Table of Content

20 March 2025, Volume 28 Issue 09

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Guidelines·Consensus

Consensus for Blood Purification Therapy Based on Pharmacokinetics in Acute Poisoning from Commonly Used Clinical Drugs

Expert Group on the Consensus for Blood Purification Therapy Based on Pharmacokinetics in Acute Poisoning from Commonly Used Clinical Drugs

2025, 28(09):  1033-1043.  DOI: 10.12114/j.issn.1007-9572.2024.0514

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The incidence of acute poisoning caused by commonly used clinical drugs has been increasing annually, yet specific antidotes are lacking for most drug poisonings. Blood purification plays a crucial role in the treatment of acute poisoning. However, there are currently no unified recommendations in China regarding its application in cases of acute poisoning from commonly used clinical drugs. This consensus centers on pharmacokinetics, summarizing and outlining the strategies for applying blood purification in the treatment of acute poisoning caused by these drugs. Its aim is to assist clinicians in improving their understanding of pharmacokinetic parameters and the corresponding blood purification methods, so that they can select the appropriate blood purification technique and develop suitable treatment plans based on the pharmacokinetic characteristics of the drug involved. Ultimately, this seeks to improve outcomes in treating patients with acute poisoning from commonly used clinical drugs.

Reflection and Debate: Focusing on Traditional Medicin

Do Higher Intellectuals Trust Traditional Chinese Medicine More?

ZHANG Minrui, LI Dan, HE Meihui, GAO Ruixiang

2025, 28(09):  1044-1051.  DOI: 10.12114/j.issn.1007-9572.2024.0102

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Background

There is growing evidence that highly educated young people from economically developed regions are becoming the main users of traditional Chinese medicine (TCM) .

Objective

This study adopts a combined variable-centered and person-centered approach grounded in the Unified Theory of Acceptance and Use of Technology (UTAUT) model to explore the factors influencing acceptance of TCM. It examines variables such as demographics, chronic disease status, health literacy, traditional cultural identity, and scientific thinking, with a particular emphasis on parents' willingness to seek TCM pediatric treatments for their children.

Methods

From July to September 2023, a total of 717 parents were conveniently sampled from a kindergarten, primary school, and middle school in Guangdong Province and surveyed via the self-developed DiggMind online psychological assessment platform. Parents' demographic variables (i.e., gender, age, education, occupation, residence, and chronic illness) were collected, and the six dimensions of the UTAUT model as well as three additional influencing variables (i.e., health literacy, traditional cultural identity, and scientific thinking) were measured using a 6-point Likert scale (with higher scores indicating greater alignment with the respondent's situation). The data were analyzed using path analysis, latent profile analysis, and Logistic regression analysis.

Results

The UTAUT model accounted for 72% of the variance in intentions and actual behaviors related to the use of TCM pediatrics. The latent profile analysis of the six dimensions of the UTAUT model—performance expectancy, social influence, facilitating conditions, risk awareness, usage intention, and usage behavior—showed that the current sample was optimally categorized into four subgroups. These subgroups, reflecting increasing levels of acceptance toward TCM pediatrics, were labeled as "Resistant""Skeptical""Accepting"and "Firmly Committed". Parents' scientific thinking and traditional cultural identity demonstrated a significantly positive impact on the acceptance of TCM pediatrics (P<0.05), whereas variables such as education level, type of residence, and occupational prestige showed no statistically significant effects (P>0.05) .

Conclusion

This study reveals that the true driving force behind the "higher intellectuals" group's trust in TCM culture lies in their intrinsic qualities, rather than external factors such as education, occupation, or residence. These findings serve as a bridge facilitating the integration of modern scientific theories with traditional medical practices.

Comparative Study of Traditional Chinese Medicine and Indian Traditional Medicine from the Perspective of International Development

CHEN Ying, ZHOU Shuduo, YANG Jian, HU Yunxuan, FENG Xiangning, XU Ming

2025, 28(09):  1052-1060.  DOI: 10.12114/j.issn.1007-9572.2023.0894

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Traditional Chinese medicine (TCM) is an important part of Chinese traditional culture. It's also an important health resource, economic resource, technological resource, cultural resource and ecological resource in our country. The international development of TCM is an important part of the inheritance and innovation of TCM. In the global traditional medicine system, Indian traditional medicine is the most influential. Development status, international development strategies and impact of Indian traditional medicine are greatly comparable with those of TCM. From the perspective of international development, this paper compared TCM and Indian traditional medicine from seven aspects: service delivery, health workforce, production capacity of traditional medicines, financial allocation for health system and health insurance policy, health governance, product export situation and target markets, international development and influence. It aimed to learn from the successful experience of the international development of Indian traditional medicine, and provide reference for the international development of TCM. In order to actively promote the international development of TCM, make important contributions to deepening the cultural identity of TCM overseas and promote the participation of TCM in global health governance.

Original Research

Clinical Characteristics and Medication Patterns of Patients with Cardiometabolic Multimorbidity

ZHENG Xiaomeng, ZHOU Xuan, SUN Yu, FAN Miao, JIN Yiyi, ZHU Suyan

2025, 28(09):  1061-1064.  DOI: 10.12114/j.issn.1007-9572.2024.0045

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Background

Cardiometabolic multimorbidity (CMM) was one of the most common comorbidity aggregation patterns in different regions and populations, with a high risk of mortality. However, studies on the clinical and medication characteristics of CMM were limited.

