to 3.09% (768/24 867) in 2023, with a statistically significant difference (χ²=81.95, P<0.001). Conclusions　The reasons for day surgery cancellations in cataract patients are multifaceted. Prioritizing patient-related factors, addressing seasonal influences on disease progression, adopting tailored interventions, and enhancing health management for elderly patients, can effectively reduce the cancellation rate, thereby contributing to the improvement and development of elderly healthcare service systems.

Effects of traditional Chinese medicine package combined with pulmonary rehabilitation training on the symptoms and pulmonary function in patients with chronic obstructive pulmonary disease in the stable phase

Bai Hefang, Bai Yunjie, Shi Junping

2025, 31(17):  2961-2965.  DOI: 10.3760/cma.j.cn441417-20250320-17028

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Objective　To investigate the effect of traditional Chinese medicine (TCM) package combined with pulmonary rehabilitation training on patients with stable chronic obstructive pulmonary disease (COPD). Methods　A total of 98 patients with stable COPD admitted to Zhumadian Hospital of Traditional Chinese Medicine from October 2022 to October 2024 were selected for a prospective study. They were divided into two groups according to the random number table method, with 49 patients in each group. In the control group, there were 22 females and 27 males; the age ranged from 48 to 72 years old [(60.00±3.54) years old]; the disease duration was 2 to 16 years [(9.98±1.13) years]. In the observation group, there were 21 females and 28 males; the age ranged from 46 to 74 years old [(60.13±3.56) years old]; the disease duration was 1 to 17 years [(9.95±1.16) years]. The control group received routine nursing care and pulmonary rehabilitation training, and the observation group received TCM package intervention on the basis of the control group. Both groups were continuously intervened and observed for 2 weeks. The dyspnea symptoms, exercise endurance, pulmonary function, and quality of life were compared between the two groups. Statistical analysis was conducted using the χ² test and t test. Results　After intervention, the score of the modified Medical Research Council (mMRC) dyspnea scale in the observation group was (1.64±0.17) points, which was lower than that in the control group [(2.18±0.20) points]; the distance of the 6-minute walk test (6MWT) was (435.67±15.62) m, which was longer than that in the control group [(390.79±15.51) m] (t=14.401 and 14.272, both P<0.05). After intervention, the forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV1/FVC in the observation group were (3.13±0.40) L, (2.30±0.39) L, and (73.48±9.75)%, which were all higher than those in the control group [(2.95±0.36) L, (2.05±0.36) L, and (69.49±9.72)%] (t=2.341, 3.297, and 2.029, all P<0.05). After intervention, the scores of poor sleep quality, dyspnea, cough, expectoration, limited activity ability, lack of energy, psychological impact, and limited outdoor activity of the COPD Assessment Test (CAT) in the observation group were (1.01±0.21) points, (1.12±0.24) points, (1.10±0.11) points, (1.12±0.19) points, (1.12±0.21) points, (1.15±0.23) points, (1.13±0.16) points, and (1.13±0.15) points, which were all lower than those in the control group [(1.34±0.26) points, (2.21±0.35) points, (2.13±0.14) points, (1.53±0.22) points, (2.04±0.28) points, (2.94±0.26) points, (2.57±0.20) points, and (1.76±0.18) points] (t=6.912, 17.979, 40.495, 9.873, 18.400, 36.096, 39.356, and 18.821, all P<0.05). Conclusion　TCM package combined with pulmonary rehabilitation training can alleviate the dyspnea symptoms in stable COPD patients, enhance the exercise endurance, improve the pulmonary function, and contributes to improving the quality of life.

Potential profile analysis of family management style in parents of refractory asthma children and its influencing factors

