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2026 Vol. 24, No. 6

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General Practice Forum
Experience sharing on enhancing surgical treatment capabilities of community hospitals at the grassroots level in Shanghai
FANG Yuan, CAO Jinfeng, GU Chunfei, WANG Wei, HUANG Chen
2026, 24(6): 903-906. doi: 10.16766/j.cnki.issn.1674-4152.004518
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As a mega-city, Shanghai is home to over 24 million permanent residents, for whom community hospitals serve as the frontline provider of healthcare. As a critical public health interface for the general population, the surgical competence of community hospitals directly impacts patients' health and safety. Current challenges in community hospitals include outdated and inadequate surgical hardware, a shortage of specialized surgical staff, insufficient continuing medical education, limited overall surgical capacity, and inadequate standardization of clinical procedures. Addressing these issues is therefore essential to improving patients' care experience and public health outcomes. This paper focuses on core strategies to enhance the surgical capacity of community hospitals, including upgrading hardware facilities to strengthen diagnostic and therapeutic capabilities, improving the systematic training of healthcare professionals, and standardizing diagnosis, treatment, and preventive care. It further shares exemplary practices from two community hospitals supported by Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine. Key initiatives highlighted include the development of standardized outpatient operating rooms at the community level, as well as two-way collaborative efforts: advancing further training for community physicians at higher-level institutions and deploying senior specialists from tertiary hospitals to community settings. These practices provide valuable experience for the future development of surgical services in primary community hospitals. Looking ahead, the urgent need to upgrade primary surgical capacity requires continued support from tertiary hospitals to advance both hardware and software development in primary care settings. Furthermore, improving the surgical skills of primary community hospitals will optimize the allocation of medical resources, enhance public satisfaction with healthcare services, and enable residents to access standardized, convenient, and high-quality surgical care.
Special Topic/Respiratory Disease of Children
Meta-analysis of Tuina Therapy for pediatric adenoid hypertrophy
REN Yan, CHEN Kecheng, YANG Run, YUAN Yuan
2026, 24(6): 907-912. doi: 10.16766/j.cnki.issn.1674-4152.004519
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  Objective  To systematically evaluate the effectiveness of Tuina therapy in treating adenoid hypertrophy in children, provide scientific evidence for guiding the use of Tuina in treating the disease.  Methods  Randomized controlled trials on Tuina therapy for adenoid hypertrophy in children were retrieved from CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, EMbase, and Web of Science databases from their establishment to November, 2024. The language was limited to Chinese and English. Firstly, the literature identified from various databases was analyzed using NoteExpress software to eliminate duplicate documents. Subsequently, two staff members further screened the documents according to the inclusion and exclusion criteria and extracted the research data from the ultimately included studies. The quality and data of the included literature were then subjected to Meta-analysis using the Cochrane system and RevMan 5.3 software.  Results  A total of 131 relevant articles was obtained. After strict screening, 13 studies involving 1 036 children were included. The meta-analysis results showed that the overall clinical effective rate of the Tuina group was higher (OR=5.43, 95% CI: 3.50-8.42, P < 0.001), the total score of TCM syndromes (MD=-3.92, 95% CI: -5.61 to -2.23, P < 0.001), the score of nasal congestion symptoms (MD=-0.91, 95% CI: -1.23 to -0.59, P < 0.001), the score of snoring symptoms (MD=-0.97, 95% CI: -1.36 to -0.58, P < 0.001), the score of mouth breathing symptoms (MD=-1.02, 95% CI: -1.41 to -0.63, P < 0.001), the A/N value of adenoids (MD=-0.03, 95% CI: -0.06 to -0.00, P=0.03), and the quality of life score (MD=-8.38, 95% CI: -10.00 to -6.77, P < 0.001) were all lower.  Conclusion  The therapeutic effect of Tuina on children with adenoid hypertrophy is definite and significantly better than that of the control group, which can improve the clinical efficacy. However, due to the limitations of the sample size and quality of the included studies, more large-sample and high-quality clinical studies are still needed to verify its effect in the future.
Value of combined lung ultrasound, CPIS, and inflammatory markers for predicting the timing of lbronchoalveolar avage intervention and outcomes of refractory Mycoplasma pneumoniae pneumonia in children
ZHU Jiangwen, CHEN Xiaoqing, CHEN Hui, ZHUANG Sisi, ZHOU Chen, ZUO Lili
2026, 24(6): 913-917. doi: 10.16766/j.cnki.issn.1674-4152.004520
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  Objective  To evaluate the value of the lung ultrasound score (LUS), clinical pulmonary infection score (CPIS), and serum inflammatory markers in predicting the timing for bronchoalveolar lavage (BAL) intervention and the outcomes of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children.  Methods  A prospective nested case-control study was conducted. Fifty children with MPP treated in the Department of Pediatrics of the First Affiliated Hospital of Nanjing Medical University from May 2023 to May 2024 were selected as the research subjects. The children were divided into the bronchoscopy group (BAL group, n=28) and the non-bronchoscopy group (non-BAL group, n=22) based on whether they received BAL intervention. Baseline data, LUS, CPIS, and serum inflammatory markers were compared between the two groups. A multivariate logistic regression model was constructed by combining the above indicators, and the receiver operating characteristic curve (ROC) was drawn to predict the timing of BAL intervention and the outcome of RMPP.  Results  There were no statistically significant differences in gender, age, weight, mean arterial pressure, blood gas [pH, arterial oxygen saturation (SaO2), lactic acid (Lac)], and lactate dehydrogenase (LDH) between the two groups (P>0.05). The BAL group had higher LUS, CPIS, IL-6, D-dimer, fever days, and hospitalization days than the non-BAL group (P < 0.05). ROC analysis indicated that the area under the curve (AUC) of the model combining LUS≥26.5 points, CPIS≥5.5 points, and IL-6≥25.1 ng/L for predicting the timing of BAL intervention was 0.950, with a sensitivity of 89.3% and a specificity of 95.0% (P < 0.05). The AUC of the model combining LUS≥27.5 points, CPIS≥6.5 points, and IL-6 ≥ 30.6 ng/L for predicting the outcome of RMPP was 0.915, with a sensitivity of 88.9% and a specificity of 86.7% (P < 0.05).  Conclusion  The combination of LUS, CPIS, and serum inflammatory markers can effectively predict the timing of BAL intervention and the outcome of RMPP in children with MPP, which is sensitive, non-invasive, and precise, and is worthy of clinical promotion.
Clinical features of children with chest tightness variant asthma and diagnostic value of EOS count, total IgE and pulmonary function in peripheral blood
GUO Haoran, SONG Mengyao, SUN Chen, XIA Qun, WANG Lei, PENG Ziyu, MA Lijuan, ZHOU Rui
2026, 24(6): 918-921. doi: 10.16766/j.cnki.issn.1674-4152.004521
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  Objective  To investigate the clinical characteristics of childhood chest tightness variant asthma (CTVA) and the diagnostic value of peripheral blood eosinophil (EOS) count, total IgE, and pulmonary function, so as to provide evidence for early identification of CTVA in children.  Methods  A total of 51 children with CTVA admitted to the First Affiliated Hospital of Bengbu Medical University from January 2023 to December 2024 were enrolled as the study subjects. In addition, 58 children with non-acute exacerbation typical asthma during the same period were selected as the CA group, and 40 healthy children served as the control group. Clinical data from the three groups were collected. Spearman correlation analysis was used to examine the correlations of peripheral blood EOS count and total IgE with pulmonary function parameters. Receiver operating characteristic (ROC) curves were plotted to analyze their diagnostic value for childhood CTVA.  Results  The age of onset in the CTVA group was 10.3 (8.8, 11.6) years, which was higher than that in the CA group [7.7 (6.4, 10.5) years, Z=-3.811, P < 0.05]. There were no statistically significant differences between the two groups in terms of disease duration, season of onset, history of comorbid allergic rhinitis, BMI, and various pulmonary function indices. The peripheral blood EOS count and total IgE in the CTVA group were lower than those in the CA group, but higher than those in the control group (P < 0.05). In the CTVA group, both peripheral blood EOS count and total IgE showed negative correlations with small airway parameters [maximal mid-expiratory flow (MMEF), forced expiratory flow at 50% of vital capacity (FEF50), forced expiratory flow at 75% of vital capacity (FEF75), r < 0, P < 0.05]. ROC curve analysis indicated that the optimal cutoff values for MMEF, FEF50, and FEF75 in the CTVA group were 76.4%, 68.3%, and 67.1%, respectively, while the optimal cutoff values for peripheral blood EOS count and total IgE were 0.12×109/L and 62.6 IU/mL, respectively. The area under the curve (AUC) for the combination of peripheral blood EOS count, total IgE, and the three small airway indices was 0.832 (95% CI: 0.731-0.907, P < 0.05), which was greater than the diagnostic efficacy of any single indicator.  Conclusion  The age of onset in children with CTVA is higher than that in children with CA. The combination of peripheral blood EOS count, total IgE, and small airway parameters can assist in the clinical diagnosis of CTVA in children.
General Practice Research
Investigation of the causal relationship between LGALS8 expression and bronchiectasis based on Mendelian randomization
TANG Jinling, ZHENG Shaochu, LUO Jin, LI Shang, XU Yang, KONG Jinliang
2026, 24(6): 922-925. doi: 10.16766/j.cnki.issn.1674-4152.004522
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  Objective  To investigate the causal association between galectin-8 (LGALS8) and bronchiectasis using Mendelian randomization (MR) analysis and clinical sample validation.  Methods  MR analysis was performed using cis-expression quantitative trait locus (cis-eQTL) data of druggable genes, protein quantitative trait locus (pQTL) data, and bronchiectasis datasets. Peripheral blood samples were collected from 34 patients with non-cystic bronchiectasis and 23 healthy controls at the First Affiliated Hospital of Guangxi Medical University between July and October 2021. LGALS8 expression was measured by RT-qPCR and analyzed by age, sex, BMI, smoking status, bronchiectasis assessment of clinical impact (BACI) score, and E-FACED score.  Results  MR analysis showed that increased LGALS8 gene expression was associated with higher bronchiectasis risk (OR=1.122, 95% CI: 1.030-1.222, P=0.008), as was increased LGALS8 protein expression (OR=1.495, 95% CI: 1.161-1.924, P=0.002). No horizontal pleiotropy or heterogeneity was detected. RT-qPCR showed significantly elevated LGALS8 expression in patients than in controls (P<0.001), with an area under the receiver operating characteristic curve of 0.910 (95% CI: 0.808-0.995). LGALS8 expression also differed significantly between patients with mild and moderate-to-severe E-FACED scores (P=0.003).  Conclusion  LGALS8 expression was causally associated with bronchiectasis. LGALS8 expression is elevated in patients with bronchiectasis, potentially contributing to the onset and progression of the disease.