Objective

To study the clinical characteristics and medication patterns of patients with CMM in the real world, and provide reference basis for the prevention and management of CMM.

Methods

Outpatient patients who were diagnosed with CMM in the hospital information system (HIS) of the First Affiliated Hospital of Ningbo University from January 2023 to June 2023 were selected. Basic prescription information was collected and analyzed using frequency analysis and association rule analysis methods.

Results

A total of 7 059 patients with CMM were included, of which 3 960 (56.1%) were male and 3 099 (43.9%) were female, with an age range of 18 to 97 years and a mean age of (58.1±13.7) years. The results showed that 3 910 patients with less than 5 types of medication, accounting for 55.4%; 2 740 patients with 5-9 types of medication, accounting for 38.8%; and 409 patients with more than 10 types of medication, accounting for 5.8%. Hypertension, dyslipidemia, and diabetes were the core diseases of CMM. Among the comorbidities of cardiovascular metabolic diseases, chronic gastritis, renal insufficiency, and hyperuricemia were more common. In the prescription of patients with CMM, statins, calcium channel blockers (CCB), angiotensin receptor blockers (ARB), metformin, and sodium-dependent glucose transporters 2 inhibitors (SGLT2i) were the core medications.

Conclusion

Our findings suggest chronic gastritis, renal insufficiency, and hyperuricemia are more common diseases in patients with CMM. Screening and prevention should be strengthened and treatment strategies should be adjusted. In the CMM drug prescription, lipid-lowering, antihypertensive, and hypoglycemic drugs are the core drugs used.

Relationship between Serum Sodium Levels and Length of Hospital Stay in Patients with Pulmonary Hypertension associated with Left Heart Disease

SUN Lin, SHI Yiwei, HOU Xiaomin, GUO Yunting, ZHAO Xu, DONG Lin, NIE Jisheng, QIN Xiaojiang

2025, 28(09):  1065-1071.  DOI: 10.12114/j.issn.1007-9572.2023.0889

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Background

Pulmonary hypertension (PH) associated with left heart disease (PH-LHD) is the most common form of PH. Studies have shown that serum sodium is associated with the severity and poor prognosis of group 1 PH, but the effect of serum sodium on PH-LHD has rarely been reported.

Objective

To investigate the relationship between serum sodium and N-terminal pro-brain natriuretic peptide (NT-proBNP) and echocardiographic indexes in PH-LHD patients, and evaluate the effect of serum sodium on the severity and length of stay of PH-LHD, so as to provide theoretical basis for clinical diagnosis and treatment of PH-LHD patients and improvement of hospital turnover.

Methods

The clinical data of 360 adult inpatients diagnosed with PH-LHD in the First Hospital of Shanxi Medical University from January 2020 to February 2022 were collected. According to the median serum sodium of 139 mmol/L (serum sodium <135 mmol/L is hyposodium), the patients were divided into 3 groups: <135 mmol/L group (n=50), 135-139 mmol/L group (n=136) and 140-145 mmol/L group (n=174). Spearman correlation analysis was used to explore the correlation of serum sodium level with length of hospital stay, NT-proBNP and echocardiographic indicators. Kaplan-Meier was used to compare the length of hospital stay of PH-LHD patients with different serum sodium levels. Binary Logistic regression analysis was used to investigate the effect of serum sodium levels on the length of hospital stay in PH-LHD patients.

Results

Age, length of stay, NT-proBNP, left atrial diameter, right atrium area, left ventricular ejection fraction and shortening fraction of PH-LHD patients in 3 groups were compared, and the differences were statistically significant (P<0.05). The length of hospitalization and NT-proBNP of patients in the serum sodium 140-145 mmol/L group were lower than those in the serum sodium <135 mmol/L group and the serum sodium 135-139 mmol/L group (P<0.05). Spearman correlation analysis showed that serum sodium level was negatively correlated with length of stay (r_s=-0.176), NT-proBNP (r_s=-0.135), right ventricular diameter (r_s=-0.110) and pulmonary artery systolic pressure (r_s=-0.105) in PH-LHD patients (P<0.05). The Kaplan-Meier survival showed that there were statistically significant differences between the length of hospital stay among the three groups of PH-LHD patients with different serum sodium levels. Binary Logistic regression analysis showed that increased serum sodium level was a protective factor for longer hospital stay in PH-LHD patients after correcting each control variable (OR=0.916, 95%CI=0.859-0.977, P=0.008). The risk of prolonged hospitalization was elevated in patients with serum sodium <135 mmol/L and those with serum sodium 135-139 mmol/L compared with patients with serum sodium 140-145 mmol/L.

Conclusion

Serum sodium level is closely related to the severity of PH-LHD, and decreased serum sodium level is an independent risk factor for the length of hospital stay in PH-LHD patients. It is a potential therapeutic consideration, providing new strategies for the diagnosis and treatment of PH-LHD and hospital turnover.

