Tianjin Medical Journal

The effect of bufalin on extracellular matrix synthesis in renal tubular epithelial cells induced by high glucose

GAO Chen, QIAO Yunyang, JI Jialing, WANG E, HUO Ying, ZHANG Aiqing

2025, 53 (10): 1009-1015. doi: 10.11958/20252443

Abstract ( 129 )

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Objective To investigate the effect and underlying mechanism of bufalin regulating ferroptosis on extracellular matrix synthesis in renal tubular epithelial cells (RTECs) under high glucose (HG) conditions. Methods RTECs were cultured in vitro and exposed to HG. The experimental groups included: the control group, the HG group, the HG + dimethyl sulfoxide (DMSO) group, the HG + bufalin group, the HG + ferrostatin-1 (Fer-1) group, the HG + bufalin + DMSO group and HG + bufalin + erastin group. The expression levels of fibronectin (FN), type Ⅰ collagen (Col Ⅰ), acyl-CoA synthetase long-chain family member 4 (ACSL4), solute carrier family 7 member 11 (SLC7A11) and glutathione peroxidase 4 (GPX4) were detected using Western blot assay and quantitative real-time PCR (qRT-PCR). The potential molecular targets of bufalin were predicted using SwissTargetPrediction, and functional enrichment analysis was conducted using Metascape. FerrDb was employed to analyze ferroptosis-related gene sets. The levels of ferrous ions (Fe²⁺), malondialdehyde (MDA) and glutathione (GSH) were measured using micro-methods to evaluate the occurrence of ferroptosis. Results Compared with the control group, the mRNA and protein relative expression levels of FN, Col Ⅰand ACSL4 were increased in the HG group, while the mRNA and protein expression levels of GPX4 and SLC7A11 were decreased (P<0.05). Compared with the HG + DMSO group, the mRNA and protein expression levels of FN, Col Ⅰand ACSL4, as well as levels of Fe²⁺ and MDA were decreased in the HG + bufalin group, while the mRNA and protein expression levels of GPX4 and SLC7A11, and the level of GSH were increased (P<0.05). In the HG + Fer-1 group, the mRNA and protein expression levels of GPX4 and SLC7A11 were increased, while the mRNA and protein expression levels of ACSL4, FN and Col Ⅰ were decreased (P<0.05). The SwissTargetPrediction database and Metascape analysis function showed that the downstream functions of bufalin were closely related to lipid metabolism, inflammatory response, programmed cell death and ferroptosis-related pathways. The FerrDb analysis results indicated that the target sites of bufalin were closely related to ferroptosis markers. Compared with the HG + bufalin + DMSO group, the mRNA and protein expression levels of GPX4 and SLC7A11 were decreased in the HG + bufalin + Erastin group, while the mRNA and protein expression levels of ACSL4, FN and Col Ⅰ were increased (P<0.05). Conclusion Bufalin attenuates extracellular matrix synthesis in HG-induced RTECs by inhibiting ferroptosis.

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Effects of drug-containing serum of Liuwei Dihuang Pill on Wnt/β-catenin pathway, migration and invasion of trophoblast cells induced by high glucose

ZHU Juhua, CHEN Kang, JIN Ye

2025, 53 (10): 1016-1020. doi: 10.11958/20251508

Abstract ( 106 )

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Objective To investigate the effect of drug-containing serum from Liuwei Dihuang Pill on Wnt/β-catenin pathway, migration and invasion of trophoblast cells induced by high glucose. Methods The drug-containing serum of Liuwei Dihuang Pill was prepared. Human chorionic trophoblast HTR-8/Svneo cells were cultured in vitro and divided into the control group (5 mmol/L glucose + blank serum), the high glucose group (30 mmol/L glucose + blank serum), the low-dose group (30 mmol/L glucose, serum medicine solution of Rehmannia Six Formula at 0.45 g/mL), the medium-dose group (30 mmol/L glucose, serum medicine solution of Rehmannia Six Formula at 0.90 g/mL) and the high-dose group (30 mmol/L glucose, serum medicine solution of Rehmannia Six Formula at 1.35 g/mL). The mRNA expressions of Wnt1, β-catenin and Cyclin D1 in HTR-8/Svneo cells were detected by real-time fluorescence quantitative PCR (qRT-PCR). The protein expressions of Wnt1, β-catenin, phosphorylated glycogen synthesis kinase-3β (p-GSK-3β) and Cyclin D1 in HTR-8/Svneo cells were detected by Western blot assay. The migration and invasion of HTR-8/Svneo cells were detected by Transwell method. Results Compared with the control group, the protein and mRNA expression levels of Wnt1, β-catenin and Cyclin D1, the numbers of migration cells and invasive cells in HTR-8/Svneo cells were decreased in the high glucose group (P< 0.05). Compared with the high glucose group, the protein and mRNA expression levels of Wnt1, β-catenin and Cyclin D1, the numbers of migration cells and invasive cells were significantly increased in the low dose, the medium dose and the high dose groups of the HTR-8/Svneo cells (P < 0.05). In addition, with the increase of the drug containing serum dose of Liuwei Dihuang Pill, the above indexes in HTR-8/Svneo cells increased successively (P < 0.05). Conclusion The drug containing serum of Liuwei Dihuang Pil can activate Wnt/β-catenin pathway in HTR-8/Svneo cells induced by high glucose, and promote the migration and invasion of HTR-8/Svneo cells.

