Tianjin Medical Journal

Let-7b inhibits the development of AML through inducing repolarization of leukemia-associated macrophages

JIANG Tianyou, LI Min, SUN Biwen, LI Yueyang, XING Lijing, TIAN Chen

2026, 54 (3): 225-231. doi: 10.11958/20252591

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Objective To study the mechanism of let-7b regulating acute myeloid leukemia (AML) by leukemia-associated macrophages (LAMs). Methods Bone marrow cells were collected from AML patients prior to any treatment and cryopreserved. Patients subsequently received induction chemotherapy with the "DA 3+7" regimen, and therapeutic responses were evaluated post-treatment. According to the efficacy assessment results, patients were stratified into two groups: the complete remission (CR) group and the non-complete remission (refractory) group. AML blasts of pre-cryopreserved patients were then respectively transplanted into NOD/SCID mice to establish AML xenograft mouse model corresponding to the CR group and the refractory group. After miRNA sequencing and polymerase chain reaction (PCR) verification, let-7b was selected as the target gene to investigate its role in MLL-AF9-induced AML. Transfection of LAMs in MLL-AF9-induced AML mice with let-7b shRNA or scramble control was validated by quantitative real-time PCR (RT-qPCR), Western blot assay and enzyme-linked immunosorbent assay (ELISA) in vitro and in vivo experiments. Results Compared with the AML CR group, the apoptosis rate of LAM cells was lower in the AML refractory group. Furthermore, let‐7b was a potentially aberrant gene in LAMs contributing to M2‐subtype characteristics. Knockdown of let‐7b in LAMs could inhibit the development of AML by repolarizing LAMs toward M1‐subtype characteristics through the activation of Toll‐like receptor and NF‐κB pathway. The results of in vivo experiments showed that knockdown of let-7b in LAMs inhibited the proliferation of leukemia cells and decreased infiltration into spleen, thereby inhibiting the progression of AML. Conclusion Let-7b interference in LAMs can activate Toll-like receptors (TLRs) and NF?κB pathway, promote the repolarization of LAMs to M1 macrophages, thereby inhibiting the development of AML.

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MiR-181a-5p regulates the proliferation and apoptosis of glomerular mesangial cells in lupus nephritis mice through HMGB1/NF-κB signaling pathway

YANG Xiaofang, JIA Xinyan, FENG Wenjun

2026, 54 (3): 232-237. doi: 10.11958/20253169

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Objective To explore the regulatory mechanism of microRNA (miR)-181a-5p on the proliferation and apoptosis of glomerular mesangial cells in mice with lupus nephritis (LN) through the high mobility group protein box 1 (HMGB1)/nuclear factor kappa B (NF-κB) signaling pathway. Methods LN mouse mesangial cells were isolated and cultured in vitro, and divided into the blank group, the mimics-NC group, the miR-181a-5p mimics group, the Si-NC group, the Si-HMGB1 group (transfected with Si-HMGB1), the mimics-NC+pcDNA-NC group, the miR-181a-5p mimics+pcDNA-NC group, the mimics-NC+pcDNA-HMGB1 group and the miR-181a-5p mimics+pcDNA-HMGB1 group. MRL/MPJ mouse mesangial cells were isolated and cultured in vitro as the control group. qRT-PCR method was implemented to measure the mRNA expression levels of miR-181a-5p and HMGB1 in cells. Dual-luciferase experiments were performed to verify the targeting relationship of miR-181a-5p to HMGB1. CCK-8 method and flow cytometry were implemented to measure cell proliferation and apoptosis, respectively. Western blot assay was performed to measure the protein expression levels of HMGB1, human inhibitor of nuclear factor κB-α (IκB-α) and NF-κB p65 in cells. Results There was a targeting relationship between miR-181a-5p and HMGB1. Compared with the control group, the cell proliferation rate, HMGB1 and NF-κB p65 protein expression were obviously increased in the blank group, and the miR-181a-5p and IκB-α expression were obviously decreased (P<0.05). Compared with the mimics-NC group, the cell proliferation rate, HMGB1 and NF-κB p65 protein expression were obviously decreased in the miR-181a-5p mimics group, and the miR-181a-5p and IκB-α expression were obviously increased (P<0.05). Compared with the Si-NC group, the cell proliferation rate, HMGB1 and NF-κB p65 protein expression were obviously decreased in the Si-HMGB1 group, and the IκB-α expression was obviously increased (P<0.05). The overexpression of HMGB1 was able to reverse the inhibitory effect of up-regulated miR-181a-5p on the excessive proliferation of glomerular mesangial cells in LN mice (P<0.05). Conclusion Overexpression of miR-181a-5p can inhibit the excessive proliferation of glomerular mesangial cells in LN mice, which may be related to the inhibition of HMGB1/NF-κB signaling pathway.

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Protective effect and mechanism of dual-specificity phosphatase 9 on myocardial injury in mice with type 2 diabetic cardiomyopathy

