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Table of Content

    25 January 2025, Volume 46 Issue 1
    Previous Issue   
    Protective effect of protein kinase C inhibitors on sunitinib-induced cardiotoxicity
    QIU Su-hua1, ZHANG Hua1, GU Pan1, SHI Chen-xia1, MA Jing-tao2, XU Yan-fang1
    2025, 46(1):  5-13.  doi:10.3969/j.issn.1007-3205.2025.01.002
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    Objective To investigate the protective effects of protein kinase C(PKC)inhibitors on the cardiotoxicity induced by sunitinib (SU) at the cellular and whole animal levels. 
    Methods The neonatal rat ventricular myocytes (NRVMs) were cultured and incubated with different concentrations of SU (1, 5, 10 μmol/L). The intracellular adenosine triphosphate (ATP) level, lactate dehydrogenase (LDH) release and the mitochondrial membrane potential (MMP) were measured. Then the effects of non-selective PKC inhibitor bisindolylmaleimide 1 (Bis-1), selective novel PKC inhibitor Rotterlin, or inhibitory peptides on SU-induced cardiotoxicity were observed. Male C57 mice were randomly divided into four groups, including control group, SU group, SU combined with PKC inhibitor chelerythrine (CHE) at low dose (i.p. 0.375 mg·kg-1·d-1) and high dose (i.p. 0.75 mg·kg-1·d-1) groups. SU was administered continuously by gavage and intraperitoneal injection of CHE was given. At 3 weeks after administration, the heart tissues were harvested and mitochondria from ventricular myocardium were extracted to measure the activity of mitochondrial complexes Ⅳ and Ⅴ. The transmission electron microscopy (TEM) was used to observe the mitochondria microstructures. Western blot analysis was performed to detect the expression of phosphorylated PKC subtypes, including p-PKCε, p-PKCδ and p-PKCα in each group. 
    Results SU significantly reduced ATP level, increased LDH release and decreased MMP in NRVMs in a concentration and time-dependent manner. TEM showed that SU-induced visible changes could be prevented by non-selective PKC inhibitor Bis-1, selective novel PKC inhibitor Rotterlin and selective PKCε inhibitory peptide. Administration of SU significantly reduced the activity of mitochondrial complexes Ⅳ and Ⅴ in mouse myocardium, and TEM showed significant morphological changes such as swelling and cristae fusion in myocardial cell mitochondria. Co-administration of different dose of CHE prevented the decrease of mitochondrial complexes Ⅳ and Ⅴ activities. Meanwhile, TEM showed that CHE significantly alleviated the mitochondrial morphological changes induced by SU. Western blot analysis showed that the expression level of p-PKCε was significantly increased in SU group compared with the control group, but p-PKCδ or p-PKCα had no significant change. High-dose CHE significantly inhibited the overexpression of p-PKCε, restoring it to the control group level. 
    Conclusion PKC inhibitors have a significant protective effect against SU-induced cardiotoxicity, which may be due to the inhibition of excessive activation of novel PKC (mainly PKCε subtype). 

    The value of triglyceride-glucose index in evaluating the severity of coronary artery lesions and long-term MACE in patients with acute coronary syndrome and DM
    HE Jian-jian1, LI Hai-jing1, WANG Bin2, LIU Ling-ling1, LIU Xiao-ming1
    2025, 46(1):  14-19.  doi:10.3969/j.issn.1007-3205.2025.01.003
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    Objective To explore the value of triglyceride-gluscose (TyG) index in evaluating the severity of coronary artery lesions and long-term major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) and diabetes mellitus (DM). 
    Methods The medical records of gender, age, TyG index, degree of coronary artery lesions (SYNTAX score), and occurrence of MACE in 142 patients with ACS and DM were collected. The Pearson correlation test was used to analyze the correlation between TyG index and SYNTAX score. The receiver operating characteristic (ROC) curve was used to analyze the evaluation value of TyG index for the severity of coronary artery lesions. The COX regression model was used to analyze the influencing factors of long-term MACE. 
