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Table of Content

    25 December 2018, Volume 39 Issue 12
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    Interaction between KLF5 and NFκB p50 promotes high glucoseinduced VSMCs inflammation
    ZHANG Manli1, ZHANG Manna2, TONG Fei1, WEN Jinkun3
    2018, 38(12):  1371-1375,1379.  doi:10.3969/j.issn.10073205.2018.12.003
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    ［Abstract］ Objective〖HTSS〗〓To explore whether Krüppellike factor 5（KLF5） was involved and the mechanism in high glucoseinduced inflammation in vascular smooth muscle cells(VSMCs).
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓VSMCs were cultured with different concentrations of glucose or treated with high glucose for various times, quantitative realtime polymerase chain reaction(qRTPCR) and Western blot were performed to examine the expression of tumor necrosis factorα(TNFα), KLF5 and NFκB p50. Endogenous KLF5 was knocked down by transfecting VSMCs with KLF5specific siRNA or nonspecific siRNA, and then treated the cells with or without high glucose, Western blot was performed to examine the expression of TNFα. VSMCs were cultured in medium containing 5.5 mmol/L or 25 mmol/L glucose. The cell lysates were immunoprecipitated With antiKLF5 or antiNFκB p50 antibody, and the resulting precipitates were analyzed by Western blot using antiNFκB p50 or antiKLF5 antibody.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓In mRNA and protein levels, high glucose increased the level of TNFα, KLF5 and NFκB p50 in a dose and timedependent manner in VSMCs（P＜005）. When knocked down endogenous KLF5, the results of Western blot suggested that high glucoseinduced TNFα expression was mediated by KLF5. The results of coimmunoprecipitation experiments showed that exposure of high glucose increased the interactions of KLF5 and NFκB p50.
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓KLF5 and NFκB p50 interactions induced by high glucose cooperatively induce proinflammatory gene expression.
    Effect of fasudil hydrochloride combined with butylphthalide soft capsules on treatment of acute cerebral infarction and serum level of MMP2 and MMP9#br#
    YIN Nan1， CHEN Hua2, DUAN Ruisheng1
    2018, 38(12):  1376-1379.  doi:10.3969/j.issn.10073205.2018.12.004
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    ［Abstract］ Objective〖HTSS〗〓To study the improvement of National Institute of Health Stroke Scale（NIHSS）score of fasudil hydrochloride injection combined with butylphthalide soft capsules in the 14 d treatment of acute cerebral infarction and the effect on the expression levels of matrix metalloproteinase2(MMP2) and matrix metalloproteinase9(MMP9)in serum.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Seventyeight patients with acute cerebral infarction were randomly divided into observation group and control group, 39 cases in each group. The control group was given conventional symptomatic treatment. On the basis of the control group, the observation group was iv administered with fasudil hydrochloride injection and po administered butylphthalide soft capsules. Both groups were treated for 14 consecutive days. The two groups were assessed with NIHSS for neurologic function and MMP2 and MMP9 levels before and after treatment were compared.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓After 14 days treatment, the total effective rate of the observation group were better than those of the control group, and the difference was significant between two groups(P＜005).The NIHSS scores and serum levels of MMP2 and MMP9 of two groups both significantly decreased after treatment(P＜005), and the indexes of the observation group decreased even more than those in the control group， the NIHSS scores and serum levels of MMP2 and MMP9 of the observation group were lower than that of the control group after treatment， presenting statistical significance(P＜005).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Fasudil hydrochloride injection combined with butylphthalide soft capsules can decrease the NIHSS score of patients with acute cerebral infarction，significantly downregulate the expression of MMP2 and MMP9 in serum. The mechanism may be related to inhibiting the inflammatory response, thereby reducing secondary brain injury after stroke.
