Journal of Shandong University (Health Sciences)

Clinical analysis of one-hole split endoscope for lumbar spinal stenosis based on enhanced recovery after surgery

HU Bingtao, ZHANG Wencan, WANG Chongyi, LIN Xiangyu, WANG Kaibin, FENG Yunze, LIU Chen, XU Wanlong, LI Le, SI Haipeng

Journal of Shandong University (Health Sciences). 2025, 63(3): 1-7. doi:10.6040/j.issn.1671-7554.0.2024.1169

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Objective To investigate the clinical efficacy of the one-hole split endoscope(OSE)treatment protocol under the enhanced recovery after surgery(ERAS)concept for treating lumbar spinal stenosis(LSS). Methods A retrospective analysis was conducted on 130 LSS patients treated at Qilu Hospital of Shandong University between January 2020 and December 2023. There were 71 males and 59 females, aged 23 to 77 years, with a mean age of(54.42±11.82)years. Patients were divided into the following two groups based on whether the ERAS concept was followed during their treatment. The ERAS group(n=65)received the OSE treatment under the ERAS concept, while the non-ERAS group(n=65)underwent the traditional interlaminar fenestration surgery without the ERAS concept. Key outcomes, including hospitalization duration, operation time, estimated blood loss, complication incidence, visual analog scale(VAS)for low back and leg pain, Oswestry disability index(ODI), Japanese Orthopaedic Association scores(JOA), and modified MacNab efficacy evaluation criteria(MacNab), were compared between the two groups. Results The ERAS group showed significantly better VAS, ODI, and JOA scores than the non-ERAS group at two days after the operation(P<0.05). However, at 3 months after the operation, there were no significant differences between the two groups in VAS, ODI, JOA scores, and modified MacNab criteria(P>0.05). The average operation time in the ERAS group was longer than in that the non-ERAS group, whereas the average estimated blood loss and hospitalization duration were significantly shorter than those in the non-ERAS group(P<0.05). No patients in either group required readmission before the end of the follow-up period. Additionally, postoperative complications were observed in three patients in the non-ERAS group, compared to only one patient in the ERAS group. Conclusion The combination of OSE surgery and ERAS concept in LSS treatment promotes rapid postoperative recovery. Consequently, the endoscopic surgical treatment under the ERAS concept could be considered an effective alternative strategy for LSS treatment.

Clinical effect of arthroscopic extensor carpi radialis brevis release combined with platelet-rich plasma in treatment of Lateral epicondylitis of the humerus

HUANG Zishuai, ZHANG Shuang, WANG Jianxu, YANG Guang, WANG Jian, FENG Haotian

Journal of Shandong University (Health Sciences). 2025, 63(3): 8-13. doi:10.6040/j.issn.1671-7554.0.2024.1145

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Objective To investigate the clinical efficacy and safety of combining arthroscopic extensor carpi radialis brevis(ECRB)tendon release with platelet-rich plasma(PRP)injection for the treatment of chronic lateral epicondylitis. Methods This study retrospectively analysed the clinical data of 20 patients diagnosed with chronic humeral epicondylitis, who were admitted to the Department of Orthopaedics, Provincial Hospital Affiliated to Shandong First Medical University between September 2023 and March 2024. Based on the results of doctor-patient communication, 10 cases were treated with arthroscopic ECRB release combined with PRP injection, while the other 10 cases received arthroscopic ECRB release alone.The study compared the visual analogue scale(VAS)scores, MAYO elbow-performance score(MEPS), and american shoulder and elbow surgeons score(ASES-S)both preoperatively and six months postoperatively between the two groups. In addition, the time to return to work and any complications were evaluated. Results The resting VAS score, active VAS score MEPS and ASES-S scores of both groups were significantly improved six months postoperatively(P<0.01). Six months postoperatively, there was no significant difference in static VAS score ［(0.40±0.70)vs.(0.60±0.52), P>0.05］ and dynamic VAS score ［(0.40±0.52)vs.(0.80±0.63), P>0.05］, but MEPS score ［(94.40±0.52)vs.(92.90±0.88), P<0.05］ and ASES-S score ［(90.60±0.70)vs.(89.60±0.84), P<0.05］ in the PRP group were significantly better than those in the release group. No complications, such as infection or vascular and nerve injury, occurred in any patient at the last follow-up. The time to return to work in PRP group was significantly earlier than that in the release group ［(2.52±0.23)weeks vs.(3.08±0.40)weeks, P<0.05］. Conclusion Arthroscopic release of the extensor carpi radialis brevis(ECRB), when combined with platelet-rich plasma(PRP)injection, has been shown to provide satisfactory results in the treatment of chronic lateral epicondylitis. This approach facilitates effective patient recovery, alleviates elbow pain symptoms, improves functional ability, and accelerates the time to return to work.