Liu Ruixia, An Zhaohui, Liu Hongyu, Yang Qin

2025, 31(17):  2966-2971.  DOI: 10.3760/cma.j.cn441417-20250313-17029

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Objective　To explore the potential profile and influencing factors of family management styles in parents of refractory asthma children, and to provide basis for formulating individualized family management intervention strategies. Methods　A total of 218 children with refractory asthma and their parents were selected from the respiratory department of Hunan Children's Hospital, Xiangya School of Medicine, Central South University from January 2024 to February 2025 by the convenience sampling method. In the 218 children, there were 130 boys (59.63%) and 88 girls (40.37%); the age ranged from 3 to 14 years old, among whom 118 cases (54.13%) aged 3 to 7 years, and 100 cases (45.87%) aged 8 to 14 years. Among the children's parents, there were 86 fathers (39.45%) and 132 mothers (60.55%); the age ranged from 25 to 35 years old in 94 cases (43.12%), and over 35 years old in 124 cases (56.88%). The data were collected through the General Information Questionnaire, Family Management Measure (FaMM), Family Hardiness Index (FHI), and Perceived Social Support Scale (PSSS). Potential profile analysis was used to classify the family management styles, and the influencing factors were screened using the χ² test, one-way analysis of variance, and multivariate logistic regression analysis. Results　The family management style in parents of refractory asthma children was divided into three potential profiles: a negative family management style group [29.36% (64/218)], a general family management style group [40.37% (88/218)], and an active family management style group [30.27% (66/218)]. Multivariate logistic regression analysis showed that the duration of asthma, attack frequency, parents' self-rated care ability, daily care time, family tenacity, and social support were independent influencing factors of family management style (all P<0.05). Conclusions　There are obvious differences in the family management styles in parents of refractory asthma children, and the family management style is affected by many factors. According to the characteristics and influencing factors of family management, nursing staff should provide targeted nursing intervention for families of refractory asthma children, so as to improve the effect of family management, reduce the burden of family, and enhance the children's quality of life.

Study on the construction of homogeneous clinical teaching mode for nursing undergraduates based on the group standards of Chinese Nursing Association

Sun Yanqi, Zhang Jingchao, Man Zhenping, Song Liping, Hou Jinghua

2025, 31(17):  2972-2976.  DOI: 10.3760/cma.j.cn441417-20250426-17030

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Objective　To explore the construction method and practical effect of homogeneous clinical teaching mode for nursing undergraduates based on the group standards of Chinese Nursing Association. Methods　Under the guidance of evidence-based nursing practice, a prospective study was conducted to construct a homogeneous clinical teaching program for nursing undergraduates based on the group standards of Chinese Nursing Association by searching relevant literatures at home and abroad and semi-structured interviews. A total of 97 nursing undergraduates who practiced in Tengzhou Central People's Hospital Affiliated to Jining Medical College from February 2023 to March 2025 were selected as the research objects. According to the practice time, 48 students who practiced from February 2023 to February 2024 were selected as the control group, including 40 girls and 8 boys, with an age of (21.5±1.2) years old, and they adopted the traditional clinical teaching mode. From March 2024 to March 2025, 49 students were selected as the observation group, including 39 girls and 10 boys, with an age of (21.3±1.3) years old, and they adopted the homogeneous clinical teaching mode based on the group standards of Chinese Nursing Association. The two groups were given 4 weeks of intervention training, and the theoretical knowledge scores, skill operation scores, post competency scores, and teaching satisfaction of the two groups were compared. Independent-sample t test and χ² test were used for statistical analysis. Results　The expert consultation opinions were summarized to form a homogeneous clinical teaching program for nursing undergraduates based on the group standards of Chinese Nursing Association. Through the comparison of practical effects, it was found that the theoretical knowledge and skill operation scores in the observation group were higher than those in the control group [(93.55±3.52) points vs. (87.62±4.33) points, (87.29±4.03) points vs. (81.17±3.67) points; t=7.408 and 7.815, both P<0.001]. The post competency score of the observation group was higher than that of the control group [(162.45±3.42) points vs. (152.54±3.98) points; t=13.162, P<0.001]. The students' satisfaction with teaching in the observation group was also higher than that in the control group (P<0.001). Conclusion　The homogeneous teaching program for nursing undergraduates based on the group standards of Chinese Nursing Association has high scientificity and effectiveness, which can effectively improve the students' theoretical knowledge, operational skills, and post competence, and improve the students' satisfaction with teaching, with good application value.

Potential profile analysis and influencing factors of mental health literacy classification of nursing students