    Effects of silver ion dressing combined with hydrogel therapy on diabetic foot patients and serum inflammatory factors#br#
    JIN Xiaoming1， HAN Sijia2， WU Yanxiang1*
    2018, 38(12):  1380-1383,1388.  doi:10.3969/j.issn.10073205.2018.12.005
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    ［Abstract］ Objective〖HTSS〗〓To explore the effects of silver ion dressing combined with hydrogel therapy on patients with diabetic foot and serum inflammatory factors.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 72 patients with the diabetic foot were collected and divided into the observation group(n=36) and the control group(n=36) randomly. The control group were given wet wound dressing combined with hydrogel, while the observation group were treated with silver ion dressing combined with hydrogel. The debridement time for diabetic foot ulcers, granulation tissue growth time, epithelial tissue formation time, the curative effects  and total effective rate, the lower extremity arterial disease score, vascular endothelial adhesion molecule1(VCAM1), tumor necrosis factorα(TNFα), interleukin6(IL6), C reactive protein(CRP) levels of two groups before and after treatment were compared.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓The debridement time, granulation tissue formation time and the granulation tissue growth time in the observation group were lower than the control group(P＜005). The total effective rate of the observation group was 91.7%, which was higher than the control group(72.2%)(P＜005). There was no significant difference between the two groups of the lower extremity arterial disease score before treatment(P＞005). After treatment, the lower extremity arterial disease score of the two groups was lower than pretreatment(P＜005), and the lower extremity arterial disease score in the observation group was lower than the control group(P＜005). There was no significant difference between two groups in VCAM1, 〖JP2〗TNFα, IL6 and CRP levels before treatment(P＞005). After treatment, the VCAM1, TNFα,〖JP〗 IL6 and CRP levels of the two groups were lower than pretreatment(P＜005), and the VCAM1, TNFα, IL6 and CRP levels in the observation group were lower than the control group(P＜005).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Compared with wet wound dressing, silver ion dressing combined with hydrogel therapy on the patients with diabetic foot could improve the clinical efficacy and the lower extremity arterial disease, which may be related to the clearance of serum inflammatory factors and worth extensive clinical application.
    Etiology and treatment effect of 485 children with short stature#br#
    WU Tao, DU Junwen, ZHANG Kun, REN Qiaohua, GUO Jingxia, ZHOU Shichao
    2018, 38(12):  1384-1388.  doi:10.3969/j.issn.10073205.2018.12.006
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    ［Abstract］ Objective〖HTSS〗〓To explore the etiology of dwarfism and observe the effect of recombinant human growth hormone on growth hormone deficiency(GHD) and idiopathic short stature(ISS).
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓The 485 cases of dwarfism were classified according to the etiology. The prepubertal GHD and ISS children were divided into the recombinant human growth hormone treatment group and the control group, and height, growth rate(GV) and height standard deviation score(HtSDS) were compared before and 3 months after treatment and 6 months after treatment. Bone age was compared before treatment and 6 months after treatment.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓Among the children with dwarfism, ISS had a maximum of 185 cases, followed by GHD 140 cases, and rare disease was found. In the GHD and ISS groups, the height of the treatment group increased gradually, the GV increased first and then decreased, and the HtDSD increased gradually. The changes of height, GV and HtDSD in the control group were not obvious. Height, GV and HtDSD in the treatment group were significantly higher than those in the control group.  There was statistically significant difference in interaction between groups, between time points and between groups(P＜005).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The causes of dwarfism in children were various, and ISS and GHD were more common.The application of recombinant human growth hormone in the early stage of patients with GHD and ISS can achieve catchup growth.
    TanshinoneⅡA induces apoptosis of CML cells by downregulation PKM2 expression#br#
    NIE Ziyuan1, ZHOU Jing2, YANG Gaoshan3, QIN Yan4*
    2018, 38(12):  1389-1393.  doi:10.3969/j.issn.10073205.2018.12.007
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    ［Abstract］ Objective〖HTSS〗〓To assess the TanshinoneⅡA antiproliferative effects on K562 cells in vitro, and investigate the underlying mechanisms.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓CCK8 method was used to detect the proliferation of the and AnnexinV/PI flow cytometry was used to detect the apoptosis rate. The expression of PKM2 mRNA was detected by RTqPCR. Western blot was used to detect the PKM2, PCNA and CleavedCaspase3 protein expression. The transfection efficiency of PKM2 overexpression vector was detected by Western blot and RTqPCR.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓TanshinoneⅡA significantly inhibited the proliferation of K562 cells in a dosedependent manner. TanshinoneⅡA also increased K562 cells apoptosis.  Tanshinone ⅡA downregulated PKM2 mRNA and protein expression in K562 cells. Tanshinone IIA also downregulated PCNA protein expression and upregulated CleavedCaspase3 expression.  Overexpresssion PKM2 reversed apoptosis induced by TanⅡA in K562 cells.
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Tanshinone Ⅱ A can inhibit the proliferation and induce apoptosis of K562 cells. It may be through downregulating the expression of PKM2 to influence the aerobic glycolysis in K562 cells to play its antileukemia role.