    Results Of 142 patients with ACS combined with DM, there were 56 patients with severe coronary artery lesions (severe group) and 86 patients with mild coronary artery lesions (mild group). The TyG index and glycosylated hemoglobin of the severe group were higher than those of the mild group (P＜0.05). Pearson correlation analysis showed that there was a positive correlation between TyG index and SYNTAX score (P＜0.05). ROC curve analysis showed that the area under the ROC curve (AUC) of TyG index to evaluate disease severity was 0.863, the optimal cutoff value was 7.73, and the specificity and sensitivity were 80.4% (45/56) and 84.9% (73/86) respectively. Among the 142 patients, 4 patients were lost to follow-up, and 138 patients completed the follow-up, including 15 patients (11.11%) developing cardiogenic death, 8 (5.80%) developing recurrent angina, 5 (3.62%) developing recurrent myocardial infarction, 4 patients developing heart failure (2.90%), and 2 patients receiving target vessel reconstruction (1.45%), with a total of 34 (24.64%) patients with MACE. Age, TyG index and glycated hemoglobin of the MACE group were higher than those of the non-MACE group, and left ventricular ejection fraction （LVEF） was lower than that of the non-MACE group (P＜0.05). COX regression model analysis showed that LVEF, age, TyG index, and glycated hemoglobin were all influencing factors of long-term MACE, and the risk of MACE events increased significantly with decreased LVEF level and increased age, TyG index and glycated hemoglobin in ACS patients with DM (P＜0.05). 
    Conclusion The TyG index is positively correlated with the severity of coronary artery lesions in patients with ACS and DM, which is an independent risk factor for long-term MACE and can be used to predict the risk of MACE. 

    Effect of individualized warfarin administration based on gene polymorphism on the incidence of complications after heart valve replacement in elderly patients
    XING Bei-bei, SHEN Hong, WANG Wei, LIU Pu-juan
    2025, 46(1):  20-24.  doi:10.3969/j.issn.1007-3205.2025.01.004
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    Objective To investigate the effect of individualized warfarin administration based on gene polymorphism on the incidence of complications after heart valve replacement in elderly patients. 
    Methods Patients treated in our hospital from January to December 2019 and from January to December 2020 were selected as the research group (n=120) and another 120 patients served as the control group. The warfarin treatment plan for patients in the control group was as follows: the initial dose of warfarin was 3 mg/d, and the dose of warfarin was adjusted to 1.5-6 mg/d according to the clinical symptoms and complications of patients. After enrollment, the research group received a dose of 3 mg/d for AA type patients, 6 mg/d for GG type, and 4.5 mg/d for AG type based on the gene polymorphisms of vitamin K epoxide reductase complex subunit 1(VKORC1) and cytochrome p450 2C9 (CYP2C9). Gene polymorphism, incidence of cardiovascular events, pharmacokinetic indexes and complications were compared between the two groups. 
    Results There was no significant difference in VKORC1 and CYP2C9 gene polymorphisms between the two groups (P＞0.05). International normalized ratio (INR) ［(2.01±0.02) vs. (2.22±0.01)］ (t=102.879, P＜0.001), times of excessive anticoagulation ［(9.62±2.37) vs. (22.58±2.74)］ (t=39.188, P=0.001), half-life of warfarin ［(58.71±0.02) h vs. (61.99±0.03) h］ (t=996.536, P＜0.001), and the peak time ［(2.71±0.02) h vs. (2.99±0.03) h］ (t=85.070, P=0.001) were lower in the research group than in the control group, while INR standard time ［(6.52±2.72) s vs. (4.89±2.33) s］ (t=4.986, P＜0.0.001), the clearance rate ［ (138.01±11.02) mL/h vs. (112.22±11.25) mL/h］ (t=17.940, P＜0.001), and the highest blood drug concentration ［(621.29±11.92) μg/L vs. (607.78±11.94) μg/L］ (t=8.772, P＜0.001) were higher than those in the control group. The incidence of skin purpura (χ2=4.655, P=0.031), gingival bleeding (χ2=7.211, P=0.007) and nasal bleeding (χ2=5.661, P=0.017) in the research group was lower than that in the control group. 
    Conclusion The individualized administration of warfarin based on gene polymorphism can effectively reduce the incidence of complications after heart valve replacement in the elderly, and it is recommended to be popularized in clinical practice. 

    The difference inclinical characteristics and prognosis between hospital-acquired and community-acquired septic shock in children
    YUE Yan-ke, LIAN Tian-tian, KANG Lei, LIU Shuai, GENG Wen-jin, XU Mei-xian
    2025, 46(1):  42-48.  doi:10.3969/j.issn.1007-3205.2025.01.008
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    Objective To explore the differences in diagnostic and treatment characteristics and prognosis in septic shock occurring in different locations in the pediatric intensive care unit (PICU). 
