Table of Content

01 November 2025, Volume 31 Issue 22

Previous Issue   

Special Column of Stroke

The mechanism and research progress of ferroptosis in ischemic stroke

Liu Yanmin, Wang Linhua, Li Tingting, Song Yingxian, Wang Meiling

2025, 31(22):  3698-3703.  DOI: 10.3760/cma.j.cn441417-20250515-22001

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Ischemic stroke (IS), a cerebrovascular disease with high global morbidity and mortality, has long lacked effective therapeutic approaches. Ferroptosis, an iron-dependent form of cell death, has been progressively elucidated in IS pathogenesis through ongoing research. Ferroptosis not only exacerbates neurological damage through iron overload, redox imbalance, and lipid peroxidation, but is also regulated by associated signaling pathways. Currently, inhibitors targeting ferroptosis mechanisms have been demonstrated to mitigate post-IS neuronal damage and improve prognosis. This review systematically summarizes the pathogenic role of ferroptosis in IS, analyzes its associated signaling pathways, the potential therapeutic effects of associated inhibitors, and its interplay with other forms of cell death, aiming to provide novel insights and directions for future clinical research and therapeutic strategies.

Fuyang jar warm moxibustion and scraping therapy combined with auricular acupuncture point seed implantation for patients with post-stroke insomnia

Bian Guangmei, Liu Mingyang, Yang Fang, He Xiaoqin

2025, 31(22):  3704-3708.  DOI: 10.3760/cma.j.cn441417-20250422-22002

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Objective　To explore the effect of Fuyang jar warm moxibustion and scraping therapy combined with auricular acupuncture point seed implantation for patients with post-stroke insomnia. Methods　Ninety patients with post-stroke insomnia treated at Liangyungang Hospital of Traditional Chinese Medicine from June 2021 to March 2025 were selected as the study objects, and were divided in a control group and an observation group according to the intervention methods, with 45 cases in each group. There were 23 males and 22 females in the control group; they were (65.02±5.09) years old; there were 28 cases of ischemic stroke and 17 cases of hemorrhagic stroke; their score of National Institutes of Health Stroke Scale (NIHSS) was 12.34±3.16. There were 24 males and 21 females in the observation group; they were (64.78±5.27) years old; there were 26 cases of ischemic stroke and 19 cases of hemorrhagic stroke; their score of NIHSS was 11.83±3.02. The control group received Fuyang jar warm moxibustion and scraping therapy; in addition, the observation group were treated with auricular acupuncture point seed implantation. The levels of anxiety and depression, sleep quality, and the incidence rates of adverse reactions were compared between the two groups. t and χ² tests were used for the statistical comparisons. Results　After the intervention, the scores of Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS), sleep latency, rapid eye movement (REM) sleep time, and score of Pittsburgh Sleep Quality Index (PSQI) in the observation group were higher than those in the control group [38.19±5.43 vs. 42.36±6.84, 34.35±6.12 vs. 40.68±7.54, (27.54±4.24) min vs. (31.98±3.61) min, (79.55±5.69) min vs. (94.17±5.25) min, and 8.99±3.50 vs. 11.08±4.67], and the total sleep time was longer [(7.99±0.50) h vs. (6.28±0.67) h, with statistical differences (all P<0.05). There was no statistical difference in the incidence rate of adverse reactions between the observation group and the control group [22.22% (10/45) vs. 20.00% (9/45); χ²=0.067; P=0.796]. Conclusion　Fuyang jar warm moxibustion and scraping therapy combined with auricular acupuncture point seed implantation for patients with post-stroke insomnia can alleviate their anxiety and depression and improve their quality of sleep, and does not increase the incidence rate of adverse reactions.

Low-frequency neuromuscular electrical stimulation with Huoxue Tongluo Shujin Formula combined for patients with post-stroke hemiplegia

Xue Liang, Li Jifeng, Zhang Guilian

2025, 31(22):  3705-3711.  DOI: 10.3760/cma.j.cn441417-20250422-22003

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Objective　To explore the effect of Huoxue Tongluo Shujin Formula combined with low-frequency neuromuscular electrical stimulation for patients with post-stroke hemiplegia. Methods　A total of 92 patients with post-stroke hemiplegia treated at Ordnance Industry General Hospital from March 2022 to March 2024 were selected for the prospective study, including 49 males and 43 females who were (56.67±6.93) years old. They were divided into an observation group and a control group using computerized randomization, with 46 cases in each group. The control group received low-frequency neuromuscular electrical stimulation; in addition, the observation group were treated with Huoxue Tongluo Shujin Formula. After one month's treatment, the clinical efficacies, muscle tonicities, motor function, daily living abilities, life quality, electromyography of lower limb on the hemiplegic side, scores of Chinese medicine symptoms, and incidence rates of adverse reactions were compared between the two groups. t and χ² tests were used for the statistical analysis. Results　The clinical efficacy in the observation group was higher than that in the control group [95.65% (44/46) vs. 80.43% (37/46)], with a statistical difference (χ²=5.059; P<0.05). The muscle tension after the treatment was lower than that before the treatment, and that the observation group was lower than that the control group, but the differences were not statistically significant (all P > 0.05). After the treatment, the scores of Fugl-Meyer Assessment (FMA) of the upper and lower limbs on the hemiplegic side, daily living ability, and life quality were higher than those before the treatment in both groups, and the scores in the observation group were higher than those in the control group (52.06±5.71 vs. 49.35±5.23, 26.51±4.08 vs. 22.64±3.51, 56.18±6.74 vs. 52.41±6.02, and 82.03±9.51 vs. 77.16±10.73; t=2.374, 4.877, 2.829, and 2.304; all P<0.05). After the treatment, the maximum amplitude of M-wave (Mmax), maximum amplitude of H-wave (Hmax), and the scores of main and secondary syndromes were lower than those before the treatment in both groups, and those in the observation group were lower than those in the control group [(1.26±0.14) mV vs. (1.41±0.17) mV, (1.31±0.36) mV vs. (1.65±0.44) mV, 10.05±2.61 vs. 11.48±3.54, and 7.53±2.31 vs. 9.06±2.52; t=4.620, 4.056, 2.205, and 3.035; all P<0.05]. No serious adverse reactions were observed in either group during the treatment. Conclusion　Huoxue Tongluo Shujin Formula combined with low-frequency neuromuscular electrical stimulation for patients with post-stroke hemiplegia is effective and can promote their recovery of motor function.

Expression and correlation analysis of plasma homocysteine and folic acid metabolism genes in elderly stroke patients

Niu Wei, Yang Fang

2025, 31(22):  3714-3717.  DOI: 10.3760/cma.j.cn441417-20250509-22004

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Objective　To investigate the expression and correlation of plasma homocysteine (Hcy) and folic acid metabolism genes in elderly stroke patients. Methods　Seventy-five elderly stroke patients treated in Xuzhou First People's Hospital from January 2021 to December 2023 were selected as a study group, and 60 healthy individuals undergoing physical examinations during the same period were selected as a control group. There were 47 males and 28 females in the study group; they were (71.85±5.06) years old. There were 39 males and 21 females in the control group; they were (72.09±5.24) years old. The genotypes and allelic genotypes of C677T of MTHFR and A66G of MTRR were compared between the two groups. The plasma Hcy levels were compared between the two groups. The plasma Hcy levels of different genotypes of C677T of MTHFR and A66G of MTRR were compared. The logistic regression analysis was used to analyze the relationship of MTHFR, MTRR genotypes, and plasma Hcy level with the occurrence of stroke in the elderly. t and χ² tests were used for the statistical analysis. Results　There were statistical differences in the polymorphisms of the C677T gene of MTHFR and the A66G gene of MTRR between the study group and the control group (both P<0.05). The frequencies of T and G allele genotypes in the study group were higher than those in the control group (both P<0.05). The Hcy level in the study group was higher than that in the control group [(34.10±4.83) μmol/L vs. (15.87±3.86) μmol/L; P<0.05]. The plasma Hcy level of the patients with TT genotype at the C677T locus of MTHFR was higher than those of the patients with CC and CT genotypes, and the plasma Hcy level of the patients with GG genotype at the A66G locus of MTRR was higher than those of the patients with AA and AG genotypes (both P<0.05). The multivariate analysis showed that the distribution of C677T gene polymorphisms of MTHFR and A66G gene polymorphisms of MTRR, as well as the plasma Hcy level, were independent influencing factors for elderly stroke (all P<0.05). Conclusion　The distribution of C677T gene polymorphisms of MTHFR and A66G gene polymorphisms of MTRR, as well as the plasma Hcy level, are independent influencing factors for elderly stroke.

Meta Analysis

Influencing factors of postoperative sore throat in adult patients taking tracheal intubation under general anesthesia: a meta-analysis

Lu Jing, Wang Renzhong, Qu Junchao, Wang Jing, Liu Huifang, Gu Yuanyuan

2025, 31(22):  3718-3722.  DOI: 10.3760/cma.j.cn441417-20250217-22005

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Objective　To conduct a meta-analysis on the influencing factors of postoperative sore throat (POST) in adult patients taking tracheal intubation under general anesthesia, to provide evidences for early identification of POST in adult patients with tracheal intubation under general anesthesia, and to reduce the incidence of POST. Methods　The literature related to POST risk factors of adult patients taking tracheal intubation under general anesthesia was systematically searched from self-established databases of each database to June 20, 2024, and  the relevant data were extracted from the included literature. The literature quality was evaluated by using the Neuskarl-Ottawa Scale (NOS), and the relevant data was meta-analyzed by Revman 5.3. Results　A total of 6 literatures were included, involving 1 754 adult patients, and the incidence rate of POST in the adult patients taking tracheal intubation under general anesthesia was 38.7%. Meta-analysis showed that multiple attempts at tracheal intubation (OR=2.49, 95%CI 1.55-3.99), high tracheal tube pressure (OR=2.02, 95%CI 1.20-3.41), female (OR=1.74, 95%CI 1.30-2.33) and cough during extubation (OR=2.99, 95%CI 1.87-4.80) were risk factors for POST in the adult patients taking tracheal intubation under general anesthesia. Conclusions　The POST of adult patients taking tracheal intubation under general anesthesia is affected by many factors, such as multiple attempts of tracheal intubation, high pressure of tracheal cuff, female and cough during extubation. Clinical medical staff should identify the occurrence of POST in adult patients taking tracheal intubation under general anesthesia early, and provide predictive nursing for POST in adult patients taking tracheal intubation under general anesthesia.

