Tianjin Medical Journal

Screening and functional validation of core pathogenic genes in aldosterone-producing adenoma based on integrated transcriptomic and proteomic analysis

ZHOU Ying, DONG Wenjing, SUN Di, SONG Lingyun, XUE Zhe, PANG Ping, YANG Guoqing

2026, 54 (9): 897-901. doi: 10.11958/20260728

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Objective To identify key pathogenic genes in aldosterone-producing adenoma (APA) and validate their biological functions through integrated transcriptomic and proteomic analysis. Methods Three samples each of APA tissue and control tissue from non-functioning adrenal adenomas were collected, and whole-transcriptome sequencing (RNA-seq) and quantitative proteomics were performed simultaneously. Based on integrated transcriptomic and proteomic analysis, differentially expressed genes and proteins were identified, and core pathways and key molecules were identified through functional enrichment analysis. Furthermore, in vitro cellular experiments were conducted using overexpression and silencing techniques to regulate fatty acid synthase (FASN) expression, and cell proliferation rates, adenosine triphosphate (ATP) levels, and the expression of aldosterone synthase (CYP11B2) protein were assessed. Results A total of 10 705 quantifiable transcripts and 3 288 quantifiable proteins were identified, of which 907 molecules were common to both omics datasets. Differential analysis revealed that 167 molecules were upregulated at both transcriptional and protein levels in APA, whilst 213 molecules were downregulated in a coordinated manner. Functional enrichment analysis indicated that the synergistically up-regulated molecules were significantly enriched in lipid metabolism-related pathways, such as fatty acid biosynthesis, the peroxisome proliferator-activated receptor (PPAR) signalling pathway and cholesterol metabolism, with the fatty acid biosynthesis pathway showing the highest level of enrichment. Further screening identified 10 key molecules commonly enriched across these core pathways; among these, FASN—the rate-limiting enzyme in fatty acid synthesis—was significantly upregulated in APA at both the messenger RNA (mRNA) and protein levels. Overexpression of FASN significantly promoted cell proliferation (P<0.01), reduced ATP production (P<0.01), and upregulated CYP11B2 protein expression (P<0.01). In contrast, silencing of FASN produced the opposite results (P<0.01). Conclusion As a key rate-limiting enzyme in the fatty acid synthesis pathway, FASN promotes tumour cell proliferation and the expression of a key enzyme involve in aldosterone synthesis, and may be involved in the pathogenesis of APA.

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Huaiqihuang regulating Jun/SLC7A11-mediated airway epithelial cell ferroptosis to inhibit airway remodeling and collagen deposition in asthmatic rats

LIU Linlin, LIANG Dongxue, LIU Lihua, TIAN Ying, SUN Lili

2026, 54 (9): 902-907. doi: 10.11958/20260423

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Objective To observe the inhibitory effect of Huaiqihuang on airway remodeling and collagen deposition in asthmatic rats by regulating airway epithelial cell ferroptosis, and to explore the possible mechanism. Methods Sixty rats were randomly divided into the normal group, the asthma group, the low-dose group, the high-dose group and the high-dose + inhibitor group, with 12 rats in each group. Except for the normal group, asthma models were established in the other groups by ovalbumin (OVA) sensitization and nebulized challenge. Rats with unsuccessful modeling were excluded, and finally 10 rats were included in each group. Rats in the low-dose group and the high-dose group, starting from the day of the first OVA challenge, received daily intragastric administration of Huaiqihuang solution at 3.6 g/kg and 7.2 g/kg, respectively. Rats of the high-dose + inhibitor group received high-dose Huaiqihuang and intraperitoneal injection of sulfasalazine (150 mg/kg). Rats of the normal group and the asthma group received daily intragastric administration of an equal volume of normal saline. Lung function and the contents of malondialdehyde (MDA), glutathione (GSH) and reactive oxygen species (ROS) in lung tissue were compared between groups. HE staining and Masson staining were used to measure the thickness of airway wall, airway smooth muscle and collagen fiber deposition. Western blot assay was used to detect the protein expression of p-Jun/Jun, solute carrier family 7 member 11 (SLC7A11) and glutathione peroxidase 4 (GPX4) in lung tissue. Results Airway resistance (RL), MDA and ROS contents in lung tissue, and p-Jun/Jun ratio were lower in the low-dose group than those in the asthma group, and those in the high-dose group were lower than those in the low-dose group. And those in the high-dose + inhibitor group were higher than those in the high-dose group (all P<0.05). Lung dynamic compliance (Cdyn), GSH content in lung tissue, and protein expression of SLC7A11 and GPX4 were higher in the low-dose group than those in the asthma group, those in the high-dose group were higher than those in the low-dose group, and those in the high-dose + inhibitor group were lower than those in the high-dose group (all P<0.05). The thicknesses of airway wall, airway smooth muscle and collagen fiber deposition were less in the low-dose group than those in the asthma group, those in the high-dose group were less than those in the low-dose group, and those in the high-dose + inhibitor group were greater than those in the high-dose group (all P<0.05). Conclusion Huaiqihuang can inhibit airway remodeling and collagen deposition in asthmatic rats, and its mechanism may be related to the inhibition of Jun activation, up-regulation of SLC7A11 expression, and thereby the alleviation of ferroptosis of airway epithelial cells.

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Establishment of a nomogram prediction model for the occurrence of acute ischemic stroke in patients with obstructive sleep apnea-hypopnea syndrome based on inflammatory indicators and clinical characteristics

