Table of Content

20 August 2025, Volume 40 Issue 8

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Incidence of sleep disorders in rheumatoid arthritis patients and influencing factors: A meta-analysis

Guo Yifan, Ren Hua, Bai Jing, Liu Sanjiao, Li Yanjuan

2025, 40(8):  677-683.  doi:10.3969/j.issn.1004-583X.2025.08.001

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Objective To systematically evaluate the incidence and influencing factors of sleep disorders in patients with rheumatoid arthritis (RA), so as to provide a basis for preventing the occurrence of sleep disorders in RA patients. Methods Articles reporting the incidence and influencing factors of sleep disorders in RA patients published from inception to 4 June 2025 were searched in PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and the Chinese Biomedical Literature Database. Meta-analysis was performed using Stata 18.0 software. Results A total of 23 articles were included. The results of meta-analysis showed that the incidence of sleep disorders in RA patients was 56.9%(95%CI 47.2%, 66.6%, P<0.001). The Disease Activity Score-28 for Rheumatoid Arthritis (DAS28) (OR=1.26, 95%CI 1.11, 1.43), body mass index (BMI) (OR=1.20, 95%CI 1.12, 1.29), depression (OR=3.65, 95%CI 1.07, 12.48), and sleep aids (OR=16.25, 95%CI 4.73, 55.79), erythrocyte sedimentation rate (ESR) (WMD=13.29, 95%CI 1.05, 25.52), C-reactive protein (CRP) (SMD=1.66, 95%CI 0.11, 3.20), the Visual Analogue Scale (VAS) score (SMD=1.30, 95%CI 0.70, 1.89), fatigue (SMD=1.45, 95%CI 0.67, 2.22), and white blood cell count (WMD=0.67, 95%CI 0.10, 1.23) were the influencing factor for sleep disorder in RA patients. Conclusion The incidence of sleep disorders in RA patients is high, and DAS28, BMI, depression, sleep aids, ESR, CRP, VAS, fatigue, and white blood cell count are the influencing factors. Medical staff should pay special attention to high-risk patients to improve their sleep quality.

A meta-analysis of the relationship between H1-antihistamines and prognosis in cancer patients receiving immune checkpoint inhibitor therapy

Ye Qian, Liu Shenxiang

2025, 40(8):  684-688.  doi:10.3969/j.issn.1004-583X.2025.08.002

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Objective To explore the impact of H1-antihistamines on the survival of cancer patients receiving immune checkpoint inhibitors (ICIs). Methods Articles on the efficacy of H1-antihistamines on immune checkpoint inhibitor therapy in cancer patients published before October 30, 2024 were searched in the China National Knowledge Infrastructure (CNKI), Wanfang, PubMed, Web of Science and Cochrane databases. Statistical analysis was performed using RevMan 5.4 and Stata14.0 software. Results Four studies were included in the meta-analysis. The results showed the patients treated H1-antihistamines with ICIs had significantly longer overall survival (OS) (HR=0.53, 95%CI: 0.41-0.69, P<0.00001) and progression-free survival (PFS) (HR=0.54, 95%CI: 0.44-0.65, P<0.00001) in comparison with those not receiving H1-antihistamines. Conclusion The concomitant use of H1-antihistamines is associated with improved outcomes among cancer patients treated with ICIs.

Correlation between social activities and heart disease in people aged 45 and over in China

You Jiawei, An Yanxin, Lyu Jianing, Gao Xiaohong, Hu Liyan, Shan Jie, Chen Lin

2025, 40(8):  689-693.  doi:10.3969/j.issn.1004-583X.2025.08.003

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Objective To explore the correlation between social activities and heart disease in Chinese people aged 45 years and above, thus providing reference data for the prevention of heart disease. Methods A cross-sectional study was conducted with data from the 2020 China Health and Retirement Longitudinal Study (CHARLS). Demographic characteristics, living habits, social activities and other indicators were compared. Multivariate Logistic regression was performed to analyze the influencing factors with stepwise adjustments for confounders like gender and age. Correlation of seven types of social activities with heart disease in middle-aged and elderly people was identified. Results A total of 18, 298 study participants were enrolled, with the prevalence of heart disease of 19.46%(3, 561/18, 298). There was a significant difference in the prevalence of heart disease between individuals who were participated in different social activities (e.g., providing free assistance to relatives, friends, or neighbors who do not live with you, or engagement in training courses) and those did not involve in social activities (P<0.01). Multivariate logistic regression analysis showed that after adjusting for sex, age and other confounders, providing free assistance to relatives, friends, or neighbors who do not live with you (OR=0.82, 95%CI=0.73-0.91, P<0.01), and engagement in training courses (OR=0.71, 95%CI=0.50-0.99, P=0.044) were negatively correlated with the risk of heart disease; while playing mahjong, playing chess, playing cards, and going to community activity rooms were positively correlated with the risk of heart disease (OR=1.10, 95%CI=0.99-1.23, P=0.046). Conclusion In the middle-aged and elderly population, strengthening social support networks and encouraging knowledge-based social participation may be an effective intervention direction for cardiovascular disease prevention, providing a theoretical basis for constructing a multidimensional healthy aging strategy.