Basic Research

Protective effect of Tianxiangdan Granules against doxorubicin-induced myocardial toxicity in rats

Liu Chong, Xuanyuan Huan, Shen Danting, Ye Shenyi

2025, 31(22):  3723-3729.  DOI: 10.3760/cma.j.cn441417-20250109-22006

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Objective　To investigate the protective effect of Tianxiangdan Granules (TXD) against doxorubicin (DOX)-induced myocardial toxicity in rats and to explore its potential mechanisms. Methods　A total of 50 SD rats, 12 weeks old and 200-230 g in body weight, were divided into a control group, a DOX group, and TXD (10, 20, and 40 mg/kg) pre-treatment groups. The DOX-induced myocardial toxicity models and H9C2 cardiomyocyte models were established. The effects of TXD (10, 20, and 40 mg/kg) against DOX-induced myocardial toxicity were evaluated assessing heart function parameters, myocardial tissue pathology (HE staining), transmission electron microscopy, cell viability (TUNEL assay), reactive oxygen species (ROS) levels, and mitochondrial energy metabolism-related protein expression. One-way analysis of variance and SNK-q test were used for the statistical analysis. Results　Compared to the DOX group, TXD could significantly improve the rats' heart function indicators, reduce myocardial tissue pathological changes, protect mitochondrial structure in cardiomyocytes, increase cell viability, and regulate apoptosis-related protein expression. Furthermore, TXD could reduce the ROS level in cardiomyocytes, enhance Na⁺ and K⁺-ATPase activity and ATP content, and improve mitochondrial energy metabolism-related protein expression. Conclusion　TXD can mediate mitochondrial energy metabolism pathways to alleviate DOX-induced myocardial injury, providing experimental evidences for the clinical prevention and treatment of doxorubicin-induced cardiotoxicity and heart protection.

Treatises

Correlation analysis on the risk of preterm birth after in vitro fertilization-embryo transfer

Wang Wenyan, Xiao Li, Zheng Jianlan

2025, 31(22):  3730-3736.  DOI: 10.3760/cma.j.cn441417-20250527-22007

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Objective　To analyze the high risk factors of premature delivery and the outcomes of premature infants after in vitro fertilization-embryo transfer (IVF-ET). Methods　A retrospective analysis was conducted to collect the data of 742 premature patients treated in the Army 73rd Group Military Hospital from January 2018 to December 2023. According to the inclusion and exclusion criteria, the premature patients were divided into four groups according to the modes of conception and the numbers of pregnant embryos: a IVF-ET pregnancy singleton group (257 cases), a IVF-ET pregnancy twin group (161 cases), a natural pregnancy singleton group (283 cases), and a natural pregnancy twin group (41 cases). The IVF-ET pregnancy premature delivery group was (32.53±4.30) years old, and the gestational age of delivery was (34.59±2.20) weeks; the natural pregnancy preterm group was (32.35±3.60) years old, and the gestational age was (35.20±1.58) weeks. The general conditions (age, gestational age, and parity), pregnancy complications and comorbidities, delivery methods, and premature birth outcomes of pregnant women in the four groups were analyzed. Statistical methods included t test, χ² test, or Fisher's exact test. Results　The advanced age and primary birth rate of the IVF-ET pregnancy preterm group were higher than those of the natural pregnancy preterm group [23.92% (100/418) vs. 17.90% (58/324) and 84.92% (355/418) vs. 45.06% (146/324)], and the gestational age lower [(34.59±2.20)weeks vs. (35.20±1.58)weeks], with statistical differences (all P<0.05). The rates of cervical insufficiency, placental abnormality, gestational diabetes mellitus, gestational anemia, cesarean section, and neonatal asphyxia in the singleton pregnancy group after IVF-ET were higher than those in the singleton natural pregnancy group [3.50% (9/257) vs. 0.71% (2/283), 22.57% (58/257) vs. 14.13% (40/283), 33.85% (87/257) vs. 25.08% (71/283), 15.18% (39/257) vs. 9.54% (27/283), 60.31% (155/257) vs. 42.40% (120/283), and 7.39% (19/257) vs. 2.12% (6/283)], with statistical differences (all P<0.05). The rates of gestational diabetes mellitus, gestational hypertension, cesarean section, postpartum hemorrhage, and neonatal intensive care unit in the twin pregnancy group after IVF-ET were higher than those in the natural twin pregnancy group [34.78% (56/161) vs. 12.19% (5/41), 32.91% (53/161) vs. 17.07% (7/41), 87.57% (141/161) vs. 53.65% (22/41), 21.73% (35/161) vs. 7.32% (3/41), and 85.71% (138/161) vs. 58.54% (24/41)], with statistical differences (all P<0.05). Conclusions　The average gestational age of twins in IVF-ET is lower; the incidence of pregnancy complications and complications is higher; the rate of cesarean section is higher. It is suggested to control the iatrogenic complications of IVF-ET, evaluate the risk and quantity of single and twin transplantation, and promote single blastocyst transfer. Pregnancy complications can lead to premature birth. Strengthening the education and management of pregnancy patients after IVF-ET can avoid the occurrence of pregnancy complications, reduce the risk of premature birth, and improve maternal and infant outcomes.

Analysis of influencing factors and risk prediction of coronary heart disease complicated with cardiogenic stroke

Di Haili, Liao Yongbin, Guo Xian

2025, 31(22):  3731-3737.  DOI: 10.3760/cma.j.cn441417-20250819-22008

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Objective　To analyze the influencing factors of in patients with cardiogenic stroke in patients with, and to construct a risk prediction model. Methods　The clinical data of 249 patients with coronary heart disease admitted to the Northwest University First Hospital from January 2022 to January 2025 were retrospectively analyzed. The patients with cardiogenic stroke were counted, and these patients were classified as a case group (105 cases). Meanwhile, gender, age, body mass index, smoking history, and drinking history were used as matching variables. The patients without concurrent cardiogenic stroke were matched at a 1:1 ratio as a control group (105 cases). There were 58 males and 47 females in the case group, aged (66.23±6.53) years. There were 54 males and 51 females in the control group, aged (64.85±6.91) years old. The clinical data of the two groups were compared, and the influencing factors of coronary heart disease complicated with cardiogenic stroke were analyzed by multivariate logistic regression. A nomogram model of coronary heart disease complicated with cardiogenic stroke was drawn; the calibration curve, receiver operating characteristic curve (ROC), and decision curve analysis (DCA) were used to evaluate the predictive performance of the nomogram model. t test and χ² test were used as the statistical methods. Results　The proportion of the patients with hypertension, arrhythmia, cardiac mural thrombus, carotid plaque, severe coronary artery disease, left atrial diameter (LAD), left atrial diameter index (LADi), and homocysteine (Hcy) in the case group were higher than those in the control group [65.71% (69/105) vs. 40.95% (43/105), 71.43% (75/105) vs. 29.52% (31/105), 21.90% (23/105) vs. 6.67% (7/105), 48.57% (51/105) vs. 26.67% (28/105), 22.86% (24/105) vs. 5.71% (6/105), (38.16±5.81) mm vs. (35.92±4.73) mm, (22.69±3.24) mm/m² vs. (19.41±2.78) mm/m², and (16.92±4.20) μmol/L vs. (13.67±3.74) μmol/L], and the left ventricular ejection fraction (LVEF) was lower [(52.58±11.83)% vs. (57.40±9.89)%], with statistical differences (all P<0.05). The multivariate logistic regression analysis showed that hypertension, arrhythmia, cardiac mural thrombus, carotid plaque, severe coronary artery disease, LAD enlargement, high LADi, and high Hcy were risk factors for coronary heart disease and cardiogenic stroke (all P<0.05), and high LVEF was a protective factor (P<0.05). The internal verification of the nomogram model constructed based on the results of multivariate analysis showed that the predicted curve was similar to the actual curve, and the consistency index was 0.847. The results of ROC showed that the area under the curve (AUC), sensitivity, and specificity of the nomogram model in predicting coronary heart disease complicated with cardiogenic stroke were 0.836 (95%CI 0.779-0.884), 82.86%, and 80.95%, respectively. The results of DCA curve showed that the nomogram model had better clinical benefits when the threshold range was 0.08-0.93. Conclusions　Hypertension, arrhythmia, cardiac mural thrombus, carotid plaque, degree of coronary artery disease, LAD, LADi, LVEF, and Hcy are the influencing factors of coronary heart disease and cardiogenic stroke. The nomogram prediction model constructed based on the above factors has good clinical value.

