Table of Content

20 October 2025, Volume 40 Issue 10

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Guidelines for diagnosis and treatment of Kawasaki disease by general practitioners (practical edition in 2025)

Kawasaki Disease Diagnosis and Treatment Center of Shaanxi Province/ Children's Hospital of Shaanxi Provincial People's Hospital, National Clinical Research Center for Child Health and Disorders/ Children's Hospital of Chongqing Medical University, National Children's Medical Center/ Beijing Children's Hospital, Capital Medical University,Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, National Regional Medical Center/ Shengjing Hospital of China Medical University, the Committee for the Compilation of Primary Guidelines for the Diagnosis and Treatment of Kawasaki Disease, Initiative Medicine Committee, World Artificial Consciousness Association

2025, 40(10):  869-873.  doi:10.3969/j.issn.1004-583X.2025.10.001

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Kawasaki disease (KD) is an acute self-limiting inflammatory disorder that mainly affects small and medium-sized blood vessels throughout the body. It is more common in infants under 5 years old. The pathogenesis of KD remains unclear, and its clinical manifestations are diverse. KD can be divided into the complete and incomplete types, and the diagnosis of the latter type is more challenging. This guideline, based on the latest evidence and practice, systematically expounded the epidemiological characteristics, diagnostic criteria, treatment principles, referral recommendations and diseases management of KD, aiming to standardize primary medical treatment behaviors, improve the prognosis of children, and reduce the risk of coronary artery complications.

Different kinesiotherapies in improving global cognitive function and executive function in elderly people with mild cognitive impairment: A network meta-analysis

Li Yongjing, Gao Chungang, Zhang Jinlong, Song Shuhua

2025, 40(10):  874-892.  doi:10.3969/j.issn.1004-583X.2025.10.002

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Objective To comprehensively evaluate and compare the results of randomized clinical trials (RCTs) of different kinesiotherapies through meta-analysis and network meta-analysis, thus obtaining the optimal intervention type and exercise program. Methods Databases including CNKI, VIP, Wanfang, CBM, The Cochrane Library, PubMed, EMbase, Web of Science, and Science Direct were systematically searched, with the retrieval period from the database establishment to July 2025. Network meta-analysis was performed using Review Manager software and Stata 18 software. Results A total of 37 RCTs were finally included. The overall meta-analysis showed that exercise had a significant intervention effect on the global cognitive function (standardized mean difference [SMD]=0.70) and executive function (SMD=-0.44) of patients with mild cognitive impairment. Subgroup analysis found that in terms of global cognitive function, the effect sizes were higher for dual-task exercise (SMD=1.8), a frequency of 5 times/week (SMD=2.47), a dose of ≥51 min/session (SMD=1.14), and 24 weeks of exercise (SMD=1.99). In terms of executive function, moderate-intensity aerobic exercise (SMD=-0.96), 50 min/session (SMD=-6.5), 5 times/week (SMD=-0.96), and 16 weeks of exercise (SMD=-1.81) all achieved large effect sizes. Network meta-analysis showed that in terms of global cognitive function, the top three intervention effects compared with the control group were high-speed resistance exercise (SMD=4.49, surface under the cumulative ranking curve [SUCRA]=94.2%), followed by the multi-component exercise (SMD=3.43, SUCRA=77.4%) and mind-body exercise (SMD=3.29, SUCRA=67.1%). In terms of executive function, the top three intervention effects compared with the control group were dual-task exercise (SMD=-38.89, SUCRA=88.6%), followed by resistance exercise (SMD=-26.78, SUCRA=63.4%) and aerobic exercise (SMD=-24.06, SUCRA=58.7%). Conclusion The exercise protocol of high-speed resistance exercise, with an intervention frequency of 5 times/week, an intervention dose of ≥51 min/session, and a period of 24 weeks, brings more benefits to the global cognitive function ability of patients with mild cognitive impairment; in terms of executive function, dual-task exercise, with an intervention frequency of 5 times/week, an intervention dose of >50 min/session, and a period of 16 weeks, can significantly improve their function. Due to the limited number of included studies in this aspect, further verification is needed.