ZHANG Jing, WEI Yuying, NING Haihong, WEI Hongmei, WANG Jiawei, CAO Wei, WU Bin

2026, 54 (3): 238-244. doi: 10.11958/20253111

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Objective To investigate the protective effect and underlying mechanism of dual-specificity phosphatase 9 (DUSP9) on myocardial injury in mice with type 2 diabetic cardiomyopathy (DCM). Methods A mouse model of type 2 diabetes was established using a high-fat, high-sugar diet combined with intraperitoneal injection of streptozotocin (STZ). After successful modeling, the mice were randomly divided into the control group (control), the diabetes mellitus (DM) group, the diabetes + empty vector (DM+Vector) group and the diabetes + DUSP9 overexpression (DM+DUSP9) group. Following a 12-week intervention via tail vein injection of AAV9-DUSP9 or empty viral vector, cardiac function was assessed by echocardiography. The body weight, fasting blood glucose and heart mass ratio were detected in mice of each group. Heart tissue samples were collected for histological examination using HE and WGA staining to observe myocardial pathological changes. The levels of inflammatory cytokines IL-6 and TNF-α in myocardial tissue were measured by ELISA. Myocardial cell apoptosis was detected by TUNEL assay. The phosphorylation levels of ERK and p38 proteins were evaluated by Western blot assay. Mitochondrial morphological changes were observed via transmission electron microscopy. Results Compared with the control group, significantly increased heart weight, heart-to-body weight ratio, cardiomyocyte cross-sectional area, levels of IL-6 and TNF-α in myocardial tissue, myocardial cell apoptosis rate and expressions of p-ERK and p-p38 in myocardial tissue were observed in the DM group and the DM+Vector group, and left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were significantly decreased (P < 0.05). Compared with the DM+Vector group, the DM+DUSP9 group exhibited significantly decreased heart weight, heart-to-body weight ratio, cardiomyocyte cross-sectional area, levels of IL-6 and TNF-α, myocardial cell apoptosis rate and expressions of p-ERK and p-p38, while LVEF and LVFS were significantly increased (P < 0.05). Conclusion DUSP9 overexpression improves cardiac function in diabetic mice. The mechanism may be related to the inhibition of ERK and p38 phosphorylation by DUSP9, thereby alleviating myocardial inflammation, apoptosis and mitochondrial damage in diabetic cardiomyopathy mice.

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The predictive value of lipoprotein-associated phospholipase A2 combined with the total burden of MRI scores on cognitive impairment in patients with cerebral small vessel disease

REN Baolong, JIAO Aiju, ZHU Ruolan, ZHAO Weijing

2026, 54 (3): 245-248. doi: 10.11958/20252966

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Objective To investigate the predictive value of lipoprotein-associated phospholipase A2 (Lp-PLA2) combined with the total burden of magnetic resonance imaging (MRI) scores on cognitive impairment in patients with cerebral small vessel disease (CSVD). Methods A total of 178 CSVD patients admitted to Gansu Wuwei Tumour Hospital (Gansu Province Wuwei Academy of Medical Sciences) from January 2023 to June 2024 were divided into the normal cognition group (n= 89, MoCA≥26) and the cognitive impairment group (n=89, MoCA<26 points). The CSVD total burden of MRI scores was evaluated by 3.0T MRI. The baseline data, Lp-PLA2 level and the total burden of MRI scores were compared between the two groups. Logistic regression was applied to analyze influencing factors of cognitive impairment in CSVD patients. The predictive value of Lp-PLA2 level combined with the total burden of MRI scores on cognitive impairment in CSVD patients were analyzed by receiver operating characteristic (ROC) curve. Results Compared with the normal cognition group, Lp-PLA2 levels, the total burden of MRI scores and IL-6 were significantly increased in the cognitive impairment group (P<0.05). Results of multivariate Logistic regression analysis showed that increased Lp-PLA2 and the total burden of MRI scores were risk factors for cognitive impairment in patients with CSVD (P<0.05). The area under curve (AUC) of Lp-PLA2 levels combined with the total burden of MRI scores for predicting cognitive impairment in patients with CSVD was 0.905 (95%CI：0.861-0.948), the sensitivity was 86.5% and the specificity was 79.8%. Conclusion Lp-PLA2 levels and the total burden of MRI scores are increased in patients with cognitive impairment, and the combination of both can serve as an early predictor of cognitive impairment in patients with CSVD.

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Development of a predictive model for colorectal polyp recurrence risk based on polyp characteristics and serum indicators

LI Bin, TAN Zhengang, ZHANG Huaqing

2026, 54 (3): 249-253. doi: 10.11958/20252207

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Objective To develop a recurrence risk prediction model for colorectal polyps based on polyp characteristics and serological indicators, aiming to improve early recognition of colorectal polyp recurrence and personalized treatment. Methods A retrospective analysis was conducted on clinical data from 235 patients who underwent colorectal polyp resection. Based on whether recurrence occurred, the patients were divided into the recurrence group (56 cases) and the non-recurrence group (179 cases). Clinical data, polyp characteristics and related serological indicators were collected. Logistic regression analysis was used to identify independent predictors for colorectal polyp recurrence. Based on the results of Logistic regression, a nomogram model for predicting colorectal polyp recurrence risk was constructed, and the model’s predictive performance was evaluated using ROC and calibration curves. Results Compared with the non-recurrence group, the recurrence group had higher age, male proportion, body mass index (BMI), family history proportion, polyp size, proportion of adenomatous polyps, proportion of high-grade lesions, and elevated serum levels of carcinoembryonic antigen (CEA) and C-reactive protein (CRP) (P < 0.05). Logistic regression analysis showed that age (OR = 1.032, 95%CI: 1.003-1.062), BMI (OR = 1.064, 95%CI: 1.000-1.131), family history (OR = 2.34, 95%CI: 1.039-5.267), high-grade pathological lesions (OR = 6.323, 95%CI: 2.184-18.430), polyp size (OR = 3.161, 95%CI: 1.434-6.965), CEA (OR = 1.486, 95%CI: 1.160-1.904), and CRP (OR = 1.132, 95%CI: 1.022-1.254) were important predictors for colorectal polyp recurrence. Based on these factors, a nomogram model for predicting colorectal polyp recurrence risk was constructed. Model evaluation showed that the nomogram had an area under the curve (AUC) of 0.893 (95%CI: 0.836-0.950), sensitivity of 81.6%, specificity of 87.5%, and good discrimination and calibration (Hosmer-Lemeshow χ² = 2.396, P = 0.743). Conclusion The recurrence risk prediction model based on polyp characteristics and serological indicators developed in this study has high predictive efficacy and can effectively assess the risk of colorectal polyp recurrence.