Clinical study on changes of homocysteine and blood lipids in patients with vestibular migraine

Zhu Menghui, Du Qing, Gu Baodong, Ma Xianjun

2025, 31(22):  3743-3746.  DOI: 10.3760/cma.j.cn441417-20250514-22009

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Objective　To analyze the changes of homocysteine (Hcy) and blood lipids in patients with vestibular migraine (VM), and to provide references for the clinical diagnosis and treatment of VM. Methods　This was a prospective clinical trial study. From December 2022 to December 2024,72 patients with VM treated in Lianyungang Hospital of TCM were selected as an experimental group, including 18 males and 54 females, aged (55.47±9.23) years. At the same time, 40 healthy subjects were selected as a control group, including 12 males and 28 females, aged (58.38±8.98) years. The patients in the experimental group with VM were divided into a young group (age<50 years), a middle-aged group (50 years≤age<60 years), and a elderly group (age≥60 years). The lipid profiles [total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C)] and homocysteine (Hcy) levels of the two groups were compared, and a one-way analysis of variance was performed on the lipid profiles and Hcy levels of the patients in the experimental group. The statistical methods were t test and F test. Results　The levels of TC, TG, LDL-C, and Hcy in the experimental group were all higher than those in the control group [(4.85±0.78) mmol/L vs. (4.37±0.88) mmol/L, (2.13±0.57) mmol/L vs. (1.62±0.45) mmol/L,(2.89±0.67) mmol/L vs. (2.43±0.72) mmol/L, and (14.47±3.95) μmol/L vs. (11.37±3.20) μmol], with statistical differences (all P<0.05). The levels of TC, TG, HDL-C, LDL-C, and Hcy in the youth group were (3.97±0.74) mmol/L, (1.71±0.31) mmol/L, (1.52±0.39) mmol/L, (2.13±0.58) mmol/L, and (11.67±2.59) μmol/L, the levels in the middle-aged group  (4.79±0.77) mmol/L, (2.39±0.59) mmol/L, (1.43±0.32) mmol/L, (2.69±0.56) mmol/L, and (14.25±3.29) μmol/L, and the levels in the elderly group (5.46±0.52) mmol/L, (2.43±0.55) mmol/L, (1.15±0.12) mmol/L, (3.76±0.57) mmol/L, and (17.93±3.67) μmol/L. There were no significant differences in TG between the middle-aged group and the elderly group and in HDL-C and Hcy between the young group and the middle-aged group (all P>0.05). There were significant differences in the other indexes between the two groups (all P<0.05). Conclusions　The metabolic disorders of lipids and higher Hcy in patients with VM may be risk factors for VM. Early discovery and intervention of the metabolic disorders of lipids and higher Hcy are beneficial to the clinical diagnosis and treatment of VM patients.

Constructing an intelligent prediction system for early neurological function deterioration in spontaneous cerebral hemorrhage based on deep learning algorithms and CT images

Zhao Yingjun, Chen Xiao, Ren Xiaojun, Guan Rong, Luo Ting, Li Ni, Chang Zhengwei

2025, 31(22):  3747-3751.  DOI: 10.3760/cma.j.cn441417-20250326-22010

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Objective　To construct an intelligent prediction system for early neurological function deterioration (END) in patients with spontaneous intracerebral hemorrhage (SICH) based on deep learning algorithms and computed tomography (CT) images. Methods　The clinical data of 369 patients with SICH who were treated in Xi 'an Encephalopathy Hospital of Traditional Chinese Medicine from January 2022 to October 2024 were retrospectively analyzed. All the patients underwent CT plain scan after admission. According to the ratio of 2:1, the patients were randomly divided into an experimental set (246 cases, 5 subsets by five-fold cross-validation) and a validation set (123 cases). There were 135 males and 111 females in the evperimental set, aged (56.79±8.82) years. There were 70 males and 53 females in the validation set, aged (57.85±9.12) years. The intelligent prediction system for END in the SICH patient was constructed based on deep learning algorithms and experimental CT image data, and the diagnostic performance of the intelligent prediction system was analyzed by the validation set. Results　The incidence rate of END in the SICH patients was 21.14% (78/369), with 51 cases occurring in the experimental group of 246 patients, and 27 cases occurring in the validation group of 123 patients. The average sensitivity, specificity, and accuracy of the model validated by 5-fold cross validation in the experimental set were 96.18%, 97.44%, and 97.16% respectively. According to the validation set evaluation, the diagnostic sensitivity, specificity, and accuracy of the intelligent prediction system for END in the SICH patient based on deep learning algorithms and CT images were 96.30%, 97.92%, and 97.56%, respectively, and the consistency with the actual occurrence of END was high (Kappa=0.930, P<0.001). Conclusion　The intelligent prediction system for END of SICH patients based on deep learning algorithms and CT images has good diagnostic performance for END, and it has a certain clinical promotion significance.

Exploring potential mechanism of Paeonia-Lobelia in treatment of colorectal cancer based on the network pharmacology method

Li Jingchun, Long Qixiong, Meng Ping, Chen Yuan, He Wenxi, Sun Wei

2025, 31(22):  3752-3760.  DOI: 10.3760/cma.j.cn441417-20250605-22011

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Objective　To explore the active ingredients and molecular mechanism of Paeonia-Lobelia against colorectal cancer based on network pharmacological analysis. Methods　The Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) was used to search the active ingredients and targets of Paeonia and Lobelia until December 2024. The GeneCards, Therapeutic Target Database (TTD), and other databases were used to screen colorectal cancer related targets. The Cytoscape (Version 3.9.1) software was used to build a drug component potential target network diagram. A protein-protein interaction (PPI) network diagram was constructed using the STRING database platform to screen out the core genes. The expression and survival analysis of the core targets were validated using the GEPIA and HPA databases. Finally, the gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway enrichment analyses on the potential targets were performed using the WebGestalt and Metascape databases. Results　Fifteen active ingredients of Paeonia and 17 active ingredients of Lobelia were screened through the TCMSP. The intersection of Paeonia and Lobelia with colorectal cancer targets was obtained using the Venn diagram, with a total of 19 potential targets. Further calculation and analysis of the drug target network relationship diagram resulted in the identification of five key components in the anti-colorectal cancer properties of Paeonia and Lobelia, including quercetin, luteolin, kaempferol, acacetin, and catechin. Through PPI network analysis, 10 core targets that may be drug-acting diseases were identified, including tumor protein P53 (TP53), MYC gene, AKT serine/threonine kinase 1 (AKT1), caspase 3 (CASP3), cyclin D1 (CCND1), NF-kappa-B inhibitor alpha (NFKBIA), matrix metallopeptidase 9 (MMP9), inhibitor of nuclear factor kappa-B kinase subunit beta (IKBKB)), prostaglandin-endoperoxide synthase 2 (PTGS2), and heat shock protein family A (Hsp70) member 5 (HSPA5). The GO enrichment analysis showed that Paeonia and Lobelia were mainly related to biological functions such as enzyme regulatory activity, antioxidant activity, and cell proliferation; the KEGG enrichment analysis showed that the main signaling pathways involved in the anti-colorectal cancer effect of Paeonia and Lobelia were the TNF signaling pathway, PI3K/AKT signaling pathway, FoxO signaling pathway, etc. Conclusion　Paeonia and Lobelia may exert their anti-colorectal cancer effects through multiple ingredients, targets, and pathways.

Clinical Research

Levels of Lp-PLA2 and sST-2 and their correlation with cardiac function and inflammatory factors in patients with coronary heart disease and heart failure

Yang Yanchi

2025, 31(22):  3761-3765.  DOI: 10.3760/cma.j.cn441417-20250703-22012

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Objective　To investigate the levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) and soluble growth stimulating expression factor-2 (sST-2) and their correlation with cardiac function and inflammatory factors in patients with coronary heart disease and heart failure. Methods　A total of 85 patients with coronary heart disease (including 41 patients with heart failure) diagnosed and treated in Qidong Second People's Hospital from January 2024 to May 2025 were selected as the study objects. The general data, levels of Lp-PLA2 and sST-2, cardiac function indicators [left ventricular ejection fraction (LVEF), cardiac output (CO), left ventricular end-systolic diameter (LVESD), and left ventricular end-diastolic diameter (LVEDD)], and inflammatory factors [neutrophil count (NEUT), procalcitonin (PCT), and heparin-binding protein (HBP)] were compared between the patients complicated with heart failure and the patients with only coronary heart disease. The Pearson correlation coefficient was used to analyze the levels of Lp-PLA2 and sST-2 in the patients with coronary heart disease and heart failure, as well as their correlation with cardiac function and inflammatory factors. Statistics were performed using t-test, χ² test, and Pearson correlation analysis. Results　There were no statistical differences in the general data between the two groups (all P>0.05). The levels of Lp-PLA2, sST-2, NEUT, PCT, and HBP, LVESD, and LVEDD in the heart failure group were higher than those in the simple coronary heart disease group, and the LVEF and CO were lower (all P<0.05). The NEUT, PCT and HBP in the heart failure group were significantly higher than those in the simple coronary heart disease group (all P<0.05). The Pearson correlation analysis showed that the levels of Lp-PLA2 and sST-2 were positively correlated with LVESD, LVEDD, NEUT, PCT, and HBP (r=0.708, 0.594, 0.401, 0.412, 0.328, 0.732, 0.610, 0.419, 0.448, and 0.357), and negatively with LVEF and CO (r=-0.694, -0.525, -0.718, and -0.573) in the patients with heart failure. Conclusion　The expression of Lp-PLA2 and sST-2 in patients with coronary heart disease and heart failure is further increased, and their levels are correlated with cardiac function and inflammatory factors.

