Clinical Focus

Intervention effect of virtual reality technology on chronic neck pain: A meta-analysis

Xian Qinan, Xu Yiwen, Li Xin, Sun Yan

2025, 40(9): 773-780. doi:10.3969/j.issn.1004-583X.2025.09.001

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Objective To evaluate the effect of virtual reality (VR)-based intervention on pain symptoms and rehabilitation management in patients with chronic neck pain. Methods Articles reporting VR-based interventions against chronic neck pain published from the establishment of the databases to December 27, 2024 were searched in China National Knowledge Infrastructure (CNKI), VIP, Wanfang Medical Database, China Biomedical Literature Service System, PubMed, Web of Science, EMbase, and the Cochrane Library. Two researchers independently screened the literatures, extracted data, and evaluated the quality. Meta-analysis was performed using Stata 16.0 software. Results A total of 7 studies involving 182 patients were included. The meta-analysis results showed that VR-based intervention significantly alleviated the pain intensity (the Numerical Rating Scale [NRS] score: $M D$ =-2.16, 95% $C I$ : -2.70, -1.62, $P$ <0.01; the Visual Analogue Scale [VAS] score: $M D$ =-1.42, 95% $C I$ : -1.82, -1.01, $P$ <0.01), neck dysfunction (Neck Disability Index [NDI]: $M D$ =-3.85, 95% $C I$ : -4.70, -3.00, $P$ <0.01), and kinesiophobia (Tampa Scale of Kinesiophobia [TSK] score: $M D$ =-2.29, 95% $C I$ : -4.42, -0.16, $P$ <0.01) in patients with chronic neck pain. Conclusion VR technology, by creating immersive virtual environments and interactive training, can improve the pain intensity, neck dysfunction, and kinesiophobia in patients with chronic neck pain. Its normalization and standardization in clinical application still need further research support.

Study of brain network in patients with stress hyperglycemia after acute cerebral infarction based on graph theory

Liu Liying, Cui Kaige, Yu Jiaqi, Jia Juan, Sun Liqiang, Yang Jiping

2025, 40(9): 781-789. doi:10.3969/j.issn.1004-583X.2025.09.002

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Objective To explore the neurophysiological mechanisms of stress-induced hyperglycemia (SIH) after acute cerebral infarction (ACI) at the level of structural brain networks based on diffusion tensor imaging (DTI) and graph theory. Methods A total of 32 SIH patients after ACI and 35 healthy controls (HC) matched for sex and age were prospectively selected. SIH patients were identified based on the stress hyperglycemia ratio (SHR). All subjects underwent magnetic resonance imaging (MRI), and structural brain networks were constructed using deterministic tractography. Graph theory analysis was applied to calculate the global attribute indicators and the Rich-Club attribute parameters of the structural brain network. Additionally, this study analyzed connection strength based on the edges of the network, and the potential correlation between the abnormal network attribute indicators and SHR in post-ACI patients. Results In the global attribute indicators, the clustering coefficient (Cp), global efficiency (Eglob), and local efficiency (Eloc) of the SIH group were significantly lower compared to the HC group, while the characteristic path length (Lp) was significantly higher compared to the HC group ( $P$ <0.01). Both the SIH group and the HC group exhibited small-world organization, and the values of small-worldness (σ), normalized characteristic path length (λ), and normalized clustering coefficient (γ) in the SIH group were significantly larger than those in the HC group ( $P$ <0.01). Compared to the HC group, the connection strength of rich connections (connections between Rich-Club nodes), local connections (connections between non-Rich-Club nodes), and feeder connections (connections between Rich-Club nodes and non-Rich-Club nodes) were significantly lower in the SIH group ( $P$ <0.01). Network-based edge analysis showed that after network-based statistics (NBS) correction, a subnetwork with reduced connection strength was found to exist in the SIH group ( $P$ =0.0002), namely the left frontal-insula-limbic system subnetwork, consisting mainly of 6 nodes and 5 connected edges. The results of the correlation analysis showed no significant association between the abnormal brain network parameter indicators and SHR ( $P$ >0.05). Conclusion Structural brain network is significantly impaired in SIH patients after ACI, and the network has a tendency to transform into a regular network. At the same time, Rich-Club properties are severely impaired in SIH patients after ACI, and the strength of multiple connections is reduced. The reduced connectivity of the left frontal-islet-limbic system sub-network involved damage to the core nodes of the brain, suggesting that this sub-network may be an indication of a pathogenic core region, as well as future multiple dysfunctions and potential disease risks.