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Development and evaluation of the tumor vaccine TCL/CpG@GNP

CHEN Minchun, XUE Runqing, ZHAO Xin, ZHANG Meng, YE Dan, ZHANG Jingyi, ZHENG Jie

2025, 53 (10): 1021-1026. doi: 10.11958/20251525

Abstract ( 84 )

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Objective To develop a tumor vaccine containing broad-spectrum neoantigen tumor cell lysate (TCL) and CpG adjuvant, and to effectively deliver it to lymph node dendritic cells. Methods A novel polymer, 9-fluorenylmethoxycarbonyl-polyethylene glycol-glycocholic acid (Fmoc-PEG-GCA), was employed to encapsulate the TCL and CpG through π-π stacking, resulting in high-density polyethylene glycol-modified glycocholic acid-decorated micelles TCL/CpG@GNP. The vaccine's drug loading, encapsulation efficiency, particle size, polydispersity index (PDI), zeta potential, morphology, stability, cellular safety, uptake capability, immune stimulation effects on bone marrow-derived dendritic cells (BMDCs) and in vivo anti-tumor efficacy were evaluated. Results The vaccine TCL and CpG demonstrated a drug loading capacity of 6.26% and the encapsulation rate was 37.59%. The drug loading capacity of CpG was 7.05%, and the encapsulation efficiency was 56.86%. The particle size measured (139.26±27.23) nm, with a PDI of 0.249±0.015, indicating favorable dispersion properties. The zeta potential was recorded at (-21.23±0.36) mV. The TCL/CpG@GNP vaccine demonstrated good stability, cell safety and uptake ability, and can promote the activation and maturation of BMDCs. In tumor-bearing mouse models, TCL/CpG@GNP inhibited tumor growth, increased the proportion of T lymphocytes in peripheral blood, and elevated IFN-γ levels in spleen. Conclusion The TCL/CpG@GNP tumor vaccine can effectively activate BMDCs and induce strong anti-tumor immune memory in a mouse lung cancer model.

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The effect of perindopril on the NOX4/NLRP3 signaling pathway in TAA-induced liver fibrosis in rats

Hudagula , MA Zhenhua, LU Yan, DUAN Chunlan, LI Kai

2025, 53 (10): 1027-1032. doi: 10.11958/20252146

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Objective To investigate the effect of perindopril on the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 4 (NOX4)/NOD-like receptor protein 3 (NLRP3) signaling pathway in rat liver fibrosis induced by thioacetamide (TAA). Methods Thirty-two SD rats were randomly divided into the blank group, the model group (TAA 200 mg/kg, twice a week for 6 weeks) and the low/high dose group (TAA+ perindopril 2/8 mg/kg), with 8 rats in each group. Two weeks after modeling, the administration group was given the corresponding dose of perindopril by gavage (for 4 weeks). At the end of the 6th week, liver pathological sections were used to observe pathological changes of liver tissue and degrees of fibrosis and inflammation. The biochemical analyzer was used to detect alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Enzyme-linked immunosorbent assay (ELISA) was used to detect NLRP3 and IL-1β. Immunohistochemistry was used to detect NOX4, NLRP3, Caspase-1, IL-1β protein and α -smooth muscle agonist protein (α-SMA). Results Compared with the blank group, liver collagen fibers were significantly proliferated in the model group, a large number of inflammatory cells infiltrated, and serum levels of ALT and AST, as well as NLRP3 and IL-1β in rats were significantly increased. The average optical density values of positive proteins such as NOX4, NLRP3, Caspase-1, IL-1β and α-SMA in rat liver tissue increased significantly (P < 0.05). Compared with the model group, the proliferation of collagen fibers and inflammatory infiltration were significantly reduced in both the low-dose and high-dose groups, and serum levels of ALT and AST, NLRP3 and IL-1β in rats were significantly decreased. The average optical density values of positive proteins such as NOX4, NLRP3, Caspase-1, IL-1β and α-SMA in rat liver tissue decreased significantly (P < 0.05). Moreover, the degree of liver fibrosis reduction in rats was better in the high-dose group than that in the low-dose group. Conclusion Perindopril may regulate the NLRP3 signaling pathway by inhibiting the expression of NOX4, thereby reducing oxidative stress damage and inflammatory responses and thus delaying the process of liver fibrosis.

