Tianjin Medical Journal

Tianjin expert consensus on the management of intestinal fecal microbiota transplantation (2025 edition)

Tianjin Digestive Quality Control Committee

2025, 53 (11): 1121-1130. doi: 10.11958/20252240

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Fecal microbiota transplantation (FMT) is a novel medical technology targeting gut microbiota for disease intervention. It offers innovative treatment strategies for various intestinal and extraintestinal refractory disorders, overcoming the therapeutic limitation of traditional therapies in certain diseases. Currently, FMT has established mature application systems in multiple regions of China, but its clinical practice within Tianjin area still needs to be standardized and managed. With the rapid advancement of FMT research, innovative strategies such as washed microbiota transplantation (WMT), donor-recipient precision matching and intelligent predictive assessment of efficacy have emerged, driving its in-depth development towards standardization and precision. Against this backdrop, in order to promote the application and development of FMT in this region, Tianjin Digestive Quality Control Committee organized experts to develop the “Tianjin Expert Consensus on the Management of Fecal Microbiota Transplantation” based on the 2022 and 2023 expert consensus standards and integrate the characteristics of regional medical practices. The consensus systematically addresses the management requirements for all aspects of FMT technology. It proposes 15 targeted recommendations from two dimensions: standardization of technical operations and innovative expansion of clinical applications. The goal is to provide scientific and standardized practical guidelines for promoting FMT diagnosis and treatment in Tianjin.

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The effect of LncRNA NNT-AS1 targeting miR-199a-5p on the proliferation, migration and invasion of oral squamous cell carcinoma cells

SHENG Lanlan, OU Xiaofei

2025, 53 (11): 1131-1137. doi: 10.11958/20251271

Abstract ( 63 )

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Objective To investigate the effect of long non-coding RNA (LncRNA) NNT-AS1 on proliferation, migration and invasion of oral squamous cell carcinoma (OSCC) cells by regulating microRNA (miR)-199a-5p. Methods CAL-27 cells were assigned into the control group, the sh-NC group, the sh-NNT-AS1 group, the sh-NNT-AS1+miR-In-NC group and the sh-NNT-AS1+miR-199a-5p-In group. The proliferation, colony formation, migration and invasion abilities of CAL-27 cells were detected by EdU method, clone formation, scratch healing and Transwell experiments. The expressions of LncRNA NNT-AS1 and miR-199a-5p in human keratinocyte cell line HaCaT, human OSCC cell line CAL-27 and each group of cells were detected by qRT-PCR experiment. Western blot experiments were performed to detect the expressions of epithelial-mesenchymal transition (EMT)-related proteins [E-cadherin, N-cadherin, Vimentin, and epidermal growth factor receptor (EGFR)]. The targeting relationship between LncRNA NNT-AS1 and miR-199a-5p was verified by dual luciferase reporter gene assay. Results Compared with HaCaT cells, the level of LncRNA NNT-AS1 was elevated in CAL-27 cells, while the level of miR-199a-5p was decreased (P<0.05). Compared with the control group and the sh-NC group, the EdU positive rate, colony formation rate, scratch healing rate, cell invasion number, expression levels of LncRNA NNT-AS1, N-cadherin, Vimentin and EGFR proteins were decreased in the sh-NNT-AS1 group, while the expression levels of miR-199a-5p and E-cadherin protein were increased (P<0.05). Compared with the sh-NNT-AS1 group and the sh-NNT-AS1+miR-In-NC group, the EdU positive rate, colony formation rate, scratch healing rate, cell invasion number, N-cadherin, Vimentin and EGFR protein expression levels were increased in the sh-NNT-AS1+miR-199a-5p-In group, while the expression levels of miR-199a-5p and E-cadherin protein were decreased (P<0.05). Compared with the miR-NC group, the relative luciferase activity of NNT-AS1-WT cells transfected with miR-199a-5p mimic was decreased (P<0.05). Conclusion LncRNA NNT-AS1 is highly expressed in OSCC. It can promote the proliferation, migration, invasion and EMT process of OSCC cells by negatively regulating miR-199a-5p.

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The mechanism of total flavonoids of Rhizoma drynariae improving lipid metabolism disorders in steroid-induced avascular necrosis of femoral head in rabbits

SU Yi, ZHOU Jinliang, DING Qiang

2025, 53 (11): 1138-1144. doi: 10.11958/20252085

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Objective To explore the mechanism of action of total flavonoids of Rhizoma drynariae (TFRD) in improving lipid metabolism disorders in rabbits with avascular necrosis of femoral head (SANFH) based on the peroxisome proliferator-activated receptor γ (PPARγ)/adenosine monophosphate-activated protein kinase (AMPK) pathway. Methods Sixty New Zealand rabbits were randomly divided into the control group (n=10) and the model group (n=50). The rabbit SANFH model was established by injecting Escherichia coli endotoxin and methylprednisolone. The control group was injected with the same amount of physiological saline. The SANFH model was randomly classified into five subgroups: the SANFH group, the TFRD-low group (30 mg/kg), the TFRD-medium group (60 mg/kg), the TFRD-high group (100 mg/kg) and the TFRD-high+inhibitor (TFRD 100 mg/kg + AMPK inhibiter 30 mg/kg) group, with 10 rabbits in each subgroup. After the intervention, venous blood sample was collected from the rabbit ear margin, and serum lipid levels [high-density lipoprotein cholesterol (HDL-C) and total cholesterol, triglycerides (TG)] were detected. Micro-CT was used to detect bone volume/total volume (BV/TV) (%) and trabecular quantity (Tb.N). Hematoxylin-eosin (HE) staining was used to observe histopathological changes of femur and calculate empty bone lacuna rate. TUNEL was used to detect apoptosis of femoral tissue. Real-time fluorescence quantitative reverse transcription polymerase chain reaction (qRT-PCR) was employed to analyze the expression of B-cell lymphoma/leukemia-2 (Bcl-2) and Bcl-2-related X protein (Bax) mRNA. Western blot assay was used to detect the expression of tissue-related proteins (PPARγ and p-AMPK/AMPK). Results Compared with the control group, HDL-C, BV/TV, Tb.N, Bcl-2 mRNAs, PPARγ and p-AMPK/AMPK were decreased in the SANFH group, and cholesterol, TG, apoptosis rate, empty bone lacuna rate and Bax mRNA were increased (P<0.05). Compared with the SANFH group, HDL-C, BV/TV, Tb.N, Bcl-2 mRNAs, PPARγ and p-AMPK/AMPK were increased in sequence in the TFRD-low group, the TFRD-medium group and the TFRD-high group, and cholesterol, TG, apoptosis rate, empty bone lacuna rate and Bax mRNA were decreased in turn (P<0.05). Compared with the TFRD-high group, changes in the above indicators were reversed in the TFRD-high+inhibitor group (P<0.05). Conclusion TFRD improves lipid metabolism disorder in SANFH rabbits by activating PPARγ/AMPK pathway.

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Analysis of microbial community composition of lower respiratory tract in patients with severe hospital-acquired pneumonia in critical care

ZHENG Tongtong, WANG Min, SHAN Qi, LI Minghang, BAI Yazhen, FU Qizhi

2025, 53 (11): 1145-1151. doi: 10.11958/20251448

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Objective To investigae microbial community structure of lower respiratory tract in severe hospital-acquired pneumonia (SHAP) patients in intensive care unit (ICU) using metagenomic next-generation sequencing (mNGS). Methods mNGS was performed on bronchoalveolar lavage fluid (BALF) of 84 patients with SHAP. Patients were grouped based on age, smoking status, underlying diseases and duration of artificial airway. The differences in α diversity, β diversity, microbial composition and community structure of airway microbiota were compared between different groups. The differential airway microbiota associated with artificial airway were screened, and microbial co-occurrence networks was constructed to observe the interaction in microorganisms. Results Results of α diversity analysis revealed that diversity and evenness of the microbial community were higher in young adults compared to those of middle-aged patients, while microbial diversity and evenness were significantly reduced in patients with comorbid stroke. In the group of artificial airway treatment, the diversity and uniformity of microorganisms decreased as the duration of artificial airway treatment increased. The diversity was the lowest when the artificial airway treatment lasted for more than 3 days. β diversity analysis confirmed that there were significant differences in the distinct microbial community structures between the >3 days support group and the non-intubated and ≤3 days support cohorts. Acinetobacter baumannii was dominant in all groups. The bacterial diversity was significantly higher in the middle-aged group, the non-smoking group, the group without artificial airway therapy, the group without diabetes mellitus, the group with artificial airway therapy ≥3 days and the group with chronic lung disease than those of other groups. In particular, pseudomonas aeruginosa, corynebacterium striatum and veillonella parvula were enriched in these groups. Difference analysis showed that there were significant differences in pseudomonas aeruginosa and corynebacterium striatum between the group with artificial airway treatment > 3 days, the group without artificial airway therapy and the group with artificial airway treatment ≤3 days. Network co-occurrence showed that there may be synergistic or antagonistic relationships between some microorganisms. Conclusion The microbial diversity of the lower respiratory tract in patients with SHAP significantly decreases in the elderly, those with concurrent stroke and those receiving artificial airway treatment. For these groups, rational use of antibiotics should be adopted to guide precise anti-infection treatment.

