四川大学学报(医学版)最新文献

Objective: To investigate the effects of blood biochemical indicators on physical functional status and exercise duration in patients with chronic kidney disease (CKD) in stages 3-5.

Methods: A total of 156 patients with stages 3-5 CKD admitted to our hospital between March 2021 and February 2024 were enrolled in the study. General information questionnaires, the Karnofsky Performance Status (KPS) scale of functional status, and the International Physical Activity Questionnaire-Long Form (IPAQ-L) were used for data collection. Blood biochemical indicators were assessed through blood tests. Patients who engaged in physical activity meeting the recommended standards of the CKD clinical practice guidelines were defined as the high-level exercise group, while the others were defined as the low-level exercise group. Pearson correlation analysis was performed to examine the relationship between blood biochemical indicators, physical functional status, and exercise duration. Multiple linear regression was performed to identify factors influencing exercise duration. The SPSS macro program Process 4.1 was used to analyze the mediating effect.

Results: The average KPS score of the 156 patients with stage 3-5 CKD was 77.03 ± 11.99, and the average weekly exercise duration was (71.67 ± 10.16) min. Compared with the high-level group, the low-level group had lower hemoglobin (Hb) ([94.76 ± 16.98] g/L) and serum albumin (Alb) ([30.96 ± 6.35] g/L) levels and a higher blood urea nitrogen (BUN) ([13.45 ± 3.28] mmol/L) level (P < 0.05). Hb levels were positively correlated with physical functional status (r = 0.248, 95% CI: 0.085 to 0.402) and exercise duration (r = 0.231, 95% CI: 0.081 to 0.372). Alb was positively correlated with physical functional status (r = 0.192, 95% CI: 0.044 to 0.329) and exercise duration (r = 0.238, 95% CI: 0.071 to 0.380). BUN was negatively correlated with physical functional status (r = －0.277, 95% CI: －0.404 to －0.115) and exercise duration (r = －0.277, 95% CI: －0.397 to －0.142). Physical functional status was positively correlated with exercise duration (r=0.240, 95% CI: 0.084 to 0.375). The factors influencing exercise duration were Hb (β = 0.160, 95% CI: 0.004 to 0.179), Alb (β = 0.162, 95% CI: 0.011 to 0.460), and BUN (β = －0.221, 95% CI: －1.199 to －0.220) levels (P < 0.05). The physical functional status played a partial mediating role between blood biochemical indicators and exercise duration, accounting for 20.45%, 16.14%, and 17.55% of the total effects of Hb, Alb, and BUN on exercise duration, respectively.

Conclusion: Hb, Alb, and BUN can directly affect the exercise duration of patients with CKD in stages 3-5, and can also indirectly affect the exercise duration of patients through physical functional status.

The innovative development of integrating digital technology with education has created a new framework and ecosystem for stomatology education. Taking the innovative ecological construction of experimental teaching at West China School of Stomatology, Sichuan University as a representative case, we systematically explored the innovative pathways and practical paradigms for experimental teaching in stomatology empowered by digital intelligence across multiple dimensions, including knowledge acquisition, clinical competency development, and evaluation of experimental teaching. A 4-wheel-driven stomatology experimental teaching system comprising intelligent-guided learning, intelligence-enhanced critical thinking, intelligence-enabled practice, and intelligent evaluation was established by West China School of Stomatology. By organically integrating technologies such as artificial intelligence, virtual simulation, and mixed reality, this system promotes a shift in the teaching paradigm from a "credit-oriented" approach to a "competency-oriented" paradigm. This transformation helps achieve seamless integration and a closed-loop process encompassing knowledge internalization, clinical reasoning, skills training, and comprehensive evaluation in experimental teaching. Practice demonstrates that this system effectively enhances students' self-directed learning skills, precision in clinical operations, and interdisciplinary diagnostic reasoning, providing valuable insights and references for advancing the application of digital technologies in the training of stomatology professionals.

Objective: To determine the prevalence of functional gastrointestinal disorders (FGIDs) in infants aged 0-9 months with gastrointestinal (GI) discomfort in different cities in China, and to investigate the associated influencing factors.

Methods: A multicenter cross-sectional survey was conducted. The questionnaire was developed based on the Rome Ⅳ Diagnostic Questionnaire for FGIDs in Neonates and Toddlers and published literature. Data were collected from infants aged 0-9 months with GI discomfort at 17 hospitals across 14 cities in eastern, central, and western China. Information on family demographics, neonatal records, feeding history, types and frequency of GI symptoms was collected. Logistic regression was performed to explore factors associated with FGIDs.

