Loading...

Table of Content

    25 March 2025, Volume 46 Issue 3
    Previous Issue   
    Application value of four-dimensional automated left atrial quantification in evaluating left atrial substrate in patients with paroxysmal atrial fibrillation
    ZHANG Xu-qian, TONG Qiao-li, WANG Jing, ZHANG Sheng-nan, YIN Hong-ning
    2025, 46(3):  254-260.  doi:10.3969/j.issn.1007-3205.2025.03.002
    Asbtract ( 141 )   PDF (1273KB) ( 65 )  
    Related Articles | Metrics
    Objective To evaluate the left atrial substrate in patients with paroxysmal atrial fibrillation (PAF) using four-dimensional automated left atrial quantification (4D Auto LAQ). 
    Methods A total of 59 patients with PAF who underwent voltage mapping of the left atrial substrate and radiofrequency ablation in the Second Hospital of Hebei Medical University were included in this study. Based on the voltage mapping results, patients were divided into the non-low voltage group (n=35) and the low voltage group (n=24). General clinical data, conventional echocardiogram parameters, left atrial strain and related parameters were compared between the two groups. The relevant factors were obtained by Logistic regression analysis. The parameters with the highest predictive value for left atrial low voltage and its cut-off value were determined by the area under receiver operating characteristic (ROC) area under curve (AUC). 
    Results The mean age, CHA2DS2-VASc score, left atrial diameter (LAD), left atrial volume index (LAVI), left atrial maximal volume (LAVmax), left atrial minimal volume (LAVmin), and left atrial stiffness (LA stiffness) of the low voltage group were higher than those in the non-low voltage group. Left atrial total emptying fraction (LAEF), left atrial reservoir longitudinal strain (LASr), left atrial conduit longitudinal strain (LAScd), left atrial contraction longitudinal strain (LASct), left atrial reservoir circumferential strain (LASr-c), left atrial conduit circumferential strain (LAScd-c) and left atrial contraction circumferential strain (LASct-c) were lower in low voltage group than in the non-low voltage group (P＜0.05). Multivariate logistic regression analysis showed that after correcting for factors such as gender, the above indicators were still correlated with the presence or absence of low voltage, and the LASr had the highest predictive value (AUC=0.904, with the optimal cut-off value of 18.50%, sensitivity of 82.9%, and specificity of 83.3%). 
    Conclusion LASr aids in non-invasive preoperative evaluation of left atrial substrate in PAF patients. 

    Application value of carotid artery pulse wave velocity in assessing renal damage in patients with hypertensive nephropathy
    WANG Yun, MI Ya-ru, WANG Yuan-yuan, DENG He-ping
    2025, 46(3):  261-266.  doi:10.3969/j.issn.1007-3205.2025.03.003
    Asbtract ( 171 )   PDF (1118KB) ( 104 )  
    Related Articles | Metrics
    Objective To explore the application potential of pulse wave velocity (PWV) measurement in evaluating renal dysfunction in patients with hypertensive nephropathy (HN). 
    Methods Clinical data of 60 patients with chronic HN, 60 patients with hypertension but without kidney damage, and 30 healthy control subjects who underwent physical examinations were selected. The demographic characteristics and laboratory indicators, including blood pressure, fast plasma glucose (FPG), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and other parameters, were collected. UFI ultrasound technology was used to determine carotid PWV ［beginning of systole PWV (BS-PWV) and end of systole PWV (ES-PWV)］, and the differences between different groups were compared. 
    Results The SBP, DBP, FPG, TG, TC, and LDL-C of the hypertension group and hypertensive kidney injury group were higher than those of the healthy control group, while HDL-C was lower than that of the healthy control group (P＜0.05). There was no significant difference in SBP, DBP, FPG, TG, TC, LDL-C, and HDL-C between the hypertension group and hypertensive kidney injury group (P＞0.05). There was no significant difference in renal filtration rate between the healthy control group and the hypertension group (P＜0.05), while the renal filtration rate in the hypertensive kidney injury group was higher than that in the healthy control group and the hypertension group (P＜0.05). The BS-PWV and ES-PWV were higher in the hypertension group and hypertensive kidney injury group than in the healthy control group, and higher in the hypertensive kidney injury group than in the hypertension group (P＜0.05). The Pearson correlation analysis results showed that as the glomerular filtration rate decreased, BS-PWV and ES-PWV gradually increased (P＜0.001). 
    Conclusion PWV serves as a non-invasive diagnostic indicator, demonstrating a strong association with glomerular filtration rate. Its clinical implications in monitoring and predicting renal damage in hypertensive individuals, particularly in the prevention of HN, are found to be substantial. 

