Table of Content

05 April 2025, Volume 45 Issue 4

Previous Issue   

Special Issues: Airway Management

Clinical and basic research in airway management

ZHAO Xin

2025, 45(4):  421-421.  doi:10.16352/j.issn.1001-6325.2025.04.0421

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Application of ECMO in perioperative airway management

ZHANG Yi, SHEN Le

2025, 45(4):  422-427.  doi:10.16352/j.issn.1001-6325.2025.04.0422

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Traditional airway management techniques may fail to provide adequate oxygenation and ventilation for high-risk patients in complex cases. As an extracorporeal life support (ECLS) technology, extracorporeal membrane oxygenation (ECMO) offers continuous oxygenation and homodynamic support for these patients and provides critical assistance in perioperative airway management. ECMO can be applied in various scenarios, including difficult airways, complex airway surgeries and emergency airway management. It plays a vital role in ensuring peri-operative safety, optimizing surgical field exposure, reducing the risk of severe peri-operative complications and improving clinical outcomes.

Influencing factors on seal pressure of laryngeal mask

FU Yunke, ZHANG Changsheng

2025, 45(4):  428-433.  doi:10.16352/j.issn.1001-6325.2025.04.0428

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As an airway management tool, the seal performance of the laryngeal mask is crucial. The seal pressure of the laryngeal mask is a key indicator for evaluating the performance of the laryngeal mask. Appropriate seal pressure is of great clinical significance to ensure effective ventilation and avoid complications. This article reviews the factors that affect the seal pressure of the laryngeal mask, including structural design, material characteristics, inflation volume, insertion skill, airway pressure, and patients' individual characteristics. Understanding and optimizing the above factors can help anesthesiologists to better apply the laryngeal mask in clinical anesthesia, to reduce patient complications, and improve patient safety as well as comfort.

Advances of airway management-related trauma in neonates and infants

ZHANG Quan, ZHAO Xin

2025, 45(4):  434-441.  doi:10.16352/j.issn.1001-6325.2025.04.0434

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This article reviews the potential iatrogenic injuries that can occur during airway management in neonates and infants, along with preventive measures. Given the significant anatomical differences between the airways of neonates/infants and adults, many existing airway management devices are adaptations of adult designs, scaled down for pediatric use. This design mismatch may contribute to airway injuries during neonatal and infant airway management. The article thoroughly examines the anatomical features of neonatal and infant airways, the impact of various risk factors (such as prematurity and congenital conditions) on airway injury, analyzes the mechanisms and grading standards of these injuries, and outlines specific strategies to prevent iatrogenic injuries associated with airway management in this population.

Original Articles

Evaluation of insulin sensitivity in mice using ¹³C-glucose labeled clamp technique

CAO Kexin, LIU Zhuohang, JIANG Yishen, SUN Xu, CHEN Jie

2025, 45(4):  442-449.  doi:10.16352/j.issn.1001-6325.2025.04.0442

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Objective To establish a ¹³C isotope-labeled hyperinsulinemic-euglycemic clamp model for the assessment of insulin sensitivity in mice. Methods The mouse model of insulin resistance was established by high-fat diet feeding. The phosphorylation level of downstream insulin signaling protein, Protein Kinase, also known as Akt was assessed. Glucose metabolism was evaluated using glucose tolerance test, insulin tolerance test, and pyruvate tolerance tests and the area under the curve of the respective testes over 2 hours was calculated to quantify overall blood glucose level. Mice underwent jugular vein catheterization surgery, and a ¹³C isotope-labeled hyperinsulinemic-euglycemic clamp experiment was conducted to monitor blood glucose levels and to calculate the glucose infusion rate(GIR).Tail vein serum was collected for liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis to determine glucose disposal rate(GDR) and hepatic gluconeogenesis rate(HGP). Following the inhibition of glycogenolysis in mice, Akt phosphorylation level was measured to evaluate insulin signaling. The clamp test was repeated to calculate GIR, and tail vein blood serum was analyzed by LC-MS/MS to determine GDR and HGP. Results After one week of high-fat diet feeding, mice exhibited significantly elevated blood glucose level (P＜0.001) accompanied by reduced p-Akt level in liver and muscle. Glucose tolerance tests, insulin tolerance tests and pyruvate tolerance test demonstrated a significant increase in blood glucose level (P＜0.05) and a higher area under curves (AUC) (P＜0.001) in high-fat-fed mice. During the ¹³C-labeled hyperinsulinemic-euglycemic clamp experiment, after the blood glucose levels were stable, the GIR of high-fat-fed mice was significantly reduced (P＜0.001), GDR was decreased (P＜0.0001)and hepatic gluconeogenesis rate was increased(P＜0.01). After pharmacological inhibition of glycogenolysis, mice showed elevated blood glucose level(P＜0.001) and further reductions in p-Akt level in liver and muscle. The ¹³C-labeled clamp experiment revealed that in the treated group, the GIR decreased(P＜0.01) while GDR was reduced (P＜0.000 1)and HGP increased (P＜0.01). Conclusions An improved hyperinsulinemic-euglycemic clamp model was developed to assess insulin sensitivity in mice.

