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Table of Content

    25 October 2020, Volume 41 Issue 10
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    Efficacy of noninvasive positive pressure ventilation combined with drugs in the treatment of acute left heart failure and its effects on the levels of biological markers
    XIN Qiu-ping, GAO Zhi-xu, QU Zhong-hui
    2020, 41(10):  1121-1125.  doi:10.3969/j.issn.1007-3205.2020.10.002
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    Objective  To explore the clinical effects of noninvasive positive pressure ventilation(NIPPV) combined with drugs in the treatment of acute left heart failure. 
    Methods  A total of 104 patients with acute left heart failure were selected as study subjects. According to the random number table method, the patients were divided into combined group and control group, with 52 cases in each group. Control group was given only conventional drug therapy, and combination group was combined with NIPPV on this basis. The plasma heart failure markers ［cardiac troponin  I(cTnI), N-terminal pro-brain natriuretic peptide(NT-proBNP), mid-atrial natriuretic peptide(MR-proANP)］, inflammatory factors ［interleukin-6(IL-6), C-reactive protein(CRP), tumor necrosis factor-α(TNF-α)］ and arterial blood gas indicators ［partial pressure of oxygen(PaO2), partial pressure of carbon dioxide(PaCO2), base excess(BE)］ and echocardiographic indexes ［left ventricular ejection fraction(LVEF), stroke volume(SV), cardiac index(CI)］ were compared between two groups before treatment and after 3 d of treatment. 
    Results  After 3 d of treatment, the levels of plasma cTnI, NT-proBNP, MR-proANP, IL-6, CRP, TNF-α and PaCO2 in two groups were significantly lower than those before treatment, and the levels in combined group were significantly lower than those in control group at the same time(P＜0.05). The levels of PaO2, BE and LVEF, SV and CI in two groups were significantly higher than those before treatment, and the levels in combined group were significantly higher than those in control group at the same time(P＜0.05). 
    Conclusion  NIPPV combined with drugs for acute left heart failure can achieve ideal efficacy, and it is beneficial to control the body inflammatory response, stabilize the internal environment balance and restore cardiac function as soon as possible.

    The correlations between acute lung injury of aortic dissection with serum CRP, MCP-1, and MMP-9
    LIU Jian, SONG Ran, SONG Zhao-guo, ZHANG Jian
    2020, 41(10):  1126-1129.  doi:10.3969/j.issn.1007-3205.2020.10.003
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    Objective  To investigate the correlations between acute lung injury(ALI) in aortic dissection(AD) with serum C-reactive protein(CRP), monocyte chemoattractant protein-1(MCP-1), matrix metalloproteinase-9(MMP9). 

    Methods  A total of 92 aortic dissection patients were selected for the study, among them, 42 were ALI patients(ALI group), and 50 were non-ALI patients(non-ALI group), 50 healthy persons(control group) were selected for physical examination during the same period, the levels of serum CRP, MCP-1, and MMP-9 were detected by enzyme-linked immunosorbent assay（ELISA）, the correlations of the expressions of CRP, MCP-1, and MMP-9 and their predictive values for ALI were also studied. 
    Results  The levels of serum CRP, MCP-1 and MMP9 in non ALI group and ALI group were higher than those in control group, and those in ALI group were higher than those in non ALI group(P＜0.05). The levels of serum interleukin-6（IL-6） and tumor necrosis factor-α（TNF-α） in non ALI group and ALI group were higher than those in control group, and those in ALI group were higher than those in non ALI group; Serum IL-10 in non ALI group and ALI group was lower than that in control group, and the difference was statistically significant(P＜0.05). Pearson correlation analysis showed that serum CRP was positively correlated with MCP-1 and MMP9(r=0.827, P＜0.001; r=0.868, P＜0.001), and MCP-1 was positively correlated with MMP9(r=0.741, P＜0.001). The AUC of CRP was 0.856, the diagnostic sensitivity was 66.70%, the specificity was 88.00%, the AUC of MCP-1 was 0.769, the diagnostic sensitivity was 69.00%, the specificity was 76.00%, the AUC of MMP9 was 0.884, the diagnostic sensitivity was 81.00%, the specificity was 90.00%. The AUC of combined detection of CRP and MCP-1 was 0.930, the diagnostic sensitivity was 83.30%, and the specificity was 90.00%. 
    Conclusion  The levels of CRP, MCP-1, and MMP9 in serum of patients with acute lung injury caused by aortic dissection are increased, and they are positively correlated, the combined diagnosis of CRP, MCP-1, and MMP9 has high sensitivity and specificity, it has high diagnostic value for acute lung injury caused by aortic dissection. 