    Relationship between left ventricular four-dimensional myocardial strain and improvement of cardiac function in patients with coronary heart disease after coronary artery bypass grafting and its predictive value
    CHEN Hong, LUO Fu-xue
    2025, 46(3):  267-273.  doi:10.3969/j.issn.1007-3205.2025.03.004
    Asbtract ( 102 )   PDF (712KB) ( 41 )  
    Related Articles | Metrics
    Objective To analyze the relationship between left ventricular four-dimensional myocardial strain and cardiac function improvement after coronary artery bypass grafting (CABG) in patients with coronary heart disease(CHD) and its predictive value. 
    Methods A total of 120 patients with CHD who underwent elective CABG at Bishan Hospital Affiliated to Chongqing Medical University were selected. The improvement of cardiac function at 6 months after surgery was statistically analyzed, and the patients were divided into the improvement group (with improved cardiac function) and the non-improvement group (without improvement in cardiac function). The preoperative left ventricular function indicators ［left ventricular ejection fraction (LVEF), left atrial area (LAA), left ventricular end-diastolic diameter (LVEDD), left ventricular mass index (LVMI)］ and left ventricular four-dimensional myocardial strain parameters ［global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), global area strain (GAS)］ were compared between the two groups. The correlation between preoperative left ventricular four-dimensional myocardial strain parameters and postoperative cardiac function improvement in patients with CHD undergoing CABG was analyzed, and the value of preoperative left ventricular four-dimensional myocardial strain parameters in predicting postoperative cardiac function improvement in patients with CHD undergoing CABG was also analyzed. 
    Results In patients with CHD who underwent CABG, 84 patients showed improvement in cardiac function at 6 months after surgery, with an improvement rate of 70.00%. The preoperative LVEF and GRS were lower in the non-improvement group than in the improvement group, while LVEDD, LVMI, GLS, GCS, and GAS were higher in the non-improvement group than in the improvement group (P＜0.05). Preoperative GLS (OR=1.330, 95%CI: 1.123-1.576), GCS (OR=1.195, 95%CI: 1.075-1.328), GRS (OR=0.879, 95%CI: 0.815-0.947), and GAS (OR=1.221, 95%CI: 1.102-1.352) were significantly associated with postoperative cardiac function improvement (P＜ 0.05). The area under the curve (AUC) values of preoperative GLS, GCS, GRS, GAS, LVEF, LVEDD, and LVMI for predicting postoperative cardiac function improvement were 0.761 (95%CI: 0.675-0.834), 0.757 (95%CI: 0.671-0.831), 0.758 (95%CI: 0.671-0.831), 0.755 (95%CI: 0.668-0.829), 0.759 (95%CI: 0.673-0.833), 0.757 (95%CI: 0.670-0.831), and 0.751 (95%CI: 0.664-0.826), respectively. No significant differences were observed in the AUC values of preoperative GLS, GCS, GRS, and GAS, as well as LVEF, LVEDD, and LVMI for predicting postoperative cardiac function improvement (P＞0.05). The AUC for predicting postoperative cardiac function improvement in patients with CHD after CABG, using a combination of preoperative GLS, GCS, GRS, and GAS, was 0.896 (95%CI: 0.828-0.945), which was higher than that predicted by preoperative GLS, GCS, GRS, and GAS alone (P＜0.05). 
    Conclusion Left ventricular four-dimensional myocardial strain parameters before CABG are significantly correlated with postoperative cardiac function improvement in patients with CHD, and can help predict the improvement of cardiac function. 

