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Table of Content

    25 November 2020, Volume 41 Issue 11
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    Effect of dihydroartemisinin on proliferation and apoptosis of human gastric cancer cell line BGC-823 and its mechanisms
    XU Yan-nan, MENG Li, ZHU Yan, YAN Jing, WANG Yan-ling, ZHOU Chen-ming
    2020, 41(11):  1245-1250.  doi:10.3969/j.issn.1007-3205.2020.11.002
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    Objective  To investigate the effect of dihydroartemisinin on the growth and apoptosis of human gastric cancer cell line BGC-823. 
    Methods  Methylthiazoletetrazolium（MTT） assay was used to determine the inhibitory rate of dihydroartemisinin with different concentrations on the proliferation of BGC-823 cells. The apoptosis rate and morphological changes of BGC-823 cells treated with dihydroartemisinin were detected by flow cytometry(FCM), fluorescence microscope, transmission electron microscope. Western-blot were used to detect the changes of Bax,Caspase-3,Caspase-8 protein levels in BGC-823 cells. 
    Results  MTT assay showed that the proliferation of BGC-823 cells was markedly inhibited after treatment with dihydroartemisinin, and the inhibition rate increases with the increase of drug concentration, and with the extension of time. It has a significant dose and time dependence(P＜0.01) and IC50 was 3.4 μmol/L. The results of flow cytometry showed that with the increase of drug concentration, the apoptotic peak became more obvious and showed a dose-dependent(P＜0.01). Typical apoptotic morphology were observed in BGC-823 cells after induced by dihydroartemisinin. Western blot showed that the expressions of Bax, Caspase-3 and Caspase-8 proteins increased with the increase of dihydroartemisinin concentration. 
    Conclusion  The result suggested that dihydroartemisinin could inhibit the proliferation of BGC-823 cells. Dihydroartemisinin promotes the apoptosis of BGC-823 cells by up-regulating the expression of Bax, Caspase-3 and Caspase-8.

    Effect of IRS-1/TAZ signaling on bone marrow lipogenesis and the mechanism
    WANG Na, LIU Chang, XUE Peng, WANG Xiao, LI Yu-kun, LIU Si-jing
    2020, 41(11):  1251-1255,封三.  doi:10.3969/j.issn.1007-3205.2020.11.003
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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 adipogenic differentiation of bone marrow derived mesenchymal stem cells(BMSCs). 
    Methods  In vivo, the adipocyte count of rat femurs in control group, sham group and ovariectomy(OVX) group was analyzed by hematoxylin and eosin(HE) staining and immunofluorescence assay, and the IRS-1 concentration in rat femurs was tested by enzyme-linked immunosorbent assay(ELISA). In vitro, the plasmid transfection was used to change the IRS-1 and TAZ expression in BMSCs, the oil red O staining and western blot was used to analyze the lipid droplets and the expression of the adipogenic differentiation related proteins. 
    Results  The adipocyte count and the IRS-1 concentration in rat femurs in OVX group was significantly reduced. High expression of IRS-1 in BMSCs increased the expression of TAZ protein, and decreased the expression of CCAAT/enhancer binding protein β(C/EBPβ) and peroxisome proliferator activated receptor γ(PPARγ) proteins, which inhibited the adipogenic differentiation of BMSCs. Knockout of IRS-1 or TAZ promoted the adipogenic differentiation of BMSCs. 
    Conclusion  IRS-1 increased the TAZ expression, which inhibited the adipogenic differentiation of BMSCs. IRS-1/TAZ signaling in stem cells might be a new target to control the bone marrow lipogenesis of osteoporosis patients.

    Study on the optimization of green channel for thrombolysis in stroke and analysis of its application effects#br#
    #br#
    LI Jing, LYU Xiao-pei, LIANG Xiao-xue, XI Yu-fang, LU Hai-li
    2020, 41(11):  1256-1260.  doi:10.3969/j.issn.1007-3205.2020.11.004
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    Objective  To explore the influence of the construction and rectification of the green channel for thrombolysis in stroke on the time from onset to treatment time（OTT）, the door to needle time（DNT）, thrombolysis rate, clinical efficacy and prognosis of thrombolysis, and highlight the value of the construction and rectification of the green channel for stroke. 
    Methods  The clinical data of 118 patients with thrombolytic therapy through green channel were collected and divided into control group(57 cases) and observation group(61 cases) according to time. The OTT, DNT, DNT≤60 min ratio, National Institute of Health stroke scale（NIHSS） score, significant efficiency, complications and Modified Rankin Scale（mRS） score were compared between two groups. 
    Results  The OTT and DNT of observation group were shorter than those of control group, and the proportion of DNT≤60 min was higher than that of control group(P＜0.01). After 72 hours of thrombolytic therapy, the clinical efficacy of observation group was better than that of control group, and the total effective rate was higher than that of control group(P＜0.01). There was no significant difference in the incidence of complications and mortality between the two groups(P＞0.05). The NIHSS scores of the two groups were gradually decreased, and the NIHSS score of the observation group was lower than that of control group and the differences of interaction among groups, time points and time points between groups were statistically significant(P＜0.01). The BI scores of two groups were gradually increased, and the BI score of the observation group was higher than that of the control group. The differences of interaction between groups, time points and time points between groups were statistically significant(P＜0.01).After 3 months of treatment, the mRS score of observation group was significantly lower than that of control group, and the proportion of ≤ 2 points was higher than that of control group(P＜0.01). 
    Conclusion  Through the establishment of the green channel for thrombolysis， the OTT and DNT can be significantly shortened, the thrombolysis rate and the efficacy of cerebral infarction can be improved, and the degree of disability can be reduced, thus achieving good social benefits.

