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Table of Content

    25 June 2020, Volume 41 Issue 6
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    The value of red blood cell distribution width combined with serum cystatin C in the early diagnosis of pulmonary hypertension secondary to chronic obstructive pulmonary disease#br#
    YUAN Sheng-fang1， SONG Ning2*， WANG Bu1， MA Shi-min2， ZHAO Jian-qing1
    2020, 41(6):  624-627,631.  doi:10.3969/j.issn.1007-3205.2020.06.002
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    Objective To explore the combined diagnostic value of red blood cell distribution width(RDW) and serum cystatin C(Cys-C) for pulmonary hypertension secondary to chronic obstructive pulmonary disease (COPD), and to provide new diagnostic indexes and methods for the early diagnosis of COPD secondary pulmonary hypertension.
    Methods A total of 122 patients with COPD were selected to measure the pulmonary arterial pressure by Doppler echocardiography (the systolic pressure of pulmonary artery>40 mmHg was pulmonary arterial pressure). The patients were divided into two groups: the normal group and the increased group. Taking 3-5 mL of venous blood from patients, ethylene diamine tetraacetic acid anticoagulation, RDW and Cys-C values were detected respectively, receiver operator characteristic curve (ROC curve) of RDW and Cys-C in diagnosing COPD secondary pulmonary hypertension was drawn, diagnostic value was calculated, and then the probability of RDW and Cys-C in diagnosing COPD secondary pulmonary hypertension was predicted by logistic regression. Finally, the ROC curve of RDW and Cys-C in COPD secondary pulmonary hypertension was drawn, and its diagnostic value was calculated.
    Results The AUC of RDW and Cys-C was 0.844 and 0.849 respectively. The sensitivity was 75.9% and 84.1% respectively, the specificity was 85.9% and 75.6% respectively, the AUC of RDW and Cys-C was 0.926, the sensitivity and specificity were 90.9% and 87.2%, respectively.
    Conclusion RDW and Cys-C have certain value in the diagnosis of COPD secondary pulmonary hypertension. The combination of RDW and Cys-C can improve the sensitivity and specificity of COPD secondary pulmonary hypertension diagnosis, and reduce the misdiagnosis rate and missed diagnosis rate.
    Observation of the therapeutic effect of oxitinib combined with craniocerebral radiotherapy on brain metastasis of lung cancer
     
    HOU Zhi-hua1， WEI Han2， WEI Hong-yan1， ZHANG Ying3*， LIU Xin-yan1， XIE Jin-yu1
    2020, 41(6):  628-631.  doi:10.3969/j.issn.1007-3205.2020.06.003
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    Objective To study the value and significance of oxitinib combined with radiotherapy in the treatment of brain metastasis of NSCLC.
    Methods Eighty patients with brain metastasis from non-small cell lung cancer were selected as the study object. The computer software was used to divide the patients into two groups. 40 patients who only received craniocerebral radiation therapy were set as the control group, and 40 patients who received combination of oxitinib and craniocerebral radiation therapy were set as the experimental group. The clinical efficacy, intracranial and extracranial progression free survival period, the expression level of antigen, carcinoembryonic antigen(CEA) and vascular endothelium growth factor(VEGF) were compared between two groups.
    Results The clinical effect of the experimental group was better than that of the control group, the objective remission rate and disease control rate were higher than that of the control group, and the intracranial and extracranial progression free survival period was longer than that of the control group(P＜0.05 or P＜0.01). After treatment, the expression level of CEA and VEGF between two groups was significantly lower than that before treatment, and the expression level of CEA and VEGF in the experimental group was significantly lower than that in the control group(P＜0.01).
    Conclusion The treatment of brain metastasis of NSCLC with oxitinib combined with craniocerebral radiotherapy can improve the clinical efficiency, reduce the expression level of CEA and VEGF, and prolong the survival period of patients. The effect is significant, which is worthy of clinical use.
    HERC2 promotes cardiomyocyte hypertrophy via activating PI3K-AKT pathway#br#
    GAO Wei-nian1, ZHAO Shu-guang1, GUO Na2, CHEN Zi-ying1*， ZHANG Wen-li1, YU Ding1
    2020, 41(6):  632-636.  doi:10.3969/j.issn.1007-3205.2020.06.004
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    Objective To investigate the roles and mechanism of HECT and RLD domain containing E3 ubiquitin protein ligase 2（HERC2） in cardiac hypertrophy.
    Methods The expression of hypertrophic genes and HERC2 were analyzed in the myocardial tissues from patients with hypertrophic cardiomyopathy and the controls by quantitative reverse transcription-polymerase chain reaction(qRT-PCR). Cardiac hypertrophy was induced in rat with angiotensin Ⅱ, and the expression of hypertrophic genes and HERC2 was analyzed. siRNA was used to knock down HERC2 in cardiomyocytes and cardiomyocyte hypertrophy was induced with angiotensin Ⅱ. Then, the cardiomyocyte size, expression of hypertrophic genes and activation of the phosphatidylinositol 3-kinase/AKT serine/threonine kinase(PI3K-AKT) signaling were analyzed.
