Zhonghua yi xue za zhi最新文献

{"title":"[Effect of preoperative timing for ultrasound-guided intra-articular hip anesthetic injection on post-arthroscopy infection and inflammation in patients with femoroacetabular impingement].","authors":"H R Teng, H Fu, Y D Wu, Z K Guo, M Y An, K K Yu, Y T Wang, Q Jia, X H Ma, C B Li","doi":"10.3760/cma.j.cn112137-20250415-00936","DOIUrl":"10.3760/cma.j.cn112137-20250415-00936","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the relationship between preoperative ultrasound-guided intra-articular local anesthetics injection at different time points and postoperative infection risk and inflammatory response after hip arthroscopy in femoroacetabular impingement(FAI). <b>Method:</b> This retrospective observational study enrolled FAI patients who underwent hip arthroscopy surgery at the General Hospital of the People's Liberation Army from May 2017 to October 2023. According to the time interval between intra-articular injection and the surgery, the patients were divided into four groups: injection time≤30 days prior to surgery, injection time between 30-90 days prior to surgery, injection time>90 days prior to surgery, and non-injection group. The temperature and peripheral blood inflammation indicators of patients within one week before surgery and during hospitalization after surgery were collected. The international hip joint score (iHOT-12), visual analogue scale (VAS) of pain and the modified Harris Hip Score (mHHS) before and within 12 months after surgery were collected. The postoperative infection rates, clinical scores, temperature and inflammatory markers between groups were compared. <b>Results:</b> A total of 425 patients were included, with 264 males and 161 females, aged (37.2±12.9) years. There were 152 cases in the≤30 d group, aged (36.9±12.5) years; 58 cases in the 30-90 d group, aged (41.4±13.2) years; 28 cases in the>90 d group, aged (37.3±12.0) years; and 187 cases in the non-injection group, aged (36.2±13.0) years. No acute and chronic infections were found in the enrolled patients, and 8 cases of suspected acute infections were found: 5 cases (2.7%) in the non-injection group, 2 cases (3.5%) in the 30-90 d group, 1 case (3.6%) in the>90 d group, and 0 case in the≤30 d group, and the difference in the proportion of patients with suspected acute infections among the various groups was not statistically significant (<i>P</i>=0.061). There were 17 patients with maximum body temperature≥38.0 ℃ on postoperative day 1, 9 (4.8%) in the non-injection group, 2 (7.1%) in the > 90 d group, 1 (1.7%) in the 30-90 d group, and 5 (3.3%) in the≤30 d group. There were 143 patients with mildly elevated body temperature (37.0-38.0 ℃), 74 (39.6%) in the non-injection group, 10 (35.7%) in the>90 d group, 17 (29.3%) in the 30-90 d group, and 42 (27.6%) in the≤30 d group, and the difference in the proportion of the number of people with different degrees of fever among the groups was not statistically significant (<i>P</i>=0.180). The peripheral blood leukocyte level was 10.6 (8.5, 12.2)×10<sup>9</sup>/L in the≤30 d group, 9.7 (7.8, 10.5)×10<sup>9</sup>/L in the 30-90 d group, 8.9 (8.0, 10.7)×10<sup>9</sup>/L in the>90 d group, 10.0 (7.9, 11.3)×10<sup>9</sup>/L in the non-injection group, and peripheral blood leukocytes in the≤30 d group were significantly higher than those in the other three groups (all <i>P</i><0.05). The differenc","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 ","pages":"2483-2490"},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Expert consensus on urate-lowering therapy for high-risk hyperuricemia (2025 edition)].","authors":"","doi":"10.3760/cma.j.cn112137-20250126-00222","DOIUrl":"10.3760/cma.j.cn112137-20250126-00222","url":null,"abstract":"<p><p>Hyperuricemia (HUA) is highly prevalent in China with an increasing prevalence and a growing trend towards the youth. Long-term HUA can lead to gout, kidney stones and renal impairment, and is also associated with the development and progression of other organ damage, including cardiovascular diseases, metabolic disorders, and neurological conditions, etc. To identify high-risk individuals for HUA-related complications and establish standardized management strategies, including determining which HUA patients may be recommended for urate-lowering therapy (ULT) and outlining detailed treatment regimens (such as optimal timing, drug selection and treatment targets, etc.), the Chinese Rheumatology Association and the Committee for Rheumatologists and Immunologists of Chinese Primary Health Care Foundation organized domestic experts to develop the Expert Consensus on Urate-lowering Therapy for High-Risk Hyperuricemia (2025 edition). This consensus systematically summarizes the latest evidence, defines high-risk hyperuricemia (HrHUA) as well as 11 ULT relevant clinical issues, and provides detailed recommendations to treatment practices, ultimately improving patient outcomes.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 ","pages":"2469-2482"},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Ultrasonic manifestations of splenic torsion in children].","authors":"N Zhao, G H Pei, W J Xu, H J Zhang, D Zhou, J Zhao, X X Zhao","doi":"10.3760/cma.j.cn112137-20250227-00466","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20250227-00466","url":null,"abstract":"<p><p>The ultrasonic image data of children who underwent abdominal ultrasound examination in Tianjin Children's Hospital from January 2018 to December 2024 and were confirmed by surgery and pathology were retrospectively analyzed, and their ultrasonic manifestations were summarized. A total of 6 children, 1 male and 5 female, were included. At the time of first diagnosis, the children were 1-14 years old with a median age of 9 years. Ultrasound showed that the twisted spleen was enlarged, with 5 cases showing abnormal spleen position and 1 case showing in-situ splenic torsion. Taking the echo of the liver as a reference, the internal echo of 4 cases showed diffuse echo enhancement and roughness, and the internal echo of 2 cases was alternating with high and low echo, with extremely low echo liquefaction area; In 6 cases, the structure of splenic pedicle at the hilum of spleen was disordered and thickened, with enhanced echoes, of which 2 cases showed vortex sign by dynamic observation; The echo of tissues around the spleen was enhanced in 6 cases and here was perisplenic effusion in 2 cases. Color Doppler flow imaging indicated that there was no blood flow signal or sparse blood flow signal in spleen parenchyma and splenic hilum. Splenectomy was performed in 6 children, and splenic torsion and infarction were confirmed by postoperative pathology. Ultrasonographic manifestations of splenic torsion in children are multiple abnormal positions of spleen; The internal echo is thickened and enhanced, and some extremely low echo liquefaction areas can be seen; The spleen pedicle is thickened and the echo is enhanced, and some of them show vortex sign; The echo of the tissue around the spleen is enhanced.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 29","pages":"2507-2510"},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Analysis of influencing factors on the efficacy of vedolizumab in the treatment of ulcerative colitis patients].","authors":"H Y Xiao, W X Wang, D Y Hu, D P Lin, Y Jiang","doi":"10.3760/cma.j.cn112137-20241101-02459","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20241101-02459","url":null,"abstract":"<p><p><b>Objectives:</b> To explore the influencing factors of the efficacy of vedolizumab (VDZ) in the treatment of ulcerative colitis (UC) patients. <b>Methods:</b> The clinical data of patients with active UC, who underwent VDZ treatment from November 2020 to February 2024 in the Second Affiliated Hospital of Wenzhou Medical University were retrospectively collected. Each patient received intravenous injection of VDZ (300 mg per dose) at weeks 0, 2 and 6, and then received the same dose of intravenous injection of VDZ every 8 weeks. At week 16, the