Correlation of oncogene c-MYC expression with mitochondrial metabolic enzyme DLAT/DLST and progression of pancreatic ductal adenocarcinoma

XU Yeting, QIN Ziyi, WANG Yucheng, WU huanwen, JU Rui, GUO Lei

2025, 45(4):  450-455.  doi:10.16352/j.issn.1001-6325.2025.04.0450

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Objective To investigate the correlation between c-MYC expression and mitochondrial metabolism in malignant duct epithelial cells of pancreatic cancer patients. Methods GEPIA database was used to analyze the correlation between c-MYC expression and overall survival. The expression of c-MYC in tumor tissues was detected by immunohistochemical staining. The difference of DLAT and DLST gene expression between tumor and normal tissues was compared in GEPIA database. HPA database was used to analyze the correlation between c-MYC and DLAT, DLST expression in tumor tissues. The expression level of DLAT and DLST in tumor tissues was evaluated by immunofluorescence staining. Results The high expression of c-MYC gene was negatively correlated with overall survival (P＜0.01). The level of c-MYC protein was positively correlated with the pathological grade of PanIN. Compared with normal tissues, the expression of DLAT and DLST genes in pancreatic cancer cells was increased (P＜0.01). The protein level of c-MYC was positively correlated with those of DLAT and DLST (P＜0.01, P＜0.001). Conclusions The high expression of mitochondrial metabolic enzymes DLAT and DLST in pancreatic ductal adenocarcinoma cells is significantly correlated with the expression level of c-MYC, which increases with the progression of pancreatic cancer.

Evaluation of chemotherapy drug efficacy using organoids model of colorectal cancer

GUO Yuehong, ZHOU Fanqi, WU Xi, ZHANG Guannan, WANG Fang, YU Jia

2025, 45(4):  456-464.  doi:10.16352/j.issn.1001-6325.2025.04.0456

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Objective To establish human colorectal cancer(CRC) organoids and to evaluate the efficacy of chemotherapy drugs. Methods Patient-derived CRC cells were cultured to form organoids. The CRC organoids and original tissues were stained with molecular markers of CRC immunohishtochemically. CRC organoids were used to test drug sensitivity and different concentrations of chemotherapy drugs 5-fluorouracil, oxaliplatin and irinotecan were given respectively; Organoid activity before and after drug treatment was measured by 3D cell viability assay. Results The patient-derived organoids(PDO) from 5 CRC tissues were successfully established. The expression of CK20, Ki67 and Villin proteins was similar in organoids and in original tumor. The organoids retained histologcial features similar to those of the original tumors. Different PDO showed differential sensitivity to different chemotherapy drugs. Conclusions CRC-PDO can dispaly their different sensitivities to different chemotherapy drugs, and could provide valuble reference for personalized treatment for CRC patients.