LI Yue, WANG Wei, OUYANG Quping

2026, 54 (9): 908-912. doi: 10.11958/20260206

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Objective To explore the related risk factors of acute ischemic stroke (AIS) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), and construct a nomogram prediction model. Methods A total of 278 OSAHS patients were selected and divided into the AIS group (n=53) and the non-AIS group (n=225) based on whether they had concurrent AIS. The patient age, gender, body mass index (BMI), neck circumference, smoking history, drinking history, underlying medical history, apnea-hypopnea index (AHI), blood biochemical indicators and inflammatory indicators were collected and compared between the two groups. Multiple Logistic regression analysis was used to screen independent risk factors for AIS in OSAHS patients, and a nomogram prediction model was constructed based on the screening results. The model performance was evaluated through the receiver operating characteristic (ROC) curve, calibration curve and decision curve. Results The patient age, BMI, AHI, neck circumference, low-density lipoprotein cholesterol (LDL-C), white blood cell count (WBC) and neutrophil to lymphocyte ratio (NLR) were significantly higher in the AIS group than those in the non-AIS group, while high-density lipoprotein cholesterol (HDL-C) and the lowest peripheral oxygen saturation (LSpO₂) were significantly lower in the AIS group than those in the non-AIS group (all P<0.05). The levels of inflammatory markers C- reactive protein (CRP), interleukin (IL) -6 and tumor necrosis factor (TNF)-α were significantly higher in the AIS group than those in the non-AIS group (all P<0.05). Multivariate Logistic regression analysis showed that BMI, AHI, neck circumference, WBC, CRP, IL-6 and TNF-α were independent risk factors for AIS in OSAHS patients (all P<0.05). The area under the ROC curve (AUC) of the nomogram prediction model constructed based on the above factors was 0.868 (95% CI: 0.822-0.905). At an optimal cutoff value was 3.411, the specificity was 75.47% and the sensitivity was 83.56%. The calibration curve and Hosmer-Lemeshow test showed good consistency between the predicted values of the model (χ²=7.093，P=0.527) and the actual values. When the decision curve indicated a high-risk threshold>0.08 and intervention was carried out, patients can obtain clinical benefits. Conclusion A nomogram constructed on the basis of inflammatory markers and clinical characteristics demonstrates good predictive performance for AIS in patients with OSAHS, and can serve as a reference for the early clinical identification of high-risk patients and the formulation of intervention strategies.

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The application effect of serrated inner blade nuclear chopper in phacoemulsification for hard nuclear cataracts

WANG Xiu, GAO Yichen, MAO Han, TIAN Fang, WEI Ruihua, YANG Jun

2026, 54 (9): 913-917. doi: 10.11958/20260990

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Objective To evaluate the safety and efficacy of the serrated inner blade nuclear chopper in phacoemulsification for hard nuclear cataracts. Methods This was a prospective, randomized controlled study. A total of 136 patients (136 eyes) with grade Ⅲ-Ⅳ nuclear cataract who received phacoemulsification combined with intraocular lens implantation at Tianjin Medical University Eye Hospital from April 2022 to April 2023 were enrolled. The patients were randomly assigned to either the experimental group or the control group using a random number table. The experimental group received a serrated inner blade nuclear chopper (patent No. ZL 202122407969.9), while the control group received a Nagahara chopper (Trimmer Y-C802). All surgeries were performed by the same experienced cataract surgeon using a standard 2.2 mm micro-incision phacoemulsification technique. Intraoperatively, success of the first chop attempt, occurrence of complications, cumulative dissipated energy (CDE) and ultrasound time (US time) were recorded. Best corrected distance visual acuity (BCDVA), intraocular pressure (IOP) and central corneal thickness (CCT) were measured preoperatively and at 1 day, 1 week and 1 month postoperatively. Corneal endothelial cell density was measured preoperatively and at 1 month postoperatively, and the percentage of endothelial cell loss was calculated. The occurrence of complications during the postoperative follow-up period was recorded. Results The first chop attempt was successful in all patients in the experimental group, while one patient in the control group failed. There was no significant difference between the two groups (P>0.05). No intraoperative complications occurred in either group. Intraoperatively, the experimental group showed significantly lower CDE and US time than those of the control group (both P<0.01). At 1 day and 1 week postoperatively, BCDVA was significantly better in the experimental group than that in the control group (both P<0.01), and CCT was significantly lower in the experimental group than that in the control group (P<0.05). There were no significant differences in IOP at each time point between the two groups (all P>0.05). One month after the operation, the experimental group showed significantly higher corneal endothelial cell density and a lower rate of endothelial cell loss than those of the control group (both P<0.01). There were no postoperative complications during the follow-up period in either group. Conclusion Compared with the Nagahara chopper, the serrated inner blade nuclear chopper is safer and more effective in phacoemulsification for grade Ⅲ-Ⅳ hard nuclear cataracts.

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The relationship between monocyte subsets and IL-37 changes after allogeneic hematopoietic stem cell transplantation and acute graft-versus-host disease

WANG Hongbo, WANG Xiujuan, XU Jianli, YUAN Hailong, JIANG Ming

2026, 54 (9): 918-922. doi: 10.11958/20253702

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Objective To investigate changes of peripheral blood monocyte subsets and interleukin-37 (IL-37) levels following allogeneic hematopoietic stem cell transplantation (allo-HSCT) and their association with the occurrence and severity of acute graft-versus-host disease (aGVHD). Methods A total of 40 patients underwent allo-HSCT and 25 healthy individuals were enrolled. Patients were followed up to 100 days post-transplantation. Patients were categorized into the aGVHD group and the non-aGVHD group based on whether aGVHD occurred. Peripheral blood samples were collected at the first follow-up visit post-transplantation and at the onset of aGVHD. Flow cytometry was used to detect the proportions of classical (cMo), intermediate (iMo) and non-classical (ncMo) peripheral blood monocytes. Plasma IL-37 levels were measured by enzyme-linked immunosorbent assay (ELISA). The differences of the above indicators were compared between the three groups. The sensitivity analysis, trend tests and correlation analyses were performed. Results There were significant differences in the proportions of cMo and iMo and IL-37 levels among the three groups (all P<0.01), whereas there was no significant difference in the proportion of ncMo (P>0.05). Post-hoc testing showed that lower cMo and IL-37, and higher iMo were found in the aGVHD group compared with those of the control group. IL-37 was lower in non-aGVHD vs controls (all P_adj<0.05). Findings were consistent in sensitivity analysis (all P<0.05). Trend analysis indicated that decreasing cMo and IL-37 and increasing iMo were in the three groups (all P<0.05). In patients with hematological malignancies underwent allo-HSCT, IL-37 levels were positively correlated with cMo and negatively correlated with iMo (all P<0.05). In aGVHD group, IL-37 correlated negatively and iMo positively with grade (all P<0.05). Conclusion Following allo-HSCT, peripheral blood exhibits immune alterations characterized by increased iMo proportion and decreased IL-37 levels, which are associated with the occurrence and severity of aGVHD.