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Effect of photodynamic therapy combined with supramolecular salicylic acid on patients with moderate to severe acne

SONG Tiejun, LIN Ningning, YANG Yueyi, WANG Yafei

2026, 54 (3): 254-258. doi: 10.11958/20252842

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Objective To investigate the effect of photodynamic therapy (PDT) combined with supramolecular salicylic acid on skin physiological parameters and serum levels of interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α) in patients with moderate to severe acne. Methods Two hundred patients with moderate to severe acne were selected and randomly divided into the observation group (treated with PDT combined with supramolecular salicylic acid, n=100) and the control group (treated with PDT alone, n=100) according to the random number table method. The clinical efficacy, lesion scores, skin physiological indicators, IFN-γ, TNF-α levels and adverse reactions were compared between the two groups. Results The total effective rate was higher in the observation group than that of the control group (95.0% vs. 86.0%，P<0.05). After treatment, the lesion scores of comedones, papules, pustules, cysts, total lesion scores, skin oil content and serum TNF-α levels were lower in the observation group than those of the control group, while the skin water content, pH value and serum IFN-γ levels were higher in the observation group than those of the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (11.0% vs. 12.0%，P>0.05). Conclusion PDT combined with supramolecular salicylic acid is effective in the treatment of moderate to severe acne. It can effectively improve the condition of skin lesions and skin physiological indicators, regulate serum levels of inflammatory factors, and has good safety.

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Analysis of risk factors and predictive value of delirium occurrence after laparoscopic radical gastrectomy under general anesthesia

ZHAO Li, MA Xiuli, LIU Yi, ZHU Yi

2026, 54 (3): 259-264. doi: 10.11958/20253057

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Objective To investigate the independent risk factors for postoperative delirium (POD) in patients undergoing laparoscopic radical gastrectomy under general anesthesia, and to construct a multifactorial combined prediction model to evaluate its diagnostic performance. Methods A total of 310 patients who underwent laparoscopic radical gastrectomy under general anesthesia were consecutively enrolled and divided into the POD group (n=78) and the non-POD group (n=232) according to whether POD occurred. Univariate analysis and multivariate Logistic regression analysis were used to screen for factors influencing POD. Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of each factor, and the area under the curve (AUC) was calculated. The predictive performance of the multifactorial combined model was also compared and assessed. Results Compared with the non-POD group, patients in the POD group were older, had higher CO₂ pneumoperitoneum pressure, higher incidence of intraoperative hypoxemia and hypotension, higher proportion of sleep disturbance, higher proportion of excessively deep anesthesia and lower hemoglobin levels (all P<0.05). Multivariate Logistic regression analysis showed that advanced age (OR=1.112, 95%CI: 1.040-1.188), excessively high CO₂ pneumoperitoneum pressure (OR=10.967, 95%CI: 4.580-16.260), intraoperative hypoxemia (OR=15.243, 95%CI: 5.564-20.676), intraoperative hypotension (OR=12.481, 95%CI: 2.812-25.388), sleep disturbance (OR =8.166, 95%CI: 2.530-26.352) and excessively deep anesthesia (OR =3.320, 95%CI: 1.135-9.645) were independent risk factors for POD, whereas higher hemoglobin level was a protective factor (OR =0.738, 95%CI: 0.652-0.834) (all P<0.05). According to the characteristics of these seven factors, patients were categorized into three groups: baseline physiological factors (age + hemoglobin), intraoperative physiological abnormalities (intraoperative hypoxemia + intraoperative hypotension+ CO₂ pneumoperitoneum pressure) and intervention-related factors (excessively deep anesthesia + sleep disturbance). The diagnostic performance ranked as follows: intraoperative physiological abnormalities (AUC=0.945, 95%CI: 0.908-0.968), baseline physiological factors (AUC=0.892, 95%CI: 0.838-0.926) and intervention-related factors (AUC=0.769, 95%CI: 0.713-0.838). Conclusion Stratified assessment of risk factors based on POD is helpful for the early identification of POD and provides evidence-based guidance for clinical interventions.

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Comparison of anesthetic effect and safety of two nerve block methods under ultrasound guidance in laparoscopic total hysterectomy

LI Jia, ZHAO Moju, YANG Huiru, GAO Lifeng, GAO Yue, LI Kan, GUO Suna, SHEN Jianjun

2026, 54 (3): 264-268. doi: 10.11958/20253133

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Objective To compare the efficacy and safety of ultrasound-guided anterolateral lumbar flexus block over the arcuate ligament with transversus abdominis plane block (TAPB) for anesthesia in laparoscopic total hysterectomy. Methods A total of 120 patients who underwent laparoscopic total hysterectomy at our hospital between October 2020 and October 2023 were selected and randomly assigned to two groups using a random number table. The control group underwent TAPB under ultrasound guidance preoperatively, while the observation group received bilateral pre-quadratus lumborum block over the arcuate ligament under ultrasound guidance. Both groups received patient-controlled intravenous analgesia (PCIA) postoperatively. The following parameters were compared between the two groups, including hemodynamic status, intraoperative remifentanil consumption, intraoperative propofol consumption, stress response, visual analog scale (VAS) scores, analgesic efficacy and postoperative recovery indicators. Results The heart rate and mean arterial pressure at intubation (T1) and extubation (T2) were higher in both groups than those at admission (T0), and those were lower in the observation group than the control group (P<0.05). The dosage of remifentanil was less during surgery in the observation group than those of the control group, while there was no significant difference in propofol usage between the two groups (P>0.05). At the end of surgery and 24 hours postoperatively, levels of epinephrine (AE), dopamine (DA) and norepinephrine (NE) were elevated in both groups compared to preoperative levels. However, these levels were lower in the observation group than those in the control group at both time points (P<0.05). The VAS scores of pain at rest and during exercise at 6, 12, 24 and 48 hours after surgery were lower in the observation group than those in the control group. The number of compressions of the analgesic pump, the rate of remedial analgesia, the time to get out of bed and move around, and the time to first exhaust were less in the observation group than those in the control group (P<0.05). Conclusion Ultrasound-guided anterolateral block of the superior lumbar quadratus muscle over the arcuate ligament for use in laparoscopic total hysterectomy can stabilize haemodynamics, reduce body stress response and provide good analgesia.

