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Survey on the current status of postoperative analgesia in neurosurgery in China

Yifang FAN ; Minyu JIAN ; Fa LIANG ; Haiyang LIU ; Ruquan HAN

Journal of Capital Medical University.2025;46(5):826-832. doi:10.3969/j.issn.1006-7795.2025.05.010

Objective To investigate the current status of postoperative analgesia practices among patients undergoing neurosurgical procedures in China to provide evidence-based support for formulating a standardized postoperative analgesia consensus and optimizing pain management strategies in the field of neurosurgery.Methods A questionnaire was designed with Wenjuanxing,covering 42 items in aspects including general information of participating medical institutions,current practices of neurosurgical postoperative analgesia,anesthesiologists'understanding and implementation of analgesic concepts,and the status of postoperative analgesic management.Distributed through the Chinese Association of Anesthesiologists,the questionnaire data were exported for descriptive statistical analysis after collection.Results A total of 116 medical institutions participated in this survey,with 178 valid questionnaires collected.Over 90%of respondents recognized the clinical necessity of postoperative analgesia for neurosurgical patients,while the actual implementation rate was only 53.9%.Although most hospitals adopted techniques such as local infiltration anesthesia,scalp nerve blocks,patient-controlled intravenous analgesia,and multimodal analgesia,their actual utilization rates remained low.Less than 50%of participating centers implemented preventive analgesia.Despite high awareness of chronic postoperative pain(96.9%),follow-up rates were relatively low.More than half of the institutions lacked acute pain service for neurosurgical analgesia management.Conclusion Postoperative analgesia in clinical neurosurgical practice in China currently remains suboptimal,with inadequate management.There is an urgent need to enhance public education,facilitate multidisciplinary collaboration,and formulate standardized guidelines for clinical practice.

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Reliability and validity of the repeatable battery for assessment of neuropsychological status scale in maintenance hemodialysis patients

Xiaoqi WANG ; Conghui LIU ; Feng SHAO ; Jingjing ZHOU ; Fan YANG ; Zhongxin LI

Journal of Capital Medical University.2025;46(5):877-884. doi:10.3969/j.issn.1006-7795.2025.05.017

Objective To evaluate the reliability and validity of the Chinese version of the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)in patients with maintenance hemodialysis(MHD).Methods The general information and medical history of 84 MHD patients were collected,and the Mini-Mental State Exam(MMSE),Montreal Cognitive Assessment Scale(MoCA),and RBANS were conducted.The reliability of the scale was assessed by Cronbach α and split-half reliability.The structure and convergent validity of the scale were assessed by confirmatory factor analysis,and the RBANS scores'correlation to MoCA and MMSE scores was analyzed by Spearman correlation analysis.The predictive value of the RBANS total score on cognitive impairment(CI)was analyzed by receiver operating characteristic(ROC)curve.Results The Cronbach's alpha coefficient of the RBANS total scale was 0.896,split-half reliability was 0.911,and reliability for the five dimensions of the RBANS ranged from 0.618 to 0.791.Confirmatory factor analysis indicated that the overall fit of the five-dimensional model of the RBANS scale was acceptable(χ2/df=1.587,root mean square error of approximation=0.084,comparative fit index=0.967,incremental fit index=0.968,Tucker-Lewis index=0.947,goodness of fit index=0.891).The average variance extracted(AVE)for the five dimensions of the RBANS ranged from 0.525 to 0.863,while the composite reliability(CR)ranged from 0.733 to 0.926,indicating good convergent validity of the scale.Furthermore,Spearman correlation analysis revealed that the total RBANS score was negatively correlated to the age of MHD patients and positively correlated to years of education,as well as the total scores of MMSE and MoCA(all P<0.01).The ROC curve analysis indicated that the area under the curve(AUC)for the total RBANS score in predicting CI was 0.891(P<0.01),suggesting a high predictive value.Conclusion The Chinese version of RBANS has good reliability and validity in MHD patients,and can be used as a measure of cognitive function in MHD patients.