    Effect of early fresh frozen plasma transfusion therapy on delayed traumatic intracranial hematoma after traumatic subdural hematoma
    ZHANG Li-min, SUN Wen-bo, WANG Xu-peng, LI Rui, WANG Xiao-dong, WANG Ming-li
    2020, 41(11):  1261-1265.  doi:10.3969/j.issn.1007-3205.2020.11.005
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    Objective  To investigate the effects of early fresh frozen plasma transfusion before opening endocranium on incidence of delayed traumatic intracranial hematoma(DTIH) in patients with subdural hematoma after trauma brain injury. 
    Methods  According to occurrence of DTIH after surgery, 197 of patients with severe trauma brain injury(TBI) were divided into DTIH group or non-DTIH(NDTIH) group. The patients′ demographics(gender, age, body mass index), vital signs(pre-operative mean arterial pressure, heart rate), initial injury severity(ISS), peri-operative transfusion(type, volume), blood product(type, volume), transfusion time of fresh frozen plasma, laboratory tests, DTIH and mortality within 30 days post-TBI were collected. To account risk factors of DTIH, the significant statistic factors between two groups in the univariate analysis were involved in a bivariate logistic regression. 
    Results  There were 32 patients developing new DTIH after surgery. The incidence of new DTIH after surgery was 16.2%. Compared with NDTIH group, the patients in DTIH group showed lower GCS, more hematoma volume, and higher ratio of early fresh frozen plasma transfusion(P＜0.05). In a bivariate logistic regression model, GCS(OR=4.23, 95%CI=1.62-8.72, P＜0.001), hematoma volume ≥100 mL(OR=5.39, 95%CI=1.75-9.38, P＜0.001), and early fresh frozen plasma transfusion(OR=1.54, 95%CI=1.27-4.29, P=0.016) were correlated with new DITH after surgery. 
    Conclusion  Increased incidence of DTIH in patients with subdural hematoma after traumatic brain injury might be associated with early fresh frozen plasma transfusion.

    Effect of bone transfer combined with end-to-end bone grafting on the treatment of large segmental bone defects of lower extremity and its effect on the expression of serum bFGF, PDGF, VEGF and TGF-β
    WAN Lun, LIU Lei-gao, ZHU Ding-chuan, GAO Feng
    2020, 41(11):  1266-1270.  doi:10.3969/j.issn.1007-3205.2020.11.006
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    Objective  To explore the effect of bone transfer combined with joint bone grafting and internal fixation in the treatment of large bone defects of the lower extremities and the serum basic fibroblast growth factor(bFGF) and platelet-derived growth factor platelet derived growth factor(PDGF), vascular endothelial growth factor(VEGF), transforming growth factor β(TGF-β) expression. 
    Methods  Fifty patients with large-segment bone defects of the lower limbs were selected for surgical treatment, and they were divided into a single group(25 cases) and a combined group(25 cases) using a random number table method. The single group was treated with bone transfer, and the combined group was treated with contralateral bone grafting and internal fixation on the basis of the single group. Comparing the healing status, complication rate, and serum inflammatory factors ［C-reactive protein(CRP) and tumor necrosis factor-α(TNF-α) and nuclear factor kappa-B(NF-κB)］, bFGF, PDGF, VEGF, TGF-β, immediately after contact with the opposite ends and 1 week after contact between the two groups expression. 
    Results  The complication rate of bone healing index, bone healing time, external fixation time, nonunion of bone commissure, and nail infection was significantly lower than that of the single group. The excellent rate of bone healing was significantly higher than that of the single group(P＜0.05); Immediately after exposure to the end, the levels of CRP, TNF-α, NF-κB and bFGF, PDGF, VEGF, TGF-β were not significantly different(P＞0.05), 1 week after exposure, combined group CRP, the levels of TNF-α and NF-κB were significantly lower than those of the single group, and the levels of bFGF, PDGF, VEGF and TGF-β were significantly higher than those of the single group(P＜0.05). 
    Conclusion  Bone transfer combined with end-to-end bone grafting for the treatment of large segmental bone defects can effectively shorten the bone healing time, improve the bone healing, reduce the inflammatory response and increase the level of bone regeneration related factors, and reduce the patients. Complications have clinical significance.

