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Table of Content

    25 August 2020, Volume 41 Issue 8
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    The effect of intravenous application of rhBNP on renal function in patients with acute anterior myocardial infarction complicated with diabetes
    SONG Bo-chao, WANG Yan-bo, HAO Guo-zhen, FAN Wei-ze, JIANG Yun-fa, GU Xin-shun
    2020, 41(8):  873-877,914.  doi:10.3969/j.issn.1007-3205.2020.08.002
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    Objective  To investigate the effect of intravenous application of recombinant human brain natriuretic peptide(rhBNP) on renal function in patients with acute anterior myocardial infarction acute anterior myocardial infarction(AAMI) complicated with diabetes.
    Methods  Fifty-three patients with AAMI combined with diabetes who underwent emergency percutaneous coronary intervention（PCI） were consecutively enrolled, and they were randomly divided into rhBNP group(n=25) and nitroglycerin group(NIT group, n=28). Two patients were given rhBNP and nitroglycerin for 72 h after direct percutaneous coronary intervention, respectively. Comparisons of levels of serum creatinine(SCr), cystatin C(CysC) and estimated glomerular filtration rate(eGFR) before and 24 hours, 72 hours and 7 days after medication were performed. Comparisons of urine volume, left ventricular ejection fraction(LVEF), early mitral valve diastolic blood flow peak(E) and early mitral annulus diastolic movement in both groups of patients before and 24 hours and 7 days after medication Speed(e′) ratio(E/e′) were also measured. The incidence of major adverse cardiac events(MACE) within 30 days was followed up.
    Results  The levels of SCr and CysC in the rhBNP group increased firstly and then decreased, and the eGFR decreased firstly and then increased. The changes were most obvious at 72 h after treatment. All indexes returned to the baseline level 7 days after treatment. Levels of SCr and CysC, as well as levels of eGFR did not change significantly in the NIT group. There were statistically significant differences in the interaction between groups, time points, and groups·time points(P＜0.05). At 7 days after medication, the urine output during 24 hours in both groups was significantly less than 24 hours after medication(P＜0.05). At 7 days after treatment, the LVEF level in the rhBNP group was higher than 24 hours after treatment, and the E/e′ value was lower than 24 hours after the medication. The LVEF level in the rhBNP group was higher than that in the NIT group, and the E/e′ value was lower than that in the NIT group(P＜0.05 ). There was no significant difference in the incidence of MACE between the 2 groups(P＞0.05).
    Conclusion  Intravenous administration of rhBNP may cause transient injury to renal function in patients with AAMI complicated with diabetes, but it could be restored in the short term with the improvement on the heart function.
    Relationship between the activity of butyrylcholinesterase and inflammatory factors, prognosis in patients with acute myocardial infarction
    MENG Hai-yun, GU Xin-shun, ZHANG Qi
    2020, 41(8):  878-881,887.  doi:10.3969/j.issn.1007-3205.2020.08.003
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    Objective  To explore the relationship between the activity of butyrylcholinesterase(BChE) and inflammatory factors and prognosisin in patients with acute myocardial infarction(AMI).
    Methods  Eighty-three inpatients with AMI treated in the hospital were selected as the subjects. According to the different activity of BChE in serum, they were divided into low-activity BChE group and high-activity BChE group. The cardiac function was graded and left ventricular function(LVEF), serum high sensitivity C- reactive protein(hs-CRP), interleukin -6(IL-6) and tumor necrosis factor α(TNF-α) were determined. The prognosis was collected.
    Results  There was no significant difference in the grade of cardiac function between two groups(P＞0.05), but the LVEF of low-activity BChE group was smaller than that of high-activity BChE group(P＜0.05). The levels of hs-CRP, IL-6 and TNF-α were significantly higher in low-activity BChE group than in high-activity BChE group(P＜0.05). The activity of BChE was positively correlated with LVEF（r=0.356， P＜0.05）, and negatively correlated with hs-CRP, IL-6 and TNF-α（r=-0.348， -0.316， -0.333，P＜0.05）. Logistic multivariate analysis of the prognosis of the patients showed that BChE activity was an independent factor affecting the prognosis of patients with myocardial infarction.
    Conclusion  The activity of BChE can be used as a predictor of cardiac function in patients with myocardial infarction. The mechanism may be predicting the prognosis by reflecting the inflammatory level after myocardial infarction.
    Effect of resveratrol on pulmonary function and cardiac function in SD rats with chronic obstructive pulmonary disease and pulmonary heart disease
    YAN Shan-shan, ZHAO Fang, XIAO Jian, ZHANG Chun-liang
    2020, 41(8):  882-887.  doi:10.3969/j.issn.1007-3205.2020.08.004
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    Objective  To investigate the effect of resveratrol on pulmonary function and cardiac function in SD rats with chronic obstructive pulmonary disease and pulmonary heart disease.
