ObjectiveTo investigate the association between the atherogenic index of plasma (AIP) during the third trimester and the prevalence of preeclampsia (PE) among Tibetan pregnant women residing in high-altitude regions. MethodsA retrospective cross-sectional study was conducted on singleton pregnancies admitted to Chaya County People’s Hospital, Changdu City, Xizang Autonomous Region, from January 2023 to May 2025. Participants were divided into PE or control groups according to established diagnostic criteria and further stratified into AIP tertiles: Q1 (AIP ≤ 0.79), Q2 (0.79 ＜ AIP ≤ 1.16), and Q3 (AIP ＞ 1.16). Baseline characteristics, laboratory parameters, and PE prevalence were compared across groups. Multivariable Logistic regression was employed to assess the association between AIP and PE, with restricted cubic splines used to characterize the dose–response relationship. ResultsCompared with controls, the PE group had significantly higher pre-delivery body mass index (pre-BMI), triglycerides (TG), serum uric acid (UA), blood urea nitrogen, serum creatinine, and AIP levels, along with elevated rates of cesarean section, low birth weight (LBW), neonatal asphyxia, and intrauterine fetal demise (all P ＜ 0.05); HDL-C levels and neonatal birth weight were significantly lower (both P ＜ 0.05). Across AIP tertiles, significant differences were observed in pre-BMI, residential altitude, hemoglobin, TG, LDL-C, HDL-C, UA, neonatal birth weight, and the incidence of PE, preterm birth, cesarean section, and macrosomia (all P ＜ 0.05). Trend analyses revealed that as AIP increased, pre-BMI, TG, LDL-C, UA, neonatal birth weight, and the incidences of PE, cesarean section, and macrosomia rose progressively, whereas residential altitude, hemoglobin, HDL-C, and the incidence of preterm birth declined (all P ＜ 0.05). Multivariable logistic regression demonstrated a positive association between AIP and PE prevalence (OR = 2.97, 95% CI: 1.44-6.15, P = 0.003), with a significant dose–response relationship (P for trend ＜ 0.05). Restricted cubic spline analysis confirmed a linear association (P for non-linearity = 0.795). Conclusion Among Tibetan women with singleton pregnancies in high-altitude regions, AIP during the third trimester is positively and linearly associated with PE prevalence, providing a practical reference for perinatal metabolic management in this population.
Objective To investigate the relationship between diaphragmatic dysfunction and postoperative pulmonary complications (PPCs) following thoracoscopic lung resection, and to assess the value of postoperative diaphragmatic excursion (DE) measured during quiet breathing in the early identification of PPCs. Methods This was a single-center, exploratory study conducted at Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University from April to December, 2024. Patients undergoing thoracoscopic lung resection were enrolled and divided into a PPCs group and a non-PPCs group based on the occurrence of postoperative pulmonary complications. General patient information, comorbidities, surgical data, lung ultrasound (LUS) scores, and diaphragmatic ultrasound parameters were collected. The diaphragmatic ultrasound parameters included diaphragmatic thickening fraction (DTF) and diaphragmatic excursion (DE) measured on the first postoperative day, and ipsilateral diaphragmatic parameters were derived according to the surgical side. Postoperative ipsilateral diaphragmatic ultrasound variables were compared between the PPCs and non-PPCs groups. Least absolute shrinkage and selection operator (LASSO) regression was used to screen for variables associated with PPCs, and a multivariate model was then established using Firth logistic regression. Receiver operating characteristic (ROC) curves were employed to evaluate the predictive performance of postoperative ipsilateral DE during quiet breathing for PPCs. Results A total of 117 patients were enrolled, of whom 21 (17.9%) developed PPCs within 30 days postoperatively. In patients with PPCs, the ipsilateral DE on the first postoperative day was 0.91 (0.84, 1.12) cm, lower than 1.20 (1.03, 1.41) cm in those without PPCs (P ＜ 0.001). LASSO regression identified six candidate variables associated with PPCs: hypertension, wedge resection, postoperative LUS score, first-postoperative-day DTF, DE, and the decrease in DTF. Firth logistic regression revealed that wedge resection and first-postoperative-day DE were both associated with a decreased risk of PPCs [OR = 0.227 (95% CI: 0.065–0.710, P = 0.010) and OR = 0.042 (95% CI: 0.002–0.436, P = 0.005), respectively]. ROC curve analysis showed that first-postoperative-day DE predicted PPCs with an AUC of 0.773 (95% CI: 0.657–0.890, P ＜ 0.001). The optimal cutoff value was 0.925 cm, yielding a sensitivity of 66.7%, a specificity of 89.6%, a positive predictive value of 58.3%, and a negative predictive value of 92.5%. Conclusion Ipsilateral diaphragmatic dysfunction after thoracoscopic lung resection is closely associated with PPCs, and postoperative ipsilateral DE serves as an important early identification indicator. Bedside diaphragmatic ultrasound monitoring facilitates early screening of high-risk patients.