    Results The expressions of HERC2 were significantly upregulated in the myocardial tissues of patients with hypertrophic cardiomyopathy compared with the controls. The overexpression of HERC2 was also observed in rat cardiac hypertrophy induced by angiotensin Ⅱ. Knockdown of HERC2 with siRNA repressed angiotensin Ⅱ-induced increase in cardiomyocyte size and expression of hypertrophic genes natriuretic peptide A, natriuretic peptide B and myosin heavy chain 7.
    Conclusion HERC2 is highly expressed in the process of cardiac hypertrophy. HERC2 can promote cardiac hypertrophy by regulating PI3K-Akt signaling pathway.
    An experimental study of covered stent combining with surgery in the treatment of head and neck cancer invading carotid artery in sheep model#br#
    ZHAO Zhen， LI Rui-cong， JING Shang-hua*
    2020, 41(6):  637-640,645.  doi:10.3969/j.issn.1007-3205.2020.06.005
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    Objective To investigate the feasibility of prepositioning covered stent in the carotid artery model of sheep and surgically removing the invaded carotid artery at the place where the invaded carotid artery was presumed to be.
    Methods The carotid artery of 10 healthy sheep was selected, and the stent was placed in the place where the carotid artery was supposed to be invaded through the common iliac artery. The carotid artery area covered by the stent was cut open, and part of the artery wall covered by the stent was removed. The bleeding and loosening of the stent were observed in the operation area. The consciousness and activity of experimental animals were recorded by observing whether there was bleeding, leakage, distortion, looseness and displacement of stent in the operation area.
    Results There was no local bleeding, except for one case where the stent was twisted after implantation, the remaining 9 stent grafts were successfully released, and the technical success rate was 90%. No complications occurred during the operation. The whole arterial wall covered by the stent graft was successfully removed during the operation, and the stent was well fixed during the operation. After the operation, the vital signs of the sheep were stable, without hemiplegia and limb movement disorders, and there was no bleeding or swelling in the covered stent area. The imaging equipment showed no bleeding and leakage in the operation area, and the stent remained stable in place, without distortion, loosening and displacement. At 12 hours after surgery, the area of the sheep's carotid artery stent graft was explored without bleeding or stent displacement. No postoperative dyskinesia, eating and behavioral abnormalities were observed in the sheep. The imaging equipment showed that the stent was placed stably, without loosening, twisting and displacement, and blood circulation was smooth. After 6 months of follow-up, the results of angiography showed that one case had thrombosis in the stent and the remaining 8 cases had no thrombosis. All sheep survived during follow-up without serious complications such as hemiplegia and vascular rupture.
    Conclusion The combination of covered stents and surgical treatment is one of the effective methods for head and neck cancer invading carotid artery.
    Study on the relationship between Down′s screening serum markers and gestational diabetes mellitus
    MI Dong-qing1， SONG Ge2*， ZHANG Jing1， ZHANG Jing1， SUN Dong-lan1， GAO Hong1
    2020, 41(6):  641-645.  doi:10.3969/j.issn.1007-3205.2020.06.006
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    Objective To explore the relationship between Down's screening serum markers and gestational diabetes mellitus(GDM).
    Methods The clinical data of 202 pregnant women(GDM group) and 337 normal pregnant women (control group) with GDM were analyzed retrospectively. The serum levels of human chorionic gonadotropin(β-HCG), pregnancy-associated plasma protein-A(PAPP-A) and alpha-fetal protein(AFP), β-HCG, unconjugated estriol(uE3) in 2 groups were compared. Logistic multivariate analysis was used to determine the influencing factors of GDM, and the working characteristic curve of subjects was used to analyze the predictive value of serum markers to GDM.
    Results The body mass index (BMI) in GDM group was higher than that in the control group, and the multiple of median(MoM) of PAPP-A in GDM group was lower than that in the control group(P＜0.01). Logistic regression analysis showed that BMI≥ 24, PAPP-A MoM<0.8 and β-HCG MoM≥1.5 in the first trimester were the influencing factors of GDM. ROC curve analysis showed that BMI and PAPP-A MoM predicted the areas of ROC in GDM were 0.664 and 0.687 respectively.
    Conclusion BMI in early pregnancy and the level of PAPP-A in serum are the influencing factors of GDM.
    Analysis of pathogens and prognosis of neonatal ventilator-associated pneumonia
    LIU Shao-xian, LIANG Zhong-xin, WANG Bao-ping
    2020, 41(6):  646-649.  doi:10.3969/j.issn.1007-3205.2020.06.007
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    Objective To investigate the drug resistance of pathogenic bacteria in neonatal ventilator-associated pneumonia ventilator associated pneumonia（VAP） and the effect of pathogenic bacteria on prognosis.
    Methods Sixty-five neonates with ventilator-associated pneumonia hospitalized in our hospital were divided into VAP group and 65 neonates who were hospitalized with mechanical ventilation but not complicated with VAP were selected as non-VAP group. The culture of endotracheal secretions and drug sensitivity test in VAP group were used to analyze the infection and short-term prognosis of pathogenic bacteria.
