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Table of Content

    25 December 2020, Volume 41 Issue 12
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    Effect of p53 knockdown gene on rats with pulmonary artery hypertension induced by hypoxia
    ZHANG Feng-yu, YU Ji-yun, CHEN Ming-xing, WANG Jun, DING Chang-ping, CAI Yi-ting
    2020, 41(12):  1369-1373.  doi:10.3969/j.issn.1007-3205.2020.12.002
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    Objective To investigate the influences of transfection of adenovirus-mediated p53 knockdown gene(Adeno-p53) on the pressure of the pulmonary artery and apoptosis of smooth muscle cells in pulmonary arteries of rats under hypoxia. 
    Methods Sixty SD rats were randomly divided into 6 groups(n=10): normoxic control group, normoxic experiment Adeno-null group, normoxic experiment Adeno-p53 group, hypoxic control group, hypoxia experiment Adeno-null group, hypoxic experiment Adeno-p53 group. Pulmonic hypertension in the hypoxia groups was induced in a hypoxic chamber by exposing the rats to an isobaric atmosphere containing 10% O2. During the third week, 3×108 MOI titers Adeno-p53 and Adeno-null were dropped into the trachea below epiglottis for the experimental groups respectively, and the culture was continued for 2 weeks. The mean carotid artery pressure and the mean pulmonary arterial pressure were measured by right heart catheterization. The right ventricle, ventricular septum, and left ventricle were weighed and the right ventricular hypertrophy index was calculated. The apoptotic index of pulmonary artery smooth muscle cells was detected by TUNEL staining in the left lung tissues. Influences of p53-knockdown gene on the pressure of the pulmonary and smooth muscle cell apoptosis were evaluated. 
    Results Compared with the rats cultured under normal pressure, the rats that continuously cultured in 10.0% O2 for 4 weeks had a significantly higher mean pulmonary artery pressure and right ventricular hypertrophy(P＜0.01 or P＜0.05). Under hypoxia culture conditions, compared with the hypoxia experiment Adeno-null group, the hypoxia experiment Adeno-p53 group had lower pulmonary artery pressure and right ventricular hypertrophy index(P＜0.05). The apoptosis index of pulmonary artery smooth muscle cells in the hypoxia experiment Adeno-p53 group was significantly higher than that of the hypoxia experiment Adeno-null group, The apoptosis index of pulmonary artery smooth muscle cells in the Adeno-p53 group was higher than that of the Adeno-null group(P＜0.05). 
    Conclusion The p53 knockdown gene can alleviate the development of hypoxic pulmonary hypertension, which may be related to the apoptosis of vascular smooth muscle in the pulmonary artery induced by the p53 gene.

    Effect and mechanism of trunk fat changes on bone mineral density in rats re-fed after food restriction
    WANG Su-xing, SHAO Wei-hua, WANG Na, LYU Cai-xia
    2020, 41(12):  1374-1378.  doi:10.3969/j.issn.1007-3205.2020.12.003
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    Objective To investigate the changes of trunk fat and its relationship with bone mineral density in rats re-fed after calorie restriction and its possible mechanism. 
    Methods Male SD rats, aged 8 weeks, were divided into normal chow(containing 4-week and 12-week subgroups, NC4 and NC12) group, calorie restriction for 4 weeks(R4) group, refeeding with normal chow after calorie restriction(RN) group, refeeding with high-fat diet after calorie restriction(RH) group. Trunk fat content and the whole body BMD were detected at the end of 4 and 12 weeks, along with body weight, fasting insulin(FINS), free fatty acids(FFA), inflammatory factors and bone turnover markers. 
    Results (1) Refeeding after calorie restriction increased the trunk fat content and trunk fat ratio significantly(vs.NC12, P＜0.01).The bone mineral density decreased in R4 group(vs.NC4, P＜0.05). After refeeding, the recovery degree of bone mineral density in RN group was higher than that in RH group.(2) The levels of triglyceride(TG), inflammatory factors(tumor necrosisfactor-α and interleuken-6,TNF-α and IL-6), bone turnover markers(alkaline phosphatase, osteocalcin) were significantly decreased in R4 group(P＜0.05). After refeeding, the levels of serum alkaline phosphatase and osteocalcin in RH and RN groups increased, but were still lower than those in NC12 group(P＜0.05),while the levels of FINS, FFA, TG, TNF-α and IL-6 were significantly increased(vs.NC12, P＜0.05), especially in RH group.(3) In the linear regression analysis, trunk fat content and trunk fat ratio were both entered as predictors(r2=0.823， P＜0.001). 
    Conclusion Refeeding after calorie restriction can lead to trunk fat accumulation and the whole body bone mineral density decrease, especially refeeding with high-fat diet. Lipid spillover and secretion of inflammatory factors increase due to fat accumulation in the trunk, and then affect bone turnover, which may be an important reason for reducing the whole body bone mineral density. 