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Clinical characteristics and influencing factors of high risk of thrombosis in patients with systemic lupus erythematosus

LAI Xia, YIN Weiyu, ZENG Yongping, YANG Youguo, LIU Yuan

2026, 54 (9): 923-927. doi: 10.11958/20253484

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Objective To analyze the clinical characteristics and related influencing factors of patients with high risk of thrombosis in systemic lupus erythematosus (SLE). Methods A total of 142 SLE patients who visited the Department of Rheumatology and Immunology at Liuzhou People's Hospital from September 2023 to December 2024 were retrospectively enrolled. Based on the Padua assessment scale scores, patients were divided into two groups: the SLE low-risk thrombosis group (score<4, n=85) and the SLE high-risk thrombosis group (score ≥ 4, n=57). The general information,clinical manifestations and comorbidities of the two groups were collected, and the disease activity was evaluated by the systemic lupus erythematosus disease activity index (SLEDAI). Blood routine, inflammatory indicators, immunoglobulin and 24-hour urine protein quantification were detected by an automatic biochemical analyzer. The antinuclear antibody spectrum, including antinuclear antibody (ANA), anti-Smith antibody (Sm), anti-cardiolipin antibody (aCL), anti-β2 glycoprotein I antibody (β2GPI) were detected by Western blot assay. Results The age of patients in the SLE high-risk thrombosis group was higher than that in the SLE low-risk thrombosis group (P<0.05). The proportion of patients complicated with lupus nephritis (LN) and hyperlipidemia were higher in the SLE high-risk thrombosis group than that of the SLE low-risk thrombosis group (P<0.05). SLEDAI scores, white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), D-dimer (D-D) and 24-hour urine protein quantification were higher in the SLE high-risk thrombosis group than those of the SLE low-risk thrombosis group, while the serum albumin (ALB) and platelet (PLT) decreased (P<0.05). Multivariate Logistic regression analysis showed that increased age, CRP, D-D, SLEDAI score, LN, aCL antibody and anti-β2GPI antibody were independent risk factors for high-risk thrombosis in SLE, while increased PLT and ALB were independent protective factors for high-risk thrombosis in SLE (P < 0.05). Conclusion Identifying risk factors is helpful for the targeted monitoring and prevention of SLE patients at high risk of thrombosis, thereby reducing the incidence of thrombotic events.

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Clinical value of ultrasound and serum S100B combined with glial fibrillary acidic protein in evaluating carotid vulnerable plaque

WANG Jing, MA Yuanyuan, WANG Zhipei, ZHAO Wenhui, XU Tingting

2026, 54 (9): 928-933. doi: 10.11958/20253193

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Objective To explore the clinical value of ultrasound combine with serum S100 calcium binding protein B (S100B) combined and glial fibrillary acidic protein (GFAP) in evaluating carotid vulnerable plaque. Methods A total of 100 patients with carotid stenosis complicated with carotid plaque who received computed tomography angiography (CTA) in Cangzhou People’s Hospital were selected. All patients received carotid ultrasound examination. Patients were divided into the vulnerable plaque group (n=63) and the stable plaque group (n=37) according to CTA attenuation density, high-resolution MRI and postoperative pathological results. General information, laboratory indicators and carotid ultrasound results were collected. Binary Logistic regression model was used to analyze the influencing factors of carotid plaque stability. Receiver operating characteristic (ROC) curves were drawn to evaluate the predictive value of the study indicators on carotid vulnerable plaque in patients. Results The levels of serum S100B and GFAP were higher in the vulnerable plaque group than those in the stable plaque group (P<0.05). According to the gold standard of comprehensive diagnostic results of CTA, high-resolution MRI and postoperative pathology, 100 patients were divided into the vulnerable plaque group (n=63) and the stable plaque group (n=37). Carotid ultrasonography identified 66 cases of vulnerable plaques and 34 cases of stable plaques, including 30 cases of type Ⅰ, 36 cases of type Ⅱ, 12 cases of type Ⅲ, 9 cases of type Ⅳ and 13 cases of type Ⅴ. The Kappa value for the consistency between carotid ultrasound findings and the gold standard was 0.760. Logistic regression analysis showed that high levels of serum S100B (OR=50.286, 95%CI: 7.648-330.815) and GFAP (OR=1.165, 95%CI: 1.086-1.251) were risk factors for carotid plaque vulnerability (P<0.05). ROC curve results suggested that the AUCs of serum S100B, GFAP, ultrasound and the combination of the three in predicting carotid vulnerable plaque were 0.820 (95%CI: 0.731-0.890), 0.855 (95%CI: 0.771-0.918), 0.874 (95%CI: 0.792-0.932) and 0.918 (95%CI: 0.846-0.964), and the sensitivities were 76.19%, 73.02%, 93.65% and 73.02%, the specificities were 83.78%, 86.49%, 81.08% and 97.30% respectively, with high predictive efficiency. Conclusion Ultrasound combined with serum S100B and GFAP are helpful for the clinical diagnosis of vulnerable plaque in patients with carotid plaques.

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Development and validation of a nomogram model based on NFE2L1 and TRIM26 expression for predicting survival in metastatic gastric cancer patients receiving immunotherapy