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The clinical significance of serum LXA4 and KLF5 expression in children with Mycoplasma Pneumoniae pneumonia

ZHANG Runchun, LI Shuhua, WANG Yuzhen, WANG Qiaowen

2026, 54 (3): 269-274. doi: 10.11958/20252960

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Objective To discuss the expression and clinical significance of serum lipoxin A4 (LXA4) and Kruppel-like factor 5 (KLF5) in children with Mycoplasma Pneumoniae pneumonia (MPP). Methods A total of 158 children with MPP were enrolled (MPP group) and further classified into the severe group (n=97) and the mild group (n=61) according to disease severity. Based on the 28-day clinical outcome, patients were also categorized into the good prognosis group (n=105) and the poor prognosis group (n=53). In addition, 91 healthy children were included as the control group. Serum levels of LXA4 and KLF5 were measured using enzyme-linked immunosorbent assay (ELISA). Multivariate Logistic regression analysis was used to identify factors influencing prognosis, and receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic value of serum LXA4 and KLF5 levels for disease and predictive value for prognosis. Results Compared with the control group, the serum level of LXA4 was decreased and the level of KLF5 was increased in the MPP group (P<0.05). Compared with the mild group, the serum level of LXA4 was decreased, and the level of KLF5 was increased in the severe group (P<0.05). The area under the ROC curve (AUC) for the combined diagnosis of disease severity in children using serum LXA4 and KLF5 was 0.936 (95%CI:0.886-0.969), indicating that the combined diagnostic performance was superior to that of LXA4 or KLF5 alone (Z _{joint - LXA4}=2.728, Z _{joint - KLF5}=4.208, P<0.05). The proportion of severe cases, levels of procalcitonin (PCT), C-reactive protein, length of hospital stay and serum KLF5 level were significantly higher in the poor prognosis group than those in the good prognosis group, while serum LXA4 level was significantly lower in the poor prognosis group (P<0.05). Severe disease, elevated levels of PCT and KLF5 were identified as risk factors for poor prognosis in children with MPP, whereas elevated LXA4 levels were protective factors (P<0.05). The area under the ROC curve (AUC) for the combined prediction of prognosis using serum LXA4 and KLF5 was 0.935 (95%CI: 0.885-0.968), which was significantly higher than that of LXA4 or KLF5 alone (Z _{joint - LXA4}=4.270, Z_{joint - KLF5}=3.136, P<0.05). Conclusion Serum LXA4 is decreased and KLF5 is increased in children with MPP. The combination of the two has high clinical application value in diagnosing disease condition and predicting the prognosis of children with MPP.

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The predictive value of uric acid, adiponectin and edema index for major adverse cardiovascular events in peritoneal dialysis patients

LIU Junfen, GUO Baozhu, CHENG Zhihua, WEI Zhifeng, LIU Shengjun

2026, 54 (3): 274-278. doi: 10.11958/20252525

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Objective To explore the predictive value of uric acid (UA), adiponectin (APN) and edema index for major adverse cardiovascular events (MACE) in peritoneal dialysis (PD) patients. Methods Eighty patients who underwent PD treatment were selected as the study group, and another 30 healthy individuals who underwent physical examination during the same period were selected as the control group. The serum levels of UA, APN and the edema index were compared between the two groups. Patients were divided into the MACE group (n=22) and the non-MACE group (n=58) based on whether MACE occurred, and the relationship between serum UA, APN and edema index and the occurrence of MACE in PD patients was analyzed. ROC curve was established to evaluate the predictive value of serum UA, APN and edema index for the occurrence of MACE in PD patients. Results The serum levels of UA, APN and the edema index were all higher in the study group than those in the control group (all P<0.01). The serum levels of UA and APN were both positively correlated with the edema index of PD patients (r=0.456, 0.341, P<0.01). The serum UA level and edema index were significantly higher in the MACE group than those in the non-MACE group, and the serum APN level was significantly lower than that in the non-MACE group (all P<0.01). The serum UA level and edema index were positively correlated with the occurrence of MACE in PD patients (r_s=0.438, 0.465, P<0.001). The serum level of APN was negatively correlated with the occurrence of MACE in PD patients (r_s=-0.447, P<0.001). The area under the curve (AUC) of serum UA, APN and edema index in predicting MACE in PD patients were 0.709 (95%CI: 0.586-0.833), 0.771 (95%CI: 0.649-0.892) and 0.722 (95%CI: 0.596-0.848), respectively. The AUC of the combined prediction of the three was 0.944 (95%CI: 0.890-0.998). Conclusion The serum levels of UA, APN and edema index are increased in PD patients. All the three are related to the occurrence of MACE. The combined detection has a higher predictive efficacy for MACE.

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The detection of metabolic dysfunction-associated fatty liver disease among new recruits in Tianjin and the effect of recruit training on the prognosis

XUE Minmin, LIU Liping, HE Zhaozhao, GUO Yan, GU Xiaomeng, ZHOU Shuning, FU Zhigang

2026, 54 (3): 279-283. doi: 10.11958/20252745

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Objective To explore metabolic dysfunction-associated fatty liver disease (MAFLD) among new recruits and the effect of recruit training on the outcome of MAFLD. Methods A total of 3 469 new recruits were selected for the spring re-examination in Tianjin in 2024. Baseline data and MAFLD status of new recruits were collected. MAFLD recruits from one training unit were selected and divided into the MAFLD-resolved group and the non-resolved group based on post-training assessment. Changes in general characteristics, body composition, laboratory parameters and transient elastography parameters before and after training were compared. Results Among the reexamined recruits, 215 cases (6.2%) were diagnosed with MAFLD. Recruits with MAFLD exhibited higher body weight, body mass index (BMI) and a greater proportion of overweight/obesity compared to those recruits without MAFLD. Of the 56 selected MAFLD recruits, 36 cases (64.3%) returned to normal after recruit training. After recruit training, body weight, BMI, waist circumference, waist to hip ratio, body fat, body fat percentage, fasting blood glucose (FPG), alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid (UA), liver steatosis analysis value and liver stiffness decreased compared to these indicators before the recruit training (P<0.05), while hip circumference, blood urea nitrogen (BUN) and triglyceride (TG) increased conversely (P<0.05). After training, the non-resolved group demonstrated higher gamma-glutamyl transferase (GGT) and liver steatosis analysis value than those of the resolved group (P<0.05), with no statistically significant differences observed in other indicators between the groups (P>0.05). Conclusion Recruit training can help MAFLD return to normal.