    Pathological classification and postoperative outcome in children with focal cortical dysplasiarelated refractory epilepsy  #br#
    DONG Changzheng, KANG Jinsheng, ZHAO Lei, ZHANG Bo, MA Wandong, LIU Xiaohui
    2018, 38(12):  1394-1397,1402.  doi:10.3969/j.issn.10073205.2018.12.008
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    ［Abstract］ Objective〖HTSS〗〓To investigate the pathological classification and postoperative outcome in children with refractory epilepsy induced by focal cortical dysplasia(FCD) and analyze the related factors affecting the surgical efficacy.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Eightysix children with refractory epilepsy undergoing surgery were selected. The excision specimens were classified according to the FCD classification criteria in 2011 International League Against Epilepsy(ILAE), and the postoperative outcome was also judged according to the ILAE Engel criteria.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓Pathological results of 86 patients: Simplex FCD 37 cases, of which the FCD Ⅰ 19 cases, FCD Ⅱ type 18 cases; Combining FCD(FCD Ⅲ type) in 49 cases. 86 patients with epilepsy in Engel grade I 57 cases, Engel Ⅱ level 16 cases, Engel Ⅲ level 10 cases, Engel level Ⅳ(3 cases). The total effective rate after operation was 66.3%, of which 20.9% was after FCD alone. The combined FCD is 45.3%. Compared with the group with poor prognosis, there were more patients in the group with good prognosis who had combined type FCD, epileptic focus located in temporal lobe, epileptic focus without adjacent functional area, positive cranial MRI, video eeg showing focal discharge and complete removal of epileptic focus(P＜005). The results of Logistic regression analysis showed that the range of eclampsia excision was an independent prognostic factor affecting the efficacy of pediatric refractory epilepsy surgery caused by FCD.
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Complete removal of intracranial epileptic foci is a key factor to improve the postoperative efficacy of children with refractory epilepsy caused by FCD.
    Neutrophil/lymphocyte ratio: a new indicator for predicting systemic inflammatory response syndrome after percutaneous nephrolithotomy for upper urinary tract calculi#br#
    SHI Jianguo, WANG Weining, WANG Lingjun, LI Chunwu, BAI Xinyu, CHEN Yudong
    2018, 38(12):  1398-1402.  doi:10.3969/j.issn.10073205.2018.12.009
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    〗［Abstract］ Objective〖HTSS〗〓To evaluate the risk factors of systemic inflammatory response syndrome(SIRS) after percutaneous nephrolithotomy for upper urinary calculi, and to evaluate the role of neutrophils/lymphocyte ratio in prediction of postoperative SIRS.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Three hundred and twentythree patients after percutaneous nephrolithotomy were divided into SIRS group and nonSIRS group according to whether SIRS occurred or not. The diabetes history, infectious stones, multichannel operation, positive rate of preoperative urine culture, NLR, hemoglobin content, albumin content, stone load and operation time were compared between the two groups. 
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓Among 323 patients, 48 had SIRS after operation. The incidence of diabetes history, infection stone history and perioperative blood transfusion history in SIRS group were higher than those in nonSIRS group. The stone load and NLR in SIRS group were higher than those in nonSIRS group(P＜005). Logistic regression showed that NLR(OR=8.886, P=0000) and infectious stones(OR=6.742, P=0000) were independent risk factors for SIRS after percutaneous nephroscopy. ROC curve analysis showed that the best cutoff point of NLR before operation was 2.31, the sensitivity was 72.9%, the specificity was 75.6%, and the area under curve was 80.8%.
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Preoperative NLR level can be used to predict the occurrence of SIRS after percutaneous nephrolithotomy. This index is simple and easy to measure, and its cost is low. It is a good index for predicting postoperative infection.
    A retrospective study comparing posterior malleolar fracture in trimalleolar fracture and tibial spiral fracture
    GUO Jialiang, DONG Tianhua, YIN Bing, YUWEN Peizhi, JI Chenni, ZHANG Yingze
    2018, 38(12):  1403-1406.  doi:10.3969/j.issn.10073205.2018.12.010
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    ［Abstract］〓Objective〖HTSS〗〓To compare the classification of posterior malleolar fracture in tibial spiral and trimalleolar fracture.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 156 patients were included in this research. 86 of them were trimalleolar fracture, and the other 71 patients were tibial spiral fracture combined with posterior malleolar fractures. The classification of fracture were identified preoperatively, and functional outcomes were also evaluated postoperatively.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓The fracture types in patients with trimalleolar fracture were more complicated.Compared with trimalleolar fracture, the patients with tibial spiral fracture combined with posterior malleolar fractureshad a shorterweighting time, higher American Orthopaedic Foot and Ankle Society(AOFAS) score, lower Visual Analogue Scale(VAS) score, dorsiflexionrestriction were smaller, and the differences were significant in two groups(P＜005).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓For patients with trimalleolar fracture, the prognosis was inferior than that of tibial spiral fracture, and more careful plan should be conducted to decrease relative complications before operation.