Allicin inhibits HBV replication through the HBV promoter SP2

LU Lili, ZHU Xilin, WU Xiaopan, LIU Ying

2025, 45(4):  465-470.  doi:10.16352/j.issn.1001-6325.2025.04.0465

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Objective To investigate the effect of allicin on the replication of hepatitis B virus (HBV) and to preliminarily elucidate its underlying molecular mechanisms. Methods HepG 2.2.15 cells were treated with different concentrations of allicin and the levels of HBsAg and HBeAg were assessed by ELISA. Cell viability was evaluated using the CCK-8 assay to determine the optimal concentration of allicin; HepG2-NTCP cells were incubated with the optimal concentration of allicin for 48 hours, and the expression of HBV-related markers was detected by RT-qPCR; The activity of four HBV promoters (Enh Ⅰ/Xp, SP1, SP2, and CP) was analyzed using a dual-luciferase reporter gene experiment. The effect of allicin on promoter activity was assessed; Gene-regulation tools were used to predict potential transcription factor that might bind to the promoter. After over-expressing the transcription factor, cells were incubated with allicin and the effect on promoter activity was examined; Finally, ChIP was used to confirm whether these transcription factors bind to the HBV promoters and whether allicin treatment affects this binding. Results Allicin significantly reduced the expression of HBsAg and slightly lowered the expression of HBeAg(P＜0.001); A concentration of 40 μmol/L allicin significantly inhibited HBV DNA replication and transcription(P＜0.05), without affecting cell viability; Allicin also significantly suppressed the activity of the HBV promoter SP2(P＜0.001). Further investigation revealed that the transcription factor SP1 could bind to the DNA sequence of the HBV promoter SP2, and this binding was significantly inhibited after allicin treatment(P＜0.001). Conclusions Allicin inhibits the binding of the transcription factor SP1 to HBV promoter SP2, thereby reducing the transcriptional activity of HBV and suppressing viral replication.

Effect of WISP-1 on fibrosis of renal tubular epithelial cell in rats with renal fibrosis

YANG Ermei, XIA Weiqing, SONG Pei, YAN Jia

2025, 45(4):  471-477.  doi:10.16352/j.issn.1001-6325.2025.04.0471

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Objective To investigate the effect and mechanism of WISP-1 on renal tubular epithelial cell fibrosis in rats with renal fibrosis. Methods Twenty-four adult rats and renal tubular epithelial cell line(NEK-52E) were selected for in vivo and in vitro experiments. The rats were randomly divided into control group and study group, and the in vivo renal fibrosis model was established. The expression of WISP-1 in the study group was blocked. The cell lines were induced to fibrosis followed by WISP-1 over-expression or inhibition. The related indicators of fibrosis were observed. Results Protein and mRNA level of Collagen Ⅰ(Col Ⅰ), fibronectin (FN), transforming growth factor-β1(TGF-β1) in WISP-1 over-expression group were all higher than those in control group. The protein and mRNA level of Col Ⅰ, FN and TGF-β1 in the WISP-1 inhibition group were lower than those in the control group(P＜0.05). WISP-1 blockade attenuated the pathological changes of renal fibrosis. The protein and mRNA levels of Col Ⅰ, FN, α-smooth muscle actin(α-SMA), TGF-β1, LC3 and Beclin-1 in the study group were lower than those in the control group, and the level of ubiquitin binding protein p62(SQSTM1/p62) was higher than that in the control group(P＜0.05). The expression of LC3 and Beclin-1 in WISP-1 inhibitor group was lower than that in the control group and the expression of SQSTM1/p62 was higher than that in the control group. The expression of LC3 and Beclin-1 in the WISP-1 over-expression group was higher than that in the control group, and the expression of SQSTM1/p62 was lower than that in the control group. Conclusions Overexpression of WISP-1 promotes the fibrosis of rat renal tubular epithelial cells, and enhanced TGF-β1-mediated autophagy might be a underlying mechanism to mediate renal fibrosis.

CTO inhibits the in situ growth of glioblastoma in mice and regulates the metabolism and inflammatory phenotype of glioma-associated microglia