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Clinical study of laparoscopic high ligation of hernia sac combined with IPOM and local anesthesia Lichtenstein repair in the treatment of male patients with inguinal hernia after radical cystectomy

WAN Fangxin, LIU Bin, ZHANG Haocheng, ZHANG Changwen, LI Baoyu

2025, 53 (10): 1033-1036. doi: 10.11958/20251780

Abstract ( 76 )

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Objective To compare the clinical efficacy of laparoscopic high ligation of the hernia sac combined with intraperitoneal onlay mesh (IPOM) and local anesthesia Lichtenstein repair for the treatment of inguinal hernia after total cystectomy in male patients. Methods A total of 59 male patients who underwent total cystectomy were included in this study and randomly divided into two groups: the laparoscopic high ligation of the hernia sac combined with IPOM group (IPOM group, 30 cases) and the local anesthesia Lichtenstein repair group (local anesthesia group, 29 cases). The patient age, surgical time, postoperative ambulation time, visual analogue scale score for pain on the 1st to 3rd days and 3 months after operation, time to first mobilization post-operation, pain scores on postoperative day 1, 2 and 3, pain scores at 3 months post-operation were observed and compared between the two groups. Data of intraoperative blood loss, hospital stay, time to return to daily activities, total surgery costs, recurrence rates at 1 year after operation and complications were also observed and compared in two groups of patients. The results were analyzed to determine the optimal surgical method. Results The IPOM group demonstrated better outcomes in terms of surgical time, time to first mobilization, pain scores on postoperative days 1, 2 and 3, pain scores at 3 months, intraoperative blood loss, hospital stay and time to return to daily activities compared to those of the local anesthesia group (P<0.01). However, the total cost of the operation was higher in the IPOM group than those of the local anesthesia group (P<0.01). There were no significant differences in postoperative complications between the two groups (P>0.05). The recurrence rate of the IPOM group one year after surgery was better than that of the local anesthesia group (P<0.05). Conclusion Laparoscopic IPOM with high ligation of the hernia sac is superior to the traditional Lichtenstein repair in reducing postoperative pain and recurrence rates. This surgical method should be the first choice when economic conditions permit.

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Establishment and validation of a column chart risk prediction model for aspiration in early enteral nutrition therapy of ICU patients

WANG Haixia, HE Fei, ZHU Congmei, WANG Jing

2025, 53 (10): 1037-1042. doi: 10.11958/20250625

Abstract ( 80 )

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Objective To investigate the risk factors of aspiration during early enteral nutrition (EEN) support treatment in patients in intensive care unit (ICU) and establish and validate the corresponding nomogram risk prediction model. Methods A total of 348 ICU patients who received EEN between June 2022 and May 2024 were enrolled and divided into the aspiration group (n=74) and the non-aspiration group (n=274) based on the occurrence of aspiration. Clinical data were collected included age, sex, body mass index (BMI), history of diabetes, endotracheal intubation/mechanical ventilation status, plasma albumin (ALB) levels within 24 h after admission to ICU, disease type (severe pneumonia/stroke/septic shock), consciousness level (Glasgow Coma Scale, GCS), APACHE Ⅱscore, nasogastric tube insertion depth, infusion volume, nutritional risk (NRS2002 score ≥3 indicating high risk), and nutrition mode (nasogastric/nasointestinal tube). Logistic regression was used to identify risk factors of aspiration, and a nomogram prediction model was constructed using R software. External validation was performed on 72 EEN-treated ICU patients admitted between June 2024 and January 2025. Results Logistic regression identified age (OR=2.701, 95% CI: 1.633-4.467), APACHE Ⅱ score (OR=2.125, 95%CI: 1.133-3.987), consciousness level (OR=2.826, 95%CI: 1.617-4.940), nasogastric tube insertion depth (OR=1.101, 95%CI: 1.006-1.136) and nutritional risk (OR=8.996, 95%CI: 5.017-16.132) were independent risk factors for aspiration (all P<0.05). A nomogram incorporating these factors was developed, converting cumulative scores into individualized aspiration risk probabilities. The model demonstrated strong predictive performance in internal validation (AUC=0.860, calibration curve slope=0.930) and external validation (AUC=0.831). Decision curve analysis (DCA) confirmed significant clinical net benefits across risk thresholds, supporting its practical utility. Conclusion The nomogram model exhibits good discrimination and accuracy, providing a valuable tool for individualized aspiration risk assessment in ICU patients receiving EEN.

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Construction and verification of atherosclerosis risk prediction model for rheumatoid arthritis patients

LYU Jing, ZHU Fangying, ZHU Kai, LI Yun, YANG Na, WEN Shuyun, ZHONG Miqian

2025, 53 (10): 1043-1047. doi: 10.11958/20251059

Abstract ( 86 )

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Objective To construct a risk prediction model for atherosclerosis (AS) in patients with rheumatoid arthritis (RA) based on Lasso-Logistic regression analysis and provide a scientific basis for individualized clinical intervention. Methods The retrospective clinical data were collected from 344 RA patients, including 86 patients with AS (RA+AS group) and 258 patients with without AS (RA group). The clinical characteristics and initial laboratory test results were compared between the two groups. Lasso regression was used to screen the key predictive variables, and Logistic regression was combined to construct the prediction mode. The discrimination of the model was evaluated through the receiver operating characteristic (ROC) curve and the area under the curve (AUC). The Hosmer-Lemeshow test was used to assess the calibration, and decision curve analysis was used to verify the clinical applicability of the model. Results Seven predictive variables were identified including RA disease duration, DAS28 score, C-reactive protein (CRP), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG) and hypertension. The risk prediction model for AS in RA patients was: Logit (P)=-2.674+0.605×RA disease duration +0.393×DAS28 score+0.310×CRP+1.346×TG- 2.289×HDL-C+0.679×FBG+0.711×hypertension. The AUC of the model was 0.965 (95% CI: 0.943-0.987), and the Hosmer-Lemeshow test showed χ²=0.547, P=1.000, indicating good discrimination and calibration. Clinical decision curve analysis showed that the probability threshold ranged from 7% to 92%, demonstrating high clinical applicability. Conclusion The AS risk prediction model constructed in this study for RA patients can effectively identify high-risk individuals, supporting the development of personalized prevention and treatment strategies.