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Perioperative oxygen concentration and postoperative organ damage in pediatric neurosurgery:a retrospective cohort study

Zhengfang HU ; Kangda ZHANG ; Huiwen WANG ; Chengwei WANG

Journal of Capital Medical University.2025;46(5):892-897. doi:10.3969/j.issn.1006-7795.2025.05.019

Objective To investigate the correlation between perioperative oxygen concentration and postoperative organ injury and other adverse reactions in children undergoing neurosurgery.Methods This study is a single-center retrospective cohort study,including 512 children aged≤14 years and operating duration≥2 hours who were transferred after surgery to postanesthesia care unit(PACU),Department of Anesthesiology,Beijing Tiantan Hospital,Capital Medical University from October 2018 to September 2023.His electronic medical record system was used to review and collect the patient's medical records during hospitalization.Including baseline data,anesthetic use,duration of anesthesia,intraoperative oxygen concentration,postoperative diagnosis,and surgical method;blood pressure,heart rate,oxygen saturation,pain score and special conditions during anesthesia recovery;infection during postoperative hospitalization(including wound infection,intracranial infection),respiratory complications[confirmed by chest radiograph/chest computed tomography(CT)report],changes in renal function(first postoperative serum creatinine value-last preoperative serum creatinine value),and incidence of delirium during recovery period during anesthesia were recorded.The area under oxygen concentration-time curve area under curve AUCFiO2=the product of intraoperative oxygen concentration(%)and duration of anesthesia(min)was calculated,and then 512 children were divided into 3 groups according to the AUCFiO2 tripartite(group 1:AUCFiO2<8 720%min,group 2:8 720%·min≤AUCFiO2≤13 800%·min,group 3:AUCFiO2>13 800%·min)were included in the data analysis.Results The incidence of emergency delirium(ED)during postoperative recovery was 24%,26.9%and 19.4%,and the incidence of acute kidney injury(AKI)was 0.6%,2.3%and 0.6%,respectively.There was no significant difference between the three groups(P>0.05).The incidence of postoperative pulmonary complications in the three groups was 20.6%,20.8%and 31.5%,respectively,and there was significant statistical difference among the three groups(P<0.05).There were no significant differences in nausea,vomiting,hypoxemia,and PACU residence time among the three groups during anesthesia recovery room(P>0.05),and there were significant differences in intracranial infection,wound infection and hospital stay during hospitalization(P<0.05).Conclusion Although oxygen concentration AUCFiO2 has no correlation with the occurrence of postoperative AKI and ED,the longer the exposure time of conventional oxygen administration strategy,the higher the incidence of postoperative pulmonary complications and postoperative infection,and the longer the hospitalization time of children.

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Application of artificial intelligence in the study of cancer diagnosis and treatment research

Honglei LIU ; Yingliang YANG ; Ronghao LI ; Congmin ZHU ; Xu ZHANG

Journal of Capital Medical University.2025;46(3):395-400. doi:10.3969/j.issn.1006-7795.2025.03.001

As a major global public health concern,cancer has witnessed a continues rise in both incidence and mortality rates.It pose not only a severe threat to human health but also a heavy burden on socioeconomic systems.Despite remarkable advancements in oncology research,critical challenges such as tumor heterogeneity,drug resistance,and limitations in early screening and diagnostic technologies remain to be addressed.Against this backdrop,artificial intelligence(AI),with its unique advantages in big data analysis,pattern recognition,and predictive modeling,has opened new avenues for cancer research.By integrating multi-modal data,including omics,imaging,and clinical information,AI not only accelerates investigations into fundamental tumor mechanisms but also demonstrates immense potential in areas such as early screening,biomarker discovery,and personalized treatment.These advancements have fostered a deeper integration of precision medicine and oncology.This review provides a comprehensive overview of the most recent progresses in the application of AI in cancer diagnosis and treatment research,with a focus on its practical value across diverse data types and clinical scenarios,as well as future directions for its development.