A single-center clinical analysis of benign paroxysmal positional vertigo

Zou Yafen, Jia Xiaoyan, Dai Cuizhao

2025, 40(8):  694-697.  doi:10.3969/j.issn.1004-583X.2025.08.004

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Objective To analyze the clinical features of benign paroxysmal positional vertigo (BPPV). Methods From February 2021 to November 2024, 339 BPPV patients diagnosed and treated in the Department of Neurology, Xiamen Chang Gung Hospital, Huaqiao University, were selected as the subjects. The clinical data were analyzed retrospectively. Results There were 138 (40.7%) males and 201 (59.3%) females, with the male-to-female ratio of 1∶1.5. The mean age was 49.6±6.5 years. A total of 155 patients (45.7%) had similar attacks in the past. The peak age of onset was 40-49 years. Classified by the clinical types, there were 210 (61.9%) cases of posterior semicircular canal BPPV, and 118 (34.8%) cases of horizontal semicircular canal BPPV, including canalolithiatic type in 91 (77.1%) cases and cupulolithiatic in 27 (22.9%) cases. The overall effectiveness rate of canalith repositioning maneuver was 99.6%. Among the 210 cases with follow-up data, the follow-up period ranged from 1 to 33 months. There were 45 cases of recurrence, with the recurrence rate of 21.4%. Conclusion The age of BPPV onset is trending younger. Posterior semicircular canal BPPV is the most common clinical type. The effectiveness rate of canalith repositioning maneuver of BPPV is high.

Analysis of prognostic risk factors and predictive value in patients with bloodstream infection complicated with sepsis

Zhuang Huicui, Guo Hao, Li Xian, Cui Dongsheng

2025, 40(8):  698-704.  doi:10.3969/j.issn.1004-583X.2025.08.005

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Objective To analyze the risk factors and predictive value of bloodstream infections (BSI) in adult sepsis patients in the intensive care unit (ICU). Methods Adult sepsis patients with BSI admitted to the ICU of Handan Central Hospital from October 2020 to October 2024 were retrospectively analyzed. Vital signs, laboratory parameters, organ dysfunction score, and treatment status within 24 hours of admission were collected. Multivariate logistic regression was used to analyze risk factors for the 28-day mortality, and receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of independent risk factors. Results Among 162 adult sepsis patients with BSI (92 males, 70 females) admitted to the ICU over a 4-year period, 91 died within 28 days. Univariate analysis revealed significant correlation of 28-day mortality with age, heart rate (HR), lactate (Lac), D-dimer, creatinine (Cr), mean arterial pressure (MAP), partial pressure of oxygen (PaO₂)/fraction of the inspired oxygen (FiO₂) ratio (P/F), white blood cell count (WBC), platelet count (PLT), ICU-acquired BSI proportion, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, modified Nutrition Risk in Critically Ill (mNUTRIC) score, sepsis-induced coagulopathy (SIC) score, the proportion of mechanical ventilation rate, deep vein catheterization rate, renal replacement therapy rate, and the use of vasoactive drug use >24 hours (P<0.05). Multivariate logistic regression identified that age (OR=1.070,95%CI:1.019-1.123,P=0.006), SOFA score (OR=1.301, 95%CI: 1.002-1.689, P=0.049), APACHE Ⅱ score (OR=1.179, 95%CI: 1.003-1.385, P=0.046), use of vasoactive drugs>24 hours (OR=4.125, 95%CI: 1.321-12.878, P=0.015), mNUTRIC score (OR=1.105, 95%CI: 1.007-1.206, P=0.014), P/F (OR=0.994, 95%CI: 0.989-1.000, P=0.044), and WBC (OR=0.940, 95%CI: 0.897-0.984, P=0.009) were independent prognostic factors for the 28-day mortality. ROC curve analysis showed that the area under the curve (AUC) of age, SOFA score, APACHEⅡ score, mNUTRIC score, P/F, WBC and using vasoactive drugs > 24 h in predicting the 28-day mortality was 0.655, 0.827, 0.799, 0.758, 0.330, 0.405 and 0.742, respectively, P/F and WBC had poor predictive performance. Conclusion Age, SOFA score, APACHEⅡ score, mNUTRIC score, and use of vasoactive drug use >24 hours are independent predictors of 28-day mortality in sepsis patients with BSI. The SOFA score demonstrated superior predictive performance compared to the APACHEⅡ score in predicting the 28-day mortality.