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The diagnostic value of serum CRP, SAA and PCT combined with LDH and ADA in cerebrospinal fluid in elderly patients with central nervous system infection

LIAO Hongliu, HU Yan, LI Yan, DENG Caiwang

2025, 53 (10): 1048-1052. doi: 10.11958/20250729

Abstract ( 91 )

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Objective To explore the diagnostic value of serum C-reactive protein (CRP)，serum amyloid A (SAA) and procalcitonin (PCT) combined with lactate dehydrogenase (LDH) and adenosine deaminase (ADA) in cerebrospinal fluid for elderly patients with central nervous system infection and their differential significance for different infection types. Methods A total of 97 elderly patients with central nervous system infection were enrolled as the infection group, including 31 cases with tuberculous meningitis (tuberculous meningitis group)，36 cases with suppurative meningitis (suppurative meningitis group) and 30 cases with viral meningitis (viral meningitis group). A total of 97 patients with normal laboratory examination indexes who were treated due to primary headache during the same period were enrolled as the control group. The samples of fasting elbow venous blood were collected in the early morning of the next day after admission, and the serum was isolated to detect CRP and SAA levels. When consultation, lumbar puncture was performed to collect cerebrospinal fluid for the detection of LDH and ADA levels. The differences in above indexes were compared between groups, and diagnostic efficiency of each index and combined detection for central nervous system infection in elderly was analyzed by receiver operating characteristic (ROC) curves. Results The serum levels of CRP, SAA and PCT, and LDH and ADA in cerebrospinal fluid were higher in the infection group than those in the control group (P<0.05). ROC curve analysis showed that the area under the curve (AUC) values of serum CRP，SAA and PCT, and cerebrospinal fluid LDH and ADA, and combined detection in the diagnosis of central nervous system infection were all >0.70 (P<0.05), showing good predictive efficiency and diagnostic efficiency, and the diagnostic efficacy of combined detection was the best. The cut-off values of serum CRP，SAA and PCT, cerebrospinal fluid LDH and ADA were 6.32 mg/L, 33.86 mg/L, 2.81 μg/L, 33.53 U/L and 1.99 U/L, respectively. The serum levels of CRP, SAA and PCT were the highest in the suppurative meningitis group, while which were the lowest in the viral meningitis group. The cerebrospinal fluid levels of LDH and ADA were the highest in the tuberculous meningitis group, while which were the lowest in the viral meningitis group (P<0.05). Conclusion The combined detection of serum CRP, SAA and cerebrospinal fluid PCT and LDH has certain diagnostic value for elderly central nervous system infection, which is beneficial to identify infection types.

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The relationship between HMOX1 and MAPK14 with the onset and prognosis of sepsis-induced acute lung injury in children

LI Bo, LIN Hong, HUANG Lanying, LI Lingyu

2025, 53 (10): 1052-1056. doi: 10.11958/20251919

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Objective To explore the relationship between the ferroptosis-related molecules heme oxygenase-1 (HMOX1) and mitogen-activated protein kinase 14 (MAPK14) with the onset and prognosis of acute lung injury (ALI) in children with sepsis. Methods A total of 102 children with sepsis were selected, including 54 in the ALI group and 48 in the non-ALI group. Clinical data, laboratory tests, organ function scores and serum levels of HMOX1 and MAPK14 were compared between the two groups. The mortality rates of children with different levels of HMOX1 and MAPK14 at 28-day and 90-day were analyzed. Results Compared with the non-ALI group, procalcitonin (PCT), lactate (Lac), pediatric organ dysfunction Logistic-2 score (PELOD-2), pediatric risk of mortality score version 3 (PRISM III) and sequential organ failure assessment (SOFA) scores were increased in the ALI group (P<0.05). Serum levels of HMOX1 and MAPK14 were significantly higher in the ALI group than those in the non-ALI group (P<0.05). HMOX1 and MAPK14 showed good predictive value for the occurrence of ALI in sepsis patients, with AUC values of 0.872 (95%CI: 0.791-0.930) and 0.825 (95%CI:0.737-0.893), and the optimal cutoff values were 3.1 μg/L and 3.8 μg/L, respectively. After grouping by the cutoff values of HMOX1 and MAPK14, there were no significant differences in the 28-day and 90-day mortality rates in children with different levels of HMOX1 and MAPK14 (P>0.05). Conclusion The expression levels of serum HMOX1 and MAPK14 increase in the early stage of sepsis-related ALI, which may serve as biomarkers for the onset of ALI, and they have no significant impact on the prognosis of children.