    Methods A total of 203 children with septic shock in the PICU of a single center were retrospectively included and divided into the hospital-acquired septic shock group (hospital-acquired group, n=45) and the community-acquired septic shock group (community-acquired group, n=158). The differences in demographics, underlying diseases, infectious foci, treatment and prognosis between the two groups were compared, and the influencing factors for the prognosis of children with septic shock were analyzed. 
    Results The hospital-acquired group had older age ［5.6(10.3) years vs. 2.1(6.8) years, and higher proportions of underlying diseases ［(62.2%(28/45) vs. 36.1%(57/158)］, malignant hematological/neoplastic diseases ［44.4%(20/45) vs. 18.9%(30/158)］ and bone marrow suppression after chemotherapy ［31.1%(14/45) vs. 1.8%(3/158)］ than the community-acquired group, showing significant differences (P＜0.05). In the hospital-acquired group, white blood cells ［1.42(10.61)×109/L］ and platelets ［26(133)×109/L］ were lower than those in the community-acquired group ［8.15(13.53)×109/L, 151(188)×109/L］, while C-reactive protein ［138(112) mg/L］ was higher than that in the community-acquired group ［64(95) mg/L］, suggesting significant differences (P＜0.05). In terms of infectious foci, the proportions of the respiratory tract and central nervous system as infectious foci in the hospital-acquired group were lower than those in the community-acquired group ［8.9%(4/45) vs. 29.1%(46/158), 6.7%(3/45) vs. 20.3%(32/158)］, and the proportion of bloodstream infection was higher than that in the community-acquired group ［35.5%(16/45) vs. 11.1%(23/158)］, showing significant differences (P＜0.05). The positive rate of fungi in the hospital-acquired group was higher than that in the community-acquired group ［8.9%(4/45) vs. 1.3%(2/158)］, showing significant differences (P＜0.05). The proportion of the use of two antimicrobial drugs in the community-acquired group was higher than that in the hospital-acquired group, the proportion of the use of three or more antimicrobial drugs in the hospital-acquired group was higher than that in the community-acquired group, and the proportion of anti-fungal drug use in the hospital-acquired group was higher than that in the community-acquired group, showing significant differences (P＜0.05). The proportion of brain dysfunction in the hospital-acquired group was higher than that in the community-acquired group ［17.7%(8/45) vs. 6.3%(10/158)］, the length of hospital stay was longer than that in the community-acquired group ［15(21) d vs. 11(17) d］, and the in-hospital mortality was higher than that in the community-acquired group ［31.1%(14/45) vs. 15.8%(25/158)］, showing significant differences (P＜0.05). Logistic regression analysis showed that hospital-acquired septic shock, combined malignant hematological/neoplastic diseases, pediatric sequential organ failure assessment score, lactic acid, platelets, activated partial thromboplastin time, international normalized ratio, invasive mechanical ventilation, use of vasoactive drugs and continuous blood purification were the influencing factors for the death of hospitalized children with septic shock (OR values=1.04, 2.42, 1.12, 1.20, 1.09, 0.48, 0.55, 0.22, 0.56 and 0.25). 
    Conclusion Compared with children with community-acquired septic shock, children with hospital-acquired septic shock have a higher proportion of underlying diseases, a higher demand for anti-infective and vasoactive drugs, and a worse in-hospital prognosis. 

    Clinical characteristics and early warning indicators of influenza A and influenza B in children
    ZHANG Wen, WEI Bo-tao, MA Cui-an, ZHANG Tong-qiang
    2025, 46(1):  49-54.  doi:10.3969/j.issn.1007-3205.2025.01.009
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    Objective To analyze the clinical characteristics and peripheral blood characteristics of influenza A and B (hereinafter referred to as influenza)in children, especially the significance of neutrop hil-to-lymphocyte ratio (NLR), in order to improve the understanding level of influenza in children and provide reference for early diagnosis of influenza in children. 
    Methods A total of 428 children with fever and/or upper respiratory tract infection were selected. According to the results of influenza virus antigen, they were divided into influenza A virus (IAV) positive group (IAV group, n=172), influenza B virus (IBV) positive group (IBV group, n=132) and control group (n=124).The epidemiological characteristics, clinical manifestations and routine examination results of peripheral blood were reviewed and analyzed. 
    Results There were no significant differences in while blood cell (WBC) levels among the three groups (P＞0.05). The levels of neutrophils, lymphocytes， NLR and C-reactive protein(CRP) in peripheral blood of IAV group and IBV group were significantly different from those of control group, respectively (P＜0.05). However, there was no significant difference in neutrophils, lymphocytes, NLR, and CRP between IAV group and IBV group (P＞0.05). 