The association of imaging indicators on computed tomography angiography of the carotid arteries and blood lipid indicators with ischemic stroke

Wang Hui, Xia Xinjian, Liu Sai, Wei Xifu, Zhang Shuzhong

2025, 40(9): 790-795. doi:10.3969/j.issn.1004-583X.2025.09.003

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Objective To explore the correlation of a combination of imaging indicators on computed tomography angiography(CTA) of the carotid arteries and blood lipid indicators with ischemic stroke, and the predictive value. Methods A total of 122 patients with cervical arteriosclerosis were selected and divided into the stroke group and non-stroke group based on whether ischemic stroke occurred. Their blood lipid indicators, including total cholesterol(TC), triglycerides(TG), high-density lipoprotein cholesterol(HDL-C), and low-density lipoprotein cholesterol(LDL-C) were measured. CTA of the carotid arteries was performed to analyze relevant imaging indicators, including the degree of vascular stenosis, plaque properties, and perivascular fat density. Logistic regression analysis was used to screen for independent risk factors for ischemic stroke. A joint prediction model was constructed. The predictive performance of the model was evaluated by drawing receiver operating characteristic(ROC) curves. According to the nature of plaques, they were divided into the non-plaque group, non-calcified plaque group, calcified plaque group, and mixed plaque group. Using unordered classification logistic regression analysis, the correlation of a combination of perivascular fat density and blood lipid indicators with vascular plaque properties was explored. According to the degree of vascular stenosis, patients were divided into non-stenosis group, mild stenosis group, moderate stenosis group, and severe stenosis group. Ordered classification logistic regression analysis was used to explore the correlation of a combination of perivascular fat density and blood lipid indicators with the degree of vascular stenosis. Results There were differences in the nature of internal carotid artery plaques, degree of internal carotid artery stenosis, average peripheral fat density, peripheral fat trough value, and LDL-C between the stroke group and the non-stroke group(P<0.05). Through logistic regression analysis, the degree of vascular stenosis, perivascular fat density, and LDL-C were identified as independent risk factors for ischemic stroke(P<0.001, 0.029, and <0.001, respectively), and a joint prediction model was constructed. The ROC curve results showed that the area under the curve(AUC) of the joint prediction model was 0.827(95% confidence interval [CI]: 0.756-0.899). The prediction model constructed by the joint indicators had good prediction accuracy. The average density of perivascular fat had a significant impact on the properties of vascular plaques(χ²=20.84, P<0.001). Conclusion The combination of cervical vascular CTA imaging indicators and blood lipid indicators has important predictive value for ischemic stroke, helping to identify high-risk populations early and providing a basis for clinical intervention.