    Methods  Forty-five adult male SD rats were randomly divided into resveratrol group, glucocorticoid group and control group with 15 rats in each group. The resveratrol group was given resveratrol intragastric administration for 28 days, the glucocorticoid group was given Budesonide aerosol inhalation for 28 days, and the control group was given normal saline for 28 days. The lung function(CL), peak expiratory flow(PEF), maximum mid expiratory flow curve(MMF) and forced expiratory volume in first 0.3 second/forced vital capacity were compared between the three groups before and after treatment, FEV0.3/FVC, left ventricular ejection fraction(LVEF), left ventricular end diastolic diameter(LVEDd), interventricular septal thickness(IVST) and left ventricular posterior wall thickness(LVPWT), Right ventricular free wall mass, left ventricle and interventricular septum mass, right ventricular free wall mass/left ventricular+ventricular septum mass ratio(RV/（LV+S） were observed.
    Results  After the intervention, the levels of CL, PEF and MMF in the three groups were lower than those before the intervention, and the levels of FEV0.3/FVC in the resveratrol group were higher than those in the glucocorticoid group and the control group, and the levels of CL, PEF, MMF and FEV0.3/FVC in the glucocorticoid group were higher than those in the control group(P＜0.05). LVEF, LVEDd, IVST, LVPWT, right ventricular free wall mass, left ventricular+interventricular septal mass and RV/（LV+S） of the three groups were higher than those before intervention. LVEF of resveratrol group was higher than that of glucocorticoid group and control group. LVEDd, IVST, LVPWT, right ventricular free wall mass, left ventricular+ventricular septum mass, RV/（LV+S） were lower than those of glucocorticoid group and control group, and LVEF of glucocorticoid group was higher than that of control group LVEDd, IVST, LVPWT, right ventricular free wall mass, left ventricle+interventricular septum mass, RV/（LV+S） in the control group were lower than those in the control group(P＜0.05). The total incidence of adverse reactions in glucocorticoid group was higher than that in resveratrol group and control group(P＜0.05).
    Conclusion  Compared with glucocorticoids, resveratrol can effectively improve the lung function of SD rats with chronic obstructive pulmonary disease complicated with pulmonary heart disease, delay the deterioration of cardiac function and structure, improve the prognosis, and avoid the occurrence of severe adverse reactions such as hyperglycemia and osteoporosis caused by glucocorticoids, which has both effectiveness and safety. The above mechanism of resveratrol needs to be further studied. The study confirmed that it is expected to provide more effective clinical basis for the treatment of chronic obstructive pulmonary disease complicated with pulmonary heart disease.
    Analysis of the inflammation index in COPD patients with or without-bronchiectasis
    WANG Zheng, WANG Zhen, CHAI Shu-kun, LIU Rong-hui, SHI Jin-ying, MENG Ai-hong
    2020, 41(8):  888-891.  doi:10.3969/j.issn.1007-3205.2020.08.005
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    Objective  To compare clinical characteristics， leukocyte (WBC)， neutrophile（N%）, C-reactive protein(CRP), procalcitonin(PCT) of chronic obstructive pulmonary disease(COPD) patients with or without bronchiectasis according to High Resolution CT (HRCT) images， and to  improve the understanding of clinical characteristics of COPD patients with bronchiectasis.
    Methods  A total of 132 COPD patients were selected in this study, and divided into group A(with bronchiectasis) 47 cases and group B (not merge bronchiectasis) 85 cases by the chest HRCT to compare and analyze the general conditions, arterial blood gas analysis, the WBC, N%, CRP and PCT between two groups. Meanwhile, WBC, N%, CRP, PCT and other inflammatory indicators between smoking and non-smoking patients in group A were also compared and analyzed.
    Results  There was no statistically significant difference in general condition and arterial blood gas analysis between two groups(P＞0.05). The body mass index(BMI) of patients in group A was lower than that in group B, while WBC, N%, CRP, PCT and daily cough sputum volume in group A were all significantly higher than that in group B, and the differences between two groups were statistically significant(P＜0.05). Comparison of smoking patients and non-smoking patients in group A showed that WBC, N%, CRP and PCT of smoking patients were significantly higher than those in non-smoking patients, and the difference between two groups was statistically significant(P＜0.05).
    Conclusion  Patients with COPD complicated with bronchiectasis have more serious infection and greater influence of smoking, which is closely related to inflammatory indicators such as WBC, CRP and PCT.PCT and CRP have certain diagnostic value in the diagnosis of COPD patients with bronchiectasis.
    Clinical features of hemorrhagic transformation after acute cerebral infarction and risk factors of prognosis
    XU Li-sha, WANG Rui, ZHOU Qian-xiao, LIU Qin, HE Feng-ming, FENG Ling*
    2020, 41(8):  892-895.  doi:10.3969/j.issn.1007-3205.2020.08.006
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    Objective  To explore the clinical features of hemorrhagic transformation (HT) after acute cerebral infarction (ACI), and to the analyze risk factors of prognosis.