Correlation analysis of S-Tp and S-Te intervals with heart failure with recovered ejection fraction

Liu Sanlong, Zhang Wenlong, Liu Ying, Du Guifang, Meng Zhaobin

2025, 40(10):  893-896.  doi:10.3969/j.issn.1004-583X.2025.10.003

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Objective To examine the correlation between the S-Tp (interval from the nadir of the S wave to the peak of the T wave) and S-Te (interval from the nadir of the S wave to the end of the T wave) on surface electrocardiography with heart failure with recovered ejection fraction (HFrecEF). Methods Consecutive patients hospitalized with heart failure at the Third People's Hospital in Liaocheng from June 2022 to June 2024 were enrolled. All patients underwent echocardiography, electrocardiography, and routine laboratory testing at baseline. The heart failure with reduced ejection fraction (HFrEF) was defined as left ventricular ejection fraction (LVEF) ≤40% at the index admission. After followup at 3 and 6 months, patients were classified at 6 months as having HFrecEF (baseline LVEF ≤40%, followup LVEF >40%, and an absolute increase ≥10%) or persistent HFrEF (all others). Betweengroup differences were assessed using independentsamples t tests. Multivariable linear regression was used to evaluate associations between S-Tp, S-Te, and heart failure-related biomarkers. Results A total of 180 patients were included; 48 (26.7%) were classified as HFrecEF and 132 (73.3%) as persistent HFrEF. Mean S-Tp and S-Te intervals were significantly shorter in HFrecEF than in persistent HFrEF (S-Tp: 0.22±0.02 ms vs 0.29±0.05 ms; S-Te: 0.31±0.05 ms vs 0.38±0.05 ms; all P<0.05). In addition, the HFrecEF group was younger and had lower rates of smoking and alcohol consumption than the HFrEF group. Serum levels of Nterminal pro-Btype natriuretic peptide (NTproBNP), low-density lipoprotein were higher than HFrecEF, cystatin C, blood urea nitrogen, and creatinine were also significantly lower in HFrecEF. In multivariable analyses, both S-Tp and S-Te were positively correlated with NTproBNP and cystatin C (all P<0.05). Conclusion S-Tp and S-Te intervals are associated with HFrecEF after treatment and may serve as independent predictors of LVEF improvement in patients initially presenting with HFrEF.

Assessment value of FT₄ combined with LVEF in hyperthyroid heart disease

Liu Shenghua

2025, 40(10):  897-903.  doi:10.3969/j.issn.1004-583X.2025.10.004

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Objective To evaluate the diagnostic value of free thyroxine (FT₄) combined with left ventricular ejection fraction (LVEF) for hyperthyroid heart disease (HHD) in patients with hyperthyroidism. Methods This retrospective study included 104 consecutive patients diagnosed with hyperthyroidism or HHD who were evaluated in the Cardiology Department (outpatient and inpatient) of Beijing Renhe Hospital from January 2023 to January 2025. Based on the presence of HHD, patients were classified into the hyperthyroidism-only group (n=64) and HHD group (n=40). The demographics (sex, age, smoking history), thyroid function indices (free triiodothyronine [FT₃], FT₄, thyroid-stimulating hormone [TSH]), and echocardiographic indices (left ventricular end-diastolic diameter [LVEDD], left ventricular end-systolic diameter [LVESD], and LVEF) between groups were compared. Multivariable logistic regression was used to analyze the independent factors associated with HHD. Receiver operating characteristic (ROC) curves were drawn to analyze the discriminative performance of individual indices and the FT₄+LVEF combination. Results Patients with HHD were older and more likely to have a history of smoking than those with hyperthyroidism alone (P<0.05). Compared with the hyperthyroidism-only group, the HHD group had significantly higher FT₃, FT₄, LVEDD, and LVESD, and lower TSH and LVEF (all P<0.05). Multivariable logistic regression analysis showed that age, smoking history, FT₃, FT₄, LVESD and LVEDD were risk factors for HHD, while LVEF and TSH were protective factors (all P<0.05). ROC analysis showed that both thyroid and cardiac indices had significant predictive value for HHD (P<0.05). The combination of FT₄ and LVEF provided the highest overall performance (area under the curve [AUC]=0.98), with a specificity of 64.06%, and a sensitivity of 51.82%(P<0.001). Conclusion FT₄ and LVEF each have clinical value in evaluating hyperthyroidism complicated by HHD. Their combination improves discrimination and can serve as an important reference for clinical decision-making.