    Effect of manipulative reduction and internal fixation through small incision of tarsal sinus on inflammatory response and bone metabolism in calcaneal fracture patients
    MA Zhuang, HUANG Yong-hong, YE Ke, TANG Ji-dong, LIU Chen, LIU Lei-gao
    2020, 41(11):  1271-1275，1280.  doi:10.3969/j.issn.1007-3205.2020.11.007
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    Objective  To investigate the effect of manipulative reduction and internal fixation with small incision for tarsal sinus on inflammation and bone metabolism in patients with calcaneal fractures. 
    Methods   Sixty patients with calcaneal fractures admitted to Chengdu Xinhua hospital were selected as observation objects, and were divided into 32 cases in the research group and 28 cases in the control group according to the treatment method. The study group was treated with manipulative reduction and internal fixation through small incision of tarsal sinus, while the control group was treated with steel plate internal fixation through l-shaped incision of lateral calcaneus. The Bohler angle, gissane angle, calcaneal width, curative effect, complications, levels of inflammatory cytokines interleukin-1β（IL-1β）, IL-6, IL-22, osteocalcin(OC), bone alkaline phosphatase(BALP) and N-terminal propeptide of type Ⅰ procollagen were compared between the two groups The levels of type Ⅰ precollagen(PINP), type Ⅰ collagen cross linked telopeptide(CTX), tartrate resistant acid phosphatase(TRAP) and pyridinoline(PYD) were measured. 
    Results  after surgery, Bohler Angle and Gissane Angle were significantly larger than those of the control group, and calcaneal width was significantly smaller than that of the control group(P＜0.05). The excellent and good rate of the study group was 93.75%, which was significantly higher than that of the control group(71.43%, P＜0.05). The levels of inflammatory cytokines IL-1 beta, IL-6 and IL-22 in the study group were significantly lower than those in the control group(P＜0.05). The levels of OC, BALP and PINP in the study group were significantly higher than those in the control group(P＜0.05), and the levels of CTX, TRAP and PYD were significantly lower than those in the control group(P＜0.05). The total incidence of postoperative complications in the study group was 9.38%, which was significantly lower than that in the control group(P＜0.05). 
    Conclusion  The reduction and internal fixation of small incision for tarsal sinus has a definite effect on calcaneal fractures, which can effectively restore the anatomical structure of the calcaneus and improve bone metabolism, with a small inflammatory stress response and fewer complications. Therefore, it can be popularized.

    Effect of somatostatin in preventing hyperamylase and post-ERCP pancreatitis
    ZHANG Pei-jian, LIU Meng-dong, LIU Ke-xia, WANG Ya-qi, LIU Xu-guang
    2020, 41(11):  1276-1280.  doi:10.3969/j.issn.1007-3205.2020.11.008
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    Objective  To investigate the function of somatostatin prophylactic treatment in patients with postoperative hyperamylasemia and post ERCP pancreatitis(PEP) after endoscopic retrograde cholangiopancreatography(ERCP). 
    Methods  A total of 280 patients to be treated with ERCP were included and treated with somatostatin 250 μg/h for 24 h. According to no use of somatostatin, they were divided into four groups by random number table 1 h before surgery, immediately after surgery, and 3 h after surgery.Serum amylase levels were detected 5 and 24 hours before and after operation, and the occurrence of postoperative hyperamylase and PEP were observed and compared. 
    Results  There was no significant difference in age, sex and operation among the groups. The incidence of postoperative hyperamylasemia in group B, C and D was significantly lower than that in group A(P＜0.05). The incidence of PEP in group B, C and D was significantly lower than that in group A, with statistically significant differences(P＜0.05). Serum amylase levels in group B, C and D were significantly lower than those in group A 5 h and 24 h after surgery(P＜0.05). In addition, there were no significant differences in the incidence of hyperamylasemia, PEP and postoperative blood amylase levels among groups B, C and D(P＞0.05). 
    Conclusion  The prophylactic application of somatostatin can reduce the incidence of hyperamylase and PEP after ERCP, and there was no significant difference in the prophylactic effect between preoperative and postoperative administration within 3 h.