    The effects of IRS-1 on osteogenic differentiation and the mechanism
    WANG Na, LIU Chang, LIU Si-jing, WANG Xiao, LI Yu-kun, XUE Peng
    2020, 41(10):  1130-1135.  doi:10.3969/j.issn.1007-3205.2020.10.004
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    Objective  To explore the influence of insulin receptor substrate 1(IRS-1)/transcriptional coactivator with PDZ-binding motif(TAZ) signaling on the osteogenic differentiation of bone marrow derived mesenchymal stem cells(BMSCs). 
    Methods  In vivo, the bone mass of rat femurs in control group, sham group and ovariectomy(OVX) group was analyzed by micro-computed tomography(μCT) and the IRS-1 expression in rat femurs was analyzed by immunofluorescence assay. In vitro, the plasmid transfection was used to change the IRS-1 and TAZ expression in BMSCs, the alizarin red staining and western blot was used to analyze the calcium nodules and the expression of the osteogenic differentiation related proteins, respectively. 
    Results  The bone mass and the IRS-1 expression in rat femurs was significantly reduced in OVX group. High expression of IRS-1 in BMSCs increased the expression of TAZ, runt related transcription factor 2(RUNX2) and osteocalcin(OCN) proteins, which promoted the osteogenic differentiation of BMSCs. Knockout of IRS-1 or TAZ inhibited the osteogenic differentiation of BMSCs. 
    Conclusion  IRS-1 increased the TAZ expression, which promoted the osteogenic differentiation of BMSCs. IRS-1/TAZ signaling in stem cells might be a new target to treat diabetic osteoporosis. 

    Clinical application of immune-enhancing enteral nutrition combined with minimally invasive abdominal drainage in severe acute pancreatitis
    MI Jun, HUA Peng, CUI Xiang, ZHOU Rong-sai
    2020, 41(10):  1136-1139,1144.  doi:10.3969/j.issn.1007-3205.2020.10.005
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    Objective  To explore the clinical effects of immune-enhancing enteral nutrition combined with minimally invasive abdominal drainage on patients with severe acute pancreatitis(SAP). 
    Methods  The clinical data of 136 patients with SAP were retrospectively analyzed. The patients were given routine comprehensive treatment measures including minimally invasive abdominal drainage. The patients were divided into control group(n=62, given ordinary enteral nutrition therapy) and combined group(n=74, given immune-enhancing enteral nutrition regimen) according to different enteral nutrition methods. The serum nutritional indicators［albumin(Alb), prealbumin(PA), transferrin(Tf)］ and serum humoral immune indexes［immunoglobulin(Ig) A, IgG, IgM］ were compared between two groups before treatment and after 7 d of treatment. The 7 d and 30 d mortality rates and basic rehabilitation indicators were compared between two groups. 
    Results  There was no significant differences in the 7 d mortality rate between two groups(P＞0.05). The 30 d mortality rate  in combined group was significantly lower than those in control group(P＜0.05). After 7 d of treatment, the levels of serum Alb, PA, Tf, IgA, IgG and IgM in two groups were significantly higher than those before treatment, and the levels of serum Alb, PA, Tf, IgA, IgG and IgM in combined group were significantly higher than those in control group(P＜0.05). The feeding recovery time, drainage time, intensive care unit(ICU) stay and hospital stay in combined group were significantly shorter than those in control group(P＜0.05). 
    Conclusion  Immune-enhancing enteral nutrition combined with minimally invasive abdominal drainage has prominent effects in the treatment of SAP, and it is beneficial to improve the survival rate and accelerate the recovery of body.

    Expression of stanniocalcin1 in serum of patients with renal cell carcinoma and its clinical significance
    SU Shi-qiang, ZHANG Jin, DU Hong, CHEN Yan, YANG Cui-xia, LI Shen
    2020, 41(10):  1140-1144.  doi:10.3969/j.issn.1007-3205.2020.10.006
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    Objective  To investigate the expression level of stanniocalcin1(STC1) in serum of patients with renal cell carcinoma(RCC) and to reveal its potential clinical significance. 
    Methods  Real-time polymerase chain reaction(Real-time, PCR) and enzyme-linked immunosorbent assay(ELISA) methods were used to measure the mRNA and protein expression level of STC1 in RCC（test group） and  the healthy person(control group). Then analyzed retrospectively the relationship between STC1 mRNA expression in peripheral blood of renal cell carcinoma patients and the clinical pathological parameters and follow-up results. Kaplan-Meier method was used to draw survival curve and tested by the log-rank test. 
    Results  The mRNA and protein expression level of STC1 in serum of patients with renal cell carcinoma was higher than that of the control group(P＜0.01). The high expression of STC1 was associated with the clinical symptoms, histology type, tumor necrosis, late clinical stage, and lymphatic and distant metastasis are closely related(P＜0.05), Patients with high STC1 expression have a poor prognosis. 
    Conclusion  STC1 is highly expressed in the serum of renal cell carcinoma patients, and its expression level is closely related to the clinical pathological parameters and poor prognosis of renal cell carcinoma. The increase of STC1 may have certain clinical value for the prognosis of renal cell carcinoma patients. 