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Correlation between disease activity and recurrence risk of adult-onset Still's disease and ¹⁸F-FDG PET/CT metabolic parameters

ZHANG Wenyan, LI Zugui, JIA Yongchun, JIANG Wei, ZHEN Yusheng, XU Liang

2026, 54 (3): 283-288. doi: 10.11958/20252530

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Objective To investigate the correlation between the maximum standardized uptake value（SUV_max） of ¹⁸F-fluorodeoxyglucose（FDG）PET/CT and clinical disease activity score as well as recurrence risk of adult-onset Still's disease (AOSD). Methods A retrospective analysis was conducted on 17 patients with AOSD who underwent ¹⁸F-FDG PET/CT at Tianjin Union Medicine Center from June 2019 to December 2023. Spearman rank correlation analysis was performed to analyze the relationship between SUV_max of lymph nodes, spleen and bone marrow with clinical disease activity score and laboratory parameters, and those between lymph node SUV_max and maximum short-axis diameter. Patients were divided into the recurrent group and the non-recurrent group based on follow-up results. The differences in SUV_max, clinical disease activity score and clinical features were assessed between the two groups. Results All 17 patients showed ¹⁸F-FDG uptake in spleen, bone marrow and lymph nodes. Additionally, 2 patients (11.76%) showed increased ¹⁸F-FDG uptake in bilateral parotid glands (SUV_max 2.3, 4.3)，1 patient (5.88%) showed increased ¹⁸F-FDG uptake in bilateral elbows, wrists, hand joints, and left ankle（SUV_max 3.9), and 1 patient (5.88%) showed increased¹⁸F-FDG uptake in bilateral submandibular glands（SUV_max 3.4). The SUV_max of spleen and bone marrow were positively correlated with C-reactive protein levels（r_s value:0.575 and 0.549; both P<0.05), while the SUV_max of lymph nodes was positively associated with their maximum short-axis diameter（r_s value:0.522, P<0.05). There was no significant correlation between disease activity score and SUV_max in spleen, bone marrow, or lymph nodes (r_s value: -0.126, 0.100 and 0.007，P>0.05). The SUV_maxof spleen in the recurrence group (9 patients) was 5.20 (4.45, 6.05), which was significantly higher than that in the non-recurrence group [8 patients, 3.80 (2.70, 4.00), P<0.05]. Conclusion ¹⁸F-FDG PET/CT is a valuable tool for assessing AOSD disease activity and predicting disease recurrence, especially the SUV_max of spleen, which shows potential clinical value in predicting recurrence.

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Risk factors for postoperative gastrointestinal dysfunction in elderly NSCLC patients

ZHU Haiyan, WANG Ye, YIN Yan

2026, 54 (3): 289-294. doi: 10.11958/20252946

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Objective To investigate the risk factors of postoperative gastrointestinal dysfunction in elderly patients with non-small cell lung cancer (NSCLC), and to develop and validate an individualized nomogram. Methods A retrospective cohort study was conducted and included 309 elderly NSCLC patients who underwent radical resection of lung cancer in the single center of our hospital. Patients were divided into the disorder group (117 cases) and the control group (192 cases) based on whether gastrointestinal dysfunction occurred after the operation. Demographic, clinical and laboratory indicators were collected. The independent influencing factors were analyzed through multivariate Logistic regression, and a nomogram was constructed based on these results. Internal validation was conducted using the Bootstrap method (1 000 resampling), and the discrimination, calibration and clinical practicability of the model were evaluated through area under the curve (AUC), calibration curve and decision curve analysis (DCA). Results Multivariate Logistic regression analysis identified that preoperative malnutrition [OR (95%CI): 4.276(2.388-7.658)], preoperative frailty [OR (95%CI): 2.163(1.211-3.865)], diabetes [OR (95%CI): 2.366(1.330-4.208)]and preoperative chemotherapy [OR (95%CI): 2.153(1.214-3.819)]were independent risk factors for postoperative gastrointestinal dysfunction in elderly NSCLC patients after surgery (P<0.05). The higher preoperative maximum voluntary ventilation as a percentage of predicted value（MVV%pred）[OR (95%CI): 0.902(0.874-0.932)] was a protective factor (P<0.05). A nomogram prediction model integrating these five factors demonstrated excellent discriminative ability (AUC = 0.873,95%CI：0.827-0.919), calibration (mean absolute error=0.021) and clinical applicability. Conclusion Nomograms constructed based on factors such as malnutrition, frailty, diabetes, preoperative chemotherapy and high MVV% can effectively predict the risk of postoperative gastrointestinal dysfunction in elderly NSCLC patients.