LI Yunfan, ZOU Jiaming, WANG Yucheng, JU Rui, GUO Lei

2025, 45(4):  478-485.  doi:10.16352/j.issn.1001-6325.2025.04.0478

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Objective To investigate the effects and regulatory mechanisms of carboxyamidotriazole orotate (CTO) on the metabolism and inflammatory mediators of glioma-associated microglia (GAM). Methods Tumor volume was regularly monitored by in vivo imaging, and histological examination was performed to detect the extent of tumor infiltration; non-targeted metabolomics analysis was used to detect the level of tricarboxylic acid cycle metabolites in cells; seahorse cell energy measurement method was used to detect the oxygen consumption rate (OCR) and extracellular acidification rate (ECAR) of cells; immunofluorescence was used to detect the degree of hypoxia in cells; quantitative PCR was used to detect the mRNA level of pro-cancer mediators M1/M2 in cells; Western blot was used to detect the protein level of hypoxia-inducible factor-1α (HIF-1α) and programmed death receptor-ligand 1 (PD-L1). Results CTO inhibited the tumor progression in mice, and down-regulated the oxidative phosphorylation level and improved cell hypoxia in vitro(P＜0.01). It also downregulated the expression of pro-oncogenic mediators iNos, Arg-1, Il-10, and Irf4 in GAM (P＜0.01). When combined with lactate dehydrogenase inhibitor stiripentol (STP), CTO-induced enhancement of glycolysis and upregulation of PD-L1 expression in GAM was attenuated(P＜0.01), and the expressions of Arg-1 and Il-10 was further downregulated (P＜0.000 1). Conclusions CTO down-regulates the expression of several oncogenic genes in GAM and inhibits tumor progression in mice. Combined use of lactate dehydrogenase inhibitors can weaken the adverse effect of CTO and reduce the transcriptional level of GAM oncogenic mediators.

Upregulation of miR-152 inhibits proliferation and migration of human vascular smooth muscle cells induced by ox-LDL

ZHOU Jing, QU Miao

2025, 45(4):  486-492.  doi:10.16352/j.issn.1001-6325.2025.04.0486

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Objective To investigate the roles of miR-152 and Rho-associated coiled-coil kinase 1 (ROCK1) in vascular smooth muscle cells (VSMCs) treated with oxidized low-density lipoprotein (ox-LDL). Methods Human vascular smooth muscle cells CRL-1999 were intervened with ox-LDL to establish an in vitro atherosclerosis model. miR-152 mimic and ROCK1 siRNA were transfected into corresponding cells. RT-qPCR was used to detect the expression of miR-152 and ROCK1 mRNA. The CCK-8 method was used to assess cell proliferation activity, and the Transwell assay was used to test cell migration ability. A luciferase reporter gene assay was conducted to determine the targeting relationship between miR-152 and ROCK1. Results CRL-1999 cells treated with 100 μg/mL ox-LDL for 48 hours showed the maximum proliferation rate. Compared with the untreated control group, the relative expression of miR-152 in the ox-LDL-induced group was significantly decreased (P＜0.05). Transfection of miR-152 mimic significantly reduced the proliferation and migration of CRL-1999 cells (P＜0.05). The luciferase reporter gene assay indicated that miR-152 targets ROCK1, and expression of ROCK1 mRNA and protein in miR-152 mimic group was reduced(P＜0.05). Transfection of ROCK1 siRNA also significantly decreased the proliferation and migration of CRL-1999 cells(P＜0.05). Conclusions miR-152 inhibits the ox-LDL induced proliferation and migration of CRL-1999 cells by downregulating ROCK1 expression, which may be a potential therapeutic target for atherosclerosis.

Artesunate inhibits proliferation and promotes apoptosis and autophagy of nephroblastoma cell line SK-NEP-1

WEI Jianxin, FANG Yanle, LU Yubo, GAO Yuguang, LANG Xing, LI Jingtao, MA Xinsheng