Construction of a transforaminal endoscopic surgical path based on bone landmarks in intraoperative C-arm X-ray radiographs

ZHANG Yixiang, LIANG Yuanhao, YANG Wenlong, LI Guoqiang, WU Wenqing, LIU Lei

Journal of Shandong University (Health Sciences). 2025, 63(3): 14-21. doi:10.6040/j.issn.1671-7554.0.2024.1205

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Objective To summarise the rules of lateral puncture positioning for the intervertebral foramen endoscopy by analyzing thin-slice CT images of the lumbar spine and to construct a surgical path for intervertebral foramen endoscopy based on the intraoperative C-arm X-ray bone landmarks, so as to apply it to clinical verification of its safety and effcacy. Methods (1) Thirty patients with lumbar disc herniation(LDH)admitted to The First Affiliated Hospital of Shandong First Medical University from January 2022 to May 2024 were selected for lumbar thin-layer CT imageing. The rules of lateral puncture of intervertebral foramen endoscopy were explored through imaging anatomy research, and the method of fixed-point puncture of the cross line of bone landmarks on intraoperative C-arm X-ray imageing was established to construct a safe and effective puncture path of intervertebral foramen endoscopy. (2) Eighty patients with LDH who underwent intervertebral foramen endoscopy surgery in our hospital from May 2023 to May 2024 were selected and divided into the cross-point positioning method group(n=40)and the surface positioning method group(n=40)according to the random number table method. All patients underwent lateral foraminal endoscopic surgery, and the surgery was performed by senior physicians experienced in spinal endoscopic surgery according to the principle of random allocation. The clinical efficacy, intraoperative parameters and postoperative complications of the two groups were observed and analysed. Results The overall efficacy rate of the observation group was higher than that of the control group, and the difference between the two groups was statistically significant(P<0.05). The single puncture success rate was 97.5% in the cross-point positioning method group and 80% in the surface positioning method group, and the difference between the two groups was statistically significant(P<0.05). The time to establish the working channel was(16.32±3.97)min in the cross-point positioning method group and(26.32±5.93)min in the surface positioning method group, and the difference between the two groups was statistically significant(P<0.05). The mean number of fluoroscopy times was 8.93±2.12 in the cross-point positioning method group and 17.53±2.73 in the surface positioning method group, with a statistically significant difference between the two groups(P<0.001). The intraoperative fluoroscopic radiation dose in the cross-point positioning method group was(10.27±5.72)mGy, while that in the cross-point positioning method group was(17.16±4.27)mGy, with a significant difference between the two groups(P<0.01). The postoperative VAS score and ODI scores in the cross-point positioning method group were significantly lower than those in the surface positioning method group(P<0.05). There was no serious complications occurred in either group. Conclusion The cross-point positioning method has significant advantages over the previous puncture positioning method, and provides a safe, effective, accurate, easy-to-mark, simple and easy-to-learn puncture positioning method for transforaminal endoscopic lumbar discectomy.

Short-term efficacy of all-inside anterior cruciate ligament reconstruction assisted by internal brace technique

WANG Jianxu, PENG Xiaohui, FENG Haotian, AN Senbo, DONG Zihao, HUANG Zishuai, LIU Zhe, YANG Guangsup>1,2

Journal of Shandong University (Health Sciences). 2025, 63(3): 22-27. doi:10.6040/j.issn.1671-7554.0.2024.0998

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Objective To investigate the short-term efficacy of all-inside anterior cruciate ligament reconstruction(ACLR)assisted by internal brace technique under arthroscopy. Methods A retrospective study was performed on 42 patients with all-inside ACLR assisted by internal brace technique who were admitted to the Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University from July 2022 to June 2023. The femoral and tibial ends were fixed by double suspension with adjustable loop titanium plates, and the autosemitendinosus for ACL graft. High-strength sutures or wire bands were inserted into the femoral ends of the titanium plates, and then fixed in the tibial cortex with knot-free anchors after pulling out the tibial ends. Clinical outcome was evaluated with International Knee Documentation Committee(IKDC)score, Lysholm score, and knee stability tests(Lachman test and pivot shift test). Results All of the 42 patients underwent successful surgery and were followed up for 6 to 12 months, with an average duration of 9.7 months. At the final follow-up, no complications, such as infection or ligament re-rupture, were observed in any of the patients. The Lysholm score and IKDC score recovered from preoperative 50.10±3.19 and 51.42±4.52 to the last follow-up 82.38±2.86 and 84.89±3.39, respectively, with statistical significance(P<0.001). All Lachman tests were positive before surgery(17 cases of grade Ⅱ and 25 cases of grade Ⅲ), and only 1 case was positive at the last follow-up(1 case of grade Ⅰ), the difference was statistically significant(P<0.001). The pivot shift test was negative at the last follow-up, significantly less than the 42 cases before surgery(2 cases in normal, 12 cases in grade Ⅰ, 28 cases in grade Ⅱ, 0 cases in grade Ⅲ), and the difference was statistically significant(P<0.001). Conclusion The application of all-inside anterior cruciate ligament reconstruction assisted by internal brace technique can obtain satisfactory short-term clinical outcomes, and has a significant improvement in the functional capacity and stability of the patients knee joint.