    Comparison of the effect of ultrasound-guided suprascapular nerve block and intermuscular sulcus brachial plexus nerve block combined with general anesthesia in arthroscopic shoulder surgery
    WEN Wei-hong, WEN Xiao-lin, HE Ying-qin
    2025, 46(3):  274-280.  doi:10.3969/j.issn.1007-3205.2025.03.005
    Asbtract ( 120 )   PDF (460KB) ( 106 )  
    Related Articles | Metrics
    Objective To compare the clinical effect of ultrasound-guided suprascapular nerve block (SSB) combined with general anesthesia and interscalene brachial plexus block (ISB) combined with general anesthesia in arthroscopic shoulder surgery. 
    Methods In total, 91 patients who underwent arthroscopic shoulder surgery at People′s Hospital of Xindu District in Chengdu, Sichuan Province and First Affiliated Hospital of Chengdu Medical College were selected and randomly divided into the ISB group (ultrasound-guided ISB combined with general anesthesia, n=45) and the SSB group (ultrasound-guided SSB combined with general anesthesia, n=46) using a computer-generated random number table. The heart rate (HR), mean arterial pressure (MAP), anesthetic dosage, surgical duration, and length of recovery room stay between the two groups at the time of entry, at 30 min after surgery, and after surgery were compared. The pain levels, wrist flexion strength, and elbow flexion strength between the two groups at 1, 6, 12, and 24 h after surgery were compared. The stress response and differences in inflammatory mediator indicators between the two groups before and at 24 h after surgery and complications in the two groups were compared. 
    Results HR and MAP in both groups were decreased at 30 min after the initiation of surgery compared with preoperative levels, and then increased at the end of the surgery. There was no significant difference between the two groups, but there were significant differences in the interaction between time points, groups, and time points between groups (P＜0.001). The success rate of nerve block in both groups was 100%, with no occurrence of nerve block failure or repeated nerve block. There was no significant difference in the dosage of propofol and remifentanil, surgical duration, and the length of recovery room stay between the two groups (P＞0.05). The visual analogue scale (VAS) scores of postoperative pain in the two groups showed a decreasing trend with the prolongation of time, with the ISB group showing a more significant downward trend than the SSB group. There were significant differences in the interaction between groups, time points, and time points between groups (P＜0.001). The wrist and elbow flexion strength of the two groups were gradually increased with the prolongation of time; there was no significant difference between groups (P＞0.05), but there were significant differences in the interaction between time points, groups, and time points between groups (P＜0.001). The differences in aldosterone (ALD) and adrenocorticotropic hormone (ACTH) levels before and at 24 h after surgery in the ISB group were significantly higher than those in the SSB group, showing significant differences (P＜0.05). The difference in interleukin-6 (IL-6) and prostaglandin E2 (PGE2) levels before and at 24 h after surgery in the ISB group was higher than that in the SSB group, suggesting significant differences (P＜0.05). Both groups did not experience nerve damage or arterial injury. The incidence of phrenic nerve paralysis in the SSB group was lower than that in the ISB group, showing significant differences (P＜0.05). There was no significant difference in the incidence of recurrent laryngeal nerve paralysis and stellate ganglion block between the two groups (P＞0.05). 
    Conclusion Compared with ultrasound-guided ISB combined with general anesthesia, SSB combined with general anesthesia in arthroscopic shoulder surgery can reduce postoperative stress and inflammatory responses, enhance wrist and elbow flexion strength, and reduce fewer complications. However, its early postoperative analgesic effect is less pronounced than that of ISB combined with general anesthesia. 

    Modeling of precancerous esophageal lesions induced by NMBA in rats of different genders and analysis of intestinal microbiota and metabolomics
    ZHANG Chen-chen, LIU Ya-ping, GAO Xiao-lu, WANG Zhi-chao, LI Sheng-chao, SHI Hui-juan
    2025, 46(3):  291-297.  doi:10.3969/j.issn.1007-3205.2025.03.008
    Asbtract ( 97 )   PDF (2273KB) ( 74 )  
    Related Articles | Metrics
    Objective To explore the difference of intestinal microbiota and metabonomics between male and female rats in the preparation of precancerous esophageal lesion models. 
    Methods N-Nitorsos-N-methyl-4-aminobutyric Acid (NMBA) solution (0.30 mg/kg) was subcutaneously injected into female rats and male rats every 3 days. The rats in the control group were not induced, and HE staining was used to observe the pathological histology of esophageal mucosa in each group. Total DNA was extracted from the contents in the cecum of rats, and 16S rRNA gene sequencing and bioinformatics analysis were used to analyze the α and β diversity and then obtain the different bacteria between groups. Non-targeted metabonomics was used to detect metabolites of plasma. 
    Results The HE staining results of rat esophageal epithelium showed that after 40 weeks of treatment with NMBA, male rats showed more stable modeling compared with female rats. The 16S rRNA gene sequencing results showed that there was no significant difference in species abundance and evenness of the samples between the two groups, while there were significant differences in the number and distribution of each community. At the genus level, there were significant differences in the expression of intestinal microbiota between the female and male mouse model groups. The metabolomics results showed that there were significant differences in blood metabolism between the male and female mouse model groups, and the metabolites with significant differences were mainly concentrated in oxidized lipids and bile acids. 
    Conclusion There are significant differences in intestinal microbiota and metabolomics between female and male mice in the preparation of esophageal precancerous lesion models. 