The Correlation of Non-alcoholic Fatty Liver Disease with Visceral Fat Area and Thyroid Nodules in Patients with Type 2 Diabetes Mellitus

ZENG Jialing, MENG Yan, DENG Tingting, LI Jinhua, ZHAO Ping

2025, 28(09):  1072-1083.  DOI: 10.12114/j.issn.1007-9572.2024.0016

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Background

The prevalence of non-alcoholic fatty liver disease (NAFLD) significantly increases in patients with type 2 diabetes mellitus (T2DM). However, the correlation of NAFLD with visceral fat area (VFA) and thyroid nodules in T2DM patients has been rarely reported.

Objective

This study aims to investigate the influencing factors for NAFLD in T2DM patients, and the correlation of NAFLD with VFA, thyroid nodules, and thyroid function in this population.

Methods

Hospitalized T2DM patients in the Department of Endocrinology, the Fourth Affiliated Hospital of Guangxi Medical University (Liuzhou Worker's Hospital) from January 2018 to April 2023 were retrospectively recruited. They were divided into two groups based on abdominal ultrasound findings: NAFLD group and non-NAFLD group. General data, including VFA, subcutaneous fat area (SFA), insulin function, thyroid function, prevalence of thyroid nodules, blood glucose levels, lipid levels, and liver and kidney function were compared between the two groups. Additionally, patients were divided into visceral obesity group (VFA≥100 cm²) and non-visceral obesity group (VFA < 100 cm²) based on VFA. Age, sex, prevalence of NAFLD and thyroid nodule were compared between the two groups. Spearman correlation analyses were employed to investigate factors associated with NAFLD and VFA, as well as their correlation with thyroid nodules. Influencing factors for the volume of thyroid nodules were explored as well. Furthermore, binary Logistic regression analysis was used to determine risk factors for both NAFLD and thyroid nodules in T2DM patients. Receiver operating characteristic (ROC) curve analysis evaluated the predictive value of BMI, waist-hip circumference, and waist-hip ratio, VFA, homeostatic model assessment for insulin resistance (HOMA-IR) in predicting NAFLD in T2DM patients and their optimal cut-off values.

Results

A total of 578 T2DM patients were enrolled in this study, including 293 (50.69%) patients in the NAFLD group and 285 in the non-NAFLD group. The age of the NAFLD group was significantly lower than that of non-NAFLD group [ (57.0±12.8) years vs. (59.3±11.6) years, P<0.05]. Compared to those of the non-NAFLD group, patients in the NAFLD group had significantly higher body weight, body mass index (BMI), waist circumference, hip circumference, VFA, SFA, glycated hemoglobin (HbA_1c), fasting insulin levels (FINS), fasting C-peptide levels (FCP), HOMA-IR, homeostasis model assessment of β-cell function (HOMA-β), free triiodothyronine levels (FT₃), serum uric acid (SUA), total cholesterol (TC), triglyceride (TG) and C-reactive protein (CRP), but significantly lower serum creatinine (SCr) (P<0.05). There were 251 cases in the visceral obesity group and 327 cases in the non-visceral obesity group. The age of the visceral obesity group was significantly lower than that of the non-visceral obesity group [ (55.3±13.4) years vs. (60.3±10.8) years, P<0.05]. The incidence of NAFLD was significantly higher in the visceral obesity group than that of non-visceral obesity group (P<0.05). However, there was no significant difference in the prevalence of thyroid nodules between the visceral obesity group and non-visceral obesity group (64.94% vs. 59.82%, P>0.05). Spearman correlation analysis revealed that the occurrence of NAFLD in T2DM patients was positively correlated with body mass, BMI, waist circumference, hip circumference, waist-to-hip ratio, VFA, SFA, HbA_1c, FINS, FCP, HOMA-IR, HOMA-β, total triiodothyronine (TT₃), FT₃, and CRP (P<0.05), but negatively correlated with age (P<0.05). VFA in T2DM patients was found to be significantly correlated with gender, age, height, body mass, BMI, waist circumference, hip circumference, waist-to-hip ratio, SFA, diastolic blood pressure (DBP), FINS, FCP, HOMA-IR, HOMA-β, TT₃, FT₃, CRP and NAFLD (P<0.05). The thyroid nodule area showed a negative correlation with height, thyroid stimulating hormone (TSH) and waist-to-hip ratio (P<0.05), while it showed positive correlations with sex, age, TT₃, TT₄ and thyroglobulin (P<0.05). Univariate unconditional Logistic regression analysis revealed that age, weight, BMI, waist circumference, hip circumference, VFA, SFA, HbA_1c, FCP, HOMA-IR, FT₃, SCr, SUA, TC and TG were the influencing factors for NAFLD in T2DM patients. Binary Logistic regression results demonstrated that body weight (OR=0.962), VFA (OR=1.025), SFA (OR=1.006), FT₃ (OR=1.429) and HOMA-IR (OR=1.140) were the influencing risk factors for NAFLD in T2DM patients. Gender (OR=0.342), age (OR=1.073) and free thyroxine (FT₄) (OR=1.140) were influencing factors for thyroid nodules in T2DM patients (P<0.05). ROC curve results showed that the area under the curve (AUC) of BMI, waist circumference, hip circumference, waist-to-hip ratio, VFA and HOMA-IR was 0.704, 0.704, 0.705, 0.629, 0.757, and 0.569, respectively. The optimal cut-off value, sensitivity and specificity of them were listed as follows: BMI (25.37 kg/m², 67.7%, 36.0%), waist circumference (84.5 cm, 67.3%, 36.4%), hip circumference (96.5 cm, 69.4%, 38.9%), waist-to-hip ratio (0.895, 38.8%, 19.1%), VFA (88.4 cm² in female and 99.45 cm² in male, 78.9%, 35.3%), and HOMA-IR (3.08, 64.3%, 49.8%) .