Application of enhanced recovery after surgery comprehensive treatment in the perioperative period of patients with triangular fibrocartilage complex injuries

MA Zhihu, YU Xiaofeng, SUN Yuliang, WANG Gang, PEI Yantao, CHEN Bin, SHI Anhao, QIAO Li, ZHU Lei

Journal of Shandong University (Health Sciences). 2025, 63(3): 28-35. doi:10.6040/j.issn.1671-7554.0.2024.0821

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Objective To observe the perioperative efficacy of the comprehensive treatment of enhanced recovery after surgery(ERAS)in patients with triangular fibrocartilage complex(TFCC)injury after undergoing transcarpal arthroscopic repair. Methods A retrospective collection was carried out on 46 patients with TFCC injuries who underwent transcarpal arthroscopic repair in Qilu Hospital of Shandong University from January to December 2023. The patients who underwent ERAS comprehensive rehabilitation were assigned to the observation group, and those who received conventional rehabilitation were designated as the control group, with 23 cases in each group. Both the observation group and the control group were treated with the same modality of external orthotic fixation postoperatively. In the initial three-week period, an above-elbow orthosis was applied. Subsequently, at the three-week mark, a review was conducted and, based on the assessment, the forearm external fixation orthosis was substituted. After six weeks, in accordance with the reevaluation findings, the external fixation orthosis was removed and a progressive resumption of rehabilitation training was initiated. Among them, the control group carried out rehabilitation exercises on their own according to the preoperative conversation and the doctors advice during the review. In the observation group, pre-rehabilitation exercises, nutritional support, and psychological counseling were initiated prior to surgery, followed by a comprehensive evaluation. Subsequently, a comprehensive assessment was conducted to develop an individualized comprehensive nursing plan for the patients. After the operation, an early progressive rehabilitation treatment was adopted, which comprised muscle training, joint mobilization, physiotherapy, and activities of daily living training. The entire process was supervised and directed by nursing staff until completion. The visual analogue scale(VAS)for pain was scored at 6 and 12 weeks postoperatively, and the range of joint motion and the modified MAYO wrist score were evaluated at 12 weeks after the operation. Results The pain VAS scores of the observation group at 6 and 12 weeks after surgery were both lower than those of the control group. At 12 weeks after surgery, the wrist joint dorsiflexion, palmar flexion, radial deviation, ulnar deviation range of motion and MAYO wrist score of the observation group were all higher than those of the control group, and the differences were statistically significant(P<0.05). Conclusion The application of the ERAS concept in patients with TFCC injuries can shorten the rehabilitation treatment time, enhance the rehabilitation effect, strengthen the curative effect of the surgery, and help patients return to social life as soon as possible.

Effect of multi-angle isokinetic muscle strength training on the recovery of knee motion and proprioception after knee arthroplasty

ZHANG Peng, YANG Peng, ZHAO Jing, ZHONG Junqiao, WAN Shaoyong

Journal of Shandong University (Health Sciences). 2025, 63(3): 36-43. doi:10.6040/j.issn.1671-7554.0.2024.0840

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Objective To investigate the effect of different angle isokinetic muscle strength training on knee joint motion and proprioception after total knee arthroplasty(TKA). Methods A total of 96 patients who underwent TKA in Affiliated Hospital of Jinggangshan University from January 2021 to June 2022 were selected, aged 37-74 years, with a mean age of 52.72±5.37 years. The patients were divided into group 0°-30°, group 31°-60° and group 61°-90° according to the range of knee flexion during isokinetic training. Muscle strength index, clinical index and proprioceptive index were compared before and after treatment in the three groups. The correlation between knee ROM and proprioception was analysed after isokinetic strength training at different angles. Results After treatment, the muscle strength indexes of the quadriceps femoris and triceps crus were significantly higher in the three groups than those before treatment(P<0.05). After treatment, the muscle strength related indexes of quadriceps femoris in group 31°-60° were significantly higher than those in group 0°-30° and group 31°-60°, while the muscle strength related indexes of triceps crus in group 0°-30° were significantly higher than those in group 31°-60° and group 31°-60°(P<0.05). After treatment, range of motion(ROM), time “ up and go” test(TUGT), visual analogue scale(VAS), Berg balance scale(BBS)score and hospital for special surgery(HSS)score were significantly improved in the three groups(P<0.05). The ROM and HSS scores of group 0°-30° were significantly higher than those in group 31°-60° and group 31°-60°, and the TUGT time of group 31°-60° was significantly lower than that of group 0°-30° and group 31°-60°(P<0.05). The BBS scores of group 0°-30° and group 31°-60° were higher than those of group 31°-60° after treatment(P<0.05). There was no significant difference in VAS score between the three groups after treatment(P>0.05). TDPM and AAR were significantly improved after treatment(P<0.05). After treatment, TDPM(30°, 45°, 60°)and AAR(30°, 45°, 60°)in group 31°-60° were significantly lower than those in group 0°-30° and group 31°-60°(P<0.05). When the training angle of isokinetic muscle strength was 0°-30°, there was a correlation between knee ROM and AAR 30° after treatment(r=-0.50, P=0.03). When the training angle of isokinetic muscle strength was 31°-60°, the knee joint ROM after treatment was correlated with TDPM 30°(r=-0.49, P=0.04), TDPM 45°(r=-0.52, P=0.03), AAR 45°(r=-0.62, P=0.00)and AAR 60°(r=-0.59, P=0.03). Conclusion Isokinetic quadriceps muscle strength training at different angles can effectively promote the rehabilitation of patients after TKA, among which isokinetic quadriceps muscle strength training in the range of 31°-60° can better improve the postoperative proprioception and quadriceps muscle strength of patients. In the range of 0°-30°, quadriceps isometric training has the most significant improvement effect on the muscle strength, ROM and HSS scores of patients calf triceps.