ZHANG Jiaming, BAN Zhichao, CHANG Liming, ZHOU Yizhai

2026, 54 (9): 934-940. doi: 10.11958/20253483

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Objective To develop and validate a nomogram model integrating nuclear factor erythroid 2-related factor 1 (NFE2L1) and tripartite motif-containing protein 26 (TRIM26) expression levels for predicting survival in metastatic gastric cancer (mGC) patients undergoing immunotherapy. Methods A total of 252 mGC patients treated with immunotherapy at our hospital were selected as the training cohort. Through simple random sampling, 108 patients were allocated as the internal validation cohort, while 62 patients from external institutions were selected as the external validation cohort. Clinicopathological characteristics (gender, age, tumor invasion depth) were collected. The expressions of NFE2L1 and TRIM26 were detected by immunohistochemistry. Univariate and multivariate Cox proportional hazards regression models identified independent prognostic factors to construct the nomogram. Internal validation employed bootstrap resampling (1 000 iterations). Discriminative ability was assessed via area under the receiver operating characteristic curve (AUC), concordance index (C-index), calibration via Hosmer-Lemeshow test, and clinical utility via decision curve analysis (DCA). Results In the modeling group, the overall survival (OS) of those with tumor invasion depth of T3-4 stage, the maximum tumor diameter ≥5 cm, low and moderate differentiation and high expression of NFE2L1 and TRIM26 was shorter than those of the corresponding parameter groups (P<0.05). Multivariate Cox analysis demonstrated that tumor invasion depth (HR=1.565, 95%CI: 1.132-2.164), maximum tumor diameter (HR=1.428, 95%CI: 1.088-1.871), high NFE2L1 expression (HR=2.788, 95%CI: 1.926-3.995) and high TRIM26 expression (HR=2.451, 95%CI: 1.759-3.412) were independent risk factors for shorter survival following immunotherapy (all P<0.05). The nomogram exhibited excellent discriminative ability in the training cohort (1-year AUC=0.924, 95%CI: 0.849-0.969; 2-year AUC=0.823, 95%CI: 0.787-0.902; C-index=0.887, 95%CI: 0.742-0.940), internal validation cohort (1-year AUC=0.896, 95%CI: 0.800-0.910; 2-year AUC=0.860, 95%CI: 0.785-0.918; C-index=0.850, 95%CI: 0.733-0.919), and external validation cohort (1-year AUC=0.864, 95%CI: 0.783-0.910; 2-year AUC=0.830, 95%CI: 0.752-0.900; C-index=0.832, 95%CI: 0.715-0.908). Calibration curves confirmed good agreement between predicted and observed outcomes (training cohort: χ²=6.325, P=0.618; internal validation: χ²=7.152, P=0.523; external validation: χ²=8.021, P=0.426). Decision curve analysis revealed superior net clinical benefit across threshold probabilities of 0.10-0.90 compared to alternative strategies. Conclusion Tumor invasion depth at stage T3-4, maximum tumor diameter ≥5 cm and high expression of NFE2L1 and TRIM26 are independent risk factors for the OS of immunotherapy in patients with metastatic gastric cancer. The nomogram model constructed based on the above indicators can effectively predict the OS of patients.

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Association between triglyceride-total cholesterol-body mass index and slow-flow or no-reflow phenomenon during emergency percutaneous coronary intervention in patients with acute myocardial infarction

BU Haiwei, LIU Jingyi, HAN Leng, YU Haiyan, YUAN Fengling, LIU Jiamei, SHAN Weichao, ZHANG Ying

2026, 54 (9): 941-947. doi: 10.11958/20260282

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Objective To investigate the association between the triglyceride-cholesterol-body mass index (TCBI) and intraoperative slow-flow/no-reflow (SR/NR) phenomenon during emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Methods A total of 557 patients diagnosed with AMI and treated with emergency PCI from January 2020 to December 2022 were selected and divided into the SR/NR group (TIMI 0-2 grade, 188 cases) and the normal blood flow group (TIMI 3 grade, 369 cases) based on the TIMI blood flow grade during PCI. The TCBI was calculated and its natural logarithm (LnTCBI) was taken to meet the normality requirement. Patients were grouped by the tertiles of LnTCBI: Q1 group (LnTCBI < 6.97, 186 cases), Q2 group (6.97 ≤ LnTCBI < 7.62, 185 cases) and Q3 group (LnTCBI ≥ 7.62, 186 cases). Baseline data of patients were collected, and differences between groups were compared. Multivariate Logistic regression was used to analyze the influencing factors of SR/NR, and patients were subgrouped based on age, smoking, hypertension, extensive anterior wall myocardial infarction and high thrombotic burden (HTB). The association between LnTCBI and SR/NR in each subgroup was analyzed. The robustness was verified by restricted cubic spline (RCS). The diagnostic efficacy of LnTCBI for SR/NR was evaluated by receiver operating characteristic curve (ROC). Results Compared with the group of normal blood flow, the SR/NR group showed lower age, higher usage rate of intra-aortic balloon counterpulsation, higher thrombus burden (HTB), higher incidence of cardiac arrest and malignant arrhythmia, higher Killip grade Ⅱ, Killip grade Ⅲ-Ⅳ, higher usage rate of clopidogrel, higher white blood cell count (WBC), absolute neutrophil count, platelet count (PLT), triglycerides, serum creatinine (Scr), urea nitrogen, blood uric acid, LnTCBI level, higher absolute lymphocyte count (ALC), and decreased systolic blood pressure, diastolic blood pressure, left ventricular ejection fraction level, usage rate of beta-blockers, ticagrelor and angiotensin-converting enzyme inhibitors/angiotensin II receptor antagonists (P<0.05). The trend test analysis showed that from the Q1 group, Q2 group to Q3 group, the incidence rates of T2DM, dyslipidemia and SR/NR in patients showed an increasing trend (P<0.05). Linear regression analysis indicated that the levels of WBC, ALC, PLT and Scr showed an increasing trend (P<0.05). Multivariate Logistic regression analysis showed that regardless of LnTCBI as a continuous variable or a three-category variable, high LnTCBI was independently associated with an increased risk of SR/NR. The model discrimination C index was 0.820 (0.786 - 0.865, P<0.01). Hosmer-Lemeshow goodness-of-fit test, χ²=5.820, P = 0.667, indicated a good model fit. RCS analysis showed that LnTCBI had a non-linear dose-response relationship with the risk of SR/NR (P_non-linear= 0.036), the inflection point value was 6.948 (95%CI: 6.921 - 6.974). Subgroup analysis showed that in different age groups, without hypertension, with and without acute extensive anterior wall myocardial infarction and HTB subgroups, LnTICB≥7.62 was a risk factor for patients to develop SR/NR (P<0.05). In the smoking population, LnTICB<6.97 and LnTICB≥7.62 were risk factors for patients to develop SR/NR (P<0.05). ROC curve analysis showed that the area under the curve of LnTCBI for predicting severe complications was 0.628, sensitivity was 62.8%, specificity was 53.1%, and the optimal diagnostic cutoff value was 7.223. Conclusion LnTCBI elevation is closely related to the increased risk of SR/NR during PCI in AMI patients, and which can be used as a biomarker for early identification of high-risk populations.