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The clinical value of NHR combined with MLR for predicting early rebleeding after endoscopic treatment in patients with cirrhosis complicated by acute esophageal-gastric variceal rupture and bleeding

LI Yan, JIAO Haitao, HUA Haiyang, LIU Wei, LIU Shuling, CAO Xinju, HAO Xin, WANG Aimin

2025, 53 (11): 1152-1157. doi: 10.11958/20251656

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Objective To evaluate the predictive value of neutrophil/high-density lipoprotein cholesterol ratio (NHR) combined with monocyte/lymphocyte ratio (MLR) for early rebleeding after endoscopic treatment in patients with cirrhosis complicated by acute esophagogastric variceal bleeding (AEVB). Methods A total of 228 patients with cirrhosis complicated by AEVB were included in this study. According to the occurrence of early rebleeding, patients were divided into the rebleeding group (96 cases) and the non-rebleeding group (132 cases). General information and laboratory indicators of both groups were collected, and the End-Stage Liver Disease (MELD) score, Child-Turcotte-Pugh (CTP) score, Fibrosis-4 (FIB-4) index, NHR, and MLR were calculated. Logistic regression analysis was used to identify the risk factors for early rebleeding in patients with cirrhosis complicated by AEVB. A nomogram model based on NHR and MLR was constructed to predict the risk of early rebleeding. The predictive performance and goodness of fit of the model were evaluated using receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test, Net Reclassification Index (NRI) and Integrated Discrimination Improvement (IDI). Results Compared with the non-rebleeding group, systolic blood pressure, platelet count (PLT), albumin/globulin ratio (A/G) and low-density lipoprotein cholesterol (LDL-C) were decreased in the rebleeding group, while total bile acids (TBA), aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBIL), activated partial thromboplastin time (APTT), thrombin time (TT), international normalized ratio (INR), Fibrosis-4 (FIB-4), NHR, MLR, MELD score and CTP score were increased (P<0.05). NHR was positively correlated with AST, TBIL and INR (P<0.05). MLR was negatively correlated with PLT, and positively correlated with AST, TBIL and FIB-4 (P<0.05). Logistic regression analysis results showed that prolonged TT, elevated NHR and MLR were independent risk factors for early rebleeding in patients with cirrhosis complicated by AEVB. The nomogram model based on NHR and MLR to predict early rebleeding had an area under the curve of 0.810 (95%CI: 0.754-0.866). The Hosmer-Lemeshow test suggested that the model fit well. IDI and NRI analyse showed that the combination of NHR and MLR had better predictive value for the early rebleeding than that of MELD score and CTP score. Conclusion NHR and MLR are effective indicators for predicting early rebleeding after endoscopic treatment in patients with cirrhosis complicated by AEVB. They are helpful in the early identification of high-risk patients and provide a reference for clinical intervention.

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Diagnostic efficacy of ultrasonic artificial intelligence combined with BRAF V600E gene testing in differentiating benign-malignant and invasive thyroid nodules

WU Menglin, MA Fang, YANG Yafei

2025, 53 (11): 1158-1164. doi: 10.11958/20252455

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Objective To investigate the application value of ultrasonic artificial intelligence (AI) combined with serine/threonine-protein kinase (BRAF) V600E gene testing in differentiating benign-malignant and invasive thyroid nodules. Methods A total of 150 patients with malignant thyroid nodules (the malignant group) and 150 patients with benign thyroid nodules (the benign group) were selected. According to whether the pathological diagnosis of the malignant group involved capsule, vascular, nerve invasion or lymph node metastasis, patients were divided into the invasive group (66 cases) and the non-invasive group (84 cases). General clinical characteristics, ultrasonic AI parameters and BRAF V600E gene testing results were compared between groups. Discrepancies between ultrasonic AI, BRAF V600E gene testing and postoperative pathological diagnoses were analyzed. ROC curves and Delong tests were usd to evaluate the diagnostic efficacy of ultrasonic AI, BRAF V600E gene and their joint inspection. Results The malignant group exhibited higher probabilities of nodule maximum diameter (>1 cm), solid structure, hypoechoic/very hypoechoic echogenicity, microcalcification, blurred margin, irregular shape, aspect ratio (>1), internal and mixed blood flow distribution and high blood flow richness (grades Ⅲ—Ⅴ) compared to those of the benign group (P<0.05). The invasive subgroup showed higher probabilities of nodule maximum diameter (>1 cm), solid structure, hypoechoic/very hypoechoic echogenicity, microcalcification, blurred margin, irregular shape, internal and mixed blood flow distribution, and high blood flow richness (grades Ⅲ—Ⅴ) than those of the non-invasive subgroup (P<0.05). For diagnosing malignant thyroid nodules, ultrasonic AI demonstrated a sensitivity of 90.00% and specificity of 80.67%. For invasive malignant nodules, sensitivity was 84.85% and specificity was 83.33%. BRAF V600E gene testing showed a sensitivity of 72.67%, specificity of 90.00% for malignant nodules. For invasive nodules, sensitivity was 74.24% and specificity was 88.10%. Receiver operating characteristic curve (ROC) analysis revealed that the AUCs (95% CI) for ultrasonic AI, BRAF V600E gene and their joint inspection in diagnosing malignant thyroid nodules were 0.853 (0.807-0.900), 0.813 (0.762-0.864) and 0.941 (0.917-0.966), with the joint inspection outperforming individual tests (P<0.05). For invasive malignant nodules, the AUCs were 0.841 (0.773-0.909), 0.812 (0.737-0.886) and 0.924 (0.880-0.967), respectively, with the joint inspection showing superior performance (P<0.05). Conclusion The joint inspection ultrasound AI with BRAF V600E gene significantly improve the diagnostic efficacy for differentiating benign and malignant thyroid nodules, and assessing their invasive potential.