    Proanthocyanidins regulate the expression of miR-21 on vascular endothelial cell function and retinal ganglion cells in rats with diabetic retinopathy
    DOU Fang-fang, LI Zhen-tong, CAO Su-ping, DENG Zhi-feng
    2020, 41(12):  1379-1383,1388.  doi:10.3969/j.issn.1007-3205.2020.12.004
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    Objective To observe the effect of proanthocyanidins on miR-21, and explore the protective mechanism of proanthocyanidins on vascular endothelial function and retinal ganglion cells in diabetic retinopathy rats. 
    Methods To observe the effect of proanthocyanidins on miR-21, and explore the protective mechanism of proanthocyanidins on vascular endothelial function and retinal ganglion cells in diabetic retinopathy rats. 
    Results The effect of proanthocyanidins on the proliferation of human umbilical vein endothelial cells（HUVECs） was concentration-dependent. There was no significant difference between the 5 mg/L group and the control group(P＞0.05). Compared with the control group, the 25 mg/L, 50 mg/L, 75 mg/L and 100 mg/L groups had statistically significant differences(P＜0.05). The migration ability of 50 mg/L was weaker than that of the control group(P＜0.05), and the expression of miR-21 was down-regulated(P＜0.05). The expression of miR-21 in the retina of rats in the model control group and the procyanidin 250 mg/kg group were higher than that in the normal group, and the model control group was higher than the procyanidin 250 mg/kg group(P＜0.05).The apoptosis index of retinal ganglion cells in the model control group and the procyanidin 250 mg/kg group was greater than that of the normal group, and the model control group was greater than the procyanidin 250 mg/kg group. 
    Conclusion  Proanthocyanidins can inhibit the proliferation and migration of vascular endothelial cells, and inhibit the apoptosis of retinal ganglion cells in diabetic retinopathy rats, and protect retinopathy. The mechanism may be related to down-regulation of miR-21 expression.

    Establishment and evaluation of a New Zealand rabbit model of cervical intervertebral fusion
    CHEN Song, SUO Shi-qi, LI Cheng-li, ZHANG Fei, LI Jia-qi, ZHANG Wei
    2020, 41(12):  1384-1388.  doi:10.3969/j.issn.1007-3205.2020.12.005
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    Objective According to the measurement data of cervical vertebrae structure in rabbits, the animal model of cervical interbody fusion and internal fixation was established. Cervical interbody fusion was observed at different time points. 
    Methods Thirty-six healthy male New Zealand white rabbits(2.0-2.5 kg) were selected and randomly divided into groups A, B, C and D, with 9 rabbits in each group. Group A was used to measure the structure of cervical vertebrae in rabbits. The models in group B, C, and D were treated with cervical intervertebral bone grafting fusion and internal fixation, and the bone graft material was rabbit iliac bone. General observation, X-ray examination, manual palpation testing, and micro-computed tomography(Micro-CT) were performed at 4, 8, and 12 weeks after the operation. 
    Results There were significant differences in the length of the vertebral body, sagittal diameter of lower vertebral body, and oblique diameter of lower vertebral body from C2 to C6(P＜0.01). X-ray examination showed that in group B, C, and D, bone grafting was sufficient, plate and screw placement was good, and screw loosening and screw withdrawal occurred in only 1 case after surgery. The results of manual palpation showed that the cervical fusion rates in group B, C, and D were 22.2%(2/9), 55.6%(5/9), and 88.9%(8/9), respectively. The ratio of the volume of new bone to the total volume of implant material and X-ray score in group C were higher than those in group B, and the BV/TV and X-ray scores in group D were higher than those in group B and C, with statistically significant differences(P＜0.01). 
    Conclusion The method of establishing the anterior cervical interbody fusion model in rabbits is simple, which can provide a reliable animal model for the study of cervical interbody fusion.