    Results Forty-nine strains of pathogenic bacteria were cultured from the secretion of 65 VAP newborns, and the results showed that all of them were Gram-negative bacteria. The proportion of species was 30.61% for Klebsiella pneumoniae, 28.57% for Escherichia coli, and 20.41% for Acinetobacter baumannii. The resistance of these three kinds of bacteria to cephalosporins and amikacin was 100% Antibiotics such as imipenem, ciprofloxacin are more sensitive. During intubation and every day after detection, the clinical pulmonary infection score of the two groups decreased gradually, and the VAP group was significantly higher than that of the non VAP group(P＜0.05); according to the results, the duration of mechanical ventilation, the length of hospitalization of NICU and the overall length of hospitalization in the VAP group were significantly longer than that in the non VAP group(P＜0.05), and the mortality of the former was significantly higher than that in the non VAP group(P＜0.05).
    Conclusion VAP newborns with drug-resistant bacteria infection, children in the treatment of anti infection will have poor efficacy, mechanical ventilation and more time needed for hospitalization, and the mortality rate of children also showed an increasing trend. In the actual diagnosis and treatment, it is necessary to give sensitive antibiotics according to the test results, control the drug resistance of pathogenic bacteria to a certain extent, and improve the cure rate.
    Study on Xpert MTB/RIF technology detection of different types of bone and joint tuberculosis specimens
    JIA Chen-guang, LIU Feng-sheng, YAO Xiao-wei， GAO Jian-guo, BAI Hong-zhong*
    2020, 41(6):  650-653,679.  doi:10.3969/j.issn.1007-3205.2020.06.008
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    Objective To compare the difference of rifampicin fluorescence quantitative nucleic acid amplification detection(Xpert MTB/RIF) technology in the detection of different types of specimens of bone and joint tuberculosis lesions.
    Methods A total of 245 patients with bone and joint tuberculosis were selected, and the pus(199 parts), cheese tissue(161 parts), granulation tissue(178 parts), and bone tissue(87 parts) in the lesion were obtained by surgery, and were respectively cultured with Mycobacterium tuberculosis Xpert MTB/RIF detection. The positive rates of 4 kinds of tissue samples were compared. The sensitivity and specificity of xpert MTB/RIF in the detection of bone and joint tuberculosis and rifampicin resistance gene were calculated.
    Results Among 245 patients, 112(45.71%) were positive for Mycobacterium tuberculosis culture, 213(P＜0.01) were positive for Mycobacterium tuberculosis culture in 625 samples. Among 245 patients, 128(52.24%) were positive for Xpert MTB/RIF, and 255(255) were positive for Xpert MTB/RIF in 625 samples. The positive rate of xpert MTB/RIF was higher in pus than in cheese than in granulation than in bone(P＜0.01). The positive rate of the two methods was 185 cases(75.51%). The positive rates of pus, granulation, cheese and bone were higher than that of Mycobacterium tuberculosis(P＜0.05 or P＜0.01). The sensitivity and specificity of Xpert MTB/RIF were 96.43%, 84.96%, 97.92% and 93.75% respectively.
    Conclusion To accurately diagnose osteoarticular tuberculosis and rifampicin resistance, it is necessary to collect as many specimens as possible, especially the pus in the focus. Xpert MTB/RIF technology is simple, rapid and accurate for the diagnosis of Mycobacterium tuberculosis infection and drug resistance.
    The research on the biological functions of miR-30c in osteosarcoma cells#br#
    SHU Li, JU Xiao-chen, CHAI Hao, YANG De-yong, SUN Rong-xin*
    2020, 41(6):  654-659.  doi:10.3969/j.issn.1007-3205.2020.06.009
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    Objective To investigate the potential biological functions of miR-30c in osteosarcoma(OS) cells.
    Methods RT-PCR was used to detect the expression of miR-30c in seven cell lines. The candidate cells were divided into 3 groups: the mock group, the negative group(NC) and miR-30c overexpression group(miR-30c mimic). Colony formation and CCK-8 assays were used to the detect the changes in cell proliferation after transfection. Flow cytometry was used to detect the effect of miR-30c on cell apoptosis in candidate OS cell. Transwell invasion and migration assays were conducted to assess the effects of miR-30c on cell metastasis capabilities in vitro after transfection. Subcutaneous tumor formation assay in nude mice was used to confirm the effect of miR-30c on OS cell proliferation in vivo.
    Results The expression of miR-30c in U2OS, Saos2, Mg63, HuO9, KIKU, 143B cell lines were significantly lower than in hFOB1.19 while U2OS cells have the biggest fold changes with hFOB1.19(P＜0.05). The miR-30c mimic group had fewer cell clones than the mock group and NC group(P＜0.05). The cell proliferation ability of each group showed an increasing trend, the cell proliferation ability of miR-30c mimic group was significantly lower than the other groups, which had statistically significant differences in interactions between groups, time points and group·time points(P＜0.05). The apoptosis rate of U2OS cells in the miR-30c mimic was significantly higher than that in the mock group and NC group(P＜0.05). The capacity of cell invasion and migration were significantly suppressed in U2OS after transfection with miR-30c mimics when compared with NC group(P＜0.05). After 4 weeks of subcutaneous tumor implantation in nude mice, the volume and weight of transplanted tumors in miR-30c mimic group were significantly smaller than those in mock group and NC group(P＜0.05).