Predicting in-hospital mortality in critically ill pulmonary embolism patients: development and validation of a machine learning-based model
LIN Li, YUAN Chao, RAO Xianqun, LIU Chang, SUN Kai
2026, 24(6): 926-931. doi: 10.16766/j.cnki.issn.1674-4152.004523
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  Objective  This study aimed to develop and validate a multidimensional risk prediction model for in-hospital mortality in critically ill patients with acute pulmonary embolism (PE) using machine learning-based nomogram techniques, and to identify key risk factors associated with adverse outcomes for improved risk stratification.  Methods  A retrospective analysis was conducted on 505 ICU patients with acute PE from the MIMIC-Ⅳ database. Patients were randomly divided into a training set (n=354) and a testing set (n=151) at a ratio of 7∶3. LASSO regression was employed to screen predictive variables, followed by logistic regression (LR) to construct the nomogram model. Model performance was validated using ROC curves, calibration curves, and decision curve analysis (DCA).  Results  LASSO regression identified vasopressor use, anion gap (AG), Charlson comorbidity index (CCI), simplified acute physiology score Ⅱ (SAPS Ⅱ), and simplified pulmonary embolism severity index (sPESI) as critical predictors. The nomogram demonstrated good discriminative performance, with AUCs of 0.813 (95% CI: 0.759-0.863) in the training set and 0.762 (95% CI: 0.683-0.838) in the testing set. Calibration curves and Hosmer-Lemeshow tests (P>0.05) indicated good agreement between predicted and observed outcomes, while DCA indicated favorable clinical utility across a wide range of threshold probabilities.  Conclusion  The nomogram integrating vasopressor use, AG, CCI, SAPS Ⅱ, and sPESI effectively predicts the risk of in-hospital mortality in critically ill patients with PE, offering a quantitative tool for clinical decision-making and risk stratification.
Effects and risk factors of diabetes and immunosuppressive state on surgical site deep infection after posterior lumbar interbody fusion surgery
MA Yunlong, FU Yu
2026, 24(6): 932-935. doi: 10.16766/j.cnki.issn.1674-4152.004524
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  Objective  To explore the relationship between diabetes (DM) and immunosuppressive state (IS) with deep surgical site infection (SSDI) after posterior lumbar fusion surgery, and to identify the related risk factors, in order to provide basis for the prevention and treatment of SSDI.  Methods  A retrospective analysis was conducted on the clinical data of 350 patients who underwent PLIF surgery in the Second Affiliated Hospital of Inner Mongolia Medical University from January 2020 to January 2025. According to whether patients had DM or (and) IS before the operation, the patients were divided into four groups: group A (n=90, DM), group B (n=46, IS), DM combined with IS (n=30, DM and IS), and No DM and no IS (n=184, neither DM nor IS). The incidence of SSDI in each group was compared, and they were grouped according to the presence or absence of SSDI. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for SSDI occurrence.  Results  The incidence of SSDI after surgery was 7.43% in the patients. A total of 35 pathogenic bacteria were detected, among which Staphylococcus aureus accounted for 60.00% (21/35). The incidences of SSDI after surgery in group A, group B, group C, and group D were 8.89%, 10.87%, 20.00%, and 3.80% respectively, and those in group C was significantly higher than that in group D (chi-square value, χ2=11.858, P < 0.008). Multivariate logistic regression analysis revealed that preoperative DM combined with IS (OR=4.600, 95% CI: 1.912-11.068), preoperative HbA1c level (OR=3.456, 95% CI: 1.654-7.221), and postoperative drainage time (OR=1.430, 95% CI: 1.058-1.934) were independent influencing factors for the occurrence of SSDI after surgery (P < 0.05).  Conclusion  DM and IS are important co-occurring risk factors for SSDI after PLIF surgery.
Establishment of a stable PD-L1-overexpressing oral squamous carcinoma MOC-1 cell line and verification of its in vivo function
SHEN Yuqing, XU Rui, ZHENG Xianyu
2026, 24(6): 936-939. doi: 10.16766/j.cnki.issn.1674-4152.004525
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  Objective  To construct a stable MOC-1 cell line with constitutive overexpression of programmed death-ligand 1 (PD-L1) and to investigate its effects on the in vivo biological behaviors of oral squamous cell carcinoma (OSCC).  Methods  The pCDH-PD-L1 overexpression plasmid was constructed via molecular cloning techniques, and then packaged into lentiviruses to infect murine oral squamous cell carcinoma (MOC-1) cells. Stable transfectants were selected with puromycin. PD-L1 expression at both the mRNA and protein levels was validated by RT-qPCR and Western blot analysis. Using a completely randomized design, 10 mice were divided into a PD-L1 overexpression group and a control group (5 mice per group) using a random number table. Stable cells were then subcutaneously implanted into mice to evaluate in vivo tumorigenicity. Immunohistochemistry (IHC) and immunofluorescence (IF) staining were performed to assess the expression of PD-L1 and Ki67, as well as the infiltration and cytotoxic function of CD8+ T cells in tumor tissues.  Results  The pCDH-PD-L1 recombinant plasmid was successfully constructed. RT-qPCR and Western blot analyses confirmed the successful establishment of a stable PD-L1-overexpressing MOC-1 cell line. In vivo subcutaneous tumor experiments showed that PD-L1 overexpression significantly accelerated tumor growth, resulting in markedly larger tumor volume and weight compared with the control group [(361.11±54.05) mm3 vs. (94.94±23.15) mm3, (14.0±4.9) g vs. (124.8±34.8) g, P < 0.001]. Immunological analyses indicated that the positive rate of PD-L1 [(60.5±4.2) % vs. (20.8±2.8) %, P < 0.001] and the proportion of Ki67-positive cells [(61.2±7.1) % vs. (30.4±5.5) %, P < 0.001] in tumor tissues of the overexpression group were both significantly increased. In contrast, the infiltration number of CD8+ T cells was significantly reduced [(5 023±961) cells/mm2 vs. (8 702±1 006) cells/mm2, P < 0.001], accompanied by impaired cytotoxic capacity.  Conclusion  We successfully established in vitro and in vivo models of PD-L1 overexpression based on the pCDH vector. PD-L1 overexpression significantly enhances the in vivo tumorigenicity of OSCC cells by inhibiting the infiltration and cytotoxic capacity of CD8+ T cells.
Analysis of the latent profile and transition of self-disgust in patients with colorectal cancer before and after stoma surgery
ZHENG Afen, YANG Wenbin, WANG Shaoyan, WANG Zhonglin
2026, 24(6): 940-943. doi: 10.16766/j.cnki.issn.1674-4152.004526
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  Objective  To explore the changing trend of potential categories of self-disgust in patients with colorectal cancer before and after stoma surgery over time and analyze its influencing factors.  Methods  Colorectal cancer patients admitted to the Second Affiliated Hospital of Wenzhou Medical University from February 2023 to February 2025 were selected as the research objects by convenience sampling method. The general information questionnaire and self-disgust scale were used to measure the enrolled research objects at admission (T1) and before discharge (T2) for potential transformation analysis.  Results  A total of 202 patients completed the investigation. Before and after stoma surgery, patients can be divided into two potential categories: the high self-disgust group and the low self-disgust group. The stability of the high self-disgust group was strong, and the probability of maintaining the original group was 0.856. Colorectal cancer patients in the low self-disgust group tended to transform to the high self-disgust group over time, and the transformation probability was 27.20%. The results of logistic regression analysis show that: patients who self-rated psychological imbalance (OR=4.722) and self-rated low social support (OR=3.380) had an increased probability of changing from the low self-disgust group to the high self-disgust group (OR>1), while patients with a monthly family income>10 000 yuan (OR=0.725) had a decreased probability of changing from the low self-disgust group to the high self-disgust group (OR < 1). Patients aged ≥60 years old (OR=1.256), residing at home (OR=1.347), self-rated mental health (OR= 2.422), and self-rated high support (OR=3.279) had an increased probability of changing from the high self-disgust group to the low self-disgust group (OR>1).  Conclusion  There is significant heterogeneity in the self-abusive state of colorectal cancer patients before and after ostomy surgery, mainly divided into two subgroups: high and low. The study confirmed that the low self-abusive group has a higher risk of deterioration during the perioperative period, driven by psychological imbalance and insufficient social support; while advanced age, family residence, and good psychological state are protective factors for promoting a favorable outcome in patients with high self-abusive status.
Efficacy analysis and safety evaluation of multi-endoscopy combination intrarenal surgery for complex renal calculi
LU Bangdong, LOU Yanting, ZHANG Yu, WANG Feifei, ZHOU Mengjiao, GU Rong
2026, 24(6): 944-947. doi: 10.16766/j.cnki.issn.1674-4152.004527
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  Objective  To investigate the stone-free rate, postoperative complications, and other indicators of percutaneous nephrolithotomy (PCNL) combined with flexible ureteroscopic holmium laser lithotripsy in the treatment of complex renal calculi, so as to evaluate its clinical application value.  Methods  The clinical data of 53 patients with complex renal calculi admitted to the Fourth Affiliated Hospital of Anhui University of Medicine from January 2022 to September 2024 were retrospectively analyzed. According to the treatment method, the patients were divided into a PCNL group (control group, n=27) and a multi-endoscopy combination group (observation group, n=26). The operation time, hospital stay, hospitalization costs, primary stone clearance rate, number of access tracts, renal function indicators, bleeding and infection indicators, pain scores, and complications were compared between the two groups.  Results  The average operation time, hospital stay, and hospitalization costs in the observation group were lower than those in the control group [(128.54±20.73) min vs. (160.81±28.24) min; (9.04±2.52) d vs. (11.04±2.88) d; (17 800±1 900) RMB vs. (20 200±3 100) RMB]. Additionally, the observation group had a higher primary stone clearance rate [84.62% (22/26) vs. 55.56% (15/27)] and fewer access tracts (1.27±0.45 vs. 2.37±0.69), with statistically significant differences (P < 0.05). There were no statistically significant differences in preoperative creatinine (Cr), blood urea nitrogen (BUN), and β2-microglobulin (β2-MG) between the two groups, but postoperative differences were statistically significant. The differences in Hb, hs-CRP, and PCT levels before and after surgery were lower in the observation group than that in the control group, with statistically significant differences (P < 0.05). At 6 hours postoperatively, the VAS score in the observation group was lower than that in the control group (P < 0.05), but no statistically significant differences were observed at 12 hours and 24 hours postoperatively. The total incidence of postoperative complications in the observation group was lower than that in the control group (P < 0.05).  Conclusion  Percutaneous nephrolithotomy combined with flexible ureteroscopic holmium laser lithotripsy for the treatment of complex renal calculi can improve the primary stone clearance rate, reduce postoperative complications, and is safe and effective.