Application of multiplex RT-qPCR in pathogen detection for septic patients

Shen Jian, Yu Sheng, Gu Xiaolei, Xia Tian, Gong Ju

2025, 40(9): 796-800. doi:10.3969/j.issn.1004-583X.2025.09.004

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Objective To evaluate the clinical value of multiplex real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) for pathogen detection in septic patients.Methods A total of 74 septic patients (Sequential Organ Failure Assessment [SOFA]≥2) in the Department of Emergency Medicine of the Fifth Clinical Medical College of Yangzhou University and 74 healthy controls were enrolled from June 2024 to May 2025. Pathogens were detected by blood culture (BacT/ALERT^® 3D), multiplex RT-qPCR (targeting 8 common pathogens), and parallel measurement of infection biomarkers (procalcitonin [PCT], C-reactive protein [CRP], interleukin 6 [IL-6]). Differences between groups were compared. Results The positivity rate of pathogens in septic patients detected by multiplex RT-qPCR was significantly higher than blood culture (89.19% vs 75.67%, P=0.027), with a reduced turnaround time ([5.42±0.32] hours vs [20.25±1.52] hours, P<0.01). Compared to blood culture, multiplex RT-qPCR showed a sensitivity of 96.4% and perfect concordance for positive cases detected by blood culture (κ=0.811). Both blood culture-positive and RT-qPCR-positive groups exhibited significantly elevated infection biomarkers (PCT, CRP, IL-6) compared to controls (P<0.01), but no significant differences were observed between these two groups ( $P$ >0.05). Conclusion Multiplex RT-qPCR demonstrates superior sensitivity, rapidity, and multi-target capacity, serving as a robust adjunct for early etiological diagnosis of sepsis.

The role of anemia in evaluating disease severity and prognosis of ANCA-associated vasculitis

Chen Lu, Qi Xiaojing, Han Runhong, Xing Guangqun

2025, 40(9): 801-810. doi:10.3969/j.issn.1004-583X.2025.09.005

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Objective To investigate the etiology of anemia in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), and to evaluate the value of baseline anemia severity, anemia subtypes, therapeutic responses in determining the severity of AAV as well as their association with renal prognosis and all-cause mortality. Methods A total of 157 AAV patients diagnosed in the Affiliated Hospital of Qingdao University between 2013 and 2022 were enrolled. Patients were stratified into the non-anemia, mild anemia, and moderate-severe anemia groups based on baseline hemoglobin levels. Etiologies of anemia were systematically analyzed. Dynamic treatment response and changes in hemoglobin levels were tracked post-treatment. Patients were categorized into four groups (HH, HL, LH, LL) according to baseline-to-endpoint hemoglobin trends (H: high; L: low). Renal outcomes and mortality were compared across groups. Results Among 157 AAV patients, there were 82 (52.2%) female and 75 (47.8%) male patients, with a median age of 67 (20-86) years. A total of 137 myeloperoxidase (MPO)-ANCA-positive, 18 proteinase 3 (PR3)-ANCA-positive, and 2 dual-positive cases were detected. The mean follow-up duration was 37±30 months. By study endpoint, 28 patients progressed to end-stage renal disease (ESRD), and 31 died. Anemia was prevalent at baseline, with only 11 non-anemic patients. A total of 67 had mild anemia, and 79 had moderate-to-severe anemia. The top 4 etiologies of anemia included anemia of inflammation (AI), renal anemia, infection-related anemia, and cardiorenal anemia syndrome. Single-etiology anemia was rare (9/146, 6.16%), while multifactorial anemia predominated (137/146, 93.84%). A higher number of etiological factors of anemia correlated with worse renal prognosis. Hemoglobin trajectory analysis revealed that the HH group (persistently high hemoglobin) exhibited the lowest all-cause mortality and highest renal survival, whereas the LL group (persistently low hemoglobin) had the highest incidence of ESRD progression (P<0.05) and mortality rate (P<0.05). Conclusion Anemia in AAV is a dynamic and clinically significant biomarker for disease activity and prognosis. Its occurrence strongly correlates with disease activity (the Birmingham Vasculitis Activity Score [BVAS]) and is predominantly multifactorial. Therapeutic response to anemia correction serves as an independent predictor of renal function deterioration and all-cause mortality.