    Conclusion miR-30c may be involved in the proliferation and metastasis of U2OS as a tumor suppressor gene.
    The feasibility analysis of the manual measurement of the tibial tuberosity-trochlear groove distance in the patient with patellar instability by modified single image method#br#
    ZHANG He1， CAO Cheng-ming2， LAN Zhi-heng1， ZHAO Zhi-guang1， LIU Wei1， HAN Shou-jiang1*
    2020, 41(6):  660-664.  doi:10.3969/j.issn.1007-3205.2020.06.010
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    Objective To discuss the feasibility of manual measurement of the tibial tuberosity-trochlear groove(TT-TG) distance in the patient with patellar instability by modified single image method.
    Methods Thirty cases patients with patellar instability were selected. Senior surgeons A and B measured the TT-TG distance of patients with patellar instability by modified single-image method and compared with senior radiologist C who measured the TT-TG distance of patients with patellar instability by double-image method.The Cronbach′s alpha coefficient was used to evaluate the reliability of the results.The intraclass correlation coefficient was used to evaluate the repeatability of the results.The Bland-Altman analysis diagram was used to evaluate the consistency of the results.
    Results Senior surgeons A and B who measured the TT-TG distance of patients with patellar instability by modified single-image method compared with senior radiologist C who measured the TT-TG distance of patients with patellar instability by double-image method: Cronbach′s alpha coefficients were 0.913 and 0.959, respectively.The intragroup correlation coefficients were 0.913 and 0.958, respectively. The Bland-Altman analysis diagrams showed that the mean of TT-TG distance D-value(mm) was -0.276(95% CI：-3.526-2.974) and 0.143 (95% CI：-3.110-3.397). Senior surgeons A and B used the modified method to measure TT-TG distance manually in patellar instability patients.The Cronbach′s alpha coefficient was 0.891. The intragroup correlation coefficient was 0.891. 〖JP2〗The Bland-Altman analysis showed that the mean of TT-TG distance difference(mm) was -0.276 (95% CI：〖JP〗-3.526-2.974).
    Conclusion The modified single image method is simple to measure TT-TG distance manually in patients with patellar instability. It can accurately measure TT-TG distance in patients with patellar instability. This method and double image method can be used interchangeably.
    Therapeutic effect of calcaneal fractures with minimally invasive closed fixation and traditional open reduction fixation
    LIU Ming, QIAN Yu-hang, YIN Yu, ZHOU Yong, WANG Yi-bing, BU Jian-li*
    2020, 41(6):  665-669.  doi:10.3969/j.issn.1007-3205.2020.06.011
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    Objective To study the efficacy of minimally invasive closed fixation and traditional open internal fixation intraarticular calcaneal fractures. A new reference standard for determining the reduction of calcaneal fractures is proposed.
    Methods Retrospective analysis of 58 cases of Sanders Ⅱ calcaneal fractures admitted to our hospital, and they randomly divided into 29 cases in the control group and 29 cases in the observation group. The control group was the traditional lateral Ⅰ-incision reduction and internal fixation of the calcaneus. The observation group was closed reset internal fixation with minimally invasive percutaneous priming. Surgical time, intraoperative bleeding, hospital expenses, incision complications, Bhler and Gissane angles, tibia and arc, fixed operation time in secondary extraction, etc were compared.
    Results The observation group was superior to the control group in the time of operation, the amount of bleeding during surgery, the complication of incision, the cost of hospitalization, the fixed time of surgery, the amount of bleeding during surgery, and the cost of hospitalization(P＜0.05). With a well-reduced calcaneal fracture, the connection between the highest point of the posterior edge of the tibia, the highest point of the posterior edge of the talus, and the highest point of the posterior edge of the calcaneus was a smooth arc, and the curvature of the arc tangent to the highest point of the posterior edge of the talus is roughly the same as that of the healthy side.
    Conclusion The efficacy of minimally invasive closed fixation and traditional open internal fixation in the treatment of calcaneal fractures is true.  However, minimally invasive closed internal fixation can greatly reduce surgical time, intraoperative hemorrhage, incision complications, hospitalization costs, and secondary extraction internal fixation time, intraoperative hemorrhage, and hospitalization costs. It is worth clinical application. The tibial distance and arc lines have reference value to the reduction of calcaneal fractures.
    Effects of L-carnitine combined with ultrapure dialysis on cardiac function and expression of irisin and s-Klotho in peripheral blood of MHD patients#br#
    SONG Yan-fang1, WU Sheng-li2
    2020, 41(6):  670-675.  doi:10.3969/j.issn.1007-3205.2020.06.012
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    Objective To explore the therapeutic effect of levocarnitine combined with ultrapure dialysis on maintenance hemodialysis(MHD) patients and its effect on cardiac function and expression of irisin and Klotho protein(s-Klotho) in peripheral blood.
    Methods A total of 186 MHD patients were divided into observation group and control group according to different treatment methods. The patients in the control group were given routine dialysis treatment, while those in the observation group were treated with levocarnitine combined with ultrapure dialysis. After 3 months, the quality of life, inflammatory factors, oxidative stress index, cardiac function, irisin and s-Klotho concentrations and complications were observed.