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Correlation analysis of lipid metabolism index, serum γ -glutamyltranspeptidase and coronary heart disease complicated with coronary calcification

LI Xueqi, LI Shiguang, XU Enwen, ZHANG Ruilei, CHEN Pengli, ZHANG Qingbin

2025, 53 (11): 1165-1169. doi: 10.11958/20252178

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Objective To analyze the correlation between lipid metabolism indexes, serum gamma-glutamyl transpeptidyase (γ-GGT) and coronary heart disease (CHD) complicated with coronary artery calcification (CAC). Methods A total of 300 CHD patients admitted in this study were divided into the CAC group (n=193) and the non-CAC group (n=107). Clinical data of the two groups were compared, including high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG), Apolipoprotein A1 (Apo-A1), Apo-B (APO-B) and γ-GGT. The influencing factors of CAC were analyzed by multiple Logistic factors. And a nomogram prediction model was established. Results The basic data of the two groups were compared. Patients of the CAC group was older, had higher proportion of patients with hypertension and diabetes, had higher levels of LDL-C, TC, Apo-B and γ-GGT and lower level of Apo-A1 than those of the non-CAC group (P<0.05). The results of Logistic multivariate regression analysis showed that advanced age, combined history of diabetes, elevated LDL-C, TC, Apo-B and γ-GGT were risk factors of CHD complicated with CAC, while elevated Apo-A1 was the protective factor of CHD complicated with CAC (P<0.05). The AUC of the constructed nomogram model was 0.880 (95%CI:0.840-0.919), which showed good distinguishing ability. Conclusion CHD complicated with CAC is related to lipid metabolism and γ-GGT level. The nomogram model constructed based on influencing factors can be used for clinical early warning of CAC risk.

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Application effect of cluster management in peri-discharge period of patients with acute exacerbation of chronic obstructive pulmonary disease

XU Shuguang, GUAN Shuhong, ZHANG Yunfeng

2025, 53 (11): 1170-1175. doi: 10.11958/20252239

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Objective To investigate the application effect of cluster management in peri-discharge period of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Using random number table method, 90 patients with AECOPD were divided into the observation group (45 cases) and the control group (45 cases). All patients underwent active treatment after admission. During the peri-discharge period, the control group received routine management, while the observation group received cluster management based on internet chronic obstructive pulmonary disease (COPD) management platform. Both groups received 12 weeks of intervention. Comparisons were made between the two groups in terms of the degree of dyspnea [modified British Medical Research Council dyspnoea scale (mMRC) dyspnoea scale], pulmonary function [forced expiratory volume in the first second as a percentage of predicted value (FEV1%pred)], exercise endurance [6-minute walk test (6MWT)], management effect (frequency of emergency infusion or hospitalization due to moderate to severe acute exacerbation, frequency of multidisciplinary outpatient follow-up, compliance with regular home-based rehabilitation and proportions of smokers before and after intervention), and levels of laboratory indices [hemoglobin (Hb) and albumin (Alb)]. Results After intervention, mMRC score of the observation group decreased and was lower than that of the control group (P<0.05). The observation group showed an increase in FEV1%pred and 6 MWT distance, both of which were superior to those in the control group (P<0.05). The proportion of smokers and number of emergency infusions or hospitalization diagnosis and treatment due to moderate-severe acute exacerbation in the observation group were lower than those in the control group. The proportion of regular home-based rehabilitation and multidisciplinary outpatient follow-up visits were higher/more in the observation group than those in the control group (P<0.05). The levels of Hb and Alb in the observation group increased compared to those before intervention and were higher than those in the control group. Hb level in the control group decreased compared to that before intervention (P<0.05). Conclusion Implementing cluster management during the peri-discharge period of patients with AECOPD can effectively alleviate dyspnea, improve exercise endurance, reduce acute exacerbation risk and promote the development of healthy behaviors.