Liu Hongyu, Yang Qin

2025, 31(17):  2977-2982.  DOI: 10.3760/cma.j.cn441417-20250211-17031

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Objective　To analyze the potential profile of mental health literacy of nursing students and explore its influencing factors. Methods　A total of 498 nursing students from the Affiliated Children's Hospital of Xiangya School of Medicine, Central South University from March to September 2024 were selected by the convenience sampling method. The general data questionnaire and Adolescent Mental Health Literacy Rating Scale were used to investigate them. Mplus 7.0 software was used for potential profile analysis, and the influencing factors were analyzed using the χ² test and multivariate logistic regression analysis. Results　This study included a total of 498 nursing students, among whom there were 14 males and 484 females; 168 cases with age <18 years old, 171 cases 18-20 years old, and 159 cases >20 years old. The total score of Adolescent Mental Health Literacy Rating Scale among the nursing students was (69.53±8.49) points. The mental health literacy was divided into three subtypes: low stable mental health literacy group [45.0% (224/498)], medium fluctuating mental health literacy group [38.2% (190/498)], and high level mental health literacy group [16.9% (84/498)]. Multivariate logistic regression analysis showed that educational level, parental educational level, school nature, and mental health level were the influencing factors of mental health literacy of nursing students (all P<0.05). Conclusions　The overall level of mental health literacy of nursing students is in the middle category, and there is heterogeneity in the classification of mental health literacy. Education level, parental education level, school nature, and mental health level are all factors affecting the classification of mental health literacy of nursing students. Nursing educators should develop individualized training programs according to the mental health literacy level of different types of nursing students and the influencing factors.

Potential profile analysis of clinical decision-making ability of nursing interns in neonatology department

Quan Yi, Lyu Bo, Quan Li, Long Yingzi

2025, 31(17):  2982-2988.  DOI: 10.3760/cma.j.cn441417-20250321-17032

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Objective　To explore the potential group characteristics and influencing factors of clinical decision-making ability of nursing interns in neonatology department, and to provide some evidences for optimizing the nursing education model. Methods　From July to December 2024, using the convenience sampling method, 287 nursing interns from the Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan Children's Hospital) were selected as the research objects, including 20 males and 267 females who were (19.8±1.2) years old. The General Data Questionnaire, Self-learning Ability Assessment Scale, Workplace Bullying Questionnaire, and Nursing Clinical Decision Scale were used to investigate the interns. The Mplus 7.0 software was used to establish the potential profile model, and the SPSS 21.0 software was used for the statistical analysis, including analysis of variance and multivariate logistic regression analysis. Results　The research found that the interns' clinical decision-making ability could be divided into three potential profiles: low, medium, and high, accounting for 30.31% (87/287), 38.68% (111/287), and 31.01% (89/287), respectively. The total scores of clinical decision-making ability in the 3 groups were 104.52±14.87, 141.23±15.13, and 161.45±12.69, respectively. The multivariate logistic regression analysis showed that educational level, class leader, attitude toward nursing profession, determination to engage in nursing work, independent learning ability, and workplace bullying were independent factors affecting the category of clinical decision-making ability (all P<0.05). Conclusions　There is obvious heterogeneity in the clinical decision-making ability of nursing interns in neonatology department. Nursing education should pay attention to the interns' individual differences, and improve their clinical decision-making ability optimizing the education model and practice environment, so as to improve nursing quality and patient safety in neonatology department.

Investigation Report

Influence of parents' attitude toward sex education on children's sexual knowledge and countermeasures

Hu Xiaoxue, Deng Huanhuan, Dai Jinlan, Liu Shanshan

2025, 31(17):  2989-2992, 封三.  DOI: 10.3760/cma.j.cn441417-20250401-17033

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Objective　To explore the influence and correlation of parents' attitude toward sex education on children's sexual knowledge, to improve children's sexual knowledge and self-protection literacy, and to reduce the incidence rate of child sexual assault cases. Methods　From August to December 2024, one school was randomly selected from each of the 2 districts, 1 county, and 2 county-level cities in Deyang City as the sampling units. The 6-12 years old children and their parents were selected as the research objects. The General Information Questionnaire, Parents' Attitude toward Sex Education Scale, and Children's Sexual Knowledge Scale were used for the investigation. Results　The total score of the parents' attitude toward sex education was 63.92±5.31, and the score of the children's sexual knowledge was 12.37±1.15. The Pearson correlation analysis revealed that the parents' attitude toward sex education was positively correlated with the children's total sexual knowledge score, reproductive physiology, pregnancy and contraception, and sexual harassment and assault (r=0.405, 0.387, 0.472, and 0.423; all P<0.01). The results indicated that the primary caregiver, mother's education level, whether kindergarten-based sex education was provided, and parents' positive attitude toward sex education were the influencing factors of the children's sexual knowledge level(all P<0.05). Conclusions　Parents' positive attitude toward sex education is positively correlated with children's sexual knowledge level (reproductive physiology, pregnancy and contraception, sexual harassment and assault, etc.). Children's sexual knowledge level is also influenced by their primary caregivers, their mothers' education level, and kindergarten-based sex education. It is recommended to strengthen parents' awareness and knowledge of sex education, especially their attitude toward sex education, and to promote cooperation between schools and families, so as to provide children with scientific and comprehensive sex education.