    Study on the relationship between the level of hormone and plasma inflammatory markers and coronary plaque stability in female patients with coronary heart disease before menopausal period
    WANG Shi-jie, LIU Rui-tao, YAO Li-mei, CHENG Min-ju, WEI Qing-min
    2020, 41(12):  1389-1392,1449.  doi:10.3969/j.issn.1007-3205.2020.12.006
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    Objective To study the relationship between the level of hormone and plasma inflammatory markers and coronary plaque stability in female patients with coronary heart disease before menopausal period. 
    Methods A total of 62 pre-menopausal female patients with coronary heart disease(CHD) diagnosed by coronary angiography were selected.According to the clinical manifestations of the patients, they were divided into acute coronary syndrome(ACS) group(n=30) and stable angina pectoris(SAP) group(n=32). At the same time, the patients with normal coronary angiography were selected as the control group(n=30). The distribution of plaques in ACS group and SAP group was examined by intracoronary ultrasound imaging. The level of plasma sex hormone(E2, P) were measured by chemiluminescence in all subjects. The level of Hcy and MPO were measured by double antibody sandwich enzyme-linked immunosorbent assay. The correlation between the level of hormone and plasma inflammatory markers in female patients with coronary heart disease(CAD) before menopausal period were analyzed. 
    Results There was significant difference in the proportion of unstable plaques and stable plaques between the two groups(P＜0.05).There was no significant difference in the proportion of mixed plaques(P＞0.05). Compared with the control group, the level of plasma E2 and P in ACS group and SAP group were significantly lower than those in control group(P＜0.05). Compared with the control group, the level of plasma Hcy and MPO in ACS group and SAP group were significantly higher than those in control group(P＜0.05).Compared with ACS group, the level of Hcy and MPO were significantly decreased in SAP group(P＜0.05).  Pearson correlation analysis showed that the level of serum P was positively correlated with the level of plasma Hcy(r=12.643, P=0.014), and positively correlated with the level of MPO(r=10.316, P=0.008). The level of serum E2 was negatively correlated with plasma Hcy level(r=-3.736, P=0.025) , and negatively correlated with the level of MPO(r=-6.124, P=0.017).
    Conclusion The levels of serum hormones and plasma inflammatory factors in female patients with CHD before menopausal may be related to the stability of coronary plaques. Lower level of serum E2, higher level of serum P and plasma Hcy, MPO may indicate plaque vulnerability or rupture.

    Short-term and long-term efficacy of minimally invasive ligation, tissue adhesive injection combined with partial splenic embolization and conventional pericardial devascularization plus splenectomy in the prevention and treatment of esophagogastric variceal rebleeding
    2020, 41(12):  1393-1396,1411.  doi:10.3969/j.issn.1007-3205.2020.12.007
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    Objective To explore the short-term and long-term efficacy of minimally invasive ligation, tissue adhesive injection(TAI) combined with partial splenic embolization(PSE) and traditional pericardial devascularization plus splenectomy(Hassab′s procedure) in the prevention and treatment of esophagogastric variceal rebleeding. 
    Methods Eighty-six patients with esophagogastric variceal bleeding in our hospital were enrolled in the study. The patients were divided into minimally invasive group(n=43) and Hassab group(n=43) according to the random number table method. Minimally invasive group was treated with ligation, TAI combined with PSE, and Hassab group was treated with Hassab′s procedure. The portal vein blood flow(trunk diameter and blood flow velocity of portal vein), hypersplenism indexes ［white blood cells(WBC), platelet(PLT)］ and liver function(Child-Pugh score) were compared between two groups before surgery and at 3 months after surgery. The success of hemostasis and improvement of varicose veins, occurrence of complications at 3 months after surgery, short-term and long-term rebleeding rates and survival rate at 12 months after surgery were recorded. 
    Results At 3 months after surgery, the trunk diameter and blood flow velocity of portal vein in two groups were decreased compared with those before surgery(P＜0.05), while the hypersplenism indexes(WBC, PLT) were increased compared with those before surgery(P＜0.05), and there were no significant differences between the groups(P＞0.05). The Child-Pugh score in two groups was decreased compared with that before surgery(P＜0.05), and the score was lower in minimally invasive group than in Hassab group(P＜0.05). The success rates of hemostasis in the two groups were both 100.00%. There were no significant differences in the improvement of varicose veins, short-term and long-term rebleeding rates and survival rate at 12 months after surgery between two groups(P＞0.05). The total incidence rate of complications at 3 months after surgery in minimally invasive group was significantly decreased compared with that in Hassab group(P＜0.05). 
    Conclusion Ligation, tissue glue injection and PSE is noninferior to traditional Hassab in the prevention and treatment of esophagogastric variceal rebleeding. However, it has smaller trauma than Hassab, and has positive significance for improving liver function.