Causal relationship between virus infection characterized by skin and mucosal lesions and dermatomyositis based on Mendelian randomization

Li Ying, Cao Tingting, Wang Cuicui, Li Yanxia, Yang Dongliang

2025, 40(9): 811-815. doi:10.3969/j.issn.1004-583X.2025.09.006

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Objective To investigate the causal relationship between viral infection characterized by skin and mucosal lesions and dermatomyositis (DM) using Mendelian randomization (MR) with single nucleotide polymorphism (SNP) as instrumental variable. Methods Genome-wide association study (GWAS) data of viral infection (Finn-B-Ab1_Viral_Skin_Mucous_Membrane) and DM (finn-b-M13_DERMATOPOLY) with the largest sample size in recent three years were obtained from the IEU Open GWAS project website. Single nucleotide polymorphisms (SNPs) with a high correlation with virus infection characterized by skin and mucous membrane were screened from Finn-b-ab1 _ viral _ skin _ mucous_membrane (threshold: $P$ <5×10^-8, width of linkage disequilibrium region: 10 000 kb, and the linkage disequilibrium coefficient $r 2$ =0.001). Highly linked SNPs related to skin and mucosal lesions were extracted from finn-b-M13_DERMATOPOLY, and the minimum $r 2$ value was >0.8. Two datasets were pooled to remove SNPs directly related to DM. Seventy-three SNPs were used as instrumental variables, including rs10051884, rs9438624 and rs62194265. MR-Egger regression, random effect inverse variance weighted method (IVW) and weighted median method (WME) regression models were used to analyze the causal relationship between viral infection characterized by skin and mucosal lesions and DM. Results Two groups of GWAS data were sourced from the European population, regardless of gender. The intercept term of MR Egger regression was -0.022 ( $P$ =0.644), indicating no pleiotropy between the screened SNPs and DM. The odds ratio ( $O R$ ) (95% $C I$ ) of MR-Egger regression, IVW, and WME was 1.676(0.808-3.480), 1.362(0.865-2.145), and 1.439 (1.021-2.029), respectively. The results of random effect IVW were of concern due to the presence of heterogeneity ( $Q$ =93.823, $P$ =0.036). Conclusion Virus infection characterized by skin and mucosal lesions is a risk factor for DM.

Analysis of risk factors for colorectal cancer with liver metastasis based on the SEER database: A propensity score matching study

Wei Tingting, Pan Zhengyan, Feng Xianyan, Long Yaxiu

2025, 40(9): 816-820. doi:10.3969/j.issn.1004-583X.2025.09.007

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Objective To analyze independent risk factors for liver metastasis in colorectal cancer based on the SEER database. Methods A total of 60, 136 colorectal cancer patients from the SEER database between 2010 and 2019 were included, among whom 5, 072 developed liver metastases. Propensity score matching(PSM)(1∶1) was used to balance the baseline clinical characteristics between the liver metastasis and non-metastasis groups, resulting in a matched cohort of 9, 716 patients with 4, 858 cases in each group. Univariate logistic regression analysis was applied both before and after matching the identified risk factors for liver metastasis. Results Before matching, univariate logistic regression analysis identified 12 factors(age, sex, race, T stage, N stage, radiotherapy, chemotherapy, brain metastasis, bone metastasis, lung metastasis, distant lymph node metastasis, and other rare site metastases) as independent risk factors for liver metastasis. After matching, chemotherapy and metastasis to other rare sites were identified as protective factors against liver metastasis in colorectal cancer(OR<1), while bone and lung metastases were independent risk factors. Additionally, among primary tumor sites, the highest incidence of liver metastasis was observed in the transverse colon(9.86%), followed by the rectosigmoid colon(8.91%). Conclusion The importance of chemotherapy as a protective factor against liver metastasis in colorectal cancer should be highlighted. For colorectal cancer patients who have already developed bone or lung metastases, enhanced monitoring and intervention for liver metastasis are essential to develop personalized treatment strategies and improve the prognosis.