    Conclusion The proportion of neutrophils, lymphocytes， CRP and NLR in peripheral blood routine can provide reference for early diagnosis of influenza in children. 

    Early diagnosis, individualized treatment and follow-up study of obstructive sleep apnea syndrome in children
    ZHANG Qiao-li1, WANG Ai-qiong1, FU Qiang2, GAO You-han1, SA Ri-na1
    2025, 46(1):  55-59.  doi:10.3969/j.issn.1007-3205.2025.01.010
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    Objective To study the early diagnosis, individualized treatment and follow-up results of obstructive sleep apnea syndrome (OSAS) in children. 
    Methods A total of 120 children with OSAS aged 5-10 years were selected as the observation subjects. General information of children was collected. Based on the clinical characteristics of the children, the diagnosis, treatment process, and follow-up results were summarized through nasopharyngeal lateral X-ray, fiberoptic nasopharyngoscopy, and polysomnography (PSG) examination. 
    Results The main clinical characteristics of children with OSAS were sleep snoring (n=120, 100.00%), sleep apnea (n=89, 74.17%), mouth breathing (n=107, 89.17%), hearing loss (n=14, 11.67%), and enuresis (n=10, 8.33%). Of the 120 children, 87 (72.50%) had tonsillar hypertrophy, 88 (73.33%) had adenoidal hypertrophy, and 15 (12.50%) had both tonsillar and adenoidal hypertrophy. There were 11 cases (9.17%) of mild OSAS, 59 cases (49.17%) of moderate OSAS, and 50 cases (41.67%) of severe OSAS. For mild and moderate OSAS children (without adenoid and tonsillar hypertrophy), combined with the parents′ wishes, 16 patients were treated with nasal glucocorticoids and/or montelukast sodium, and 10 patients (62.50%) were cured or significantly improved. In addition, 45 patients underwent tonsillectomy, and 44 patients (97.78%) were cured or significantly improved; 42 patients underwent adenoidectomy, and 40 patients (95.24%) were cured or significantly improved. Another 15 patients underwent tonsillectomy and adenoidectomy, and 14 patients (93.33%) were cured or significantly improved. At 3 and 6 months after treatment, the obstructive apnea index and sleep apnea hypopnea index in children with OSAS were lower than those before treatment, and the lowest arterial oxygen saturation was higher than that before treatment (P＜0.05). 
    Conclusion Children with OSAS have obvious clinical manifestations and more accompanying diseases. The diagnosis can be combined with lateral nasopharyngeal X-ray, PSG and fibrous nasopharyngoscopy, and individualized treatment can be developed according to the specific conditions of children. Among them, tonsillectomy and adenoidectomy are effective treatment methods for OSAS. 

    Risk factor analysis of mild cognitive impairment and construction of the risk prediction model in the elderly in Shijiazhuang City
    ZHANG Yuan-yuan1, LI Xiu-li2, MENG Yu-han3, SUN Ke-juan2, CUI Hui-xian4, LI Yan3
    2025, 46(1):  66-71.  doi:10.3969/j.issn.1007-3205.2025.01.012
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    Objective To identify the relevant risk factors of mild cognitive impairment (MCI) in the elderly and to establish a nomogram of MCI risk, so as to provide references for early clinical identification and intervention. 
    Methods A total of 322 elderly people who underwent physical examination in the community of Shijiazhuang City from September 2021 to July 2022 were selected as the research subjects, and the general information, clinical detection indicators, and status of daily leisure activities were collected. Univariate analysis and multivariate Logistic regression analysis were used to determine the independent risk factors of MCI risk in the elderly. The nomogram prediction model was established and the discrimination and calibration of the nomogram model were evaluated by the receiver operating characteristic (ROC) curve, Hosmer-Lemeshow (H-L) test, and calibration curve. 
    Results Multivariate Logistic regression analysis showed that advanced age, low education level, low cognitive activity participation, and Apolipoprotein E (ApoE) ε4 risk gene were independent risk factors for MCI. A nomogram predictive model was established and the area under the ROC curve (AUC) was 0.887 (95%CI: 0.834-0.939, P＜0.001), and the P value of the H-L test was 0.675. The Brier value of the calibration curve was 0.078, the absolute error was 0.013, and the calibration curve was very close to the ideal reference line. 