Conclusion

The prevalence of NAFLD and thyroid nodules in T2DM patients significantly increase, but not correlated. Obese T2DM patients, especially those with visceral obesity, are more likely to suffer from NAFLD, thyroid nodules, hyperlipidemia, hyperuricemia and other metabolic diseases. HOMA-IR is a influencing factor for NAFLD in T2DM patients, but it is not a influencing factor for thyroid nodules. BMI, waist circumference, hip circumference and VFA are predictive factors of NAFLD in T2DM patients, and VFA has the highest diagnostic value and HOMA-IR has the lowest value. VFA predicts NAFLD in T2DM patients with the optimal cut-off value of 88.4 cm², which is equal in females and 99.45 cm² in males.

The Prognosis of Stage 4 Chronic Kidney Diseasetreated with Fermented Cordyceps Sinensis Powder: Based on a Retrospective Cohort Study

WANG Yiquan, CHEN Wanjia, LIU Wangyi, ZHANG Luyun, DENG Yueyi

2025, 28(09):  1084-1091.  DOI: 10.12114/j.issn.1007-9572.2024.0106

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Background

Chronic kidney disease (CKD) is a worldwide public health problem, stage 4 CKD is a critical stage during the course of CKD, marking the significant decline of kidney function and the obvious appearance of symptoms. Although fermented cordyceps sinensis powder has been used in the treatment of chronic kidney disease for a long time, its prognostic effect on CKD, especially the curative effect of stage 4 CKD, lacks evidence-based medical evidence.

Objective

To explore the long-term prognosis of stage 4 CKD patients treated with fermented cordyceps sinensis powder and the potential related factors affecting the prognosis.

Methods

A total of 631 patients diagnosed with stage 4 CKD in the nephrology Department of Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from 2013 to 2022 were collected. Based on standardized integrated Chinese and Western medicine treatment, patients were divided into cordyceps treatment group (339 cases) and integrated Chinese and Western medicine treatment group (252 cases) according to whether fermented cordyceps sinensis powder was used. Data such as patients' basic information, whether they were accompanied by diabetes, the occurrence and time of endpoint events, the time of diagnosis of stage 4 CKD, and relevant laboratory indicators at diagnosis were collected. After eliminating baseline differences between groups with propensity score matching, COX regression analysis was conducted to analyze potential prognostic factors. Survival curve was drawn by Kaplan-Meier method, and the difference of survival between groups was compared by Log-rank test.

Results

A total of 378 patients were included after matching at a ratio of 1:1. Multivariate Cox proportional hazard regression analysis showed that the using of fermented cordyceps sinensis powder (HR=0.79, 95%CI=0.64-0.98, P=0.030), the increased level of estimated glomerular filtration (HR=0.97, 95%CI=0.94-1.00, P=0.025) and serum albumin (HR=0.97, 95%CI=0.96-0.99, P=0.002) prolonged the survival time of stage 4 CKD patients; male (HR=1.37, 95%CI=1.09-1.71, P=0.006), the increased level of brain natriuretic peptide (HR=1.00, 95%CI=1.00-1.00, P=0.003), blood phosphorus (HR=2.44, 95%CI=1.63-3.67, P<0.001) and 24 h urinary protein (HR=1.00, 95%CI=1.00-1.00, P<0.001) shortened the survival time of patients with stage 4 CKD. The results of survival curve analysis showed that cumulative survival rate of cordyceps treatment group was higher than that of integrated Chinese and Western medicine treatment group (HR=0.70, 95%CI=0.57-0.86, P<0.001). The cumulative survival rate in the low protein level subgroup was higher in the cordyceps treatment patients than in the integrated Chinese and western medicine treatment patients (HR=0.67, 95%CI=0.52-0.85, P<0.001). In the high urinary protein level subgroup, there was no significant difference in cumulative survival between the two treatment groups (P=0.518) .

Conclusion

Long-term use of fermented cordyceps sinensis powder can prolong the progression of renal function in patients with stage 4 CKD, and can play a better clinical effect under the premise of active control of urinary protein. Relatively low levels of brain natriuretic peptide and serum phosphorus, and relatively high levels of serum albumin are also potential factors for good prognosis in patients with stage 4 CKD.