    Clinical analysis on 40 patients with subacute combined degeneration of the spinal cord
    AN Hong, QIN Wei, MENG Xiang-long, LU Ming, DONG Qian, HU Wen-li
    2025, 46(3):  298-303.  doi:10.3969/j.issn.1007-3205.2025.03.009
    Asbtract ( 136 )   PDF (1743KB) ( 81 )  
    Related Articles | Metrics
    Objective To investigate the etiology, clinical features, laboratory examinations and imaging characteristics of subacute combined degeneration (SCD) of the spinal cord. 
    Methods Clinical data of patients diagnosed with SCD in our department from May 2015 to October 2022 were analyzed retrospectively. In this study, 22 males and 18 females were included. According to the etiology, the patients were divided into vitamin B12 deficiency group (n=34) and nitrous oxide (N2O) abuse group (n=6). 
    Results The clinical course of SCD was subacute or chronic. Most patients began with paresthesia and/or limb weakness. Cognitive impairment occurred in a small number of patients and was more significant in N2O abuse group. Laboratory tests showed decreased vitamin B12 level in most patients, accompanied by decreased folate, megaloblastic anemia, hyperhomocysteinemia, and positive anti-internal factor antibodies or anti-parietal cell antibodies. Spinal MRI revealed that the lesions mostly involved the posterior and lateral cord of cervical and thoracic spinal cord, which was characterized by an "inverted V sign" on the axial T2WI. Most patients achieved improvement in symptoms and signs after vitamin B12 treatment. 
    Conclusion SCD of the spinal cord is closely related to vitamin B12 deficiency. N2O abuse is a common cause in young patients with SCD. The clinical manifestations of SCD are complicated and varied, and spinal "inverted V sign" is an important evidence for diagnosis. Early diagnosis and standard treatment are the key to obtaining a good prognosis. 

    Comparison of serum levels of MMP-9, SAA and TPS-2 in patients with acute pancreatitis of different severity
    WANG Chen-chen, ZOU Xue-fei, CHEN Nan
    2025, 46(3):  304-308.  doi:10.3969/j.issn.1007-3205.2025.03.010
    Asbtract ( 95 )   PDF (505KB) ( 33 )  
    Related Articles | Metrics
    Objective To investigate the changes of serum matrix metalloproteinase-9 (MMP-9), serum amyloid A (SAA) and trypsinogen-2 (TPS-2) levels in patients with acute pancreatitis (AP) of different severity. 
    Methods A retrospective analysis was conducted on the clinical data of 84 patients with AP admitted to Liaocheng People′s Hospital in Shandong Province. Based on their Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores, the patients were divided into the severe group (APACHE Ⅱ score ≥ 8 points, n=30) and the mild group (APACHE Ⅱ score＜8 points, n=54). Additionally, 50 healthy physical examinees were selected as controls. The differences in MMP-9, SAA, and TPS-2 between the patient group and the control group were compared, and the general information and serum MMP-9, SAA, and TPS-2 levels of patients with different severity were observed. The risk factors for the progression of AP to severe AP were identified through multiple Logistic regression analysis. Receiver operating characteristic (ROC)curve was used to analyze the value of serum MMP-9, SAA, and TPS-2 in predicting severe AP. 
    Results Serum levels of MMP-9, SAA and TPS-2 in patient group were significantly higher than those in control group (P＜0.05). The serum levels of MMP-9, SAA and TPS-2 in the severe group were (610.48±178.25) μg/L, (597.67±168.49) mg/L and (244.56±80.11) kU/L, respectively, which were significantly higher than those in the mild group ［(346.77±113.23) μg/L, (339.78±107.66) mg/L, (64.76±21.07) kU/L］ (P＜0.05). Multivariate Logistic regression analysis showed that high levels of serum MMP-9 (OR=2.688, 95%CI: 1.351-5.348), SAA (OR=3.273, 95%CI: 1.509-7.099), and TPS-2 (OR=2.817, 95%CI: 1.418-5.596) were the risk factors for the progression ofAP to severe AP in patients (P＜0.05). ROC analysis showed that the area under the ROC curve (AUC) of serum MMP-9, SAA and TPS-2 in predicting severe AP was 0.831, 0.888 and 0.841, respectively, the sensitivity was 0.767, 0.800 and 0.733, respectively, and the specificity was 0.833, 0.926 and 0.870, respectively (all with P＜0.05). 
    Conclusion Serum MMP-9, SAA, and TPS-2 levels can predict the severity of AP to a certain extent, and can be used as serum indexes to predict severe AP. 