Mapping and ablation on the non-coronary cusp for treating para-Hisian premature atrial contractions and atrial tachycardia

Liu Zhenliang, Zhou Yangjie, Wen Wei, Li Wanneng, Xi Binwu, Zhao Xu, Liu Qifang

2025, 40(10):  904-909.  doi:10.3969/j.issn.1004-583X.2025.10.005

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Objective To evaluate the feasibility, safety, and effectiveness of a noncoronary cusp (NCC) approach to map and ablate premature atrial contractions (PACs) or atrial tachycardia (AT) arising from the para-Hisian region. Methods This retrospective study included 13 consecutive patients treated with radiofrequency ablation under CARTO 3 guidance at Qixingguan District People's Hospital and Guizhou Provincial People 's Hospital between January 2019 and April 2023. Intraoperative electrophysiologic study confirmed that the earliest atrial activation was located at or near the His bundle. Clinical characteristics and procedural data related to NCC mapping and ablation were analyzed. Results Para-Hisian PACs/AT displayed characteristic surface ECG findings. Target sites were within 5 mm of the His bundle. In all 13 patients, NCC mapping identified the earliest local atrial activation preceding the surface P-wave onset by (31.5±15.0) ms. Local electrograms were characterized by a bipolar signal with large A and small V, unipolar QS morphology, and absence of a His bundle potential. Ablation was successful in all cases with no complications observed. Conclusion Para-Hisian PACs/AT present with distinctive ECG features. Guided by these features, three-dimensional electroanatomical mapping with CARTO 3, combined with NCC mapping and ablation, is a safe and effective strategy.

Clinical study of endoscopic retrograde appendicitis therapy of acute uncomplicated appendicitis

Zhang Yihan, Liu Tianyu, Jiao Li, Meng Xia, Hao Yurong, Liang Yulong, Wang Junmin

2025, 40(10):  910-917.  doi:10.3969/j.issn.1004-583X.2025.10.006

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Objective To explore the clinical efficacy of endoscopic retrograde appendicitis therapy (ERAT) of acute uncomplicated appendicitis (AUA). Methods AUA patients hospitalized in the Hebei Medical University Third Hospital from January 2022 to January 2024 were selected for the study. Informed consent was obtained via telephone follow-up. Patients were divided into three groups according to their treatment modality: ERAT group (n=26), laparoscopic appendectomy (LA) group (n=63), and non-operative management (NOM) group (n=37). Inflammatory marker levels, length of hospitalization and costs, incidence of complications, and recurrence rates were compared among the three groups. Results The initial cure rate and incidence of adverse events were comparable across all three treatment methods, and all surgical methods could effectively alleviate pain. Both the white blood cell count (WBC) and neutrophil count (NEUT) decreased significantly (P<0.05). On day 1 post-treatment, interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) in the LA group were significantly higher than the ERAT and NOM groups (P<0.05), while D-dimer was comparable. Patients in the ERAT group had significantly shorter duration of off-bed activities than the LA group (P<0.01). Compared with NOM group, patients in the ERAT group had significantly shorter duration of first temperature drop and length of stay (P<0.05). Cost of hospitalization was the highest in LA group, followed by ERAT and NOM groups (P<0.05). The highest recurrent rate was seen in the NOM group, followed by ERAT and LA groups. Obesity, preservation of the appendix and presence of appendiceal fecal stones were independent risk factors for the recurrence of AUA (P<0.05). Conclusion ERAT, as a minimally invasive treatment option, demonstrates significant clinical value in the management of AUA, offering unique advantages over LA and NOM.

Clinical efficacy of mechanical resection versus high-frequency electrical resection of 6-15 mm sessile colorectal polyps