Effect of alone and combined exposure to cadmium and microplastics on cognitive function in mice

ZHANG Hongjia, YAO Wenhuan, KOU Ruirui, CHENG Dong, ZHANG Tianliang, ZHAO Xiulan

Journal of Shandong University (Health Sciences). 2025, 63(3): 44-54. doi:10.6040/j.issn.1671-7554.0.2024.1110

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Objective To investigate the mechanism of cognitive impairment caused by cadmium(Cd)and microplastics(MPs)exposure alone or in combination. Methods Female mice were divided into control group, Cd group(Cd: 5 mg/kg·bw CdCl₂), MPs group(MPs: 10 mg/kg·bw), Cd+MPs combination group(Cd+MPs: 5 mg/kg·bw CdCl₂+10 mg/kg·bw MPs)by random number method according to body weight, with 14 mice in each group. The mice were given CdCl₂ and MPs once daily by gavage. At the end of 12 weeks, the neurobehavioral performances of the mice were evaluated. Subsequently, 4 mice from each group were randomly selected and transcardially perfused with 4% paraformaldehyde(PFA), and the brains were dissected for immunohistochemical staining with NeuN. Another 5 mice from each group were treated with Evans blue by tail vein injection to determine the blood-brain barrier(BBB)permeability. The remaining mice of each group were sacrificed and the brains were subjected to Western blotting for detection of protein expression of interest. The Cd content in the brain of the mice was analysed by graphite furnace atomic absorption spectrophotometer. Results The results of the open field test showed that the dwell times in the peripheral area of mice from the Cd group, MPs group and Cd+MPs combination group were higher than those of the control group(P<0.05), and the activity times in the central region were lower than those of the control group(P<0.05). The results of the novel object recognition experiment showed that the recognition index of all mice in the Cd group, MPs group and Cd+MPs combination group was significantly decreased compared with the control mice(P<0.05). Evans blue detection showed that the OD values of brain homogenate of mice from the Cd group, MPs group and Cd+MPs combination group significantly increased(P<0.05)compared with the control values, indicating the obvious increase of BBB permeability. The results of Cd analysis showed that the Cd content of mouse brain in Cd group and Cd+MPs combination group was significantly increased(P<0.05), and the Cd level of mouse brain in Cd+MPs combination group was significantly higher than that of Cd group(P<0.05). The neuron count results after NeuN immunohistochemical staining showed that compared with the control group, the decrease of neurons in the brain cortex of mice from Cd group, MPs group and Cd+MPs combination group was statistically significant(P<0.05). Western blotting results showed that the protein expressions of synapsin1(Syn-1), synaptonphysin(SYP)and postsynaptic density protein 95(PSD95)in the brain cortex of mice from the Cd group, MPs group and Cd+MPs combination group were decreased(P<0.05), with the greatest decrease in the Cd+MPs combination group. Compared with the control group, the key inflammatory regulatory protein, NF-κB, was activated in the brain tissue of Cd, MPs and Cd+MPs combination groups, as evidenced by the p-NF-κB/ total NF-κB ratio, which was significantly increased(P<0.05). Immunofluorescence double staining of the downstream protein of the pyrotosis axis, Gasdermin D(GSDMD), with NeuN showed that co-localization of GSDMD and NeuN-positive neurons was observed in the Cd group, the MPs group and the Cd+MPs combination group, and the most of the neurons with pyrotosis were observed in the Cd+MPs combination group. Conclusion Both Cd and MPs individual exposure could lead to cognitive impairment in mice, and their combined exposure aggravated the brain damage. The activation of NF-κB, inflammatory pyrotosis of neurons in the brain, may be one of the shared mechanisms of Cd and MPs.