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Serum levels and clinical significance of ANGPTL2 and NRG-1 in Parkinson's disease patients

SUN Longyin, MENG Ying, WANG Jiaying

2026, 54 (3): 294-298. doi: 10.11958/20252282

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Objective To explore the clinical significance of serum angiopoietin-like protein 2 (ANGPTL2) and neuregulin-1 (NRG-1) levels in patients with Parkinson's disease (PD). Methods A total of 274 PD patients and 266 healthy volunteers were selected as the observation group and the control group, respectively. The Montreal Cognitive Assessment (MoCA) was used to evaluate the cognitive function of PD patients, and patients were divided into the cognitive impairment group (MoCA score <26, n=161) and the non-cognitive impairment group (MoCA score ≥26, n=113). The Hoehn-Yahr (H-Y) scale was used to grade the severity of PD, and patients were classified into the H-Y stages 1-2 (118 cases), the stage 3 (94 cases) and the stage 4 (62 cases). Enzyme-linked immunosorbent assay (ELISA) was used to measure serum ANGPTL2 and NRG-1 levels in both groups. Pearson correlation analysis was used to examine the relationship between serum ANGPTL2 and NRG-1 levels in PD patients. Logistic regression was used to analyze influencing factors of PD. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficacy of both markers for PD. Results The serum NRG-1 and education years of PD patients were prominently lower in the observation group than those of the healthy group (P<0.05), and the serum ANGPTL2 and proportion of PD family history were prominently higher in the observation group than those of the control group (P<0.05). The serum ANGPTL2 levels were higher in the cognitive impairment group than those of the non cognitive impairment group (P<0.05), and NRG-1 prominently lower than the non cognitive impairment group (P<0.05). The serum ANGPTL2 levels increased successively in PD patients with H-Y stages 1-2, 3 and 4, and serum NRG-1 lvevels decreased successively (P<0.05). The serum levels of ANGPTL2 and NRG-1 were negatively correlated in PD patients (r=-0.373, P<0.001). Logistic regression analysis showed that elevated serum ANGPTL2 levels were the independent risk factors affecting the occurrence of PD, while high level of NRG-1 was an independent protective factor for PD (P<0.05). The area under the curve (AUC) of serum ANGPTL2, NRG-1 and their combined diagnosis for PD was 0.689 (95%CI: 0.645-0.733), 0.717 (95%CI: 0.674-0.760) and 0.768 (95%CI: 0.729-0.808), respectively. The combined diagnosis of the two was superior to the individual prediction of ANGPTL2 and NRG-1 (Z_{ANGPTL2-combination}=2.608, Z_{NRG-1-combination}=2.017, P=0.009, P=0.044). Conclusion PD patients have elevated serum ANGPTL2 levels and reduced NRG-1 levels, with the extent of these changes correlating with disease severity. Combined testing of these two indicators has important clinical value for the diagnosis of PD.

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The impact of combined fixation with personalized lumbar cushions and body membranes on the positioning accuracy and stability of patients with cervical cancer undergoing radiotherapy

LI Ming, JIN Jianhua, WU Jianting, WANG Junhui, XU Jun

2026, 54 (3): 299-302. doi: 10.11958/20252617

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Objective To explore the impact of personalized waist cushion combined with body membrane fixation on the positioning accuracy and stability in patients with cervical cancer radiotherapy. Methods A total of 72 cervical cancer radiotherapy patients were randomly divided into three groups: the experimental group, the control groupⅠand the control group Ⅱ, with 24 patients in each group. The experimental group used a personalized waist cushion combined with body membrane fixation, the control group Ⅰ used body membrane fixation, and the control group Ⅱ used a vacuum cushion. Cone-beam CT (CBCT) was used to measure the positioning errors of the three groups, and the positioning errors and coefficients of variation (CV) were compared between the three groups of patients. Results There were no significant differences in the X and Z-axis translational errors between the three groups. The Y-axis translational error was smaller in the experimental group than that in the control group Ⅰ and the control group Ⅱ. In terms of rotational errors, there were no significant differences in the Y and Z-axis rotational errors between the three groups, but the X-axis rotational error was smaller in the experimental group than that in the control group Ⅰ (P<0.05). Regarding the CV of positioning errors, the CV of X and Y-axis translational errors was smaller in the experimental group than that in the control group Ⅰ and the control group Ⅱ, and the CV of X-axis rotational error was smaller than that of the control group Ⅱ (P<0.05). Conclusion For patients with cervical cancer undergoing radiotherapy, the combined fixation of personalized waist cushion and body membrane can improve Y-axis positioning accuracy, reduce X-axis rotational errors and has better positioning stability.

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The predictive value of refractory diffuse large B-cell lymphoma based on enhanced CT lymph node marginal features combined with IPI score

LIU Xiaohua, HAN Tingting, GAO Yujie

2026, 54 (3): 303-308. doi: 10.11958/20252816

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Objective To explore the value of lymph node margin features based on pre-treatment enhanced CT combined with the international prognostic index (IPI) in predicting refractory diffuse large B-cell lymphoma (DLBCL) and to construct a nomogram prediction model. Methods A total of 98 patients with newly diagnosed DLBCL were selected. Clinical data, pathological findings and baseline enhanced CT of the patients were collected. The lymph node margin feature scores in CT images were independently evaluated by two senior radiologists, and the highest score was taken as the final lymph node margin feature score of the patient. All patients received chemotherapy based on the R-CHOP regimen (6-8 cycles). Patients were classified into the non-refractory group (69 cases) and the refractory group (29 cases) according to the Lugano 2014 response evaluation criteria. Logistic regression analysis was used to identify the factors influencing the development of refractory DLBCL. A nomogram was constructed based on the results of the multivariate Logistic regression model. The receiver operating characteristic (ROC) curve was used to evaluate the discrimination ability of the nomogram, and Hosmer-Lemeshow goodness-of-fit test was used to assess its calibration. Results Compared with the non-refractory group, patients of the refractory group had higher IPI scores, lymph node margin feature scores and serum PCT levels (P<0.05). Univariate binary Logistic regression analysis showed that lymph node margin feature scores and IPI scores were factors influencing the development of refractory DLBCL (P<0.01). Multivariate binary Logistic regression analysis showed that increased lymph node margin feature scores and IPI scores were risk factors for refractory DLBCL. A nomogram prediction model for the development of refractory DLBCL was established based on the results of Logistic regression analysis. The ROC curve analysis showed that the area under the curve (AUC) of the nomogram model for predicting refractory DLBCL was 0.840 (95% CI: 0.759 - 0.920), and Hosmer-Lemeshow χ² = 5.794, P = 0.670, indicating good fit. Conclusion The enhanced CT lymph node margin feature scores combined with IPI scores can effectively predict patients with refractory DLBCL. The constructed nomogram provides a potential predictive tool for the early identification of high-risk patients and individualized treatment strategies in clinical practice.