Analysis of patients discharged from the general medicine department of a tertiary A-grade hospital in Jiangsu province from 2023 to 2024
LI Yaru, SHEN Huimin, DONG Chao, YANG Dandan, CHEN Yujie, CAO Feifei, TENG Fei
2026, 24(6): 948-952. doi: 10.16766/j.cnki.issn.1674-4152.004528
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  Objective  To analyze the diagnosis and treatment profile of discharged patients from the Department of General Practice at Xuzhou Central Hospital, summarize the characteristics of the disease spectrum, and provide evidence for the development of general practice and health policy-making.  Methods  Medical records of patients discharged from the general medicine ward between June 1, 2023, and May 31, 2024, were extracted from the hospital's electronic database, including demographic information, diagnoses, and hospitalization-related indicators.  Results  A total of 725 patients were discharged from the Department of General Practice within one year, including 347 males (47.86%) and 378 females (52.14%). Age was (57.66±14.83) years; length of hospital stay was 7 (6, 9) d; and hospitalization cost was 6 502.46 (5 511.46, 7 662.79) CNY. Patients admitted with undifferentiated diseases showed significantly lower medical resource consumption compared to those with clear diagnoses upon admission (P < 0.05). The top five primary discharge diagnoses were: cerebral infarction and vertebrobasilar syndrome (230 cases, 31.72%), type 2 diabetes mellitus and related complications (106 cases, 14.62%), gastroesophageal reflux disease and chronic gastritis (82 cases, 11.31%), respiratory tract infections (45 cases, 6.21%), and psychosomatic diseases (34 cases, 4.69%). There were statistically significant differences in length of hospital stay and hospitalization costs among patients with different numbers of chronic diseases, and both indicators increased with the rising number of chronic diseases (P < 0.001).  Conclusion  The Department of General Practice treats patients across all age groups and covers a broad spectrum of diseases involving multiple systems. Its scope includes not only common and chronic diseases but also undifferentiated and psychosomatic diseases, with a high proportion of patients having multimorbidity. These characteristics are closely aligned with the evolving trends in general practice.
General Clinical Research
The comparison of the effects of UBE and PTED on intervertebral space height and lumbar function in patients with DLSS
WANG Wei, ZHANG Liwei, YUAN Chiting, FAN Shaohua, HONG Dun
2026, 24(6): 953-956. doi: 10.16766/j.cnki.issn.1674-4152.004529
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  Objective  To compare the efficacy of unilateral biportal endoscopic (UBE) and percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of degenerative lumbar spinal stenosis (DLSS), and to provide evidence for optimizing the selection of minimally invasive surgical techniques.  Methods  A total of 70 patients with DLSS from May 2023 to December 2024 treated at Taizhou Hospital of Zhejiang Province were retrospectively included and divided into a study group (n=36, UBE) and a control group (n=34, PTED) according to the surgical methods. The general surgical conditions, VAS scores, Oswestry disability index (ODI) scores, intervertebral space height, multi-fissure muscle area, and depth of fat infiltration were compared between the two groups. Postoperative complications were also observed and compared.  Results  Compared with the control group, the study group had a shorter operative time, less intraoperative blood loss, a greater increase in dural sac area, and higher hospitalization cost (P < 0.05). The VAS scores in the study group were significantly higher than those in the group at 1 week, 1 month, 3 months, and 6 months after the surgery (P < 0.05). The study group also had higher ODI scores at 3 and 6 months postoperatively (P < 0.05). At 6 months after surgery, intervertebral space height was significantly higher in the study group than in the control group (P < 0.05), and the excellent--good rate was significantly higher [91.66% (33/36) vs. 73.53% (25/34), P < 0.05]. At 3 months postoperatively, the study group had a smaller area of the decompressed-side and contralateral multifidus muscles, as well as a greater depth of fat infiltration in the multifidus muscles, compared with the control group (P < 0.05). There was no significant difference in the incidence of complications between the two groups [5.56% (2/36) vs. 5.88% (2/34), P>0.05].  Conclusion  UBE offers advantages in terms of shorter operation time, reduced intraoperative blood loss, better preservation of intervertebral space height, and a superior decompression effect, whereas PTED demonstrates advantages in postoperative pain relief, preservation of the multifidus muscles, and recovery of lumbar function. Both techniques are safe and effective, and the selection of the surgical approach should be individualized based on the specific anatomical conditions, lesion characteristics, and treatment objectives.
Effect of alirocumab combined with statin therapy on short-term major adverse cardiovascular events in patients with acute myocardial infarction after percutaneous coronary intervention
CHEN Dongmei, XUAN Ling, LI Jingjing, WANG Maolin, LI Xiaoxi
2026, 24(6): 957-961. doi: 10.16766/j.cnki.issn.1674-4152.004530
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  Objective  To investigate the effect of alirocumab combined with statin therapy on the short-term prognosis of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI), and to identify independent predictors of major adverse cardiovascular events (MACE).  Methods  A total of 120 AMI patients who underwent PCI between January 2022 and December 2023 were retrospectively enrolled and divided into an alirocumab group and a control group (n=60 each). The control group received standard secondary prevention therapy, whereas the alirocumab group received additional alirocumab treatment. Lipid profiles, renal function parameters, and CRP levels were assessed at baseline and 14 days after treatment. Patients were followed up for 6 months to record occurrence of MACE. Kaplan-Meier analysis was used to compare cumulative event rates, and Cox proportional hazards regression models were applied to identify independent predictors of MACE.  Results  Compared with the control group, the alirocumab group showed significantly lower levels of TC, TG, low density lipoprotein cholesterol (LDL-C), and CRP, as well as significantly higher levels of high-density lipoprotein cholesterol (HDL-C) levels at 14 days after treatment (P < 0.05). Serum creatinine and blood urea nitrogen levels were also significantly reduced (P < 0.05), while ALT and AST levels showed no significant differences between the two groups (P>0.05). During the 6-month follow-up period, the incidence of MACE was significantly lower in the alirocumab group [10.0% (6/60) vs. 31.7% (19/60), P < 0.05]. Cox regression analysis identified alirocumab use as an independent protective factor for MACE (HR=0.451, 95% CI: 0.271-0.762, P=0.029), whereas elevated baseline LDL-C, CRP, and serum creatinine levels were independent risk factors (P < 0.05).  Conclusion  The addition of alirocumab to standard antiplatelet and statin therapy can further improve lipid profiles, reduce inflammation, preserve renal function, and decrease the risk of short-term MACE in patients with AMI after PCI.
Bidirectional two-sample Mendelian randomization study on Alzheimer's disease and COPD
LIU Liangshan, SHENG Jiagang, XU Ling, JI Siqin, SU Qiuling, LU Yajun, WANG Zhenwei
2026, 24(6): 962-967. doi: 10.16766/j.cnki.issn.1674-4152.004531
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  Objective  Using bidirectional two-sample Mendelian randomization (MR), this study examines the causal associations between Alzheimer's disease (AD) and chronic obstructive pulmonary disease (COPD), as well as their pathological features and comorbidities, thereby providing evidence to inform clinical comorbidity management.  Methods  Data for Alzheimer's disease were obtained from the R9 (9 301 cases and 367 976 controls), R10 (10 520 cases and 401 661 controls), R11 (11 755 cases and 441 978 controls), and R12 (13 964 cases and 486 384 controls) releases of the Finnish database. Data for COPD, its pathological features, and comorbidities were sourced from the UK Biobank (UKB) database. The inverse-variance weighted (IVW) method was used to derive the primary causal estimates. To ensure the validity and robustness of the causal inferences, supplementary analyses were performed using MR-Egger, weighted median, simple mode, weighted mode, leave-one-out sensitivity analysis, MR-Egger intercept test, funnel plots, and forest plots.  Results  Forward MR analysis indicated that AD was significantly positively associated with the risk of COPD in the R9 (P=0.010), R10 (P=0.001), and R11 (P=0.011) datasets. A positive association between AD and the risk of emphysema was also observed in R11. Reverse MR analysis revealed that COPD was significantly negatively associated with AD in the R9 (P=0.048), R11 (P=0.046), and R12 (P=0.032) datasets. No evidence of a genetic causal relationship was identified between AD and the pathological features or comorbidities of COPD.  Conclusion  AD is a potential risk factor for COPD and emphysema, potentially mediated by AD-related neuroinflammation, neutrophil activation, and chronic hypoxia. Conversely, COPD may indirectly reduce the risk of AD by modulating oxidative stress and gut microbiota.