    Methods  The clinical features of 40 HT patients who were admitted to the hospital were retrospectively analyzed. According to different prognosis of HT patients, they were divided into good group(22 cases) and bad group(18 cases). The clinical case data in both groups were retrospectively collected. The risk factors that affected prognosis of patients were analyzed.
    Results  The clinical features of HT: In HT patients, lobe infarction, large area infarction and cardioembolism(CE) accounted for 52.50% 65.00% and 62.50%, respectively. The occurrence of HT at 8-14 d after onset accounted for 57.50%. The patients with hemorrhagic infarction(HI) and parenchyma haematoma(PH) accounted for 90.00% and 10.00%, respectively. After HT, the patients with symptom aggravation accounted for 42.50%. The Results   of univariate analysis showed that stroke history, gender, age, score of National Institutes of Health Stroke Scale (NIHSS) and taking anticoagulants were related with prognosis(P＜0.05). The Results   of multivariate analysis showed that NIHSS scores higher than 12 points and taking anticoagulants were independent risk factors of prognosis(P＜0.05). 
    Conclusion  Patients with lobe infarction, large area infarction and ACI of CE type are more likely to be accompanied with HT. HT mostly occurs at 8-14 d after after ACI, most of which is HI type. There is no symptom aggravation in most of patients. NIHSS score higher than 12 points and taking anticoagulants are independent risk factor of prognosis in HT patients.
    Multiple white and flat elevated lesions observed in the stomach：a new subtype of hyperplastic  polyps
    ZHOU Sheng-yun, DUAN Zhi-hui
    2020, 41(8):  896-898,904.  doi:10.3969/j.issn.1007-3205.2020.08.007
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    Objective  To clarify the clinicopathological features of multiple white and flat elevated lesions（MWFLs） in the stomach and to explore the risk factors in affected individuals.
    Methods  The subjects were 926 consecutive individuals undergoing endoscopy. The white light and narrow-band images of gastric mucosa were reviewed. The clinicopathological and endoscopic characteristics of multiple white and flat elevated lesions observed in the stomach were analyzed.
    Results  The prevalence rate of MWFLs was 8.1%(75/926). The proportion of female and PPI use in the MWFLs positive group was higher than that in the MWFLs negative group(P＜0.05). The age in the MWFLs positive group was significantly higher than that in the MWFLs negative group(P＜0.05). There was no significant difference between two groups regarding H.P. status, atrophy, and the duration of PPI use(P＞0.05). The pathological Results   of MWFLs were chronic mucosa inflammation and gastric fundus epithelium hyperplasia, but no intestinal metaplasia and atrophy were observed.With the following risk factors identified on a logistic regression analysis: use of proton pump inhibitors, odds ratio （OR=1.951, 95%CI:1.052-3.613), female sex(OR=2.112, 95%CI:1.180-3.762), and older age(>55 years) （OR=2.541, 95%CI: 1.400-4.611）were risk factors for MWFLs.
    Conclusion  Long-term use of PPIs ,female sex and age are risk factrors for MWFLs, and hyperplastic changes of the foveolar epithelium in the fundic glands is observed. We believe that endoscopists should recongize these lesions,and these lesions are not intestinal metaplasia.
    Effects of ulinastatin combined with Danhong injection on the level of STREM-1and HBP, Th17/Treg and clinical efficacy in sepsis patients
    CHANG Qing, CHEN Dou-dou, WU Wei-qin, ZHANG Jin-song
    2020, 41(8):  899-904.  doi:10.3969/j.issn.1007-3205.2020.08.008
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    Objective  To investigate the effect of ulinastatin combined with Danhong injection on the level of soluble triggering receptor exprssed on myeloid cells-1(STREM-1) and heparin-bindingprotein(HBP), T help cell 17(Th17)/T regular cell(Treg) and clinical efficacy in sepsis patients.
    Methods  A total of 120 patients with sepsis were selected and divided into control group and observation group according to the method of random number table, 60 cases each. The control group was treated with routine method combined with ulinastatin, and the observation group was injected with Danhong injection on the basis of the control group. The clinical efficacy of the two groups after treatment, Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) score, serum HBP and sTREM-1 levels, T cell subsets, coagulation function indexes and adverse reactions were compared before and after treatment.
    Results  After 7 d of treatment, the effective rate of the observation group was 90.00%(54/60), which was significantly higher than that of the control group 75.00%(45/60), and the difference was statistically significant(χ2=4.490, P=0.034). There were significant differences in APACHEⅡ scores between two groups at different time points(P＜0.05). The serum HBP and sTREM-1 levels in two groups were lower than before treatment(P＜0.05), and the serum HBP and sTREM-1 levels in the observation group were significantly lower than those in the control group(P＜0.05 or P＜0.01). The expression rate of Th17 and Treg（CD4+CD25+, CD4+CD25high） in the two groups was significantly lower than that before treatment(P＜0.05). The expression rate of Th17 and Treg(CD4+CD25+, CD4+CD25high) in the observation group was significantly lower than that in the control group(P＜0.05 or P＜0.01). After treatment, platelet count(PLT) and fibrinogen(FIB) of two groups were increased, prothrombin time(PT), activated partial thromboplastin time(APTT) and thrombin time(TT) were decreased(P＜0.05); PLT and FIB of the observation group were significantly higher than those of control group, PT, APTT and TT were significantly decreased(P＜0.01). There was no significant difference in the incidence of adverse reactions between two groups(χ2=0.260, P=0.609).