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Analysis of the predictive value of serum peroxiredoxin 4 in early pregnancy for the risk of gestational diabetes

WU Huan, ZHUANG Ying, ZHOU Min, PENG Ziping, YU Chan

2025, 53 (10): 1057-1061. doi: 10.11958/20252188

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Objective To investigate changes of serum peroxiredoxin 4 level in patients with gestational diabetes mellitus (GDM) at the early stage and its diagnostic value for GDM. Methods A total of 372 early pregnant women who visited our hospital from March 2021 to May 2024 were selected as the study subjects. The diagnosis of GDM was determined based on the results of the oral glucose tolerance test (OGTT). Pregnant women were divided into the GDM group (n=89) and the control group (n=283). Clinical data, laboratory indicators and levels of peroxiredoxin 4 were compared between two groups of patients. The correlation between serum peroxiredoxin 4 levels and laboratory indicators was analyzed. Risk factors for the occurrence of GDM and its diagnostic efficacy for GDM were also analyzed. Results The proportion of family history of diabetes, insulin resistance index (HOMA-IR), fasting plasma glucose (FPG), postprandial 1 h glucose (1 hPG), postprandial 2 h glucose (2 hPG), C-peptide and serum peroxidase reductase 4 were higher in the GDM group than those in the control group (P<0.05), while the pancreatic β-cell function index (HOMA-β) was lower in the GDM group than those in the control group (P<0.05). The level of serum peroxidase reductase 4 was positively correlated with HOMA-IR, FPG, 1 hPG, 2 hPG and C-peptide in the GDM group, and which was negatively correlated with HOMA-β (P<0.05). Multifactorial Logistic regression analysis showed that elevated HOMA-IR, FPG, 1 hPG, 2 hPG, C-peptide and peroxidase reductase 4 were risk factors for the occurrence of GDM, while elevated HOMA-β was the protective factor for the occurrence of GDM (P<0.05). The area under the curve (AUC) for peroxidase reductase 4 in diagnosing GDM was 0.912 (95% CI: 0.871-0.953), with a sensitivity of 79.79% and specificity of 89.36% when the optimal cutoff value was 0.93 U/L. Conclusion The serum level of peroxiredoxin 4 in GDM patients is significantly elevated, showing good diagnostic efficacy for GDM.

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The influencing factors of readmission within 90 days for weak patients with chronic obstructive pulmonary disease and construction of an early warning model

LIU Xin, GU Jing, YANG Jie, CHEN Xinping, CAI Chuanfeng, ZHANG Xiumei

2025, 53 (10): 1061-1065. doi: 10.11958/20251088

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Objective To explore the influencing factors of readmission within 90 days in frail patients with chronic obstructive pulmonary disease (COPD), construct an early warning model and evaluate its discrimination and effectiveness. Methods A total of 831 COPD patients with frailty were included and divided into the readmission group (290 cases) and the control group (541 cases) based on whether they were readmitted within 90 days after discharge. The electronic medical record data were collected and compared between the two groups of patients. Multivariate Logistic regression analysis was used to screen independent influencing factors for readmission within 90 days in COPD weak patients. A predictive model was established. The column chart was drawn. The discriminability of the predictive model was evaluated through receiver operating characteristic (ROC) curves. The clinical practicality and the predictive model calibration were evaluated through decision curves and calibration curves. Results The body mass index (BMI) of the readmission group was lower than that of the non readmission group, and the proportion of acute exacerbation of COPD hospitalizations ≥ 2 times in the past year， the Edmonton frailty scale (REFS) score and the Chalson comorbidity index (CCI) were higher in the readmission group than those of the non readmission group (P<0.05). Multivariate Logistic regression analysis showed that BMI (OR=0.721, 95%CI: 0.636-0.818), the number of acute exacerbations of COPD hospitalizations in the past year (OR=3.040, 95%CI: 1.944-4.753), REFS score (OR=1.726, 95%CI: 1.486-2.005) and CCI score (OR=3.917, 95%CI: 3.079-4.983) were all independent influencing factors for readmission within 90 days in COPD frail patients (P<0.05). Based on the results of multiple factor Logistic regression analysis, the column chart warning model was constructed. The AUC value of the ROC curve was 0.847 (95%CI: 0.820-0.874), the specificity was 87.20% and the sensitivity was 64.50%. The calibration curve of the predictive model was close to the diagonal, and the calibrationa degree was good. The decision curve suggested that the prediction model had clinical practicality. Conclusion The early warning model constructed based on the influencing factors of readmission hospitalization within 90 days in weak patients with COPD has good predictive effect and clinical practicability.