    Comparison of the efficacy of cold light whitening and inhome bleaching for dental fluorosis by the enamel adhesive binding#br#
    ZHAO Zengbo1， WANG Huimin2， CHEN Zhiyu3， LYU Bingjian2， LI Xiaona1， YANG Yuntian1*
    2018, 38(12):  1407-1410,1418.  doi:10.3969/j.issn.10073205.2018.12.011
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    ［Abstract］〓Objective〖HTSS〗〓To compare the recoloring effect of cold light whitening and inhome bleaching for dental fluorosis by the enamel adhesive binding.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓The 104 patients with moderate staining fluorosis were randomly divided into four groups:A,B, C and D, with 26 in each group, goup A cold light whitening+enamel adhesive, group B cold light whitening, group C inhome bleaching + enamel adhesive, group D inhome bleaching. After treatment, color change, tooth sensitivity and periodontal tissue stimulation were compared.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓After 3 months, the total effective rate of the four groups was 100.0%. After 12 months, group A is higher than group B,  group C is higher than group D, the difference is statistically significant(P＜005). There was no tooth sensitivity in group A and group C immediately after bleaching, 3 days after bleaching, 7 days, and 30 days. The sensitivity of teeth was higher in group B than in group A immediately after bleaching and 3 days after bleaching. The sensitivity of teeth was higher in group D than in group C immediately after bleaching and 3 days after bleaching, the difference is statistically significant(P＜005). There was no significant difference in tooth sensitivity rate 7 days and 30 days after bleaching in groups A and B, C and D(P＞005). There was no significant difference in gingival index in 4 groups after moderate fluorosis bleaching(P＞005).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The use of enamel adhesive can effectively reduce the chance of recoloration and the sensitivity of air stimulation after moderate dental fluorosis by cold light whitening and family whitening.
    Effect of bone morphogenetic protein2(BMP2) on periodontal regeneration after delayed replantation of avulsed tooth in rat#br#
    HU Tong1， YUAN Yingjiao2， LI Wenjin3， GUO Jiao4， CHEN Huizhen3*
    2018, 38(12):  1411-1414.  doi:10.3969/j.issn.10073205.2018.12.012
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    ［Abstract］ Objective〖HTSS〗〓To investigate the effect of bone morphogenetic protein2(BMP2) on periodontal regeneration after delayed replantation of avulsed tooth in rat.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Sixteen male Wistar rats weighed 250 to 300 g were randomly assigned to a control group(n=8) and experimental group(n=8). The teeth were extracted and airdried for 1 hour. The root canals were endodontically treated and the root apexes were sealed with glass ionomer. In experimental group, BMP2 paste is applied to root surface of each tooth and replanted in the original socket. Teeth in control group is replanted without any surface treatment. After 8 weeks of replantation, the bone segment from the replantation site is obtained, decalcified and evaluated histologically.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓There was no statistically significant difference regarding the cementum regeneration, replacement root resorption and inflammatory root resorption in both groups(P＞005).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The results indicate that the application of BMP2 may promote cementum regeneration and inhibit the inflammatory root resorption. However, the inhibitory effect was not significant in the delayed replantation of avulsed teeth.
    Influence of different treatment methods on the sealing effect of lightcuring pit and fissure sealant#br#
    LYU Bingjian1, MA Zhe2*, WANG Huimin1, ZHAO Zengbo3
    2018, 38(12):  1415-1418.  doi:10.3969/j.issn.10073205.2018.12.013
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    ［Abstract］ Objective〖HTSS〗〓To explore the effects of different ways of treating tooth surface on pit and fissure sealant.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Fortyeight isolated premolars were randomly divided into 4 groups(n=12): group A(cupshaped brush sealant technique+pit and fissure sealant), group B(enameloplasty sealant technique+pit and fissure sealant), group C(50 μm alumina oxide particles air abrasion+pit and fissure sealant), group D(27 μm alumina oxide particles air abrasion+pit and fissure sealant).The infiltration depth of the sealants were observed by stereomicroscope, and then the infiltration rate of sealants was calculated. Scanning electron microscope was used to observe the marginal adaptation and interface condition between pit and fissure sealant and tooth.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓The results of scanning electron microscopy and polarized light microscopy showed that the sealant in group B, group C and group D could infiltrate into the bottom of the fossa and no cavitation occurred. Osmotic pressure in group B, group C and group D was higher than that in group A, and the difference was statistically significant(P＜005).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Compared with traditional cupshaped brush pit and fissure sealant, 50 μm, 27 μm aluminum oxide particle air abrasion and enameloplasty sealant technique with highspeed tapered emery needle can effectively enhance the permeability of the sealants, etching technique and lightcured sealant can achieve a good fit and seal. In order to achieve a good seal, 27 μm particles air abrasion should be used to process the tooth with deeper pits and fissures or suspicious caries cases before pit and fissure sealant.