Mechanism of Tongqiao desensitization prescription mediated Notch signaling pathway on regulating Th1/Th2 immune imbalance in allergic rhinitis rats

MA Fengmei, RONG Ting, MA Yunlei

Journal of Shandong University (Health Sciences). 2025, 63(3): 55-62. doi:10.6040/j.issn.1671-7554.0.2024.0681

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Objective To investigate the mechanism of Tongqiao desensitizing prescription in regulating Th1/Th2 immune imbalance in rats with allergic rhinitis(AR). Method AR rat model was established using ovalbumin(OVA)emulsified with aluminum hydroxide. Following successful model establishment, the rats were allocated into five groups: model group, positive control group(loratadine, 0.9 mg/kg), Tongqiao desensitizing prescription low, medium, and high dose groups(5.54, 11.08, and 22.16 g/kg respectively), and a healthy control group, with 12 rats in each group. Post-modeling, loratadine and the Tongqiao desensitizing prescription were administered via oral gavage once daily for two weeks. Nasal symptoms were recorded and scored. Histopathological changes in the nasal mucosa were examined using hematoxylin and eosin(HE)staining. Serum levels of OVA specific serum immunoglobulin(OVA-sIg)E and IgG1, as well as Th1 cytokines(IL-1, IL-2, TNF-α, TNF-β, IFN-γ)and Th2 cytokines(IL-4, IL-5, IL-6, IL-10, IL-13)in nasal lavage fluid were quantified by ELISA. The ratio of Th1 to Th2 cells in serum was determined by flow cytometry. Expression levels of Notch1, Notch1 intracellular domain(NICD), and Hes1 mRNA and protein in the nasal mucosa were assessed by qRT-PCR and Western bloting analysis. Results Compared with the healthy control group, the nasal mucosal tissue of rats in the model group exhibited pronounced pathological damage, and the nasal symptom scores were significantly elevated(P<0.05). The serum levels of OVA-sIgE and IgG1, as well as the concentrations of IL-4, IL-5, IL-6, IL-10, and IL-13 in nasal lavage fluid, were markedly increased(all P<0.05). Conversely, the ratio of Th1/Th2 cells in the serum and the levels of IL-1, IL-2, TNF-α, TNF-β, and IFN-γ in nasal lavage fluid were significantly reduced(all P<0.05). Additionally, the mRNA and protein expression levels of Notch1, NICD, and Hes1 in the nasal mucosa were notably upregulated(all P<0.05).In comparison to the model group, the histopathological alterations in the nasal mucosa of rats in both the positive control group and the Tongqiao desensitizing prescription dose groups were substantially ameliorated, with a significant decrease in nasal symptom scores(P<0.05). The serum levels of OVA-sIgE and IgG1, along with the concentrations of IL-4, IL-5, IL-6, IL-10, and IL-13 in nasal lavage fluid, were markedly decreased(all P<0.05). Moreover, the ratio of Th1/Th2 cells in the serum and the levels of IL-1, IL-2, TNF-α, TNF-β, and IFN-γ in nasal lavage fluid were significantly elevated(all P<0.05). The mRNA and protein expression levels of Notch1, NICD, and Hes1 in the nasal mucosa were also notably downregulated(all P<0.05). Conclusion Both Tongqiao desensitizing prescription and loratadine are capable of modulating Th1/Th2 immune imbalance and ameliorating nasal mucosal injury and inflammation in AR rats. The underlying mechanism may involve the inhibition of Notch signaling pathway activation.

Effects of depression on sleep and cognitive function in patieuts with Parkinsons disease

ZHU Xiaoran, LI Xiuhua, REN Yanhong, MAO Fei, FANG Yuqing, ZHAO Zhangning, WANG Yalin, LIU Tianhao, ZHANG Yanqing, HAN Rundong

Journal of Shandong University (Health Sciences). 2025, 63(3): 63-70. doi:10.6040/j.issn.1671-7554.0.2024.1221

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Objective To investigate the impact of depression on sleep and cognitive function in patients with Parkinsons disease(PD). Methods A total of 136 patients diagnosed with PD and hospitalised between 2018 and 2023 were carefully identified and categorised into PD with depression group(n=93)and PD without depression group(n=43), according to their Hamilton depression scale(HAMD)score. We collected sleep and cognition scale, such as Parkinsons disease sleep scale(PDSS), Montreal cognitive assessment(MoCA)and other clinical scales and polysomnography in the two groups. The Wilcoxon rank-sum test was used to assess discrepancies in sleep and cognitive metrics between the PD with depression group and the PD without depression group; the relationship between depression, cognitive function, and sleep quality was examined by Spearman rank correlation analysis; the risk factors associated with PD-related depression were examined by multiple linear regression analysis. Results ESS score and PDQ-39 scores in the PD with depression group were higher than those in the PD without depression group, whereas PDSS scores and MoCA scores were lower in the PD with depression group. Sleep latency in the PD with depression group was longer than that in the PD without depression group, and the differences were statistically significant(P<0.05). Depression scores were significantly correlated with MoCA and various sleep state scores(P<0.05). Multiple linear regression analysis showed that anxiety and quality of life had some predictive value for PD depression(P<0.05). Conclusion In PD patients, the more severe the depressive symptoms, the more severe the sleep disturbance and cognitive impairment, and the more impaired the quality of life.