    Effect of Shenkang injection on renal function and serum TNF-α, MCP-1, IL-6 in patients with diabetic nephropathy
    HE Li-fang, LI Qing-ke, MA Yu-xia, REN Ping-xiang, YAN Shuang-huan
    2020, 41(12):  1397-1400.  doi:10.3969/j.issn.1007-3205.2020.12.008
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    Objective To investigate the effect of Shenkang injection on renal function and serum levels of Tumor necrosis factor-α(TNF-α), Monocyte chemoattractant protein-1(MCP-1), interleukin-6(IL-6) in patients with diabetic nephropathy. 
    Methods A total of 160 patients with diabetic nephropathy were randomly divided into control group(n=80) and observation group(n=80). The control group was treated with valsartan 80 mg once a day, and the observation group was treated with Shenkang injection once a day on the basis of the control group, both groups were treated for 4 weeks. The 24-hour urinary protein quantification(UTP), serum creatinine(SCr), cystatin C(Cystatin C), plasma potassium, TNF-α, MCP-1 and IL-6 levels were compared between two groups before and after treatment. 
    Results After treatment, the levels of UTP, SCr, Cystatin C and serum TNF-α, MCP-1 and IL-6 in two groups were significantly lower than those before treatment, and all indexes in the observation group were significantly lower than those in the control group（P＜0.05）. There was no significant difference in plasma potassium before and after treatment(P＞0.05). 
    Conclusion Shenkang injection can effectively reduce the levels of proteinuria, serum creatinine and cystatin C in patients with diabetic nephropathy, and its mechanism may be through reducing the levels of serum TNF-α, MCP-1 and IL-6, inhibiting inflammatory reaction and playing a protective role in kidney.

    Effects of edaravone combined with adaptive mechanical ventilation on serum levels of CC16, PARC/CCL18 and KL-6 in COPD patients with respiratory failure
    LUO Bi-jun, KONG Ming-xi
    2020, 41(12):  1401-1405.  doi:10.3969/j.issn.1007-3205.2020.12.009
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    Objective To observe the efficacy of edaravone combined with adaptive mechanical ventilation on chronic obstructive pulmonary disease(COPD) with type Ⅱ respiratory failure and their impact on serum clara cell secretory protein(CC16) and pulmonary activation-regulating chemokine(PARC/CCL18) and krebs von den lundgen-6(KL-6) .
    Methods A total of 112 COPD patients with type Ⅱ respiratory failure were divided into observation group and control group according to random number method, each group had 56 cases. The control group were treated with adaptive mechanical ventilation, and the observation group was treated with edaravone on the basis of the control group. The efficacy, COPD assessment test(CAT) score, dyspnea, quality of life were observed in two groups after treatment,the forced vital capacity(FVC), peak expiratory flow(PEF), forced expiratory volume second(FEV1), maximum voluntary ventilation(MVV), partial pressure of oxygen(PaO2), partial pressure of carbon dioxide(PaCO2), oxygen saturation(SaO2), pH, CC16, PARC/CCL18 and KL-6 were observed in two groups before and after treatment. 
    Results The total effective rate was 94.64% in the observation group, and 80.36% in the control group, the difference was statistically significant by rank sum test(Z=6206，P＜0.01). After treatment the quality of life, FVC, PEF, FEV1, MVV, PaO2, SaO2, pH and CC16were significantly increased compared with before treatment(P＜0.01), while the CAT score, dyspnea score, PaCO2, PARC/CCL18 and KL-6 was significantly lower than before treatment(P＜0.01), while the increasing or decreasing levels in the observation group were more obvious than those in the control group(P＜0.01). 
    Conclusion Edaravone combined with adaptive mechanical ventilation has significant effects on COPD with respiratory failure, improving respiratory function and quality of life, correcting blood gas, and contributing to the repair of alveolar cells.