    Study on the correlation between different subtypes of emphysema and pulmonary function in chronic obstructive pulmonary disease#br#
    HE Li1, LIU Zhai1*, JIA Lizhuo2, MU Jiankui1, LI Zhu3, REN Qingyun1
    2018, 38(12):  1419-1423.  doi:10.3969/j.issn.10073205.2018.12.014
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    ［Abstract］〓Objective〖HTSS〗〓To explore the correlation between pulmonary emphysema and pulmonary function test(PFT) in different pathological types of chronic obstructive pulmonary disease(COPD).
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓The 42 patients with clinically confirmed COPD emphysema were selected. In the present study，pulmonary emphysema was divided into the following 2 subtypes according to MSCT feature: centrilobular emphysema(CLE) group(n=28)and panlobular emphysema(PLE)group(n=14). The percentage of lower attenuation voxel volume(LAV%) was automatically measured with quantitative analysis software which was pulmonary emphysema index for the total lung and each lobar. The forced expiratory volume in 1 second predicted(FEV1%), the ratio of forced expiratory volume in 1 second over forced vital capacity(FEV1/FVC) , the ratio of residual volume to total lung capacity ratio(RV/TLC) and percentage of the diffusing capacity for carbon monoxide per literof lung volume predicted value（DLco%） were measured using spirometer.The correlation between LAV% and PFT index were analyzed in 42 patients with emphysema.LAV% and PFT index were compared between different groups.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓LAV% of both lung and each lobar in CLE group was statistically lower than PLE group( P＜005)，and DLco% of both lung and each lobar in CLE group was statistical higher than PLE group(P＜005). There were no difference between CLE and PLE groups for FEV1%, FEV1/FVC and RV/TLC(P＞005) . LAV% of both lungs ，left lung，right lung and each lobar were negatively correlated with FEV1/FVC(P＜005）. Apart from right middle lobar，LAV% of both lungs，left lung，right lung and each lobar were negatively correlated with DLco%（P＜005）.
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓DLco% in CLE group was statistically higher than PLE group. LAV% were correlated with the PFT index. The subtype according to the CT features was helpful for the individualized treatment of pulmonary emphysema in COPD.
    Wholelesion ADC value histogram in the differentiation of malignant and benign lung lesions#br#
    ZHANG Ying， GENG Guang， HOU Zhihua*， LIU Yufang， WEI Han
    2018, 38(12):  1424-1427.  doi:10.3969/j.issn.10073205.2018.12.015
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    ［Abstract］ Objective〖HTSS〗〓To explore the value of the wholelesion apparent diffusion coefficient(ADC) value histogram of DWI examination in the differentiation of malignant and benign lung lesions, and choose the best diagnostic parameters.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓The 22 lung cancer and 17 benign lung lesions (including pneumonia and tuberculosis), which received lung biopsy or surgical operation and had pathology results were collected. Before treatment, all patients received lung DWI examination with 6 b values: b=0, 50, 150, 400, 600, 800 s/mm2. The wholelesion ADC value histogram and related parameters was calculated, including skewness, kurtosis, entropy, ADC mean value, ADC median value, lesion volume, ADC value standard deviation, and the 5 th, 10 th, 15 th, 30 th, 50 th, 70 th ,90 th ADC value percentile. And the differences between the 2 groups were compared.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓Lung cancer group parameters of ADC values histogram of skewness, kurtosis, mean, standard deviation, ADC50th, ADC70th, ADC90th were lower than lung benign lesions, the difference was statistically significant(P＜005).  Receiver operator characteristic curve(ROC) was plotted with ADC histogram parameters to calculate area under curve(AUC). The diagnostic efficacy of the ADC standard deviation was the highest. When the ADC standard deviation was 0.810(×10-3mm2 /s), the AUC was 0.789, the specificity was 94.1%, and the sensitivity was 68.2%. When ADC90th is 1.940(×10-3mm2/s), AUC is 0.785, specificity is 94.1%, and sensitivity is 54.5%.
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The wholelesion apparent diffusion coefficient(ADC) value histogram can be used in the differentiation of malignant and benign lung lesions. Among the parameters, ADC value standard deviation have the best diagnostic performance.