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Study on the safety and efficacy of transcatheter atrial septal defect closure using exclusive ultrasound guidance

ZHU Mengya, HUO Ying, GUO Zhipeng, LIU Yang, LIU Gang

2026, 54 (3): 309-313. doi: 10.11958/20252635

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Objective To investigate the safety, feasibility and effectiveness of simple ultrasound-guided percutaneous atrial septal defect (ASD) closure in children. Methods A total of 180 children who underwent interventional closure after strict cardiac ultrasound assessment were included. They were divided into the X-ray group (120 cases) and the ultrasound group (60 cases) based on the guiding method. The preoperative clinical characteristics, surgical indicators and postoperative outcomes were compared between the two groups. Results Compared with the X-ray group, the proportion of preoperative pulmonary valve insufficiency and mitral valve insufficiency were lower in the ultrasound group, and the cardiothoracic ratio was smaller (P < 0.05). All surgeries in both groups were successfully completed. Compared with the X-ray group, the defect diameter and the diameter of the used occluder were smaller in the ultrasound group, and the distances from the opposite side edge and the inferior vena cava entrance were longer in the ultrasound group (P < 0.05). Compared with the X-ray group, the postoperative hospital stay in the ultrasound group was shorter, the difference in white blood cell levels before and after surgery was greater, the postoperative right atrial diameter and postoperative right ventricular diameter were larger, the postoperative reduction rate of right ventricular dirameter and the incidence of postoperative arrhythmia was lower (P < 0.05). There was no statistically significant difference in the incidence of occluder endothelialization within 6 months after surgery between the two groups. Conclusion Simple ultrasound-guided ASD closure is safe and effective. The surgical success rate is not inferior to that of X-ray-guided ASD closure, and the postoperative hospital stay is shorter.

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Effects of erector spinae plane block with different concentrations of ropivacaine in patients with thoracoscopic lobectomy

XIONG Bingxian, WANG Jingkun, LIU Chenyun, CHEN Huiqun

2026, 54 (3): 314-318. doi: 10.11958/20252134

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Objective To investigate the effects of different concentrations of ropivacaine in erector spinae plane block (ESPB) on postoperative pain and stress response in patients undergoing thoracoscopic lobectomy, and to evaluate their impact on postoperative pulmonary function and early recovery. Methods A total of 114 patients scheduled for thoracoscopic lobectomy were finally included and were randomly divided into the group A (0.375% ropivacaine, 57 cases) and the group B (0.5% ropivacaine, 57 cases) using a random number table method. Intraoperative surgical indicators were recorded, and postoperative patient-controlled intravenous analgesia (PCIA) usage was monitored in the two groups of patients. Pain intensity was assessed using the Visual Analog Scale (VAS) at 2, 6, 12, 24 and 48 hours postoperatively. Stress markers [adrenocorticotropic hormone (ACTH), norepinephrine (NE) and cortisol (Cor)] were measured preoperatively and at 6, 24 and 48 hours postoperatively. Pulmonary function parameters [forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁) and FEV₁/FVC ratio] were evaluated one week after surgery. Recovery time, post-anesthesia care unit (PACU) stay duration and perioperative adverse event rates were also recorded. Results Compared with the group A, the group B exhibited a longer time to first PCIA demand and fewer PCIA presses within 48 hours (P<0.05). VAS scores increased at 12, 24 and 48 hours compared to 2 hours postoperatively in both groups (P<0.05), but the VAS scores of pain were significantly lower at 24 and 48 hours after surgery in the group B than those of the group A (P<0.05). ACTH, NE and Cor levels increased at 6, 24 and 48 hours postoperatively (P<0.05), but each time point index was lower in the group B than that of the group A (P<0.05). Compared with preoperative values, the FVC, FEV₁ and FEV₁/FVC levels were increased one week after surgery in both groups (P<0.05), but there were no significant differences between the two groups (P>0.05). The recovery time and the PACU stay time were significantly longer in the group B than those of the group A (P<0.05). There were no significant differences in perioperative adverse event rates between the two groups (14.04% vs. 22.81%, P>0.05). Conclusion The 0.5% ropivacaine ESPB can better alleviate pain and stress response of patients undergoing thoracoscopic lobectomy beyond 24 hours postoperatively, whereas 0.375% ropivacaine facilitates earlier recovery. Both concentrations demonstrate good safety, and clinical selection should be individualized.

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The effects of oxycodone and sufentanil on postoperative analgesia, cognitive function and inflammatory factors in elderly patients with ERCP