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Clinical study on the combination of belimumab and glucocorticoids in the treatment of systemic lupus erythematosus in children

GUO Jingxiao, YANG Yanjun, CHEN Xin, GE Lanlan, LIU Fujuan

2025, 53 (10): 1066-1070. doi: 10.11958/20251061

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Objective To observe the clinical efficacy of belimumab combined with glucocorticoids in the treatment of children with systemic lupus erythematosus (SLE). Methods A total of 64 children with SLE were randomly divided into the observation group and the control group, with 32 cases in each group. The control group was treated with oral prednisone tablets combined with hydroxychloroquine sulfate tablets, while the observation group was treated with belimumab on the basis of treatment in the control group. After 6 months of treatment, the clinical efficacy, systemic lupus erythematosus disease activity index (SLEDAI) scores and laboratory indicators [complement C3, complement C4, immunoglobulin IgG (IgG), B lymphocytes, white blood cell count (WBC), erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP), 24-hour urine protein quantification (24 h UP), serum creatinine (SCr) and blood urea nitrogen (BUN)] were compared between the two groups. Results After 6 months of treatment, the total effective rate was higher in the observation group than that of the control group (93.8% vs. 75.0%, P<0.05). Compared with before treatment, both groups showed lower SLEDAI scores, IgG, B lymphocytes, ESR, CRP, SCr, 24 h UP and BUN after treatment, while C3, C4 levels and WBC were higher. Moreover, the improvement of all indicators was better in the observation group than that in the control group (P<0.05). Conclusion Belimumab combined with glucocorticoids can improve the clinical efficacy, control disease activity and enhance immune function in children with SLE.

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Clinical efficacy of caragliflozin and empagliflozin in obese patients with type 2 diabetes mellitus

HU Limei, LIU Huiying, CHEN Yaru, ZHAO Panpan, GU Jun, REN Weidong

2025, 53 (10): 1071-1076. doi: 10.11958/20252351

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Objective To analyze effects of caragliflozin and empagliflozin on inflammatory markers, glucose and lipid metabolism and miR-144 expression in obese patients with type 2 diabetes mellitus (T2DM). Methods A total of 148 obese T2DM patients admitted to our hospital from June 2021 to May 2024 were selected and divided into the caragliflozin group and the empagliflozin group by random number table method. The two groups were treated with canagliflozin and empagliflozin on the basis of conventional treatment for 6 months. The inflammatory indicators, glucose metabolism indicators, lipid metabolism indicators, microRNA-144 (miR-144) expression, body mass index (BMI), clinical efficacy and incidence of adverse reactions were compared between the two groups. Results After a total of 7 cases were excluded during the treatment period, there were 71 cases in the caragliflozin group and 70 cases in the empagliflozin group. After treatment, the levels of tumor necrosis factor-α, interleukin-6, C-reactive protein, fasting blood glucose (FBG), 2 h postprandial blood glucose (2 h-PPG), glycosylated hemoglobin (HbA1c), triglyceride (TG), total cholesterol, low density lipoprotein cholesterol, BMI and miR-144 expression were lower than those before treatment in two groups of patients (P<0.05), and the levels of FBG, 2 h-PPG, HbA1c, TG and miR-144 expression were lower in the caragliflozin group than those of the empagliflozin group (P<0.05). After treatment, high density lipoprotein cholesterol was higher than that before treatment in the two groups (P<0.05), and that in the canagliflozin group was higher than the empagliflozin group (P<0.05). There were no significant differences in the clinical efficacy and incidence of adverse reactions between the two groups after treatment (P>0.05). Conclusion Both caragliflozin and empagliflozin have certain therapeutic efficacy and good safety for obese T2DM patients, and caragliflozin is more effective in improving glucose and lipid metabolism.

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Preventive efficacy of rhGM-CSF combined with Kangfuxin liquid on radiation dermatitis of breast cancer

LIU Yuanyuan, HUANG Xiaoqing, YAN Liang, YI Shuping

2025, 53 (10): 1076-1080. doi: 10.11958/20250747

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Objective To investigate the preventive efficacy of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) combined with Kangfuxin liquid on radiation dermatitis in breast cancer patients underwent radiotherapy. Methods A total of 90 breast cancer patients were randomized into the control group (45 cases, rhGM-CSF alone) and the observation group (45 cases, rhGM-CSF + Kangfuxin liquid). Both groups received radiotherapy. The incidence of radiation dermatitis, the time of first occurrence, the healing time and severity of radiation dermatitis (graded by RTOG criteria) were compared between the two groups. Skin growth factors [epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), transforming growth factor-β (TGF-β)] were measured via enzyme linked immunosorbent assay (ELISA) before radiotherapy and 2 weeks after radiotherapy. The quality of life of patients was assessed using the EORTC QLQ-C30 V3.0 questionnaire. Results The incidence of radiation dermatitis was significantly lower in the observation group (35.56%, 16/45) than that in the control group (68.89%, 31/45, P<0.05), and the first occurrence time of dermatitis was later, the healing time was shorter, and the severity grade of dermatitis was lower (P<0.05). Two weeks after radiotherapy, levels of EGF, bFGF, TGF-β and the scores of QLQ-C30 increased in both groups, and those of the observation group were significantly higher than the control group (P<0.05). Conclusion Combining rhGM-CSF with Kangfuxin liquid can effectively prevent radiation dermatitis in breast cancer patients by reducing incidence and severity, delaying onset time, accelerating healing, and improving quality of life.