    Double reverse traction versus open reduction for tibial plateau fractures: A Meta-analysis
    LIANG Hao, HUO Yu-hang, WANG Shuang, CONG Long-xu, FAN Xiao-long, WANG Yu-lu
    2025, 46(3):  309-316.  doi:10.3969/j.issn.1007-3205.2025.03.011
    Asbtract ( 105 )   PDF (4188KB) ( 21 )  
    Related Articles | Metrics
    Objective To compare the therapeutic outcomes of double reverse traction-assisted minimally invasive closed reduction with plate fixation and open reduction with plate fixation in the treatment of tibial plateau fractures. 
    Methods Constructed search equations to search across databases such as PubMed, Cochrane Library, EMbase, Web of Science, and Chinese databases including CNKI, Wanfang, VIP, and the China Biomedical Literature Service System for literature on the treatment of tibial plateau fractures via double reverse traction-assisted minimally invasive closed reduction and open reduction. The timeframe for our search was from the inception of these databases until April 2024. Two separate researchers conducted the literature quality assessment and data extraction, with data analysis performed using RevMan 5.3 software. 
    Results Our study encompasses seven articles, involving a total of 511 patients, of whom 234 were treated with the minimally invasive method and 277 with the open reduction method. The findings indicated that the minimally invasive group demonstrated superior outcomes in terms of intraoperative blood loss (MD=-2.55, 95%CI: -3.94--1.17, P＜0.01), length of hospitalization (MD=-0.54, 95%CI: -0.75--0.33, P＜0.01), Hospital for Special Surgery (HSS) score (MD=0.71, 95%CI: 0.50-0.910, P＜0.01), fracture healing time (MD=-0.39, 95%CI: -0.70--0.08, P=0.01), incidence of complications (OR=0.30, 95%CI: 0.16-0.57, P＜0.01), and wound complications (OR=0.26, 95%CI: 0.10-0.68, P=0.006) when contrasted with the open reduction group. However, both techniques showed comparable duration of operation (MD=0.03, 95%CI: -1.54-1.61, P＞0.05), postoperative weight-bearing time (MD=-0.92, 95%CI: -2.14--0.3, P=0.14) or the incidence of deep vein thrombosis in the lower limbs (OR=0.78, 95%CI: 0.31-2.00, P=0.61). 
    Conclusion Double reverse traction-assisted minimally invasive closed reduction plate fixation presents enhanced efficacy in the management of tibial plateau fractures relative to open reduction withplate internal fixation. 

    Repair of diabetic foot wounds with periwound flaps and analysis of prognostic factors
    YAN Chang-bao, ZHANG Jie, GENG Yi-he, LIU Da-fang, WANG Yan-yang, ZHAO Liang
    2025, 46(3):  317-322.  doi:10.3969/j.issn.1007-3205.2025.03.012
    Asbtract ( 111 )   PDF (1100KB) ( 47 )  
    Related Articles | Metrics
    Objective To explore the preliminary clinical effect of periwound flap in the treatment of diabetic foot. 
    Methods From January to June 2022, 52 patients diagnosed with diabetic foot in Beijing Luhe Hospital Affiliated to Capital Medical University were retrospectively analyzed. All patients underwent repair of diabetic foot wound susing periwound flaps. The general data were analyzed, and primary wound healing rate, ulcer reappear rate, ulcer recurrence rate, ankle amputation rate, incidence of adverse events, and wound healing time were compared among the groups. The risk factors affecting the prognosis of patients were analyzed. 
    Results The overall primary wound healing rate was 96.20%, the ulcer reappear rate was 9.60%, the ulcer recurrence rate was 3.80%, the ankle amputation rate was 1.90%, the incidence of adverse events was 11.50%, and the healing time was （44.52±14.85） d. The primary wound healing rate of patients with cerebral infarction (83.30%) was significantly lower than that of patients without cerebral infarction (100%, P=0.050). The recurrence rate of ulcer in patients aged ≤60 years was 28.60%, which was significantly higher than 2.60% in patients aged >60 years (P=0.022). The recurrence rate of ulcer in patients with coronary heart disease(CHD) (16.70%) was significantly higher than that in patients without CHD (0%) (P=0.050). The wound healing time of patients with Wagner3 was （37.32±10.54） d, which was significantly shorter than that of patients with Wagner4 ［(48.59±13.07） d, P=0.001］. There was no significant difference in the prognostic indicators between ischemic and non-ischemic diabetic foot. Regression analysis showed that age ≤60 years was an independent risk factor for ulcer recurrence (P=0.022). Higher Wagner grade was an independent risk factor for prolonged wound healing time (P=0.001). 
    Conclusion Periwound flap represents an effective method for rapid closure of diabetic foot wounds. In the meantime, attention should be paid to the non-foot comorbidities of diabetic foot and the diagnosis and management of peripheral vascular diseases in these patients. 