    Application and quality control of bedside chest DR in acute myocardial infarction
    ZHANG Xinqi1, ZHANG Yinfeng1, SONG Zhenhu1, WANG Ning1, GAO Yanhui2
    2018, 38(12):  1428-1432,1437.  doi:10.3969/j.issn.10073205.2018.12.016
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    ［Abstract］ Objective〖HTSS〗〓To investigate the application and quality control measures of bedside chest digital radiography(DR) in acute myocardial infarction.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 100 patients with acute myocardial infarction and  photographic parameters were equally divided into noquality control group and quality control group. The photographic parameters of the noquality control group were 93 kV/1.6 mAs, 88 kV/2 mAs, etc., randomly selected. Exposure in eupnea, the exposure field was set to the maximum, the flat panel detector was placed on the back including the chest, and the received image was simply processed. The quality control group, the exposure parameters of 79-81 kV/1 mAs, 84-85 kV/1 mAs, 88-89 kV/1 mAs and 93-96 kV/1 mAs were selected according to the lean, medium, fat and obese body types. The technology of adjusting and controlling ultrashort exposure time was used to improve the exposure mode. The patients were exposed in breathholding state after deep inhalation. The irradiation field was controlled reasonably. The detector plate was placed flat under the patient′s back. By optimizing and adjusting the parameters of image postprocessing, the best combination of parameters was found and the obtained image was postprocessed.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓The radiation doses received by patients of each body type in quality control group were significantly lower than those of the noquality control group. Especially lean patients receive the most radiation dose. The difference between the two groups was statistically significant(P＜005). The image quality of the quality control group was significantly higher than the noquality control group .The first film rate(scores 10) is 80.0%(40/50). The unqualified film is 0, while the noquality control group ,the first film rate(scores 10) is only 14.0%(7/50), the top quality film accounts for 24.0%(12/50), the unqualified film is 20.0%(10/50), The difference scores between the two groups was statistically significant(P＜005).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The two methods were compared, after quality control, the radiation dose of bedside chest DR in acute myocardial infarction disease was significantly reduced, and the image quality was greatly improved, should be applied widely.
    The correlation analysis between CT volume parameters and pulmonary function test in emphysematype chronic obstructive pulmonary disease patients
    LIU Zhai1, JIA Lizhuo2, HE Li1, REN Qingyun1*, LI Zhu3
    2018, 38(12):  1433-1437.  doi:10.3969/j.issn.10073205.2018.12.017
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    ［Abstract］〓Objective〖HTSS〗〓To analyze the relationship between percentages of low attenuation volume（LAV%） and pulmonary function test（PFT）， and to explore the diagnostic value of LAV%  in the quantitative emphysema assessment by using  computed tomography(CT) and the 3D Synapse software.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Thirtyone patients with emphysematype chronic obstructive pulmonary disease underwent CT examinations with a 64detectorrow CT scanner and pulmonary function tests. For the quantitative assessment, LAV% of whole lung, right lung, left lung, and each lobe were obtained using the 3D Synapse software. The relationship of LAV% and PFT parameters was analyzed. Then all the patients were divided into two groups on the basis of LAV%=15% ，which were the mild emphysema group(n=23) and the severe(n=8), LAV% in whole lung, right lung, left lung, and each lobe between the two group was compared.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓The LAV% of both lower lobes, left lung and whole lung were weakly, negatively correlated to airflow limitation parameter(ratio of FEV1  to forced vital capacity)(P＜005). LAV% of right lung, left lung, both upper lobes and whole lung showed highly negative correlations with diffusing capacity(P＜005), and LAV% of right middle and both lower lobes were moderate negative correlations with diffusing capacity(P＜005) . The LAV% of whole lung, right lung, left lung, and each lobe in patients with severe emphysematype COPD group  was larger than in mild emphysematype COPD group(P＜005).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓LAV% of the emphysematype COPD  was  correlated to pulmonary function test. The change of pulmonary function test can be reflected effectively by the LAV%.
    Effects of dexmedetomidine on inflammatory response, insulin resistance and myocardial injury caused by lower limb tourniquet surgery in diabetic patients#br#
    WANG Li， LIU Xiuye*，GUO Qiongmei， SUN Yuan
    2018, 38(12):  1438-1441,1446.  doi:10.3969/j.issn.10073205.2018.12.018
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    ［Abstract］〓Objective〖HTSS〗〓To investigate the effects of dexmedetomidine on inflammatory response, insulin resistance and myocardial injury caused by lower limb tourniquet surgery in diabetic patients.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓According to random data table method, a total of 60 diabetic patients who were accepted lower limb orthopedic surgery were divided into observation group and the control group, 30 cases in each group. In observation group，dexmedetomidine 1 μg/kg (initial dose) was given(15 min) after induction of anesthesia，followed by continuous infusion at 0.5 μg·kg-1·h-1, until the end of operation. The equal volume of normal saline was given instead of dexmedetomidine in the control group．Before the tourniquet(T0), after loose tourniquet 15 min(T1), after loose tourniquet 1 h(T2) and after loose tourniquet 12 h(T3), blood samples were collected for determination of tumor necrosis factor α(TNFα), interleukin 6(IL6), blood glucose and insulin, cardiac troponin I(cTnI) and phosphoric acid creatine kinase isoenzyme(CKMB) concentrations. The insulin sensitivity index(ISI) was obtained．
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓The concentration of TNFα、blood glucose and insulin in the two groups were firstly increased and then decreased, while the levels of IL6, cTnI and CKMB were gradually increased, all indexes of the observation group were lower than those of the control group, there were statistically significant differences between groups, time points and their interactions(P＜005). The SIS were gradually decreased in the two groups, and the observation group was higher than the control group, there were statistically significant differences between groups and time points(P＜005), while there was no significant difference between their interactions(P＞005).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Dexmedetomidine can reduce the inflammatory response, alleviate myocardial injury caused by lower limb tourniquet surgery, thus reducing blood glucose and insulin resistance in diabetic patients.