    A Meta analysis of modified Koyanagi technique and Duckett+Dupaly technique in the one-stage treatment of proximal hypospadias
    WANG Chong-bo, GUO Ping-ying, LI Yong-zhang, WANG Xin, CHANG Xue-liang, XUE Wen-yong
    2020, 41(11):  1281-1285，1290.  doi:10.3969/j.issn.1007-3205.2020.11.009
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    Objective  To evaluate the clinical effect of modified Koyanagi technique and Duckett+Duplay technique in the treatment of proximal hypospadias. 
    Methods  In this study, we searched Chinese and English databases and manually searched relevant journals. According to the inclusion and exclusion criteria, we searched by keywords to select the research that met the requirements. We used review manage 5.3 software to analyze the extracted data. 
    Results  Five eligible studies were included in this study, including 227 patients with modified Koyanagi technique and 235 patients with Duckett+Duplay technique. The results of meta analysis showed the incidence of urethral fistula and operation time: there was no statistical difference between two groups. Incidence of urethral stricture: the incidence of urethral stricture after modified Koyanagi technique was relatively low(Z=3.01, P=0.003). Operation success rate: the operation success rate of modified Koyanagi technique was higher(Z=2.09, P=0.04). There was no significant difference in the incidence of urethra fistula between the modified Koyanagi technique and Duckett+Duplay technique with the “tennis racket” flap reconstruction of urethra plate; the incidence of urethra stenosis and the success rate of the modified Koyanagi technique were lower and higher. There was no significant difference in the incidence and success rate of urethra fistula and stricture between the modified Koyanagi technique and Duckett+Duplay technique. 
    Conclusion  Compared with Duckett+dupaly technique, the modified Koyanagi technique has a lower incidence of urethral stricture and a higher success rate.
    Study on the miRNA expression differences in patients with HPV 18 and different pathological types of cervical cancer
    LIU Miao, ZHANG Xiao-xiao, LI Rui-zhen, YE Jing, WU Lan-na
    2020, 41(11):  1286-1290.  doi:10.3969/j.issn.1007-3205.2020.11.010
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    Objective  To investigate and analyze the micro ribonucleic acid（miRNA） expression differences in patients with human papillomavirus 18（HPV 18）and different pathological types of cervical cancer. 
    Methods  Thirty patients with HPV18 positive cervical adenocarcinoma were chosen as the group A，30 patients with HPV18 positive cervical squamous carcinoma at the same time were chosen as the group B， 15 persons with normal cervix at the same time were chosen as the group C. Then the tissue differentially expressed miRNA of group A and group B were tested，and the expression situation of differentially expressed miRNA and target gene of three groups were compared，the expression situation of group A with different ages，stages，differentiation degree and transfer situation were compared too. 
    Results  The differentially expressed miRNA of group A and group B were miR-34 and miR-19. The miR-19 and survivin of group A were significantly higher than those of group B. The miR-34 and phosphatase and tensin homolog deleted on chromosome ten（PTEN）were significantly lower than those of group B. The expression of group A and group B were significantly different from group C， there were statistically significant differences（P＜0.05）. The expression situation of group A with different ages were compared， there were no statistically significant differences（P＞0.05）. The expression situation of group A with different stages， differentiation degree and transfer situation were compared， there were statistically significant differences（P＜0.05）.
    Conclusion  The expression differences of miR-19， miR-34， survivin and PTEN in patients with HPV 18 and different pathological types of cervical cancer are significant， and the expression differences of patients with different stages， differentiation degree and transfer situation are obvious. 
    Relationship between embryogenic IL-1β and human embryonic development and implantation
    ZHU Xu-li, ZHAO Zhi-ming, CAO Jin-feng, DU Yuan-jie, ZHOU Liang, WANG Yue
    2020, 41(11):  1291-1295.  doi:10.3969/j.issn.1007-3205.2020.11.011
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    Objective  To investigate the relationship between the level of interleukin-1β(IL-1β) secreted by embryos in embryo culture medium and embryo development and implantation potential. 
    Methods  Eighty patients with fresh cycle infertility who underwent the first intracytoplasmic sperm injection-embryo transfer(ICSI-ET) operation were selected. Embryos were cultured in vitro with single droplet single embryo. Embryo transfer was performed on the third day after oocyte retrieval and fertilization, and the number of transferred embryos was 2. The corresponding microdroplets of cleavage-stage culture fluid from fresh-cycle embryos were collected and the levels of IL-1β in their supernatants were measured by enzyme-linked immunosorbent assay.According to the implantation rate per cycle, the patients were divided into group A(43 cases, implantation rate was 0%), group B(27 cases, implantation rate was 50%), and group C(10 cases, implantation rate was 100%). The main clinical data of the three groups were compared with the relevant parameters of embryo laboratory, the level of IL-1β secreted in embryo transfer medium, and the cumulative score of embryo transfer morphology. The correlation between the level of IL-1β and the cumulative score of embryo transfer morphology was analyzed. 
    Results  There were 37 clinical pregnancies in 80 patients, and the clinical pregnancy rate was 46.3%, including 27 singleton pregnancies and 10 twin pregnancies.There was no significant difference in the main clinical data and embryo laboratory parameters among three groups(P＞0.05). The level of IL-1β in the culture medium of embryo cleavage stage in group B was higher than that in group A, and that in group C was higher than that in group A and group B, the difference was statistically significant(P＜0.05). There was no significant difference in cumulative scores of morphology among the three groups(P＞0.05). The level of IL-1β was positively correlated with the cumulative score of embryo morphology(r=0.587, P＜0.05). 
    Conclusion  Endogenous IL-1β secreted by embryos during embryo culture is closely related to embryo development and implantation, and its evaluation of embryos and study on early embryo intervention can provide reference significance. 

    Regulation of autophagosomes and apoptotic bodies on bronchopulmonary dysplasia in neonatal mice
    ZHENG Yu, LI Lan, HU Hui-ping, LI Zheng-tao, LIU Wen-chun, PENG Yi-jie
    2020, 41(11):  1296-1300.  doi:10.3969/j.issn.1007-3205.2020.11.012
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    Objective  To investigate the regulation effect of autophagosomes and apoptotic bodies on bronchopulmonary dysplasia(BPD) in neonatal mice. 
    Methods  Thirty-six neonatal SD mice were randomly and equally divided into three groups for different treatments, control group, model group and intervention group. On the 22nd day, the general situation of mice in each group was observed, the pathological changes of lung tissue were observed by HE staining, and the ultrastructure of type Ⅱ alveolar epithelial cells in each group was observed by transmission electron microscopy. The expression levels of autophagy related proteins ［P62, microtubule-related protein light chain 3B(LC3B)］ and apoptotic related proteins ［Bcl-2-related X protein(Bax), caspase-3］ in lung tissues were detected by Western blot. 
    Results  Compared with the model group, the mental state, hair growth, diet, breathing and body weight of the mice in the intervention group were significantly improved, with no mice died. Moreover, the pathological changes of lung tissue in the intervention group were also significantly improved. The number of autophagosomes and apoptotic bodies in the cytoplasm of type Ⅱ alveolar epithelial cells in the intervention group was significantly lower than that of the model group. The levels of LC3B, P62, Bax and caspase-3 in the lung tissue among three groups were the highest in the intervention group, followed by model group and control group, with statistic difference(P＜0.05). 
    Conclusion  After excessive autophagy activation of type Ⅱ alveolar epithelial cells in newborn mice, autophagosomes are increased, which promotes a large number of apoptosis of type Ⅱ alveolar epithelial cells and increases the apoptotic corpuscles, thus leading to the occurrence of bronchopulmonary dysplasia, so it can provide theoretical support for the prevention and treatment of BPD. 