    Surgical treatment for severe acute congenital heart disease in low body weight infants with pulmonary infection
    LYU Ying, LI Xiao-bing, HUANG Jian-Cheng, LI Zhi-jie, ZHANG Hui-jun, WANG Jun
    2020, 41(12):  1406-1411.  doi:10.3969/j.issn.1007-3205.2020.12.010
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    Objective To evaluate the surgical effect of severe congenital heart disease with pulmonary infection in infants with low body weight(≤5 kg) and summarize the clinical experience. 
    Methods A total of 110 cases of severe congenital heart disease with low body weight(≤5 kg) in cardiac surgery department were collected. According to the preoperative lung conditions, all the cases were divided into the infected group and the non-infected group, including 64 cases in the infected group and 46 cases in the non-infected group. To study the early results of surgical correction of low weight critical congenital heart disease complicated with pulmonary infection. The perioperative complications of the infected group and the non-infected group were analyzed. 
    Results There was no statistically significant difference with the two groups in intraoperative aortic block time, extracorporeal circulation time, and the secondary intubation group, but the number of cases, duration of mechanical ventilation(≥48 h), duration of positive inotropic drug time and duration of ICU(≥72 h) in the infected group was higher than that in the non-infected group, with statistically significant differences(P＜0.05). There was no statistically significant difference in the incidence of pathogen infection between two groups(P＞0.05). After operation, white blood cells, C-reactive protein and procalcitonin in 2 groups were all increased first and then decreased to normal levels. There were statistically significant differences in the interaction between groups, time points, and time points between groups(P＜0.05). 
    Conclusion The critical congenital heart disease in infants was complicated with pulmonary infection before operation, and the perioperative complications were higher than those in the non-infected group, but the early operation effect was good. The key to the treatment is to strengthen the protection of myocardium and lungs, improve the operation technique, shorten the operation time, strengthen anti-infection and postoperative monitoring, and deal with all kinds of postoperative complications in time.

    Analysis of the efficacy of laparoscopic primary suture of common bile duct with three endoscopes
    TANG Shi-chuan, LIU Jin-heng, YIN Si-neng
    2020, 41(12):  1412-1416.  doi:10.3969/j.issn.1007-3205.2020.12.011
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    Objective To investigate the clinical efficacy and pros and cons of laparoscopic primary closure of common bile duct in patients with choledocholith-iasis by three endoscopes(laparoscopy + choledochoscopy + duodenoscope). 
    Methods The clinical data of 123 patients with common bile duct stones who underwent choledocholithotomy  were collected by retrospectively analysis method. Among the 123 cases, 62 cases(50.4%) underwent combination appliances of three endoscopes combined with choledocholithotomy and nasobiliary drainage through abdomen and primary closure of common bile duct，and hereinafter referred to as the three-endoscopes group. And 61 cases(49.6%) underwent choledocholithotomy plus T-tube drainage, and hereinafter referred to as the T-tube group. With observation on the general conditions before operation, situations at surgery, postoperative recovery situations and complications and follow-up situations of patients, we had a contrastive analysis of the pros and cons of primary suture of common bile duct with three endoscopes and T-tube drainage after choledocholithotomy. 
    Results The differences of gender, age, preoperative with acute pancreatitis, preoperative chronic disease rate (hypertension, diabetes, heart disease), the number of stones, operation time, nasobiliary and T-tube drainage volume on the first day after operation, postoperative removal of abdominal drainage tube time, the rate of postoperative bile leakage, the postoperative hemorrhage, and the rate of complications of postoperative pancreatitis and hospitalization cost of patients all had no statistics significance(P＞0.05) between the three-endoscopes group and the T-tube group. But the differences of common bile duct diameter, preoperative total bilirubin, severe degrees of preoperative cholangitis(According to the 2018 version of the Tokyo Guideline classification), previous history of upper abdominal surgery, the estimated intraoperative bleeding volume, the size of stone, the abdominal drainage volume on the 1st postoperative day, the rate of postoperative residual stone, the cost of surgical treatment, and the hospitalization time of patients had statistics significance(P＜0.05) between the three-endoscopes group and the T-tube group. All 140 cases underwent operations successfully and recovered well. There were no stone recurrence, biliary stricture or other related complications occurred during the follow-up period.  
    Conclusion With the support of reliable endoscopic suture technique, the laparoscopic primary suture of common bile duct with three endoscopes is safe and feasible, and the clinical effect is satisfactory. However, we should not blindly choose primary suture. Individualized surgical treatment should be formulated according to the patient′s own conditions and the advantages and disadvantages of different surgical.