    Conclusion The nomogram model based on the four risk factors, including age, education level, cognitive activity index, and ApoE ε4 risk gene, can effectively predict the risk of MCI in the elderly in Shijiazhuang City, and further external verification research can be carried out. 

    Effects of semaglutide and empagliflozin on structure and function of the aorta of obese mouse
    YUE Lin1, CHEN Shu-chun2, NIU Shu3, WANG Yue1, WEI Xue-ying1, DONG Xi-hong1
    2025, 46(1):  72-79.  doi:10.3969/j.issn.1007-3205.2025.01.013
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    Objective To determine whether semaglutide (Sema) and empagliflozin  (Empa) can improve aortic injury in obese mice and to compare the efficacy of the two drugs. 
    Methods Obese mouse models were constructed by high-fat diet. The obese mice were intervened with Sema, Empa and the combination of Sema and Empa (S+E), respectively. The mice were closely monitored for changes in body weight. Serological parameters and changes in aortic function and structure were measured at the end of the experiment. 
    Results Under the influence of a high-fat diet, the weight of mice in each group increased significantly, while the weight of mice in each group subjected to different drug interventions decreased. Statistical analysis showed that there were significant differences in the interaction between groups, time points, and time points between groups (P＜0.05). Specifically, total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) of mice in the high-fat diet (HFD group) were significantly higher than those of the normal control diet (NCD group) (P＜0.001). In addition, after glucose load, the glucose of the mice in the HFD group was higher than that of the NCD group at all time points. In the mean time, the pulse wave velocity, aortic intima-media thickness(IMT) and collagen content of the mice in the HFD group were also significantly higher than those in the NCD group, showing significant differences (P＜0.05). Compared with the HFD group, the TG level of mice receiving Sema intervention and S+E intervention was significantly reduced (P＜0.05). In addition, the Sema group, Empa group and S+E group also showed significant results in reducing the levels of TC and LDL-C (P＜0.05). However, the difference in high-density lipoprotein cholesterol (HDL-C) levels between drug intervention groups was not significant. In terms of blood glucose levels, compared with the NCD group, the fasting blood glucose levels of mice in the Sema group, Empa group and S+E group increased, but the blood glucose level of these groups decreased significantly at 15 min and 30 min after glucose load (P＜0.05). In terms of pulse wave velocity, the pulse wave velocity of the mice in the Sema group, Empa group and S+E group was lower than that of the HFD group, whereas the pulse wave velocity of the mice in the Empa group was higher than that of the Sema group and the S+E group, suggesting significant difference (P＜0.05). In terms of the elastic fiber area of the aorta, no significant difference was observed between the NCD group, the HFD group, the Sema group, the Empa group and the S+E group (P＞0.05). However, in terms of the aortic IMT and collagen content, the values of the Sema group and the S+E group mice were significantly lower than those of the HFD group, showing significant differences (P＜0.05). 
    Conclusion Our results suggest that both Sema and Empa have a protective effect against obesity-induced structural and functional impairment of the aorta. 

    Clinical predictive value of CTSI score combined with lactate in predicting for severe acute pancreatitis complicated with acute kidney injury in severe acute pancreatitis
    ZHAO Xiao-juan, LI Xin-xin
    2025, 46(1):  80-85.  doi:10.3969/j.issn.1007-3205.2025.01.014
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    Objective To assess the clinical value of CT severity index (CTSI) combined with lactate in predicting acute kidney injury (AKI) in elderly patients with severe acute pancreatitis (SAP)during hospitalization. 
    Methods A total of 328 elderly SAP patients hospitalized in the First Hospital of Harbin Medical University were retrospectively included, and were divided into the AKI group (n=68, 20.73%)and the non-AKI group (n=260, 79.07%) according to whether AKI occurred during hospitalization. The clinical data of all patients were collected through the inpatient medical record system. Multivariate Logistic regression analysis was used to screen the risk factors for AKI during hospitalization in SAP patients, and receiver operating characteristic (ROC) curve was used to assess the clinical efficacy of CTSI and lactate in predicting the occurrence of AKI. 