Clinical efficacy of medicinal cake fire dragon moxibustion in the treatment of rheumatoid knee arthritis of the wind-cold-dampness syndrome type
XU Xiaoyan, LI Jian, FENG Jiong, CHENG Dong, ZHOU Chunting, FANG Lingli
2026, 24(6): 968-971. doi: 10.16766/j.cnki.issn.1674-4152.004532
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  Objective  There is a lack of specific treatments for rheumatoid arthritis of the knee. This study aimed to evaluate the clinical efficacy of fire dragon moxibustion with medicinal cake, a traditional Chinese medicine therapy, for patients with wind cold damp obstruction type rheumatoid knee arthritis.  Methods  A total of 108 patients with wind cold damp obstruction type rheumatoid knee arthritis admitted to the Department of Rheumatology and Immunology, Jinhua Hospital of Chinese Medicine, from June 2023 to October 2025 were enrolled. Patients were randomly divided into a control group and a trial group (n=54 each) using a random number table. The control group received celecoxib, and the trial group received fire dragon moxibustion with medicinal cake for 4 weeks. Traditional Chinese medicine (TCM) syndrome scores, visual analogue scale (VAS) pain scores, Lysholm knee scores, laboratory parameters including erythrocyte sedimentation rate (ESR), C reactive protein (CRP), rheumatoid factor (RF), tumor necrosis factor-α (TNF-α), and musculoskeletal ultrasound findings were compared between the two groups. Clinical efficacy and safety were evaluated.  Results  After 4 weeks of treatment, TCM syndrome scores and VAS scores decreased in both groups compared with baseline, while Lysholm scores increased (P < 0.05). The trial group showed significantly lower VAS scores (1.65±0.43 vs. 2.70±0.68), and higher Lysholm scores (82.70±6.24 vs. 78.19±6.07) than the control group (P < 0.05). Levels of ESR, CRP, RF, and TNF α decreased in both groups after treatment, with significantly lower values in the trial group (P < 0.05). Musculoskeletal ultrasound findings, including synovial thickness, suprapatellar effusion thickness, and synovial blood flow score, improved significantly in both groups, with better outcomes in the trial group (P < 0.05). The TCM syndrome efficacy rate was significantly higher in the trial group (P < 0.05), and no serious adverse events occurred in either group.  Conclusion  Fire dragon moxibustion with medicinal cake can effectively relieve clinical symptoms, reduce immune inflammatory responses, alleviate synovial inflammation, and improve knee function in patients with wind cold damp obstruction type rheumatoid knee arthritis. It demonstrates significant clinical efficacy and good safety.
Construction and clinical application of a family-medical staff collaborative integrated care model for improving discharge readiness in neonates with congenital heart disease in PICU
RONG Jing, LYU Lizhi, GENG Xiaoxiao, XING Xinxin, HUANG Jing, LI Xuemei
2026, 24(6): 972-976. doi: 10.16766/j.cnki.issn.1674-4152.004533
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  Objective  To construct a family-medical staff collaborative integrated care model for medical intervention of PICU congenital heart disease newborns' discharge readiness, and study its clinical application value.  Methods  PICU congenital heart disease newborns admitted to Capital Medical University Affiliated Beijing Anzhen Hospital from October 2024 to October 2025 were selected as the research subjects, the experimental group and the control group were 60 cases each. The experimental group adopted a family-medical staff collaborative integrated care model, while the control group adopted a conventional medical plan. The preparation for discharge of newborns and the medical ability of caregivers before and after the intervention were compared.  Results  After intervention, the total score of discharge readiness in the experimental group was higher than that in the control group [(183.19±10.73) points vs. (160.55±9.11) points, P < 0.001]. The total score of caregivers' medical abilities was higher than that of the control group [(137.86±4.22) points vs. (126.89±4.68) points, P < 0.001]. After controlling for confounding factors such as disease severity, grouping remained an independent influencing factor for discharge readiness (B=18.230, 95% CI: 14.670-21.790, P < 0.001) and caregiver medical ability (B=10.560, 95% CI: 8.120-13.000, P < 0.001). The readmission rate of the experimental group [6.67% (4/60) vs. 20.00% (12/60), P=0.032] and the total incidence of complications [13.33% (8/60) vs. 31.67% (19/60), P=0.016] were significantly lower than those of the control group.  Conclusion  The family-medical staff collaborative integrated care model effectively enhances discharge readiness in neonates with CHD in the PICU and improves caregiver competency.
Analysis of pregnancy outcomes and predictive factors for miscarriage risk after transvaginal multifetal pregnancy reduction
HU Jingjing, YANG Wenjuan, HE Ye, XU Xiaofeng, SHEN Qunshan
2026, 24(6): 977-980. doi: 10.16766/j.cnki.issn.1674-4152.004534
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  Objective  To evaluate the safety and influencing factors of transvaginal ultrasound-guided multiple pregnancy reduction procedure (TV-MFPR).  Methods  A retrospective analysis was conducted on 338 pregnant women who underwent reduction surgery for multiple pregnancies after assisted reproductive technology at the First Affiliated Hospital of Anhui Medical University from March 2018 to May 2024. The clinical indicators were compared among groups based on the outcome, cause of miscarriage, and the number of surviving triplets. Logistic regression analysis of risk factors influencing miscarriage after reduction.  Results  Divided into the miscarriage group (LC, 36 cases) and the live birth group (FM, 302 cases) based on outcomes after reduction. The gestational age at reduction of the LC group [65.00 (61.00, 70.50) days vs. 61.00 (60.00, 64.00) days, Z=-3.475, P < 0.001], and the usage rate of KCL [15 cases (41.7%) vs. 40 cases (13.2%), P < 0.001] were all higher than those of the FM group. Logistic regression showed that the use of KCL (OR=0.318, P=0.009), each unit increase in BMI (OR=0.895, P= 0.022), and each delay of gestational age in reduction (OR=0.946, P=0.032) all increased the risk of miscarriage. The proportion of transferring two embryos in the single-embryo survival group and the rate of monozygotic twins were both significantly higher than those in the twin pregnancy group (P < 0.05). The incidence of complications during twin delivery was significantly higher in the live birth group than in the singleton group.  Conclusion  TV-MFPR is a safe and effective intervention method for multiple pregnancies after ART. It is recommended to perform early reduction at 7-9 weeks, control BMI, and use KCL with caution. The risk of complications in twin pregnancies is high, and individualized selection of reduction schemes and optimization of pregnancy outcomes are necessary.
Latent profile analysis and factors influencing fear of childbirth in late-pregnancy women
HUANG Can, ZHU Minli, YU Li
2026, 24(6): 981-984. doi: 10.16766/j.cnki.issn.1674-4152.004535
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  Objective  Employing latent profile analysis (LPA), this study investigated the latent subpopulations of childbirth fear among women in late pregnancy and examined their associated determinants, with the objective of furnishing a theoretical foundation for targeted fear management and the delivery of personalized psychological interventions.  Methods  A convenience sample of late-pregnancy women attending Xiaoxian People's Hospital in Suzhou, Anhui Province, from December 2024 to March 2025 was recruited. Data were collected using a general information questionnaire, the fear of childbirth scale, the flourishing scale, and the family resilience scale to assess demographics, childbirth fear, flourishing, and family resilience levels. Mplus software was used to perform LPA on childbirth fear scores and select the best-fitting latent profile model. Multivariate logistic regression analysis was employed to explore the factors influencing childbirth fear across the identified subgroups.  Results  Childbirth fear among late-pregnancy women was classified into three distinct latent profiles: the severe childbirth fear group (77, 38.3%), the moderate childbirth fear group (86, 42.8%), and the insignificant childbirth fear group (38, 18.9%). Significant differences were observed among the three profiles with respect to monthly family income, participation in prenatal classes, level of prenatal knowledge, availability of newborn care support, flourishing level, and family resilience (P < 0.05). Level of prenatal knowledge was independently associated with the moderate childbirth fear group. Flourishing level, family resilience, and monthly family income were independently associated with the severe childbirth fear group.  Conclusion  Childbirth fear in late-pregnancy women can be categorized into three latent profiles. Healthcare professionals can utilize population characteristics to predict group membership and develop tailored intervention strategies to mitigate childbirth fear.
Current status and influencing factors of discharge readiness among high-risk pregnant women and their spouses
LU Tingting, GU Mengru, JIA Chenyu, XU Ke, TANG Shuting, LI Jinzhi
2026, 24(6): 985-988. doi: 10.16766/j.cnki.issn.1674-4152.004536
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  Objective  To understand the current status of discharge readiness among high-risk pregnant women and their spouses, analyze the influencing factors, and provide a theoretical basis for developing personalized discharge health education plans and continuous care plans.  Methods  A total of 230 pairs of high-risk parturients and their spouses hospitalized in the Department of Obstetrics at the First Affiliated Hospital of Bengbu Medical University from August to November 2024 were selected as the study subjects using a convenience sampling method. Questionnaires were administered using the parturient general information questionnaire, spouse general information questionnaire, parturient readiness for hospital discharge scale, and caregiver readiness scale. Statistical analysis was conducted on the discharge readiness scores of high-risk parturients and the preparedness scores of their spousal caregivers. Univariate analysis and multiple linear stepwise regression analysis were employed to explore the influencing factors of discharge readiness among high-risk parturients and caregiving preparedness among their spouses.  Results  The discharge readiness score of high-risk pregnant women was (112.46±15.59) points, with parity, mode of delivery, number of pregnancy complications and comorbidities, and participation in prenatal education courses identified as influencing factors (P < 0.01). The caregiver readiness score of spouses was (24.48±3.51) points, with maternal parity, education level, number of pregnancy complications and comorbidities, and total maternal discharge readiness score identified as influencing factors (P < 0.05).  Conclusion  The level of discharge readiness among high-risk pregnant women and their spouses still needs improvement. Clinical healthcare professionals should focus on the discharge readiness status, needs, and concerns of high-risk pregnant women and their spouses. Targeted and diversified continuous nursing care service plans should be developed based on the influencing factors mentioned above to enhance their discharge readiness level and promote maternal and infant health.
Comparative evaluation of neck circumference, body mass index, and waist circumference for detecting abnormal glucose and lipid metabolism in community-dwelling older adults
ZHAO Liang, SHEN Yanting, FANG Tingting, LIU Fang, SHI Jianwei, NI Ming
2026, 24(6): 989-992. doi: 10.16766/j.cnki.issn.1674-4152.004537
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  Objective  To assess the ability of neck circumference (NC), body mass index (BMI), and waist circumference (WC) to predict abnormal glucose and lipid metabolism in community-dwelling older adults and to examine sex-specific differences.  Methods  Data from 2 449 elderly individuals (≥60 years; 1 061 males, 1 388 females) undergoing physical examinations at the Shanghai Minhang Shenxin Community Health Service Center (April to May 2024) were retrospectively analyzed. Height, weight, NC, WC, fasting glucose, and lipid profiles were recorded. BMI was calculated. Using MedCalc 21.0, receiver operating characteristic (ROC) curves were generated by gender to compare the area under the curve (AUC) for NC, BMI, and WC, determine optimal cut-offs, and perform Z-tests.  Results  Men had significantly higher weight, NC, and WC than women (P < 0.01), while BMI did not differ significantly between the genders (P>0.05). The optimal NC cut-off for predicting abnormal glucose metabolism in women was 35 cm; for dyslipidemia, it was 37 cm in men and 34 cm in women. In women, no significant differences were observed among BMI, NC, and WC in predicting abnormal glucose metabolism. In men, BMI, NC, and WC showed comparable predictive efficacy for dyslipidemia; in women, NC and WC performed similarly.  Conclusion  NC has a comparatively better predictive value for dyslipidemia in community-dwelling adults aged ≥60 years and for dysglycemia in older women. BMI, NC, and WC showed similar performance in predicting dyslipidemia. Routine inclusion of NC in community health examinations may aid early detection and intervention for abnormal glucose and lipid metabolism.