Clinical efficacy of levofloxacin versus minocycline in the treatment of children with macrolide-resistant Mycoplasma pneumoniae pneumonia

Liu Jiao, Shang Yun, Cui Qingyang, Zhang He, Qiu Meng

2025, 40(9): 821-827. doi:10.3969/j.issn.1004-583X.2025.09.008

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Objective To compare the clinical efficacy and safety of levofloxacin versus minocycline in treating children with macrolide-resistant $M y c o p l a s m a p n e u m o n i a e$ pneumonia (MRMP), and to analyze the therapeutic differences between the two drugs in mild, moderate, and critical subgroups, thus providing a basis for the drug use in MRMP. Methods A total of 204 children with MRMP admitted to the Eighth Medical Center of the PLA General Hospital and the First Affiliated Hospital of Xinxiang Medical University from May 2023 to October 2024 were included. They were divided into the levofloxacin group ( $n$ =65) and the minocycline group ( $n$ =139) based on the treatment drug. Outcomes included rehabilitation indicators (e.g., temperature recovery, cough relief, disappearance of rales), inflammatory indicators, overall effectiveness, and short-term and long-term adverse reactions. Results There was no significant difference in the overall effectiveness rate between the levofloxacin group and the minocycline group ( $P$ >0.05). Body temperature recovery time, cough relief time, wheezing relief time, blister sound disappearance time and imaging improvement time were comparable between the two groups ( $P$ >0.05). Differences in the white blood cell count, C-reactive protein, procalcitonin, erythrocyte sedimentation rate, interleukin-6, lactate dehydrogenase and other inflammatory indicators before and after treatment were comparable between the two groups ( $P$ >0.05). However, in the critical subgroup, the time for rales to disappear in the minocycline group was significantly shorter than that in the levofloxacin group ( $P$ <0.05). In terms of safety, short-term adverse reactions were mainly mild gastrointestinal reactions, without abnormalities in liver and kidney functions and long-term adverse reactions. Conclusion The overall efficacy and safety of levofloxacin and minocycline in treating children with MRMP are comparable. Minocycline, due to its high lipid solubility and strong lung tissue penetration, can relieve pulmonary signs faster in critically ill children. Clinicians should develop individualized treatment plans based on the age of children and the severity of the disease.

Pure sensory Guillain-Barré syndrome with a sensory level: A case report and literature review

Li Xinyuan, Zhao Ying, Meng Heng, Xu Anding

2025, 40(9): 828-832. doi:10.3969/j.issn.1004-583X.2025.09.009

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Objective To investigate the clinical characteristics and treatment strategies of pure sensory Guillain-Barré syndrome (GBS) accompanied by a sensory level. Methods A retrospective analysis was conducted on a case of pure sensory GBS with a sensory level, supplemented by a literature review. Results A 22-year-old male developed numbness, tightness, and hyperalgesia in both lower limbs after a cold. Symptoms progressed to the inguinal level within 3 days and peaked. Sensory disturbances were confined below the inguinal level. Physical examination revealed hyperalgesia and impaired deep sensation in the lower limbs, especially in the distal end. Positive Romberg's sign, absence of tendon reflexes in all limbs, and negative pathological reflexes were found. Lumbar puncture examination of cerebrospinal fluid suggested protein-cell separation, serum anti-GD1a antibody IgG (++), anti-Sulfatides antibody IgG (+), and electrophysiological studies showed no abnormalities. The patient was diagnosed with pure sensory GBS. Symptoms were alleviated after receiving immunoglobulin pulse therapy and neurotrophic treatment. Conclusion The presence of a sensory level and purely sensory manifestations are both atypical features of GBS, and their co-occurrence is rare. Positive cerebrospinal fluid or serum peripheral nerve antibodies are crucial for diagnosis. Current treatment lacks high-level evidence, but intravenous immunoglobulin therapy can alleviate symptoms.