    The effect of intramedullary nail in the treatment of chronic infectious tibial plateau fractures and its influence on knee joint function and inflammation#br#
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    QI Xiao-dong, XU Ning
    2020, 41(10):  1145-1148,1153.  doi:10.3969/j.issn.1007-3205.2020.10.007
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    Objective  To compare the efficacy of intramedullary nail and plate internal fixation in the treatment of chronic infectious tibial plateau fractures, and their effects on knee joint function and inflammation. 
    Methods  Ninety patients with chronic infectious tibial plateau fractures were selected and divided into study group and control group according to different surgical methods, with 45 cases in each group. The study group received intramedullary nail treatment, and the control group received steel plate internal fixation. The operation time, intraoperative blood loss, wound healing time, hospitalization time, fracture healing time, full weight bearing time and complication rate were compared between two groups. The callus growth score, knee joint function score, maximum knee extension angle and maximum knee flexion angle were compared between two groups at 1 day and 3 months after surgery. Serum high-sensitivity C-reactive protein(hs-CRP) was compared between two groups at 1 day and 2 weeks after surgery interleukin-6(IL-6), interleukin-8(IL-8) and tumor necrosis factor-α(TNF-α) levels. 
    Results  The operation time, intraoperative blood loss, wound healing time, hospitalization time, fracture healing time and full weight bearing time in the study group were significantly less than those in the control group(P＜0.01). At 3 months after surgery, the callus growth score, knee joint function score, maximum knee extension angle, and maximum knee flexion angle in two groups were significantly higher than those at the first day after surgery. The callus growth score, knee joint function score, and knee extension maximum in the study group, the angle and the maximum angle of knee bending were higher than those of the control group(P＜0.01). Two weeks after surgery, the serum levels of hs-CRP, IL-6, IL-8 and TNF-α in two groups were significantly reduced on the first day after surgery. The serum hs-CRP, IL-6, IL-8 and TNF-α in the study group were lower than those in the control group(P＜0.01). The incidence of complications in the study group was lower than that in the control group(P＜0.05). 
    Conclusion  Intramedullary nails are more effective in treating chronic infectious tibial plateau fractures, with less trauma and less blood supply damage, which is beneficial to promote postoperative knee function recovery and control inflammation. 

    Treatment of TossyⅢ acromioclavicular dislocation by suture anchor and suture bridge technique
    ZHANG Shang-pu, DONG Zhi, ZUO Bai-jun, HE Jia, LI Bu-qiang, SONG Heng-yi
    2020, 41(10):  1149-1153.  doi:10.3969/j.issn.1007-3205.2020.10.008
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    Objective  To investigate the clinical effect of Tossy Ⅲ acromioclavicular dislocation treated by suture anchor and suture bridge technique. 
    Methods  Sixty-four cases of fresh TossyⅢ acromioclavicular dislocation were randomly divided into observation group and control group, 32 cases in each group, the observation group treated by suture anchor and suture bridge technique;the control group treated by using clavicular hook plates.The functional recovery time of the two groups was compared, the joint function was evaluated, and the complications were observed. 
    Results  Sixty-four cases were followed up  for 6-18 months, with an average of 12 months. The excellent and good rate in the observation group was higher than that in the control group according to the Lazzcano evaluation standard(P＜0.05). Daily activity time of observation group was shorter than that of control group, the difference was statistically significant(P＜0.01). The incidence of postoperative complications in the observation group was lower than that in the control group(P＜0.05). 
    Conclusion  The treatment of TossyⅢ acromioclavicular joint dislocation by suture anchor and suture bridge is a simple and effective method. Combined with early postoperative functional training,satisfactory clinical results can be obtained.