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Epidemiological investigation on diphtheria serum IgG antibody levels in people aged 1-59 years old in Shaanxi province

ZHANG Chao, ZHOU Tiantian, LI Siwen, TANG Weijun, HU Weijun

2025, 53 (10): 1081-1086. doi: 10.11958/20251924

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Objective To investigate the serum diphtheria antibody levels in healthy people aged 1-59 years old in Shaanxi Province. Methods A stratified random sampling method was used to select healthy people aged 1-59 years old from 30 county-level disease surveillance sites in 10 cities of Shaanxi province from November to December 2017. Diphtheria IgG antibody was detected by enzyme-linked immunosorbent assay (ELISA), and the positive rate (IgG≥0.01 IU/mL) and mean geometric concentration (GMC) of diphtheria IgG antibody were analyzed. Results A total of 6 439 subjects completed laboratory testing. The positive rate and GMC of diphtheria IgG antibody were 85.79% and 0.035 (0.034-0.036) IU/mL, respectively. The GMC and the positive rate of diphtheria IgG antibody were higher in males than those in females (P<0.01). The positive rate of diphtheria IgG antibody in different cities was 65.25%-98.23%, and the GMC was 0.021 (0.018-0.024) IU/mL-0.046 (0.037-0.055) IU/mL, the difference between the groups was statistically significant (P<0.01). The GMC of the group with DCV immunization history, the group without DCV immunization history and the group with unknown DCV immunization history were 0.097 (0.090-0.105), 0.018 (0.018-0.019) and 0.027 (0.026-0.028) IU/mL, respectively, and the positive rates of diphtheria IgG antibody were 92.74%, 80.18% and 85.44%, respectively. There were significant differences between the three groups (P<0.01). Among the 9 age groups, the group with the lowest positive rate of diphtheria IgG antibody was the 40-49 age group (78.39%), and the highest was in the 1-2 age group (95.77%), which decreased with age (χ²=200.612, P<0.01). It showed a downward trend with age (χ²=200.612，P<0.01). The lowest GMC (IU/mL) was in the 40-49 age group [0.017 (0.016-0.017)], and the highest was in the 7-9 age group [0.190 (0.162-0.226)], showing a downward trend with increasing age (P<0.01). After the whole course of vaccination, the positive rate of diphtheria IgG antibody and the interval between the last dose of vaccination showed a downward trend (P<0.01). Conclusion The diphtheria immune barrier in whole population has been established in Shaanxi province, but the positive rate of diphtheria antibody and GMC in healthy people aged 1-59 years old show a downward trend with age.

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Epidemiological analysis of high-risk HPV infection and genotype distribution in 13 105 women in Zhongguancun area, Beijing

YANG Yanyan, WANG Ping, YI Xue, PENG Jinzhu, HE Yu, ZHANG Wenyu, CHEN Lei, Aziya

2025, 53 (10): 1086-1090. doi: 10.11958/20252016

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Objective To analyze the epidemiological characteristics of human papillomavirus (HPV) infection in women in the Zhongguancun area of Beijing, and to evaluate the infection rates and genotype distribution between different populations and age groups. Methods A retrospective analysis was conducted on HPV genotyping results of 13,105 women who visited the gynecology outpatient department or underwent routine health check-ups at Zhongguancun Hospital from March 2019 to April 2024. High-risk HPV genotypes (15 types) were detected using a fluorescence PCR assay. Positive cases were classified as single, dual or multiple (≥3) infections based on the number of genotypes. Subjects were stratified into six age groups (≤30, 31-40, 41-50, 51-60, 61-70, and ≥71 years), and the characteristics of infection by type and age group were analyzed. Results The overall HPV positivity rate was 10.78% (1,413/13,105), with a significantly higher rate in the outpatient group than that in the health check-up group (16.36% vs. 6.06%, P<0.01). The three most prevalent genotypes were HPV52 (18.83%), HPV58 (13.85%), and HPV16 (11.28%). Single infections accounted for 79.19% of cases, dual infections for 15.93% and multiple infections for 4.88%. Age distribution showed a U-shaped pattern, with higher infection rate in women aged ≤30 years (15.06%) and 61-70 years (13.19%), and the lowest rate in the ≥71 years (8.09%). Notably, women aged ≤30 years had the highest proportion of multiple infections (31.72%). Conclusion These findings provide a basis for cervical cancer screening strategies, HPV vaccination promotion and individualized prevention of cervical cancer in this region.

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A case study on multidisciplinary support in comprehensive diagnosis and treatment of combined small cell lung cancer and exploration of MRD

LIU Chang, MENG Fanlu, YANG Jing, ZHANG Rongxin, WANG Junping, XIONG Jianhua, ZHONG Diansheng

2025, 53 (10): 1091-1097. doi: 10.11958/20251929

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Combined small cell lung cancer (C-SCLC) accounts for approximately 20% of all SCLC cases, while the propotion of C-SCLC mixed with squamous cell carcinoma component comprises less than 3%. At the pathological level, accurate diagnosis requires to distinguish it from other lung tumor types, and even rely on molecular testing. This article presents a case of a 67-year-old patient initially diagnosed with a peripheral lung tumor. The patient underwent comprehensive multidisciplinary management, including surgical resection, postoperative pathological differential diagnosis, chemotherapy, thoracic radiotherapy, brain metastasis, cranial radiotherapy, dynamic follow-up of imaging changes after cranial radiotherapy, and cranial surgery. Molecular residual disease (MRD) monitoring was integrated at critical time points during dynamic monitoring to inform personalized treatment decisions. The early MDT has brought the patient's condition under control, and the overall survival of the patient exceeded 30 months. Through the introduction of the diagnosis and treatment process of this patient, we aim to offer novel perspectives on clinical decision-making for C-SCLC.