Impact of Mycoplasma infection on pulmonary function and fractional exhaled nitric oxide in adults

ZHANG Rugang, YIN Yue, LI Daiyun, DUAN Mengqi, LIU Guilian, WANG Ying

Journal of Shandong University (Health Sciences). 2025, 63(3): 71-75. doi:10.6040/j.issn.1671-7554.0.2024.1356

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Objective To investigate the effects of Mycoplasma infection on pulmonary function and fractional exhaled nitric oxide(FeNO)production in adults. Methods Based on the results of pulmonary imaging examination, a total of 94 adult patients with Mycoplasma infection were enrolled, in which 52 patients suffered from acute trachea-bronchitis(bronchitis group)and 42 patients suffered from Mycoplasma pneumoniae pneumonia(MPP group). Fifty healthy individuals who underwent physical examination during the same period were selected as a control group. The differences in pulmonary function and FeNO among the three groups were compared. Results The differences in lung function among the three groups were statistically significant(P<0.05). However, there was no statistically significant difference in FeNO among the three groups(P>0.05). Specifically, the MPP group and the control group showed statistically significant differences in forced vital capacity(FVC), forced expiratory volume in one second(FEV₁), FEV₁/FVC, peak expiratory flow(PEF), maximal mid-expiratory flow curve(MMEF), and the percentage of each value relative to the predicted value(%pred)(all P<0.017). The bronchitis group and the control group showed statistically significant differences in FEV₁, FEV₁/FVC, PEF, MMEF, and the percentage of each value relative to the predicted value(all P<0.017). The MPP group and the bronchitis group showed statistically significant differences only in FVC%pred, FEV1%pred, and MMEF%pred(all P<0.017). Conclusion All patients with Mycoplasma infection have declined lung function, with damage to both large and small airways, and predominantly obstructive ventilation function impairment. Patients with MPP have even more significant decreases in lung function, with more pronounced damage to the small airways. There is no significant difference in FeNO among the three groups.

Role of GPR133 gene methylation in predicting lymph node metastasis in early gastric cancer

ZHANG Jie, ZHAO Yinghui, DONG Yaqi, LI Juan, LI Peilong, DU Lutao

Journal of Shandong University (Health Sciences). 2025, 63(3): 76-84. doi:10.6040/j.issn.1671-7554.0.2024.0670

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Objective To explore the clinical value of quantitatively detecting methylation sites in the GPR133 gene for predicting lymph node metastasis(LNM)in early gastric cancer. Methods This retrospective study included 100 patients with T1 stage gastric cancer treated at the Department of Gastroenterology, Second Hospital of Shandong University, from January 2023 to May 2024. The MethylationEPIC array was used to analyze the whole-genome methylation status of surgical tissue samples from LNM-positive and LNM-negative patients, so as to identify differentially methylated positions(DMPs). Candidate DMPs were determined based on gene enrichment analysis and functional prediction. Pyrosequencing was performed on FFPE sections from 20 LNM-positive and 80 LNM-negative patients to validate the methylation levels of candidate DMPs. The clinical value of DMPs in diagnosing early gastric cancer lymph node metastasis was assessed using the area under the receiver operating characteristic curve(AUC). Results MethylationEPIC array analysis revealed a specific methylation pattern in T1 stage gastric cancer LNM-positive samples. Using a threshold of |Δβ|≥0.1 and P<0.01, a total of 1,794 DMPs were initially identified. According to the results of gene matching and TCGA database analysis and cAMP binding pathway enrichment, cg00633768 on GPR133 gene was identified as a candidate site. Pyrosequencing results showed that cg00633768 methylation level could significantly distinguish between LNMS positive and negative samples(AUC=0.869, sensitivity=64.3%, specificity=100%, cut-off value=0.618 9). Conclusion The methylation level of cg00633768 in the GPR133 gene is significantly higher in LNM-positive patients compared to LNM-negative patients. This site has substantial clinical value for predicting lymph node metastasis in early gastric cancer.

HBV RNA status and changes after intervention in HBeAg-positive chronic hepatitis B patients with low level viremia

ZHANG Yushuang, WU Juanli, GAO Han, ZHANG Yiheng, LI Tao, WANG Lei

Journal of Shandong University (Health Sciences). 2025, 63(3): 85-91. doi:10.6040/j.issn.1671-7554.0.2024.1035