    Conclusion  Ulinastatin combined with Danhong injection has significant curative effect on sepsis patients. It can effectively regulate sTREM-1, HBP levels and Th17/Treg expression rate, improve immune and coagulation functions, and promote prognosis.
    Evaluation of reliability and validity of muscular endurance scale of myasthenia gravis
    QI Guo-yan, LIU Peng, GU Shan-shan, LIU Chao-ying, LI Yong-zhao, DONG Hui-min
    2020, 41(8):  905-909.  doi:10.3969/j.issn.1007-3205.2020.08.009
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    Objective  To evaluate the validity and reliability of myasthenia gravis muscular endurance scale(MGMES) among myasthenia gravis(MG) patients in China.
    Methods  Altogether 60 patients with myasthenia gravis were selected to receive examination and evaluation by 2-3 MG specialist physicians in accordance with Quantitative Myasthenia Gravis Score(QMGS), Myasthenia Gravis Composite(MGC), Absolute and Relative Score of MG(ARS-MG) and MGMES. As for MGMES, the internal consistency was assessed by Cronbach's α coefficient, the test-retest reliability was evaluated byintraclass correlation efficient(ICC), and the structural validity the test-retest reliability was evaluated by KMO(Kaiser-Meyer-Olkin) test, Bartlett's test of sphericity, and factor analysis. The correlation between criterion-related validity and scales was evaluated using Spearman correlation coefficient.
    Results  The scale had good internal consistency(Cronbach′s α =0.854) and test-retest reliability(ICC=0.987, P＜0.01). There were 4 common factors, the cumulative variance contribution rate was 69.51%, and the construct validity was good. It was highly correlated with QMGS(r=0.806, P＜0.01), moderately correlated with MGC and ARS-MG(r=0.745, r=0.675, P＜0.01).
    Conclusion  The MGMES is proven to have good validity and reliability, as it can reflect the severity of MG in a relatively comprehensive and accurate way. Thus, it can be further promoted in the clinical practice.
    Clinical observation of pancreatic kininogenase enteric-coated tablets combined with sodium berprost in the treatment of diabetic lower extremity arterial stenosis
    FENG Yan-jing, YIN Zhi-ye, LI Su-fang, LI Yan-jun
    2020, 41(8):  910-914.  doi:10.3969/j.issn.1007-3205.2020.08.010
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    Objective  To observe the clinical efficacy of pancreatic kininogenase enteric coated tablets combined with beraprost sodium in the treatment of type 2 diabetes mellitus(T2DM) with lower extremity artery stenosis.
    Methods  Sixty patients with type 2 diabetes mellitus complicated with anterior tibial artery, posterior tibial artery and peroneal artery stenosis were included in the study, and they were randomly divided into observation group and control group. Both groups were strictly controlled blood glucose and anti arteriosclerosis treatment. The control group was treated with beraprost sodium alone. The observation group: orally taking beraprost sodium, combined with pancreatic kininogenase enteric coated tablets. The maximum walking distance, painless walking distance, ankle brachial index(ABI), peak systolic blood flow velocity(PSV) and diameter stenosis rate were recorded before and after treatment in the two groups.
    Results  After treatment, the painless walking distance, maximum walking distance and ABI of the two groups were significantly higher than those before treatment(P＜0.05); After treatment, the painless walking distance, maximum walking distance and ABI of the observation group were significantly higher than those of the control group(P＜0.05). After treatment, PSV of anterior tibial artery, posterior tibial artery and peroneal artery in the two groups were significantly reduced, and the stenosis rate of diameter was significantly lower than that before treatment(P＜0.05), and after treatment, PSV of each artery in the observation group was significantly slower than that in the control group, and the diameter stenosis rate was significantly lower than that in the control group(P＜0.05).
    Conclusion  Pancreatic kininogenase enteric coated tablets combined with beraprost sodium can more effectively improve the maximum walking distance, painless walking distance and ABI index in patients with type 2 diabetes mellitus complicated with lower extremity artery stenosis. The mechanism may be related to that the combination of pancreatic kininogenase enteric coated tablets and beraprost sodium can more effectively reduce the peak blood flow velocity, reduce the stenosis rate of vascular diameter and improve the lower limb ischemia.