2025, 45(4):  493-498.  doi:10.16352/j.issn.1001-6325.2025.04.0493

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Objective To investigate the effects of artesunate (Art) on the proliferation, apoptosis, and autophagy of nephroblastoma cell line (SK-NEP-1). Methods SK-NEP-1 cells were intervened with different concentrations of Art (0, 10, 20, 40 and 80 μmol/L), and MTT method was applied to calculate the cell proliferation inhibition rate to screen the optimal intervention concentration; SK-NEP-1 cells were separated into control group, Art group, 3-MA group (Art+autophagy inhibitor, 3-methyladenine), and Rapa group (Art+autophagy activator rapamycin). EdU and flow cytometry were applied to detect cell proliferation and apoptosis, respectively; MDC staining was applied to detect autophagy in cells; the level of reactive oxygen species (ROS) in cells was detected by DCFH-DA fluorescent probe; the expression of proliferating cell nuclear antigen (PCNA), anti apoptotic factor B cell lymphomatoma-2 (Bcl-2), Bcl-2 associated X protein (Bax), microtubule junction protein 1 light chain 3Ⅱ/3Ⅰ (LC3Ⅱ/LC3Ⅰ), selective autophagy junction protein 1 (p62), and benzyl chloride 1 (Beclin-1) proteins in cells were detected by Western blot. Results Compared with 0 μmol/L Art, the proliferation inhibition rate of SK-NEP-1 cells was gradually increased after 10, 20, 40 and 80 μmol/L Art treatment (P＜0.05), and the IC₅₀ value was 46.881 μmol/L, so 40 μmol/L Art was selected for follow-up experiments. Compared with the control group, the apoptosis rate, relative autophagy fluorescence intensity, ROS level, Bax, LC3 Ⅱ/LC3 Ⅰ, Beclin-1, PINK1, and Parkin protein expression levels of SK-NEP-1 cells in the Art group were obviously increased, the EdU positive cell rate, PCNA, Bcl-2, and P62 protein expression levels were obviously reduced (P＜0.05); The autophagy inhibitor 3-MA inhibited the promoting effect of Art on apoptosis and autophagy of nephroblastoma cells and inhibit proliferation (P＜0.05). Conclusions Art inhibits the proliferation of nephroblastoma cell line SK-NEP-1, and promotes autophagy and apoptosis.

Association between plasma trimethylamine N-oxide level and atrial fibrillation

YANG Wentao, ZHAO Qing, LI Xiangdong, WANG Yutang, LIU Wei

2025, 45(4):  499-504.  doi:10.16352/j.issn.1001-6325.2025.04.0499

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Objective To explore the relationship between plasma trimethylamine N-oxide(TMAO) level and atrial fibrillation(AF) by a clinical trial. Methods Totally 257 patients with AF were enrolled including 114 patients with paroxysmal AF and 143 with persistent AF. The control group had 122 non-AF patients; Plasma TMAO level, the demographic characteristics and clinical data of patients were collected. Regression analysis was performed to identify the association between TMAO and presence of AF. Results Plasma TMAO level of patients with AF was higher than that of patients without AF(3.9[2.4-5.9]vs. 2.4[1.6-3.7]μmol/L,P＜0.001);Even after adjust-ment of confounding factors including age, hypertension, diabetes, heart failure and body mass index; Plasma TMAO level was still related to presence of AF(OR:1.290,95% CI:1.151-1.445;P＜0.001).The plasma TMAO level of patients with persistent AF was higher than that of patients with paroxysmal AF(4.4[2.8-6.8]vs. 3.2[2.2-5.0]μmol/L,P＜0.01); Even after adjustment of confounding factors including age, hypertension, diabetes and heart failure and coronary heart disease; Plasma TMAO level was still related to persistent AF(OR:1.092,95% CI:1.009-1.182;P=0.029). Conclusions The level of plasma TMAO of patients with AF is higher than that of patients without AF. Elevated plasma TMAO level is related to an increased risk of AF. Elevated plasma TMAO level in patients with AF is related to an increased risk of persistent AF.

Two patients with type A insulin resistance syndrome carried mutation with insulin receptor gene c.3449T＞C

WANG Huiping, REN Weidong, REN Yanlin, SHI Li

2025, 45(4):  505-510.  doi:10.16352/j.issn.1001-6325.2025.04.0505

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Objective To report two cases of type A insulin resistance syndrome with new insulin receptor gene mutations. Methods Clinical data, laboratory examination, imaging examination and mutation scanning of insulin receptor gene were collected, and type A insulin resistance syndrome reported by domestic and foreign scholars were analyzed retrospectively. Results One case had dry mouth, polydipsia and hyperandrogenemia, and another case had primary amenorrhea, both of them had insulin resistance. Two cases had heterozygous missense mutation in insulin receptor gene C.3449T＞c (p.L1150P). The mothers of the two probands all carried this mutation, while the fathers did not. This mutation has not been reported previously. Literature review shows that the onset age of this disease is young, and it is more common in women. BMI 20.37±5.47 kg/m², fasting blood-glucose 4.50 mmol/L(4.10,13.00), the proportion of insulin resistance is 100%, 92.0% has acanthoid nigricans, and the proportion of Testosterone above normal is 81.3%, diabetes complications appear earlier. Conclusions Genetic analysis is helpfulfor the etiological diagnosis in children with severe insulin resistance.

