Journal of Shandong University (Health Sciences)

Focus on further more use of arterial grafts in coronary artery bypass grafting in patients with coronary heart disease in China

CHEN Xujun, HE Guowei

Journal of Shandong University (Health Sciences). 2025, 63(5): 1-5. doi:10.6040/j.issn.1671-7554.0.2024.0230

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Use of multiple arterial grafts in coronary artery bypass grafting(CABG)has become mainstream for the surgical treatment of coronary heart disease worldwide. This review focuses on the current application status of multiple arterial grafts of the Society of Thoracic Surgeons(STS)of USA, the new concept of anatomic complete revascularization in CABG and its multi-center clinical outcomes, the results of quick extubation of total arterial revascularization in patients with coronary heart disease, the application of arterial grafts in childrens coronary artery disease in China, and the benefits of arterial grafts for patients with diabetes in order to further promote the wide use of multiple arterial grafts in CABG in China.

Application interpretation of STS multi-vessel coronary artery bypass grafting

XIAO Fei, WANG Lianqun, JI Qiang

Journal of Shandong University (Health Sciences). 2025, 63(5): 6-11. doi:10.6040/j.issn.1671-7554.0.2024.0879

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The data from the Adult Cardiac Database(ACSD)of the American Society of Thoracic Surgeons(STS)shows that there are multiple revascularization options in coronary artery bypass grafting(CABG)with multiple vessel lesions, and studies have found that multivessel CABG improves long-term survival. The number of cases of multiple artery CABG in the United States accounts for about 10% of the total number of CABG operations, which is on the rise in the past five years, but is lower than that in Europe and Australia. The data of the ACSD showed that perioperative mortality and major cardiovascular adverse events were lower in patients with multiple artery grafting than those with single artery grafting. The number and proportion of patients with multiple arterial grafting vary greatly between different regions and different hospitals in the United States. The main factors influencing the surgeons use of multiple artery grafting include the lack of high-quality prospective randomized study data, the need for longer surgical time, the need to occupy more medical resources, and the more complex surgical techniques needed. A large number of prospective, randomized controlled studies with clear conclusions are needed to support the wider application of multiple artery grafting.

Anatomic complete revascularization is a new strategy of surgical treatment for coronary heart disease

CHEN Xujun, SHEN Lin, CHEN Jun, YU Tao, CAO Guangqing, XIAO Fei

Journal of Shandong University (Health Sciences). 2025, 63(5): 12-17. doi:10.6040/j.issn.1671-7554.0.2024.0771

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Complete revascularization(CR)has received increasing attention in coronary artery bypass grafting(CABG)and is categorized as anatomic complete revascularization(ACR)and functional complete revascularization(FCR). Multiple clinical trials validated that CR was associated with improved mid-term and long-term clinical outcomes in CABG. A recent randomized controlled multicenter trial(ISCHEMIA study)showed that both ACR and FCR in CABG led to improved angina-related health status and life quality, reduced incidence of cardiac death and myocardial infarction, and improved mid-term and long-term outcomes compared with incomplete revascularization and conservative management in patients with stable ischemic heart disease, more pronounced with ACR than FCR. Although there are urgent problems to be solved, ACR, as a new surgical strategy, might offer a new perspective for improving safety and efficacy of CABG and promise to be widely used in total arterial CABG, surgical treatment of chronic ischemic cardiomyopathy, and hybrid coronary revascularization.

Multi-center mid-term clinical outcomes in coronary patients undergoing total arterial bypass surgery with anatomic complete revascularization in China

GUO Ke, CHEN Xujun, ZHENG Baoshi, HUANG Keli, WANG Xiaowu, CHEN Jingwei, LIN Yu, LUO Junhui, WANG Haichen, WANG Zhendong, LIAO Chengquan, LI Youjin, CHEN Wensheng

Journal of Shandong University (Health Sciences). 2025, 63(5): 18-25. doi:10.6040/j.issn.1671-7554.0.2024.0850