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Advances in artificial intelligence for airway management of intubated patients

LI Jiarong, ZHU Xiaomin, ZHAO Xiaoyun

2025, 53 (10): 1098-1104. doi: 10.11958/20251687

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Airway management is a critical component of critical patient care. Although traditional methods of airway management are effective to some extent, they still face many challenges, such as difficult airways, delayed endotracheal intubation, endotracheal tube migration, unpredictable airway complications and failure to mechanical ventilation weaning. Artificial intelligence (AI), a technological tool with advanced algorithms, offers important innovations to improve the safety and efficiency of airway management with its multimodal data integration and real-time decision support capabilities. For example, AI can be used in areas such as real-time monitoring of patients' vital signs, dynamic adjustment of ventilator parameters, monitoring and assessment of airway complications, and assisted robotic tracheal intubation. In addition, AI is able to build predictive models based on big data to help reduce the risk of injury in mechanically ventilated patients and assist clinicians in making timely decisions. This paper reviews the research progress of AI in airway management and discusses issues of privacy and security, ethics, model performance and interpretability that may be faced during the use of AI, and looks forward to a more active role for AI in airway management in future.

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The mechanism and research progress of neutrophil extracellular traps on arteriosclerotic cardiovascular disease

JIN Jiachun, LU Caixia, WU Yanjun

2025, 53 (10): 1104-1109. doi: 10.11958/20252054

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Atherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of death worldwide, and its progression is closely related to the pathological effects of neutrophil extracellular traps (NETs). In atherosclerosis (AS), NETs aggravate the process of disease by promoting inflammatory response, inducing endothelial dysfunction, promoting thrombosis and other mechanisms. The components such as myeloperoxidase (MPO), neutrophil elastase (NE) and citrullinated histone H3 (CitH3) released by NETs can activate the immune inflammatory cascade, directly damage the vascular endothelium and promote thrombosis. In vascular inflammation, the formation of NETs is regulated by actin, and the released harmful molecules can induce endothelial cell apoptosis and drive the progress of inflammation through oxidative stress. The degradation and clearance of NETs depend on the action of enzymes such as deoxyribonuclease Ⅰ (DNase Ⅰ), and its regulatory mechanisms in atherosclerosis and vascular inflammation remain to be further studied. Based on the above mechanism, NETs-related markers have shown the potential as novel diagnostic and prognostic assessment biomarkers for ASCVD. This article aims to systematically elaborate the core pathological mechanism of NETs driving ASCVD through inflammatory activation, endothelial injury and thrombosis, providing a theoretical basis for targeted intervention.

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Research progress on the mechanism of low-density lipoprotein transendothelial transport

ZHAO Shuzhan, JIN Dongxia, LI Ximing, HAO Tianxu, LU Yibei

2025, 53 (10): 1110-1115. doi: 10.11958/20251034

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The transendothelial transport of low-density lipoprotein (LDL) and its subendothelial accumulation represent a central pathogenic mechanism in atherogenesis. This process involves a variety of receptors and molecular mechanisms that work together to regulate the transport of LDL in endothelial cells and its accumulation in blood vessel wall. In addition to receptor-mediated transport mechanisms, physiological and pathological factors such as hormones, inflammatory mediators and metabolites also play an important role in it. Recent studies have further elucidated the critical regulatory roles of these factors in LDL transendothelial transport, suggesting that targeting LDL transcytosis may represent an effective strategy for the prevention of early atherosclerosis and the treatment of related vascular diseases. This review summarizes recent advances in this field and discusses their potential clinical applications.

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Research progress of dendritic cell exosomes as vaccine carriers

XU Tong, ZHANG Wei, LIU Yonghui

2025, 53 (10): 1115-1120. doi: 10.11958/20252450

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Tumor vaccines face challenges such as low antigen delivery efficiency and significant side effects of carriers in stimulating specific anti-tumor immunity. Dendritic cell-derived exosomes (Dex), as endogenous nanovesicles, provide a new strategy for the development of novel vaccine carriers due to their excellent biocompatibility, targeted delivery capability and the ability to load intrinsic immune-active molecules. Dex can efficiently deliver tumor antigens, directly activate T, B and NK cells or indirectly promote antigen cross-presentation, and reshape the immune-suppressive microenvironment, thereby triggering a potent anti-tumor immune response. Studies have shown that Dex-based vaccines exhibit significant effects in inhibiting tumor growth and prolonging survival in models such as hepatocellular carcinoma and melanoma. This review summarizes the biological properties of Dex, its advantages as a vaccine carrier and the research progress in different tumor immunotherapies, aiming to provide references and ideas for further research on Dex in the field of vaccine carriers and to promote breakthroughs in its clinical application.

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