The Impact of the Monocyte-to-High-Density Lipoprotein Cholesterol Ratio on the Prognosis of Patients with Non-Viral, Non-Alcoholic Hepatocellular Carcinoma: a Retrospective Cohort Study

LOU Xianzhe, MIAO Tongguo, ZHANG Shiya, MA Dong, NAN Yuemin

2025, 28(09):  1092-1099.  DOI: 10.12114/j.issn.1007-9572.2023.0855

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Background

The incidence of primary non-viral hepatocellular carcinoma (NBNC-HCC) continues to increase, and abnormal lipid metabolism accompanied by inflammation is one of the main causes of NBNC-HCC, so the detection and evaluation of inflammatory markers may be an important method to predict the prognosis of NBNC-HCC.

Objective

To investigate the prognostic value of monocyte/high-density lipoprotein ratio (MHR) as a predictor in patients with NBNC-HCC.

Methods

A total of 119 patients diagnosed with NBNC-HCC at the Third Hospital of Hebei Medical University between January 2013 and February 2020 were enrolled. General information and laboratory test results were collected. Patients were divided into four groups based on the quartiles of their MHR values: Q1 (MHR<0.33, n=28), Q2 (0.33≤MHR<0.66, n=31), Q3 (0.66≤MHR<1.59, n=30), and Q4 (MHR≥1.59, n=30). Patients were followed up regularly, and data on their survival status and time of death were recorded. The primary endpoint was the overall survival (OS) of patients with NBNC-HCC. Restricted cubic splines (RCS) were plotted to assess the correlation between MHR at admission and patient mortality. Receiver operating characteristic (ROC) curves were plotted to analyze the value of MHR at admission in predicting 36-month survival of patients with NBNC-HCC. Cox proportional hazards models and BP neural network models were used to analyze the independent risk factors for patients with NBNC-HCC. The Kaplan-Meier method was used to plot survival curves for the prognosis of patients with NBNC-HCC, and the Log-rank test was performed.

Results

There were statistically significant differences in diabetes, proportion of surgeries, Barcelona Clinic Liver Cancer (BCLC) stage, aspartate aminotransferase (AST), C-reactive protein (CRP), gamma-glutamyltransferase (γ-GT), cholinesterase (CHE), urea (UREA), creatinine (Scr), high-density lipoprotein cholesterol (HDL-C), white blood cell count (WBC), red blood cell count (RBC), monocyte count (MONO), neutrophil count (NEUT), and albumin-bilirubin (ALBI) score among the Q1 to Q4 groups (P<0.05). ROC curves were plotted for MHR, MONO, and HDL-C to predict the prognosis of patients with NBNC-HCC. The results showed that MHR (AUC=0.822, 95%CI=0.742-0.903, P<0.05) had a better predictive effect on patient prognosis than MONO (AUC=0.723, 95%CI=0.618-0.828) (Z=4.34, P<0.05) and HDL-C (AUC=0.216, 95%CI=0.119-0.313) (Z=2.088, P<0.05). Multivariate Cox regression analysis showed that BCLC stage B-D, CRP, and MHR were independent risk factors for all-cause mortality in patients with NBNC-HCC (P<0.05). After adjusting for hypertension, smoking, alcohol consumption, diabetes, alanine aminotransferase (ALT), and AST, Q2 (OR=1.926, 95%CI=1.005-3.689, P=0.015), Q3 (OR=3.418, 95%CI=1.774-6.586, P<0.05), and Q4 (OR=7.677, 95%CI=3.773-15.621, P<0.05) were risk factors for patient mortality. RCS results showed a non-linear dose-response relationship between MHR at admission and the risk of mortality in patients with NBNC-HCC (P_trend<0.001, P_{non-linearity}<0.001). When MHR at admission was>0.67, the hazard ratio (HR) was>1, indicating that MHR at admission was a risk factor for mortality in patients with NBNC-HCC (P<0.05). BP neural network model analysis found that the main factors affecting the prognosis of patients with NBNC-HCC included BCLC stage (100.0%), vascular invasion (76.3%), extrahepatic metastasis (40.6%), MHR (39.3%), CRP (38.7%), ALBI score (35.5%), total bilirubin (35.0%), MONO (34.8%), and NEUT (29.8%). There was a statistically significant difference in the cumulative survival rates among the Q1 to Q4 groups (χ²=61.86, P<0.001) .

Conclusion

MHR was related to the prognosis of NBNC-HCC patients with a good predictive value.

Risk Factors, Prognosis and Rapid Screening in Patients with Acute Aortic Dissection Complicated with Type 2 Diabetes

HUANG Lujie, ZHANG Xiaoying, YU Shasha

2025, 28(09):  1100-1105.  DOI: 10.12114/j.issn.1007-9572.2023.0754

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Background

The incidence of acute aortic dissection with type 2 diabetes is on the rise; however, relatively little research has been done on its risk factors and prognosis. Therefore, actively seeking a simple and effective diagnostic tool has become the focus of research.

Objective

To analyze the risk factors, prognosis and rapid screening of AAD patients with type 2 diabetes.

Methods

A total of 168 patients with AAD admitted to Ningbo Medical Center Li Huili Hospital from January 2016 to October 2022 were selected as the study objects, and the patients were initially screened and triaged using the aortic dissection detection risk score (ADD-RS) table. Aortic CTA was selected as the "gold standard" for the diagnosis of AAD, and the diagnostic results of aortic CTA were compared with the preliminary screening results of ADD-RS. The general data of the diabetic group and the non-diabetic group were compared, and the risk factors of type 2 diabetes in AAD patients were analyzed by multivariate Logistic regression analysis. The short-term prognosis and pain score of the two groups were compared. The factors influencing the short-term prognosis of AAD patients were analyzed by Cox regression analysis, and the predictive value of ADD-RS was analyzed by ROC curve.