Analysis of multi-dimensional influencing factors on the current social function and self-efficacy of young and middle-aged patients with coronary heart disease returning to work after PCI

Luo Zhaochuan, Qiu Yun, Lai Xiaowen, Yang Xiaoyan, Niu Qiang

2025, 31(22):  3762-3766.  DOI: 10.3760/cma.j.cn441417-20250804-22013

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目的　探讨中青年冠心病（CHD）患者经皮冠状动脉介入术（PCI）后重返工作岗位（RTW）社会功能现状及自我效能的多维度影响因素。方法　选取2023年1月至2025年1月广汉市人民医院接受PCI治疗的中青年CHD患者153例，评估一般资料问卷、重返工作自我效能量表（RTW-SE）、重返工作准备度量表（RRTW）、社会支持量表（SSRS）、患者积极度量表（PAM）、匹兹堡睡眠质量指数（PSQI）和焦虑自评量表（SAS），采用采用t检验、χ²检验、单因素分析、多因素logistic回归分析Pearson相关性分析评价结果。结果　患者RTW-SE总均分（41.25±7.21）分，条目均分（3.75±0.82）分，处于中低水平；RRTW总均分（42.51±1.58）分，处于中低水平；SSRS总均分（33.23±5.82）分，处于中等水平；PAM总均分（29.12±5.82）分，处于中等水平；PSQI总均分（9.55±2.62）分，处于睡眠质量较差水平；SAS总均分（52.02±9.45）分，处于轻度焦虑水平。RTW-SE评分与RRTW、SSRS、PAM评分呈显著正相关性（r=0.652、0.439、0.753，均P<0.001），而与PSQI、SAS评分呈显著负相关性（r=-0.259、-0.821，均P<0.001）。经单因素与logistic多因素分析显示，CHD病程、SAS、PSQI评分均为独立危险因素，RRTW、SSRS和PAM均为保护因素（均P<0.05）。结论　中青年CHD患者PCI术后RTW社会功能亟待提高，针对性提供心理干预、社会支持及睡眠指导等综合性干预可能有利于提高其RTW自我效能与积极度。

Continuous improvement of pediatric outpatient waiting time using PDCA

Chen Chunmei, Huang Junbin, Lai Min, Liu Su

2025, 31(22):  3770-3774.  DOI: 10.3760/cma.j.cn441417-20241021-22014

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Objective　This study aimed to implement the PDCA (Plan-Do-Check-Act) cycle in pediatric outpatients to shorten the waiting time and improve patient satisfaction. Methods　A project team was established to carry out improvement work. The waiting time and patient satisfaction of 28 612 pediatric outpatients in the Seventh Affiliated Hospital of Sun Yat-sen University from January 2024 to June 2024 were analyzed retrospectively. According to the PDCA management method, we analyzed the possible causes, supervised the implementation of measures, and compared the differences in waiting time and patient satisfaction between before and after implementation. Results　The main factors affecting waiting time in pediatric outpatients included: late arrival of patients who have made appointments, low proportion of appointments in advance, disordered follow-up visits, and unreasonable allocation of registration. After the implementation of PDCA cycle, the waiting time was shortened (P<0.05), particularly for the patients who made appointments, registered on-site, and visitsed in the afternoon; the patient satisfaction was improved (P<0.05). Conclusion　The PDCA method is helpful in shortening waiting time and improving patient satisfaction in pediatric outpatients.

Effect of liposomal bupivacaine on postoperative nausea and vomiting after laparoscopic hepatectomy

Ying Meijing, Li Weishan, Tong Jie, Liang Chao

2025, 31(22):  3775-3778.  DOI: 10.3760/cma.j.cn441417-20250509-22015

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Objective　To investigate the effect of liposomal bupivacaine (LB) as a local anesthetic for nerve block on postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic atypical hepatectomy. Methods　Ninety-six patients who underwent laparoscopic atypical hepatectomy at Xiamen Branch, Zhongshan Hospital, Fudan University between January and March 2025 were selected for the randomized controlled trial. The patients were divided into a control group and a study group by the random number table method, with 48 cases in each group. The control group consisted of 26 males and 22 females; they were (52.90±13.67) years old; their body mass index (BMI) was (22.92±3.26) kg/m². The study group consisted of 34 males and 14 females; they were (53.81±14.13) years old; their BMI was (23.61±3.77) kg/m². The study group received ultrasound-guided nerve block with LB and general anesthesia, while the control group received general anesthesia alone. The incidence rates and frequencies (graded according to it) of PONV 48 h after the operation, total intraoperative opioid consumptions, operation times, postoperative hospitalization times, and perioperative anesthesia satisfaction were compared between the two groups. Statistical analyses were performed using the t, χ², and rank-sum tests. Results　The total number of PONV episodes in the study group was significantly lower than that in the control group (4 times vs. 17 times), with a statistical difference (P<0.05). All the 4 PONV episodes in the study group were grade Ⅰ, and the 17 PONV episodes in the control group were grades Ⅰ-Ⅳ, with a statistical difference (P<0.01). The total intraoperative sufentanil consumption in the study group was less than that in the control group [(30.08±10.30) μg vs. (48.71±13.99) μg], with a statistical difference (P<0.01). There were no statistical differences between the two groups in the time to first ambulation, postoperative hospitalization time, and operation time (all P>0.05). The patient satisfaction with analgesic effect in the study group was higher than that in the control group [97.9% (47/48) vs. 85.4% (41/48)], with a statistical difference (P<0.05). Conclusion　The use of LB as a local anesthetic for nerve block in the perioperative period of laparoscopic atypical hepatectomy not only can improve the patient satisfaction with perioperative anesthesia, but also can reduce the usage of intraoperative opioid and the incidence of PONV.

The predictive value of uterine artery blood flow parameters combined with echocardiography for early-onset preeclampsia

Dai Aiying, Liu Wei, Tian Rui

2025, 31(22):  3779-3783.  DOI: 10.3760/cma.j.cn441417-20250310-22016

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Objective　To explore the predictive value of uterine artery blood flow parameters combined with echocardiography for early-onset preeclampsia (PE). Methods　A retrospective study was conducted to collect the data of 90 patients with early-onset PE admitted to Shangluo Central Hospital from June 2022 to August 2024. The patients were included in a case group [age 21-45 (30.21±4.17) years]. In addition, the data of 90 healthy pregnant women who received regular prenatal examination in the hospital during the same period were collected according to the ratio of 1:1 and included in a control group [age 20-45 (29.32±4.45) years]. The uterine artery blood flow parameters [resistance index (RI), pulsatility index (PI), and systolic phase/diastolic phase (S/D)] and echocardiographic parameters [left ventricular ejection fraction (LVEF), fractional shortening (FS), cardiac index (CI), and early diastolic flow velocity/late diastolic flow velocity (E/A)] were collected and compared between the two groups at 14-20 weeks of gestation. The measurement data were of the normal distribution, and the independent sample t test was used to test the differences between the groups. The Mann-Whitney U test was used to test the difference between the groups. The χ² test was used to test the differences between the groups. The receiver operating characteristic curve (ROC) and the area under the curve (AUC) were used to evaluate the predictive value of uterine artery blood flow parameters combined with echocardiography for early onset PE. Results　The RI, PI, and S/D in the case group were all higher than those in the control group (0.84±0.25 vs. 0.68±0.13, 1.08±0.29 vs. 0.86±0.17, and 2.60±0.58 vs. 2.12±0.25), and the LVEF, E/A values were lower [(61.58±5.74)% vs. (66.44±6.02)%, and 0.93±0.22 vs. 1.17±0.36], with statistical differences (all P<0.05). The ROC showed that the combined prediction of AUC for early-onset PE by logistic regression probability models of RI, PI, S/D, LVEF, E/A alone and several at 14-20 weeks of pregnancy was greater than 0.7 (95%CI 0.914-0.975 for joint prediction), which had certain predictive value, and the joint prediction value was higher than those of RI, PI, S/D, LVEF, and E/A alone (P<0.05). Conclusion　Uterine artery blood flow parameters (RI, PI, and S/D) and echocardiographic parameters (LVEF and E/A) have certain predictive value for early-onset PE, and the combined predictive value is higher.

Effect of intermittent pneumatic compression combined with anticoagulants in prevention of deep venous thrombosis of lower extremity in patients after cesarean section

Sun Jianfang, Bai Long

2025, 31(22):  3784-3788.  DOI: 10.3760/cma.j.cn441417-20240707-22017

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Objective　To investigate the effect of intermittent pneumatic compression (IPC) combined with anticoagulants in the prevention of deep venous thrombosis of lower extremity in patients after cesarean section. Methods　Ninety-six pregnant women undergoing cesarean section in Yan'an City Hospital of Traditional Chinese Medicine from July 2021 to June 2022 were included in the study, and were divided into a combination group and an anticoagulation group according to the treatment plans, with 48 cases in each group. The combination group were (28.98±3.81) years old, and had delivered (0.98±0.23) times. The the anticoagulation group were (29.52±4.06) years old, and had delivered (1.04±0.29) times. The anticoagulation group subcutaneously injected low molecular weight heparin sodium after cesarean section; in addition, the combination group took IPC. The incidences of venous thrombosis of lower extremity, perioperative coagulation function [prothrombin time (PT), thrombin time (TT), D-dimer (D-D), and fibrinogen (FIB)], hemorheology indicators [plasma viscosity (PV), high shear viscosity (HBV) of whole blood, and erythrocyte deformity-index (EDI)], and surgery-related indicators (postoperative exhaust time, postoperative off-bed time, and lower limb pain) were compared between the two groups. t test, repeated measure analysis of variance, and Fisher exact probability method were used for statistical comparisons. Results　The incidence rate of venous thrombosis of lower extremity in the combination group was 0, and that in the anticoagulation group 4.17% (2/48), with no statistical difference (P=0.495). Five days after the surgery, the PT and TT were higher than those before the surgery in both groups, and the levels of D-D and FIB were lower; the PT, TT, and levels of D-D and FIB in the combination group were better than those in the anticoagulation group [(13.29±1.27) s vs. (12.67±1.62) s, (15.04±1.09) s vs. (14.38±1.17) s, (1.74±0.32) mg/L vs. (2.41±0.53) mg/L, and (4.39±0.51) g/L vs. (5.01±0.48) g/L], with statistical differences (all P<0.05). Five days after the surgery, the PV, HBV, and EDI were higher than those before the surgery in both groups; the PV and HBV in the combination group were lower than those in the anticoagualation group [(1.92±0.44) mPa/s vs. (2.17±0.51) mPa/s and (4.81±0.51) mPa/s vs. (5.12±0.57) mPa/s], and the EDI was higher (1.29±0.23 vs. 1.06±0.21), with statistical differences (all P<0.05). The postoperative exhaust time and off-bed time in the combination group were shorter than those in the anticoagulation group [(17.63±1.85) h vs. (20.17±1.73) h and (24.25±2.53) h vs. (31.88±2.46) h], and the score of Visual Analogue Scale was lower (1.27±0.45 vs. 2.08±0.28), with statistical differences (all P<0.05). Conclusion　PIC combined with anticoagulants can effectively improve the coagulation function and hemodynamics of parturients after cesarean section, effectively prevent the formation of deep venous thrombosis of lower extremity, and promote their recovery.