Exploration and practice of a family doctor "doctor-assistant" co-management model based on MLP neural network feature screening and dynamic monitoring of service quality in hierarchical diagnosis and treatment
DONG Xiuquan, CHANG Fei, WANG Haitang, CUI Chenhui
2026, 24(6): 993-997. doi: 10.16766/j.cnki.issn.1674-4152.004538
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  Objective  To explore the impact of the family doctor "doctor-assistant co-management" model on the quality of contract services, and to construct a machine learning-driven service quality evaluation system.  Methods  Sixty general practitioners from Shanghai Pudong Shanggang Community Health Service Center between June 2023 and June 2024 were enrolled and randomly assigned at a 1∶1 ratio into an experimental group and a control group using a computer-generated random number method, with 30 practitioners in each group. The control group received the conventional self-management model for family doctor contract services, whereas the experimental group received the "doctor-assistant" co-management model in addition to conventional services. Differences in 10 indicators, including the number of signed contracts and visit flow, were compared between the two groups, and an MLP neural network was used to analyze feature importance.  Results  In the annual assessment, the total score of the experimental group was 75 (64, 83), which was significantly higher than that of the control group [69 (60, 75), P < 0.05]. Significant differences were observed in seven core indicators, such as the number of signed contracts [20 (15, 25) vs. 15 (10, 20)] and the proportion of key populations [6 (5, 7) vs. 5(4, 7)], P < 0.05. The total score of the experimental group from July to December was significantly higher than that of the control group (P < 0.05). Machine learning analysis showed that the number of signed contracts, the proportion of key populations, within-team visit rate, and the number of glycated hemoglobin tests as the key driving indicators, with a cumulative contribution rate of 69.1%. Following the intervention, the total score of the experimental group increased by 44.1%. Core indicators, such as the number of signed contracts, the proportion of key populations, and within-team visit rate, showed significant improvements (P < 0.05), along with significant enhancement in non-core indicators (P < 0.05). The total score of the control group increased by 27.3%, with improvements observed only in some non-core indicators (P < 0.05).  Conclusion  The "doctor-assistant co-management" model can effectively improve the quality of family doctor contract services. When integrated with MLP-based feature screening technology, it enables dynamic monitoring and precise optimization, providing a practical paradigm for deepening the hierarchical diagnosis and treatment system.
Analysis of the antidepressant effect of EEG biofeedback therapy combined with relaxation therapy in patients with major depressive disorder
ZHANG Fengfei, LU Yan, RUAN Zhuoer, ZOU Shengzhen, CHEN Jing
2026, 24(6): 998-1001. doi: 10.16766/j.cnki.issn.1674-4152.004539
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  Objective  To analyze the antidepressant effects and safety of EEG biofeedback therapy combined with relaxation therapy in patients with major depressive disorder, and to examine its impact on suicide risk and EEG wave amplitude.  Methods  A retrospective study was conducted, selecting 182 patients with major depressive disorder from the Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Province, between December 2023 and November 2025. The patients were divided into two groups based on different treatment methods: the control group (90 patients) who received EEG biofeedback therapy from December 2023 to October 2024, and the observation group (92 patients) who received EEG biofeedback therapy combined with relaxation therapy from November 2024 to November 2025. The clinical outcomes, depressive and anxiety symptoms, suicidal ideation, EEG wave amplitude, and adverse reactions were compared between the two groups.  Results  The total effective rate of the observation group was 92.4% (85/92), which was higher than the [82.2% (74/90)] of the control group, and the difference was statistically significant (χ2=4.261, P=0.039); After treatment, the 24 Hamilton depression rating scale (HAMD-24) scores, Hamilton anxiety rating scale (HAMA), and psychiatric and psychological suicide risk assessment scale score in the observation group were all lower than those in the control group (P < 0.05); The observation group exhibited higher αwave power and lower δand θwave power compared to the control group (P < 0.05); There was no statistically significant difference in the comparison of adverse reactions between the two groups (P>0.05).  Conclusion  The combination of EEG biofeedback therapy and relaxation therapy has a good antidepressant effect and high safety in patients with severe depression. It can effectively alleviate patients' anxiety and depression, reduce suicidal ideation, and have a positive impact on patients' EEG waves.
Application of shear wave elastography in perineal assessment during vaginal delivery
ZHANG Hanmei, LIU Mingyang, LUO Qi, LI Jiaxin, CHENG Yuting, LIU Xueqin, ZHOU Lihua, CHENG Juan
2026, 24(6): 1002-1005. doi: 10.16766/j.cnki.issn.1674-4152.004540
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  Objective  To employ shear wave elastography (SWE) technology to quantitatively measure the perineal body tissue in late-pregnant women, analyze its efficacy in assessing perineal body elasticity, and explore its application value in the clinical perineal assessment for vaginal delivery.  Methods  A prospective study design was employed. Convenience sampling was employed to select 197 late-pregnant women who met the inclusion criteria and underwent prenatal examinations at the First Affiliated Hospital of Anhui Medical University from March 2022 to November 2023. SWE was used to measure perineal body elasticity. Their delivery outcomes were followed up, and clinical perineal assessment indicators were collected for those who underwent vaginal delivery. After excluding cases involving forceps-assisted delivery, prolonged second stage of labor, and acute fetal distress, participants were categorized into an episiotomy group (53 cases) and a non-episiotomy group (50 cases) based on whether an episiotomy was performed during vaginal delivery. The perineal assessment indicators were compared between the two groups. Using episiotomy as the dependent variable, logistic regression was performed, a combined prediction model was constructed, and a receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of SWE measurements for episiotomy.  Results  Among the clinical perineal assessment parameters, perineal body elasticity showed a statistically significant difference (P < 0.05) between the episiotomy and non-episiotomy groups. There were statistically significant differences (P < 0.05) in the Max, Min, and Mean values of SWE measurements between the two groups. The areas under the ROC curve (AUC, 95% CI) for predicting the necessity of episiotomy using SWE Mean value, clinical elasticity assessment, and their combination were 0.647 (0.538-0.756), 0.796 (0.705-0.887), and 0.829 (0.749-0.908), respectively. The corresponding sensitivities were 0.904, 0.904, and 0.885; specificities were 0.674, 0.630, and 0.674; and Youden indices were 0.230, 0.534, and 0.559. The predictive efficacy of the Mean value combined with clinical elasticity was superior to that of either clinical elasticity or the Mean value alone.  Conclusion  Clinical perineal body elasticity assessment in combination with SWE measurement offers enhanced assessment accuracy and shows favorable application prospects.
Construction of a risk prediction model for cerebral infarction complicated with hypertension based on clinical laboratory indicators
WU Xuan, WEI Wenjie, CHEN Lin, ZHU Mingyao, HAN Weiwei, HUANG Qing, FANG Jiamin
2026, 24(6): 1006-1009. doi: 10.16766/j.cnki.issn.1674-4152.004541
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  Objective  To establish a prediction model for evaluating the occurrence risk of cerebral infarction combined with hypertension based on Lasso-logistic regression through clinical indicators, and to evaluate the diagnostic value of the model.  Methods  A total of 127 confirmed patients of cerebral infarction admitted to the Second Affiliated Hospital of Bengbu Medical University from January 2022 to December 2024 were included. Based on the presence or absence of a history of hypertension, patients were assigned to two groups: the cerebral infarction group (CI) and the cerebral infarction complicated with hypertension group (CIHT). Clinical data and laboratory indicators were compared, and multivariate logistic regression was utilized to analyze the risk factors associated with cerebral infarction accompanied by hypertension, and the Nomogram model was established. The ROC curve was drawn to analyze its predictive value.  Results  The National Institute of Health stroke scale (NIHSS) scores, BMI, CRP, D-dimer, and neutrophil-lymphocyte ratio (NLR) in the CI group were significantly lower than those in the CIHT group (P < 0.05). The results of the multivariate logistic regression revealed that BMI, CRP, D-dimer, NLR, and NIHSS were all risk factors for cerebral infarction complicated with hypertension. Based on these five independent influencing factors, the Nomogram model was constructed, and the ROC curve was drawn. The AUC was 0.885, the sensitivity was 77.8%, the specificity was 88.9%, and the Youden's index was 0.667, reflecting the excellent discriminatory ability of the established model. The calibration curve results showed that the mean absolute error (MAE) was 0.021, and the calibration curve was highly consistent with the ideal curve, demonstrating a satisfactory calibration of the model.  Conclusion  BMI, CRP, D-dimer, NLR, and NIHSS scores were identified as risk factors for cerebral infarction complicated with hypertension. The constructed Nomogram prediction model has a good calibration and clinical practicality.
Exploring the mechanisms of mitochondrial and endoplasmic reticulum dysfunction in metabolic associated fatty liver disease
RUAN Hejing, ZHAO Wen, LI Dongdong, ZHAO Jiufa
2026, 24(6): 1010-1013. doi: 10.16766/j.cnki.issn.1674-4152.004542
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  Objective  Metabolic associated fatty liver disease (MAFLD) is a chronic liver condition pathologically defined by insulin resistance and excessive hepatic lipid accumulation. Despite its escalating global health burden, no targeted therapy is yet available. This review systematically delineates the roles of three interconnected pathological hubs: (1) Mitochondrial dysfunction, featuring impaired fatty acid oxidation, ROS overproduction, aberrant dynamics, and defective autophagy, which collectively precipitate an energy crisis and lipotoxicity; (2) Endoplasmic reticulum stress (ERS) drives a dynamic shift from compensatory protection to pathological injury during disease progression through the three unfolded protein response (UPR) signaling pathways-IRE1α, PERK, and ATF6. The precise regulation of this signaling dynamics has thus emerged as a key target for therapeutic intervention; (3) Structural and functional alterations in mitochondria-associated endoplasmic reticulum membranes (MAMs)-a central hub for inter-organelle communication-lead to calcium homeostasis imbalance, lipid metabolism disorders, and impaired insulin signaling, thereby integrating and amplifying upstream stress signals to drive disease progression toward hepatitis and fibrosis. By synthesizing the crosstalk within this network, this review aims to identify novel targets for MAFLD intervention.