    Results Univariate analysis showed that age ＞70 years, diabetes mellitus, morbidity and mortality, proportion of consecutive renal replacement therapy, and interleukin 6, lactate, CTSI, sequential organ failure estimation score, acute physiology and chronic health evaluation Ⅱ scores, and Charlson comorbidity index were higher in AKI group than in the non-AKI group, showing significant difference (P＜0.05). The results of multivariate Logistic regression analysis showed that age ＞70 years (OR=1.267, 95%CI: 1.042-1.541), CTSI (OR=1.632, 95%CI: 1.291-2.064), and lactate (OR=1.428, 95%CI: 1.133-1.798) were risk factors for AKI in SAP patients during hospitalization. The ROC curve showed that the area under the ROC curve (AUC) of CTSI combined with lactate in patients with SAP complicated with AKI was ［0.869 (95%CI: 0.818-0.920)］, which was higher than that predicted by CTSI ［0.733 (95%CI: 0.664-0.802)］, and orlactate ［0.695 (95%CI: 0.624-0.766)］ alone, showing optimal predictive performance. 
    Conclusion CTSI and lactate are independent risk factors for AKI during hospitalization in SAP patients, and the combined detection can predict the risk of AKI, and then assist in clinical practice to screen out the high-risk group for targeted intervention. 

    Correlation of free fatty acid and placental growth factor levels with the results of non-invasive hemodynamic monitoring in preeclamptic patients
    SUN Tian, YU Li-tao
    2025, 46(1):  86-91.  doi:10.3969/j.issn.1007-3205.2025.01.015
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    Objective To explore the correlation between free fatty acids (FFA), placental growth factor (PLGF), and results of non-invasive hemodynamic monitoring in patients with preeclampsia to enhance the early diagnosis and management of preeclampsia. 
    Methods Eighty patients with preeclampsia were selected as the observation group, and 75 normal pregnant women undergoing prenatal examinations during the same period were selected as the control group. The levels of FFA, PLGF, and hemodynamic indicators were compared between the two groups, and the correlation between FFA, PLGF levels, and hemodynamic indicators in the observation group was analyzed. 
    Results The serum PLGF levels in the observation group were lower than those in the control group ［(62.03±18.45) ng/L vs. (106.95±12.34) ng/L］, while the FFA levels were higher than those in the control group ［(0.77±0.66) mmol/L vs. (0.59±0.57) mmol/L］ (P＜0.05). The mean arterial pressure (MAP) in the observation group was higher than that in the control group ［(103.56±11.12) mmHg vs. (84.87±9.54) mmHg］, as were the systemic vascular resistance (SVR) ［(1,467.45±487.12) dyne·s·cm5 vs. (1 032.45±274.45) dyne·s·cm5］, systemic vascular resistance index (SVRI) ［(2 596.58±790.69) dyne·s·cm5·m2 vs. (1 762.45±537.42) dyne·s·cm5·m2］, and tissue perfusion ［(33.22±5.23) koh-m-1 vs. (30.45±5.87) koh-m-1］ levels (P＜0.05). The cardiac index (CI) ［(3.12±0.56) L·min-1·（m2）-1 vs. (3.45±0.71) L·min-1·（m2）-1］, cardiac output (CO) ［(5.54±1.13) L/min vs. (6.23±1.15) L/min］, stroke index (SI) ［(34.36±7.74) mL/beat·m2 vs. (39.12±8.24) mL/beat·m2］, stroke volume (SV) ［(62.35±14.54) mL/beat vs. (69.22±15.11) mL/beat］, arterial compliance index (ACI) ［（91.87±34.89）10-2·s-2 vs.（117.12±42.78）10-2·s-2］, and vascular index (VI) ［（51.45±18.87）10-3·s-1 vs.（67.14±20.53）10-3·s-1］ levels in the observation group were lower than those in the control group (P＜0.05). There were no significant differences in the changes in the left ventricular function index and systolic time ratio between the two groups (P＞0.05). Spearman correlation analysis showed that FFA levels were positively correlated with the severity of preeclampsia (r=0.615, P＜0.05), while PLGF levels were negatively correlated with the severity of preeclampsia (r=-0.587, P＜0.05). In the observation group, MAP, SVR, SVRI, and tissue perfusion were positively correlated with FFA levels and negatively correlated with PLGF levels. Conversely, CI, CO, SI, SV, ACI, and VI were positively correlated with PLGF levels and negatively correlated with FFA levels. 
    Conclusion In patients with preeclampsia, FFA levels are elevated, and PLGF levels are decreased. There is a certain correlation between the levels of FFA and PLGF and the results of non-invasive hemodynamic monitoring, which can aid in the early diagnosis of preeclampsia. 