    Effects of double abdominal fixation approach of indwelling catheter in urinary management after operation of Snodgrass
    CHEN Jun-xiao, ZHAO Ya-yuan, ZHAO Chun-ling, SHI Lei, LI Jian-hong, QI Jin-chun
    2020, 41(12):  1417-1420.  doi:10.3969/j.issn.1007-3205.2020.12.012
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    Objective To evaluate the clinical application effect of double abdominal fixation approach of indwelling catheter in urinary management after operation of Snodgrass for hypospadias(longitudinal incision and rolling tube). 
    Methods A total of 112 children with hypospadias who underwent Snodgrass operation were selected as the research objects and randomly divided into observation group and control group according to random number table method, 56 cases in each group. The observation group was treated with abdominal double fixed catheter method, while the control group was treated with the traditional method of fixing urinary catheter in the medial thigh. The incidence of catheter traction pain, poor drainage, urinary fistula and the frequency of C-type catheter fixation device replacement within 24 h after operation were compared between two groups. 
    Results The catheter traction pain score of the observation group was lower than that of the control group, the incidence of poor drainage was lower than that of the control group, the frequency of C-type catheter fixation device replacement within 24 hours after operation was less than that of the control group, the difference was statistically significant(P＜0.05). Incidence of urinary fistula between two groups had no statistical significance(P＞0.05). 
    Conclusion Abdominal double fixed catheter method can enhance the firmness of the fixed catheter after Snodgrass operation, increase comfort, reduce the poor drainage, the replacement frequency of catheter fixation device and reduce the workload of nursing staff, which can be widely applied in clinical practice.

    Expression of SERPINE1 and its prognostic significance in colorectal cancer
    MA Jing-yu, ZHU Yu-feng, BAI Guang
    2020, 41(12):  1421-1427.  doi:10.3969/j.issn.1007-3205.2020.12.013
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    Objective To identify differentially expressed genes in colorectal cancer through bioinformatics, and to study the expression of candidate genes in colorectal cancer, as well as their pathological characteristics and prognostic significance. 
    Methods Differentially expressed genes in colorectal cancer were identified by analyzing gene expression data sets from the GEO database, protein interaction networks was constructed, core proteins were found, gene set enrichment analysis was performed, and protein action pathways were clarified, then core protein expression levels between colorectal cancer tissues and normal tissues was compared by immunohistochemistry, finally the relationship between core genes and the prognosis of colorectal cancer was further clarified though survival analysis. 
    Results A total of 89 differentially expressed genes were identified by screening criteria, and the core gene SERPINE1 was screened though constructing protein interaction network. Gene enrichment analysis showed that SERPINE1 expression was related to inflammation and angiogenesis. The high expression of SERPINE1 was significantly related to the invasion depth （P=0.012）, lymph node metastasis （P=0.025）, distant metastasis （P=0.040）, and TNM stage （P=0.016） of colorectal cancer. Survival analysis showed that high expression of SERPINE1 was associated with poor overall survival of colorectal cancer(P=0.002). 
    Conclusion SERPINE1 may be an oncogene in the development of colorectal cancer, and high expression of SERPINE1 is a poor prognostic factor for colorectal cancer.

    Influence of different methods of clamping umbilical cord on jaundice and blood system in premature infants
    YU Ling, XU Liu, ZHAO Yi-ran, LI Cong-zhe, YU Chang-li
    2020, 41(12):  1428-1431.  doi:10.3969/j.issn.1007-3205.2020.12.014
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    Objective To explore the influence of different umbilical cord ligation methods on premature infants with a gestational age of less than 34 weeks. 
    Methods A total of 388 premature infants with a gestational age of less than 34 weeks were selected and divided into routine group, delayed umbilical cord ligation group and umbilical cord milking group according to the umbilical cord ligation method. In the conventional group, the umbilical cord was ligated within 30 s after delivery. In the delayed umbilical cord ligation group, the umbilical cord was ligated 120 s after delivery. In the umbilical cord milking group(UCM), the procedure was to milk approximately 20 cm from the newborn′s end, milk the umbilical cord from the mother′s end to the newborn′s end for 2-3 times and then ligate the umbilical cord, which took 5-10 s. Venous blood was collected at 48 h and 7 d after birth for detection of hemoglobin(Hb) and hematocrit(HCT), and measure percutaneous bilirubin value 1-7 days after birth. The incidence of phototherapy, one-week anemia, blood transfusion and asphyxia during hospitalization were recorded. 
    Results The Hb and HCT level of the delayed umbilical cord ligation group and the umbilical cord milking group at 48 h and 7 d were significantly higher than the routine group, and the differences were statistically significant(P＜0.05), while there was no significant difference in the level of Hb and HCT between the delayed umbilical cord ligation group and the umbilical cord milking group at 48 h and 7 d(P＞0.05). The incidence of one-week anemia and blood transfusion in the delayed umbilical cord ligation group and the milking umbilical cord group was lower than that in the routine group, and the difference was statistically significant(P＜0.05), while there was no significant difference between the delayed umbilical cord ligation group and the umbilical cord milking group(P＞0.05). There was no significant difference in the incidence of phototherapy and asphyxia among three groups(P＞0.05). 
    Conclusion Both rapid milking of the umbilical cord and delayed umbilical cord ligation can improve the levels of Hb and HCT of premature infants, reduce the incidence of one-week anemia and blood transfusion, and meanwhile not increase the risk of postnatal asphyxia and phototherapy.