    Results After treatment, the scores of SF-36 in the two groups were significantly higher than those before treatment, and the scores of SF-36 in the observation group were higher than those in the control group(P＜0.05); the levels of interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) and C-reactive protein(CRP) in the two groups were significantly lower than those before the treatment(P＜0.01), and the levels of IL-6, TNF-α and CRP in the observation group were lower than those in the control group(P＜0.05 or P＜0.01); the levels of SOD, MDA and GSH-Px in the two groups were significantly lower than before the treatment(P＜0.01), and the levels of SOD, MDA and GSH-Px in the observation group were significantly lower than those in the control group(P＜0.01). The levels of cardiac output(CO) and left ventricular ejection fraction(LVEF) in the two groups were significantly higher than those before treatment, and the levels of CO and LVEF in the observation group were significantly higher than those in the control group(P＜0.01), the levels of irisin and s-Klotho in the two groups were significantly higher than those before the treatment(P＜0.01), and the level of irisin and s-Klotho in the observation group was significantly higher than that in the control group(P＜0.01). The incidence of complications in the observation group was significantly lower than that in the control group(P＜0.01).
    Conclusion Levocarnitine combined with ultrapure dialysis can significantly improve the inflammatory state and oxidative stress of MHD patients, improve their cardiac function, and reduce the expression of irisin and s-Klotho in peripheral blood.

    Effects of platelet transfusion on the level of serum MMP-9, MMP-2 and VEGF levels in patients with advanced lung cancer
    HAN Li-na1, SUN Nan1, WANG Shan1, ZHAO Sha2, ZHOU Xin-liang3, ZHAO Xue-tao1*
    2020, 41(6):  676-679.  doi:10.3969/j.issn.1007-3205.2020.06.013
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    Objective To investigate the effects of platelet infusion on serum matrix metalloproteinase 9(MMP-9), Matrix metalloproteinase 2(MMP-2) and vascular endothelial growth factor(VEGF) levels in patients with advanced lung cancer, and to observe whether the platelets injected can promote the metastasis of advanced lung cancer.
    Methods A total of 89 patients with advanced lung cancer who received platelet infusion were selected. They are divided into the effective group and the ineffective group according to whether platelet infusion was effective(CCI>7.5 was effective). The serum levels of MMP-9, MMP-2 and VEGF in the two groups were compared before and after platelet infusion(12-24 h).
    Results The effective rate of platelet infusion was 80.90%(72/89).After platelet infusion, the serum levels of MMP-9, MMP-2 and VEGF in the effective group were significantly higher than those in the ineffective group, and the serum levels of MMP-9, MMP-2 and VEGF in the effective group were higher than those before platelet infusion, and all the differences were statistically significant(P＜0.05).
    Conclusion The effective infusion of platelets can increase the levels of serum MMP-9, MMP-2, and VEGF in patients with advanced lung cancer, which may promote the invasion and metastasis of lung cancer, suggesting that platelets should be injected into lung cancer patients more carefully.
    Efficacy of different atomization methods combined with vibration sputum elimination device in the treatment of elderly patients with lower respiratory tract infection#br#
    HE Xiao-jiao
    2020, 41(6):  680-685.  doi:10.3969/j.issn.1007-3205.2020.06.014
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    Objective To study the Efficacy of different atomization methods combined with vibration sputum elimination device in the treatment of elderly patients with lower respiratory tract infection.
    Methods One hundred and twenty cases of elderly patients with lower respiratory tract infection were selected as the research object. They were divided into 4 groups according to the random number table method, 30 cases in each group. The basic treatment group was treated with vibration expectorant on the basis of basic treatment, the ultrasonic atomizer group was treated with ultrasonic atomizer on the basis of basic treatment, the oxygen atomizer group was treated with oxygen atomizer on the basis of basic treatment, and the pressure atomizer group was treated with pressure atomizer group B was treated with pressure atomization on the basis of the basic treatment group for 7 days. The differences of physiological indexes, blood gas indexes, lung function, 24 hour sputum discharge and adverse reactions were observed before and after the treatment.
    Results There was no significant difference in heart rate, respiratory rate and blood oxygen saturation among the four groups(P＞0.05). After 7 days of treatment, there was no significant difference in heart rate, respiratory rate and blood oxygen saturation among the four groups(P＞0.05). After 7 days of treatment, arterial partial pressure of oxygen(PaO2) of the four groups was higher than that before treatment, and arterial blood carbon dioxide partial pressure(PaCO2) was lower(P＜0.01). After 7 days of treatment, PaO2 of the ultrasonic atomizer group, oxygen atomizer group and pressure atomizer group were higher than that of the basic treatment group, PaO2 of the oxygen atomizer group and pressure atomizer group were higher than that of the ultrasonic atomizer group, PaO2 of the oxygen atomizer group was lower than that of the ultrasonic atomizer group, PaO2 of the pressure atomizer group was lower than that of the oxygen atomizer group, and PaO2 of the oxygen atomizer group was higher than that of the oxygen atomizer group(P＜0.01)）. After 7 days of treatment, forced expiratory volume in one second(FEV1%), forced expiratory volume in one second/forced vital capacity(FEV1/FVC) and peak expiratory flow(PEF) of the four groups were significantly higher than those before treatment(P＜0.01). After 7 days of treatment, FEV1, FEV1/FVC and PEF in the ultrasonic atomization group, oxygen atomization group and pressure atomization group were higher than those in the basic treatment group, FEV1, FEV1 / FVC and PEF in the oxygen atomization group and pressure atomization group were higher than those in the ultrasonic atomization group, FEV1, FEV1 / FVC and PEF in the pressure atomization group were lower than those in the oxygen atomization group, the difference was statistically significant(P＜0.01). After 7 days of treatment, the amount of sputum excretion in the four groups increased significantly compared with that before treatment(P＜0.01). After 7 days of treatment, the sputum volume of ultrasonic atomization group, oxygen atomization group and pressure atomization group was more than that of basic treatment group. The sputum volume of oxygen atomization group and pressure atomization group was more than that of ultrasonic atomization group. The sputum volume of pressure atomization group was less than that of oxygen atomization group, the difference was statistically significant(P＜0.01). There were significant differences in adverse reactions(P＜0.01). The biggest adverse reaction rate was in the pressure atomization group.