Results

59 patients with AAD combined with type 2 diabetes (diabetes group) and 109 patients with AAD combined with non-diabetes (non-diabetes group) were screened by ADD-RS table. Multivariate Logistic regression analysis showed that increased age (OR=1.088, 95%CI=1.042-1.136, P<0.001), BMI≥25 kg/m² (OR=2.000, 95%CI=1.421-2.834, P<0.001), coronary heart disease (OR=7.654, 95%CI=1.850-31.677, P=0.005), hyperlipidemia (OR=4.948, 95%CI=1.384-17.681, P=0.014), and LVEF (OR=1.199, 95%CI=1.109-1.297, P<0.001) were risk factors for AAD combined with type 2 diabetes. There was no statistically significant difference in pain score between AAD patients with or without diabetes mellitus (P>0.05), and the 30-day mortality of the two groups was 3.39% and 3.67%, respectively, with no statistically significant difference between the two groups (P>0.05). Cox regression analysis showed that hypertension was not an independent factor affecting the short-term prognosis of patients with acute aortic dissection (HR=0.673, 95%CI=0.094-4.791, P>0.05). The ADD-RS score of the diabetic group was 1 ⁽¹⁾, significantly higher than that of the AAD patients in the non-diabetic group 1 ⁽²⁾ (Z=-4.640, P<0.001). The high risk and moderate risk in diabetic group were higher than those in non-diabetic group (Z=2.309, P=0.021). The maximum area under ROC curve is 0.706 (95%CI=0.634-0.779) .

Conclusion

Risk factors for AAD patients with type 2 diabetes include age, BMI≥25 kg/m², coronary heart disease, hyperlipidemia, and LVEF. Moreover, ADD-RS score has high clinical value in the risk assessment of AAD patients with type 2 diabetes.

Risk Prediction Models for Refractory Mycoplasma Pneumoniae Pneumonia in Children: a Systematic Review

LI Ruitong, YUE Yuchuan, GU Xujie, XIONG Lingling

2025, 28(09):  1105-1114.  DOI: 10.12114/j.issn.1007-9572.2024.0098

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Background

Mycoplasma pneumoniae pneumonia (MPP) is a common respiratory disease in children, which can easily develop into refractory Mycoplasma pneumoniae pneumonia (RMPP). Children with RMPP have complex conditions, are difficult to treat, and are associated with multiple serious complications. A risk prediction model for RMPP in children can help healthcare professionals to identify children at high risk of RMPP and provide timely therapeutic countermeasures.

Objective

To systematically review the risk prediction models for RMPP in children.

Methods

CNKI, Wanfang Data, VIP, CBM, PubMed, Embase, Web of Science and Cochrane Library were searched to collect the related studies on risk prediction models for RMPP in Children to February 20th, 2024. Two reviewers independently screened the literature, extracted data and evaluated the quality of the included studies. Meta-analysis of the incidence and predictors of RMPP in children was performed using Stata 18.0 software.

Results

A total of 14 papers were included, containing 17 risk prediction models. Ten studies were internal validated, and only four studies were external validated, all of which had AUC>0.7. PROBAST results showed that 14 included papers were all at high risk of bias. The results of Meta-analysis showed that the incidence of RMPP in children was 28.2% (95%CI=21.2%-35.1%), hyperthermia, lactate dehydrogenase, C-reactive protein, age, neutrophil ratio, procalcitonin and D-dimer were independent influences on the occurrence of RMPP in children (P<0.05) .

Conclusion

Risk prediction models for RMPP in children have good predictive performance, but the overall risk of bias was high and external validation was lacking. The future risk prediction model should focus on hyperthermia, lactate dehydrogenase, C-reactive protein, age, neutrophil ratio, procalcitonin and D-dimer.

Original Research

Risk Prediction Model for High Myopia in Primary and Secondary School Students: Based on Nested Case-control Study

CHEN Shenglan, ZHENG Yongtao, HU Wangcheng, NI Zuowei, XIA Bing, YE Chunmei, DU Chixin, CHEN Xiaodan

2025, 28(09):  1115-1121.  DOI: 10.12114/j.issn.1007-9572.2024.0318

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Background

The vision health of primary and secondary school students has become a growing concern due to increasing academic pressure, the widespread use of electronic devices, and poor eye care habits. High myopia, as an advanced stage of myopia, emerging as a global public health issue. While many existing studies have explored the risk factors for myopia, few have specifically addressed the complex non-linear relationships between these factors and the development of high myopia. This study combines a nested case-control study with restricted cubic splines to develop a risk prediction model for high myopia in primary and secondary school students. By identifying high-risk individuals early, this model aims to delay or prevent the progression of high myopia, contributing to tertiary prevention of myopia, and positively impacting the academic and life quality of students.

Objective

To investigate the prevalence and risk factors of high myopia in primary and secondary school students, and conduct a risk prediction model to provide a scientific basis for myopia prevention.