Role of musculoskeletal ultrasound in the early diagnosis of seronegative rheumatoid arthritis

Shen Xuejiao, Wang Ting, Wang Yuan, Li Yan, Wei Jiaqi

2025, 40(8):  705-710.  doi:10.3969/j.issn.1004-583X.2025.08.006

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Objective To explore the value of musculoskeletal ultrasound in the early differential diagnosis of seronegative rheumatoid arthritis (SNRA). Methods A total of 112 patients with swelling and positive tenderness of wrist or finger metacarpophalangeal joint, and proximal interphalangeal joint who for the first time visited the Department of the Rheumatology, the Second Hospital, Lanzhou University from January 2018 to December 2022 were selected. After 6 months of follow-up, patients were divided into the SNRA group(n=45) and the non-RA group(n=67). Musculoskeletal ultrasound was used to observe the two-dimensional gray scale (GS), power Doppler (PD) and bone erosion (BE) of synovial hyperplasia in the bilateral wrists, bilateral finger joints and tendons of the two groups, and semi-quantitative scoring was performed. Clinical data, such as age, gender, course of disease, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were recorded. The differences in ultrasound scores between the two groups were analyzed, and the correlations of ultrasound scores with course of disease, ESR, CPR in the SNRA group were also analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of ultrasound indicators for SNRA. Results There were no significant differences in age, gender, and course of disease between the two groups (P>0.05). However, CRP and ESR levels were significantly higher in the SNRA group compared to the non-RA group (P<0.01). Joint GS, PD, and BE scores showed significant differences between the two groups (P<0.05), whereas tendon GS scores did not (P>0.05). Patients in the SNRA group had significantly higher tendon PD scores than the non-RA group (P<0.05). No significant differences were observed in lesion locations between groups (P>0.05), but patients in the SNRA group exhibited a significantly higher proportion of joint lesions and BE involvement compared to the non-RA group (P<0.05). Joint GS, PD, and BE grades also demonstrated significant differences between groups (P<0.01). Joint GS and PD scores in the SNRA group showed low positive correlations with CRP and ESR (r=0.366, 0.306, 0.444, and 0.384, respectively; all P<0.05). Tendon GS and PD scores exhibited moderate positive correlations with CRP and ESR (r=0.732, 0.532, 0.772, and 0.538, respectively; all P<0.05). Joint BE scores showed a moderate positive correlation with CRP (r=0.539; P<0.05). The sum of joint and tendon PD scores in the SNRA group demonstrated the highest diagnostic efficacy. Using a cutoff value of 10, the sensitivity and specificity for diagnosing SNRA were 82.2% and 90.0%, respectively. Conclusion Musculoskeletal ultrasound can be used as a non-invasive imaging method for the early differential diagnosis of SNRA.

Value of texture analysis of histograms of energy spectrum CT images in differentiating bone islands from osteoblastic bone metastases

Wang Bohuan, Huang Junbin, Li Zhiqiong, Xiong Yuchao, Guo Wei, Zeng Xuwen

2025, 40(8):  711-716.  doi:10.3969/j.issn.1004-583X.2025.08.007

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Objective To compare the diagnostic performance of dual-energy computed tomography (CT) images combined with histogram texture analysis in differentiating osteoblastic bone metastases (OBM) from bone islands (BI). Methods Ninety-four patients (216 lesions) undergoing spectral CT in Guangzhou Red Cross Hospital from March 21, 2023 to September 1, 2023 were enrolled. They were divided into BI group (n=81, 125 lesions) and OBM group (n=13, 91 lesions). Spectral images were reconstructed using a spectral analysis platform, generating nine monochromatic images (40-200 keV, 20 keV intervals) and conventional polychromatic images. Histogram texture parameters (entropy, mean, and maximum) were extracted from the maximal cross-sectional area of each lesion using Pyromics software. Diagnostic performance was evaluated via the receiver operating characteristic (ROC) curves, and DeLong's test compared parameter efficacy. Results At 40 keV, entropy in gray-level histogram texture analysis demonstrated a superior discrimination of OBM from BI, with an area under the curve (AUC) of 0.934(95%CI: 0.895-0.973). Entropy of conventional images by reconstructed spectral CT yielded an AUC of 0.910(95%CI: 0.872-0.949). DeLong's test confirmed significant superiority of 40 keV entropy over conventional CT (P<0.05). Conclusion Entropy of histogram texture parameters based on a 40 keV image of a plain spectral CT scan can effectively distinguish OBMs from BIs, which is higher than that of traditional images reconstructed from spectral CT.