    Construction and validation of risk model for fetal growth restriction in patients with gestational diabetes
    DING Ai-ping, WANG Wen-li
    2025, 46(3):  323-328.  doi:10.3969/j.issn.1007-3205.2025.03.013
    Asbtract ( 128 )   PDF (642KB) ( 149 )  
    Related Articles | Metrics
    Objective To explore the risk factors of fetal growth restriction (FGR) in patients with gestational diabetes, and to construct and validate the risk prediction model. 
    Methods The medical records of 256 pregnant women with gestational diabetes who delivered in Changzhou Maternal and Child Health Hospital from December 2018 to December 2023 were retrospectively analyzed, and were divided into training set (n=204) and validation set (n=52) according to an 8〖DK〗∶2 ratio. According to restriction of FGR, they were divided into abnormal group and normal group, the risk factors of FGR in patients with gestational diabetes were screened, and the risk prediction model was constructed and verified. 
    Results Among 204 patients with gestational diabetes, 22 had intrauterine growth restriction (IUGR), with an incidence of 10.78% (22/204). The glycated hemoglobin A1c (HbA1c), systolic peak velocity (S)/diastolic peak velocity (D), resistance index (RI), and soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) of the abnormal group were higher than those of the normal group (P＜0.05), and the flow mediated dilation (FMD) of the brachial artery was lower than that of the normal group (P＜0.05). HbA1c (OR=3.601, 95%CI: 1.511-8.578), S/D (OR=3.307, 95%CI: 1.388-7.879), RI (OR=3.714, 95%CI: 1.558-8.848), sVEGFR-1 (OR=3.425, 95%CI: 1.437-8.159), FMD (OR=0.212, 95%CI: 0.089-0.506) were risk factors for FGR in patients with gestational diabetes (P＜0.05). The sensitivity of the risk model to predict the occurrence of FGR in diabetic patients during pregnancy in the training set was 0.823 (95%CI: 0.729-0.908), the specificity was 0.826 (95%CI: 0.751-0.916), and the area under the curve (AUC) was 0.884 (95%CI: 0.819-0.945). The sensitivity, specificity, and AUC of the risk model for predicting the occurrence of FGR in pregnant women with diabetes were 0.731 (95%CI: 0.643-0.861), 0.825 (95%CI: 0.712-0.907), and 0.818 (95%CI: 0.726-0.913) respectively. 
    Conclusion The changes of HbA1c, S/D, RI, sVEGFR-1 and FMD levels are related to the occurrence of FGR in patients with gestational diabetes. Constructing a risk prediction model is helpful to identify the risk of FGR at an early stage. 

    Study on the characteristics of intestinal flora in children with sepsis and its correlation with the severity of the disease
    CAO Li-jing, XU Mei-xian, ZHANG Hui-fen, LYU Zhao-yi, BAI Xin-feng
    2025, 46(3):  329-335.  doi:10.3969/j.issn.1007-3205.2025.03.014
    Asbtract ( 112 )   PDF (2066KB) ( 56 )  
    Related Articles | Metrics
    Objective To explore the characteristics of changes in gut microbiota diversity in children with sepsis and its correlation with the severity of the disease. 
    Methods Fifteen children who met the diagnosis of sepsis and were admitted to the Department of Intensive Care Medicine in our hospital were selected as the research subjects, and 28 infected but non-sepsis children admitted to the pediatric intensive care unit (PICU) during the same period were selected as the control group. The feces of the patients on the first day of admission was collected, to extract the microbial DNA from the feces, and the 16S rDNA gene was amplified. Through Illumina sequencing platform, species annotation, diversity, and species difference analysis were performed on the sequencing results. The pediatric risk of mortality score Ⅲ (PRISM Ⅲ) and pediatric critical illness score (PCIS) for pediatric patients were recorded. The composition of gut microbiota in the two groups was compared and their correlation with the disease score were analyzed. 
    Results The PCIS score of the sepsis group ［78(8)］ was lower than that of the non-sepsis group ［90(12)］, and the PRISM Ⅲ score ［16(16)］ was higher than that of the non-sepsis group ［12(9)］ (P＜0.05). Stool samples of the two groups were sequenced and a total of 1 489 022 valid sequences were detected. The gut microbiota abundance index ［Ace index (99.458±38.948), Chao index (99.400±38.943)］, and gut microbiota diversity index ［Shannon index (3.647±.411)］ in the sepsis group were lower than those in the non-sepsis group ［Ace index (107.879±25.242), Chao index (107.893±25.238), and Shannon index (4.125±1.160)］. Principal Coordinated Analysis (PCoA) analysis showed that the distribution of microbiota in the sepsis group and non-sepsis group showed relative concentration within the group and relative separation between the groups, and the difference in microbiota structure between the two groups of stool samples was significant (P＜0.05). There were significant differences in the structure of the dominant gut microbiota between the two groups at the phylum, class, and genus levels (P＜0.05). At the phylum and class levels, Acidobacterium and Halophilic Bacteroides were positively correlated with PRISM Ⅲ scores and negatively correlated with PCIS scores (P＜0.05). 
    Conclusion The diversity and abundance of gut microbiota in children with sepsis are lower than those in non-sepsis children. The proportion of enterococci in the sepsis group is significantly higher than that in the non-sepsis group, and the proportion of pathogenic bacteria increases significantly. The imbalance of gut microbiota is correlated with the severity of the disease. 