    Effects of dexmedetomidine and creatine phosphate sodium on postoperative delirium in elderly patients with radical resection of esophageal carcinoma#br#
    TONG Tong1, LIU Xiangdong2， WU Zhen1, SONG Zixian1, LIU Huaqin1*
    2018, 38(12):  1442-1446.  doi:10.3969/j.issn.10073205.2018.12.019
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    ［Abstract］〓Objective〖HTSS〗〓To investigate the effects of dexmedetomidine, creatine phosphate sodium and the combination of both on postoperative delirium in elderly patients with radical resection of esophageal carcinoma.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Eighty elderly patients who underwent selective esophageal carcinoma resection surgery were selected. All patients were divided into four groups randomly with the help of random number table.There were 20 individuals in each group.Patients in group C were given 20 mL NS within 10 minutes before induction of anesthesia; patients in group D were administered  dexmedetomidine(0.4 μg/kg), group P sodium phosphocreatine(4.0 g), and Group DP both of them at the same time within the same volume respectively. MiniMental State Examination(MMSE) scores were evaluated for every patient in all four groups on the day before surgery(T0) and 24 h after surgery(T3). Heart rate(HR) and systolic blood pressure(SBP) were recorded before the administration(T1) and after the administration(T2). A 4 ml of internal jugular vein blood sample was taken before  infusion of the experimental drug(T1) and 48 h after the surgery(T4) to determine the concentration of S100β protein. Visual Analogue Scale(VAS) scores were recorded at T3, T4 after surgery.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓At T1, there was not significant difference among all the four groups in HR and SBP（P>005). At T2, HR and BP of group D were lower than their counterparts at T1. At T2, HR and BP of group D were lower than their counterparts of group C, group P, and group DP, and the difference was significant(P< 0.05). At T0, there was not significant difference in MMSE scores of four groups（P>005). At T3, MMSE  of group C, group D, and group DP were lower,compared with the MMSE scores at T0. MMSE scores of group C, group D, and group DP were significant higher than that of group C, and moreover, MMSE scores of group DP was higher than that of group P, which were all significant with(P＜005).  At T0, there was not significant difference among four groups on S100β concentration（P>005). At T3, the S100β concentration were all higher than that in four groups at T0.At T3, the S100β concentration of group D, group P, and group DP were all lower than that of group C. And the S100β concentration of group DP was lower than that of group D and group P(P＜005). At T3 and T4, the VAS scores of group D and group DP were significant lower than that of group C with (P＜0.05).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Single use of dexmedetomidine or creatine phosphate sodium could decrease the prevalence of postoperative delirium in elderly patients with radial resection of esophageal carcinoma.Moreover, with the combination of both drugs, better results were observed.
    Application of dexmedetomidine in fasttrack anesthesia for children undergoing cardiac surgery with cardiopulmonary bypass#br#
    ZHOU Xiaohui, GUO Qiongmei, WANG Li, ZHANG Ze, WEI Yanyan, ZHOU Changhao*
    2018, 38(12):  1447-1450,1454.  doi:10.3969/j.issn.10073205.2018.12.020
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    ［Abstract］ Objective〖HTSS〗〓To observe the effect of dexmedetomidine on fasttrack anesthesia in children opening cardiac operation by cardiopulmonary bypass(CPB).
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 60 children patients undergoing opening cardiac operation by CPB,ASAⅡorⅢ, were randomized two groups. The 30 cases in group D were given dexmedetomidine fasttrack anesthesia. The 30 cases in groups C were conventional fasttrack anesthesia. Patients in group D were received an initial bolus dose of dexmedetomidine(1.0 μg/kg) over 15 min, immediately followed by a comtinuous infusion of 0.4 μg·kg-1·h-1 until the end of the operation. The same volume of normal saline was given in the group C. Heart rate, systolic blood pressure, diastolic blood pressue were measured before injection(T1), 10 min after administration(T2), after incision(T3), 5 min after sternum saw(T4), after CPB(T5), after ectubation(T6). The changes of cardiac troponin I(cTnI) and creatine kinaseMB(CKMB) were measured in T1, T5, T6. Dosage of sufentanil and rocuronium during operation 、mechanical ventilation time and hospital stay length were recorded.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓Heart rate, systolic blood pressure, diastolic blood pressue were decreased at T2-T6 in group D than in group C（P＜005）. CKMB and cTnI levels were decreased in group D compared to that in group C at T5, T6（P＜005）. The dosage of sufentanil and rocuronium in group D was lower than that in group C（P＜005）. Compared with group C, mechanical ventilation time and hospitalization time were significantly reduced in group D（P＜005）. 