Analysis of clinical characteristics of malaria-related acute kidney injury based on Gabonese data

Ma Liang, Severine Martin, Sun Guangdong

2025, 40(8):  717-720.  doi:10.3969/j.issn.1004-583X.2025.08.008

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Objective To analyze the epidemiological characteristics and primary clinical features of malaria-associated acute kidney injury (MAKI) in adults in Franceville, Gabon, thus providing evidence for the prevention and control of malaria complications among Chinese overseas workers. Methods A retrospective analysis was conducted on 1, 185 adult patients with Plasmodium falciparum (P. falciparum) malaria admitted to the Sino-Gabonese Friendship Hospital in Gabon between November 2023 and October 2024. The incidence of MAKI and the number of patients per month were calculated. Logistic regression analysis was used to identify significant clinical features associated with MAKI. Results A total of 127 MAKI cases were identified, with an incidence of 10.72%. The incidence of MAKI showed a strong positive correlation with the seasonal distribution of P. falciparum infections (r=0.94, P<0.01). MAKI patients had a mean age of (41.26±7.63) years, and 87 (68.50%) were male. Their mean body mass index (BMI) was (27.31±4.75) kg/m², and 94 patients (74.02%) reported urinary abnormalities. Laboratory findings included a mean red blood cell count of (4.27±0.74)×10¹²/L and hemoglobin level of (42.98±13.96) g/L. Logistic regression identified the following clinical features significantly associated with MAKI development: reported urinary abnormalities (OR=23.21, 95%CI=13.75-39.20, P<0.01), male sex (OR=3.92, 95%CI=2.35-6.56, P<0.01), age (OR=1.04, 95%CI=1.01-1.07, P<0.01), hemoglobin level (OR=0.93, 95%CI=0.91-0.96, P<0.01), and BMI (OR=0.94, 95%CI=0.90-0.99, P<0.05). Conclusion The incidence of adult MAKI exhibits seasonal variation closely aligned with P. falciparum infection patterns. MAKI is significantly associated with male sex, advanced age, reported urinary abnormalities, anemia (low hemoglobin), and lower BMI. We recommend incorporating urinary symptom monitoring into the health management of Chinese overseas workers. Enhanced education targeting males, older individuals, and those with lower BMI is crucial. Renal function assessment should be prioritized following malaria diagnosis to reduce MAKI incidence.

Pulmonary tuberculosis with the “crawling sign” as the main imaging feature:A case report and literature review

Li Guo, Guo Sanjun

2025, 40(8):  721-725.  doi:10.3969/j.issn.1004-583X.2025.08.009

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Objective To explore the imaging characteristics and clinical diagnostic value of pulmonary tuberculosis with the “crawling sign” as the main radiological feature. Methods Clinical and imaging data of a patient treated in the Respiratory Department of Xichong County People's Hospital were retrospectively analyzed. Results A 55-year-old man with type 2 diabetes mellitus presented with a pulmonary nodule found on routine examination 10 months earlier. During an 8-month follow-up, chest CT showed disease progression from a solitary nodule in the apicoposterior segment of the left upper lobe to a tubular lesion extending along the bronchovascular bundles toward the hilum, which was known as the crawling sign. Pathologic biopsy revealed granulomatous inflammation with necrosis. Tuberculosis (TB)-DNA testing confirmed a diagnosis of secondary pulmonary tuberculosis. Conclusion The crawling sign may serve as a suggestive imaging feature of pulmonary tuberculosis, particularly secondary pulmonary tuberculosis. It helps improve the accuracy of early diagnosis.

Malignant osteopetrosis in infants: A case report and literature review

Zhao Wei, Xu Huijuan, Zhao Yanxia, Wang Lingzhen, Lu Yuan, Yang Jing

2025, 40(8):  726-730.  doi:10.3969/j.issn.1004-583X.2025.08.010

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Objective To report a case of infantile malignant osteopetrosis presented with anemia and thrombocytopenia, and to summarize clinical manifestations and treatment options for it through literature review, thus expanding the gene mutation profiles of the TCIRG1 gene in infantile malignant osteopetrosis. Methods Through clinical examination, laboratory testing, and genetic sequencing, a case of infantile malignant osteopetrosis was diagnosed. The clinical manifestations and genetic mutation characteristics were analyzed, and relevant literatures were reviewed. Results This case occurred during infancy and was mainly characterized by anemia and thrombocytopenia. Genetic testing revealed a new mutation in the TCIRG1 gene. Based on literature review, the clinical manifestations of infantile malignant osteopetrosis were diverse, with a poor prognosis. Hematopoietic stem cell transplantation is currently the most effective treatment method. Conclusion This case enriches the spectrum of the TCIRG1 gene mutations, suggesting that clinical doctors should consider the possibility of malignant osteopetrosis in infants with unexplained anemia and thrombocytopenia. Hematopoietic stem cell transplantation is a key treatment for improving prognosis.