    Early intervention of atorvastatin postmenopausal women with breast cancer
    BAO Shuang-zhen, YANG Jin-qiang, WANG Zhi-chao, ZHAO Feng-long, YIN Chang-heng, XING Hong-li
    2020, 41(8):  915-918,932.  doi:10.3969/j.issn.1007-3205.2020.08.011
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    Objective  To investigate the clinical efficacy of atorvastatin in early intervention of postmenopausal breast cancer patients.
    Methods  A total of 200 cases of postmenopausal breast cancer were selected and divided into control group (100 cases) and research group (100 cases) according to random number table method. In control group, patients were given letrozole, while in study group, patients were given atorvastatin calcium on this basis. Both groups were treated for 2 years. The blood lipid levels, cardiovascular events, recurrence and metastasis of breast cancer before treatment, 12 months after treatment and 24 months after treatment were compared between two groups.
    Results  The levels of blood lipid in two groups were higher after the treatment than before the treatment(P＜0.01), but the level of blood lipid in the study group was significantly lower than that in the control group after 12 and 24 months of treatment(P＜0.01). However, the blood lipid level of the study group was significantly lower than that of the control group after 12 months of treatment(P＜0.05). The incidence of cardiovascular events(MACE) in the study group was significantly lower than that in control group(P＜0.05). The recurrence and metastasis rate of breast cancer in the study group was significantly lower than that in the control group(P＜0.05).
    Conclusion  Atorvastatin can not only effectively regulate the dyslipidemia caused by letrozole in postmenopausal breast cancer patients, but also help to reduce the incidence of cardiovascular events and do not affect the treatment of breast cancer.
    Curative effect of microwave ablation for thyroid nodules and its effect on immune function
    LI Yang, WANG Hao, CHEN Wei, DI Tai-lin, HAN Ke-song, JIANG Yu-shi
    2020, 41(8):  919-922.  doi:10.3969/j.issn.1007-3205.2020.08.012
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    Objective  To explore the curative effect of microwave ablation for patients with benign thyroid nodules and its effect on their immune function.
    Methods  A total of 100 patients with thyroid nodules were selected and randomly divided into two groups according to the random number table. The 50 cases treated with microwave ablation were set as the observation group, whereas the 50 cases who had received conventional thyroidectomy as the control group. The surgical Results  , postoperative complications and postoperative 30 d T lymphocyte subsets in the two groups were compared.
    Results  The levels of CD4+, CD8+ and CD4+ /CD8+ in the observation group did not change significantly. The levels of CD4+, CD4+ /CD8+ in the control group decreased first and then increased, while the level of CD8+ increased first and then decreased. The interaction between groups, time points and between groups had statistical significance(P＜0.05). There was no significant difference in nodule regression rate between the observation group and the control group 12 months after operation(P＞0.05). The operation time and hospitalization time of the observation group were shorter than those of the control group, and the intraoperative blood loss was less than that of the control group (P＜0.01). The total complication rate of the observation group was lower than that of the control group(P＜0.01).
    Conclusion  For patients with thyroid nodules, microwave ablation is safe and reliable and is with more significant effects than conventional thyroidectomy, which produces less trauma and incurs less postoperative blood loss and complications, shorten the duration of the operation and improve the patients' immune function.
    Analysis of prognostic factors in elderly patients with ruptured intracranial aneurysms
    YANG Jun, SUN Xiao-feng, LIU Jian-xin, KANG Hui-bin, LIU Dong-yuan, ZHANG Hong-bing
    2020, 41(8):  923-927.  doi:10.3969/j.issn.1007-3205.2020.08.013
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    Objective  To investigate the influencing factors affecting the prognosis of ruptured intracranial aneurym surgery in the elderly patiens.
    Methods  Seventy-four elderly patients with ruptured intracranial aneurysms were retrospectively analyzed. According to the Modified Rankin Scale(mRS) 6 months after surgery, 45 patients were divided into the good prognosis group(mRS 0-2 points) and 29 patients into the poor prognosis group(mRS 3-6 points). The influencing factors that may affect the prognosis of the surgery were analyzed.
    Results  There were no significant differences in gender, hypertension, diabetes, coronary heart disease, smoking history, alcohol history, history of anti-platelet or anti-coagulation medications, history of cerebral hemorrhage, aneurysm site, multiple aneurysms, operation time, rebleeding, epilepsy, and severe symptoms of non-nervous system between the two groups(P＞0.05). The good prognosis group had lower proportion of patients with age ≥ 70 years old, Hunt-Hess grade Ⅲ-Ⅴ, frailty, timing of operation >3 days, aneurysm diameter ≥7 mm, cerebral ischemic stroke and hydrocephalus than the poor prognosis group, and the differences were statistically significant(P＜0.05 or P＜0.01). The Results   of multivariate Logistic regression analysis showed that Hunt-Hess grade, frailty, timing of operation and cerebral ischemic stroke could influence the prognosis, with statistically significant differences(P＜0.05). While age, aneurysm diameter and hydrocephalus had no effects on the prognosis, with no statistically significant differences(P＞0.05).