    Conclusion Oxygen atomization therapy combined with expectorant therapy, the patient′s blood gas indicators and lung function indicators are significantly improved, the rate of adverse reactions are low, it is worth promoting in clinical.
    Study of real-time three-dimensional transthoracic combined intraoperative esophageal echocardiography in the follow-up of mitral valve disease#br#
    ZHANG She-fang, CHU Wen*, WANG Hua, ZHOU Ding-wen
    2020, 41(6):  686-689,708.  doi:10.3969/j.issn.1007-3205.2020.06.015
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    Objective To explore the application of real-time three-dimensional transthoracic echocardiography combined with intraoperative transesophageal ultrasound in patients with mitral valve disease.
    Methods Retrospective analysis with mitral valve parallel membrane disease mitral valve lesions (40 cases), of which 7 cases of children patients, 33 patients with adult, respectively in the preoperative and postoperative march into the group of patients after the left front diameter(LAAPD), left ventricular ejection fraction(LVEF), left ventricular end-diastolic diameter(LVEDD), left ventricular ejection fraction(LVEF) %, mitral valve lesions, and so on and so forth.
    Results Compared with the preoperative, and in patients with postoperative children before and after 3 months of left atrium diameter(LAAPD), left ventricular end-diastolic diameter (LVEDD) were significantly decreased, and only in patients with postoperative LVEF value increased significantly, the difference was statistically significant (P＜0.05), postoperative 3 months follow-up showed that when the children and the number of cases of postoperative mitral regurgitation in patients with preoperative significantly reduce the difference was statistically significant(P＜0.05),MR grade was positively correlated with surgical procedure.
    Conclusion Real-time three-dimensional transthoracic echocardiography combined with intraoperative esophageal ultrasound has the advantages of non-invasive, simple operation and time-saving, playing an extremely important value in the application of mitral valve disease, and can accurately display the location and degree of valvular disease and guide the selection of operative methods.
    Evaluation of ovarian reserve function in luteinized unruptured follicles by transvaginal three-dimensional ultrasound#br#
    ZHANG Zhi-feng1， LIU Yan-ge2， WU Ya-li1， TIAN Li-huan1
    2020, 41(6):  690-693,699.  doi:10.3969/j.issn.1007-3205.2020.06.016
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    Objective To analyze the value of three-dimensional vaginal ultrasound in evaluation of ovarian reserve function of patients with luteinized unruptured follicle syndrome.
    Methods One hundred infertile patients in our hospital were selected as the research objects. According to the relevant evaluation criteria, the patients who were diagnosed as luteinized unruptured follicle syndrome were taken as the research group（n=20）, and the other normal ovulated infertile patients were taken as the control group（n=80）. The endometrial thickness, six levels of serum sex stimulating hormone, ovarian blood flow parameters at the dominant side of each follicle and blood flow classification of mature follicles in the periovulation period were compared in the two groups.
    Results The difference of vascularization index（VI）, blood flow index（FI） and vascularized blood flow index（VFI） between inter group, time point and inter group·time point interaction were statistically significant(P＜0.01). The blood flow of mature follicles in the control group was 3-4 grades, and that in the study group was 1-2 grades. There was significant difference between two groups(P＜0.01).
    Conclusion Low blood flow and less neovascularization of mature follicles are the characteristics of blood flow perfusion in luteinized unruptured follicle syndrome. Transvaginal three-dimensional ultrasound is more conducive to early evaluation of ovarian reserve function, guiding clinical recognition and prediction of follicular dysplasia and early ovulation disorders.
    The diagnostic value of PCMRI basilar artery hemodynamic parameters in combination with serum PLGF and LDH in diagnosis of reversible posterior leukoencephalopathy syndrome in pregnant women with eclampsia#br#
    ZHANG Wan1, WANG Jiang-feng2*, LIU Hui1, XIU Bao-gang3, YANG Yong-kang4
    2020, 41(6):  694-699.  doi:10.3969/j.issn.1007-3205.2020.06.017
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    Objective To investigate the diagnostic value of phase contrast magnetic resonance imaging(PCMRI) combined with serum placental growth factor(PlGF) and lactate dehydrogenase(LDH) on the reversible posterior leukoencephalopathy syndrome(RPLS).