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Objective To investigate serum HBV RNA levels in HBeAg-positive chronic hepatitis B patients with low-level viremia(LLV)following long-term nucleoside/nucleotide analogues(NAs)therapy and to assess changes after NAs intervention. Methods This was a nested case-control study and patients with LLV were matched 1∶1 with who achieved a maintained virological response(MVR)after antiviral therapy. LLV patients were then categorized into an NAs intervention group and a control group based on their willingness to undergo further treatment. Clinical data were collected and followed up. Serum HBV RNA was quantified using the Specific RNA Target Capture combined with the Simultaneous Amplification and Testing(SAT)method. Results A total of 62 LLV patients and 62 MVR patients were enrolled. Serum HBV RNA levels are higher in the LLV group compared with the MVR group at baseline, 24 weeks and 48 weeks of follow-up(P<0.001). During the follow-up period, serum HBV RNA decreased from baseline in the LLV patients, but the results were not statistically different. The decrease in serum HBV RNA changes in LLV patients in the control and intervention groups followed up to 24 and 48 weeks only decreased in the intervention group at 48 weeks, but there was no statistically significant difference. Conclusion Serum HBV RNA levels are higher in the LLV patients compared to the MVR group and decline slowly. The decrease in HBV RNA levels after adjustment for NAs treatment is not significant compared to the maintained regimen group. It is suggested that combinations of other interventions are necessary to further reduce HBV transcriptional activity.

Genetic analysis and literature review of a case of non-syndromic tooth agenesis caused by compound heterozygous mutations in WNT10A

DING Tingting, LIU Haochen

Journal of Shandong University (Health Sciences). 2025, 63(3): 92-98. doi:10.6040/j.issn.1671-7554.0.2024.1342

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Objective To investigate the pathogenic gene mutations in a patient with non-syndromic tooth agenesis(NSTA)and analyze the characteristics of tooth absence. Methods Blood samples were collected from the patients family and normal controls, and DNA was extracted. Whole exon sequencing(WES)and Sanger sequencing were used to identify and verify the pathogenic gene mutations. Functional impacts of the mutations were analyzed using the prediction software Polyphen-2, Mutation Taster, CADD, and fathmm. Conservation analysis and protein three-dimensional structure analysis were used to predict the effects of the mutations on protein function. Previously published literature was reviewed to analyze the tooth agenesis phenotypes associated with the mutated gene. Results Rare compound heterozygous mutations in WNT10A(c.637G>A/p.Gly213Ser and c.1009G>T/p.Val337Phe)in a patient with NSTA were identified, with the c.1009G>T mutation being novel. Polyphen-2, CADD, and fathmm predicted both mutations to be deleterious; Mutation Taster predicted c.637G>A to be benign and c.1009G>T to be deleterious. Conservation analysis showed that both mutation sites(213Gly and 337Val)were highly conserved through evolution, and three-dimensional structure analysis of the proteins indicated that the amino acid changes(p.Gly213Ser and p.Val337Phe)affected protein function. 142 cases of NSTA caused by WNT10A mutations were reviewed, and it is found that tooth loss was bilaterally symmetrical. The most frequently missing tooth positions were the mandibular second premolar(60.2%), maxillary second premolar(58.5%), and maxillary lateral incisor(53.9%); the least frequently missing tooth positions were the maxillary central incisor(2.1%), mandibular first molar(12.0%), and maxillary first molar(12.3%). Conclusion This study identified compound heterozygous mutations in WNT10A(c.637G>A/p.Gly213Ser and c.1009G>T/p.Val337Phe)in a Chinese patient with NSTA, with the c.1009G>T(p.Val3337Phe)variant being reported for the first time, thus expanding the mutation spectrum of the WNT10A gene. In addition, phenotypic analysis of WNT10A-related NSTA provides valuable insights for clinical diagnosis, treatment, and genetic counseling.

Causal associations between length of stay and readmission rates in patients with mental disorders

YUAN Ying, ZHANG Shuaijie, SUN Shuangshuang, ZHANG Botao, XU Zhaoke, HU Xifeng, YU Yuanyuan, XUE Fuzhong

Journal of Shandong University (Health Sciences). 2025, 63(3): 99-109. doi:10.6040/j.issn.1671-7554.0.2024.1054

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Objective To explore the causal associations between length of stay(LOS)and readmission rates among patients with mental disorders, so as to provide evidence for improving patient prognosis and refining clinical management. Methods A real-world, new-user cohort was constructed using the Cheeloo Lifespan Electronic-Health Research Data-library. Patients were categorized into five groups based on LOS, with the middle group(15-30 days)as the control and the other four groups(1-7, 8-14, 31-60, 61-90 days)as treatment groups. L1 regularization was used for high-dimensional variable selection, followed by propensity score matching using 1∶1 nearest-neighbor match with a defined caliper. The matching quality was assessed via comparability and balance diagnostics. The proportional hazards models were applied to evaluate the causal associations between LOS and 1-year readmission rates, including both mental disorder-related and all-cause readmissions. Results A total of 22,437 mental disorder inpatients were included, with baseline data comprising 1,794 covariates, covering demographics, hospitalization, disease, medication, and procedure information. L1 regularization selected 374, 293, 293 and 255 variables for matching. Balance diagnostics indicated all covariates were well-balanced. Compared with patients hospitalized for 15 to 30 days, patients with a LOS of 1 to 7 days had significantly reduced 1-year mental disorder-related readmission rate(HR=0.54; 95%CI: 0.46-0.65)and all-cause readmission rate(HR=0.75; 95%CI: 0.67-0.84); patients with a LOS of 8 to 14 days had a significantly lower rate of 1-year mental disorder-related readmission(HR=0.85; 95%CI: 0.74-0.99); patients with a LOS of 61 to 90 days had a significantly increased rate of 1-year mental disorder-related readmission(HR=1.37; 95%CI: 1.15-1.63). Conclusion The 1-year mental disorder-related readmission rate among patients with mental disorders showed an increasing trend with longer LOS, but this trend was not significant between the longer stay group(31-60 days)and the control group. All-cause readmission rates were significantly lower only in the very short stay group(1-7 days). These results indicate that LOS significantly affects the readmission rates of patients with mental disorders. Shortening LOS does not increase the risk of readmission, whereas excessively prolonged LOS predicts higher readmission rates. This finding provides evidence to inform more effective hospital management decisions in clinical practice.