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Correlation between serum MIF, 25(OH)D and cognitive function in patients with vestibular migraine

JIN Xiao, WANG Yanhong, YANG Lianqi, ZHANG Dong, LI Yong, REN Zhihua, WANG Caihong

2025, 53 (11): 1175-1179. doi: 10.11958/20251691

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Objective To explore the correlation between serum macrophage migration inhibitory factor (MIF), 25-hydroxyvitamin D [25(OH)D] and cognitive function in patients with vestibular migraine (VM). Methods A total of 200 patients with VM were selected and used as the VM group. Based on the Montreal Cognitive Assessment (MoCA) criteria, patients were divided into the cognitively normal group (128 cases) and the cognitively impaired group (72 cases). Additionally, 200 healthy individuals undergoing routine health examination were selected as the control group. Serum MIF and 25(OH)D levels were measured using enzyme-linked immunosorbent assay. Multivariate Logistic regression was used to analyze influencing factors of cognitive impairment in VM patients. The value of serum MIF and 25(OH)D levels in diagnosing cognitive impairment in patients with VM was analyzed by using the receiver operating characteristic (ROC) curve. Results The serum MIF was higher in the VM group than that of the control group, and serum 25(OH)D was lower in the VM group (P<0.05). The serum MIF was higher in the cognitive impairment group than that of the cognitive normal group, while the serum 25(OH)D was lower in the cognitive impairment group than that of the cognitive normal group (P<0.05). Multivariate Logistic regression found that increased serum MIF level and decreased 25(OH)D level were independent risk factors for cognitive impairment in VM patients (P<0.05). ROC curve analysis showed that the AUC (95%CI) of the combined diagnosis of cognitive impairment in VM patients using serum MIF and 25(OH)D levels was 0.900 (0.850-0.938), which was higher than that of MIF diagnosed alone [0.797 (0.735-0.851)] and 25(OH)D alone [0.817 (0.756-0.868), P<0.05]. Conclusion VM patients with cognitive impairment have elevated serum MIF levels and decreased 25(OH)D levels. The combined diagnostic value of the two markers has a relatively high value for VM patients with cognitive impairment.

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Analysis of influencing factors of secondary coagulopathy in patients with severe acute pancreatitis and establishment of prediction model

ZHANG Yi, YU Hehua, XU Tianpeng

2025, 53 (11): 1180-1185. doi: 10.11958/20252150

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Objective To investigate the influencing factors of secondary coagulation dysfunction in patients with severe acute pancreatitis (SAP) and establish the prediction model. Methods A total of 298 SAP patients in our hospital from July 2021 to July 2024 were consecutively selected, and those with secondary coagulation dysfunction were included in the observation group, while those without secondary coagulation dysfunction were included in the control group. Multivariate Logistic regression analysis was employed to investigate the risk factors for secondary coagulation dysfunction in patients with SAP and to establish a multivariate joint prediction model. The receiver operating characteristic curve (ROC) and decision curve were used to evaluate the predictive value of the multivariate joint prediction model for secondary coagulation dysfunction in SAP patients. Results The incidence of secondary coagulation dysfunction in SAP patients was 32.21%. The activated partial thromboplastin time (APTT), prothrombin time (PT) and fibrinogen (FIB) were longer in the observation group than those in the control group (P < 0.05). Acute physiological and chronic health score Ⅱ (APACHEⅡ) score, sequential organ failure assessment (SOFA) score, D-dimer, C-reactive protein and albumin were independent influencing factors of secondary coagulation dysfunction in SAP patients (P < 0.05). The regression equation model was established according to the results of multivariate analysis screened variables, logit (P) =-24.747+0.363×APACHEⅡ score +0.952×SOFA score -0.449× albumin +1.768× D-dimer +1.004× C-reactive protein, with a good fit. Regression model predicted that the AUC value of secondary coagulation dysfunction in SAP patients was 0.937. Decision curve analysis results showed that the Logistic regression model could achieve the maximum clinical benefit when the threshold probability was in the range of 0.06 to 0.97. Conclusion A comprehensive assessment of influencing factors can comprehensively evaluate the condition of patients and identify patients at high risk of coagulation disorders at an early stage.

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The evaluate value of combined plasma ET-1 and NO levels in maternal and infant outcomes of patients with hypertensive disorders in pregnancy