Clinical and high-resolution manometric characteristics of secondary esophageal motility disorders
QI Hongyan, LIN Lin, ZHANG Qing, TANG Yurong
2026, 24(6): 1014-1018. doi: 10.16766/j.cnki.issn.1674-4152.004543
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  Objective  Esophageal motility disorders (EMD) comprise a spectrum of conditions characterized by impairments in neuromuscular coordination leading to abnormal esophageal function. Etiologies are multifactorial, encompassing both primary idiopathic forms and disorders secondary to neurological or immune-mediated diseases. Notable secondary causes include Parkinson's disease, stroke and systemic sclerosis. These conditions disrupt esophageal motility through mechanisms such as autonomic denervation, smooth muscle dysfunction, and connective tissue fibrosis, resulting in compromised upper esophageal sphincter (UES) function, aberrant peristalsis, inadequate lower esophageal sphincter (LES) relaxation, or impaired bolus clearance. Clinical manifestations are heterogeneous and commonly include dysphagia, chest pain, and regurgitation. Severe cases may lead to significant morbidity, including aspiration pneumonia and malnutrition, profoundly diminishing quality of life. The nonspecific nature of symptoms complicates diagnosis, underscoring the necessity for objective physiological assessment. High-resolution esophageal manometry (HREM), utilizing a solid-state catheter with 36-64 pressure sensors, enabling detailed topographic visualization of esophageal pressure dynamics with high spatiotemporal resolution. It is currently the gold-standard modality for evaluating esophageal motor function, permitting precise characterization of UES and LES function, peristaltic vigor and propagation, and bolus transit patterns. This review synthesizes current evidence on the clinical and manometric features of EMD secondary to neurological and autoimmune conditions. Key manometric phenotypes include hypomotility and UES/LES dysfunction in Parkinson's disease, dyssynergia and uncoordinated motility following stroke, and hypocontractility with prevalent gastroesophageal reflux disease (GERD) in systemic sclerosis. We further elucidate the underlying pathophysiological mechanisms-such as neurodegeneration, autoimmunity, and fibrotic remodeling-and discuss the utility of HREM in tracking disease progression and evaluating treatment responses. Our objective is to enhance early recognition and inform holistic management strategies for these complex disorders.
Time-series analysis of air pollution and outpatient visits for pediatric respiratory diseases
WU Shanshan, SHI Hengyuan, XU Yanlong, LI Hui, XING Wenguo
2026, 24(6): 1019-1023. doi: 10.16766/j.cnki.issn.1674-4152.004544
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  Objective  To investigate the association between air pollution and outpatient visits for pediatric respiratory diseases at Bengbu First People's Hospital, thereby providing a scientific basis for reducing the incidence of such diseases.  Methods  This study included outpatient for pediatric respiratory diseases from Bengbu First People's Hospital spanning January 1, 2021, to December 31, 2023. Concurrently collected air pollutant and meteorological data were analyzed using descriptive statistical methods. Time-series plots were constructed to visualize temporal trends. A generalized additive model (GAM) was employed to evaluate the effects of air pollutions on outpatient visits for pediatric respiratory diseases.  Results  Outpatient visits for pediatric respiratory diseases exhibited seasonal fluctuations, with higher volumes in winter. O3 showed no significant correlation with CO and NO2, and PM 10 was not correlated with NO2; however, all other pollutant pairs were significantly correlated. The GAM analysis revealed significant effects of air pollutants on outpatient visits at both single-day lag effects (lag 0 to lag 3) and cumulative lag effects (lag 1 to lag 7). The maximum single-day lag effects occurred at lag 1 for PM 2.5, PM 10, and O3, at lag 2 for SO2, and at lag 3 for CO and NO2. For every 10 μg/m3 increase in pollutant concentration, outpatient visits increased by 1.29% for PM 2.5, 0.83% for PM 10, 0.08% for CO, 0.68% for NO2, 5.14% for O3, and 9.79% for SO2. The significance cumulative lag effects of PM 2.5, PM 10, CO, NO2, O3, and SO2 was observed at lags 01 to 07. The strongest cumulative lag effects occurred at lag 05, 07, 07, 06, 07, and 07, respectively. For every 10 μg/m3 increase in pollutant concentration, outpatient visits increased by 2.43%, 1.63%, 0.19%, 1.42%, 14.07%, and 36.05%, respectively. The ER associated with the pollutants was ranked as SO2 > NO2 > PMX.  Conclusion  Increased concentrations of air pollutant concentrations are associated with high numbers of outpatient visits for pediatric respiratory diseases, and these effects exhibit significant lag and cumulative lag characteristics.
Correlation of traditional Chinese medicine syndrome types of rheumatoid arthritis with plasma albumin and Th17/Treg related cytokines
CHANG Junying, WANG Yong, GAO Wei, KANG Hua
2026, 24(6): 1024-1028. doi: 10.16766/j.cnki.issn.1674-4152.004545
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  Objective  To study the correlation of the traditional Chinese medicine (TCM) syndrome types of rheumatoid arthritis (RA) with plasma albumin (ALB) and helper T cell 17/regulatory T cell (Th17/Treg) related cytokines.  Methods  A total of 102 RA patients (RA group) and 50 healthy individuals undergoing physical examinations during the same period (control group) were selected as the research subjects. The relationships between Th17/Treg-related cytokines, ALB, and the traditional Chinese medicine syndrome types were analyzed.  Results  There were 50 cases of damp-heat obstruction syndrome, 20 cases of cold-dampness obstruction syndrome, 17 cases of phlegm-stasis obstruction syndrome, and 15 cases of liver-kidney deficiency syndrome. The levels of Th17, interleukin-17 (IL-17) and IL-23 in the RA group were higher than those in the control group (P < 0.05), while regulatory T cells (Treg) and plasma ALB were lower (P < 0.05). Th17, IL-17, IL-23 and the rheumatoid arthritis disease activity score (DAS28) score in RA patients were positively correlated pairwise, while ALB was significantly negatively correlated with the scores of Th17, IL-17, IL-23 and DAS28 (P < 0.05). In RA cases, Th17 in cold-dampness obstruction syndrome and liver-kidney deficiency syndrome was lower than that in damp-heat obstruction syndrome and phlegm-stasis obstruction syndrome (P < 0.05), while IL-17 and IL-23 were higher (P < 0.05), ALB was the lowest in liver-kidney deficiency syndrome, followed by damp-heat obstruction syndrome (P < 0.05). The proportions of DAS28 scores >5.1 were the highest in damp-heat obstruction syndrome. The proportion of DAS28 score ranging from 3.3 to 5.0 was the highest in patients with liver-kidney deficiency syndrome (P < 0.05). Compared with the syndrome of liver -kidney deficiency, the VAS scores of damp-heat obstructions syndrome, cold-dampness obstruction syndrome and phlegm-stasis obstruction syndrome were higher, the number of joint swellings and joint tenderness was more, and the levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were higher (P < 0.05).  Conclusion  The TCM syndrome types of RA patients are correlated with ALB, Th17/Treg balance, and related cytokines, necessitating targeted TCM treatment.
Application of flipped classroom combined with case-based learning in cultivating clinical reasoning skills for chest pain diagnosis
CHEN Tianping, ZHANG Naiju
2026, 24(6): 1029-1031. doi: 10.16766/j.cnki.issn.1674-4152.004546
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  Objective  Chest pain has complex etiologies and poses significant diagnostic challenges. Traditional teaching methods often fall short in developing clinical reasoning skills in medical students. This study aimed to evaluate whether a teaching model combining case-based learning (CBL) with flipped classroom (FC) could effectively improve medical students' clinical reasoning skills in chest pain diagnosis.  Methods  A single-center randomized controlled trial was conducted at the First Affiliated Hospital of Bengbu Medical University from September 2023 to March 2024. A total of 122 clinical medicine undergraduates were randomly allocated using a random number table into an experimental group (CBL+FC, n=61) and a control group [traditional lecture-based learning (LBL), n=61]. The experimental group watched multimodal case videos on chest pain before class and participated in group discussions during class; the control group received traditional textbook-based lectures. Assessment metrics included the diagnostic thinking inventory (DTI) score, diagnostic accuracy, self-directed learning ability, and teaching satisfaction score.  Results  The experimental group scored higher than the control group in the DTI (160.3±17.3 vs. 149.4±10.9, P < 0.001), diagnostic accuracy (91.8% vs. 75.4%, P=0.014), self-directed learning ability (79.7±5.6 vs. 69.3±6.0, P < 0.001), and teaching satisfaction (86.1±7.2 vs. 83.6±6.7, P=0.042).  Conclusion  The teaching model combining CBL and FC can significantly enhance medical students' clinical reasoning ability and diagnostic efficiency for chest pain, strengthen their self-directed learning awareness, and effectively improve classroom time utilization.
Practical research on standardized patient teaching combined with feedback teaching mode in the training of general practice resident training instructors
ZHU Yingfei, LUO Yingquan, ZHANG Yuwei, LEI Si, ZENG Lingfeng, XU Yan
2026, 24(6): 1032-1036. doi: 10.16766/j.cnki.issn.1674-4152.004547
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  Objective  In order to improve the teaching ability and teaching quality of general practice resident training instructors, this paper was discussed to explore the practical effect of standardized patient teaching and feedback teaching mode among general practice resident training instructors.  Methods  From February 2023 to January 2024, a total of 30 instructors from the general practice residential training base of the Second Xiangya Hospital of Central South University were selected as the research objects, and the instructors were divided into the study group and the control group according to random number table, with 15 cases in each group. The study group adopted the standardized patient teaching and feedback teaching mode, and the control group adopted the traditional teaching mode. After 6 months of training and 6 months of teaching, the instructors' standardized patient role-playing teaching ability, Mini-CEX assessment teaching ability, and feedback teaching ability were assessed. A self-designed satisfaction questionnaire was used to evaluate the satisfaction of skill tutors, core members of the general practice resident training base, and general practice resident physicians with the instructors.  Results  The total score of the research group of the standardized patient's role-playing teaching ability was better than that of the control group [(83.33±4.37) points vs. (74.87±7.55) points, t=3.760, P=0.001]; The total score of the study group of Mini-CEX assessment ability of general practice resident physicians taught by the instructor was better than that of the control group (P=0.002); The total score of the study group of feedback-based teaching ability was better than that of the control group (P=0.001). The total score of the skill tutor satisfaction study group was higher than that of the control group (P < 0.001). The total score of satisfaction with the residential training base in the study group was higher than that in the control group (P=0.001). The total score of satisfaction with resident physicians in general practice in the study group was higher than that in the control group (P < 0.001).  Conclusion  The standardized patient teaching and feedback teaching mode improved the instructors' standardized patient role-playing teaching ability, Mini-CEX assessment teaching ability, and feedback teaching ability, improved the ability of general practice resident physicians to use Mini-CEX assessment, and improved the teaching satisfaction of instructors.