    RSA gene regulates embryonic development of Caenorhabditis elegans by mbk-2
    ZHAI Jia-jia, ZHANG Jun-di, ZUO Zhi-hong, WANG Chuan, ZHANG Lei
    2020, 41(10):  1154-1159.  doi:10.3969/j.issn.1007-3205.2020.10.009
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    Objective  To observe the effects of rsa gene on embryonic development and egg hatching of mbk-2 mutant C. elegans by using Caenorhabditis elegans(C.elegans) as a model organism, and the role and mechanism of mbk-2 in embryonic development were preliminarily discussed. 
    Methods  RNAi technology was used to directionally interfere with the expression of rsa gene in mbk-2 mutant C. elegans. The egg hatching level and embryonic development of nematode after rsa silencing were analyzed to detect the changes in the growth and reproductive capacity of C. elegans. 
    Results  Compared with mbk-2 gene mutation group fed with L4440, the hatchability of eggs in mbk-2 gene mutation group treated with rsa-1 and rsa-2 RNAi bacteria increased significantly, reaching 41.8% and 49.2%(P＜0.05), and rsa-2 treatment group was significantly higher than rsa-1 group(P＜0.05). The hatchability of eggs of N2 wild-type C. elegans treated by rsa-1 and rsa-2 RNAi bacteria was 3.9% and 5.7% respectively, which was significantly lower than that of mbk-2 mutant C. elegans treated by rsa-1 and rsa-2 RNAi bacteria(P＜0.05). rsa-2 RNAi treatment of mbk-2 mutant C. elegans significantly increased abnormal embryonic development. 
    Conclusion  mbk-2 is an important factor in C. elegans development, rsa is an important modification gene of mbk-2, and the two interact to regulate C. elegans embryo development and egg hatching.

    Relationship between breast ultrasound and ovarian, uterine ultrasound, bone age and sexual development in adolescent girls
    YUAN Bo, PI Ya-lei, ZHANG Ya-nan, YAN Xue, FENG Na, ZHANG Hui-feng
    2020, 41(10):  1160-1164,1171.  doi:10.3969/j.issn.1007-3205.2020.10.010
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    Objective  To investigate the relationship between breast, ovary, uterus ultrasound, bone age and sexual development in adolescent girls. 
    Methods  A retrospective analysis of 110 cases of girls who were treated to evaluate puberty development was conducted. The height, weight, bone age film, sex hormone, pelvic ultrasound and breast ultrasound were performed. According to the breast ultrasound grading and clinical Tanner stage, the growth and development parameters related to breast ultrasound grading were analyzed, and the differences among the five ultrasonic grading parameters were evaluated The girls in stage Ⅱ were divided into three subgroups according to breast ultrasound, and the girls with grade B breast ultrasound were also divided into three subgroups according to Tanner stage. 
    Results  Breast ultrasound grading was positively correlated with age, bone age, uterine volume, uterine length and ovarian volume(mean volume of left and right ovaries), but not with FSH. According to breast ultrasound, 110 girls were divided into Grade A(20.9%), grade B 46(41.8%), grade C 18(16.4%), grade D 5(4.5%), and grade E 18(16.4%). The age, bone age, BMI, uterine volume, uterine length diameter and ovarian volume of group C, D and E were higher than or larger than those of group A and group B. the level of E2 in Group E was higher than that in group A and group B, and the level of LH in group D and E was higher than that in group A and group B(P＜0.05). Among the 110 subjects, 60(54.5%) were clinical Tanner stage Ⅱ girls. According to the breast ultrasound classification, 15 cases(25.0%) were grade A, 38 cases(63.3%) were grade B, and 7 cases(11.7%) were grade C. There were significant differences in E2, uterine volume, uterine length and ovarian volume among the three groups(P＜0.05), and the above parameters gradually increased with the increase of ultrasonic grading. There was no significant difference in age, bone age, LH, FSH and BMI(P＞0.05). According to Tanner stage, there were 5 cases(10.9%) in stage Ⅰ, 36 cases(78.2%) in stage Ⅱ and 5 cases(10.9%) in stage Ⅲ. There were no significant differences in age, E2, LH, FSH, BMI, uterine volume, uterine length diameter and ovarian volume among the three groups(P＞0.05). The bone age of Tanner stage Ⅲ group was greater than that of Tanner stage I group, and the difference was statistically significant(P＜0.05). 
    Conclusion  There is a significant positive correlation between breast ultrasound grading and bone age, uterine volume, uterine length diameter, ovarian volume, which is more accurate and objective for the evaluation of puberty breast development of girls.