Clinical efficacy of predeposit and intraoperative autologous blood transfusion in women with high hemorrhagic risk taking cesarean section

Han Li, Wang Yan, Han Xing

2025, 31(22):  3785-3789.  DOI: 10.3760/cma.j.cn441417-20250618-22018

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Objective　To analyze the clinical effect of predeposit and intraoperative autologous blood transfusion in women with high hemorrhagic risk taking cesarean section. Methods　One hundred and eighty-four high-risk pregnant women undergoing cesarean section at Hanzhong Central Hospital between October 2016 and August 2024 were selected as the study objects. Based on the transfusion methods, the women were divided into a control group and an observation group, with 92 cases in each group. The control group were (32.54±4.25) years old, and received conventional allogeneic transfusion. The observation group were (32.21±4.66) years old, and received autologous transfusion with predeposit and intraoperative autologous blood. The coagulation parameters [activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (FIB), and activated clotting time (ACT)], white blood cell counts, neutrophil percentages, lymphocyte percentages, oxygenation indicators [arterial oxygen partial pressure (PaO₂) and mixed venous oxygen saturation (SvO₂)], and incidence rates of adverse reactions were compared between the groups. Statistical analysis was performed using t and χ² tests. Results　After the transfusion, there was no statistical difference in the FIB level between the two groups (P>0.05); the APTT, PT, and ACT in the observation group were shorter than those in the control group [(34.78±2.71) s vs. (35.83±2.14) s, (15.82±2.25) s vs. (16.69±2.18) s, and (120.54±24.52) s vs. (129.32±25.23) s], with statistical differences (t=2.917, 2.664, and 2.394; all P<0.05). The white blood cell count and neutrophil percentage in the observation group were lower than those in the control group [(9.25±1.36)×10⁹ vs. (10.41±1.55)×10⁹ and (70.28±2.57)% vs.(72.30±2.61)%], while the lymphocyte percentage was higher [(5.96±1.04)% vs. (5.44±1.02)%], with statistical differences (t=5.396, 5.290, and 3.424; all P<0.05). Both PaO₂ and SvO₂ in the observation group were higher than those in the control group [(124.41±18.57) mmHg vs. (113.85±17.46) mmHg (1 mmHg=0.133 kPa) and (87.21±5.57)% vs. (84.13±4.32)%], with statistical differences (t=3.974 and 4.191; both P<0.05). There was no statistical difference in the incidence rate of adverse reactions between the observation group and the control group [8.70% (8/92) vs. 14.13% (13/92); P>0.05]. Conclusion　Predeposit and intraoperative autologous blood transfusion can significantly enhance coagulation function and oxygenation status while attenuating the inflammatory response in women with high hemorrhagic risk taking cesarean section, without increasing adverse events.

Analysis of influenza surveillance results in Haizhu district of Guangzhou from 2021 to 2024

Chen Qiujie, Bai Shanshan, Tan Yonghui, Cai Zhenlian, Wu Xiaobin

2025, 31(22):  3793-3798.  DOI: 10.3760/cma.j.cn441417-20250208-22019

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Objective　To analyze the epidemic patterns and pathogenic characteristics of influenza viruses in Haizhu District from 2021 to 2024, and to provide scientific basis and technical support for formulating influenza prevention and control measures. Methods　From March 2021 to December 2024, 5 120 throat swab samples from influenza-like cases were sent for nucleic acid testing in the Huizhou District Center for Disease Control and Prevention. The number of male samples tested was 2 698, and the number of female samples tested was 2 422. The age ranged from 1 day to 98 years old. The detection rates of influenza A/B viruses in the samples were analysed, and the population and seasonal distribution characteristics of different types of influenza viruses were compared. The statistical methodology employed the χ² test and the Bonferroni method for multiple comparisons. Results　A total of 5 120 throat swab samples were tested, and 2 578 samples were found to be positive for the influenza virus. The positive detection rate was 50.34%. Among them, the positive detection rate of influenza A was 68.11% (1 756/2 578), and the positive detection rate of influenza B was 31.89% (822/2 578). The predominant infection was caused by the influenza A virus, especially in 2023, when the positive detection rate of the influenza A virus reached as high as 75.12%. The positive detection rates in winter [63.86% (569/891)] and in spring [62.17% (1 047/1 684)] were both higher than those in summer and autumn. There was a statistically significant difference in the positive detection rate of influenza viruses between different seasons (χ²=1 313.806, P<0.001). The detection results of different seasonal influenza virus subtypes were analyzed. The proportion of type A (H1N1) influenza virus was the highest in spring (77.9%), while the detection rate of type A (H3N2) virus was higher in winter (37.65%). In autumn, there was a dual dominant trend of type A (H3N2) and type B (Victoria) subtypes, and the difference was statistically significant (χ²=490.000, P<0.001). The positive detection rates for males and females in the test samples were 50.22% (1,355/2,698) and 50.50% (1,223/2,422), respectively. For 939 of the samples, subtype detection of the influenza virus was conducted. The results showed that among all the subtypes, the detection rate of influenza subtypes in males was higher than that in females, and the difference was statistically significant (χ²=214.892, P<0.001). The highest positive detection rate of influenza virus nucleic acid was observed in the age group of 5 to <15 years old, with a detection rate of 73.55% (2 077/2 824), while the detection rate for the elderly in the ≥60-year-old age group was the lowest, only 8.14% (31/381). The detection rates of influenza A in all age groups were higher than those of influenza B. There was a statistically significant difference in the positive detection rate of influenza viruses between different age groups (χ²=12.095, P=0.017). The positive detection rate of influenza virus of the student group was higher than those of other groups. There was a statistically significant difference in the detection rate between different occupations (χ²=2 157.191, P<0.001). Conclusions　At the Haizhu District of Guangzhou City, the dominant influenza strains showed seasonal alternation in their prevalence from 2021 to 2024. The prevalence of type A influenza was generally higher than that of type B influenza. The detection rate was higher among children aged 5 to <15 years old and students. Continuous influenza pathogen monitoring should be carried out in schools. Through vaccination and health education measures, the monitoring and prevention of influenza outbreaks in kindergartens and primary and secondary schools should be strengthened.

Clinical observation of Jiawei Danggui Shaoyao San combined with epalrestat tablets in the treatment of elderly patients with diabetic peripheral neuropathy

Xu Yanna, Wang Liang, Wu Hongqun

2025, 31(22):  3794-3800.  DOI: 10.3760/cma.j.cn441417-20250528-22020

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Objective　To evaluate the therapeutic efficacy of Jiawei Danggui Shaoyao San combined with epalrestat tablets in the treatment of diabetic peripheral neuropathy (DPN) in elderly patients. Methods　A prospective study was conducted on 120 elderly DPN patients treated at Shangluo Central Hospital from January 2021 to January 2023. Using a convenience sampling method, the patients were divided into an experimental group (60 cases) and a control group (60 cases). In the control group, there were 29 males and 31 females, with an age of (69.14±4.31) years; in the experimental group, there were 30 males and 30 females, with an age of (69.39±4.26) years. The control group received epalrestat tablets, while the experimental group received Jiawei Danggui Shaoyao San and epalrestat. The treatment duration was 3 months. The TCM syndrome scores, EMG indicators of lower limbs [sensory nerve conduction velocity(SCV) and motor nerve conduction velocity(MCV)], blood glucose status [fasting plasma glucose (FPG), 2-hour postprandial glucose (2 hPG), and glycated hemoglobin(HbA1c)], neuropathy [Michigan Diabetic Neuropathy Score(MDNS) score and Toronto Clinical Scoring System(TCSS) score], oxidative stress [malondialdehyde(MDA) and superoxide dismutase(SOD)], serum levels [brain-derived neurotrophic factor(BDNF), nitric oxide(NO), endothelin-1 (ET-1), and ficolin-3], and adverse reactions were compared between the two groups. Statistical methods employed t test and χ² test. Results　After the treatment, the scores of main syndrome, secondary syndrome, MDNS, and TCSS, FPG, HbA1 c, 2 hPG, MDA, ET-1, and ficolin-3 in the experimental group were lower than those in the control group [2.19±0.37 vs. 5.24±0.85, 1.39±0.28 vs. 2.86±0.47, 13.67±2.18 vs. 17.11±2.79, 6.03±0.78 vs. 7.91±0.93, (5.08±0.66) mmol/L vs. (7.02±1.20) mmol/L, (6.77±0.92)% vs. (7.22±1.03)%, (9.13±1.61) mmol/L vs. (12.22±2.64) mmol/L, (2.48±1.75) U/ml vs. (4.19±1.82) U/ml, (24.41±3.87) ng/L vs. (34.73±4.32) ng/L, and (9.71±2.62) μg/L vs. (12.45±3.70) μg/L], and the SCV of sural nerve, MCV of common peroneal nerve, and levels of SOD, BDNF, and NO were higher [(43.01±4.13) m/s vs. (38.65±3.81) m/s, (51.91±4.91) m/s vs. (46.45±3.35) m/s, (133.21±12.33) U/ml vs. (121.31±18.03) U/ml, (6.17±0.71) ng/L vs. (4.25±0.36) ng/L, and (3.96±0.72) μmol/L vs. (3.34±0.63) μmol/L], with statistical differences (all P<0.05). The incidence rate of adverse reactions in the experimental group was lower than that in the control group [3.33%(2/60) vs. 16.67%(10/60)], with a statistical difference (χ²=5.926; P=0.015). Conclusions　Jiawei Danggui Shaoyao San combined with epalrestat tablets in the treatment of elderly patients with DPN can effectively improve their symptoms and neurological function, regulate blood glucose, reduce the degree of neuropathy, improve the level of antioxidant and regulatory factors, and have high safety.