Study on the characteristics, etiology, diagnosis and treatment of fatigue patients in general practice wards of general hospitals
XU Linlin, CHEN Mingmin, REN Jingjing, MA Yundi
2026, 24(6): 1037-1041. doi: 10.16766/j.cnki.issn.1674-4152.004548
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  Objective  To analyze the clinical characteristics, etiology, and diagnosis-treatment outcomes of patients admitted with "fatigue of unknown origin" in the general practice ward of a general hospital, and to provide references for enhancing the diagnostic and management capabilities of general practitioners.  Methods  A retrospective study was conducted on 289 patients with "fatigue of unknown origin" as the primary diagnosis in the General Practice Ward of the First Affiliated Hospital of Zhejiang University School of Medicine from October 31, 2022, to December 31, 2024. Data on demographics, predisposing factors, accompanying symptoms, final etiological diagnoses, and treatment outcomes were collected and statistically analyzed.  Results  Among the 289 patients, 175 (60.55%) were female and 114 (39.45%) were male, with a mean age of (56.37±12.28) years. The most common predisposing factors were sleep deprivation (139 cases, 48.10%) and nutritional issues (93 cases, 32.18%). The top three etiological categories were mental disorders (97 cases, 33.56%), digestive system diseases (70 cases, 24.22%), and endocrine system diseases (62 cases, 21.45%). Regarding treatment outcomes, a definitive plan was established within the general practice ward for 106 patients (36.68%), 82 patients (28.37%) required referral to specialists, and no definitive plan was established for 101 patients (34.95%).  Conclusion  Patients with fatigue of unknown origin in the general practice ward of a general hospital are predominantly middle-aged and elderly females. Sleep deprivation and nutritional issues are the main predisposing factors, while mental disorders, digestive, and endocrine system diseases are the leading causes. General practitioners need to enhance competencies in differential diagnosis, comorbidity management, psychological assessment and intervention, and multidisciplinary collaboration and referral to improve patient outcomes.
The causal relationship between education level and peptic ulcer was analyzed based on Mendelian randomization
WANG Wei, KUANG Yuhui, LIU Huayi, YANG Kuo, LI Yupeng, ZHANG Tao, ZHANG Xue
2026, 24(6): 1042-1046. doi: 10.16766/j.cnki.issn.1674-4152.004549
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  Objective  The Mendelian randomization (MR) method is applied to analyze the potential causal relationship between educational attainment and peptic ulcers, aiming to uncover novel biological links between socioeconomic factors and gastrointestinal health.  Methods  Single-nucleotide polymorphisms (SNPs) were screened based on the aggregated data of the genome-wide association study (GWAS). The EA data were from the SSCSG database, and the peptic ulcer data were from the R10 version of the FinnGen database. Inverse variance weighted (IVW), MR-Egger, and weighted median estimation were used to determine the causal relationship between EA and peptic ulcer. Cochran Q-test was used to evaluate heterogeneity, the MR-Egger intercept test, F-statistic, and leave-one-out analysis were used for multi-effect and sensitivity analysis, and MR-PRESSO was used for outlier test.  Results  A total of 604 SNPS were selected to predict EA, and the results showed that IVW (OR=0.529, 95% CI: 0.42-0.66, P < 0.001), MR-Egger (OR=0.451, 95% CI: 0.23-0.88, P=0.020), and weighted median (OR=0.657, 95% CI: 0.47-0.92, P= 0.013), indicating that EA was negatively correlated with peptic ulcer. The MR-PRESSO test detected no outlier SNPs (P= 0.220). Furthermore, Cochran's Q test indicated no significant heterogeneity (P=0.215), and the MR-Egger regression intercept test revealed no evidence of horizontal pleiotropy (P=0.623). The results of the leave-one-out analysis revealed no individual SNPs that significantly influenced the overall results, and the funnel plot displayed a generally symmetrical distribution of SNPs, suggesting that the findings are robust and reliable.  Conclusion  EA has a negative causal association with peptic ulcer, and EA is negatively correlated with the risk of peptic ulcer.
Construction of a preoperative nutrition management plan for patients with gastric cancer conversion therapy based on evidence summary
REN Li, GE Jiaoyu, FU Huanying, XIE Mengjiao, WANG Shanshan
2026, 24(6): 1047-1050. doi: 10.16766/j.cnki.issn.1674-4152.004550
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  Objective  Systematically integrate evidence-based medical findings in the field of preoperative nutritional management for patients undergoing neoadjuvant therapy for gastric cancer, and to develop a scientific and standardized implementation plan for preoperative nutritional management.  Methods  By systematically searching domestic and foreign authoritative databases and combining with scientific literature quality evaluation and analysis methods, a preliminary preoperative nutrition management plan for gastric cancer patients undergoing conversion therapy was formulated. From October to December 2024, the Delphi method was used to conduct two rounds of letter consultation with 14 experts. According to expert feedback, the items of the plan were revised and optimized, and the latest evidence-based evidence was integrated to finally form a perfect preoperative nutrition management plan.  Results  Patients with gastric cancer are often accompanied by severe malnutrition and cachexia. The implementation of standardized preoperative nutritional support can significantly improve the clinical prognosis of patients with gastric cancer conversion therapy, not only improve serum protein and hemoglobin levels, strengthen the tolerance of conversion therapy such as chemotherapy and radiotherapy, but also reduce the incidence of adverse reactions such as nausea and vomiting from 70% to 40%-50%. The interruption of treatment due to adverse reactions was reduced to ensure the continuity of treatment. In addition, nutritional intervention can improve the tumor response rate, prolong the survival of patients, and reduce the prolonged hospitalization and medical costs caused by malnutrition. Through two rounds of expert consultation (the recovery rates were 93.3% and 100.0%, respectively), a preoperative nutrition management plan for patients with gastric cancer conversion therapy was constructed, including 7 first-level items and 36 second-level items. The authority coefficient was 0.825, and the Kendall harmony coefficients were 0.259 and 0.530, respectively (P < 0.001). The coefficient of variation of each item ranged from 0 to 0.175.  Conclusion  The evidence-based preoperative nutrition management plan for patients with gastric cancer conversion therapy is scientific and clinical practical, which can provide a reference for the practice of preoperative nutrition management for patients with gastric cancer conversion therapy in the future.
Visual analysis of research hotspots in cancer symptom management in China based on CiteSpace
LIU Xianli, QIU Hongli, LAN Yunxia, ZHANG Ziqi
2026, 24(6): 1051-1054. doi: 10.16766/j.cnki.issn.1674-4152.004551
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  Objective  To analyze the research status, hotspots, and trends of cancer symptom management in China using the visualization software CiteSpace, and to provide references for further research.  Methods  Literature related to cancer symptom management was retrieved from the CNKI, Wanfang, and VIP databases up to December 31, 2024. Duplicates were removed by NoteExpress and verified manually. Eligible studies focused on cancer symptom management, while abstracts, brief reviews, and notices were excluded. The included literature was imported into CiteSpace 6.3.R1, with the timespan set as 2009-2024, slice length of one year, and threshold set as Top 50. Publication output, authors, institutions, and keywords were analyzed, and network indicators were calculated.  Results  A total of 3 314 papers were included. The annual number of publications increased year by year, reaching 542 in 2024. Sixty-two core authors published 353 papers (10.6%), indicating a relatively dispersed research capacity. A total of 247 institutions contributed publications, with the top 10 all being universities, led by Shandong University, Zhengzhou University, and Anhui Medical University. Keyword co-occurrence analysis showed that "quality of life" "symptom cluster" and "symptom management" were high-frequency themes, with "quality of life" demonstrating the highest centrality. Cluster analysis generated eight themes, indicating reasonable clustering results. Recent research frontiers focused on "review" "immunotherapy" "colorectal cancer" "gynecologic cancer" "breast cancer" "self-efficacy" and the "Delphi method".  Conclusion  Research on cancer symptom management in China started relatively late but has developed rapidly. Research hotspots have evolved from single symptoms to symptom clusters, with increasing emphasis on multidisciplinary comprehensive interventions. Future efforts should strengthen inter-institutional and interdisciplinary collaboration, promote the development of standardized assessment tools, deepen research on the mechanism of symptom clusters, and integrate information-based and individualized strategies to enhance clinical application value.
The effect of empowering nursing on compliance with dual induction therapy in patients with acute promyelocytic leukemia
LIANG Shunyu, MA Xia, JIN Aiai, RAO Jie, ZHANG Junling, WU Tao
2026, 24(6): 1055-1058. doi: 10.16766/j.cnki.issn.1674-4152.004552
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  Objective  To explore the clinical value of empowerment nursing (EN) for patients with acute promyelocytic leukemia (APL) undergoing dual induction therapy, as well as its impact on patients' empowerment level, treatment compliance, and complications.  Methods  A total of 100 APL patients admitted to the Department of Hematology, 940th Hospital of the Joint Logistics Support Force of Chinese People's Liberation Army from August 2023 to March 2025 were enrolled and randomly divided into a control group (n=50, routine nursing) and an experimental group (n=50, routine nursing+EN) using a random number table method. Empowerment levels, treatment compliance, remission of disease, and complications were compared between the two groups.  Results  The empowerment level of the experimental group was superior to that of the control group (Z=3.960, P < 0.001). After 8 months of intervention, the scores for medication, diet, environment, psychological status, and overall compliance in both groups were significantly higher than those before the intervention, and these scores, as well as the total scores, were significantly higher in the experimental group (P < 0.05). The level of peripheral white blood cell count (WBC) was significantly higher than that in control group (P < 0.05), while the proportion of promyelocyte was significantly lower (P < 0.05). The incidence of major complications such as hemorrhage, infection, differentiation syndrome (DS) and central nervous system leukemia (CNSL) in the experimental group was significantly lower than those in the control group (P < 0.05).  Conclusion  EN has positive significance in improving compliance with dual induction therapy in APL patients, decreasinging the proportion of promyelocytes, reducing the incidence of major complications during treatment.