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Diagnostic value of gastrointestinal filling contrast-enhanced ultrasound for gastroduodenal diseases in pregnant women

LU Nannan, LIU Xin, SHU Hongyan, SHEN Cui

2026, 54 (9): 948-951. doi: 10.11958/20260370

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Objective To evaluate the diagnostic value of gastrointestinal filling contrast-enhanced ultrasound (GIC-US) for gastroduodenal diseases in pregnant women, and to compare it with the result of gastroscopy. Methods A total of 144 pregnant women with upper gastrointestinal symptoms were enrolled and divided into the early-mid pregnancy group (gestational age ≤28 weeks, n=93) and the late pregnancy group (gestational age >28 weeks, n=51). All patients underwent both GIC-US and gastroscopy. Using the result of gastroscopy as the reference standard, sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (-LR) of GIC-US were calculated. The diagnostic performance between the two groups was compared, and the McNemar test was used to analyze the difference in detection rates between the two methods. Results The overall sensitivity, specificity, accuracy, PPV and NPV of GIC-US were 90.15%, 66.67%, 88.19%, 96.75% and 38.10%, respectively, with a+LR of 2.70 and a -LR of 0.15. The early-mid pregnancy group showed higher sensitivity (93.02% vs. 84.78%), specificity (71.43% vs. 60.00%) and accuracy (91.40% vs. 82.35%) compared with those of the late pregnancy group. The overall detection rate of gastroscopy was 91.67% (132/144) compared with 85.42% (123/144) for contrast-enhanced ultrasound, showing no statistically significant difference (P=0.052). The tolerance of patients to GIC-US was significantly better than that of gastroscopy (VAS score: 1.49±1.12 vs. 4.67±1.66, P<0.01). Conclusion GIC-US can serve as an important non-invasive auxiliary method for the screening and diagnosis of gastroduodenal diseases during pregnancy, with better diagnostic performance, particularly in the early-to-mid trimester.

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The clinical predictive value of thrombelastography combined with the systemic immune-inflammation index for postpartum hemorrhage after vaginal delivery

YIN Huicong, FAN Huili, MA Wenjuan

2026, 54 (9): 952-956. doi: 10.11958/20253593

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Objective To investigate the clinical predictive value of thromboelastography (TEG) combined with systemic immune-inflammation index (SII) for postpartum hemorrhage (PPH) in vaginal delivery. Methods A total of 199 puerperae undergoing vaginal delivery in our hospital were retrospectively enrolled, and they were divided into the PPH group (48 cases) and the non-PPH group (151 cases) according to inclusion and exclusion criteria. General clinical data, coagulation function indicators, blood routine indicators, TEG parameters and SII levels were compared between the two groups. The predictive value of TEG parameters, SII levels and their combined detection for PPH was analyzed by receiver operating characteristic (ROC) curve, and multivariate Logistic regression analysis was performed to identify independent risk factors for PPH. Results Compared with the non-PPH group, there were higher incidence of previous PPH history, pregnancy induced hypertension, pregnancy induced diabetes, prenatal anemia, oxytocin use, instrument assisted delivery and abnormal placental exfoliation in the PPH group, and longer prothrombin time (PT), activated partial thromboplastin time (APTT), higher levels of white blood cell count (WBC), neutrophil count (NEUT) and SII, and lower lymphocyte count (LYM), hemoglobin (Hb) and platelet count (PLT) in the PPH group (all P<0.05). The solidification time (K) in the PPH group was significantly higher than that in the non PPH group, while the maximum amplitude (MA) and coagulation index (CI) were significantly lower than those in the non PPH group (all P<0.01). ROC curve analysis showed that the area under the curve (AUC) for predicting PPH using K value, MA value, CI value, SII and their combined values were 0.706, 0.795, 0.746, 0.766 and 0.917, respectively. The efficiency of joint prediction is the highest, with a sensitivity of 81.63% and a specificity of 91.49%. Multivariate Logistic regression analysis revealed that elevated K value and SII were independent risk factors for PPH (all P<0.05), while elevated MA value and CI value were independent protective factors for PPH (P<0.05). Conclusion TEG parameters and SII are closely related to the occurrence of postpartum hemorrhage during vaginal delivery. The combined detection of the two has good predictive value for PPH.

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Evaluation and prognosis prediction of serum levels of C-reactive protein and serum amyloid A in premature infants with necrotizing enterocolitis

ZHANG Weiye, ZHU Ping, GAO Hang, BAO Fengyuan, XI Yue, YANG Jing

2026, 54 (9): 957-961. doi: 10.11958/20253327

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Objective To investigate the clinical value of serum C-reactive protein (CRP) and serum amyloid A (SAA) levels in evaluating the severity and predicting the prognosis of necrotizing enterocolitis (NEC) in preterm infants. Methods A total of 90 preterm infants with NEC were enrolled as the NEC group. According to the modified Bell-NEC staging criteria, the patients were divided into stage Ⅱ (49 cases) and stage Ⅲ (41 cases). In accordance with the therapeutic outcomes at 28 days after discharge, patients were categorized into the improved prognosis group (64 cases) and the poor prognosis group (26 cases). Another 90 healthy preterm infants admitted during the same period were selected as the control group. Differences in general clinical data and serum CRP and SAA levels were compared between the NEC group and the control group. The differences of CRP and SAA levels in infants with different NEC stages and their correlations with disease staging were analyzed. Receiver operating characteristic (ROC) curve was adopted to evaluate the diagnostic efficacy of serum CRP and SAA for NEC and their predictive value for prognosis. A multivariate Logistic regression model was established to control confounding factors, and to analyze the effects of the above two indicators on prognosis. Results Serum levels of CRP, SAA, procalcitonin (PCT) and interleukin (IL)-6 were significantly higher in the NEC group than those in the control group (P<0.01). Serum CRP and SAA levels in children with stage Ⅲ NEC were higher than those in stage Ⅱ (P<0.01). Spearman correlation analysis showed that serum CRP and SAA levels were significantly positively correlated with NEC stage (P<0.01). The area under the curve (AUC) for serum CRP, SAA, and their combined diagnosis of NEC were 0.883 (95%CI: 0.798-0.941), 0.863 (95%CI: 0.774-0.926), and 0.960 (95%CI: 0.896-0.990), respectively. The levels of serum CRP and SAA in the poor prognosis group were higher than those in the improved prognosis group (P<0.01).Multivariate Logistic regression analysis revealed that elevated serum CRP and SAA were both independent risk factors for poor prognosis in patients with NEC (P<0.05). The AUC (95%CI) of serum CRP, SAA and combined detection for patients with poor prognosis of NEC were 0.896 (0.813-0.951), 0.889（95%CI：0.817-0.953） and 0.951(0.884-0.986), respectively. Conclusion Serum CRP and SAA levels are positively correlated with the severity of NEC in premature infants, and their elevated levels are independent risk factors for poor prognosis of NEC premature infants.