Bezafibrate for one patient with lipoprotein lipase deficiency and its molecular mechanism

Wang Zhenjing, Tian Mingzhong, Liu Xin, Li Xin, Xu Chao, Wang Shuping

2025, 31(22):  3804-3808.  DOI: 10.3760/cma.j.cn441417-20250515-22021

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Objective　To investigate the effect of bezafibrate in the treatment of lipoprotein lipase deficiency (LPLD) and its potential molecular mechanisms. Methods　A case of LPLD caused by compound heterozygous mutations (c.3G>C and c.835_836delCT) in the lipoprotein lipase (LPL) gene was reported. The clinical data, treatment response, and follow-up data were analyzed. Molecular docking simulations of bezafibrate with both the wild-type and mutant LPL were performed using the AutoDock Vina software, and binding conformations were visualized using PyMol. Results　After the treatment with bezafibrate, the triglyceride level in the patient decreased by 63.7%. The molecular docking showed that bezafibrate binded to the polypeptide "lid" domain and adjacent regions of the mutant LPL, with a binding energy of -5.305 kcal/mol, potentially inducing conformational changes that partially restore enzyme function. Additionally, as a pan-PPAR agonist, bezafibrate synergistically lowered the lipids activating the PPARα, β, and γ pathways. Conclusions　Bezafibrate demonstrates significant efficacy for patients with LPLD. Its mechanism may be related to direct modulation of mutant LPL activity and systemic activation of PPAR pathways.

High risk factors analysis and model construction of early pregnancy prediction of gestational diabetes

Liu Jing, Liu Jing, Wang Jianying, Wang Yanxia

2025, 31(22):  3809-3814.  DOI: 10.3760/cma.j.cn441417-20250428-22022

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Objective　To analyze the high-risk factors influencing the onset of gestational diabetes mellitus (GDM) in the early stage of pregnancy and to construct a risk prediction model. Methods　The clinical data of 326 pregnant women who underwent regular prenatal check-ups and gave birth at Northwest Women and Children's Hospital from January 2022 to June 2024 were included. They were 21 to 46 years old. Based on the results of the 75 g oral glucose tolerance test (OGTT) conducted at 24-28 weeks of pregnancy, the subjects were divided into a GDM group (62 cases) and a non-GDM group (264 cases). t-test and χ² test were used to compare the basic data and laboratory indicators of the two groups during the early pregnancy (10-12 weeks). Through multivariate logistic regression, the influencing factors of GDM onset were screened, and a prediction model for GDM in early pregnancy was established. The predictive efficacy of the model was tested using the receiver operating characteristic curve (ROC). Results　Among the 326 pregnant women in the early stage of pregnancy, 62 cases (19.02%) developed GDM Univariate and logistic multivariate regression analyses showed that age ≥35 years, pre-pregnancy body mass index (BMI) ≥24.0 kg/m², and elevated fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), and C-reactive protein (CRP) levels in the early pregnancy were all independent risk factors for GDM. The elevation of HDL-C and ADPN in the early pregnancy stage were both protective factors (both P<0.05). The GDM prediction model was constructed. The AUC of this model was 0.909 (95%CI 0.865-0.952). When the optimal prediction value was greater than 13.98, the corresponding sensitivity was 79.03%, the specificity was 92.75%, and the Youden index was 71.78%. Conclusion　The risk prediction model established based on the pregnant woman's age, pre-pregnancy BMI, FPG in the early pregnancy, HbA1c, CRP, HDL-C, and ADPN can provide references for the early warning of GDM.

Current status and influencing factors of fear in patients before gastrointestinal endoscopy

Tan Wenhui, Sun Yining, Liang Biao, Lyu Fang, Wang Yimin

2025, 31(22):  3815-3820.  DOI: 10.3760/cma.j.cn441417-20250618-22023

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Objective　To investigate the current status of fear and its influencing factors in patients before gastrointestinal endoscopy, and to provide a basis for developing targeted psychological interventions. Methods　A total of 528 patients scheduled for gastrointestinal endoscopy at Guangdong Second Provincial General Hospital between May and December 2024 were selected by the convenient sampling method for the cross-sectional survey. Their demographic data were collected. The Self-Rating Anxiety Scale (SAS) and Fear of Progression Questionnaire-Short Form (FoP-Q-SF) were used to assess their anxiety levels and fear of disease progression. The Pearson correlation analysis and multiple linear regression analysis were utilized to identify the influencing factors. Results　The total FoP-Q-SF score was 23.22±10.39. Notably, 16.90% of the patients exhibited a high level of fear (FoP-Q-SF score≥34). The univariate analysis revealed significantly higher fear levels in the females, patients who were 18-30 years old, unmarried individuals, and patients with chronic diseases (all P<0.05). The total SAS score was positively correlated with the total FoP-Q-SF score (r=0.745, P<0.01). The multiple linear regression analysis identified the history of chronic diseases (β= 0.050, P=0.017) and anxiety level (β=0.721, P < 0.001) as the independent predictors of fear. Conclusions　Fear is prevalent among patients before gastrointestinal endoscopy and is influenced by anxiety levels, history of chronic diseases, and specific demographic characteristics (female gender and being 18-30 years old). Implementing stratified interventions targeting high-risk groups is warranted. These interventions should focus on cognitive restructuring, anxiety management, and reframing disease perceptions to enhance procedural adherence and improve the overall healthcare experience.

Case Report

One case of intracranial hemorrhage caused by ruxolitinib and voriconazole

Han Hua, Zhang Meixiang, Ren Hanyun, Wei Mingxia, Wang Chunjian

2025, 31(22):  3821-3823.  DOI: 10.3760/cma.j.cn441417-20250519-22024

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A 74-year-old male patient with systemic lupus erythematosus who had been taking methylprednisolone tablets for a long time. He had primary myelofibrosis, and took ruxolitinib phosphate tablets 15 mg twice a day, hydroxyurea tablets 0.5 g twice a day, and stanzolol 2 mg three times a day. The patient was admitted to hospital due to bacterial pneumonia and invasive pulmonary aspergillosis. At that time, the white blood cell count was 19.29×10⁹/L, hemoglobin 70 g/L, and platelet count 113×10⁹/L. In the anti-bacterial aspect, imipenem and cilastatin sodium for injection, ceftazidime for injection, and cefoperazone and sulbactam sodium for injection were successively given. Voriconazole for injection was given for antifungal treatment. After that, the patient's body temperature returned to normal, and the symptoms of coughing and expectoration improved compared to before. On the 14th day of admission, the patient's family member noticed that the patient fell off the chair and landed on the ground, and then developed consciousness disorders. After that, the body temperature was normal, and the cough and sputum production were better than before. On the 14th day of admission, the family member found that the patient had slipped to the floor in his sitting position and had disturbance of consciousness. At that time, the white blood cell count was 11.69×10⁹/L, hemoglobin 88 g/L, and platelet count 63×10⁹/L; head CT showed extensive hemorrhage in the ventricular system. Cerebral hemorrhage is considered to be highly associated with ruxolitinib. His family member requested conservative treatment and died of respiratory and circulatory failure.

Esophageal and retroperitoneal perforation caused by esophageal stent in an elderly patient

Zhu Fengchun, Zhang Conglin, Zhu Mingli, Jiang Kaitong, Fu Jixin, Zeng Xianzhong

2025, 31(22):  3824-3827.  DOI: 10.3760/cma.j.cn441417-20250421-22025

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With the advancement of minimally invasive techniques, esophageal stent placement has become an important therapeutic approach. However, it may also lead to severe complications. This article reports one elderly patient who developed esophageal and retroperitoneal perforation after the placement of a covered esophageal stent. It focuses on the successful treatment of this patient using a minimally invasive approach that combined esophageal covered stent placement with peritoneal lavage. The aim is to provide new diagnostic and therapeutic insights for managing complex esophageal perforations, highlighting the application value and prospects of this combined minimally invasive strategy in elderly patients.