Current status and influencing factors of sedentary behavior during treatment intervals in lung cancer patients
YUAN Niu, QIU Wenjuan, ZHOU Yunxian, ZHANG Ruhui
2026, 24(6): 1059-1062. doi: 10.16766/j.cnki.issn.1674-4152.004553
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  Objective  To investigate the current status and influencing factors of sedentary behavior during the treatment intermission in lung cancer patients, providing a reference for the development of targeted intervention strategies in the future.  Methods  A convenient sampling method was employed to select 310 lung cancer patients who visited the First Affiliated Hospital of Zhejiang University School of Medicine from April to July 2024. Data were collected through a series of questionnaires, including a general information questionnaire, the Chinese version of the adult sedentary behavior questionnaire, the Barthel Index for activities of daily living, numerical rating scale for pain, modified Medical Research Council scale, hospital anxiety and depression scale, perceived social support scale, and the Tilburg frailty indicator. Binary logistic regression was used to identify the factors influencing sedentary behavior during the treatment intermission in lung cancer patients.  Results  A total of 308 valid questionnaires were collected. The survey results revealed that the time spent on sedentary behavior during the treatment intermission was 6.25 (4.50, 7.50) hours. Binary logistic regression analysis identified lung cancer type (OR=2.408, 95% CI: 1.251-4.695, P=0.009), activities of daily living (OR=0.961, 95% CI: 0.937-0.984, P=0.001), anxiety and depression (OR=1.033, 95% CI: 1.004-1.065, P=0.028), perceived social support (OR=0.971, 95% CI: 0.948-0.993, P=0.011), and frailty (OR=3.225, 95% CI: 1.891-5.605, P < 0.001) as significant factors influencing sedentary behavior during the treatment intermission in lung cancer patients.  Conclusion  Lung cancer patients exhibit prolonged sedentary behavior during the treatment intermission. Based on these influencing factors, future intervention strategies can be designed to address and improve sedentary behavior in this patient population.
The impact of rapid response nursing team model on the quality of hierarchical nursing management and rescue efficiency in emergency departments of tertiary hospitals
YE Ting, CHEN Ruimin, HUANG Haiqun, LIAO Dejun, YAN Leilei
2026, 24(6): 1063-1065. doi: 10.16766/j.cnki.issn.1674-4152.004554
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  Objective  Analysis of the application effect of the rapid response team (RRT) model in the hierarchical nursing management of the emergency department of tertiary hospitals, and to provide a scientific basis for the promotion of the RRT model in the emergency department of tertiary hospitals.  Methods  A total of 120 emergency trauma patients who visited the Second Affiliated Hospital of Wenzhou Medical University from January 2021 to June 2024 were selected as the research subjects. Using a random number table, the research subjects were randomly divided into two groups (60 cases each). The control group patients received the conventional stratified nursing management model, while the observation group patients received the rapid response team mode intervention in addition to the conventional emergency stratified nursing management. Nursing efficiency, rescue success rate, satisfaction of patients' families, and incidence of adverse events were compared between the two groups.  Results  After the intervention, the time for establishing intravenous access, the time for using the spinal board, the time for sending blood routine tests, the time for using hemostatic drugs, the time for the first CT examination, and the time spent in the rescue room in the observation group were all shorter than those in the control group (P < 0.05). The rescue success rate in the observation group was 98.33% (59/60), significantly higher than that in the control group 86.67%, 52/60), and the incidence of adverse events [3.33% (2/60)] was significantly lower than that in the control group [13.33% (8/60)], with statistically significant differences (P < 0.05). The scores of nursing satisfaction of patients' families in the observation group were significantly higher than those in the control group (χ2=4.324, 3.927; P=0.038, 0.048).  Conclusion  The RRT model significantly improves the standardization and timeliness of emergency department nursing management, shortens emergency response time, increases the rescue success rate, and reduces the incidence of adverse events, providing effective practical guidance for nursing management in emergency departments of tertiary hospitals.
Influence of health management based on dual-frame design of framing effect on self-care ability of type 2 diabetes patients
LIN Danhong, WU Minfeng, WU Xiaoya, DONG Yin
2026, 24(6): 1066-1070. doi: 10.16766/j.cnki.issn.1674-4152.004555
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  Objective  To explore the influence of health management based on the dual-frame design of framing effect on the self-care ability of type 2 diabetes patients, and to provide a basis for optimizing clinical diabetes health management strategies.  Methods  A total of 164 patients with type 2 diabetes who were admitted to Yuhuan People's Hospital from August 2024 to July 2025 were selected by a convenience sampling method as the research objects. They were divided into a control group and an observation group with 82 cases each by a random number table. The control group applied conventional health management, while the observation group implemented health management based on the dual-frame design of the framing effect. Both groups received continuous intervention for 6 months. The blood glucose levels, self-care ability, decision preparation, and decision self-efficacy were compared between the two groups of patients.  Results  After intervention, the levels of FPG, 2hPG, and HbA1c in the observation group were significantly lower than those in the control group [(6.51±0.83) mmol/L vs. (7.33±1.16) mmol/L, (8.85±1.19) mmol/L vs. (10.03± 1.47) mmol/L, (6.90±0.87)% vs. (7.85±1.02)%], and the differences between groups were statistically significant (P < 0.05). The total score and all dimension scores of the summary of diabetes self-care activities (SDSCA) in the observation group were significantly higher than those in the control group (P < 0.05); The scores of the preparation decision making scale (PrepDMS) and the Chinese version of decision self-efficacy scale (DSES) were also significantly higher than those in the control group (P < 0.05).  Conclusion  Health management based on a dual-frame design of framing effect can enhance the self-care ability of type 2 diabetes patients, control blood glucose level, and enhance patients' decision self-efficacy, which is worthy of clinical application. However, due to the single source of sample and short intervention period in this study, the extrapolation of the conclusions needs to be further verified by multi-center, long-term studies.
A case study on community-based sarcopenia management by general practitioners based on expert consensus
YU Su, SUN Yange, DING Qian, LI Jing, YANG Ling, REN Longbing, XIN Xiaoyi
2026, 24(6): 1071-1074. doi: 10.16766/j.cnki.issn.1674-4152.004556
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This article describes the complete process of screening and intervention for a patient with sarcopenia in a community setting. By integrating a real-world case with expert consensus, it provides practical insights for general practitioners into the screening and management of sarcopenia. The patient was an elderly female identified during a routine osteoporosis clinic visit who presented with persistent fatigue and unintentional weight loss. Further evaluation revealed a grip strength of 17.6 kg and an appendicular skeletal muscle mass index of 3.98 kg/m2, measured via bioelectrical impedance analysis (BIA), confirming a diagnosis of sarcopenia. An interdisciplinary team comprising geriatric specialists from a tertiary hospital, general practitioners, rehabilitation therapists, and nutritionists from our center collaboratively designed an intervention plan that incorporated individualized nutrition and exercise programs for community-based sarcopenia management. After 26 weeks of intervention, improvements were observed in muscle strength, muscle mass, 5-times sit-to-stand test, and 6-meter walking speed. Although some comprehensive hospitals have established sarcopenia clinics, such initiatives remain limited in primary care settings. This article explores feasible strategies for the prevention and management of sarcopenia within communities, emphasizing on early identification and intervention. This findings from this case may assist general practitioners in improving sarcopenia screening, prevention, and treatment practices in community healthcare.
A case report and literature review of Waldenström macroglobulinemia with pleural effusion
ZHANG Rui, WU Tao, MAO Dongfeng, ZHOU Rui, LI Yunyun, GAO Mingmin, WANG Xiangli, LIU Yang
2026, 24(6): 1075-1077. doi: 10.16766/j.cnki.issn.1674-4152.004557
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This study reports a rare case of Waldenström's macroglobulinemia (WM) in a patient presenting with dyspnea and subxiphoid distending pain as the primary symptoms. A retrospective analysis of the clinical data was conducted alongside a comprehensive literature review to delineate the clinical manifestations, pathological characteristics, and diagnostic challenges associated with WM. The patient was diagnosed through a multifaceted approach, including bone marrow aspiration, histopathological examination of lymph node lesions, immunofixation electrophoresis, and flow cytometry of pleural effusion. Following a therapeutic regimen of Rituximab combined with Zanubrutinib, the patient's pleural effusion significantly decreased, and the clinical condition stabilized. This case emphasizes the clinical heterogeneity of WM and underscores the necessity for clinicians to employ integrated diagnostic techniques to reduce misdiagnosis and delayed diagnosis of this malignancy.
A case of castleman disease misdiagnosed as angioimmunoblastic T-cell lymphoma
YUAN Bolin, SUN Caifeng, WANG Liang, LIU Guoqiang
2026, 24(6): 1078-1080. doi: 10.16766/j.cnki.issn.1674-4152.004558
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Castleman disease and angioimmunoblastic T-cell lymphoma share certain histological similarities, such as cellular arrangement and cell morphology within the lymph nodes. These similarities may lead to misdiagnosis in clinical and pathological practice. Additionally, there may be some overlap in their clinical manifestations, further increasing the difficulty of differential diagnosis. This article reports the diagnosis and treatment process of a patient initially diagnosed with angioimmunoblastic T-cell lymphoma but later confirmed as Castleman disease, aiming to reduce the misdiagnosis rate and improve clinical decision-making regarding such diseases.
A case report of pseudohypoparathyroidism with epilepsy as the initial symptom
CHEN Yanna, GU Wensha, ZHOU Yue, HU Changjun, CAO Huimin, SHI Min
2026, 24(6): 1081-1084. doi: 10.16766/j.cnki.issn.1674-4152.004559
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Pseudohypoparathyroidism (PHP) is a rare inherited disease, of which biochemical parameters show low blood calcium, high blood phosphorus, and high parathyroid hormone. The clinical manifestations of PHP are significantly heterogeneous. These PHP patients with epilepsy as the first symptom and without albright hereditary osteodystrophy (AHO) are easily misdiagnosed. This article selected one case of PHP with epilepsy from the Department of Endocrinology in the Huai'an No.1 People's Hospital. Its clinical data, laboratory tests, imaging examinations, genetic testing results, and follow-up were analyzed in combination with relevant literature at home and abroad. We aimed to explore the clinical characteristics and management strategies of PHP in order to improve the diagnostic and management abilities of clinical doctors for this disease.

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