Methods

A nested case-control study was conducted in 2023, involving students with moderate myopia from 12 schools in Hangzhou to establish a cohort. Myopia status among the students was monitored in accordance with the National Monitoring and Intervention Program for Common Diseases and Health-Related Factors in Students. Students who progressed to high myopia were classified as the case group, while the others formed the control group, vision care behaviors were surveyed for both groups. Lasso regression was used to select feature variables, followed by multivariate logistic regression analysis to identify factors influencing the development of high myopia among primary and secondary school students. A Nomogram was employed to visualize the risk prediction model. The model's performance was evaluated using the Hosmer-Lemeshow test, receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Additionally, restricted cubic splines were used to further clarify the relationship between age and the risk of high myopia.

Results

A total of 2468 students from 12 primary and secondary schools were enrolled. Among them, 1 293 students did not progress to high myopia, while 1 175 students with moderate myopia progressed to high myopia, resulting in a high myopia incidence rate of 47.61% (1 175/2 468). Significant differences were observed between the two groups in terms of age, grade level, BMI, daily sleep time, geographic region, outdoor activity time, electronic device usage time, after-school homework time, and household lamp usage (P<0.05). Lasso regression identified eight feature variables: grade level, BMI, daily sleep time, geographic region, outdoor activity time, electronic device usage time, after-school homework time, and household lamp usage. Multivariate Logistic regression analysis revealed that the risk factors for high myopia in primary and secondary school students included being in middle school (OR=2.612, 95%CI=2.185-3.127), being overweight or obese (OR=2.140, 95%CI=1.458-3.169), being underweight (OR=1.807, 95%CI=1.430-2.290), sleeping after 22: 00 daily (OR=1.408, 95%CI=1.188-1.670), engaging in outdoor activities for 1-2 h/d (OR=1.371, 95%CI=1.122-1.675) or <1 h/d (OR=1.648, 95%CI=1.342-2.027), using electronic devices >2 h/d (OR=1.440, 95%CI=1.1191.856), and spending 1-2 h/d (OR=1.461, 95%CI=1.126-1.899) or >2 h/d (OR=1.534, 95%CI=1.218-1.935) on after-school homework (P<0.05). In contrast, being in high school was identified as a protective factor against high myopia (OR=0.560, 95%CI=0.419-0.743, P<0.05). A risk prediction model was constructed based on six variables: grade level, BMI, daily sleep time, outdoor activity time, electronic device usage time, and after-school homework time. The model achieved an area under the ROC curve of 0.840 (95%CI=0.825-0.855), demonstrating good fit, consistency, and applicability. Additionally, restricted cubic spline analysis indicated that the age group of 13~15 years was the high-risk period for developing high myopia.

Conclusion

The incidence of high myopia among primary and secondary school students was notably high. The risk prediction model could provide a scientific basis for the prevention and control of high myopia. Strengthening myopia prevention and control measures in middle school, along with improving students' vision care behaviors, was essential for reducing the occurrence of high myopia.

Diagnostic Performance of SPECT in Patients with Coronary Microcirculation Disturbance after PCI

JIA Shuo, CHENG Gong, GUAN Lei, FENG Panpan, XU Bailing, FANG Wei, ZHANG Ji

2025, 28(09):  1122-1127.  DOI: 10.12114/j.issn.1007-9572.2023.0536

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Background

Patients after percutaneous coronary intervention (PCI) may still experience typical angina, potentially due to concomitant coronary microcirculation disturbance (CMD). Single-photon emission computed tomography (SPECT) serves as a non-invasive method for quantitatively assessing coronary flow reserve (CFR) in CMD patients. However, research on its diagnostic performance in this population is limited.

Objective

To evaluate the diagnostic performance of SPECT in patients with CMD after PCI by using upgraded acquisition techniques and novel myocardial blood flow quantitative analysis software.

Methods

A total of 32 patients who still had typical angina symptoms after PCI for coronary artery disease in Shaanxi Provincial People's Hospital between November 2020 and November 2021 were included in the study. General data of the patients were collected. Coronary angiography was performed, the fractional flow reserve (FFR) and index of microcirculatory resistance (IMR) were measured using a temperature/pressure guidewire, and patients with FFR>0.8 and no pericardial subvascular obstructive stenosis postoperatively were selected, encompassing 60 vessels in total. Pearson's test was used to explore the correlation between IMR and CFR. With IMR as the gold standard, a receiver operating characteristic (ROC) curve was plotted for CFR in diagnosing CMD, and the area under the ROC curve (AUC) was calculated.

Results

Twenty CMD patients were included in the study, comprising 15 males and 5 females, with an average age of (64.2±9.3) years. Of the 60 vessels included, 21 were left anterior descending, 17 were left circumflex, and 22 were right coronary arteries. Pearson's test showed a negative correlation between IMR and CFR (r=-0.526, P<0.001). The AUC for CFR in diagnosing CMD was 0.840 (95%CI=0.716-0.964), the truncation value is 1.985.

Conclusion

SPECT has demonstrated good diagnostic performance in patients after PCI. Upgraded acquisition techniques and novel myocardial blood flow quantitative analysis software make SPECT an effective tool for diagnosing the presence of CMD in patients without pericardial subvascular obstructive stenosis after PCI.