    Clinical value of pro-inflammatory cytokines in assessing disease severity and prognosis of early childhood purulent meningitis
    LI Jing, YANG Zan-zhang, YAN Xiao-jing, ZHANG Na, ZHANG Yan-ling
    2020, 41(11):  1301-1305，1316.  doi:10.3969/j.issn.1007-3205.2020.11.013
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    Objective  To evaluate the clinical value of pro-inflammatory cytokines in early diagnosis, evaluation of disease severity and prognosis of early childhood purulent meningitis(PM). 
    Methods  A total of 25 children aged 2 years or younger with PM were enrolled and divided into two groups based on the pathogenetic severity, namely general PM group(n=17), and severe PM group(n=8). 18 non-CNS infection children were chosen as the control group. Blood and CSF were collected within the first 12 hours after hospitalization. The level of tumor necrosis factor-α（TNF-α）, interleukin（IL）-1β, IL-6 and IL-8 was measured by enzyme linked immunosorbent assay(ELISA). Long-term prognosis was evaluated at 6 months of follow-up. 
    Results  The AUC of ROC curve was 0.932 for CSF IL-6, 0.916 for CSF IL-8, which suggested that the diagnostic efficiency of CSF IL-6 and CSF IL-8 were higher than that of other parameters. All four cytokines were higher in CSF than in serum（P＜0.05）, and the CSF levels of TNF-α, IL-1β, IL-6 and IL-8 were significantly higher in severe PM group than with general PM group. According to the ROC curve in distinguishing the severity of PM, the AUC of CSF TNF-α was largest. When the level of CSF-TNF-α was 70.4 ng/L, the Youden Index was the biggest, and the sensitivity and specificity were 100% and 94.1%, respectively. Levels of CSF IL-6 in poor prognosis group were obviously increased in comparison with that of mild poor prognosis group with a statistical difference(P＜0.05), and levels of CSF IL-6 in mild poor prognosis group was significantly higher than that in good prognosis group(P＜0.05). 
    Conclusion  CSF IL-6 and IL-8 can be used as auxiliary indicators in early diagnosis of early childhood PM. CSF TNF-α may be helpful to evaluate the severity of early childhood PM. CSF IL-6 is expected to have value for the evaluation of the long-term prognosis of early childhood PM.