    Characteristics of EIF2AK3 gene polymorphism in children with short stature and its correlation with changes in Ghrelin, Nesfatin-1, IGF-1 and bone metabolism indexes before and after treatment with different doses of growth hormone
    SU Dan, YU Xin, PAN Dong-ning
    2025, 46(3):  336-341.  doi:10.3969/j.issn.1007-3205.2025.03.015
    Asbtract ( 105 )   PDF (425KB) ( 75 )  
    Related Articles | Metrics
    Objective To investigate the characteristics of eukaryotic translation initiation factor 2-alpha kinase 3 (EIF2AK3) gene polymorphism in children with short stature and its correlation with the changes in Ghrelin, Nesfatin-1, insulin-like growth factor-1 (IGF-1) and bone metabolism indexes before and after treatment with different doses of growth hormone. 
    Methods In total, 126 patients with short stature were selected as research subjects. The envelope method was used to randomly divide the above patients into groups A, B and C, and 126 healthy volunteers undergoing physical examination during the same period were selected as control group. The therapeutic dose was 0.26 mg/kg in group A, 0.35 mg/kg in group B, and 0.41mg/kg in group C. The polymorphism characteristics of EIF2AK3 gene in children with short stature were analyzed, and the changes in GHRL, Nesfatin-1, IGF-1 and bone metabolism indexes treated with different doses of growth hormone were also analyzed. 
    Results By analyzing the EIF2AK3 gene polymorphism in the control group and the observation group, it was found that there were significant differences in the genotypes and allele frequencies of rs1805165, rs13045, rs867529, and rs11684404 in the EIF2AK3 gene in both groups (P＜0.05). The analysis showed that mutations in T allele of rs1805165, G allele of rs13045, G allele of rs867529, and C allele of rs11684404 could lead to the onset of short stature. The differences in height ［(111.35±3.85) vs. (112.82±2.9) vs. (114.81±3.88) cm］, height standard deviation ［(2.37±0.82) vs. (1.86±0.77) vs. (1.56±0.78)］, growth rate ［(8.09±3.17) vs. (9.22±3.03) vs. (11.11±3.89) cm/year］, bone age ［(10.49±3.61) vs. (10.8±3.79) vs. (11.75±2.88) years］, height gain ［(1.31±0.26) vs. (1.32±0.58) vs. (1.37±0.64) cm］, predicted adult height ［(155.75±3.07) vs. (158.4±3.75) vs. (160.99±3.07) cm］, and genetic target height ［(156.57±2.54) vs. (159.01±2.59) vs. (161.49±2.49) cm］ after one year of treatment differed significantly among the three groups (P＜0.05). Through pairwise comparisons, it was found that as the dosage of growth hormone increased, the height, height standard deviation, growth rate, bone age, height age, height gain, predicted adult height and genetic target height of the patients in the three groups showed a significant upward trend. The GHRL, Nesfatin-1, and IGF-1 in all three groups improved significantly. Furthermore, with an increase in the doses of treatment, GHRL ［(250.76±2.73) vs. (245.22±3.49) vs. (240.74±2.65) ng/L］ decreased significantly while Nesfatin-1 ［(0.10±0.02) vs. (0.15±0.03) vs. (0.20±0.02) μg/L］ and IGF-1 ［(218.35±3.87) vs. (227.23±3) vs. (300.09±3.97) μg/L］ increased significantly in patients. 
    Conclusion The polymorphism of EIF2AK3 gene in children with short stature is mainly manifested in rs1805165, rs13045, rs867529, rs11684404 mutations. With the increase of the dose of growth hormone for patients, its therapeutic effect is significant. 