Construction of an Artificial Intelligence Model and Application for an Automatic Recognition of Traditional Chinese Medicine Herbals Based on Convolutional Neural Networks

WANG Ganhong, ZHANG Zihao, XI Meijuan, XIA Kaijian, ZHOU Yanting, CHEN Jian

2025, 28(09):  1128-1136.  DOI: 10.12114/j.issn.1007-9572.2024.0394

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Background

Conventional methods for identifying traditional Chinese medicine (TCM) herbals mainly rely on subjective experiences, making it difficult to meet the needs for accurate classification and identification.

Objective

This study aims to develop an artificial intelligence model and a desktop application capable of automatically recognizing 163 types of TCM herbals based on convolutional neural networks (CNN) .

Methods

From January 2020 to June 2024, data from two datasets of 163 TCM herbals were collected for training, validation, and testing of the deep learning model. The performance of the CNN model was evaluated for the accuracy, sensitivity, specificity, precision, area under the receiver operating characteristic (ROC) curve (AUC), and F1 score. After model training, an application was developed using PyQt5 technology for convenient clinical use.

Results

A total of 276 767 images were included in this study. Five models, including EfficientNetB0, ResNet50, MobileNetV3, VGG19, and ResNet18, were developed. After comparing their performance, the EfficientNetB0 model achieved the highest accuracy (99.0%) and AUC (0.994 2) in the validation dataset, and it was selected as the optimal model. In the test dataset, the EfficientNetB0 model achieved an accuracy of 99.0%, sensitivity of 99.0%, specificity of 100.0%, and an AUC of 1.0 across all categories, demonstrating an excellent performance.

Conclusion

The deep learning model developed based on CNN can quickly and accurately recognize 163 types of TCM herbals with high sensitivity and recognition capability, thus providing a robust support for physicians to accurately identify TCM herbals.

Frontiers of Medicine

Myocardial Viability Testing in Patients with Ischemic Cardiomyopathy

SU Lifang, WANG Yanbo, JIANG Yunfa, LIU Changchang, GU Xinshun

2025, 28(09):  1137-1142.  DOI: 10.12114/j.issn.1007-9572.2024.0132

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Ischemic cardiomyopathy (ICM) is an important cause of heart failure with reduced ejection fraction. Despite the improvement of treatment methods, it still has a high mortality. Coronary revascularization is an important treatment for ICM patients, due to the fact that ICM patients are elderly, have multiple diseases and severe coronary artery lesions, the risk of revascularization is relatively high. Currently, there is still controversy over whether and how to revascularization in ICM patients. Myocardial viability has predictive value for the prognosis of ICM patients and provides reference for selecting treatment strategies, but its guiding value for revascularization in ICM patients still needs further verification. This article provides a review of the current treatment of ICM patients, commonly used methods for myocardial viability assessment, and the clinical application of myocardial viability to guide revascularization, so as to provide reference for clinical work.

The Roles of Deubiquitination in Age-related Diseases

XU Linhui, LI Pengfei, WU Miaomiao, KANG Lihua, JI Min, YU Ying, GUAN Huaijin

2025, 28(09):  1143-1155.  DOI: 10.12114/j.issn.1007-9572.2024.0357

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Deubiquitination, mediated by deubiquitinating enzymes (DUBs), represents a crucial class of post-translational protein modifications. Its primary mechanism involves in the interaction of DUBs with ubiquitinated target proteins, whereby the DUBs cleave or remove ubiquitin chains from these targets, subsequently restoring their expression levels and functional activities. This article systematically reviews the latest research progress on deubiquitination in age-related diseases, covering the types of DUBs, their roles in cellular aging, and the regulatory mechanisms in age-related diseases through different pathways. It also summarizes the research progress in the development of small-molecule drugs targeting DUBs and related mechanisms. This review demonstrates that as the body ages, factors such as decreased protein renewal function and oxidative damage lead to the accumulation of ubiquitinated proteins, resulting in cellular dysfunction. DUBs play an important and complex regulatory role in age-related diseases by modulating mechanisms such as protein homeostasis, mitochondrial function, and cell cycle in aging cells.

Research Progress of Exosome miRNA Involved in the Repair of Diabetic Foot Ulcer

CEN Nimiao, WEI Yunshi, HUANG Lina, WU Biaoliang

2025, 28(09):  1156-1160.  DOI: 10.12114/j.issn.1007-9572.2024.0342

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Diabetic foot ulcer (DFU) is usually accompanied by varying degrees of peripheral neuropathy and vasculopathy. It is a difficult-to-heal wound. The delayed healing process is mainly due to new blood vessel regeneration disorder, persistent wound inflammation, wound re-epithelialization disorder and abnormal fibroblast proliferation. Exosomal miRNA, as an important medium for intercellular communication, is involved in a variety of biological processes and can regulate the transcription and translation of various target genes affecting DFU healing. This paper aims to briefly review the role of exosomal miRNAs in the regulation of neointimal regeneration, inflammatory response, wound re-epithelialization function, and fibroblast proliferation function in the repair of DFU, to provide new ideas for the treatment of DFU.