Olanzapine-induced peripheral edema: A case report and literature review

Sun Zhenxiao, Yu Xiangfen

2025, 40(9): 833-836. doi:10.3969/j.issn.1004-583X.2025.09.010

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Objective To explore the clinical characteristics of olanzapine-induced peripheral edema. Methods Clinical data of a case of olanzapine-induced peripheral edema were reported, and a comprehensive analysis of similar cases was made by literature review. Results A 42-year-old female patient with anxiety disorder was treated with venlafaxine sustained-release tablets 75 mg and zopiclone tablets 7.5 mg once daily at night. She was additionally given to olanzapine tablets 5 mg once daily at night. On the 5th day, the patient developed swelling of eyelids, ankles and dorsum of feet. Edema subsided after 5 days of olanzapine tablet withdrawal, while other drugs remained unchanged. However, after four days of re-use of olanzapine tablets 5 mg once daily at night, the patient developed swelling of eyelids, ankles and dorsum of feet again, and subsided after 4 days of withdrawal. Literature review of 23 cases of olanzapine-induced peripheral edema showed that 17 (73.91%) cases developed edema within 30 days of olanzapine medication at any dosages, with an increased risk by taking a higher dose of olanzapine. Edema could affect the lower limbs, feet, periorbital, eyelids, globular conjunctiva, and tongue, and multi-site edema was seen in some cases. Withdrawal or reducing the dosage of olanzapine resulted in edema subside within 30 days, and within 14 days in 19 (82.61%) cases. Conclusion Olanzapine-induced peripheral edema often occurs early in the medication period, with a good prognosis after withdrawal or reducing the dosage.

Ectopic ACTH syndrome caused by recurrent adrenal pheochromocytoma: A case report and literature review

Xie Liran, Rao Xiaojuan, Yu Ling, Shi Shuangwei, Fang Yifan, Zhao Mingming, Jiao Peilin, Song Shumin, Sang Yanhong

2025, 40(9): 837-843. doi:10.3969/j.issn.1004-583X.2025.09.011

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Objective To explore the clinical diagnosis and treatment of ectopic adrenocorticotropic hormone (ACTH) syndrome caused by recurrent adrenal pheochromocytoma, thus enhancing the awareness and attention of clinicians to such a rare disease. Methods Clinical data of a patient with ectopic ACTH syndrome caused by recurrent adrenal pheochromocytoma were retrospectively analyzed, and relevant literatures were reviewed. Results A 64-year-old female patient was admitted due to hyperglycemia for 8 years, accompanied by dizziness and weight loss for 2 months. She had a surgical history of right adrenal pheochromocytoma. The patient has now suffered from persistent hypokalemia. ACTH and cortisol (COR) levels were more than 10 times higher than the normal reference ranges. The high-dose and low-dose dexamethasone suppression test showed that the lease of ACTH was not suppressed. All six indicators in the blood catecholamine panel were significantly elevated. The combined plain and contrast-enhanced computed tomography (CT) scans of the chest and abdomen showed multiple occupying lesions in the right adrenal area and the right perirenal region, suggesting a possible recurrence of pheochromocytoma and multiple perirenal metastases. A conventional dose of phenoxybenzamine was administered for preoperative preparation, and laparoscopic resection of the right adrenal tumor was performed. The pathology suggested a pheochromocytoma of the right adrenal gland. The immunohistochemistry results showed CgA(+), NSE(+), Ki-67 (+ approximately 2%), Sny(+), and ACTH(-). After the surgery, ACTH and cortisol levels rapidly returned to the normal reference ranges. The follow-up examinations at 3, 6, and 12 months postoperatively indicated that catecholamines, ACTH, and cortisol were all within the normal reference ranges. The patient's blood pressure did not rise again, and the blood sugar decreased significantly compared to pre-treatment levels. The weight gradually returned to normal. Conclusion Ectopic ACTH syndrome caused by recurrent pheochromocytoma is a rare disease. Clinically, this possibility should be considered when encountering ectopic ACTH syndrome. Surgical resection is an effective treatment, and preoperative preparation should be completed in accordance with the standards for pheochromocytoma before surgery.

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