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Comparison of the prognostic value of 15 nutritional/inflammatory indicators in postoperative cancer patients

Xiaoqian LIU ; Kai SUN ; Xiaolin WANG ; Qianqian ZHAO ; Xiaoxiao WU ; Fangqi SHEN ; Xi CHEN ; Chenxu TIAN ; Di WU ; Chunhua SONG ; HongXia XU ; Minghua CONG ; Hanping SHI ; Pingping JIA

Journal of Capital Medical University.2025;46(3):410-419. doi:10.3969/j.issn.1006-7795.2025.03.003

Objective To explore and identify the nutritional/inflammatory indicator with the highest predictive potential for overall survival(OS)in postoperative tumor patients so as to provide guidance for postoperative rehabilitation of tumor patients.Methods Data from 3 191 surgical patients were collected,including 15 nutritional/inflammatory indicators.The maximum selection rank statistic method was used to calculate the optimal cut-off values for continuous indicators.The Kaplan-Meier method was used to assess OS,and Cox proportional hazards models were used to analyze the association between the aforementioned 15 indicators and survival.The predictive value of these 15 indicators was evaluated with receiver operating characteristic(ROC)curves and C-index.Results Multivariate analysis showed that all 15 indicators were significantly associated with poorer OS in surgical patients(P＜0.05 for all).Time-dependent area under the curve(AUC)and C-index analysis indicated that 3 indicators with the highest predictive potential in OS in postoperative tumor patients were the nutritional risk index(NRI)(C-index:0.597),C-reactive protein-to-albumin ratio(CAR)(C-index:0.587),and C-reactive protein-to-lymphocyte ratio(CLR)(C-index:0.587).The optimal cut-off value for NRI was determined to be 104.31(i.e.,NRI＜104.31 suggests malnutrition)with the maximum selection rank statistic method,the optimal cut-off value for CAR to be 0.05(i.e.,CAR≥0.05 suggests a strong inflammatory response,often accompanied by malnutrition),and the optimal cut-off value for CLR to be 1.18(i.e.,CLR≥1.18 suggests a strong inflammatory response).Subgroup analysis indicated that NRI,CAR,and CLR had good correlation with tumor staging,and there were significant differences between tumor node metastasis(TNM)Ⅲ/Ⅳ stage patients and TNM Ⅰ/Ⅱ stage patients when there was a strong inflammatory response or malnutrition.Conclusion In postoperative tumor patients,NRI,CLR,and CAR have high prognostic value.Combining these with the patient's clinical stage,it enables more precise guidance for clinical diagnosis and treatment strategies.

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B cell receptor signaling pathway and its therapeutic implications in B-cell lymphoma

Jingwen WANG ; Zhenjun LI ; Liangcheng LYU ; Xiaoyu YAO ; Ning DING

Journal of Capital Medical University.2025;46(3):436-441. doi:10.3969/j.issn.1006-7795.2025.03.006

B-cell lymphomas account for 70％-80％of non-Hodgkin lymphomas(NHL)and exhibit significant heterogeneity in genetic profiles,phenotypic characteristics,and clinical manifestations,posing substantial challenges for clinical management.The B-cell receptor(BCR)is a transmembrane receptor on the surface of B cells that plays a central regulatory role in B-cell development,activation,and adaptive immune responses.As a core mechanism driving malignant transformation in various B-cell malignancies,aberrant activation of the BCR signaling pathway,plays a pivotal role in B lymphoma pathogenesis.Dysregulated BCR signaling not only promotes tumor cell proliferation,survival,and anti-apoptotic capacity but also accelerates malignant progression.Consequently,researchers are vigorously exploring therapeutic strategies targeting BCR and its downstream pathways,including inhibitors of Bruton's tyrosine kinase(BTK)and PI3K,as well as direct BCR-targeted approaches.The central role of BCR signaling in lymphoma pathogenesis and treatment underscores its potential as a critical focus for future therapeutic development,offering new directions and hope for improved clinical outcomes.