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Objective To evaluate the safety and efficacy of total arterial myocardial revascularization(TAR)with anatomical complete revascularization(ACR)in treatment of coronary heart patients. Methods Between January 2018 and April 2024, a total of 117 patients, including 80 males and 37 females, 33-67 years old, with an age of(55.5±9.7)years, received TAR in 13 cardic surgery centers. There were 50 patients with primary hypertension and 57 patients with diabetes mellitus. Among them, there were 47 of severe left main lescons and 103 of triple vessel lesions, including 33 cases of chronic total occlusions. Results A total of 117 pedicled left internal mammary artery(LIMA), 117 left radial artery(LRA), 114 right radial artery(RRA), and 47 free right mammary artery grafts(RIMA)were observed in 117 patients. A total of 57 composite Y arterial grafts were constructed while the rest were single arterial graft. The number of distal anastomosis was(4.2±0.4). The time for ascending aorta clamp and bypass duration was(101.5±15.4 )minutes and(145.4±19.2)minutes, respectively. The duration of tracheal intubation was(8.5±9.3)hours. Intraoperative aortic balloon bump was implanted in 21 cases. Postoperatively, 10 patients developed atrial fibrillation, 6 had forearm hematomas, 1 experienced myocardial infarction, and 5 developed acute renal insufficiency. No surgical deaths occurred. No patients had chest bone infections/non healing. The follow-up duration was(64.3±7.5)months, with a 100% follow-up rate. During the follow-up period, 3 patients died, among them, 2 of COVID-19 and 1 of colon cancer. It was showed that left ventricular ejection fraction ［(60.3%±9.3%)vs.(55.0%±7.3%), t=20.01, P<0.001］ and cardiac function(94.74% vs. 80.34%, New York Heart Association class ≤ 2, χ2=10.90, P<0.001)were improved significantly. A total of 91 patients underwent CT angiography(CTA), with duration of(40.5±7.7)months and it was showed that patency rates of LIMA, LRA, RRA, and RIMA was 97.80%, 86.81%, 93.41%, and 94.50% respectively in CTA(χ2=9.062, P=0.028). Conclusion This multicenter study preliminarily confirmed that TAR with ACR is safe in the short-term and has satisfactory results in the med-term in the treatment of coronary artery disease.

Multi-center clinical outcomes of fast-track extubation in total arterial coronary bypass grafting in China

GUO Ke, CHEN Xujun, ZHENG Baoshi, SHI Chao, HUANG Keli, CAO Yong, CHEN Jun, WU Dongkai, ZHANG Xiaoshen, LUO Junhui, SHEN Lin, MO Xumin, YANG Min, WANG Xiaowu, LEI Yinsheng, TIAN Maozhou, WANG Zhendong, MENG Zili, SUN Zhongdong, LI Youjin, LU Huihui, MENG Chunying, GAO Feng, CHEN Qiansu, GUO Nengrui, LIU Debin, ZHANG Nan, LIN Yu, CHEN Wensheng, SONG Baoguo, FANG Zhi, WANG Haichen, LIAO Xiaobo, XU Chaojun

Journal of Shandong University (Health Sciences). 2025, 63(5): 26-32. doi:10.6040/j.issn.1671-7554.0.2024.0805

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Objective To evaluate the safety and efficacy of fast-track extubation(FTE)in total arterial revascularization(TAR)in coronary bypass grafting(CABG)by a multi-center study. Methods The clinical data of all the patients who underwent TAR in 34 heart centers in China between January 2018 and May 2024 were retrospectively analyzed. The perioperative medical records and follow-up data of patients undergoing TAR with FTE(defined as extubation within 6 hours after surgery)were studied. Results Of 640 patients underwent TAR, a total of 221 patients(180 males and 41 females), with an age of(55.5±11.7)years, who accepted ETE, were included in this study. There were 171 cases of triple-vessel and 50 of double-vessel disease, with 70 of left main coronary artery lesions. Seventy-five patients had diabetes mellitus. All patients underwent TAR by on pump CABG. A total of 201 left internal mammary artery, 221 left radial artery, 200 right radial arteries, and 21 right internal mammary artery conduits were harvested to construct 612 single and 31 composite Y grafts. The number of distal anastomosis was 3.35±0.7. The time for tracheal intubation duration, ICU stay and postoperative hospital stay was(3.5±2.7)hours,(23.5±12.9)hours and(7.5±3.1)days, respectively. There was one surgical death. There was no other postoperative reintubation. Intra-aortic balloon pump was implanted in 17 patients. There were 22 patients with new-set atrial fibrillation, 11 with forearm hematoma, 13 with hypoxemia and 6 with acute renal insufficiency. No chest bone infection occurred. The follow-up duration was(54.3±7.5)months, with a follow-up rate of 90.91%. Compared to those of before operation, there was a significant improvement in left ventricular ejection fraction ［(60.0%±5.3%)vs.(55.1%±7.3%), t=11.16, P<0.001］ and an obvious decrease in left ventricular end diastolic diameter ［(51.6±2.2)mm vs.(55.0±7.5)mm, t=9.77, P<0.001］. All patients survived without major adverse cardiovascular and cerebrovascular event during follow-up. Conclusion This study suggests that FTE in TAR appears to be safe and effective.