    Application of SMILE human corneal stromal lens in corneal ulcer
    FENG Mei, YU Su-ying, TAN Sa, JIANG Lan-lan, CHEN Dong-bin, DENG Ying-ping
    2020, 41(12):  1432-1435,1459.  doi:10.3969/j.issn.1007-3205.2020.12.015
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    Objective To analyze the effect of human corneal stroma lens from femtosecond laser small incision lenticule extraction（SMILE）sources in corneal ulcer. 
    Methods Seventy-five patients with corneal ulcer were selected as the main subjects.It was randomly divided into observation group(38 cases) and control group(37 cases). SMILE source of human corneal stroma lens combined with amniotic membrane transplantation was used in the observation group. To observe the therapeutic effect of the two groups, At the same time, the difference of visual acuity between two groups was compared, and the incidence of postoperative complications was calculated. 
    Results The total effective rate in the observation group was 97.37%, which was significantly higher than that in the control group(P＜0.05). After operation, the difference of visual acuity were not statistically significant between two groups(P＞0.05). After operation, the incidence of postoperative complications was 2.63% in the observation group, which was significantly lower than that in the control group(P＜0.05). 
    Conclusion Human corneal stromal lens from SMILE sources has good therapeutic effect in corneal ulcer, can effectively improve the postoperative visual condition of patients, and has high safety, which is worth popularizing.
    Clinical effect of two kinds of operation on severe puborectalis syndrome
    LIU Jiao, WU Shi-xiong, KANG Ya-chao, LIU Bo, LIU Man-jun
    2020, 41(12):  1436-1438,1443.  doi:10.3969/j.issn.1007-3205.2020.12.016
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    Objective To observe the clinical effect of two kinds of operation on severe puborectalis syndrome. 
    Methods A total of 70 patients with severe puborectalis syndrome. Methods: Seventy patients were randomly divided into experimental group and control group, 35 cases in each group. In the experimental group, the puborectal muscle was partially severed through a small incision, and in the control group, the puborectal muscle was sutured. The total effective rate, wound healing time, postoperative pain, incision infection, anal sphincter function and reoperation were observed and compared between two groups. 
    Results The total effective rate of the two kinds of operation was 97.14% in the experimental group and 94.29% in the control group, respectively(P＞005). But the experimental group was better than the control group in the time of incision healing and postoperative pain(P＜005). 
    Conclusion The treatment of severe puborectal syndrome with partial puborectal myotomy with small incision has the advantages of short course and less pain, which is worth popularizing. 

    Application of magnetic resonance 3D-Tricks combined with serum IL-6 and anti-HSP60 detection in the diagnosis of tubal infertility
    LI Jing, WEN Tie, FENG Xu-xia
    2020, 41(12):  1439-1443.  doi:10.3969/j.issn.1007-3205.2020.12.017
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    Objective To study clinical value of magnetic resonance three-dimenstional time resolved imaging of contrast kinetics(3D-Tricks) combined with serum interleukin-6(IL-6) and antibody to heat shock protein 60(anti-HSP60) detection in the diagnosis of tubal infertility. 
    Methods A total of 120 patients with suspected tubal infertility were examined by magnetic resonance 3D-Tricks technique and serum IL-6 and anti-HSP60 detection. It was divided into three methods: routine serum IL-6 anti-HSP60, magnetic resonance 3D-Tricks technique and combination of two detection methods, and the results of laparoscopic pathology were taken as the diagnostic gold standard. The sensitivity and specificity of magnetic resonance 3D-Tricks combined with serum IL-6 and anti-HSP60 detection were evaluated and the positive rate of IL-6 and anti-HSP60 were investigated in the diagnosis of tubal infertility. 
    Results Eighty-four cases were diagnosed by laparoscopy in 120 cases, among of which the diagnostic coincidence rate of combined group(96.43%) was significantly higher than that of single group(80.00%), and the positive rates of serum anti-HSP60 and IL-6 in 84 cases of tubal infertility were significantly higher than that of non-tubal infertility, with statistical significance(P＜0.05).The sensitivity of parallel combined detection and diagnosis of magnetic resonance 3D-Tricks combined the detection of IL-6 anti-HSP60 was significantly higher than that of the single detection of 3D-Tricks and serum IL-6 and anti-HSP60(P＜0.05), the specificity of series combined detection was significantly higher than that of both alone(P＜0.05). The sensitivity of the series joint detection of magnetic resonance 3D-Tricks technique combined the detection of serum IL-6 and anti-HSP60 was significantly lower than that of parallel combined detection(P＜0.05), and the specificity was significantly higher than that of parallel combined detection . The area under the ROC curve of magnetic resonance 3D-Tricks technique combined the detection of serum IL-6 and anti-HSP60 was significantly higher than that of single detection(P＜0.05). 
    Conclusion The combination of magnetic resonance 3D-Tricks and serum IL-6 and anti-HSP60 parallel detection can improve the sensitivity of the clinical diagnosis of tubal infertility, the series of tests can improve the specificity of the clinical diagnosis of tubal infertility, which is of great value for the early diagnosis of tubal infertility.