    Methods A total of 110 patients with preeclampsia(PE) in our hospital were selected as the study objects. All patients were scanned with conventional MR according to the results of conventional MRI, the patients were divided into two groups: normal group and RPLS group. At the same time, PCMRI was used to measure the hemodynamic parameters of basilar artery, and enzyme-linked immunosorbent assay(ELISA) was used, The level of PLGF and LDH in serum of the two groups were measured by ELISA, and the differences of laboratory test results, parameters of basilar artery hemodynamics, values of PLGF and LDH in serum were compared. The diagnostic value of basilar artery hemodynamics parameters combined with serum PlGF and LDH in PE patients with RPLS was determined by drawing ROC curve.
    Results No obvious lesions were found in the normal group. The results of conventional MRI in RPLS group showed that T1WI was slightly low signal or equal signal, T2WI and flair were high signal, and DWI sequence was slightly low signal or equal signal. The MF, MV and vascular cross-sectional area of BA in RPLS group were significantly higher than those in MRI group, while RI was significantly lower than that in MRI group(P＜0.01). In RPLS group, PLGF water was significantly lower than that in MRI normal group, and LDH was significantly higher than that in MRI normal group(P＜0.01). Spearman correlation analysis showed that BAMV, MF and LDH were positively correlated with SBE(r=0.71,0.67, 0.68， P＜0.01 ）, RI was negatively correlated with SBE score(r=- 0.65， P＜0.01 ）。 The area under the curve of pcmri blood flow parameters combined with vascular endothelial damage markers in the diagnosis of RPLS was zero point eight nine seven （95%CI：0.853-0.941）The corresponding sensitivity and specificity were 93.0%, 100.0%, which was obviously better than the independent detection of each index.
    Conclusion The BA blood flow parameters of RPLS and the changes of serum PlGF and LDH are closely related to the occurrence and development of the disease and the severity of brain edema. Imaging examination combined with serum index detection can improve the diagnostic specificity of the disease.
    Application of ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture for awake tracheal intubation in patients with cervical spinal cord injury
    CAI Wen-bo, YI Shuang-qiang, HAO Jian-hong, ZHANG Jie, DONG Bu-huai, LUO Zhen-guo*
    2020, 41(6):  700-703.  doi:10.3969/j.issn.1007-3205.2020.06.018
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    Objective To explore the efficacy of the ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture for awake tracheal intubation in patients with cervical spinal cord injury.
    Methods Eighty patients with cervical spinal cord injury scheduled for selective surgery under awake tracheal intubation were enrolled .The patients were randomly divided into two groups(n=40): control group and ultrasound group.Control group received superior laryngeal nerve block combined with cricothyroid membrane puncture using the acupoint-located method by anatomical landmark. Ultrasound group received ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture.The mean arterial pressure(MAP) and heart rate(HR) were recorded at the time of burglary (T0 ),before the endotracheal tube into the nasopharynx (T1 ), endotracheal tube into the glottis immediately(T2 ), 5 min after intubation (T3 ). The time of intubation, the success rate of intubation were recorded.The incidence of complications were also recorded,including cough,nausea and vomiting,and the tolerance degree of tube postoperative.
    Results The mean arterial pressure and heart rate of T1, T2 and T3 in the control group were significantly higher than T0(P＜0.05). There was no significant difference in the mean arterial pressure and heart rate of T1, T2 and T3 between two groups(P＞0.05). The incidence of choking in the ultrasound group was significantly lower than that in the control group(P＜0.05). The degree of tube resistance in the ultrasonic group was higher than that in the control group(P＜0.05).
    Conclusion Ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture can meet the needs of conscious tracheal intubation through nose, with stable hemodynamics and less adverse reactions.
    To explore the clinical significance of ABO, Rh blood type investigation and establishment of Rh phenotype library in safe blood transfusion#br#
    HU Mei-jing1,CHE Li-min2*, ZHANG Yan-bin1, YANG Jun-qing3
    2020, 41(6):  704-708.  doi:10.3969/j.issn.1007-3205.2020.06.019
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    Objective To investigate the distribution of ABO，RhD blood type in Fengfeng mining area of Handan City, Hebei Province, to analyze the results of irregular antibody screening, and to explore the clinical significance of ABO、 Rh blood type investigation and establishment of Rh phenotype bank in safe blood transfusion.
    Methods The results of ABO blood type and RhD blood type of 8 000 inpatients in our hospital were collected. The irregular antibody was detected in 5 000 patients who needed blood transfusion. The positive samples were further identified with antibody specificity. Three thousand bags of RhD positive filter red blood cell suspension were randomly selected to detect Rh phenotype, and the Rh phenotype database of blood donors was established by computer to explore its significance and value in blood transfusion.