WANG Lyu, LU Hong

2025, 53 (11): 1185-1190. doi: 10.11958/20252166

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Objective To explore the value of combined evaluation of plasma endothelin-1 (ET-1) and nitric oxide (NO) levels in maternal and infant outcomes of patients with hypertensive disorders of pregnancy (HDP). Methods A total of 228 patients with HDP were selected. The levels of plasma ET-1 and NO in all patients were detected, and adverse maternal outcomes and adverse neonatal outcomes were statistically analyzed. The receiver operating characteristic (ROC) curve was drawn to analyze the evaluation value of plasma ET-1 and NO levels for outcomes of parturients and neonates. The influencing factors of adverse outcomes in parturients and neonates of patients with HDP were analyzed through multivariate Logistic regression, and the importance ranking of the influencing factors was visualized. Results The incidence of adverse outcomes in parturients of HDP patients was 22.4%, and the incidence of adverse outcomes in neonates was 30.3%. The plasma ET-1 levels of HDP patients with adverse maternal outcomes and adverse neonatal outcomes were higher than those with normal outcomes, and NO levels were lower than those with normal outcomes (P<0.05). The area under the receiver operating characteristic curve (AUC) for the combined prediction of adverse maternal outcomes using plasma ET-1 and NO levels was 0.819 (95%CI：0.763-0.867), while the AUC for predicting adverse neonatal outcomes reached 0.855 (95%CI：0.803-0.898). Advanced maternal age, preeclampsia, severe proteinuri and elevated ET-1 levels were identified as independent risk factors for adverse outcomes in parturients and neonatal of HDP patients. The elevated NO levels demonstrated a protective effect, serving as an independent protective factor (P<0.05). The top 5 factors in terms of the importance of each factor for adverse maternal outcomes were ET-1, NO, age, degree of proteinuria and disease type in sequence. The top 5 factors in terms of the importance of each factor for adverse neonatal outcome were NO, ET-1, age, disease type and degree of proteinuria in sequence. Conclusion The combination of ET-1 and NO has a high evaluation value for the adverse outcomes of parturients and neonates in patients with HDP.

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The efficacy analysis of arthroscopic reduction combined with percutaneous screw technique in the treatment of Sanders type Ⅱ and type Ⅲ calcaneal fractures

SONG Kang, DONG Yu, DAI Yongwen, ZHAO Deyuan, SONG Tienan, SONG Bo, XU Gang

2025, 53 (11): 1191-1196. doi: 10.11958/20252115

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Objective To explore the efficacy of arthroscopic reduction combined with percutaneous screw fixation in the treatment of Sanders types Ⅱ and Ⅲ calcaneal fractures. Methods Forty-eight patients with Sanders types Ⅱ and Ⅲ calcaneal fractures were divided into the arthroscopic reduction combined with percutaneous screw fixation (arthroscopy) group (n=23) and the tarsal sinus approach open reduction combined with screw internal fixation (tarsal sinus approach) group (n=25) according to different surgical methods and plans. The operative time, incision length, postoperative complications and secondary removal of internal fixation were compared between the two groups. Changes in B?hler’s angle and Gissane’s angle were evaluated and compared between the two groups at 3 months, 6 months after operation and at the last follow-up. Additionally, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and the visual analog scale (VAS) for pain were used to assess outcomes at the last follow-up. Results Compared with the tarsal sinus approach group, the incision length was reduced, the operation time was prolonged and the incidence of complications was decreased in the arthroscopic group (P<0.05). At 3 months, 6 months after the operation and the last follow-up, there were no significant differences in the B?hler Angle, Gissanes Angle, AOFAS and VAS scores between the arthroscopic group and the tarsal sinus approach group (P>0.05). Conclusion Both groups of regimens can enable patients to achieve good postoperative therapeutic efficacy. However, under arthroscopic assistance, surgical incisions inherently possess minimally invasive advantages, while the incidence of postoperative complications is lower compared to the sinus tarsi approach.

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The effect of BOLD combined with mDixon Quant in quantitatively evaluating the early renal oxygen metabolism and iron deposition in patients with type 2 diabetes

REN Yu, LI Huiyu, MA Yajie, ZHANG Yuling, JI Qian

2025, 53 (11): 1197-1203. doi: 10.11958/20251550

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Objective To assess renal oxygen metabolism and iron deposition in type 2 diabetes mellitus (T2DM) patients using a combination of blood oxygen level-dependent (BOLD) and mDixon Quant techniques. Methods Clinical data of 58 T2DM patients from Tianjin First Central Hospital (September 2022-December 2023) were prospectively collected. According to urinary albumin-to-creation ratio (ACR), patients were divided into the normal albuminuria (NAU, ACR<30 mg/g, n=35) group and the microalbuminuria (MAU, 30 mg/g≤ACR<300 mg/g, n=23) group. Thirty-three healthy volunteers were included as the control group during the same period. All participants underwent renal BOLD and mDixon Quant MRI to obtain cortical and medullary apparent relaxation rate (R2^*) values. The differences of general data and image parameter values were compared between groups. Receiver operating characteristic (ROC) curves were used to analyze the diagnostic efficacy of relevant parameters for early renal function changes. Results There were significant differences in body weight, estimated glomerular filtration rate (eGFR) and ACR between the control group, the NAU group and the MAU group (P<0.01). The R2^* value in renal cortex was lower than that in renal medulla (P<0.01) in the same group. Apart from R2^* value of BOLD renal cortex, which showed no significant difference between the three groups (P<0.05)，and the differences in the other parameters were statistically significant (P < 0.05). When distinguishing between the control group and the NAU group, the NAU group and the MAU group, as well as between the control group and the early-stage T2DM (NAU+MAU) group, the combined two-sequence approach demonstrated higher area under the curve (AUCs) than any single sequence alone, with AUC value of 0.892 (95%CI: 0.809-0.975), 0.785 (95%CI: 0.666-0.904) and 0.841 (95%CI: 0.756-0.926), respectively. Conclusion The combination of BOLD imaging with mDixon Quant enables noninvasive and quantitative assessment of alterations in renal oxygen metabolism and iron content in early-stage T2DM patients. The diagnostic performance of this combined approach surpasses that of individual methods.