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A study on the distribution patterns of traditional Chinese medicine syndrome types in antipsychotic-induced metabolic syndrome

Shulian XIAN ; Hongxiao JIA ; Xue LI ; Di WANG ; Mingkang SONG ; Dongqing YIN ; Hairong JIANG

Journal of Capital Medical University.2025;46(3):463-470. doi:10.3969/j.issn.1006-7795.2025.03.010

Objective To explore the distribution patterns of traditional Chinese medicine(TCM)syndromes in patients with metabolic syndrome caused by antipsychotic drugs.Methods A standardized TCM syndrome survey was performed to collect diagnostic information from 160 patients diagnosed with metabolic syndrome due to antipsychotic drug use.Subsequent frequency analysis,cluster analysis,and Bayesian network analysis were carried out.The syndrome pattern distribution was ultimately determined through relevant literatures and expert opinions.Results Five TCM syndromes were identified through frequency,cluster,and Bayesian network analyses.The most common syndrome was qi deficiency with phlegm-dampness(30％),followed by spleen deficiency with phlegm-Heat(23.75％),qi and yin deficiency Pattern(21.88％),yin deficiency with damp-heat(17.50％),and stomach fire hyperactivity pattern(6.88％).Conclusion The pathogenesis of antipsychotics-induced metabolic syndrome involves a complex interplay of deficiency and excess factors.The primary disease is mainly located at the spleen and stomach,with involvement of the liver,kidney,and heart.Pathogenic factors include qi deficiency,yin deficiency,dampness,heat,pathogenic fire,and phlegm.

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Qingre Jiedu recipe in the treatment of bipolar depression with the syndrome of internal stagnation of fire-heat:a randomized double-blind controlled trial

Dongqing YIN ; Hongxiao JIA ; Xue LI ; Sisi ZHENG ; Yanzhe NING

Journal of Capital Medical University.2025;46(3):479-486. doi:10.3969/j.issn.1006-7795.2025.03.012

Objective To evaluate the efficacy and safety of Qingre Jiedu recipe in the treatment of bipolar depression.Methods A randomized,double-blind,Chinese medicine and western medicine placebo control design was used in this study.Totally 80 subjects with bipolar depression and fiery internal depression that met the enrollment criteria,were divided into the experimental group(EG,40 cases of western medicine simulation tablets+Chinese medicine formula granules)and the control group(CG,40 cases of western medicine+Chinese medicine placebo)according to a 1∶1 ratio at last,7 cases dropped out after enrollment,EG 36 cases,CG 37 cases.TCM Heat Internal Depression Syndrome(TCMHIDS),Hamilton Depression Scale-24 Item(HAMD-24),Hamilton Anxiety Scale(HAMA),Hypomania Checklist-33(HCL-33),Young Manic Rating Scale(YMRS)and Treatment Emergent Symptom Scale(TESS)scores were assessed at baseline and at the 2nd,4th and 8th week after treatment.Important signs and adverse events were recorded.Blood routine,hepatic and renal function,urine routine and electrocardiogram were performed during the screening period and the 8th week after treatment.For the patients who dropped out of the examination program,the examination item are identical to those at week 8.The primary outcome measure was the change in HAMD score from baseline to 8th week.Secondary outcome evaluation indicators included the changes of TCMHIDS,HAMA,HCL-33 and YMRS scores from baseline to 8th week.Results The scores of the HAMD-24 between EG and CG decreased significantly compared with the baseline at different time-point,and the difference was statistically significant(P＜0.01).However,the scores of the EG on the HAMD-24 decreased more significantly compared with the CG at the 4th and 8th week,and this difference was statistically significant(P＜0.01).The TCMHIDS and HAMD scores between two groups decreased compared with the baseline at different time-point,and this difference was statistically significant(P＜0.01).However,the TCMHIDS and HAMD scores of the EG decreased more significantly ot the 4th and 8th week,compared with the CG,and this difference was statistically significant(P＜0.01).Both YMRS and HCL-33 scores decreased more significantly between two groups at different time-point,compared with the baseline,and this differences was statistically significant,but there was no difference between two groups.Conclusion TCM Qingre Jiedu recipe could effectively relieve depression and anxiety mood of bipolar depression,with more advantages than western medicine.In addition,it showed a certain effect on hypomania or manic-related symptoms of bipolar disorder,No risk of turning to hypomania or manic,better safety and less adverse reactions were observed.