Diabetic patients arterial grafts in coronary artery bypass grafting: current research status

LU Shengxun, XING Yachuang, LUO Junhui, LIU Jie, HE Houle, WANG Zhiqiang, ZHANG Na

Journal of Shandong University (Health Sciences). 2025, 63(5): 33-39. doi:10.6040/j.issn.1671-7554.0.2024.0889

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Coronary artery bypass grafting(CABG)is the preferred method for severe triple-vessel coronary artery disease in patients with diabetes mellitus(DM). Due to the higher long-term patency rate compared to venous grafts, arterial grafts are increasingly used in CABG procedures, and their application in DM patients has garnered increasing attention. Current research focuses on the impact of DM on coronary vessels and the quality of potential arterial graft vessels, strategies and methods for the application of multiple arterial grafts in CABG for DM patients, and the patency rates and long-term outcomes of different arterial grafts in DM patients. This article reviews the application and current research status of arterial grafts in CABG for DM patients, aiming to provide a scientific basis and reference for the rational selection of vascular grafts in clinical practice, the optimization of surgical plans, and the improvement of the long-term prognosis of DM patients after CABG surgery.

Application of coronary artery bypass grafting in pediatric cardiovascular disease

MO Xuming, WANG Qingfeng

Journal of Shandong University (Health Sciences). 2025, 63(5): 40-46. doi:10.6040/j.issn.1671-7554.0.2024.0769

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Before the 1970s, coronary artery bypass surgery for children was rarely performed due to the lack of convincing surgical indications. The development of coronary artery bypass surgery for children has become inevitable due to the emergence of coronary artery sequelae caused by Kawasaki disease and the emergence of new procedures such as aortic valve replacement surgery and congenital coronary artery malformation repair, which lead to the occurrence of coronary artery complications. Due to the rapid growth of children, their long life expectancy, and their increasing demand for athletic ability, the strategy for coronary artery bypass surgery in children should be different from that in adults. Because the internal thoracic artery can grow according to the physical growth of children and has a high long-term patency rate, coronary artery bypass surgery using unilateral and bilateral internal thoracic arteries in children has become the most reliable surgical method. It is worth noting that venous grafts should be avoided in children. At pre-sent, coronary artery bypass surgery for children has become a new field of cardiac surgery.

Total arterial coronary artery bypass grafting for treatment of coronary artery aneurysm after Kawasaki disease in a child: case report and literature review

WANG Zhiqi, QI Jirong, HU Yuanli, CHEN Xujun, WANG Qingfeng, MO Xuming

Journal of Shandong University (Health Sciences). 2025, 63(5): 47-53. doi:10.6040/j.issn.1671-7554.0.2024.0809

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Objective To investigate the advantages of using the radial artery as a conduit in adolescent CABG by reporting the treatment of a child with a giant coronary artery aneurysm complicating Kawasaki disease who underwent total arterial coronary artery bypass grafting(CABG)and to review relevant literature. Methods A case of a 13-year-old male with a coronary artery aneurysm secondary to Kawasaki disease was reviewed. The child developed a large coronary artery aneurysm as a complication of Kawasaki disease. CABG was performed using bilateral radial arteries as grafts. Results Postoperative recovery was uneventful, with patency of the grafts and significant improvement in cardiac function. Conclusion Coronary artery aneurysms caused by Kawasaki disease are a leading cause of acquired heart disease in children. CABG plays a critical role in treating giant coronary aneurysms. The selection of arterial grafts is crucial for ensuring survival and optimal outcomes.