    Effect of stellate ganglion block combined with epidural block using low-concentration ropivacaine on perioperative analgesia in patients undergoing radical resection of ovarian cancer
    LIU Ru-yu, ZHANG Pan-pan, WANG Wen-hui, FU Yao
    2025, 46(3):  342-348.  doi:10.3969/j.issn.1007-3205.2025.03.016
    Asbtract ( 109 )   PDF (466KB) ( 30 )  
    Related Articles | Metrics
    Objective To investigate the perioperative analgesic effect of stellate ganglion block combined with epidural block using low-concentration ropivacaine in patients with ovarian cancer undergoing radical resection. 
    Methods A total of 118 ovarian cancer patients admitted to the Third Hospital of Shandong Province were selected and divided into research group (n=59) and control group (n=59) by random number table method. All patients underwent radical resection of ovarian cancer and were given general intravenous anesthesia. The control group received epidural block using low-concentration ropivacaine before surgery, while the research group received stellate ganglion block combined with epidural block using low-concentration ropivacaine (planetary ganglion block before epidural block). Postoperative analgesia, visual analog scale (VAS) score, hemodynamics ［heart rate (HR), mean arterial pressure (MAP)］, stress response ［cortisol (Cor) and adrenocorticotropin (ACTH)］, immune function ［CD3+, CD4+, natural killer cells (NK)］, and adverse drug reactions were compared between the two groups. 
    Results The number of effective analgesic pump, the rate of relief analgesia and the dosage of sufentanil in the research group were (3.20±0.41) times, 10.17% and (55.27±6.85) μg, respectively, which were lower than those in the control group (P＜0.05). The VAS scores of the research group were (2.19±0.36), (1.43±0.29) and (0.72±0.15) at 2 h, 24 h and 48 h after surgery, respectively, which were lower than those in the control group (P＜0.05). HR and MAP of the research group were (80.10±6.18) times/min and (85.36±6.10) mmHg （1 mmHg=0.133 kPa） respectively immediately after intubation (T1) and at 1 h (T2) after initiation of surgery, which were lower than those in thecontrol group (P＜0.05). The Cor and ACTH of the research group at 24 h after surgery were (342.07±43.79) nmol/L and (16.29±3.74) ng/L, respectively, which were lower than those in the control group (P＜0.05). The CD3+, CD4+ and NK cells in the research group were (53.27±5.12) %, (29.42±3.07) % and (21.18±3.16) %, respectively, which were higher than those in the control group (P＜0.05). There was no difference in the total incidence of adverse drug reactions between the two groups (P＞0.05). 
    Conclusion Epidural block using low-concentration ropivacaine combined with stellate ganglion block has a definite perioperative analgesic effect in patients receiving radical resection of ovarian cancer, which can alleviate stress response, improve postoperative short-term immunosuppression, reduce the use of analgesic drugs, maintain intraoperative hemodynamics, and do not increase the risk of adverse drug reactions. 

    A study on the current status and influencing factors of medical humanistic care ability of clinicians in grade-A tertiary hospitals in Hebei Province
    FAN Ying-ying, LI Zi-qi, LIU Jia-wen, XIE Jin, LIU Yun
    2025, 46(3):  349-354.  doi:10.3969/j.issn.1007-3205.2025.03.017
    Asbtract ( 155 )   PDF (409KB) ( 143 )  
    Related Articles | Metrics
    Objective To understand the current status of medical humanistic care ability of clinicians and to analyze its influencing factors. 
    Methods Using convenience sampling method, a questionnaire survey was conducted on 472 clinicians from some grade-A tertiary hospitals in Hebei Province. Univariate analysis was performed using rank sum test, and for factors with significant difference, multiple stepwise linear regression analysis was further used to analyze the influencing factors. 
    Results The overall average score of medical humanistic care ability of clinicians was (4.101±0.413) points, which was above the average level. The dimension with the highest score was medical service, which was (4.453±0.518) points, and that with the lowest score was the humanistic environment, which was (3.907±0.459) points. Multiple stepwise linear regression analysis showed that the main influencing factors of medical humanistic care ability were "evaluation of one′s own medical humanistic care ability", "years of work", "support and care provided by colleagues and leaders", "emphasis on employee respect, care for patients, and protection of patient rights in the hospital", and "love for the doctor profession" (P＜0.05). 
    Conclusion The medical humanistic care ability of clinicians is above average. Hospitals should establish a mechanism for mentoring, creating a growth environment for young doctors, strengthen the construction of hospital humanistic environment, creating a good departmental atmosphere, promote continuing medical education and humanistic training, build a learning platform for clinical doctors, and enhance their humanistic care abilities through various means.