Liu Dongya, Sun Zhenglu, Du Yingying, Han Dazheng

2025, 40(10):  918-922.  doi:10.3969/j.issn.1004-583X.2025.10.007

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Objective To compare the clinical effects of mechanical resection and high-frequency electrocautery resection in patients with 6-15 mm sessile colorectal polyps. Methods A total of 120 patients with 6-15 mm sessile colorectal polyps treated at our hospital from January 2023 to December 2024 were randomly assigned (random number table) to either a mechanical resection group using the cold snare technique or a high-frequency electrocautery resection group using the hot snare technique (n=60 each). Surgical outcomes, perioperative recovery metrics, serum gastrointestinal function markers, and complication rates were compared between groups. Results The mechanical resection group achieved a significantly higher cecal intubation rate and a significantly lower proportion of cumulative submucosal injury than the high-frequency electrocautery group (both P<0.05). The proportions of polyp recovery and polyp en bloc resection, and the total resection rate were comparable between the two groups ( all P>0.05).Operative time, time to first postoperative flatus, length of hospital stay, time to first postoperative bowel movement, and intraoperative blood loss were significantly lower in the mechanical resection group (all P<0.05). There was no significant difference in preoperative gastrointestinal function between groups (P>0.05). At postoperative day 3, serum levels of intestinal fatty acid-binding protein (I-FABP), vasoactive intestinal peptide (VIP), and diamine oxidase (DAO) were significantly lower in the mechanical resection group than in the high-frequency electrocautery group (all P<0.05). The overall incidence of complications was significantly lower with mechanical resection (P<0.05). Conclusion Both mechanical resection (cold snare) and high-frequency electrocautery resection (hot snare) provide effective treatment for 6-15 mm sessile colorectal polyps. However, mechanical resection demonstrates overall superiority in procedural performance, tissue safety, recovery, and complication profile, and may be recommended as the first-line technique for this population.

Association between the body roundness index and carotid intima-media thickness in patients with type 2 diabetes mellitus

Yang Xiaodong, Yu Xiao, Ma Ruixue, Tong Xi, Liu Jianfeng

2025, 40(10):  923-929.  doi:10.3969/j.issn.1004-583X.2025.10.008

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Objective To investigate the association between the body roundness index (BRI) and carotid intima-media thickness (cIMT) in patients with type 2 diabetes mellitus (T2DM), and to evaluate the predictive value of BRI. Methods This retrospective study included 1, 136 patients with T2DM treated at Cangzhou People's Hospital between January 2018 and December 2024. Multivariable logistic regression was used to examine the association between BRI and cIMT. A generalized additive model (GAM) was employed to fit smooth curves and visualize the exposure-response relationship. Predictive performance was evaluated using receiver operating characteristic (ROC) curve and compared with body mass index (BMI). Subgroup analysis was used to evaluate the correlation between BRI and cIMT in T2DM patients in different populations. Results Overall, 608 patients met criteria for cIMT thickening. Across BRI quartiles, the incidence of cIMT increased significantly with higher BRI (P<0.01). After adjustment for potential confounders, multivariate logistic regression analysis showed that BRI remained an independent risk factor for cIMT (OR=1.35; 95%CI: 1.11-1.65; P=0.003). Compared with the lowest quartile (Q1), adjusted odds ratios for Q2, Q3, and Q4 were 2.23(95%CI: 1.53-3.24; P<0.01), 3.44(95%CI: 2.17-5.44; P<0.01), and 3.96(95%CI: 2.03-7.42; P<0.01), respectively. ROC curve analysis showed that the area under the curve (AUC) for BRI in predicting cIMT was 0.70, with sensitivity and specificity of 74.2% and 61.7%, respectively, and BRI outperformed BMI (Z=2.398; P=0.017). Subgroup analysis showed significant interactions with diabetes duration (interaction P<0.05). Conclusion BRI is an effective predictor of cIMT in T2DM patients, which helps to identify high-risk patients and guide early intervention.

CUBN variants in child with isolated proteinuria: A case report and literature review

Zhang Wenxiao, Wang Wenhong

2025, 40(10):  930-934.  doi:10.3969/j.issn.1004-583X.2025.10.009

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Objective To describe the diagnosis, treatment, and follow-up of a child with isolated proteinuria attributable to CUBN mutations, and to contextualize the case with a literature review. Methods We retrospectively reviewed one pediatric case of isolated proteinuria and surveyed relevant published reports. Results A 3-year-old boy with normal growth and development and no family history of kidney disease presented with subnephrotic, albumin-predominant proteinuria in the absence of edema or oliguria. Renal function was preserved, and megaloblastic anemia was not present. Genetic testing identified two heterozygous CUBN variants: A nonsense variant in exon 42, c.6360G>A (p.Trp2120*), and a frame shift variant in exon 47, c.7341delC (p.Ser2448Valfs*45). These findings are consistent with autosomal recessive chronic benign proteinuria. The patient received an angiotensin-converting enzyme inhibitor plus Bailing capsules. During 2.5 years of follow-up, proteinuria remained stable without clear remission or progression. Conclusion CUBN mutation-associated isolated proteinuria in children appears clinically benign but warrants proactive longitudinal monitoring.