del Nido cardioplegia in cardiac surgery: past, present and future

ZHAO Zhimin, WANG Chun, LI Bailing

Journal of Shandong University (Health Sciences). 2025, 63(5): 54-59. doi:10.6040/j.issn.1671-7554.0.2024.0785

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In the past, del Nido cardioplegia was mainly used in pediatric congenital heart disease surgery, but now it is gradually expanding from pediatric congenital heart disease to adult cardiac surgery and is widely used in various cardiac surgeries, including heart valve surgery, large vessel surgery, coronary artery surgery and left heart assist device surgery. With the vigorous development of minimally invasive surgery in cardiac surgery, it is expected that there will be more complete myocardial protection monitoring methods and application strategies in the future, so as to be more conducive to the selection of the most suitable cardioplegia to provide strong support for surgery. The purpose of this review is to summarize the past application, current development and potential application of del Nido cardioplegia in new neighborhoods, in order to provide reference for the development of related fields.

A Meta-analysis of the timing of coronary artery bypass grafting surgery for acute non-ST myocardial infarction

WEN Xuelong, LIU Anhui, CHEN Jingwei, WU Mengting, YANG Min

Journal of Shandong University (Health Sciences). 2025, 63(5): 60-70. doi:10.6040/j.issn.1671-7554.0.2024.0961

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Objective To investigate the influence of the time interval of coronary artery bypass grafting(CABG)on the clinical outcomes of patients who suffered from acute non-ST elevated myocardial infarction(NSTEMI). Methods CNKI, PubMed, Web of Science, Cochrane Library and Google Scholar were searched. The search time of the databases was from the establishment of the database to July 2024. Meta-analysis was performed using RevMan 5.4 software and patients were divided into 3 subgroups according to the time interval from diagnosis of NSTEMI to CABG at 1 day, 3 days, and 7 days, respectively, namely the early group(<1 d,<3 d,<7 d)and the delayed group(>1 d,>3 d,>7 d). The primary outcome measure was all-cause mortality during hospitalization, and the secondary outcome measure was the incidence of recurrent myocardial infarction and stroke during perioperative period. Results A total of 13 studies were included, containing 6 retrospective studies and 7 database studies, involving 657 555 patients. Among them, 10 studies compared the impact of CABG within 1 day and after 1 day in NSTEMI patients on patient outcome indicators, 6 studies sorted out the effects of CABG within 3 days and CABG after 3 days in NSTEMI patients on patient outcome indicators, 3 studies examined the effects of CABG within 7 days and CABG after 7 days on outcomes in NSTEMI patients. Meta analysis showed that compared with the delayed group, the all-cause mortality rate was higher in the early 1-day group(OR=1.58, 95%CI:1.09-2.30, P=0.02),and the difference was statistically significant. The risk of perioperative recurrence of myocardial infarction(OR=0.61, 95%CI:0.28-1.33, P=0.21)and stroke(OR=0.95, 95%CI: 0.58-1.55, P=0.82)were lower, but the difference was not statistically significant. There was no statistically significant difference in the all-cause mortality(OR=1.01, 95%CI:0.73-1.41, P=0.95), perioperative recurrence of myocardial infarction(OR=0.89, 95%CI:0.36-2.18, P=0.79)and stroke(OR=1.59, 95%CI:0.80-3.17, P=0.19)risks between the early 3-day group and the delayed group. There was no statistically significant difference in the all-cause mortality rate between the early 7-day group and the delayed group(OR=1.14, 95%CI: 0.63-2.08, P=0.67), and perioperative recurrence of myocardial infarction and stroke were not included as outcome indicators. Conclusion The risk of CABG operation within 1 day in acute NSTEMI patients was higher than that in the delayed group. CABG for NSTEMI patients should be postponed after 1 day if possible.