Association between heat waves and other infectious diarrhea among school-aged children in Shandong Province from May to October, 2018 to 2022

LI Xinyi, ZHANG Xiaochi, LI Wen, GAO Shanshan, ZHAO Qi, ZHANG Wei

Journal of Shandong University (Health Sciences). 2025, 63(3): 110-116. doi:10.6040/j.issn.1671-7554.0.2024.1044

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Objective To provide evidence for the development of targeted other infectious diarrhea(OID)prevention and control measures for individuals aged 6-18 years(school-aged individuals)by examining the association between heat waves(HW)and OID in Shandong Province, and explore the potential modifying effect of urbanization. Methods Data from 2018 to 2022 in Shandong Province were collected, including daily OID cases among school-aged individuals, meteorological data, and urbanization indicators(per capita GDP, urbanization rate, and per capita medical institution beds). The study period was set from May to October each year. Two definitions of HW(HW1 and HW2)were established based on the 90th and 95th percentiles of daily average temperature for each city, with a minimum duration of three consecutive days. A time-series analysis was conducted using a quasi-Poisson regression model combined with distributed lag non-linear models to explore the association between HW and OID incidence. Interaction terms were added to quantify the modifying effects of urbanization indicators. Results A total of 35,929 cases of OID were reported among school-aged individuals in Shandong Province during the study period. Compared to non-HW days, the effects of HW1 and HW2 peaked on the current day of exposure(lag 0 day)and the lag 2 days, with relative risks(RRs)being 1.05(95%CI: 1.02-1.09)and 1.08(95%CI: 1.05-1.11), respectively. Over the entire lag period(lag 0-15 days), the cumulative RR values were 1.62(95%CI: 1.37-1.92)for HW1 and 1.93(95%CI: 1.47-2.53)for HW2. Areas with lower urbanization rate and per capita GDP showed a higher risk of HW-related OID. Conclusion HW are associated with an increased incidence of OID among school-aged individuals, with urbanization considered as strong effect modifiers.

Mediating effect of social support between self-management and discharge readiness in patients with SCI neurogenic bladder

ZHANG Yanyan, SUN Jingni, ZHU Fengying, DU Yijun, ZHAO Changmei, CAO Xingtao, ZHANG Yuan, LYU Ming

Journal of Shandong University (Health Sciences). 2025, 63(3): 117-124. doi:10.6040/j.issn.1671-7554.0.2024.1095

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Objective To investigate the status of self-management, social support and discharge readiness for patients with neurogenic bladder(NB)resulting from spinal cord injury(SCI), and to analyze the mediating effect of social support between self-management and discharge readiness in patients. Methods A total of 222 patients with NB due to SCI were recruited from 20 medical units in Shandong Province, including tertiary hospitals, specialist rehabilitation hospitals, and private rehabilitation institutions, from November 2023 to May 2024. Face-to-face questionnaire surveys were conducted. Pearson correlation, univariate analysis, multiple linear regression analysis, and bootstrap method were employed for statistical analysis. Results The mean scores for self-management ability, social support and readiness for discharge among 222 patients with NB caused by SCI were 116.09±36.92, 37.55±8.55 and 67.17±23.36, respectively. Self-management was positively correlated with discharge readiness (r=0.304, P<0.001), and social support was positively correlated with discharge readiness(r=0.311, P<0.001). Educational level (β=0.178, P=0.008), self-management(β=0.206, P=0.003), and social support(β=0.172, P=0.012)were positive predictors of discharge readiness, which was also affected by the payment method(β=-0.133, P=0.044). The total effect of self-management on discharge readiness was 0.19(P<0.001), and the direct effect was 0.13(68.42%), the mediating effect of social support between self-management and discharge readiness was 0.06(31.58%). Conclusion SCI resultes in insufficient discharge readiness of NB patients, and social support plays a partial mediating effect between their self-management ability and readiness for discharge.

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