patients were divided into clinical remission group (who achieved clinical remission) and clinical non-remission group. At week 34, the patients were divided into mucosal healing group (who achieved mucosal healing) and mucosal non-healing group, as well as pathological remission group (who achieved pathological remission) and pathological non-remission group. The serum cytokines levels [interleukin (IL)-4, IL-6, IL-10, and tumor necrosis factor (TNF)-α] were detected at week 0, and 16, and the magnitude of cytokine changes (the difference between week 16 and week 0) was caculated. At week 16, the clinical remission of the patients was evaluated. At week 34, the patients underwent re-examination of colonoscopy to assess intestinal inflammation and histopathological activity. Multivariate logistic regression models were used to explore the influencing factors of clinical remission, mucosal healing, and pathological remission. <b>Results:</b> A total of 100 patients were included, 54 males and 46 females, aged (43.5±13.7) years. At week 16, there were 68 patients in clinical remission group and 32 patients in clinical non-remission group. In clinical remission group, the reductions of IL-6 [<i>M</i> (<i>Q</i>₁, <i>Q</i>₃), -0.85 (-1.23, -0.46) vs -0.26 (-1.04, 0.19) ng/L, <i>P</i><0.001] and IL-6+TNF-α [-0.99 (-1.46, -0.52) vs -0.30 (-0.83, 0.47) ng/L,<i>P</i><0.001] were higher than those in clinical non-remission group. IL-6 reduction≥0.40 ng/L (<i>OR</i>=15.33, 95%<i>CI:</i> 4.42-53.19), disease location limited to the rectum and left sided colon (<i>OR</i>=0.16, 95%<i>CI:</i> 0.05-0.51) and baseline partial Mayo score<5 scores (<i>OR</i>=0.25, 95%<i>CI:</i> 0.07-0.84) were favorable factors of clinical remission at week 16. At week 34, a total of 87 patients underwent re-examination of colonoscopy. There were 43 patients in mucosal healing group and 44 patients in mucosal non-healing group. In mucosal healing group, the reductions of IL-6 and IL-6+TNF-α were higher than those in mucosal non-healing group, and the increase in IL-10 was also higher than that in the mucosal non healing group (all <i>P</i><0.05). IL-6 reduction≥0.45 ng/L (<i>OR</i>=13.53, 95%<i>CI:</i>2.67-68.45) and baseline Mayo endoscopic score (MES)<2 scores (<i>OR</i>=0.08, 95%<i>CI:</i> 0.01-0.65) were the favorable factors of mucosal healing at week 34. At week 34, there were 23 patients in pathological re","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 29","pages":"2500-2506"},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Relationship between primary tumor lymph node indicators and prognosis and treatment response in colorectal cancer patients with lung metastases].","authors":"R S Xiang, Q Zhang, S B Lu, W J Yang, D Y Kong, Y Sun, H R Zhang, J L Fan, L Feng, H Z Zhang","doi":"10.3760/cma.j.cn112137-20250324-00724","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20250324-00724","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To analyze the relationship between primary tumor lymph node indicators and prognosis and clinical efficacy in colorectal cancer patients with lung metastases. &lt;b&gt;Methods:&lt;/b&gt; A retrospective analysis was performed on the clinical data of 204 patients diagnosed with colorectal cancer accompanied by solitary pulmonary metastases at the Cancer Hospital, Chinese Academy of Medical Sciences between January 2010 and December 2020. The cohort comprised 121 male and 83 female, with a mean age of (58.6±9.1) years. Patient survival status was documented, and the follow-up continued until the patient's death or December 31, 2024. The influencing factors of overall survival (OS) in colorectal cancer patients with pulmonary metastases were analyzed using a multivariate Cox proportional hazards regression model. Survival curves were plotted using the Kaplan-Meier method, and the log-rank test was employed to evaluate the differences in OS among colorectal cancer patients with lung metastases who had primary colorectal tumors with different lymph node statuses. An