Correlation between orthostatic intolerance symptom scores, catecholamine and emotional disorders in children with vasovagal syncope

LI Ling, YAN Yuhan, KONG Qingyu, WANG Minmin, ZHAO Haizhao, ZHAO Cuifen

Journal of Shandong University (Health Sciences). 2025, 63(5): 71-78. doi:10.6040/j.issn.1671-7554.0.2025.0044

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Objective To explore the clinical significance of orthostatic intolerance(OI)symptom scores and 24 h urinary catecholamines in the assessment of anxiety and depressive disorders in children with vasovagal syncope(VVS). Methods This was a retrospective analysis. The medical records of 53 children with VVS admitted to the Department of Pediatrics, Qilu Hospital of Shandong University from June 2018 to December 2021 were collected. They were divided into anxious group(29 cases), non-anxious group(24 cases), depressed group(13 cases), and non-depressed group(40 cases)according to the scores of psychological scale. All children were assessed using the OI symptom score, screen for child anxiety related emotional disorders(SCARED), and child depression inventory(CDI)scales. The childrens 24 h urinary catecholamine levels were analyzed by liquid chromatography-tandem mass spectrometry. Normative controls were derived from nationally published studies of school-aged children normal model group assessed with the same scales. t-test, Mann-Whitney U-test, and χ² test were used to compare the data between groups. The Pearson or Spearman correlation method was used for correlation analysis, and the predictive value of the OI symptom scores was analyzed using the ROC curve. Results (1)The mean SCARED score of 53 children with VVS was 26.7±15.5, higher than that of the normal model group(t=5.73, P<0.001); the detection rate of anxiety disorder was 54.7%, which was also higher than that of the normal model group(χ²=21.12, P<0.001). The mean CDI score of 53 children was 14.3±8.8, higher than that of the normal model group(t=2.21, P=0.032); the detection rate of depressive disorder was 24.5%, higher than that of the normal model group(χ²=3.95, P=0.047). (2)The non-anxious group had lower OI symptom scores than the anxious group(Z=5.25, P<0.001); 53 children had a positive correlation between SCARED scores and OI symptom scores(r_s=0.76, P<0.001); there was no correlation with 24 h urinary nonepinephrine levels(r=-0.16, P=0.254), and no correlation with 24 h urinary adrenaline or dopamine levels(r_s=-0.16, -0.21; P=0.245, 0.136). (3)There was no significant difference in OI symptom scores between non-depressive and depressive children(Z=1.68, P=0.093); there was a positive correlation between CDI scores and OI symptom scores in 53 children(r_s=0.41, P=0.002), and there was no correlation with 24 h urinary nonepinephrine levels(r=-0.07, P=0.616)and no correlation with 24 h urinary adrenaline and dopamine levels(r_s=-0.09, -0.10; P=0.502, 0.475). (4)When the OI symptom score in children with VVS was 8.5, its sensitivity for predicting the presence of anxiety disorders in children with VVS was 75.9% and its specificity was 95.8%, while those for depressive disorders were 69.2% and 65.0%, respectively. Conclusion SCARED and CDI scores of children with VVS are positively correlated with OI symptom scores, but not with 24 h urinary catecholamine levels; OI symptom scores have predictive value for emotional disorders in children with VVS.

Application of circulating tumor cells combined with serological detection in non-small cell lung cancer

ZHAO Hanqing, ZHOU Xinrui, LI Zijian, TANG Xing

Journal of Shandong University (Health Sciences). 2025, 63(5): 79-85. doi:10.6040/j.issn.1671-7554.0.2024.0763

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Objective To explore the application of circulating tumor cells(CTCs)combined with detection of lung cancer autoantibodies and tumor markers in non-small cell lung cancer(NSCLC). Methods The venous blood of 161 patients with NSCLC, 19 patients with benign lung lesions and 20 healthy volunteers were collected, and CTCs were detected by negative enrichment method of immunomagnetic beads. The correlation between CTCs and clinical data of NSCLC was analyzed, and the diagnostic efficiency of CTCs, autoantibodies and tumor markers of lung cancer were compared. Results There were no significant differences of CTCs counts in gender, smoking history, tumor site and lymph node metastasis(all P>0.05). There were significant differences of CTCs counts in age, T stage, maximum tumor diameter, tumor stage and pathological type(all P<0.05). The optimal cutoff value of folic acid receptor positive CTCs in peripheral blood of NSCLC patients was 8.9 FU/3mL. The sensitivity and specificity of diagnosis were 84.5% and 76.9%, respectively, and the area under ROC curve was 0.801. Combined detection of CTCs, lung cancer autoantibodies and tumor markers could improve the diagnostic efficiency of NSCLC. The area under ROC curve of the three combined tests was 0.914, and the 95%CI was 86.8-96.1(P<0.001). Conclusion The detection of CTCs, lung cancer autoantibodies and tumor markers can provide some reference for the diagnosis and screening of NSCLC in clinic, and the combination of the three items can improve the clinical significance of the diagnosis of NSCLC.