Results: A total of 2528 infants aged 0-9 months with GI discomfort were enrolled, with 1315 males (52.02%) and 1213 females (47.98%). Among the surveyed infants, 72.55% were diagnosed with FGIDs, with no statistically significant difference in prevalence between male and female infants (P = 0.397). Regurgitation, with a prevalence of 39.83%, was the most common FGID. The prevalence of regurgitation and colic in infants decreased with increasing age, while the prevalence of dyschezia and functional constipation increased with increasing age. The prevalence of a single symptom was 57.48%, and approximately 15% of infants presented with 2 or more symptoms. The proportion of those presenting with 2 or more symptoms was the highest in infants aged 0-3 months (22.02%), whereas infants aged 6 to 9 months predominantly presented with a single symptom (65.96%). Univariate logistic regression identified significant associations between FGIDs and the geographic region, parental educational attainment, monthly per capita household income, infant age in days, gestational age at birth, duration of exclusive breastfeeding, and probiotic use (all P < 0.05). Logistic regression analysis results showed that residing in the western region (odds ratio [OR] = 0.407, 95% CI: 0.324-0.510), probiotic use (OR = 0.69, 95% CI: 0.560-0.847), gestational age at birth (OR = 0.914, 95% CI: 0.837-0.998), and the duration of exclusive breastfeeding > 4 months (OR = 0.75, 95% CI: 0.595-0.946) were significant factors influencing the occurrence of FGIDs (all P < 0.05).

Conclusion: FGIDs are highly prevalent among infants aged 0-9 months with gastrointestinal symptoms in China. Their occurrence is linked to geographic region, probiotic use, gestational age, and breastfeeding duration. Future studies should focus on whether improved feeding guidance and breastfeeding promotion can help prevent FGIDs.

Objective: To analyze the distribution characteristics and drug resistance of bacterial pathogens in children with community-acquired pneumonia (CAP) in a single center, and to provide evidence for clinical diagnosis and treatment.

Methods: A total of 2850 children with CAP admitted to the Department of Pediatrics of a tertiary hospital in Sichuan between January 2022 and December 2024 were enrolled. Clinical data, sputum culture and bacterial drug sensitivity results, and respiratory pathogen nucleic acid testing results were collected. A retrospective analysis was conducted on the clinical data, etiological testing results, and drug sensitivity data.

Results: Among the 2850 CAP children, the overall pathogen positivity rate was 73.4% (2093/2850), with viral, bacterial, and Mycoplasma pneumoniae/Chlamydia pneumoniae infections accounting for 33.6% (958/2850), 32.6% (929/2850), and 24.7% (703/2850), respectively. The predominant bacterial pathogens identified were Haemophilus influenzae (38.8%), Streptococcus pneumoniae (29.7%), Moraxella catarrhalis (21.4%), and Staphylococcus aureus (10.1%). Multivariable logistic regression analysis (Bonferroni-corrected) revealed that age was an independent risk factor for bacterial infection, although the risk profile varied by bacterial species. The risk of Staphylococcus aureus infection was highest during infancy (infancy adjusted odds ratio [aOR] = 1) and was significantly lower among the school-age children (aOR = 0.09, 95% CI: 0.02-0.52). The risk of Streptococcus pneumoniae infection peaked in the preschool children (aOR = 2.66, 95% CI: 1.75-4.05), followed by school-age children (aOR = 2.60, 95% CI: 1.48-4.57) and toddlers (aOR = 1.90, 95% CI: 1.26-2.87). The risk of Moraxella catarrhalis infection significantly decreased in school-age children (aOR = 0.24, 95% CI: 0.08-0.69). Antimicrobial susceptibility testing demonstrated that the resistance rates of Haemophilus influenzae and Moraxella catarrhalis to ampicillin were 75.45% and 41.53%, respectively. The resistance rate of Streptococcus pneumoniae to erythromycin was 93.75%, while that of Staphylococcus aureus to penicillin was 83.33%.

Conclusion: In this pediatric CAP cohort, the main bacterial pathogens are Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, and Staphylococcus aureus. The distribution of bacterial pathogens exhibits distinct age-specific characteristics.