    Clinical value of serum PCT, ALB and PSP in predicting the prognosis of sepsis in children
    AN Liang-bin, WEN Hang-wei, LIU Zuo-jiao
    2020, 41(11):  1306-1310.  doi:10.3969/j.issn.1007-3205.2020.11.014
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    Objective  To explore the clinical value of serum procalcitonin(PCT), albumin(ALB), and pancreatic stone protein(PSP) in diagnosing sepsis. 
    Methods  A total of 322 children with sepsis were selected as the study subjects. According to the severity of the disease, the children were divided into the sepsis group(126 cases), the severe sepsis group(105 cases), and the septic shock group(91 cases). Another 80 healthy children were selected as the control group. Serum PCT, ALB and PSP levels were compared in each group to analyze the relevant influencing factors for the prognosis of children with sepsis, and the predictive value of PCT, ALB and PSP for the prognosis of children with sepsis was evaluated by ROC curve. 
    Results  There were statistically significant differences in serum PCT, ALB and PSP levels among 4 groups(P＜0.05). PCT, PSP levels of sepsis group were higher than the control group, propagated level was lower than the control group. PCT, PSP levels of severe sepsis group were higher than that of sepsis group and the control group, propagated level below the sepsis group and the control group, PCT, PSP levels of septic shock group were higher than that of severe sepsis group, sepsis group and the control group, propagated levels below severe sepsis, sepsis group and the control group, the difference was statistically significant(P＜0.05). After 28 days of follow-up, 48 of the 322 children died(14.91%) and 274 survived(85.09%). The mortality of the severe sepsis group was higher than that of the sepsis group, and the mortality of the septic shock group was higher than that of the sepsis group and the severe sepsis group, and the difference was statistically significant(P＜0.01). PCT and PSP levels in the death group were higher than those in the survival group, ALB levels and PCIS scores were lower than those in the survival group, and the differences were statistically significant(P＜0.05).Multivariate Logistic regression analysis showed that serum PCT, ALB, PSP and PCIS scores were risk factors for death in children with sepsis(P＜0.05). ROC curve showed that serum PCT, ALB and PSP had certain predictive value for the death of children with sepsis(area under the curve, Area under curve, AUC=0.741, 0.783, 0.784, P＜0.01), the sensitivity and specificity of the three combinations were 87.5% and 91.6%, with high predictive value(AUC=0.953, P＜0.01).
    Conclusion  Serum PCT, ABL and PSP levels are of certain predictive value for the prognosis of children with sepsis, and the combined prediction of the three levels has high specificity and sensitivity, which makes the prediction of prognosis more accurate and clinical monitoring can be strengthened.
    Ultrasound assessment of breast and pelvic: distinction between premature thelarche and idiopathic central precocious puberty
    YUAN Bo, PI Ya-lei, ZHANG Ya-nan, TIAN Ying-jun, CHANG Jie, ZHANG Hui-feng
    2020, 41(11):  1311-1316.  doi:10.3969/j.issn.1007-3205.2020.11.015
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    Objective  To explore the imaging features of ultrasound in girls at different developmental stages and their ability to distinguish idiopathic central precocious puberty from premature thelarche. 
    Methods  We performed a retrospective study with a sample of 124 girls, who underwent ultrasound for evaluation development. We evaluated breast ultrasound grade, breast and pelvic ultrasound, and clinical characteristics including age and body mass index. Among the 124 girls, 52 were up to 9 years old with early breast development. We divided them into idiopathic central precocious puberty(16 cases), and premature thelarche groups(38 cases) and evaluated the clinicoradiologic findings for each group. 
    Results  A total 124 girls were graded by breast ultrasound grade, including 34 cases of grade A(27.4%), 49 cases of grade B(39.5%), 18 cases of grade C(14.5%), 5 cases of grade D(4%) and 18 cases of grade E(14.5%). There were statistical differences in age, BMI, uterine volume, uterine length diameter, anterior-posterior diameter of uterus/anterior-posterior diameter of cervix(FCR), maximum ovarian volume, endometrial thickness, vaginal wall thickness, number of ≥4 mm follicles, maximum follicular diameter, breast bud diameter and breast bud volume for girls(P＜0.05). There were 16 cases of ICPP and 38 cases of PT. The age, uterine volume, uterine length, endometrial thickness, maximum ovarian volume, ≥4 mm follicle number, maximum follicle diameter, breast bud diameter and breast bud volume of girls between ICPP and PT groups were statistically different(P＜0.05), while BMI, FCR value and vaginal wall thickness were not statistically different(P＞0.05). The breast ultrasound grade of 16 ICPP subjects were as follows: grade A in 1 case(6.3%), B in 13 cases and （81.2%), C in 2 cases(12.5%); breast ultrasound grade in 38 PT subjects was grade A in 18 cases(47.4%), B in 18 cases(47.4%), C in 2 cases(5.2%). There was statistical difference in breast ultrasound grading between two groups(P＜0.05). 
    Conclusion  〖JP2〗It was shown that the ultrasonographic staging of breast development could provide more accurate and objective data.Ultrasound has the ability to distinguish idiopathic central precocious puberty from premature thelarche. 〖JP〗

    Efficacy of Clostridium butyricum tablets combined with ferrous succinate tablets in the treatment of children with iron deficiency anemia
    QIAN Hui-li, ZHAO Na, JIAO Chao-yan
    2020, 41(11):  1317-1320.  doi:10.3969/j.issn.1007-3205.2020.11.016
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    Objective  To observe the clinical efficacy of  clostridium butyricum tablets combine with ferrous succinate tablets treatment on iron deficiency anemia and the incidence of anemia complications. 
    Methods  Eighty-one children with iron deficiency anemia were selected and randomly divided into treatment group(40 cases) and control group(41 cases). The control group was given ferrous succinate tablets, and the treatment group was treated with clostridium butyricum tablets combined with ferrous succinate tablets. Hematocrit, hemoglobin, serum iron and serum ferritin anemia were compared between two groups, and the adverse reactions of nausea, vomiting, anorexia, diarrhea and constipation were compared between two groups, and the clinical efficacy was compared between two groups. 
    Results  After treatment, hematocrit, hemoglobin, serum iron and serum ferritin levels of the two groups were higher than those before treatment, hematocrit, hemoglobin, serum iron and ferritin levels in the treatment group were higher than those in the control group, the difference was statistically significant(P＜0.05). The incidence of adverse reactions in the treatment group was lower than that in the control group(P＜0.05). There was no significant difference in the total effective rate between two groups(P＞0.05). 
    Conclusion  The efficacy of clostridium butyricum tablets combined with ferrous succinate tablets in the treatment of iron deficiency anemia is better than that of ferrous succinate tablets monotherapy. It can significantly reduce the incidence of adverse reactions and has good clinical use value. 