    Conclusion  The prognosis of aneurysm surgery is affected by a number of factors. Hunt-Hess grade, risk score, timing of surgery and post-operative cerebral infarction are the important factors.
    Retroperitoneal laparoscopic lithotomy, flexible ureteroscopic lithotripsy and percutaneous nephrolithotomy in the treatment of impacted upper ureteral calculi
    SHI Jian-guo, WANG Wei-ning, YANG Xiao-xia, HAN Gang, WANG Ling-jun
    2020, 41(8):  928-932.  doi:10.3969/j.issn.1007-3205.2020.08.014
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    Objective  To investigate the effect and to determine the best treatment among the three method of retroperitoneal laparoscopic lithotomy(RPLU), lithotripsy with flexible ureteroscope(FURL) and percutaneous nephrolithotomy(PCNL) in the treatment of impacted upper ureteral calculi larger than 1.5 cm. 
    Methods  One hundred and fifty-nine cases of upper ureteral impacted calculi were retrospectively analyzed. The preoperative and intraoperative data were collected and the cases were divided into RPLU group(56 cases), FURL group(55 cases) and PCNL group(48 cases) according to different operation style. The operation time, postoperative hospital stay, stone clearance rate and postoperative complications were statistically analyzed. 
    Results  The operation time and postoperative hospital stay in FURL group were significantly shorter than those in RPLU group and PCNL group(P＜0.05). The stone clearance rate of RPLU group(100%, 100%) was slightly higher than that of FURL group(90.9%, 94.5%) and PCNL group(93.8%, 93.8%) at 3 days and 1 month after operation, but the differences were not statistically significant(P＞0.05). There were no serious complications in the three groups. 
    Conclusion  It shows that the three Methods   are safe and effective in the treatment of incarcerated upper ureteral calculi. The FURL group has the advantages in shorter operation time and hospitalization stay, and the patients recover faster after operation, compared with other two Methods  .
    The role and mechanism of all-trans-retinoic acid in LPS-induced epididymal epithelium in mice
    LU Bao-sai, GUO Ping-ying, YIN Yue-wei, FENG Teng-fei, LIANG Zhuang, LI Wei
    2020, 41(8):  933-939,956.  doi:10.3969/j.issn.1007-3205.2020.08.015
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    Objective  To study and explore the role and molecular mechanism of all-trans retinoic acid(atRA) in inflammatory response of epididymal epithelium cells induced by lipopolysaccharide(LPS).
    Methods  Epididymal epithelial cells treated with LPS and different concentrations of atRA, atRA receptor inhibitors and Si-TGF-β1. Real-time quantitative PCR was used to detect the  mRNA expression levels of interleukin-1β(IL-1β)，interleukin-6(IL-6), Tumor Necrosis Factor-α(TNF-α) and Transforming growth factor β1(TGF-β1), enzyme-linked immunosorbent assay was used to detect the content of IL-1β， IL-6 and TNF-α in  the supernatants of cultured epididymal epithelial cells and the protein expression level of TGF-β1 in epididymal epithelial cells was determined by Western blot.
    Results  The mRNA expression levels of IL-1β, IL-6 and TNF-ɑ in the epididymal epithelial cells in the LPS group were significantly higher than those of the control group. The mRNA expression levels of inflammatory cytokines IL-1β, IL-6 and TNF-ɑ in the epididymal epithelial cells treated with atRA at different concentrations were significantly decreased in a concentration dependence(P＜0.01). The contents of IL-1β， IL-6 and TNF-α in  the supernatants of cultured LPS induced epididymal epithelial cells were significantly higher than those in the control group. The contents of IL-1β， IL-6 and TNF-α in  the supernatants of  cultured LPS induced epididymal epithelial cells after treating with atRA at different concentrations were significantly decreased(P＜0.01).The mRNA expression level of TGF- 1β  in the epididymal epithelial cells in the LPS group was significantly lower than that in the control group and was significantly increased after treatment with different concentrations of atRA(P＜0.01). The mRNA expression level of TGF-β1  in Si-TGF-β1 group was significantly lower than that in Si-Ctl group(P＜0.01).The relative mRNA levels of IL-1β, IL-6 and TNF-ɑ in the atRA+ Si-Ctl +LPS group were lower than those of the Control+LPS group, and the relative mRNA levels of IL-1β, IL-6 and TNF-ɑ in the atRA+Si-TGF-β1 +LPS group were significantly higher than those of the atRA group(P＜0.01). The levels of IL-1β, IL-6 and TNF-ɑ in the supernatants of cultured epididymal epithelial cells in atRA+Si-Ctl+LPS group were lower than those of Control+LPS group, and the levels of IL-1β, IL-6 and TNF-ɑ in the supernatants of cultured epididymal epithelial cells in atRA+Si-TGF-β1+LPS group were significantly higher than those of atRA group(P＜0.01). The mRNA expressions of Retinoic acid alpha(RARɑ) and Retinoic acid beta(RARβ) in the epididymal epithelial cells in atRA group were significantly higher than those in the Normal group(P＜0.01). The relative expression level of TGF-β1 mRNA in the atRA+BMS195614 group were significantly lower than those in the Control group(P＜0.01).