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Role of CysLTs and NLRP3 inflammasome pathways in mucous plug formation in children with severe Mycoplasma pneumoniae pneumonia and construction of a combined early-warning model

SUN Changcheng, WU Jianlin, CHEN Yiqiao, TENG Yanmei, HAN Yubing, LIU Zhenyu

2026, 54 (9): 962-966. doi: 10.11958/20253748

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Objective To investigate the association of cysteinyl leukotrienes (CysLTs) and NLRP3 inflammasome pathway activation with mucous plug formation in severe Mycoplasma pneumoniae pneumonia (SMPP) patients, and to develop/validate a combined predictive model. Methods A total of 202 children with SMPP were selected and divided into the mucus plug group (54 cases) and the non-mucus plug group (148 cases) based on the results of fiberoptic bronchoscopy. Baseline characteristics, serum CysLTs levels and NLRP3 inflammasome pathway components (NLRP3, caspase-1) were compared. Multivariate Logistic regression analysis was used to screen risk factors for mucous plug formation, and the predictive efficacy of each index and the combined model was evaluated by receiver operating characteristic (ROC) curve. Results Compared to controls, the mucous plug group showed significantly elevated serum CysLTs, NLRP3, Caspase-1, CRP levels and PRISM Ⅲ scores, with reduced partial pressure of oxygen in arterial blood/Fraction of inspired oxygen（PaO₂/FiO₂）(P<0.05). Multivariate Logistic regression analysis revealed that elevated serum levels of CysLTs, NLRP3, Caspase-1, CRP and decreased PaO₂/FiO₂ were independent risk factors for the formation of mucus plugs in children with SMPP (P<0.05). The results of the ROC curve analysis showed that the area under the curve (AUC) of the combined prediction model of the above five indicators was 0.972（95%CI：0.947-0.996）, with a sensitivity of 94.4% and a specificity of 93.9%. The predictive efficacy of this model was superior to that of any single indicator. Conclusion Serum CysLTs and activation of the NLRP3 inflammasome pathway, hypoxia state and high systemic inflammatory load are independent risk factors for mucus plug formation in children with SMPP. The combined prediction model constructed based on these factors has excellent predictive performance.

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Influencing factors and construction of a predictive model for postoperative complications of Craig type I clavicle fractures in adolescents

SONG Xiaolei, ZHANG Wenlu, LI Yongben, LI Na, LUO Yingying, LIU Zhen, ZHANG Qing

2026, 54 (9): 967-972. doi: 10.11958/20253733

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Objective To investigate the influencing factors of postoperative complications in adolescents with Craig type Ⅰ clavicle fractures, analyze the protective effect of retrograde elastic intramedullary nailing, and develop/validate a predictive model for postoperative complications. Methods A total of 180 adolescent patients with Craig type Ⅰ clavicle fractures were selected. The patients were followed up for 1 year after surgery, and they were divided into the complication group (56 cases) and the non-complication group (124 cases) based on whether complications occurred. The clinical data of the two groups were compared, and the influencing factors of postoperative complications were analyzed using multivariate Logistic regression, and a nomogram prediction model was constructed accordingly. The predictive efficacy of each factor and the combined model was evaluated using the receiver operating characteristic (ROC) curve. Results Compared with the non-complication group, the intraoperative blood loss and serum N-terminal peptide cross-linking (NTX) level were higher in the complication group, while the Constant-Murley shoulder joint score, serum type Ⅰ procollagen N-terminal propeptide (PⅠNP) and the proportion of retrograde elastic nail internal fixation were lower in the complication group (P<0.05). Multivariate Logistic regression analysis revealed that high intraoperative blood loss and high NTX level were independent risk factors for postoperative complications, while retrograde elastic nail internal fixation, high Constant-Murley score and high PⅠNP level were protective factors (P<0.05). Based on this, a predictive model was constructed. The model passed the Omnibus test (P<0.01) and fitted well (Hosmer-Lemeshow test, χ² = 10.047, P = 0.262). ROC curve analysis showed that the combined predictive model of surgical method, intraoperative blood loss, Constant-Murley score, PⅠNP and NTX had the best discrimination efficacy, with an area under the curve (AUC) of 0.949 (95% CI: 0.914-0.984), which was significantly higher than any single predictive factor (P<0.05), and its prediction sensitivity and specificity were 91.1% and 87.9%, respectively. Conclusion The constructed combined predictive model has good discrimination and predictive efficacy for postoperative complications in adolescents with Craig type Ⅰ clavicle fractures, and can provide a quantitative tool for clinical risk assessment.

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Correlation analysis between non-alcoholic fatty liver disease and severity of coronary artery stenosis in patients with coronary heart disease

JIANG Lei, LI Bingqiang, YUAN Ruyu

2026, 54 (9): 973-976. doi: 10.11958/20260303

Abstract ( 111 )

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Objective To investigate the effect of non-alcoholic fatty liver disease (NAFLD) on the severity of coronary artery stenosis in patients with coronary heart disease (CHD), and to analyze the role of proprotein convertase subtilisin/kexin type 9 (PCSK9) and inflammatory factors in it. Methods A total of 537 CHD inpatients diagnosed by coronary angiography at Tianjin Nankai Hospital from September 2015 to September 2025 were enrolled. Based on abdominal ultrasound or CT findings, they were divided into the non-NAFLD group, the mild NAFLD group and the moderate-to-severe NAFLD group. Serum biochemical parameters, levels of PCSK9, interleukin-1β (IL-1β), IL-6 and tumor necrosis factor-α (TNF-α) were measured. The Gensini score was used to assess the severity of coronary artery stenosis. The correlations between NAFLD and the severity of coronary stenosis as well as various indicators were analyzed. Results The Gensini scores of the non-NAFLD group, the mild NAFLD group and the moderate-to-severe NAFLD group increased successively (P<0.05). Serum levels of total protein (TP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), lactate dehydrogenase (LDH), creatine kinase (CK), CK-MB, total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), PCSK9, IL-1β, IL-6 and TNF-α increased sequentially in the non-NAFLD group, the mild NAFLD group and the moderate-to-severe NAFLD group, while levels of albumin (ALB) and high-density lipoprotein cholesterol (HDL-C) decreased sequentially (all P<0.05). Spearman correlation analysis revealed that the severity of NAFLD was positively correlated with TP, ALT, AST, GGT, LDH, TC, TG, LDL-C, PCSK9, IL-1β, IL-6, TNF-α levels and Gensini score, and negatively correlated with ALB and HDL-C levels (all P<0.05). Pearson correlation analysis showed that Gensini score was positively correlated with TP, ALT, AST, GGT, LDH, TC, TG, LDL-C, PCSK9, IL-1β, IL-6 and TNF-α levels, and negatively correlated with ALB (all P<0.05). PCSK9 was also positively correlated with IL-1β, IL-6 and TNF-α levels (all P<0.05). Conclusion NAFLD is positively correlated with the severity of coronary artery stenosis in CHD patients, and the underlying mechanism may be related to the elevated PCSK9 levels, inflammatory response and lipid metabolism disorders.