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Dosimetric comparison of two irradiation modes after radical mastectomy for breast cancer

HUANG Xiaoqing, LIU Yuanyuan, YAN Liang, YI Shuping

2025, 53 (11): 1204-1207. doi: 10.11958/20252154

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Objective To compare the dosimetric differences between volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) in the irradiation of chest wall and upper and lower clavicle regions after radical mastectomy for breast cancer. Methods A total of 100 patients who were scheduled to receive radiotherapy after radical mastectomy were included and selected as research subjects. Patients were divided into the VMAT group and the IMRT group by random number table method, with 50 cases in each group. The target dose parameters, exposure dose of organs at risk, monitor unit (MU) and treatment time were compared between the two groups. Results There were no statistical differences in V₉₅ and V₁₁₀ between the VMAT group and the IMRT group (P>0.05). The D_2% in the VMAT group was lower than that of the IMRT group, while D_98% and D_50% were higher in the VMAT group than those in the IMRT group (P<0.05). Target area uniformity and target area conformity were better in the VMAT group than those in the IMRT group (P<0.05). There were no significant differences in mean cardiac dose (D_mean) and ipsilateral lung V₅ and V₁₀ between the VMAT group and the IMRT group (P>0.05). The heart V₂₀ and V₃₀, contralateral lung D_mean, maximum spinal cord dose (D_max), contralateral breast D_mean, ipsilateral lung D_mean, V₂₀, V₃₀ and mean MU were lower in the VMAT group than those in the IMRT group, and the treatment time was shorter than that in the IMRT group (P<0.05). Conclusion In the irradiation treatment of chest wall and upper and lower clavicle regions after radical mastectomy, VMAT demonstrates superior dosimetric characteristics and higher treatment efficiency compared with IMRT, particularly in terms of target area uniformity, target area conformity and exposure doses to organs at risk.

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Occurrence risk establishment of predictive mode of surgically induced astigmatism in elderly patients with diabetic cataract

LIU Yan, SUN Hong, SUN Jingwen

2025, 53 (11): 1208-1213. doi: 10.11958/20251200

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Objective To construct and verify the risk profile model of surgically induced astigmatism (SIA) in elderly patients with diabetic catarac. Methods A total of 309 patients admitted to our hospital for phacoemulsification were selected as the study objects. Patients were divided into the SIA group (n=158) and the non-SIA group (n=151) according to whether SIA occurred after surgery. Multivariate Logistic regression analysis was used to analyze the factors influencing the occurrence of SIA in diabetic cataract patients, and the nomogram model of SIA in diabetic cataract patients was constructed. ROC curve, calibration curve and decision curve were used for evaluation and verification of the model. Results The patient age and the lens nucleus hardness level Ⅲ-Ⅳ, incision size ≥3.00 mm, incision shape as trapezoidal transparent corneal incision, corneal incision length ≥1.75 mm and horizontal diameter of the cornea were significantly higher in the SIA group than of the non-SIA group (P<0.05). There were no significant differences in gender, body mass index (BMI), duration of diabetes, history of hypertension, history of cardiovascular disease, grading of diabetic retinopathy, axial length, anterior chamber depth, central corneal thickness, total corneal refractive power, astigmatism axis position and ultrasound phacoemulsification time between the two groups of patients (P>0.05). Multivariate Logistic regression results showed that incision size, incision shape, corneal incision length and corneal horizontal diameter were the factors affecting the occurrence of SIA in diabetic cataract patients (P<0.05). The R software was used to incorporate four influencing factors to generate a nomogram model that could be used to predict the occurrence of SIA in diabetic cataract patients. ROC curve analysis results showed that the area under the curve (AUC) value of this histogram to predict SIA in diabetic cataract patients was 0.810 (95%CI=0.761-0.860). Hosmer-Lemeshow test and calibration curve analysis showed that the model fit well (χ²=11.142, P=0.194). The results of decision curve analysis showed that when the probability of high risk threshold 0.35-0.8, the clinical net benefit rate of the column graph model was greater than 0. Conclusion Incision size, incision shape, corneal incision length and corneal horizontal diameter are influential factors for the occurrence of SIA in patients with diabetic cataract. Based on the above influential factors, the columniogram model for predicting the occurrence risk of SIA in patients with diabetic cataract has good differentiation, accuracy and clinical applicability.