Objective: To investigate the metabolic characteristics of gouty arthritis (GA) with dampness syndrome (GA-DS), to identify potential diagnostic and recurrence-predictive biomarkers, and to preliminarily elucidate the underlying mechanisms of the effect of traditional Chinese medicine (TCM) dampness syndrome on metabolic abnormalities in patients with gout.

Methods: The study was conducted as part of a clinical trial-Clinical Cohort Construction and Efficacy Evaluation of Gouty Arthritis With Dampness Syndrome, which has been registered in the Chinese Clinical Trial Registry (ChiCTR) and assigned the registration number of ChiCTR2000038969. Healthy controls (HC), patients with GA-DS, and those with GA with non-dampness syndrome (GA-NDS) were enrolled. Clinical assessments of metabolic and inflammatory parameters were performed, and targeted metabolomic profiling of plasma samples was conducted. Diagnostic and recurrence prediction models were constructed using random forest and logistic regression, and the efficacy of the recurrence model was validated in an independent cohort.

Results: GA-DS patients exhibited significant metabolic disturbances, with significantly elevated levels of body mass index (BMI), serum uric acid (SUA), and lipid metabolism indicators. Metabolomic analysis revealed significantly elevated plasma acetovanillone and cyclic adenosine monophosphate (cAMP) in the GA-DS group compared with those in the HC and GA-NDS groups (all q < 0.05). These two metabolites were significantly correlated with SUA and the inflammatory marker C-reactive protein levels (r = 0.50 and r = 0.48, respectively; both P < 0.05). A logistic regression model based on acetovanillone and cAMP effectively distinguished GA-DS patients from HC and GA-NDS patients (out-of-bag error: 0.158 ± 0.038; accuracy: [84.2 ± 6.6]%; adjusted P < 0.001 for both indicators vs. those of the other models). Further analysis showed that cAMP and ureidosuccinic acid levels increased in patients who later experienced GA recurrence (P < 0.05), with detectable changes as early as 24 weeks before recurrence. A recurrence prediction model combining cAMP and creatine kinase-MB (CK-MB) achieved the best performance and was validated in an independent cohort (accuracy: 67.39%, 95% CI: 52.0%-80.5%; area under the curve [AUC] = 0.803, 95% CI: 0.676-0.930).

Conclusion: GA-DS patients display distinct metabolic abnormalities. Acetovanillone and cAMP hold promise as diagnostic biomarkers, while cAMP in combination with CK-MB can be used for the early prediction of the risk of GA-DS recurrence. These findings provide novel insights into the metabolic basis of TCM dampness syndrome and offer potential biomarkers for early diagnosis and stratification of recurrence risk in GA.

Objective: To investigate the clinical phenotypes and genotypic characteristics of Chinese patients with Coffin-Lowry syndrome.

Methods: The clinical data and genetic test results of a family with Coffin-Lowry syndrome were retrospectively analyzed. A literature review was conducted to summarize the clinical characteristics and gene mutation characteristics of patients with Coffin-Lowry syndrome in China.

Results: The proband was a 1-year-old boy with distinctive facial features, puffy but tapered fingers, hypotonia, growth retardation, and delayed cognitive and motor development. Genetic analysis revealed a hemizygous c.1603-2A>G mutation in intron 17 of the RPS6KA3 gene in the proband. His mother was a heterozygous carrier. The identified mutation has not been reported previously. The proband's maternal half-brother and half-sister also exhibited similar clinical manifestations and were diagnosed with Coffin-Lowry syndrome together with the proband. The proband was followed up until 3 years and 8 months old, by which time he was not capable of walking steadily independently or speech. Including the 4 members of this family, a total of 28 Chinese patients were identified. Their clinical manifestations included special facial features (100%), cognitive and language/motor developmental delays (92.6%), hypotonia (95.2%), tapered fingers (88.5%), and scoliosis or kyphosis (45%). Genetic sequencing was performed in 24 patients, revealing missense mutations in 3 cases (12.5%), frameshift mutations in 5 cases (20.8%), nonsense mutations in 9 cases (37.5%), splice-site mutations in 4 cases (16.7%), and exon deletions in 2 cases (8.3%). No mutation hotspots were identified.

Conclusion: Coffin-Lowry syndrome should be considered in children with cognitive and language/motor developmental delays, distinctive facial features, tapered fingers, and hypotonia. Genetic testing can assist with early diagnosis.