    Minimally invasive extraction of supernumerary teeth in premolar region under the guidance of CBCT
    MEI Shuang, ZHANG Hao, ZHANG Xiao, REN Gui-yun
    2020, 41(11):  1321-1325.  doi:10.3969/j.issn.1007-3205.2020.11.017
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    Objective  To investigate the clinical outcomes of minimally invasive extraction of supernumerary teeth in premolar region under Cone beam Computer Tomography(CBCT) guidance, and provide reference concerned. 
    Methods  Patients with supernumerary teeth in premolar region and accepted the tooth extraction by oral implant machine under the guidance of CBCT were collected. The distribution of supernumerary teeth in upper and lower jaw, position characteristics, operation duration and postoperative reaction were analyzed. 
    Results  The ratio of supernumerary teeth located in the mandible of premolar region was 70.13%. Supernumerary teeth impacted on the lingual(palatal) side has accounted for 89.61%. The average operation time of supernumerary teeth in maxilla was(26.96±7.60) min, and in mandible was(27.70±7.35) min. Visual Analogue Scale（VAS） score was respectively(maxilla 2.48±0.90， mandible 2.54±0.98） one day after extraction and(maxilla 0.57±0.51， mandible 0.59±0.53) seven days after extraction. 
    Conclusion  Supernumerary teeth in premolar region are always impacted in the lingual side(89.61%). Combined application of CBCT and implantology surgical unit can not only reduce the operation time of extracting supernumerary teeth located in premolar region, but also reduce the trauma and postoperative complications.

    MR-DWI and MSCT diagnostic value of primary retroperitoneal tumor
    FENG Yuan-chun, ZHANG Wei, LI Qing-rui, LUO Cheng-hua
    2020, 41(11):  1326-1330.  doi:10.3969/j.issn.1007-3205.2020.11.018
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    Objective  To analyze the evaluation and application value of magnetic resonance diffusion-weighted imaging(MR-DWI) and multi-slice spiral CT(MSCT) in primary retroperitoneal overlying tumor(PRT). 
    Methods  A retrospective study was conducted on the clinical data of 67 patients with primary retroperitoneal overlying tumors. A total of 45 cases were diagnosed as malignant by pathological examination(malignant group), 22 cases of benign lesions(benign group) were all given MR-DWI and MSCT examination, and the positive detection rate, negative detection rate, misdiagnosis rate, missed diagnosis rate, sensitivity, and specificity of different methods were observed and evaluation. 
    Results  A total of 67 patients with primary retroperitoneal overlying tumors were diagnosed by pathology. The results showed that according to the origin of PRT lesions: 23 cases of neurogenic origin, 27 cases of mesenchymal tissue origin, 8 cases of germ cell origin, 7 cases of lymphoid tissue origin 2. The other 2 cases. According to the nature of the tumor: 45 cases were malignant and 22 cases were benign. The misdiagnosis rate and missed diagnosis rate of MR-DWI were lower than MSCT(P＜0.05). The AUC value of the area under the curve of MR-DWI is(0.988), the sensitivity was 93.33%, and the specificity was 86.36%. The AUC value of the area under the curve of MSCT was 74.80%, the sensitivity was 75.56%, and the specificity was 45.45%. 
    Conclusion  MR-DWI is used for the diagnosis of primary retroperitoneal tumors. Its accuracy is higher than that of MSCT, and it can provide an objective basis for the differentiation of benign and malignant tumors.

    Analysis of color Doppler ultrasound in the measurement of interlobular arterial resistance index and evaluation of renal function
    FAN Yan-hui, WANG Li-xian, NIE Li-li, HE Xin-jian, ZHAO Zhen, LIU Lei
    2020, 41(11):  1331-1334，1343.  doi:10.3969/j.issn.1007-3205.2020.11.019
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    Objective  To investigate the value of color Doppler ultrasound in the determination of interlobular artery resistance index and evaluation of renal function in children with hydronephrosis. 
    Methods  Fifty-eight children with hydronephrosis were selected as case group, in the same period, 70 healthy children as control group, Color Doppler ultrasonography was used to measure the pulsatility index(PI) of interleaf renal artery in 2 groups PI, resistance index(RI), maximum systolic blood flow velocity(Vmax); and Vmax and minimum diastolic blood flow velocity(Vmin). The arterial resistance index ratio(RIR), RIR=RI/contralateral RI were calculated. Glomerular filtration rate of the affected kidney by dynamic renal radionuclide imaging glomerular filtration rate（GFR) was determinated. The correlation between renal ultrasound index and GFR in case group was analyzed. 
    Results  The values of PI and RI in the healthy kidney of the children with unilateral hydronephrosis were significantly lower than those in the control group, while the values of PI and RI in the affected kidney of the children with unilateral hydronephrosis were significantly higher than those in the control group and the healthy kidney of the children with unilateral hydronephrosis,the difference was statistically significant(P＜0.05). Comparison of RIR between case group and control group, difference was statistically significant(P＜0.05). And with the increase of hydronephrosis, the RIR of children with IV degree hydronephrosis decreased, difference was statistically significant(P＜0.05). Forty-eight patients with unilateral hydronephrosis had lower renal GFR than healthy patients, difference was statistically significant(P＜0.01). There was no correlation between renal PI and GFR(r=0.071, P=0.574); Low correlation between RI and GFR(r=0.506, P=0.041). RIR had a moderate correlation with GFR(r=0.731, P=0.026). 
    Conclusion  RIR is related to the degree of hydronephrosis, and it is less affected by age factors. Color Doppler ultrasound can indirectly evaluate the renal function of children with hydronephrosis RIR, It can be used as the first choice to evaluate renal function in children with hydronephrosis.
    The value of oral contrast-enhanced transabdominal ultrasound in the diagnosis of gastric lesions
    WU Min, ZHANG Tong-di, XU Wen-sheng
    2020, 41(11):  1335-1338.  doi:10.3969/j.issn.1007-3205.2020.11.020
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    Objective  To evaluate the value of oral contrast-enhanced transabdominal ultrasound in the diagnosis of gastric lesion. 
    Methods  A total of 130 patients with stomach discomfort in our hospital were examined by the oral contrast-enhanced transabdominal ultrasound.The oral contrast-enhanced transabdominal ultrasound results were compared with gastroscopy or other imaging examinations. 
    Results  In 130 cases, there were 113 cases of stomach diseases. There were 44 cases of gastritis by oral contrast-enhanced transabdominal ultrasound, and the diagnostic coincidence rate was 87.6%. There were the 13 cases of gastric cancer, the 7 cases of gastric stromal tumor, the 17 cases of gastric ulcer, the 15 cases of gastric polyps, and the 3 cases of hiatal hernia diagnosed by oral contrast-enhanced transabdominal ultrasound. The diagnostic rate of oral contrast-enhanced transabdominal ultrasound was 88.2%.   
    Conclusion  In the diagnosis of gastric lesion，the oral contrast-enhanced transabdominal ultrasound are used,non-invasive, non-radiative, simple and easy to be performt, and it has a good diagnostic coincidence rate for stomach diseases. It can be used as the first choice for screening gastrointestinal diseases, supplementing the gastroscope and upper gastrointestinal angiography. 