Correlation between serum galactomannano level and Aspergillus fumigatus specific antibody in patients with allergic bronchopulmonary aspergillus recurrence

WANG Wentao, TAN Wei

2025, 45(4):  511-516.  doi:10.16352/j.issn.1001-6325.2025.04.0511

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Objective To explore the relationship between serum galactomannano (GM) level and specific antibody level of Aspergillus fumigatus in patients with allergic bronchopulmonary aspergillus (ABPA) recurrence. Methods A total of 124 patients diagnosed with ABPA and treated with hormone therapy in our hospital from June 2020 to June 2023 were retrospectively analyzed. According to the recurrence after treatment, the patients were divided into non-recurrence group (n=72) and recurrence group (n=52). The clinical data, blood routine indicators, GM and Aspergillus fumigatus specific antibody level of the two groups were recorded. Results Age, white blood cell(WBC),neutrophil(NEU), lymphocyte(LYM), eosinophil(EOS), GM, serum total immunoglobulin E(tIgE),Aspergillus fumigatus specific immunoglobulin E (sIgE) and Aspergillus fumigatus specific immunoglobulin G(sIgG) were higher in the recurrence group than in the non-recurrence group (P＜0.05). There was a nonlinear relationship between GM and sIgE/sIgG (P＜0.05). GM, sIgE and sIgG were independently correlated with the risk of ABPA recurrence (P＜0.05), and had a nonlinear dose-response relationship with the risk of ABPA recurrence (P_{for non linear}＜0.05). Under different GM level, the higher the sIgE and sIgG, the higher the ABPA recurrence rate. There was an interaction between GM and sIgE/ sIgG. Conclusions With the increase of GM, sIgE and sIgG level, the recurrence rate of ABPA increases. Serum GM level in ABPA recurrence patients is correlated with Aspergillus fumigatus specific antibody.

Clinical Sciences

Effect of exercise on the function and size of the liver in adolescents

ZHANG Liyuan, GUO Xiaoyuan, DU Hanze, CHEN Shi, BAN Bo, ZHANG Mei, PAN Hui

2025, 45(4):  517-521.  doi:10.16352/j.issn.1001-6325.2025.04.0517

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Objective To evaluate the effects of physical exercise on liver function and size in adolescents. Methods A total of 361 adolescent subjects from Jining,Shandong Province were selected and divided into low, moderate, and high-intensity exercise groups according to the frequency of moderate intensity exercise. Physical examination tests were conducted including morphological indicators, blood biochemical indicator measurements, liver size and the presence of non-alcoholic fatty liver disease. Independent sample t-tests and variance analysis were performed using SPSS 26.0, and correlation analysis was conducted using Spearman correlation analysis and multivariate linear regression analysis. Results Compared with the moderate and low-intensity exercise groups, the high-intensity exercise group had significantly lower diastolic blood pressure, homeostatic model assessment of insulin resistance (HOMA-IR), and triglycerides (TG), as well as significantly higher height, maximum oblique diameter of the right liver lobe, and direct bilirubin (DBIL). Correlation analysis showed that as exercise intensity increased, aspartate aminotransferase/alanine aminotransferase, DBIL, and the maximum oblique diameter of the right liver lobe increased significantly (P＜0.05). The results of the cumulative effect of exercise type and intensity indicate that exercise type does not influence the effect of exercise intensity on liver function and size. Conclusions Regular exercise in adolescents can not only shape body, but also improve glucose and lipid metabolism and enhance liver function.