    A meta analysis of the relationship between risk factors and childhood leukaemia
    WANG Shi-bo, WANG Li-yi, SUN Hong-mei, GAO Yan-jun
    2020, 41(10):  1165-1171.  doi:10.3969/j.issn.1007-3205.2020.10.011
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    Objective  To evaluate the relationship between risk factors and childhood leukaemia.
    Methods  WanFang database, CNKI, DAYI database, PubMed database were searched to obtain the related articles about the relationship between risk factors and childhood leukaemia, retrieval time until August 20, 2019, the research results were analyzed with revman 5.3 software. 
    Results  A total of 25 case-control studies on risk factors of childhood leukemia were included, including 4 307 cases in the case group and 5 159 cases in the control group. Meta-analysis results showed that the OR and 95% confidence interval（CI）, of the first three factors with a correlation between childhood environmental risk factors and childhood leukemia: history of paint exposure OR(5.75), 95%CI(3.17,10.44);Toxic chemical exposure history OR(3.46), 95%CI(2.00, 6.00); Family genetic history OR(3.32), 95%CI(2.52, 4.38). The OR and 95%CI of the first three factors with a correlation between environmental risk factors of mothers before pregnancy or during pregnancy and the incidence of childhood leukemia: house decoration or new furniture OR(3.19), 95%CI(1.63, 6.27); Toxic chemical exposure history OR(2.44), 95%CI(1.81,3.30); abortion history OR(2.15), 95%CI(1.28,3.61). The environmental risk factors of fathers association with childhood leukemia were: smoking history OR(2.18), 95%CI(1.19, 4.01); history of toxic chemical exposure OR(1.52), 95%CI(1.25,1.85). 
    Conclusion  The incidence of childhood leukemia is closely related to the children themselves, the mother and the father. Improving the family living environment and creating a good family atmosphere provide effective measures for the prevention of childhood leukemia.

    A comparative study of the effect of tissue removal thickness on corneal biomechanics in patients with ametropia treated with SMILE and FLEx
    LYU Peng, BAI Ning-yan, XU Hao, CHEN Yu-hong, CHEN Zhuo-qian
    2020, 41(10):  1172-1175,1199.  doi:10.3969/j.issn.1007-3205.2020.10.012
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    Objective  To investigate the effects of tissue removal thickness on corneal biomechanics after small incision femtosecond laser corneal stromal lens extraction(SMILE) and femtosecond laser corneal stromal lens extraction(FLEx) in ametropic patients. 
    Methods  A total of 240 cases of refractive lensectomy due to refractive errors. According to the operation method, the patients were divided into observation group and control group. The observation group was treated with SMILE, while the control group was treated with FLEx. The changes of visual acuity, corneal height and corneal biomechanical parameters were observed after operation. 
    Results  There were significant differences in UDVA and BCVA between two groups at 1 day, 1 week, 1 month, and 1 year(P＜0.01), and interactions between different operations and time(P＜0.01). However, there was no difference between the groups at each time point(P＞0.05); after 3 months, the control group and the observation group measured the cornea. The height of each region was changed, and there was no significant difference between the apex and the 2 mm ring. However, the difference between two groups was significant at 4 mm and 6 mm rings(P＜0.05). There were significant differences in △CH and △CRF between two groups at 1 week, 1 month, and 3 months after operation(P＜0.01), and interactions between different operations and time(P＜0.01), but two groups. There was no difference at the time point(P＞0.05).
    Conclusion  The visual acuity of patients after SMILE and FLEx can be improved. However, in terms of corneal biomechanical changes, SMILE has less impact on corneal biomechanics, and corneal biomechanical stability is better after surgery. 