    Imaging diagnosis and differential diagnosis of aggressive osteoblastoma
    ZHONG Zhi-wei, MA Jie-lin, YU Bao-hai, GUO Zhe, WANG Yong, WU Wen-juan
    2020, 41(11):  1339-1343.  doi:10.3969/j.issn.1007-3205.2020.11.021
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    Objective  To analyze the imaging features of aggressive osteoblastoma（AO） and summarize its imaging characters and differential diagnosis. 
    Methods  Retrospectively analyzed the X-ray,CT and MRI of 7 cases of AO were confirmed by pathology, and analyzed the imaging findings,including the location of the tumor,the destruction of the bone, and the density in the lesion,characteristics of magnetic resonance signals and range of encroachment. 
    Results  There were 4 males and 3 females,aged from 13-56 years old,median age 32 years old.There were 5 cases occurred at vertebra,1 case occurred at scapular and 1 case occurred at humerus. X-ray and CT showed expansive bone destruction and cortical disruption. Six cases showed calcification or ossification within the lesion, 5 cases showed soft tissue mass around the lesion,3 cases with adjacent bone involved, 2 cases with less edema of bone marrow, 1 case with periosteal reaction. MRI showed moderate and low mixed signals on T1WI, and showed heterogeneous signals on T2WI, low signal of calcification or ossification on both on T1WI and T2WI, and heterogeneous enhancement were observed in AO, liquid and liquid surface in 2 lesions(combined with aneurysmal bone cyst). 
    Conclusion  AO is a rare bone tumor with strong local aggressiveness,there were some imaging features of AO: the lesions of AO showed large expansive destruction and the cortex is incomplete, and calcification or ossification within the lesion. AO should be distinguished from giant cell tumor, chondroblastoma, osteosarcoma and bone metastases.

    Effect of dexmedetomidine on IL-1β， IL-6， S-100β and postoperative delirium in severe burns patients
    ZHANG Li, WANG Li, TIAN Chang-zheng, HAO Xue-lian
    2020, 41(11):  1344-1348.  doi:10.3969/j.issn.1007-3205.2020.11.022
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    Objective  To observe the effects of dexmedetomidine on postoperative delirium in severe burns patients. 
    Methods  Forty patients with severe burns classified as American Society of Anesthesiologists（ASA） from Ⅱ to  Ⅲ  and scheduled for escharotomy and homograft， were randomly allocated into two groups(n=20): Dex group(Dex group) and normal saline group(NS group). Before ansthesia induction， Dex［1.0 μg/kg bolus and infusion at a rate of 0.5 μg·kg-1·h-1］was administered to the patients of Dex group， while the patients of NS group were given with equivalent normal saline at the same time．Heart rate，mean arterial pressure were observed at before anesthesia induction(T1)， at 10min after induction(T2)， at 1h(T3)， and the levels of interleukin(IL)1β and IL-6 in were determined at T1, T2, T3 and 24 h(T4) after operation finished. S-100 beta protein(S-100 beta protein) of radial glial cells in serum were determined at the preoperative 1 d(T0) and 24 h(T4)， 48 h (T5)， 72 h(T6)  after operation finished. The prevalence of delirium was estimated daily for 72 h via the confusion assessment method for intensive care. 
    Results  HR and MAP at T2, T3 were lower in group D than that in group C(P＜0.05). The value of IL-1β and IL-6 were lower in group D than that of group C at T2, T3, T4（P＜0.05）. The value of S-100β were decreased in group D than that of group C at T4, T5, T6（P＜0.05）. Incidence of delirium was lower in group D than this in group C（P＜0.05）.
    Conclusion  Dexmedetomidine which was infused iv 1 μg/kg in over 10 min before anaesthesia induction, and then was infused at a rate of 0.5 μg·kg-1·h-1 during operation, can reduce plasma IL-1β 、 IL-6 levels, reduce the level of serum S-100β， and decrease the incidence of postoperative delirium.