Effects of relaxation training combined with basic psychological intervention on attention deficit factor scores in children with attention deficit hyperactivity disorder

XU Hongning, LU Linyang, CHEN Xiaoyun, KAI Hongxia, WANG Yi, ZHU Qidong, HUANG Yuanyuan

2025, 45(4):  522-526.  doi:10.16352/j.issn.1001-6325.2025.04.0522

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Objective To evaluate the effect of relaxation training combined with basic psychological intervention on attention deficit factor score in children with attention deficit hyperactivity disorder. Methods A total of 320 children with attention deficit hyperactivity disorder were enrolled in Anhui Children's Hospital affiliated to Anhui Medical University from April 2022 to April 2024. The children were divided into 2 groups by random number table method with 160 cases in each. The control group received basic psychological intervention and the observation group received relaxation training combined with psychological intervention. Attention deficit factor score, hyperactivity factor score, oppositional defiant factor score, Weiss Functional Deficit Scale(parent version) score and satisfaction were compared between the two groups. Results The Pittsburgh Sleep Quality Index(PSQI) score of the observation group was higher(17.35±1.42) than that of the control group(P＜0.05). The scores of Attention Deficit Hyperactivity Disorder Rating Scale-Parent Version (SNAP-Ⅳ) in observation group were lower than those in control group(P＜0.05), including attention deficit factor(14.25±1.58), hyperactivity factor(12.01±1.33) and oppositional defiant factor(9.79±1.27). There was no difference in Weiss functional deficit Scale (parent version) between the two groups before intervention, and Weiss functional deficit scale (parent version) score of the observation group was higher than that of the control group after intervention(P＜0.05). The satisfaction of observation group was higher than that of control group(P＜0.05). Conclusions The effect of relaxation training combined with psychological intervention is obvious in children with attention deficit hyperactivity disorder, and the symptoms of attention deficit are significantly improved.

The clinical pathological characteristics of malignant melanoma in nasal cavity and paranasal sinuses and its correlation with subsets of tumor infiltrating lymphocytes

WANG Lining, LIU Honggang

2025, 45(4):  527-531.  doi:10.16352/j.issn.1001-6325.2025.04.0527

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Objective To identify independent predictors of prognosis in MMNS and to examine the expression of CD4, CD8, CD20 and their relationship with prognosis. Methods 87 patients with MMNS were retrospectively analyzed to summarize their clinicopathologic characteristics; the expression of CD4, CD8, and CD20 in MMNS were observed by EnVision immunohistochemical staining (IHC) to analyze the relationship between the expression of these markers and prognosis. Results MMNS with sinus, surrounding tissue invasion, larger tumor and higher AJCC stage showed a worse prognosis. No significant correlation was found among sex, age, histological type,melanin granules, mitotic figures and survival rate. The counts of CD4⁺, CD8⁺ and CD20⁺ TILs in intra-tumoral stroma were positively correlated with the density of TILs at the base of the tumor. CD20⁺ B cells did not have a central tendency to aggregate to form tertiary lymphoid structures, whether in the intratumoral stroma or in the basal stroma of the tumor, the three cell subsets were admixed. There was no statistically significant difference in OS between CD4⁺, CD8⁺, and CD20⁺ subsets. Conclusions The number of CD20⁺ B cells was significantly less than that of CD4⁺ and CD8⁺ T cells in both the intratumoral stroma and the basal stroma of the tumor, and tertiary lymphoid structures fail to be formed, which, unlike cutaneous malignant melanoma, might be a cause of the poor prognosis of MMNS.

Case Reports

Anesthesia management for posterior correction of scoliosis in a child with absence of the right pulmonary artery: a case report

DAI Ziyi, MA Lulu

2025, 45(4):  532-535.  doi:10.16352/j.issn.1001-6325.2025.04.0532

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Objective To discuss the perioperative anesthesia management strategy for posterior correction of scoliosis in children with unilateral absence of pulmonary artery (UAPA). Methods Clinical data of one case of an adolescent male with absence of right pulmonary artery receiving posterior scoliosis correction surgery was retrospectively collected; the preoperative evaluation, intraoperative anesthesia management and postoperative pain treatment were analyzed and summarized. Results UAPA is a rare congenital cardiovascular anomaly that can further increase the cardiovascular and respiratory risks of surgical treatment in scoliosis patients. As the patient was concurrent with hemoptysis, after multidisciplinary consultation and evaluation, an emergency plan for hemoptysis was developed, and invasive arterial pressure monitoring, sufficient analgesia, close respiratory monitoring, and lung protective ventilation strategy was performed intraoperatively. Ensuring respiratory function after surgery, multimodal analgesia was administered. Confirming satisfactory treatment results, the patient was discharged from the hospital. Conclusions For symptomatic UAPA patients, clinicians should focus on the circulation and respiratory system, maintain perioperative hemodynamic stability, prevent hypoxia and carbon dioxide retention so to reduce the risk of complications.