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Clinical observation of Bushenqiangji decoction combined with adalimumab in patients with ankylosing spondylitis

ZHANG Yong, ZHANG Zhonghui, YANG Qing, CHEN Tianlong

2025, 53 (11): 1214-1218. doi: 10.11958/20241020

Abstract ( 36 )

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Objective To explore the clinical effect of Busshenqiangji decoction combined with adalimumab (Adam) in patients with ankylosing spondylitis. Methods A total of 114 patients with ankylosing spondylitis were included and randomly divided into the Adam group and the combined group, with 57 cases in each group. Patients in the Adam group were given adalimumab by subcutaneous injection, 40mg/ time, once every other week. Patients in the combined group were treated with Bushenqiangji decoction (1 dose/day) on the basis of the above, and both groups were treated continuously for 12 weeks. The efficacy, Traditional Chinese Medicine (TCM) syndrome score, spinal function, clinical index, serological index and adverse reactions were evaluated between the two groups. Results The total effective rate was 92.98% (53/57) in the combination group, which was higher than that of the Adam group ( 75.44%, 43/57, P<0.05). After treatment, the total score of TCM syndromes, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Andylosing Spondylitis Function Index (BASFI) scores were decreased in the combination group, and which were lower than those of the adalimumab group (P<0.05). After treatment, the finger-to-floor distance and occipital bone-to-wall distance were decreased in the combination group, and which were smaller than those in the Adam group (P<0.05). The chest range of motion increased, and which was greater than that in the Adam group (P<0.05). After treatment, serum levels of sclerostin and 25 hydroxyvitamin D were significantly increased in the combination group than those in the Adam group (P<0.05). There were no significant differences in the total incidence rates of adverse reactions, such as skin rash and gastrointestinal reactions between the two groups [10.53% (6/57) vs. 14.04% (8/57), P>0.05]. Conclusion Bushenqiangji decoction combined with adalimumab can play a synergistic role in the treatment of patients with ankylosing spondylitis, significantly improving the symptoms of pain and morning stiffness. The mechanism of action may be related to improving the expression of osteosclerosis protein and the increase of 25-hydroxyvitamin D.

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A case of frequent premature atrial complexes secondary to aortic compression of the right atrium

ZHANG Enyuan, HE Le, ZHANG He’nan, LU Fengmin

2025, 53 (11): 1219-1222. doi: 10.11958/20251486

Abstract ( 45 )

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A 78-year-old male patient presented with significant dilation of the non-coronary sinus of the aorta, which compressed the right atrium and formed a local low-voltage area, resulting in frequent polymorphic atrial premature beats (24-hour load 40.9%). Through dual-chamber combined activation mapping, the target point (right atrial appendage - tricuspid valve annulus junction) was locked. After radiofrequency ablation, atrial premature beats disappeared, and there was no recurrence during the follow-up period of six months. Currently, there are many causes of atrial arrhythmias related to atrial compression, but it is extremely rare for the right atrium to be involved and cause isolated frequent atrial premature beats. Treatment should be individualized, choosing either interventional or surgical methods, and emphasizing the interpretation of anatomical-electrical correlations using multimodal imaging (ultrasound, CT angiography, three-dimensional electroanatomical system).

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Research progress of biological functions of miR-101-3p in cardiovascular diseases

PANG Zhihua, LIU Limei, YAO Zhuhua

2025, 53 (11): 1223-1228. doi: 10.11958/20252447

Abstract ( 46 )

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miR-101-3p is an evolutionarily conserved non-coding RNA that has shown aberrant expression and regulatory functios in various cardiovascular diseases (CVDs) in recent years. It participates in key pathological processes including post-infarction myocardial remodeling, myocardial fibrosis in heart failure and the development of atherosclerosis by modulating pathways such as apoptosis, autophagy and metabolism. In addition, it exhibits immunoregulatory potential in myocardium injury related to systemic diseases. This review summarizes the recent advances in understanding the role of miR-101-3p in CVDs, focusing on its expression dynamics and regulatory mechanisms in different disease models. It further elaborates on the biological effects of miR-101-3p in cardiovascular pathology and explores its potential as a diagnostic biomarker and therapeutic target. miR-101-3p is expected to provide novel insights for early detection and targeted intervention of cardiovascular diseases.

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Application of transcranial electrical stimulation in psychiatry and the progress of clinical research

MENG Lin, WU Shiqi, WU Zhen, DONG Yueqing

2025, 53 (11): 1228-1232. doi: 10.11958/20252538

Abstract ( 54 )

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Transcranial electrical stimulation (tES) is a process, in which a specific pattern of low-intensity electrical currents is applied to the cerebral cortex through a combination of electrode sheets placed on the surface of scalp, modulating neural activity and corresponding human behaviors. In recent years, its application in the field of psychiatry has been gradually increasing. This paper reviews the clinical applications and latest research progress of tES technology in schizophrenia, depressive disorders, bipolar disorder, obsessive-compulsive disorder and sleep disorders, aiming to provide references for its application and further research in the field of psychiatric practice.

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