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Application of lacrimal probe positioning combined with artificial lacrimal duct implantation in traumatic lacrimal canaliculus rupture and analysis of the factors affecting the surgical effect

WEI Ziyue, GE Zhenhua, WANG Tingting

2026, 54 (9): 977-981. doi: 10.11958/20253755

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Objective To analyze the effect of probe localization of lacrimal passage combined with artificial lacrimal duct implantation in traumatic lacrimal canaliculi rupture and the factors affecting the surgical effect. Methods A total of 141 patients with traumatic lacrimal canaliculus rupture from January 2022 to December 2024 were selected. Another 34 patients with the same disease admitted from January to August 2025 were selected for internal validation of the model. All patients underwent lacrimal duct probe localization method combined with artificial lacrimal duct implantation. The surgical efficacy and postoperative complications were analyzed. According to the follow-up results at 6 months after surgery, patients were divided into the unobstructed group and the blocked group. The factors affecting the surgical effect were analyzed, and a prediction model was constructed. The predictive efficacy of the model was evaluated using the receiver operating characteristic (ROC) curve. Results Ninety-six patients were cured, 38 improved, and the clinical effective rate was 95.04%, with a complication rate of 7.80%. After 6 months of follow-up, there were 108 patients in the unobstructed group and 33 patients in the obstruction group. No long-term complications such as late displacement of the stent, formation of granulation tissue, or restenosis were observed. Compared with the unobstructed group, the blocked group had a higher incidence of proximal fracture, a longer time from injury to seeking medical treatment (≥ 24 hours), and a higher proportion of complete fractures. The indwelling tube time was shorter (P<0.05). Multivariate Logistic regression analysis showed that the fracture site being proximal, complete fracture and the time of visit being ≥ 24 hours were risk factors affecting the surgical outcome of the patients, while a longer catheter retention time was a protective factor for the surgical outcome of patients (P<0.05). The area under the curve (AUC) of the prediction model based on these indicators for predicting the surgical effect of patients was 0.830 (95%CI: 0.751-0.909), with a sensitivity of 84.80% and a specificity of 74.10%, and the internal validation model accuracy rate was 88.24%. Conclusion The prediction model of the lacrimal duct probe localization method combined with artificial lacrimal duct implantation for traumatic lacrimal canaliculus rupture constructed in this study can provide individualized surgical risk stratification and prognosis assessment tools for clinicians.

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Risk factors for bronchopulmonary dysplasia and construction of a prediction model in very/extremely preterm infants

XU Haijuan, ZHANG Di, YAO Wenxiu, QIU Ruiqin, QIAO Mu

2026, 54 (9): 982-986. doi: 10.11958/20253697

Abstract ( 106 )

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Objective To explore risk factors of bronchopulmonary dysplasia (BPD) in very/extremely preterm infants and construct the prediction model. Methods A total of 206 very/extremely preterm infants were selected and divided into the BPD group (101 cases) and the non-BPD group (105 cases). The differences in perinatal and neonatal clinical data were compared between the two groups. Logistic regression analysis was used to analyze influencing factors of BPD occurrence and construct a prediction model. The receiver operating characteristic (ROC) curve was used to evaluate the discrimination of the model. Internal validation of the model was conducted by Bootstrap method (repeated sampling for 1000 times). The predictive value of the model for the severity of BPD was further evaluated by ROC curve. Results The proportion of intrauterine infection during pregnancy was higher in the BPD group than that in the non-BPD group (P<0.05). The comparison of early neonatal factors showed that the proportion of gestational age < 28 weeks, neonatal respiratory distress syndrome, patent ductus arteriosus, infectious pneumonia, and invasive mechanical ventilation time >7 d were significantly higher in the BPD group than those in the non-BPD group (P<0.05). Multivariate Logistic regression analysis showed that intrauterine infection during pregnancy (OR=6.846, 95%CI: 1.757-26.667), gestational age <28 weeks (OR=4.241, 95%CI: 2.072-8.683), neonatal respiratory distress syndrome (OR=6.346, 95%CI: 3.003-13.411), patent ductus arteriosus (OR=4.935, 95%CI: 1.919-12.695), infectious pneumonia (OR=3.323, 95%CI: 1.465-7.540) and invasive mechanical ventilation time >7 d (OR=4.954, 95%CI: 2.226-11.025) were independent risk factors for BPD in very/extremely premature infants (P<0.01). The combined prediction model was constructed based on the above influencing factors, and its goodness of fit was detected by Hosmer-Lemeshow test (χ²=8.433, P=0.296). The area under the curve (AUC) of the model for predicting BPD was 0.837 (95%CI: 0.783-0.891), AUC of internal validation was 0.814 (95%CI: 0.754-0.875), and AUC of the model for predicting severe BPD was 0.874 (95%CI: 0.816-0.933). Conclusion The risk prediction model of BPD constructed based on prenatal and postnatal data has good discrimination and calibration in very/extremely preterm infants, which is conducive to early clinical intervention.