Causal association of metabolic syndrome and its components with digestive system malignancies: a two-sample Mendelian randomized study

HUANG Xin, WANG Mengxue, FU Shufan, ZHANG Qiyue, XU Li

Journal of Shandong University (Health Sciences). 2025, 63(5): 86-94. doi:10.6040/j.issn.1671-7554.0.2024.0658

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Objective To provide new clues for the prevention and treatment of digestive system malignancies by using two sample Mendelian randomization(TSMR)method so as to explore the causal relationship between metabolic syndrome(MetS)and its components and digestive system malignancies from a genetic perspective. Methods Based on the summary data of genome-wide association study(GWAS), MetS and its components were used as exposure factors, and digestive system maligancies were used as outcome variables. The inverse variance weighted(IVW)method was used as the main analysis method, and weighted median(WM)and MR Egger were used as supplementary analysis methods to evaluate causal effects. The sensitivity analysis was used to verify the reliability of the research results. Results The IVW method showed that MetS is associated with an increased risk of liver cancer(OR=1.357, 95%CI=1.004-1.834, P=0.047)and esophageal cancer(OR=1.001, 95%CI=1.000-1.001, P=0.037). Among the components of MetS, waist circumference(WC)is associated with an increased risk of gastric cancer(OR=1.809, 95%CI=1.024-3.196, P=0.041)and esophageal cancer(OR=1.001, 95%CI=1.000-1.002, P=0.020); High density lipoprotein(HDL)is associated with a reduced risk of colorectal cancer(OR=0.789, 95%CI=0.633-0.984, P=0.035); Sensitivity analysis suggests that the research results are robust. Conclusion MetS increases the risk of liver and esophageal cancer, with WC being a risk factor for gastric and esophageal cancer, while HDL is a protective factor for colorectal cancer.

A case report and literature review of anti-Homer3 antibody-associated autoimmune cerebellar ataxia mimicking multiple system atrophy

WEI Xupeng, CHANG Cheng, ZHAO Xiuhe

Journal of Shandong University (Health Sciences). 2025, 63(5): 95-100. doi:10.6040/j.issn.1671-7554.0.2024.1426

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Objective To enhance clinical awareness of differential diagnosis between anti-Homer3 antibody-associated autoimmune cerebellar ataxia and cerebellar-type multiple system atrophy(MSA-C)through reporting a special case and literature review. Methods A 61-year-old female patient presented with progressive worsening over two years, manifesting as dizziness, ataxia, and dysarthria. Serum and cerebrospinal fluid analyses confirmed positive anti-Homer3 IgG antibodies, with significant symptom improvement following intravenous methylprednisolone therapy. Results Post-immunotherapy cerebellar symptom remission was observed, and the disease progression pattern combined with treatment response characteristics demonstrated that anti-Homer3 antibody-associated autoimmune cerebellar ataxia could closely mimic MSA-C in clinical presentation. Conclusion This case highlights the necessity of comprehensive exclusion of treatable disorders like autoimmune cerebellar ataxia before diagnosing MSA-C. The significant prognostic differences between these conditions emphasize that timely and accurate diagnosis hold crucial clinical significance, as some autoimmune cerebellar ataxia patients may achieve symptomatic improvement through adequate corticosteroid therapy.