    Conclusion  atRA can inhibit the inflammatory response of epididymal epithelial cells induced by LPS in mice, and its possible molecular mechanism may be up-regulating the expression of TGF-β1 by binding to RARɑ receptor.
    Effect of transverse bone transfer technique combined with PRP on serum factor in diabetic foot patients
    HE Yin-xi, CHEN Yan-xia, XU Ying, GUO Yu-song, TIAN Li-jun, LIU Pin-li
    2020, 41(8):  940-943.  doi:10.3969/j.issn.1007-3205.2020.08.016
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    Objective  To investigate the effect of transverse bone transfer technique combined with platelet-rich plasma（PRP） in the treatment of diabetic foot and its effect on serum factors.
    Methods  Eighty patients with diabetic foot were chosen and divided into treatment group and control group, 40 cases in each group. The control group was treated with PRP topical wound after debridement, the treatment group was treated with PRP external wound combined with transverse tibial bone transport. The treatment effects between the two groups were compared. And venous blood was extracted before and after treatment to monitor the improvement of patients epidermal growth factor(EGF), vascular endothelial growth factor(VEGF), basic fibroblast growth factor(bFGF), platelet derived growth factor(PDGF) and calcitonin gene-related peptide(CGRP).
    Results  The total effective rate was 90.00% in the treatment group and 67.50% in the control group, the difference in the total effective rate between two groups was statistically significant(P＜0.05). After treatment, the detection values of EGF, VEGF, bFGF, PDGF and CGRP in both groups were improved, and the improvement degree in the treatment group was greater than that in the control group(P＜0.01).
    Conclusion  The transverse bone transfer technique combined with PRP has a significant effect on the treatment of diabetic foot, which can effectively improve the serum levels of EGF, VEGF, bFGF, PDGF and CGRP.
    Effect of combination therapy of NGF and naloxone on prognosis and expression of PDCD5 and hs-CRP in neonates with hypoxic ischemic encephalopathy
    WU Xiao-xu
    2020, 41(8):  944-947,951.  doi:10.3969/j.issn.1007-3205.2020.08.017
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    Objective  To investigate the therapeutic effect of nerve growth factor(NGF), naloxone combined with erythropoietin(EPO) in the treatment of neonatal hypoxic-ischemic encephalopathy(HIE), and their effects on the levels of programmed cell death 5(PDCD5) and 8-hydroxy-2-deoxyguanosine(8-OHdG).
    Methods  A total of 90 cases of neonatal hypoxic ischemic encephalopathy were randomly divided into observation group and control group, 45 cases in each group. The patients in the control group were treated with naloxone combined with NGF, and the patients in the observation group were treated with erythropoietin on the basis of the therapeutic method of the control group. The recovery time of consciousness, convulsion disappearance, muscle tension recovery and reflex recovery were detected and recorded. The neonatal neurobehavioral assessment(NBNA) score, serum PDCD5 and 8-OHdG levels were compared between the two groups. The mental retardation index(MDI) and psychomotor development index(PDI) of the two groups were evaluated after one year of treatment. The incidence of adverse reactions during the treatment of the two groups were recorded.
    Results  The total effective rate of the observation group was 91.1%, and that of the control group was 73.3%. The effective rate of the observation group was higher than that of the control group(P＜0.05). The recovery time of consciousness, convulsion disappearance, muscle tension recovery and reflex recovery in the observation group were significantly shorter than those in the control group(P＜0.01). After treatment, the NBNA scores of the two groups were significantly increased(P＜0.01), and the NBNA score of the observation group was significantly higher than that of the control group(P＜0.01). After treatment, PDCD5 and 8-OHdG in the two groups were significantly lower than those before treatment(P＜0.01), while PDCD5 and 8-OHdG in the observation group were significantly lower than those in the control group(P＜0.01). The MDI and PDI of the observation group were higher than those of the control group after 1 year of treatment(P＜0.05). There were no serious adverse reactions in both groups.
    Conclusion  NGF combined with naloxone can reduce the expression of PDCD5 and 8-OHDG, which can reduce brain tissue damage and inhibit cell apoptosis, improve neurological function and promote psychological and motor development of children.
    Clinical observation of pulp revascularization and calcium hydroxide for pulpal cut of young permanent teeth
    ZHU Ni-man, ZHANG Cheng-yi, XIONG Ya-fang*
    2020, 41(8):  948-951.  doi:10.3969/j.issn.1007-3205.2020.08.018
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    Objective  To compare the clinical effects of pulp revascularization and calcium hydroxide in the treatment of young permanent teeth with pulpotomy, and then  to explore the advantages of pulp revascularization in the treatment of young permanent teeth with unexpected pulp exposure.