    Clinical application of CXCL8 and its receptor in the diagnosis of pulmonary tuberculosis
    XING Zhi-wei, ZHANG Xun, WAND Hong, HAN Yun-xiao, ZHANG Jian-wu
    2020, 41(10):  1176-1180.  doi:10.3969/j.issn.1007-3205.2020.10.013
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    Objective  To evaluate the expression of CXC chemokine ligand 8(CXCL8), CXC chemokine receptor 1(CXCR1), CXC chemokine receptor 2(CXCR2) mRNA in peripheral blood of patients with pulmonary tuberculosis, and to investigate their clinical significance in the diagnosis of pulmonary tuberculosis. 
    Methods  Case-control study was performed，and expression levels of CXCL8, its receptor CXCR1 and CXCR2 mRNA were detected by reverse transcription polymerase chain reaction(RT-PCR) in peripheral blood of 125 pulmonary tuberculosis patients, 109 latent infectious patients and 112 healthy controls in this experiment. Pulmonary tuberculosis patients were divided subgroups according to cavity formation：patients with lung cavity vs those without lung cavity. The expression of CXCL8, CXCR1 and CXCR2 mRNA was compared between two groups. All tuberculosis patients were treated with standardized anti-tuberculosis therapy for 6 months, and the dynamic changes of CXCL8, CXCR1 and CXCR2 mRNA were monitored. The value of CXCL8, CXCR1 and CXCR2 in the laboratory diagnosis of pulmonary tuberculosis were analyzed by receiver operator characteristic curve(ROC curve).
    Results  The mRNA expression levels of CXCL8, CXCR1 and CXCR2 were significantly higher in peripheral blood in pulmonary tuberculosis group than those in latent tuberculosis group and control group and the differences were statistically significant（P＜0.05）. The mRNA expressions of CXCL8, CXCR1 and CXCR2 in tuberculosis patients with lung cavity group were significantly higher than that in tuberculosis patients without lung cavity group and the differences were statistically significant（P＜0.05）. The mRNA expression levels of CXCL8, CXCR1 and CXCR2 after 3 months treatment were significantly decreased than those before treatment, and the mRNA expression levels of CXCL8, CXCR1 and CXCR2 after 6 months treatment were significantly decreased than those before treatment or after 3 months treatment, and the differences were statistically significant(P＜0.05). The area under ROC curve of CXCL8 in the diagnosis of pulmonary tuberculosis was 0.888, sensitivity was 76.8% and specificity was 90.5%. The area under ROC curve of CXCR1 in the diagnosis of pulmonary tuberculosis was 0.819, sensitivity was 72.8% and specificity was 79.2%. The area under ROC curve of CXCR2 in the diagnosis of pulmonary tuberculosis was 0.756, sensitivity was 59.2% and specificity was 78.8%. 
    Conclusion  Chemokine CXCL8 and chemokine receptor CXCR1 and CXCR2 are involved in the anti-tuberculosis immunity of the body. They may be one of the biomarkers for the diagnosis and illness condition assessment of pulmonary tuberculosis.

    Effects of dexmedetomidine on apoptosis of polymorphonuclear neutrophils and NF-κB activity in peripheral blood in pediatric patients undergoing cardiopulmonary bypass
    GUO Qiong-mei, LIU Xiu-ye, WANG Li, ZHOU Xiao-hui, WEI Yan-yan, MAO Rui-fen
    2020, 41(10):  1181-1184,1189.  doi:10.3969/j.issn.1007-3205.2020.10.014
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    Objective  To evaluate the effects of dexmedetomidine on apoptosis of polymorphonuclear neutrophils and nuclear factor-κB（NF-κB） activity in peripheral blood in pediatric patients undergoing cardiopulmonary bypass. 
    Methods  Sixty pediatric patients，of American Society of Anesthesiologists（ASA） physical statusⅡ or  Ⅲ，scheduled for elective repair of ventricular septal defect under continuous blood purification（CPB）, were randomly divided into 2 groups(n=30 each) using a random number table：control group(group C) and dexmedetomidine groups(group D)．In group D， dexmedetomidine 0.5 μg/kg(initial dose) was given over more than 10 min after anesthesia induction， followed by continuous infusion at 0.4 μg·kg-1·h-1, until the end of operation．The equal volume of normal saline was given instead of dexmedetomidine in group C．Before administration(T0)，30min after begainning of CPB, at 30min, 4 and 24 h after termination of CPB(T1-4)，blood samples were collected for determination of NF-κB activity , apoptosis rate and express of  caspase-3 of polymorphonuclear neutrophils. 
    Results  Compared with the baseline value at T0, NF-κB activity of polymorphonuclear neutrophils was significantly increased, the value  of group D was decreased than that of group C at T1-4, there were statistically significantly difference between groups, time points and their interaction（P＜0.05）. Apoptosis rate and express of  caspase-3 of polymorphonuclear neutrophils were gradually decreased at T0-T2, and then increased at T3, T4, while significantly decreased than that of T0 in two groups, and the value  of group D was increased than that of group C at T1-4, there were statistically significantly difference between groups and time points（P＜0.05）. The apoptosis rate of polymorphonuclear neutrophils was negatively correlated with the activity of NF-κB（group C：r=-0.606， P＜0.05；group D：r=-0.691， P＜0.05）.  
    Conclusion  The inhibition of NF-κB activity is involved in the reduction of apoptosis inhibition of polymorphonuclear neutrophils in peripheral blood in pediatric patients undergoing open heartsurgery under cardiopulmonary bypass by dexmedetomidine .