efficacy analysis was also conducted for patients with pulmonary metastases who solely received medical treatment. &lt;b&gt;Results:&lt;/b&gt; A total of 204 patients were followed up for 48.0(34.1, 80.4) months. One patient was lost to follow-up, and 39.7% (81/204) patients had died. The median OS was 48.0 months (95%&lt;i&gt;CI&lt;/i&gt;: 11.5-119.3 months), with a 5-year overall survival rate of 58.5%. Multivariate analysis showed that pathological lymph node stage (pN) (+) (&lt;i&gt;HR&lt;/i&gt;=2.14, 95%&lt;i&gt;CI&lt;/i&gt;: 1.17-3.92), number of negative lymph node (NLN)&lt;13 (&lt;i&gt;HR&lt;/i&gt;=1.97, 95%&lt;i&gt;CI&lt;/i&gt;: 1.22-3.18), carcinoembryonic antigen (CEA) during lung metastasis≥10 μg/L (&lt;i&gt;HR&lt;/i&gt;=2.25, 95%&lt;i&gt;CI&lt;/i&gt;: 1.28-3.98), multiple lung metastases (&lt;i&gt;HR&lt;/i&gt;=2.16, 95%&lt;i&gt;CI&lt;/i&gt;: 1.08-4.31), and non-surgical resection of lung metastases (&lt;i&gt;HR&lt;/i&gt;=2.28, 95%&lt;i&gt;CI&lt;/i&gt;: 1.11-4.65) were risk factors affecting OS in patients with colorectal cancer lung metastasis. Kaplan-Meier survival curves showed that patients with colorectal cancer lung metastases had shorter OS when primary tumor pN (+), primary tumor logarithmic odds of positive lymph node (LODDS)≥-1.1, primary tumor lymph node ratio (LNR)≥0.02, primary tumor NLN&lt;13, or primary tumor total number of lymph node (TLN)&lt;16(all &lt;i&gt;P&lt;/i&gt;&lt;0.05). Among the 204 patients, 72 with pulmonary metastases did not undergo surgical intervention and solely received medical treatment. Based on their prognosis, they were categorized into the partial response (PR) group (&lt;i&gt;n&lt;/i&gt;=32) and the stable disease (SD)+progressive disease (PD) group (&lt;i&gt;n&lt;/i&gt;=40). The results indicated that the PR group had significantly lower rates of pN(+), LODDS≥-1.1, LNR≥0.02, NLN&lt;13, and TLN&lt;16 compared to the SD+PD group (all &lt;i&gt;P&lt;/i&gt;&lt;0.05). &lt;b&gt;Conclusions:&lt;/b&gt; Patients with colorectal cancer lung metastases who have primary tumors with pN(+), LODDS≥-1.1, LNR≥0.02, NLN&lt;13, or TLN&lt;16, tend to have shorter OS and","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 29","pages":"2491-2499"},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A century of glorious achievements and passing on the flame of medical wisdom: emotional resonance on the occasion of the 110th anniversary of the Chinese Medical Association and the National Medical Journal of China].","authors":"X S Chen","doi":"10.3760/cma.j.cn112137-20250427-01059","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20250427-01059","url":null,"abstract":"<p><p>The article systematically reviewed the key historical stages of the development of National Medical Journal of China over more than a century. It provides a comprehensive discussion on the significant contributions made by the journal to the advancement of China's medical and healthcare during different periods, under the leadership of successive chief editors. The article reflects the journal's development history from its original purpose and core content. By showcasing the academic achievements published in the journal, it highlights the country's accomplishments in academia, and elucidates the important role the journal has played in guiding the development of Chinese medicine, facilitating academic exchanges, and nurturing medical talent.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 26","pages":"2151-2153"},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Association of capsular types with antibiotic resistance and clinical prognosis in <i>Acinetobacter baumannii</i>].","authors":"C Y Jiang, H N Li, S G Li, H Wang","doi":"10.3760/cma.j.cn112137-20250118-00157","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20250118-00157","url":null,"abstract":"<p><p><b>Objective:</b> Analysis of antimicrobial resistance and clinical outcomes in patients infected with different KL types of <i>Acinetobacter baumannii</i>. <b>Methods:</b> This is a cross-sectional