Focal segmental glomerulosclerosis (FSGS) is a refractory kidney disease that poses substantial clinical challenges. FSGS is primarily characterized by proteinuria and progressive loss of renal function. Its pathogenesis is complex and varied, involving immune-mediated injury, podocyte dysfunction, genetic factors, and changes in renal hemodynamics. According to pathologic features and etiology, FSGS can be classified into primary, hereditary, secondary, and undetermined-cause forms. Existing therapeutic strategies are mostly based on specific disease classifications and include the administration of hormones and drugs such as immunosuppressants, angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs). For drug-induced FSGS, the key measure is to discontinue the causative drug. On the other hand, for cases caused by hypertension and other factors, controlling blood pressure is a critical component of treatment. However, the effectiveness of current therapeutic strategies remains variable, and the relatively high rates of adverse effects and recurrence underscore the fact that they do not fully meet the clinical needs. Therefore, in-depth exploration and optimization of FSGS treatment strategies, along with the development of novel drugs with enhanced therapeutic efficacy and reduced risks of adverse effects and recurrence, have become the core direction of current renal disease research. With a deeper understanding of the pathogenesis of FSGS, new approaches such as immunomodulation, podocytoprotection, and genetic targeted interventions are emerging, which is expected to promote innovation in treatment modalities and improve prognosis and quality of life for patients. Against this background, this article reviews the status of existing treatments and outlines future directions for research and clinical practice, providing both theoretical basis and practical guidance for exploration in this field.

Dental stem cells (DSCs) are a type of adult stem cells derived from teeth and their surrounding tissues. DSCs have attracted significant attention in tooth and bone regeneration research due to their strong osteogenic/odontogenic differentiation potential. Recent studies have shown that lipid metabolism plays a crucial role in stem cell biological activities and may even serve as a key determinant of cell fate. However, the specific roles and regulatory mechanisms of lipid metabolism in the osteogenic/odontogenic differentiation of DSCs have not yet been systematically summarized or comprehensively elucidated. Based on the latest research advances, we systematically analyzed the changes in lipid metabolism during the osteogenic/odontogenic differentiation of DSCs and explored the key regulatory functions involved in this process, aiming to provide new perspectives on metabolic regulation and potential intervention strategies for regenerative medicine research.

Objective: To analyze the relationship between changes in platelet-activating factor (PAF), fibulin-3, and umbilical artery blood flow during late pregnancy in pregnant women with gestational hypertension (GH) and neonatal outcomes.

Methods: The data of 420 pregnant women with GH who underwent regular prenatal examinations and who delivered at our hospital between January 2020 and December 2024 were collected. The pregnant women were divided into a good outcome group (n = 319) and a poor outcome group (n = 101) according to the neonatal outcomes. Univariate and multivariate logistic regression analyses were performed to identify the risk factors of adverse neonatal outcomes, and a prediction model was constructed based on the results of risk factors analysis. The receiver operating characteristic (ROC) curve and the Hosmer-Lemeshow test were adopted to evaluate the discrimination ability and calibration ability of the model.

Results: Statistically significant differences were observed between the poor outcome group and the good outcome group in terms of age, pre-pregnancy body mass index (BMI), severe GH, PAF, fibulin-3, and umbilical artery blood flow parameters (ratio of peak systolic velocity to end-diastolic maximum velocity [S/D], pulsatility index [PI], and resistance index [RI]) (P < 0.05). Multivariate logistic regression analysis showed that elevated serum PAF, decreased fibulin-3, and increased umbilical artery S/D, PI, and RI were independent risk factors for adverse neonatal outcomes in pregnant women with GH ( P < 0.05). A prediction model was constructed based on the results of the multivariate analysis, and the model formula was manifested as Logit (P) = 1.364 × S/D + 4.199 × PI + 5.303 × RI + 0.534 × PAF (μg/L) － 0.229 × fibulin-3 (ng/mL) － 7.996. ROC curve analysis revealed that the area under the curve (AUC), sensitivity, and specificity of the model were 0.945 (95% CI: 0.923-0.898), 85.90%, and 89.10%, respectively. The Hosmer-Lemeshow goodness-of-fit test revealed χ ² = 12.538 and P = 0.129.

Conclusion: Changes in serum PAF, fibulin-3, and umbilical artery blood flow parameters in pregnant women with GH are associated with neonatal outcomes. Increased fibulin-3 is a protective factor, whereas decreased serum PAF level and decreased umbilical artery S/D, PI, and RI are risk factors. The prediction model based on fibulin-3, PAF, S/D, PI, and RI in this study demonstrates high clinical applicability and potential for broader use.