Mini Reviews

Acetylation modification and chronic obstructive pulmonary disease

WANG Pei, BIAN Tao, WU Yan

2025, 45(4):  536-541.  doi:10.16352/j.issn.1001-6325.2025.04.0536

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The main features of chronic obstructive pulmonary disease include chronic airway inflammation, persistent airflow limitation, progressive dyspnea, and impaired lung function. Acetylation is one of the most common post-translational modifications of proteins, which plays an important role in the pathogenesis of chronic obstructive pulmonary disease, such as oxidative stress, inflammatory reaction, and airway remodeling, by regulating gene expression, cell signaling, and protein function. Therefore, exploring the regulatory mechanism of acetylating modification in chronic obstructive pulmonary disease can not only deeply understand the pathophysiological mechanism of the disease, but also provide a theoretical basis for the development of new treatment strategies.

Research progress of perforin 2

DENG Zhiyuan, BAI Lu, YU Rong

2025, 45(4):  542-545.  doi:10.16352/j.issn.1001-6325.2025.04.0542

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Perforin 2 (MPEG 1) is a member of the MACPF(membrane attack complex/PRF membrane attack complex/perforin) superfamily, which is mainly secreted by cytotoxic T lymphocytes, natural killer cells and macrophages Through the formation of active pores on the target cell membrane, perforin 2 participates in altering the permeability-pressure of the target cell, or collaborates with granzymes to induce the apoptosis of target cells. Recently, with the development of molecular biology, MPEG 1 has been increasingly studied, and the unique gene sequence and cell types of perforin 2 have specific functions and adaptive evolution in different immune cells, which may determine its performance and therapeutic potential in different disease states.

Research progress on biomarkers of diabetic nephropathy

ZHAO Qingqing, CHENG Xiaoliang

2025, 45(4):  546-550.  doi:10.16352/j.issn.1001-6325.2025.04.0546

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Diabetic nephropathy (DN) is one of the most common complications of diabetes, and has become the main cause of chronic kidney disease and end-stage renal disease worldwide. At present, the pathogenesis of DN is not completely clear. For a long time, the routine treatment of DN is a combination of life management, hypoglycemic, hypotensive with other symptom-based treatment, but its progress cannot be delayed. Therefore, early detection, diagnosis, and treatment of DN are particularly important, but there is currently no single indicator that can be used for early diagnosis of DN. Therefore, the development of simple, sensitive, and efficient biomarkers is becoming increasingly important.

Medical Education

Reform and exploration of the “4+4” clinical medical talent training model

LU Yongping, PAN Tingfang

2025, 45(4):  551-555.  doi:10.16352/j.issn.1001-6325.2025.04.0551

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In order to cultivate interdisciplinary innovative medical talents who can adapt to the development of the needs of national medical care and of global file of medical education, Peking Union Medical College has initiated the project of the “4+4” model, which covers a series of education remodeling like candidate trainees’ enrollment, curriculum integration application of new teaching methods, assessment and evaluation, etc., and has made a great progress. The existing evaluation data show that there is no significant difference between the academic performance of students in the “4+4” training model and the traditional eight-year program, but the capacity building of clinical performance and scientific research is slightly lower than those of the traditional eight-year program students. The quality of talents cultivated under the new training model needs to be further followed up and a final conclusion of learning and training outcomes of this kind program must be well evaluated by the performance of the students in clinical skill and social service.

Global health education at the U.K. medical schools and its implications to China

HOU Jianlin, KE Yang

2025, 45(4):  556-560.  doi:10.16352/j.issn.1001-6325.2025.04.0556

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Medical schools in the United Kingdom are fully aware of the importance of global health education in cultivating future medical talents. Global health education has been integrated into medical education and with novo curriculum and implementation of smart teaching technology. The medical schools constantly update and improve learning outcomes of global health curriculum and achieved the goal of education reformation. Drawing on the relevant experience from the U.K., China should steadily develop global health education for medical students, strengthen the construction of global health courses and degree programs, enhance medical students' global health competence, and attach importance to the cultivation of high-level global health professionals.