Nursing Research

Research on application value of goal-oriented progressive nursing mode in elderly patients with lumbar vertebral compression fractures

Han Chonglan, Zhang Xiaowen, Xu Huiyun, Hou Weikun

2025, 31(22):  3828-3832.  DOI: 10.3760/cma.j.cn441417-20250314-22026

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Objective　To evaluate the clinical efficacy of the goal-oriented progressive nursing model in the rehabilitation process of elderly patients with vertebral compression fractures, as well as its impact on the quality of life of these patients. Methods　A prospective randomized controlled study was conducted, including 120 elderly patients with lumbar vertebral compression fractures who were treated at Ankang Hospital of Traditional Chinese Medicine from April 2023 to March 2024. They were divided into an observation group and a control group by the random number table method, with 60 cases in each group. The observation group had 28 males and 32 females, with an age of (72.5±6.3) years and a disease duration of (3.2±1.4) months. The control  group had 26 males and 34 females, with an age of (73.1±6.5) years and a disease duration of (3.4±1.5) months. The control group received routine nursing measures, while the observation group was given the additional targeted and stepwise nursing intervention plan on top of the routine measures. Both groups were intervened for 8 weeks. The Visual Analogue Scale (VAS) scores, Activities of Daily Living (ADL) scores, as well as the incidence rates of complications and nursing satisfaction before and after the intervention in the two groups were compared. Statistical methods employed t-test and χ² test. Results　After the intervention, the VAS score of the observation group was lower than that of the control group [(3.1±0.8) points vs. (4.5±1.0) points], and the ADL score was higher than that of the control group [(45.8±5.1) points vs. (38.6±4.8) points], with statistical differences(t=8.526 and 7.843; both P<0.05). The total incidence rate of complications in the observation group was lower than that in the control group [6.7% (4/60) vs. 20.0% (12/60)], and the nursing satisfaction rate was higher [96.7% (58/60) vs. 83.3% (50/60)], with statistical differences were statistically significant (χ²=4.385 and 5.926; both P<0.05). Conclusions　The goal-oriented progressive nursing mode can effectively alleviate the pain of elderly patients with lumbar vertebral compression fractures, enhance their ability to take care of daily life, reduce the incidence of related complications, and increase their satisfaction with the nursing services. It has high clinical promotion value.

Application effect of perineum massage combined with doula accompany delivery in maternal delivery

Wang Haili, Ni Lingyu, Pan Shuting

2025, 31(22):  3832-3837.  DOI: 10.3760/cma.j.cn441417-20250214-22027

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Objective　To explore the application effect of perineal massage with birthing ball combined with full-time doula companionship during labor in parturients. Methods　A prospective study was conducted on 98 parturients who delivered at the Women and Children's Hospital of Zhumadian Central Hospital from November 2021 to November 2023. They were randomly divided into two groups, with 49 cases in each group. The control group were 23 to 37 (30.56 ± 2.12) years old, and received routine care. The observation group were 23 to 37 (30.59 ± 2.14) years old. They were given perineal massage with a birthing ball combined with full-time doula accompaniment during the delivery process. The effects of labor analgesia, psychological state, comfort levels, progress of labor, incidence rates of adverse labor outcomes, and maternal satisfaction were compared between the two groups. Statistical methods employed t-test and χ² test. Results　The Visual Analogue Scale (VAS) scores for the first, second, and third stages of labor in the observation group were all lower than those in the control group [(1.49±0.54) points vs. (3.56 ±0.67) points, (3.53±1.01) points vs. (8.68±0.52) points, and (2.79±0.64) points vs. (4.46±1.03) points], and the differences were statistically significant (t=16.839, 31.734, and 9.640, all P<0.05). The scores of the Hamilton Anxiety Scale (HAMA) and the Edinburgh Postnatal Depression Scale (EPDS) in the observation group were lower than those in the control group 2 days after delivery [(9.91±2.04) points vs. (14.42±2.18) points and (2.14±0.35) points vs. (4.97±0.62) points], and the differences were statistically significant (t=10.574 and 27.824; both P<0.05). The scores of each item in the Comfort Scale for Delivery (GCQ) of the observation group were all higher than those of the control group 2 days after delivery, and the duration of the labor process of the observation group was shorter than that of the control group (all P<0.05). The total incidence rate of adverse delivery outcomes in the observation group was lower than that in the control group [4.08% (2/49) vs. 16.33% (8/49)], and the difference was statistically significant (χ²=4.009, P<0.05). The scores of satisfaction in the observation group were all higher than those in the control group in each aspect (all P<0.05). Conclusion　During the childbirth process of a pregnant woman, using a birthing ball for perineal massage combined with continuous doula accompaniment can alleviate the pain during childbirth, enhance the effect of labor pain relief, improve the negative psychological state of the pregnant woman, increase her sense of security and comfort, facilitate the smooth progress of childbirth, reduce the occurrence of adverse childbirth outcomes, and achieve higher satisfaction among pregnant women.

Influence of pre-anesthesia room appointment process on efficiency of preoperative anesthesia coordination

Tan Jiayu, Li Fang, Zeng Yingyu, Kang Yubo, Zhu Qiongfang, Wu Wenyuan

2025, 31(22):  3837-3842.  DOI: 10.3760/cma.j.cn441417-20250709-22028

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Objective　To explore the impact of the pre-anesthesia area (PAA) appointment process on the efficiency of preoperative anesthesia coordination, to compare the cooperation completion rate and average operation time before and after process optimization, and to evaluate the application value of an information-based closed-loop management system in enhancing surgical workflow integration. Methods　A retrospective controlled study was conducted. The data of 375 patients who underwent elective general anesthesia surgeries at First Affiliated Hospital of Sun Yat-sen University between May and June 2025 and required pre-anesthesia procedures in the PAA were collected. According to the implementation time of the optimized scheduling process, the patients were divided into a traditional scheduling group (May 2025; 188 cases) and an optimized scheduling group (June 2025; 197 cases). There were 102 males and 86 females in the traditional scheduling group who were (54.8±12.7) years old. There were 106 males and 91 females in the optimized scheduling group who were (55.3±11.9) years old. In the traditional scheduling group, the operating room nurses notified anesthesiologists of the required anesthesia procedures in paper form one day before surgery, with verbal communication of anesthesia operation needs on the day of surgery. The optimized scheduling group utilized an electronic mini-program for appointment booking, with anesthesiologists, pre-anesthesia nurses, and operating room nurses collaboratively managing patient transport and anesthesia procedures. The procedure cooperation frequencies, completion rates, and cooperation times were compared between the two groups. The enumeration data were analyzed using the chi-square test, and the measurement data the independent-sample t test. Results　The optimized scheduling group demonstrated a higher concentration of procedure types and significantly shorter mean times for the three most frequent pre-anesthesia procedures (all P<0.001): 197 procedures were completed in the optimized scheduling group, including femoral nerve block in 47 cases [88.68% and (16.5±2.1) min], internal jugular vein puncture in 134 cases [99.26% and (12.2±1.8) min], and radial artery puncture in 90 cases [100% and (9.5±1.2) min]; in the traditional scheduling group, 188 procedures were completed, including femoral nerve block in 36 cases [63.16% and (22.5±2.1) min], internal jugular vein puncture in 125 cases [96.15% and (19.2±1.8) min], and radial artery puncture in 83 cases [98.81% and (18.5±1.2)] min. The scores of information and education, procedural experience and safety, patient–clinician communication and responsiveness, and overall satisfaction in the optimized scheduling group were higher than those in the traditional scheduling group (15.66±2.15 vs. 14.89±2.32, 35.26±4.20 vs. 30.52±4.61, 20.97±3.72 vs. 15.04±2.29, and 81.79±5.82 vs. 70.28±6.01), with statistical differences (all P<0.001); there was no statistical difference in the score of perceived psychological support between the two groups (P=0.281). Conclusion　Optimization and implementation of the PAA appointment process significantly improves the timeliness of preoperative anesthesia cooperation, facilitates smoother surgical turnover, enables better allocation of recovery resources, and increases the efficiency of preoperative anesthesia coordination.

The application value of dual-dimensional psychological and behavioral interest induction in preschool children with type 1 diabetes

Lin Fangbing, Guo You, Gu Jianping, Wei Shupei

2025, 31(22):  3843-3848.  DOI: 10.3760/cma.j.cn441417-20250311-22029

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Objective　To explore the effects of dual-dimensional psychological-behavioral interest-inducing nursing on the blood glucose levels and dietary compliance of preschool children with type 1 diabetes. Methods　A prospective study was adopted. A total of 104 preschool children with type 1 diabetes who were admitted to Henan Children's Hospital from November 2022 to November 2024 were selected. They were randomly divided into a conventional group and a research group, with 52 cases in each group. The research group had 30 males and 22 females, with an age of (4.79±1.12) years and a disease duration of (8.04±2.39) months; They received dual-dimensional fun-inducing psychological and behavioral nursing. The control group had 28 males and 24 females, with an age of (4.72±1.05) years and a disease duration of (7.89±1.78) months; They received routine care. The blood glucose levels and dietary compliance before and after the intervention were compared between the two groups. The Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS) were used to assess the psychological state of the main caregivers. The burden level of the main caregivers was evaluated using the Chinese version of the Caregiver Burden Inventory (CBI). Statistical methods employed t-test and χ² test. Results　After the intervention, the fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), and 2-hour postprandial blood glucose (2 hPG) in the study group were all lower than those in the control group [(5.04±0.87) mmol/L vs. (6.41±0.66) mmol/L, (6.29±0.89)% vs. (7.20±0.75)%, and (6.31±1.22) mmol/L vs. (7.43±1.07) mmol/L], and the differences were statistically significant (t=9.047, 5.638, and 4.977; all P<0.05). The dietary compliance scores of the research group were all higher than those of the control group (all P<0.05). The SAS and SDS scores of the research group were both lower than those of the control group [(41.65±5.19) points vs. (45.93±3.65) points and (40.02±4.31) points vs. (44.61±6.10) points], and the differences were statistically significant (t=4.864 and 4.432; both P<0.05). The CBI score of the research group was lower than that of the control group [(40.51±5.13) points vs. (46.78±7.06) points], and the difference was statistically significant (t=5.181, P<0.05). Conclusion　The dual-dimensional psychological-behavioral interest-inducing nursing method can not only effectively improve the blood glucose levels of children with type 1 diabetes and enhance their dietary compliance, but also alleviate the negative emotions of the main caregivers and reduce the burden of care.