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Observation on the efficacy of millimeter wave adjuvant therapy for knee osteoarthritis

LIU Zhentao, SUN Guodong, XU Wei, MA Shuai, KANG Linlin

2026, 54 (9): 987-991. doi: 10.11958/20260057

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Objective To evaluate the efficacy of millimeter wave adjuvant therapy on knee osteoarthritis (KOA) and the influence on peripheral blood T helper type 1/T helper type 2 (Th1/Th2) cytokine balance. Methods A total of 90 patients with KOA were selected and randomly assigned into the control group (conventional comprehensive therapy, 45 cases) and the observation group (conventional comprehensive therapy plus millimeter wave adjuvant therapy, 45 cases). The clinical efficacy, pain visual analogue scale (VAS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee range of motion (ROM), levels of peripheral blood Th1/Th2 cytokines and adverse reactions were compared between the two groups of patients. Results After 12 weeks of treatment, the total effective rate was higher in the observation group than that in the control group (P<0.05). Pain VAS scores after 4, 8 and 12 weeks of treatment were lower in the observation group compared to those of the control group (P<0.05). After 12 weeks of treatment, WOMAC scores, IL-2 and IFN-γ levels were lower in the observation group compared to those of the control group, and ROM, IL-4 and IL-10 were higher (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Millimeter wave adjuvant therapy can regulate the peripheral blood Th1/Th2 cytokine balance, effectively relieve the joint pain and improve the knee function in KOA patients, with good safety.

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Evaluation of lip closing force in adult female with normal occlusion based on the self-developed LCF measurement system

YANG Yue, GUO Ziyuan, PENG Peng

2026, 54 (9): 992-998. doi: 10.11958/20260727

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Objective To assess the characteristics of lip closing force (LCF) in young adult females with normal occlusion using a self-developed LCF measurement system, and to clarify the relationship between lip soft tissue indicators and lip closure stability, so as to provide a basis for clinical evaluation of lip muscle function. Methods A total of 81 adult female volunteers aged 19 to 24 years with normal occlusion were enrolled in this study. Eight cephalometric lip soft tissue indicators (A-Sn, UIC-UL, B-Si, LIC-LL, Sn-Stms, Stmi-Si, UL-EP and LL-EP) were measured. Meanwhile, LCF electrical signals were collected via the self-developed LCF measurement system, LCF curves were plotted, and three core indicators including maximum value, mean value and first wavelet packet entropy (FWPE) were extracted. The lip soft tissue indicators were divided into 5 grades according to the degree of deviation from the median (grade 5: closest to the standard; grade 1: most deviant), and then integrated into a clinical grade (CG). After eliminating invalid data caused by environmental interference and subjective consciousness, the effects of LCF-related indicators (maximum value, mean value, and stability) on lip soft tissue morphology were analyzed. The dependent variable CG grade was an ordinal categorical variable. Eventually, an ordinal Logistic regression model was constructed with 38 valid samples. Pseudo R² and P-value (test level α=0.05) were adopted to evaluate the reliability of the regression model. Results The finally established regression model showed acceptable fitting effect (Pseudo R²=0.532). An increase in FWPE would increase the probability of CG tending to a lower grade (β₃=-0.175, OR=0.839, 95%CI: 0.722-0.976), indicating that the lip soft tissue indicators deviated more from the standard values. In contrast, the smaller the FWPE, the better the lip closure stability, and the closer the lip soft tissue indicators were to the standard values. Conclusion The self-developed LCF measurement system can be effectively used for the evaluation of lip closing force in adult females with normal occlusion.

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A study on the relationship between hypertension prevalence and altitude in Tashkurgan Tajik Autonomous County, Xinjiang

LIU Xinlin, LUO Tinggang, DU Zhenhua, AMUERDING Reyijiapu, BAO Buhe

2026, 54 (9): 999-1002. doi: 10.11958/20260988

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Objective To investigate the association between altitude and the prevalence of hypertension (HTN) among residents in the high-altitude areas of Tashkurgan Tajik Autonomous County, Xinjiang (referred to as “Taxian”). Methods A cross-sectional survey was conducted in 20 667 permanent residents aged ≥18 years from 11 townships (towns) in Taxian. Participants were divided into 3 groups according to the altitude gradient of the townships: the altitude < 2 800 m group (2 351 cases), the altitude 2 800-3 300 m group (13 254 cases) and the altitude ≥ 3 300 m group (5 062 cases). The gender, ethnicity, age, occupation, educational level, HTN prevalence and family history, smoking and drinking habits, physical exercise, and physical examination indicators [height, body weight, body mass index (BMI), non-consecutive three blood pressure measurements] of the study subjects were collected. A multivariate Logistic regression model was used to analyze the influencing factors related to HTN prevalence. Results The standardized prevalence rate of HTN in Taxian residents was 25.92%. There were statistically significant differences in age, Tajik ethnicity, occupation (agriculture, forestry and animal husbandry), HTN family history, educational level, alcohol consumption, smoking, exercise, HTN and BMI distribution between the different altitude groups (P<0.01).The prevalence of HTN showed an increasing trend with the increase of altitude (χ²=83.360, P<0.01). The multivariate Logistic regression analysis showed that the age of 45-59 years old, ≥ 60 years old, Tajik ethnicity, occupation (agriculture, forestry and animal husbandry), HTN family history, BMI being overweight and obese, altitude 2 800-3 300 m and≥ 3 300 m areas were risk factors for HTN, and BMI being underweight was a protective factor for HTN (P<0.05). Conclusion The prevalence of hypertension among adults in the high-altitude area of Taxian, Xinjiang, is relatively high, and the risk of developing hypertension increases with increasing altitude.

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Stratification value and application strategies of HPV E6/E7 mRNA testing in cervical cancer screening

LIU Jie, LIU Yunchang, YAN Lichen, WANG Yilin

2026, 54 (9): 1003-1008. doi: 10.11958/20260725

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With the deepening understanding of the pathogenesis of cervical cancer and the development of diverse screening modalities for cervical cancer, the detection of human papillomavirus (HPV) E6/E7 mRNA targets the transcriptional activity of viral oncogenes, directly reflects the carcinogenic potential and viral integration status of HPV, driving a paradigm shift in cervical cancer screening strategies from merely "detecting infection" to precisely "assessing risk". This article systematically reviews the molecular basis, technical characteristics, diagnostic performance and triage application of HPV E6/E7 mRNA testing, explores its value in dynamic monitoring for risk-stratified management of precancerous lesions and the clinical challenges encountered, and provides insights for precision prevention and control of cervical cancer and optimization of healthcare resources.

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