Allergic rhinitis and asthma are common chronic inflammatory airway diseases, and allergic rhinitis frequently coexists with asthma, significantly impairing patients' quality of life and imposing a substantial economic burden. The 2024–2025 revision of Allergic Rhinitis and Its Impact on Asthma（ARIA）guidelines 2024–2025 revision adopts a patient-centered, digitally enabled, and artificial intelligence-assisted approach, following the Grading of Recommendations Assessment, Development and Evaluation framework to assess the quality of evidence and the strength of recommendations. This revision represents not only a methodological update but also marks the official transition of guidelines for the diagnosis and management of allergic rhinitis into the era of digitalization and intelligent healthcare. This article summarizes the key updates of the new guidelines and, in the context of clinical practice in China, discusses their implications for allergic rhinitis management while highlighting the future prospects of digital medicine and artificial intelligence.
Blood pressure management strategies after endovascular thrombectomy (EVT) in patients with acute ischemic stroke are a current research focus. Multiple randomized controlled trials, including ENCHANTED2/MT and OPTIMAL-BP, as well as meta-analyses, have consistently shown that the routine use of intensive blood pressure-lowering strategies after EVT does not improve 90-day functional outcomes in patients with acute ischemic stroke, and may even be harmful by aggravating hypoperfusion. This article systematically describes the pathophysiological basis of blood pressure management after EVT, including impaired cerebral blood flow autoregulation, reperfusion injury and futile reperfusion, and the compensatory role of collateral circulation. Through a systematic interpretation of key trials and their subgroup analyses, this article reveals heterogeneity in responses to blood pressure management among different subgroups. For example, patients with poor collateral circulation, intracranial atherosclerotic stenosis, or incomplete recanalization are more sensitive to hypoperfusion, and the harm caused by intensive blood pressure lowering is particularly significant. Based on the above evidence, this article proposes an individualized management pathway centered on rapid assessment, risk stratification, and dynamic adjustment. Patients are classified into three categories: hypoperfusion risk-dominant type, hyperperfusion risk-dominant type, and intermediate type, and a stratified management model with different initial targets is established. Future research should further focus on validation in specific subgroups, continuous monitoring technologies, and optimization of management quality.
ObjectiveTo evaluate the clinical efficacy and safety of moxibustion combined with immunotherapy in patients with advanced non-small cell lung cancer (NSCLC), based on the traditional Chinese medicine (TCM) theory of reinforcing healthy qi and eliminating pathogenic factors. MethodsSeventy patients with advanced NSCLC of the lung-spleen qi deficiency syndrome who were admitted to Nanchong Central Hospital from March 2025 to March 2026 were enrolled and divided by stratified randomization into a moxibustion group (immunotherapy combined with moxibustion, n = 35) and an immunotherapy group (immunotherapy alone, n = 35). In addition to tislelizumab immunotherapy, patients in the moxibustion group received moxibustion at Zusanli (ST36), Shenque (CV8), Guanyuan (CV4), and Qihai (CV6) five times per week for 9 weeks. Short-term objective efficacy, immune function indicators [proportions of CD3+, CD4+, and CD8+ T cells and the ratio of CD4+ T cells to CD8+ T cells (CD4+/CD8+)], TCM syndrome scores, and quality of life were compared between the two groups. ResultsAfter treatment, the proportions of CD3+ and CD4+ T cells and the CD4+/CD8+ ratio were higher in the moxibustion group than in the immunotherapy group (all P ＜ 0.05), whereas no statistically significant between-group difference was observed in the proportion of CD8+ T cells (P ＞ 0.05). The TCM syndrome score was lower in the moxibustion group than in the immunotherapy group, while the scores for functional dimensions and overall health status were higher (all P ＜ 0.05). The short-term disease control rate was higher in the moxibustion group (91%) than in the immunotherapy group (74%), with a statistically significant difference (P ＜ 0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P ＞ 0.05). ConclusionsMoxibustion combined with immunotherapy can enhance cellular immune function, alleviate the burden of TCM symptoms and signs, improve quality of life, and enhance short-term efficacy in patients with advanced NSCLC, with a favorable safety profile, demonstrating the synergistic advantages of the TCM principle of reinforcing healthy qi and eliminating pathogenic factors and immunotherapy.