    The relationship between ARFI quantitative parameters and hemodynamics in patients with atherosclerotic renal artery stenosis and the ROC curve analysis of these indicators for jointly evaluating the severity of renal artery stenosis
    YANG Cui-ying1, XUE Li-li1, ZHAO Ya-pei1, ZHAO Yan-qin1, ZHANG Dong-qing2, XIE Ying-xin1
    2025, 46(1):  92-98.  doi:10.3969/j.issn.1007-3205.2025.01.016
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    Objective To investigate the relationship between quantitative parameters of acoustic radiation force impulse (ARFI) and hemodynamics in patients with atherosclerotic renal arterial stenosis (ARAS), and to analyze their value in combined evaluation of severity of renal artery stenosis. 
    Methods A total of 138 ARAS patients were selected as the observation group, and 138 healthy physical examinees were selected as the control group by 1〖DK〗∶1 principle. The shear wave velocity (SWV) of the renal cortex, renal medulla, and renal sinus, as well as the hemodynamic parameters of the renal aorta ［peak systolic velocity (PSV), end diastolic velocity (EDV), renal-aortic PSV ratio (RAR), renal-interlobar ratio (RIR)］ were recorded in two groups. Pearson analysis was used to assess the correlation between these parameters. Based on the degree of renal artery stenosis, patients were categorized into mild to moderate, and severe stenosis groups. The quantitative parameters of ARFI and hemodynamic parameters were compared among patients with different degrees of renal artery stenosis. The receiver operating characteristic (ROC) curve, area under ROC curve (AUC), net reclassification index (NRI), and integrated discrimination improvement (IDI) were used to evaluate the diagnostic efficiency of renal artery stenosis. 
    Results ①EDV, PSV, RAR, RIR, and SWV of the renal aorta, renal cortex, renal medulla, and renal sinus in the observation group ［(40.45±8.85) m/s, (151.12±35.35) m/s, (2.38±0.66), (7.55±2.26), (3.28±0.55) m/s, (2.40±0.46) m/s, (2.31±0.41) m/s, respectively］ were higher than those in the control group ［(25.62±4.41) m/s, (114.42±34.43) m/s, (1.70±0.48), (5.24±1.58), (2.66±0.43) m/s, (1.81±0.30) m/s, (1.88±0.33) m/s (P＜0.05), respectively］. ②In ARAS patients, the SWV of the renal cortex, renal medulla, and renal sinus was positively correlated with EDV, PSV, RAR, and RIR (P＜0.05). ③The SWV of renal cortex, renal medulla, renal sinus, and the EDV, PSV, AT, RAR, and RIR of renal aorta in patients with severe renal artery stenosis were higher than those in patients with mild to moderate renal artery stenosis (P＜0.05). ④The AUC of SWV in the renal cortex, renal medulla, and renal sinus, EDV, PSV, RAR, and RIR for diagnosing the degree of renal artery stenosis was 0.813, 0.827, 0.752, 0.809, 0.802, 0.758, and 0.819, respectively. The combination of SWV and hemodynamic parameters had the highest diagnostic accuracy for NRI and IDI, with AUC of 0.688 (95%CI: 0.450-0.971) and 0.089 (95%CI: 0.030-0.115), respectively. 
    Conclusion The SWV in the renal cortex, renal medulla, and renal sinus of ARAS patients shows high expression and is positively correlated with hemodynamic parameters. Combined detection is beneficial to improving the diagnostic efficiency of renal artery stenosis and guiding clinical diagnosis and treatment. 

    Gene detection and value of gray-scale ultrasound for predicting the prognosis and influencing factors analysis of ablation treatment in patients with colorectal liver metastasis
    SUN Yu1, ZHANG Chen-xue1, YAN Ji1, WU Xue-liang2, ZHANG Jian-feng3, WANG Li-kun4
    2025, 46(1):  99-107.  doi:10.3969/j.issn.1007-3205.2025.01.017
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    Objective To explore the key factors influencing progression-free survival (PFS) and overall survival (OS) after radical ablation therapy for metachronous liver metastases from colorectal cancer(CRC) from multiple dimensions, including genetic testing, clinical characteristics, and ultrasound indicators, to identify the primary prognostic risk factors for ablation treatment of colorectal liver metastases (CRLM) and to establish a predictive model. 
    Methods A retrospective, multicenter analysis was conducted, including 298 eligible patients with CRLM. These patients were randomly divided into a model training cohort (n=208) and a validation cohort (n=90). Clinical data, clinical characteristics of tumor, imaging, and routine laboratory indicators were collected for all patients. Univariate and multivariate Cox regression analyses were used to identify the main factors affecting prognosis in patients with CRLM. Based on the Cox model′s risk results, independent factors were assigned scores, and risk prediction nomograms were constructed to predict 1-year PFS and 3-year OS, followed by curve validation. 