WANG Ying, LI Linyan, LI Xingyue, SUN Yingui

2026, 54 (3): 319-323. doi: 10.11958/20252821

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Objective To compare the effect of oxycodone and sufentanil on postoperative pain, cognitive function and inflammatory response in elderly patients with endoscopic retrograde cholangiopancreatography (ERCP). Methods Elderly patients scheduled for elective ERCP were selected and divided into the oxycodone group and the sufentanil group by random number table method. Both groups received patient-controlled intravenous analgesia (PCIA) postoperatively, with oxycodone in the oxycodone group and sufentanil in the sufentanil group. A total of 162 patients were ultimately included, including 79 in the oxycodone group and 83 in the sufentanil group. The primary outcome was the resting pain visual analogue scale (VAS) score within 72 hours postoperatively. Secondary indicators included the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores 1 day before the operation and 7 days after the operation, and the incidence of postoperative cognitive dysfunction (POCD), and serum C-reactive protein (CRP) and interleukin-6 (IL-6) levels before the operation and at 6, 24 and 72 hours after the operation. The occurrence of adverse reactions in patients was recorded. Results The VAS scores for pain within 72 hours postoperatively in the oxycodone group were significantly lower than that in the sufentanil group (P<0.01). Seven days after the operation, the oxycodone group had significantly higher MMSE and MoCA scores, and the incidence of POCD was significantly lower (11.39% vs. 26.51%, χ²=5.975, P<0.05). Within 72 hours postoperatively, the CRP and IL-6 levels in the oxycodone group were lower than those in the sufentanil group (P<0.01). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). The VAS score for pain within 72 hours after surgery in the oxycodone group was significantly lower than that in the sufentanil group, and the MMSE score and MoCA score were both higher in the oxycodone group than those in the sufentanil group, and the incidence of POCD (11.39%) was lower than that in the sufentanil group (26.51%). Within 72 hours after the operation, the levels of CRP and IL-6 were lower in the oxycodone group than those in the sufentanil group (P<0.01). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion In elderly ERCP patients, oxycodone provides better postoperative pain relief, has a lesser impact on cognitive function and more effectively suppresses the inflammatory response compared to sufentanil.

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Observation on the clinical efficacy of compound kushen injection combined with targeted and immune therapy in the treatment of advanced hepatocellular carcinoma

SU Ya, ZHANG Dongwei, YU Minghui, WANG Chunhua, WU Yueyue

2026, 54 (3): 324-328. doi: 10.11958/20252381

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Objective To observe the clinical efficacy of compound kushen injection combined with targeted and immunotherapy in patients with advanced malignant liver tumors. Methods A total of 100 patients with advanced primary liver cancer were divided into two groups according to the treatment methods: the control group (camrelizumab + lenvatinib, n = 50) and the observation group (camrelizumab + lenvatinib + compound Sophora flavescens injection, n = 50). Both groups received three treatment cycles. The clinical efficacy, traditional Chinese medicine (TCM) syndrome scores, T lymphocyte subset levels, incidence of adverse reactions and survival time were compared before and after treatment between the two groups. Results The objective response rate (ORR), disease control rate (DCR) and total effective rate of TCM syndrome score were significantly higher in the observation group than those of the control group (P < 0.05). After treatment, TCM syndrome scores for hypochondriac pain, abdominal distension, poor appetite, jaundice and fatigue were lower in the observation group than those of the control group. Levels of CD4⁺ and the CD4⁺/CD8⁺ ratio were higher, while CD8⁺ levels were lower in the observation group than those in the control group (P < 0.05). The total incidence of adverse reactions was significantly lower in the observation group than that of the control group. Moreover, both progression-free survival (PFS) time and overall survival (OS) time were significantly longer in the observation group than that of the control group (P<0.05). Conclusion Compound Sophora flavescens injection combined with targeted and immunotherapy demonstrates good clinical efficacy in patients with advanced malignant liver tumors. It can effectively improve clinical symptoms, regulate immune function, prolong survival time and have good safety.

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Analysis of screening results of FMR1, SMN1 and deafness-related genes in reproductive-age women in Mianyang area

WANG Dan, JIN Zhuoting, PAN Changqing, ZHENG Qianwen, YU Wenliang, DENG Yanmei, ZHANG Yong

2026, 54 (3): 329-332. doi: 10.11958/20251484

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Objective To investigate the combined screening results and their clinical significance of Fragile X Mental Retardation 1 (FMR1) gene, Survival Motor Neuron 1 (SMN1) gene and hearing loss-related genes in Mianyang region of Sichuan province. Methods A cross-sectional study was conducted with 1 000 women of reproductive age who sought prenatal counseling. The CGG repeat number of the FMR1 gene was detected using the AmplideX technique, while SMN1 gene copy number variations were detected by real-time fluorescence quantitative PCR. The genotypes and allele frequencies of 15 loci in hearing loss-related genes were determined by melting curve analysis. Results In the 1 000 samples, 27 different CGG repeat numbers of FMR1 gene were detected, with the repeat range from 26 to 62. No full mutation carriers were found, but 2 cases (0.2%) of FMR1 gene premutation were identified. Among the SMN1 gene copy numbers, 981 cases (98.10%) had ≥2 copies, while 19 cases (1.90%) were SMA carriers with only 1 copy of the SMN1 gene. In the hearing loss-related gene screening, 43 carriers of hearing loss genes (4.30%) were identified. There were no significant differences in the distribution of CGG repeat numbers, SMN1 copy numbers and hearing loss-related gene carrier between the normal pregnancies and the miscarriages (P>0.05). Conclusion The study provides a preliminary understanding of the distribution of FMR1, SMN1 and hearing loss-related genes in the Mianyang region. It can serve as a basis for prenatal diagnosis and the prevention of birth defects in high-risk fetuses.

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Research progress on the relationship between EGFR-TKI resistance and p53 mutation in non-small cell lung cancer

HUANG Zengyuan, FU Jing, ZHAO Ya, WANG Longhao, CANG Shundong

2026, 54 (3): 333-336. doi: 10.11958/20252986

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The main reason for the failure of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in the treatment of non-small cell lung cancer (NSCLC) is targeting drug resistance, and the main cause of drug resistance is the mutation of the tumor suppressor gene p53. How to prevent or reverse p53 mutations to solve the problem of EGFR-TKI resistance in advanced NSCLC has become a research hotspot in this field. This article summarizes the common mutation types of p53 and their related mechanisms affecting EGFR-TKI resistance, as well as how to intervene in p53 mutations to reverse EGFR-TKI resistance, and conducts an in-depth discussion on the relationship between EGFR-TKI resistance and p53 mutations in NSCLC patients.

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