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Ecto-5'-nucleotidase(Nt5e/CD73)gene knockout exacerbates vascular remodeling and inflammatory response in mice after intravenous transplantation

Tingting LIU ; Hongtao SHI ; Hui XU ; Jie DU ; Chunmei PIAO

Journal of Capital Medical University.2025;46(3):511-519. doi:10.3969/j.issn.1006-7795.2025.03.016

Objective To examine the phenotypic characteristics of Ecto-5'-nucleotidase(NtSe/CD73)gene knockout mice in restenosis of blood vessels after vein transplantation so as to identify potential targets for early diagnosis and drug treatment of vascular restenosis after clinical coronary artery bypass surgery.Methods CD73 gene knockout mice aged 8-10 weeks were used as the experimental group,and the littermate wild-type mice were used as the control group.Using the inferior vena cava of mice as a donor,we transplanted to the right carotid artery of allogeneic mice with a trocar method to establish a mouse inferior vena cava carotid artery vascular transplantation model.At the 4th week post-model establishment,we systematically evaluated the patency of the transplanted blood vessels,the formation of the vascular intima,the proliferation of the media,the morphology of the elastin layer,and the expression of inflammatory factors.The vascular smooth muscle cells(VSMCs)from the inferior vena cava of mice were isolated in vitro,and the migration and proliferation were assessed with CD73 inhibitor adenosine 5'-(alpha,beta-methylene)diphosphate(APCP).Results In CD73 knockout mice,neointima formation was impaired,the elastic fiber layer was disrupted and lost,and medial smooth muscle cells proliferated more actively.These changes ultimately led to decreased vascular wall elasticity and increased blood flow resistance.The immunohistochemical staining results suggest that in CD73 gene knockout mice the transplanted vein tissue showed extensive infiltration of Mac-2 positive macrophages,and the expression of cytokines interleukin-1 β(IL-1 β),IL-6,and transforming growth factor β(TGF-β)was significantly increased.CD73 deficiency exacerbated inflammatory responses and vascular remodeling in venous tissues.Scratch wound healing and cell proliferation assays revealed that CD73 inhibition promoted VSMCs proliferation,yet concurrently impaired their migratory capacity.Conclusion Knockout of the CD73 gene exacerbates vascular remodeling and inflammatory response in vein grafts,offering crucial insights for the precise diagnosis and targeted treatment of patients with CD73 gene defects undergoing coronary artery bypass surgery in clinical practice.

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Clinical features and prognostic analysis of adenoid cystic carcinoma of the external auditory canal

Jun WU ; Xi ZHAO ; Tingyao MA ; Guoliang YANG ; Shujing ZHANG ; Yue ZHAO ; Yixuan LIU ; Xiaohong CHEN

Journal of Capital Medical University.2025;46(3):559-566. doi:10.3969/j.issn.1006-7795.2025.03.022

Objective To investigate the clinical characteristics,treatment strategies,and prognostic factors of adenoid cystic carcinoma(ACC)of the external auditory canal(EAC),and to provide evidence for optimizing surgical extent and adjuvant therapy.Methods A retrospective cohort study was conducted on 58 patients with pathologically confirmed ACC of the EAC treated in Department of Otorhinolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,between January 2001 and December 2021.All patients underwent surgical treatment,with some receiving adjuvant radiotherapy.The primary outcome was local recurrence,while secondary outcomes included overall survival(OS)and local recurrence-free survival(LRFS).Survival analysis was performed by the Kaplan-Meier method,and Cox regression models were used to identify risk factors for recurrence.Results The median follow-up time for the entire cohort was 6.27(3.25,11.30)years.The 1-year,3-year,and 5-year OS rates were 96.55％,91.37％,and 89.66％.43.10％of cases were classified as T4 stage at diagnosis,indicating advanced local progression.Local recurrence occurred in 23 patients(39.66％),and distant metastasis was observed in 28 patients(48.28％),with pulmonary metastasis accounting for 92.86％of cases.Multivariate analysis revealed that the solid histological pattern(HR=2.729,95％CI:1.025-7.226,P=0.044)and perineural invasion(PNI)(HR=9.891,95％CI:3.525-27.752,P＜0.01)were independent risk factors for local recurrence.Conclusion ACC of the EAC is characterized by a high propensity for local recurrence and distant metastasis.The solid histological pattern and perineural invasion are critical prognostic determinants.Multimodal therapy(surgery combined with adjuvant radiotherapy)may improve clinical outcomes,and early diagnosis and intervention are pivotal for enhancing survival rates.

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