study. From 2011 to 2021, 675 non-repetitive <i>A. baumannii</i> strains were isolated from patients with bloodstream infection (BSI, 234 cases), hospital acquired pneumonia (HAP, 423 cases), intra-abdominal infection (IAI, 17 cases) and urinary tract infection (UTI, 1 case) in 10 hospitals across 8 provinces of China. KL types and resistance genes were identified using bioinformatics methods. The minimum inhibitory concentrations of different antibiotics against 675 <i>A.baumannii</i> strains were determined by agar or microbroth dilution method. Ten strains were randomly selected from each KL type using simple random sampling for whole blood survival experiments. Differences in hospitalization duration and clinical outcomes were analyzed among patients infected with different KL types. <b>Results:</b> The 675 patients were aged (59±20) years, including 460 males. The predominant KL types included KL2 (22.0%, 149 strains), KL3 (17.5%, 118 strains), KL210 (7.0%, 47 strains) and KL160 (7.0%, 47 strains), while non-predominant KL types accounted for 314 strains (46.5%). The four predominant KL types showed higher overall resistance rates to most antibiotics compared with non-predominant KL types (all <i>P</i><0.05). KL2 (92.6%, 113 strains) showed higher resistance to sulfamethoxazole-trimethoprim than KL3 (55.9%, 66 strains) (<i>P</i><0.05). KL2 (87.2%, 130 strains) and KL210 (91.5%, 43 strains) showed higher resistance to minocycline than KL3 (67.8%, 80 strains) and KL160 (66.0%, 31 strains) (all <i>P</i><0.05). KL2 exhibited stronger whole blood survival capacity [(58.36±20.33)%] than other KL types (all <i>P</i><0.05). The fatality rate of KL2-infected patients was 30.9% (46 cases), higher than that of patients infected with KL3 (11.9%, 14 cases) and KL210 (6.4%, 3 cases) (all <i>P</i><0.05). The hospitalization duration [<i>M</i>(<i>Q</i>₁,<i>Q</i>₃)] of KL2-infected patients was 46.00 (26.50, 74.00) days, longer than that of patients infected with KL3 [30.00 (15.25, 40.75) days], KL210 [27.00 (21.00, 44.00) days], KL160 [27.00 (20.00, 34.00) days] and non-predominant KL types [25.00 (12.00, 40.00) days] (all <i>P</i><0.05). <b>Conclusions:</b> Different KL types of <i>A.baumannii</i> show variations in antimicrobial resistance and clinical outcomes of infected patients. KL2 demonstrates higher resistance rates and is associated with poorer clinical prognosis.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 26","pages":"2212-2217"},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Predictive value of CT-based tumor and peritumoral radiomics for WHO/ISUP grading of non-metastatic clear cell renal cell carcinoma].","authors":"J K Xu, H Guo, Z Y Wang, Y M Zhang, X R Ba, S Zhou, Y Wang, L L Meng, Z Zhang, X Y Ren, Y H Xia, J X Li, R Xu, L T Wang, J H Wang, H Ma","doi":"10.3760/cma.j.cn112137-20250226-00460","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20250226-00460","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To investigate the value of CT-based tumor and peritumoral radiomics in predicting the World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading for non-metastatic clear cell renal cell carcinoma (ccRCC). &lt;b&gt;Methods:&lt;/b&gt; A total of 503 patients with non-metastatic ccRCC were retrospectively enrolled from 7 tertiary hospitals between February 2017 and December 2023. Patients from 4 hospitals within Shandong Province were divided into a training set and an internal validation set in a 7∶3 ratio, while patients from 3 hospitals outside Shandong Province constituted the external validation set. Regions of interest (ROI) were manually delineated slice-by-slice along the tumor margin on contrast-enhanced CT images. Peritumoral regions were obtained by expanding 10 mm outward from the tumor boundary. Key radiomics features were selected using Least Absolute Shrinkage and Selection Operator (LASSO) regression with five-fold cross-validation to build tumor models and peritumoral models for predicting the WHO/ISUP grading. Univariate logistic