    Effects of oxycodone under laryngeal mask in elderly undergoing transurethral resection of the prostate
    TIAN Qing-chuan, YANG Xiao-chun, SUN Hai-jun
    2020, 41(10):  1185-1189.  doi:10.3969/j.issn.1007-3205.2020.10.015
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    Objective  To observe the effects oxycodone with laryngeal mask anesthesia in elderly undergoing transurethral resection of the prostate. 
    Methods  A total of 90 elderly with transurethral resection of the prostate underwent laryngeal mask general anesthesia were divided into three groups randomly: group fentanyl(group F), group sufentanil(group S),group oxycodone(group O). The induction of group F patients with fentanyl 1.5 μg/kg, group S sufentanil 0.15 mg/kg, group O oxycodone 0.15 mg/kg. Drugs of other induction and maintenance were the same. The data of mean arterial pressure(MAP) and heart rate(HR) were recorded at base line T0, induction completed T1, laryngeal mask placed 20 seconds(T2), operation started(T3), operation finished(T4), laryngeal mask pulled out(T5). The recovery time, dosage of drugs for maintenance, the Visual Analogue Score(VAS) and adverse reactions were recorded. 
    Results  The dosages of remifentanil in group F were significantly higher than group S and group O(P＜0.05) .With the time extending, the MAP and HR of three groups all showed fluctuation, the MAP and HR in group F were significantly higher than group S and group O at T2(P＜0.05). There were significant differences in MAP and HR among time points of 3 groups(P＜0.05). The VAS scores of 3 groups increased with time extending, group F were higher than group S and group O, group S were higher than group O, there were significant differences in VAS scores among groups, time points and groups·time points of 3 groups(P＜0.05). 
    Conclusion  Oxycodone 0.15 mg/kg was effectively applied to the elderly with transurethral resection of the prostate. It has more stable hemodynamic and an obvious advantage of postoperative analgesia, with no more adwerse reactions.
    The value of cone beam CT in the interventional treatment of colorectal cancer liver metastases
    WU Yong-chao, WU Zhong-lin, RONG Xiao-cui, LI Ya-zhou, KANG Yi-he, LI Zhi-gang
    2020, 41(10):  1190-1194.  doi:10.3969/j.issn.1007-3205.2020.10.016
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    Objective  To explore the value of cone beam CT in transarterial chemoembolization of colorectal liver metastases（CRLM), and to provide effective information for the interventional treatment of clinical CRLM. 
    Methods  Fifty patients with CRLM were enrolled. A total of 146 metastases were detected by abdominal CT or magnetic resonance imaging (MRI) intensive examination. All patients underwent digital subtraction angiography（DSA） two-dimensional angiography, and the liver metastases（LM） staining, number and location were observed. Cone beam CT(CBCT) enhanced scanning was performed to observe the LM staining, number and location. Combined with the performance of two methods, super-selective lipiodol embolization was performed. After the embolization was completed, the CBCT was scanned again to observe the degree of LM embolization. 
    Results  Fifty patients underwent routine DSA. angiography, 97 CRLM were seen. The angiographic findings showed ring-shaped staining around the early tumor in the artery. There was no staining in the central region, and the annular staining in the late arterial phase became lighter. The normal liver parenchyma filling defect was clearly developed. Twenty-four were moderate of blood supply, 73 were lack of blood supply, and no CRLM were rich of blood supply. A total of 142 LM were detected by CBCT enhanced scan, and 45 more than DSA angiography(P＜0.05), there were statistically significant. LM showed peripheral enhancement of the tumor in the CBCT enhanced scan, while the central area was not enhanced, consistent with CT or MRI imaging findings. Fifty patients underwent CBCT scan after embolization, and 142 metastases clearly showed embolization of liver metastases. The 107 metastases were consistent with CBCT enhanced scan and preoperative imaging enhancement, 35 metastases and dual-phase scans. The enhancement range was poor, and the second embolization was performed. The CBCT scan again showed that the deposition range of the liver metastasis was consistent with the enhancement range. 
    Conclusion  When patients of CRLM is treated with TACE, CBCT enhanced scan after DSA two-dimensional angiography can effectively detect metastasis missed in two-dimensional angiography, and CBCT plain scan after CRLM embolism can accurately and immediately judge the deposition of iodized oil and improve the TACE efficacy of CRLM. CBCT technique can play a guiding role in CRLM.