Dynamic prediction model for the colorectal cancer patients prognosis based on MFPC-Cox

DU Xue, LI Chunxia, LIU Yunxia, ZHANG Tao

Journal of Shandong University (Health Sciences). 2025, 63(5): 101-110. doi:10.6040/j.issn.1671-7554.0.2024.0531

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Objective To evaluated the utility of repeated measurements of carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9)in improving the prognosis of colorectal cancer(CRC)patients, and to predict dynamically the future longitudinal trajectories of CEA and CA19-9, as well as the survival probability. Methods CRC patients who underwent radical resection at Yunnan Cancer Hospital between January 2011 and December 2018 were selected as the study subjects. Based on the clinical data and perioperative longitudinal measurements of CEA and CA19-9 in patients, multivariate functional principal component analysis(MFPCA)was used to extract the trajectory features of longitudinal CEA and CA19-9 measurements within 12 months postoperatively. The corresponding multivariate functional principal component scores were incorporated as covariates into the Cox proportional hazards model to construct a MFPC-Cox dynamic prediction model for the colorectal cancer patients prognosis. The predictive performance of models was quantitatively assessed by the time-varying area under the curve(AUC)and Brier score(BS), and compared with a static prediction model that only considered baseline information. Results The first seven principal components were selected to describe their longitudinal characteristics in the MFPCA of CEA and CA19-9. Compared to the static model, the dynamic prediction model increased the AUC of the 60-month postoperative survival rate from 0.727 to 0.787 and reduced the BS from 0.077 to 0.072. The accuracy of the model prediction improved significantly with the inclusion of aforementioned longitudinal biomarker measurements. Conclusion After considering the perioperative longitudinal measurements of CEA and CA19-9, the prognostic model for CRC based on the MFPC-Cox has high accuracy and can update the risk at each follow-up visit, enabling dynamic prediction. It is recommended to repeatedly measure CEA and CA19-9 during the postoperative follow-up of CRC patients.

Structural changes and influencing factors of hospitalization expenses for rare diseases patients in a tertiary general hospital in Shandong Province

ZHANG Yongyuan, WANG Qingliang, LIAN Xuehong

Journal of Shandong University (Health Sciences). 2025, 63(5): 111-119. doi:10.6040/j.issn.1671-7554.0.2024.0793

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Objective To provide references for controlling hospitalization expenses effectively, and reduce the economic burden of patients by analyzing the trend of changes, the structural changes, and influencing factors of hospita-lization expenses for rare diseases patients. Methods Medical records data of rare diseases patients in a tertiary general hospital in Shandong Province from 2019 to 2023 were collected, and structural variation analysis, grey correlation degree method and quantile regression model were used to analyze the structural changes and influencing factors of hospitalization expenses in rare diseases patients. Results In the past 5 years, there was an overall decreasing trend for the hospitalization expenses for rare diseases patients. Inspection expenses, drug expenses and consumables expenses were the main factors that leaded to changes in expenses structure, accounting for a cumulative contribution rate of 94.41%, with an increase in inspection expenses and decreases in drug and consumables expenses. Treatment expenses and inspection expenses were the factors with the largest correlation with hospitalization expenses. The results from quantile regression models showed that first hospitalization, operation, payment method, disease type and length of stay were associated with all three quantile points(P5, P50,P95)of hospitalization expenses(P<0.05). Conclusion The composition of hospitalization expenses in rare diseases needs to be further optimized. It is necessary to emphasis on multidisciplinary collaboration, exploring new treatment methods, controlling hospitalization time, and reducing increase in hospitalization expenses. It is also needed to gradually improve multi-payment medical security mechanism, and to reduce economic burden of rare diseases patients, by incorporating the epidemiological characteristics of local rare diseases.

Connection between reproductive tract microbes and the development of endometriosis

ZHANG Shuqi, JIANG Yanjiao, YIN Dan

Journal of Shandong University (Health Sciences). 2025, 63(5): 120-126. doi:10.6040/j.issn.1671-7554.0.2024.0976

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Microorganisms in the human body play a crucial role in human health. Maintaining the ecological balance of the internal microbial flora in the human body to achieve a balanced immune system is conducive to maintaining health. Dysbiosis of this microbial community has been linked to the onset of various diseases, including endometriosis. In cases of endometriosis, such dysbiosis may incite chronic inflammation, thereby fostering an environment conducive to its progression. This review specifically analyzed how dysbiosis in this region influences the pathogenesis of endometriosis, aiming to provide references by elucidating these underlying mechanisms.

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