regression was used to screen clinical factors associated with the WHO/ISUP grading, which was included to construct a combined predictive model together with tumor and peritumoral features. The predictive performance of the models for WHO/ISUP grading was evaluated using receiver operating characteristic (ROC) curves, and the Youden index and optimal cutoff value were calculated for risk stratification. Calibration curves were used to validate model performance, and decision curve analysis (DCA) was employed to evaluate the clinical value of the models. &lt;b&gt;Results:&lt;/b&gt; The median age [&lt;i&gt;M&lt;/i&gt;(&lt;i&gt;Q&lt;/i&gt;&lt;sub&gt;1&lt;/sub&gt;,&lt;i&gt;Q&lt;/i&gt;&lt;sub&gt;3&lt;/sub&gt;)] of the 503 patients was 59.0 (52.0, 66.0) years, with 335 males and 168 females. Univariate logistic regression analysis showed there was a statistically significance in age between low and high WHO/ISUP grades (&lt;i&gt;P&lt;/i&gt;=0.043). The AUC of the tumor model and peritumoral model in the internal validation set were 0.744 (95%&lt;i&gt;CI&lt;/i&gt;: 0.700-0.788) and 0.742 (95%&lt;i&gt;CI&lt;/i&gt;: 0.709-0.774), respectively. In the external validation set, the AUC of the tumor model and peritumoral model were 0.685 (95%&lt;i&gt;CI&lt;/i&gt;: 0.651-0.720) and 0.655 (95%&lt;i&gt;CI&lt;/i&gt;: 0.628-0.683), respectively. The combined model demonstrated the best predictive performance in both internal and external validation sets, with AUC of 0.760 (95%&lt;i&gt;CI&lt;/i&gt;: 0.721-0.800) and 0.706 (95%&lt;i&gt;CI&lt;/i&gt;: 0.675-0.737), respectively. Using the Youden index calculated from the ROC curve from the combined model, the optimal cutoff value was 0.504 for risk stratification, where 190 cases were classified as low-grade and 313 as high-grade, achieving a concordance rate of 0.718 (361/503) with the WHO/ISUP grading. Calibration curve tests indicated good fit for the combined model (internal validation set: &lt;i&gt;P&lt;/i&gt;=0.932; external validation set: &lt;i&gt;P&lt;/i&gt;=0.404). DCA showed that the combined mode","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 26","pages":"2195-2202"},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical efficacy of sub-anesthetic doses of esketamine in providing perioperative anesthesia and analgesia for elderly patients with gastrointestinal tumors in plateau areas].","authors":"J Tang, Y J Yuan, Y H Guo, W J Li, J La","doi":"10.3760/cma.j.cn112137-20241228-02950","DOIUrl":"10.3760/cma.j.cn112137-20241228-02950","url":null,"abstract":"<p><p>To investigate the clinical anesthetic and analgesic effects of sub-anesthetic doses of esketamine in elderly patients with gastrointestinal tumors during the perioperative period in plateau areas, a prospective study was conducted to include elderly patients (≥60 years) undergoing laparoscopic radical resection of gastrointestinal tumors under general anesthesia at the Affiliated Hospital of Qinghai University from June 2023 to October 2024. They were randomly divided into an experimental group and a control group. The experimental group received an intravenous infusion of esketamine at 0.2 mg·kg⁻¹·h⁻¹ from 10 min before anesthesia induction until 10 min before the end of surgery, while the control group was administered an equal-volume infusion of normal saline at the same rate during the same period. The perioperative clinical data and differences in anesthesia and pain-related indicators at different time points were compared between the two groups. Finally, 67 patients were included for analysis, including 33 patients in the control group [23 males, aged (68.8±6.2) years] and 34 patients in the experimental group [24 males, aged (67.7±5.1) years]. There were no significant differences in age, gender, American Society of Anesthesiologists classification, and operation duration between the two groups (all <i>P</i>>0.05). The mean arterial pressure in the experimental group was higher than that in the control group at 1 min of pneumoperitoneum and 30 min of extubation [(87.6±8.5) mmHg vs (81.7±8.8) mmHg; (95.6±10.3) mmHg vs (90.1±9.0) mmHg (1 mmHg=0.133 kPa), all <i>P</i><0.05]. The visual analog scale for pain in the experimental group was lower than that in the control group at 2, 12, and 24 h after surgery (all <i>P</i><0.05). The amount of propofol, remifentanil, norepinephrine, and fluid infusion in the experimental group were all lower than those in the control group (all <i>P</i><0.05), and the recovery time of spontaneous breathing [(8.6±2.6) min vs (13.4±4.1) min, <i>P</i><0.05] and the awakening time [(11.6±3.5) min vs (16.4±5.2) min, <i>P</i><0.05] were both shorter than those in the control group. This study suggests that in elderly patients with gastrointestinal tumors undergoing general anesthesia in plateau areas, the combination of sub-anesthetic doses of esketamine can improve the efficacy of anesthesia and analgesia without affecting recovery, and reduce the amount of other anesthetic drugs used.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 26","pages":"2244-2248"},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A prospective cohort study on the association of sleep duration and fasting plasma glucose with risk of stroke].","authors":"M D Wang, L Yin, B Yang, Y J Zhao, X R Fu, W F Huo, Y Y Wu, X X He, M N Liu, Y J Su, Y C Ren, Y Liu, M Zhang, Y Zhao, D S Hu","doi":"10.3760/cma.j.cn112137-20250404-00833","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20250404-00833","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the association of sleep duration and fasting plasma glucose with the risk of stroke. <b>Methods:</b> A Prospective cohort study. Two towns in Xin'an County, Henan Province were selected as study sites. Using natural villages as the sampling unit, cluster random sampling was used to recruit 20 194 participants in 2007-2008 for the baseline study, and two follow-up studies were completed in 2013-2014 and 2018-2020, respectively. A total of 13 741 eligible participants were included in the analysis. Multivariate Cox proportional hazards regression model was used to assess the association of sleep duration and fasting plasma glucose with stroke risk and the restricted cubic spline was applied to fit the dose-response relationships. <b>Results:</b> The age [<i>M</i> (<i>Q</i>₁, <i>Q</i>₃)] of 13 741 participants was 51.0 (41.0, 60.0) years, and 5 308 (38.63%) participants were male. Over a median follow-up of 10.18 years, 1 612 incident stroke events were observed. Compared with participants sleeping 7 to<8 h/d, the risk of stroke increased for those sleeping<6 and≥10 h/d, with <i>HR</i> (95%<i>CI</i>) of 1.44 (1.04-2.00) and 1.37 (1.13-1.66), respectively. A U-shaped relationship between sleep duration and stroke risk was observed (<i>P</i>_nonlinear<0.001). Compared to people with normal fasting glucose, the <i>HR</i> (95%<i>CI</i>) of stroke risk was 1.58 (1.36-1.84) for diabetes patients. A nonlinear association between fasting plasma glucose level and stroke risk was observed (<i>P</i>_nonlinear=0.036). Compared to individuals with sleep duration of 7 to<9 h/d and normal fasting glucose, the <i>HR</i> (95%<i>CI</i>) of stroke risk was 1.60 (1.18-2.16) for those with sleep duration<7 h/d and prediabetes, and 2.07 (1.27-3.39) for those with sleep duration<7 h/d and diabetes; the <i>HR</i> (95%<i>CI</i>) of stroke risk was 1.18 (1.01-1.39) for those with sleep duration≥9 h/d and prediabetes, and 1.84 (1.50-2.26) for those with sleep duration≥9 h/d and diabetes. But no significant interaction between sleep duration and fasting plasma glucose was found on stroke risk (<i>P</i>>0.05). <b>Conclusions:</b> Inadequate sleep duration, prolonged sleep duration and elevated fasting plasma glucose level were associated with increased risk of stroke, and the stroke risk was further increased when sleep duration<7 or≥9 h/d coexisted with abnormal fasting plasma glucose states.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 26","pages":"2227-2235"},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}