    Methods  Ninety-eight patients(98 teeth) from 7 to 16 years old who underwent pulpotomy of mandibular premolars were divided into two groups according to random number table method. The two groups included observation group(49 patients underwent pulp revascularization) and control group(49 patients underwent calcium hydroxide apexification). After 6 months of complete treatment, the clinical effects of two groups were compared and analyzed.
    Results  The total effective rate of the observation group(95.92%) was significantly higher than that of the control group(69.39%). The incidence of adverse reactions of the observation group(8.16%) was lower than that of the control group (34.68%) with statistical significance(P＜0.05),and the thickness of the root canal wall(2.54±0.32) mm and the length of the teeth（21.50±1.70） mm in the observation group were higher than the root canal wall（2.21±0.31) mm and the length of teeth（20.80±3.50） mm respectively. The difference was statistically significant(P＜0.05).
    Conclusion  Pulp revascularization is superior to calcium hydroxide paste in pulpotomy for young permanent teeth. It can improve the success rate significantly, promote the root development of young permanent teeth effectively, and make clinical treatment more efficient.
    The value of CTA in the diagnosis of coronary artery anomalies in patients with complex congenital heart disease
    JING Shu-yan, ZHANG Jia-kai, LIU Chun-ying, HOU Rui-hong, YANG Wen-kun, REN Qing-yun
    2020, 41(8):  952-956.  doi:CTA10.3969/j.issn.1007-3205.2020.08.019
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    Objective  To study the ability of cardiac computed tomography angiography(CTA) to detect and diagnose coronary artery abnormality in patients with complicated congenital heart disease.
    Methods  Retrospective analysis of 35 patients with complex congenital heart disease with coronary artery abnormalities undergoing cardiac CTA examination, and analysis of coronary artery abnormality types.
    Results  The image quality scores of 35 patients with complex congenital heart disease(CHD) with coronary artery abnormalities were independently evaluated by two CT angiography 〖JP2〗senior radiologists specialty. The difference was statistically significant(χ2=70.972，P＜0.001), and the consistency was good〖JP〗(Kappa index=0.835). In this study, 43 mutations were found, mainly involving 5 types of abnormal origin, number, course, termination, and dysplasia of coronary arteries, of which 31(72.1%) were abnormal in origin of coronary artery.
    Conclusion  Cardiac CTA can well display the number and type of coronary artery abnormality in patients with complex congenital heart disease, providing a more intuitive and accurate imaging basis for clinical cardiac surgery planning and decision making.
    The method and evaluation of hematuria detection in two kinds of urine dry chemistry analyzer
    YANG Hong-le, DU Huan-huan, YANG Li-miao, LI Yan-hui, SONG Jian-qiang, WANG Ran
    2020, 41(8):  957-962.  doi:10.3969/j.issn.1007-3205.2020.08.020
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    Objective  To clarify the rules of two urine dry chemical analyzers in detecting hematuria with different hemoglobin concentrations, and to explore the relevant measures.
    Methods  Fifteen simulated hemoglobin samples with different hemoglobin concentrations were prepared. The parallel control tests were carried out in centrifugation or not with Kebao XL automatic urine analyzer and Beckman IRIS iQ200 automatic urine analyzer. 11 detection Results   were compared and analyzed.
    Results  When the hemoglobin concentration in the sample arrive 1 g/L, the COMBI XL automatic urine analyzer will report the false positive Results   of WBC. With the hemoglobin concentration increasing,bilirubin, nitrite, ketone body, urinary cholanogen, SG and vitamin C would be reported false positive Results   in turn. When the hemoglobin concentration was 5 g/L, the Beckmann IRIS iQ200 automatic urine analyzer would report the false positive Results   of BIL, and when it reached 19 g/L, KET false positive Results   would appear. Other effects hadn't been found in these detections.
    Conclusion  When the hematuria samples in different hemoglobin concentrations were detected with the two urine dry chemical analyzers, their respective anti-interference characteristics should be taken consider.
    Tibial plateau Hoffa fracture
    LI Qi-cai, ZHU Jian, ZHU Yan-bin, YE Zhi-peng, YU Teng-bo, ZHANG Ying-ze
    2020, 41(8):  972-973,封三.  doi:10.3969/j.issn.1007-3205.2020.08.023
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    A case of special proximal tibial fracture-tibial plateau Hoffa fracture was introduced in this article. A 41-year-old male patient presented with pain and swelling of the left knee joint after kicked on the lateral calf. The posteromedial split fracture of left tibial plateau was seen on X-ray and CT scan. We used the technique of double reverse traction and minimally invasive fixation for treatment. The Results   of postoperative imaging examination and clinical effect were satisfactory. The tibial plateau Hoffa fracture is usually caused by the vertical shear force from femoral condyle in a flexion position of the knee and is extremely prone to be overlooked. Minimally invasive technique should be used to treat this kind of fracture, which is beneficial to the early recovery of patient and reduce the postoperative complications.