    Results The distribution of ABO blood type in 8 000 patients was B blood(32.02%), O blood(28.98%), A blood(27.01%), AB blood(11.99%). There was significant difference in ABO blood type distribution among different age groups(P＜0.05), but there was no significant difference in ABO blood type distribution between different sex groups(P＞0.05). RHD was negative in 48 of 8 000 patients(0.60%). There was no significant difference in Rh blood type distribution between male and female(P＞0.05). Among the 5 000 blood samples of patients who needed blood transfusion, 30(0.60%) were positive for irregular antibody, 19(63.33%) were positive for Rh blood type system antibody, and the detection rate of anti-E was the highest. The detection rate of irregular antibody in female was significantly higher than that in male(P＜0.05). There were 8 Rh blood type phenotypes in 3 000 RhD positive blood donors, of which CCDee was the most frequently detected, followed by CcDEe，DcDEE and ccDee were less frequently detected.
    Conclusion The distribution of ABO blood type is related to region and age. In addition to irregular antibody screening before blood transfusion, the antibody specificity should be further tested. The establishment of Rh phenotype database of blood donors is conducive to prevent hemolytic blood transfusion reaction caused by Rh phenotype mismatch, which is of great significance for clinical safe blood transfusion.
    Tyrosine phosphatase SHP-2 specific inhibitor PHPS1 accelarate the progression of AS in apoE-deficient mice by promoting foam cell formation#br#
    MA Qian1, LU Yong-gang1， LI Xin-xin1, TAN He1, ZHU Xue-can2， TIE Yan-qing1*
    2020, 41(6):  709-714.  doi:10.3969/j.issn.1007-3205.2020.06.020
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    Objective To investigate the effects of Src Homology 2 Containing Protein Tyrosine Phosphatase 2(SHP2)specific inhibitor phenylhydrazonopyrazolonesulfonate1(PHPS1) on the progression of AS in apoE-/- mice.
    Methods Early AS model was constructed in 28 apoE-/- mice on 1.25% high-cholesterol feed for 4 weeks, and they were randomly divided into control group and PHPS1 group. The size and cell components of descending aorta plaques were observed to evaluate the changes in the contents of the signaling pathway, scavenger receptor(SR) protein and mRNA in the plaques. Oxidized low density lipoprotein(ox-LDL) and green fluorescent microspheres with or without PHPS1 intervened bone marrow-derived macrophage(BMDM)cells in 16 h, and observed green fluorescent deposition of the BMDM.
    Results The area of oil red O, the size of plaques and the content of macrophages in plaques in PHPS1 group were significantly increased compared with the control group, and the differences were statistically significant(P＜0.01). The green fluorescence intensity of macrophages in PHPS1 group was significantly higher than that in the control group(P＜0.01). The mRNA expression levels of cluster of differentiation 36(CD36) and scavenger receptorA1(SRA1) in PHPS1 group were significantly higher than those in the control group, and the differences were statistically significant(P＜0.01). Phosphorylated extracellular regulated kinases(p-ERK), phosphorylated phosphatidylinositol 3-kinase(p-PI3K) and phosphorylated protein kinase B(p-AKT) in the PHPS1 group were significantly higher than those in the control group.The differences were statistically significant(P＜0.01).
    Conclusion PHPS1 mainly affects the overexpression of SR through extracellular-regulated kinases and phosphatidylinositol 3-kinase/protein kinase B signaling pathways, thereby increasing the phagocytosis of ox-LDL by macrophages and ultimately promoting the formation of foam cells and the progression of AS.
    A comparative study of three different detection methods for Mycobacterium tuberculosis and drug-resistant mutations
    XUE Jian-chang1, DI Hong-qin2, WU Hai-feng1, ZHENG Hao3*, ZHENG Li-heng1, LIANG Bing-feng4
    2020, 41(6):  715-719.  doi:10.3969/j.issn.1007-3205.2020.06.021
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    Objective To evaluate the application value of three routine detection methods in the laboratory for the diagnosis of Mycobacterium tuberculosis(MTB) and drug-resistant mutations in patients with tuberculosis.
    Methods A retrospective study of 246 patients with tuberculosis who were positive for MTB was made. Gene Xpert MTB/RIF(Xpert method), BD960 liquid rapid culture method(BD960 method) combined with rapid drug sensitivity test(drug sensitivity test), and mycobacterial nucleic acid test(TB-DNA method) combined with MTB drug resistance gene test(DNA chip method) tests were performed to assess the detection of three MTB and drug-resistant mutations.
    Results The positive detection rate of MTB by BD960 method was lower than that of TB-DNA method and Xpert method, the difference was statistically significant(P＜0.05). There was no significant difference in drug sensitivity test, MTB resistance gene detection and Xpert rifampicin resistance detection rate(P＞0.05). Compared with the rifampicin resistance test results, the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and Youden index of the DNA chip method and Xpert method were 91.30%, 95.32%, 84.00%, 97.60%, 94.47%, 86.63% and 95.65%, 93.57%, 80.00%, 98.77%, 94.01%, 89.22%, The results of rifampin resistance detected by X-Pert and MTB are highly consistent(Kappa value=0.833, 0.840). There was no significant difference in the detection rate of isoniazid resistance between drug sensitivity test and MTB resistance gene detection(P＞0.05).
    Conclusion The BD960 method, Xpert method and TB-DNA method can accurately detect MTB in samples. Drug susceptibility test, DNA chip method and Xpert method can analyze the resistance of MTB rifampicin(isoniazid). MTB resistance gene detection and Xpert method have high sensitivity and specificity, which can be applied in MDR-TB control according to the actual needs.