Effects of individualized nutritional management using the WeChat platform for patients taking peritoneal dialysis

Chen Xiaoqing, Sun Wenli, Huang Chunhong, Weng Bixia, Shao Yixin, Hu Fang, Zheng Haiying

2025, 31(22):  3844-3848.  DOI: 10.3760/cma.j.cn441417-20250615-22030

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Objective　To explore the impact of an individualized nutrition management plan based on the WeChat platform on the nutritional status, dietary compliance with renal diet, and related anthropometric indicators of peritoneal dialysis (PD) patients. Methods　A prospective study was adopted. The patients who were regularly followed up at the PD nursing specialty clinic of the First Affiliated Hospital of Fujian Medical University from August 2022 to November 2023 were selected and divided into two groups using the random number table method. The control group consisted of 29 males and 13 females, with an age of (50.81±12.22) years. They received routine nutritional management. The intervention group consisted of 24 males and 19 females, with an age of (47.09±12.88) years. They received individualized nutritional management based on the WeChat platform. Both groups were intervened for 3 months. The nutritional status, the score of the Renal Diet Adherence Questionnaire (RABQ), and the related human measurement indicators of nutrition were compared between the two groups. Statistical methods employed were t-test, Mann-Whitney U test, and χ² test. Results　After the intervention, the incidence rate of malnutrition in the intervention group was lower than that in the control group [9.30% (4/43) vs. 28.57% (12/42)], and the RABQ score was higher [89.0 (88.0, 90.0) points vs. 84.0 (77.8, 89.0) points], and the differences were statistically significant (χ²=5.163 and Z=-4.087; both P<0.05). The anthropometric indicators of the intervention group, such as triceps skinfold thickness (TSF) and upper arm circumference (MAC), were both greater than those of the control group [16.0 (13.3, 18.5) mm vs. 11.8 (9.0, 17.0) mm and 27.0 (25.0, 30.0) cm vs. 24.5 (22.0, 28.0) cm], and the differences were statistically significant (Z=-2.089 and -2.552; both P<0.05). Conclusion　Implementing individualized nutritional management for PD patients through the WeChat platform can help improve their nutritional status and enhance the compliance of their dietary behaviors regarding kidney diseases.

Analysis of factors influencing core competence of tumor care in nursing staff in Shaanxi Province based on logistic regression and decision tree models

Cheng Gaiping, Xie Juan, Zhao Jiang, Yang Zhihua, Chang Li, Fan Chunxiu, Shen Honghong, Yue Qin, Gao Li

2025, 31(22):  3853-3860.  DOI: 10.3760/cma.j.cn441417-20250213-22031

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Objective　To analyze the factors influencing core competence in oncology nursing among nursing staff in Shaanxi Province using logistic regression and decision tree interaction detection, and to provide some evidences for optimizing training and intervention strategies. Methods　A total of 1 529 nurses from 62 hospitals in Shaanxi Province from August to September 2022 were selected as the survey subjects, including 26 males and 1 503 females. There were 397 nurses, 580 senior nurses, 485 nurses-in-charge, and 67 chief nurses. A self-designed general information and core competency questionnaire was used for the cross-sectional survey. χ² test, logistic regression analysis, and decision tree interaction detection were used to analyze the differences between the results of the two models. Results　A total of 1 650 questionnaires were distributed, and 1 529 valid ones were ultimately collected, with an effective response rate of 92.67%. The total core competency score was 186.24±59.76, indicating a moderate proficiency. The logistic regression model showed that obtaining municipal-level oncology certification (OR=0.43, 95%CI 0.26-0.73), participating in oncology training (OR=2.19, 95%CI 1.31-3.60), and working in oncology departments (OR=0.51, 95%CI 0.37-0.71) were the predictive factors of core competence in oncology nursing. The decision tree analysis prioritized work satisfaction as the primary factor, followed by certification, training, and oncology department affiliation. The area under the ROC (AUC) of the logistic regression model was 0.745, and the AUC of the decision tree model was 0.721. There is no statistical difference in the prediction efficiency between the two prediction models (Z=1.943; P>0.05). Conclusions　Core competence in oncology nursing of nursing staff in Shaanxi Province is at a moderate level. Work satisfaction, certification, training, and oncology department affiliation are critical influencing factors. Integrating logistic regression's quantitative risk assessment with decision tree's dynamic pathway analysis enhances prediction accuracy. Managers should adopt dual-model strategies to establish baseline standards and design tiered interventions for high-risk subgroups.

Qualitative research on motivation of dietary management behavior change in patients after bariatric and metabolic surgery

Han Hongna, Yang Lin, Tian Ming, An Yanxin, Li Haiying, He Ping

2025, 31(22):  3854-3858.  DOI: 10.3760/cma.j.cn441417-20250402-22032

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Objective　To explore the motivation of dietary management behavior change in patients after bariatric and metabolic surgery. Methods　Adopting the purposive sampling method, 12 patients who underwent postoperative follow-up at the First Affiliated Hospital of Xi'an Medical College and Baoji Hospital of Xi'an Medical College were selected for in-depth interviews from March to April 2024, including 6 males and 6 females who were (32.83±6.49) years old. The data were analyzed using the Braun & Clarke thematic analysis. Results　The four themes of motivation for dietary behavior change during nursing care after bariatric and metabolic surgery were as below: awareness of the risks of postoperative complications, awareness of the harms of non-compliant dietary behaviors, awareness of the benefits of healthy dietary management, and awareness that social support and positive psychological factors were conducive to mental and physical well-being and quality of life. Conclusions　By enhancing patients' awareness of postoperative complications and the risks of harmful behaviors, along with their level of social support and positive psychological well-being, we can improve their understanding of healthy dietary management practices. This, in turn, will strengthen their motivation to change dietary behaviors during nursing care. Based on these factors, clinical nursing staff should implement effective interventions to enhance the effectiveness of dietary management in patients after bariatric and metabolic surgery and to improve their clinical outcomes.

Investigation Report

Sleep status of primary and secondary school students in Bincheng District, Binzhou City and its influencing factors

Liu Yandi, Li Yingying, Huo Yingqian, Li Dongyang, Guo Ao, Ma Wenbin

2025, 31(22):  3865-3869.  DOI: 10.3760/cma.j.cn441417-20250527-22033

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Objective　To understand the sleep status of primary and secondary school students in the Bincheng District of Binzhou City and analyze its influencing factors, and oprovide countermeasures for improving the sleep quality of primary and secondary school students. Methods　This survey was conducted from May to June 2023. A stratified sampling method was adopted to select 534 primary and secondary school students in the Bincheng District of Binzhou City as the survey objects. A self-designed electronic questionnaire was used to investigate the sleep status of primary and secondary school students. Results　14.79% of primary school students sleeped less than 8 hours, 40.96 percent of middle school students between the than 7 hours, and 52.26 percent of high school students between the less than 6 hours. The sleeping time of primary school students mainly concentrated in 21:00－22:00 (47.47%) and 22:00－23:00 (38.52%). The sleeping time of junior and senior students was mainly 22:00－23:00 (35.74%) and 23:00－24:00 (19.13%), the waking time of primary school students mainly 06:30－07:00 (61.48%), and that of junior and senior high school students 05:30－06:00 (54.15%). There were significant differences in the time of falling asleep and getting up in the morning between the students of different school ages (P<0.05). The most prominent sleep-related psychological problems of primary and secondary school students were morning difficulty (35.77%); It was followed by daytime sleepiness (14.79%), poor attention (14.05%), poor memory (11.61%), anxiety (10.67%), and depression (8.05%). Multivariate logistic regression analysis showed that late bedtime (OR=4.205, 95%CI: 1.608～10.997) and distance from home to school (OR=1.946, 95%CI: 1.108-3.419) affected the sleep time of primary school students (P<0.05). Late sleep time (OR=7.106, 95%CI: 3.718～13.578) affected the sleep time of middle and high school students (P<0.05). Conclusions　The majority of primary and middle school students in Binzhou City have insufficient sleep time, some of them have sleep-related psychological problems and late sleep time is a risk factor affecting sleep time. It is suggested that relevant departments should pay attention to and strengthen children's sleep health education, home-school co-education, and effectively improve the sleep quality of primary and secondary school students.

Clinical Teaching

Application of OSCE teaching with real clinical cases in the clinical nursing education of fall-related adverse events in eldly patients

Wang Hongxia, Guan Hailing, Wu Yuling, Liu Xiangli, He Jianru

2025, 31(22):  3870-3872.  DOI: 10.3760/cma.j.cn441417-20250817-22034

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Objective　To explore the application effect of the objective structured clinical examination (OSCE) teaching method based on real clinical cases in the clinical teaching of fall care for elderly patients. Methods　A prospective experimental research design was adopted. A total of 60 nursing students who were on internship at the Second Hospital of Traditional Chinese Medicine of Guangdong Province from July 2024 to May 2025 were selected as research subjects through cluster random sampling. They were divided into a control group and an experimental group by the random number table method, with 30 cases in each group. The control group comprised 25 females and 5 males, aged 20.87±0.49 years, including 26 with associate degrees and 4 with bachelor's degrees; the experimental group consisted of 25 females and 5 males, aged 21.13±0.35 years, including 23 with associate degrees and 7 with bachelor's degrees. The control group received traditional teaching methods, while the experimental group underwent OSCE-style teaching based on real fall cases in addition to traditional instruction. Theoretical assessment scores, practical skill evaluation results, and teaching satisfaction were compared between the two groups. Data analysis was performed using t-tests and chi-square tests. Results　The total scores of theoretical and operational skills assessment and teaching satisfaction in the experimental group were higher than those in the control group [(94.63±2.08) points vs. (86.7±3.15) points, (91.47±2.8) points vs. (79.9 ±3.1) points, and (22.23±1.14) points vs. (16.83±1.53) points], and the differences were statistically significant (t=11.511, 15.164, and 15.505; all P<0.001). Conclusion　Integrating OSCE teaching with real clinical cases significantly improves nursing students,learning outcomes and satisfaction in the education of fall-related adverse events.