    Results Univariate analysis identified patient gender, age, ultrasound grayscale values ≥100, and targeted therapy as factors associated with poorer PFS (P＜0.05). Multivariate analysis confirmed that male gender, age ≥60, value of gray-scale ultrasound ≥100, and targeted therapy were influencing factors of poorer PFS (P＜0.05). Similarly, univariate analysis showed that BRAF gene mutation and value of gray-scale ultrasound ≥100 were associated with poorer OS (P＜0.05). Multivariate analysis confirmed BRAF gene mutation and value of gray-scale ultrasound ≥100 as significant factors influencing OS (P＜0.05). Based on the model analysis of the training set data, several highly correlated variables were included in the prognostic model for radical ablation. Nomograms were developed to predict 1-year PFS and 3-year OS, where the overall probability of 1-year PFS was calculated as follows: 27.5×(female)+ 31×(age＜60)+100×(value of gray-scale ultrasound＜100)+ 22.5×(no targeted therapy). The 3-year OS probability was calculated as: 25×(BRAF wild-type) + 100×(value of gray-scale ultrasound＜100). The area under the ROC curve (AUC) of the 1-year PFS prediction model was 0.88 (95%CI: 0.76-1.00) in the training cohort and 0.81 (95%CI: 0.71-0.90) in the validation cohort. For the 3-year OS prediction model, the AUC value was 0.80 (95%CI: 0.66-0.94) in the training cohort and 0.54 (95%CI: 0.36-0.72) in the validation cohort. 
    Conclusion Value of gray-scale ultrasound, genetic mutations, and treatment modalities are influencing factors of PFS and OS in patients with metachronous liver metastases from CRC. By integrating these prognostic risk factors into a comprehensive model, it may effectively predict the medium-and long-term outcomes for these patients. 

    Clinical value of magnetic resonance imaging in the diagnosis of rotator cuff injury
    HE Ya-nan, WANG Cheng-jian, QU Bo, GUAN Hao-tian, ZHANG Xiang-chen, SHI Xiang-ming
    2025, 46(1):  108-112.  doi:10.3969/j.issn.1007-3205.2025.01.018
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    Objective To explore the clinical value of magnetic resonance imaging (MRI) in the diagnosis of rotator cuff injury. 
    Methods One hundred and twenty patients with suspected rotator cuff injury were selected, and all of them were given MRI examination, to analyze the value of MRI in the diagnosis of rotator cuff injury. In the meantime, patients with confirmed rotator cuff injury were given non-surgical treatment, and the difference of clinical imaging data between patients with effective and ineffective treatment were compared. 
    Results The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRI in diagnosing rotator cuff injury were 98.04%, 94.44%, 97.50%, 99.01% and 89.47%, respectively. The detection rates of infraspinatus tendon injury and subscapular tendon injury in oblique coronal scan were 52.94% and 49.02%, respectively, which were significantly lower than those in axial and oblique sagittal scan (P＜0.05). The detection rate of supraspinatus tendon injury in oblique sagittal scan was 77.45%, which was significantly lower than that in oblique coronal scan (P＜0.05). The detection rates of teres minor tendon injury in axial and oblique coronal scan were 7.84% and 13.73%, respectively, which was significantly lower than those in oblique sagittal scan (P＜0.05). The age of patients with ineffective treatment was (65.54±7.03) years, and the retraction distance of supraspinatus muscle was (24.41±5.93) mm, which were significantly higher than those in patients with effective treatment (P＜0.05). The degree of subscapular muscle tear in patients with ineffective treatment was significantly greater than that in patients with effective treatment (P＜0.05), and the complete tear ratio was 80.95%. Logistic regression analysis showed that age, and degree of subscapular muscle tear were the influencing factors of non-surgical treatment effect in patients with rotator cuff injury (P＜0.05). Logistic regression model was constructed, and the area under the ROC curve of the model in predicting ineffective treatment was 0.813 (95%CI: 0.728-0.898, P＜0.05), with sensitivity and specificity of 88.00% and 64.50%, respectively. 
    Conclusion MRI has high sensitivity and specificity in the diagnosis of rotator cuff injury, and the MRI parameter, subscapular muscle tear, is related to the effect of non-surgical treatment, which is worthy of further study.