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Dexmedetomidine can stabilize hemodynamics and protect cardiac function on fasttrack anesthesia in children opening cardiac operation by CPB, which is conducive to the recovery of children and reduces mechanical ventilation time and hospitalization time.
    The application of laryngeal mask  airway combined with bronchial blocker in myasthenia gravis patients undergoing thoracoscopic thymectomy#br#
    SONG Tieying， YANG Yanchao, WANG Hong, ZHANG Yuqiang, LIU Zhiqi
    2018, 38(12):  1451-1454.  doi:10.3969/j.issn.10073205.2018.12.021
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    ［Abstract］ Objective〖HTSS〗〓To  evaluate  the feasibility of application of  laryngeal  mask combined with bronchial  blocker  for  thoracoscopic thymectomy  in  myasthenia  gravis patients.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Sixteen patients with myasthenia gravis type Ⅰ or type ⅡA, scheduled for thoracoscopic thymectomy，were divided into endotracheal tube bronchial blocker group(group T) and laryngeal mask plus bronchial blocker group(group L)(n=8 each) using a random number table. Midazolam 0.04 mg/kg, sufentanil 0.3-0.4 μg/kg, propofol 1-2 mg/kg and cisatracurium 0.1 mg/kg were injected intravenously for induction of anesthesia. endotracheal tube with a bronchial blocker was intubated in group T, Patients in the group L was placed laryngeal mask followed by a bronchial blocker, and the accuracy was assessed by using a flexible fiberoptic bronchoscopy. Blood pressure and heart rate were recorded  before anesthesia induction and endotracheal intubation, and the different values(△BP and △HR) were calculated. The arterial blood samples 1ml were collected for blood gas analysis at 10 min after one lung ventilation. The partial pressure of oxygen(PaO2), partial pressure of carbon dioxide(PaCO2), and peak airway pressure(Ppeak) were recorded , and the dynamic compliance(Cdyn) was calculated. Intraoperative pulmonary collapse was observed. The patients were followed up 6 hours after operation to record whether there were complications such as sore throat, nausea and vomiting.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓Compared with groupT, the △BP and △HR were lower in group L（P＜005）. There were no significant differences between the two groups in PaO2, PaCO2, Ppeak,Cdyn,the quality of lung collapse, and the incidences of throat pain, nausea and vomiting(P＞005).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓laryngeal mask plus bronchial  blocker may be considered an alternative onelung ventilation technique, which can be used in thoracoscopic myasthenia gravis surgery.
    Relationship analysis of interleukin 4 rs2070874 gene polymorphism with H.pylori infection and susceptibility to gastric cancer#br#
    GUO Xin1, LI Yunting1, HAO Jihong1, BU Jingying2, LI Wei1
    2018, 38(12):  1455-1459.  doi:10.3969/j.issn.10073205.2018.12.022
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    ［Abstract］ Objective〖HTSS〗〓 To evaluate the relationship of interleukin4（IL4） rs2070874 gene polymorphism with H.pylori infection and susceptibility to gastric cancer in different groups of the Han nationality adults.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 311 subjects were recruited and divided into three groups: 105 H. pylori positive, 103 gastric cancer people, and 103 H. pylori negative. The peripheral venous bloods were extracted and direct sequencing method were used for IL4 rs2070874 gene polymorphism analysis. 
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓The main genotype of IL4 rs2070874 in H. pylori infection group was TT type, accounting for 55.24% of the total, TC type was the main genotype in gastric cancer group, accounting for 55.34% of the total, and TT type was the main genotype in noninfection group, accounting for 44.66% of the total. TC genotype in gastric cancer group was higher than that in H. pylori infection group and noninfection group, and the genotype distribution had significant difference(P＜001).But no significant difference was found between H. pylori positive and negative group. T was the high expression gene of this locus and no different frequency was founded in the three groups(P＞005). The C frequency of IL4rs2070874 in Han nationality adults was 0.3215.
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓IL4 rs2070874 gene polymorphism may be associated with gastric cancer susceptibility, but not with H. pylori infection, TC gene may increase the risk of gastric cancer.