    The diagnosis value of direct multi-slice computed tomography venography in lower extremity thrombosis
    HOU Rui-hong, MU Jian-kui, SUN Meng-yue, JING Shu-yan, LI Zi-jian, LI Shu-jing
    2020, 41(10):  1195-1199.  doi:10.3969/j.issn.1007-3205.2020.10.017
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    Objective  To explore the value and clinical significance of direct multi-slice computed tomography venography(MSCTV) in diagnosing venous obstructive diseases. 
    Methods  Forty-eight patients with high clinical suspicion of lower extremity venous thrombotic disease were examined by MSCTV. The original data were sent to the workstation for multiple image post-processing to find out the characteristic imaging manifestations of the disease, and compared with the digital subtraction angiography(DSA) results. 
    Results  Among the 48 patients, 36 had deep vein thrombosis of lower extremities, 3 had simultaneous involvement of both lower extremities, 21 had left lower extremity involvement, and 12 had right lower extremity involvement. 27 had iliac vein compression syndrome and 18 had accompanied with deep vein thrombosis.With DSA results as the gold standard, the sensitivity and specificity of MSCTV for the diagnosis of deep venous thrombosis of lower extremities were 97.2% and 100.0%. 
    Conclusion  MSCTV may be used as the first choice in diagnosing venous thrombosis of the lower extremity.

    Application of MRI combined with intraluminal filling coupling agent in preoperative evaluation of rectal cancer
    SONG Jun-wei, LU Wei-dong, LI Xiao-jing, ZHAO Xin-hai, LI Kai, GUAN Hao
    2020, 41(10):  1200-1205.  doi:10.3969/j.issn.1007-3205.2020.10.018
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    Objective  To evaluate the value of rectal MRI combined with intraluminal filling coupling agent in preoperative evaluation of rectal cancer. 
    Methods  A total of 76 cases of rectal cancer were reviewed. All patients underwent rectal MRI examination and MRI examination after intraluminal filling of coupling agent. The T stage, N stage, mesangial vessel invasion and circumferential margin of the tumors were evaluated respectively. The results were compared with the pathological results after operation. 
    Results  Rectal MRI was consistent with postoperative pathology in 58 patients with rectal cancer T stage, the overall coincidence rate was 76.3%. N stage was consistent with postoperative pathology in 55 cases, the overall coincidence rate was 72.3%(Kappa=0.572, χ2= 4.366, P＜0.001). EMVI analysis showed that MRI was consistent with pathology in 55 cases, EMVI(+) was misdiagnosed as EMVI(-) in 9 cases and EMVI(-) was misdiagnosed as EMVI(+)in 12 cases. The overall coincidence rate was 72.3%(Kappa=0.564, χ2= 23.677, P < 0.001). According to CRM analysis, 68 cases were consistent with pathology, including 4 cases of CRM(+) and 4 cases of CRM(-)were misdiagnosed . The overall coincidence rate was 89.5%(Kappa=0.754, χ2= 8.556, P=0.004). Sixty-six cases of rectal cancer T staging were consistent with postoperative pathology after filling the rectum cavity with coupling agent, the overall coincidence rate was 86.8%, and the coincidence rate with rectal MRI was analyzed by chi square test(Kappa=0.736, χ2= 3.102, P=0.043). N staging was consistent with postoperative pathology in 55 cases, with an overall coincidence rate of 72.3%. The coincidence rate with rectal MRI was examined by chi square test(Kappa=0.569, χ2= 0.000, P=1.000). EMVI analysis showed that MRI was consistent with pathology in 61 cases, among which EMVI(+) was misjudged as EMVI(-) in 7 cases and EMVI(-) was misjudged as EMVI(+) in 8 cases. The overall coincidence rate was 80.3%. The coincidence rate with rectal MRI was verified by chi square test(Kappa=0.612, χ2= 1.314, P=0.252). According to CRM analysis, 65 cases were consistent with pathology, including 4 cases of CRM(+) and 7 cases of CRM(-) were misdiagnosed. The overall coincidence rate was 85.5%. The coincidence rate of MRI and rectal MRI was analyzed by chi square test(Kappa=0.712, χ2= 0.543, P=0.465). 
    Conclusion  Rectal MRI combined with intraluminal coupling agent can improve the accuracy of preoperative T staging and mesangial vessel invasion in rectal cancer, but has no significant influence on the accuracy of N staging and circumferential margin.

    Preliminary study on patella reversal transplantation for repairing the articular surface of old tibial plateau fracture malunion
    ZHAO Wei-guang, LIAN Xiao-dong, ZHENG Zhan-le, ZHANG Ying-ze
    2020, 41(10):  1231-1232，封三.  doi:10.3969/j.issn.1007-3205.2020.10.026
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    The old tibia platform fracture malunion belongs to orthopaedic trauma treatment problem. In this article,for the first time with the method of patellar take reverse bone transplantation treatment of one patient with old tibial plateau fracture malunion. During operation, the central patellar articular surface was drilled out. High specification was 22 mm, 15 mm diameter cylinder. The section contained information about the cylinders implanted in the form of joint surface toward the femoral condyle inside, patellar residual cavity in ilium tamponade. Postoperative imaging examination and clinical effect were satisfactory.