    Intravenous dexmedetomidine infusion for epidural-related maternal fever during labor analgesia
    CHEN Wei-ye, LI Zong-cun, XI Si-ping, ZHANG Li-xian
    2020, 41(12):  1444-1449.  doi:10.3969/j.issn.1007-3205.2020.12.018
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    Objective To evaluate the safety and efficacy of intravenous dexmedetomidine(Dex) infusion for epidural-related maternal fever during labor analgesia. 
    Methods A total of 192 term laboring nulliparous women, with a singleton fetus in vertex presentation, were randomly allocated into two groups. 97 cases of primiparas were received an intravenous Dex infusion of 0.4 μg·kg-1·h-1 following epidural analgesia initiation, discontinued at full cervical dilatation as the experimental group(Group D), and 95 cases of primiparas were received an intravenous normal saline infusion of equivalent volume following epidural analgesia initiation, discontinued at full cervical dilatation as the control group(Group C). Maternal tympanic temperature, febrile rate, visual analogue scale(VAS) and Ramsay sedation scale were evaluated at the initiation of analgesia, 1, 2, 3, 4 h post analgesia and parturition. Blood samples were obtained before analgesia and at parturition to detect maternal serum interleukin-6(IL-6) and interleukin-1β(IL-1β) levels. The analgesic consumption, analgesic time, neonatal umbilical artery lactate levels, Apgar scores, labor duration, delivery mode, oxytocin dosage, postpartum hemorrhage and adverse effects were also recorded. 
    Results Maternal tympanic temperature increased progressively in two groups as analgesic time increased(P＜0.05).  Primiparas in group D had a lower tympanic temperature at 4 hours post analgesia and at parturition compared with group C(P＜0.05). The febrile rate of parturient in group D was lower than that in the group C at parturition(P＜0.05). Maternal Ramsay sedation scale increased in two groups after labor analgesia(P＜0.05). Primiparas in group D had a higher Ramsay sedation scale at 4 hours post analgesia and at parturition compared with group C(P＜0.05). VAS decreased significantly in two groups after labor analgesia(P＜0.05). Serum IL-1β and IL-6 levels showed a highly significant rise in two groups, serum IL-6 levels decreased in group D at parturition compared with that in group C(P＜0.05). Primiparas in group D had less analgesic consumption and a low incidence of urinary retention than that in group C(P＜0.05). There were no difference between two groups in VAS at same time-points, analgesic time, labor duration, delivery mode, oxytocin dosage, postpartum hemorrhage, neonatal Apgar scores and umbilical artery lactate levels(P＞0.05). 
    Conclusion Intravenous Dex infusion during labor analgesia is effective and safe in attenuating epidural-related maternal fever through alleviating IL-6 production and reducing anaesthetic requirments. 

    Comparison of the analgesic effect of quadratus lumborum block and transversus abdominis plane block in gynecological laparoscopic surgery
    ZHANG Long-sheng, LU Yan, ZHANG Kai-hong, YANG Duo, YE Shu-jun, HUANG Zhi-liang
    2020, 41(12):  1450-1454.  doi:10.3969/j.issn.1007-3205.2020.12.019
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    Objective To analyze the analgesic effect of quadratus lumborum block and transversus abdominis plane block in gynecological laparoscopic surgery. 
    Methods Fifty patients undergoing laparoscopic ovarian tumor resection were selected and divided into two groups. They were quadratus lumborum block(QLB) group and transverse abdominis plane block(TAP) group, 25 cases in each group. Tracheal intubation and total intravenous anesthesia were used in both groups.Before anesthesia induction, QLB group received bilateral quadratus lumborum block, TAP group received bilateral transversus abdominis plane block. Patient controlled intravenous analgesia was used postoperatively in both groups. The following indexes were compared between the two groups, including visual analogue scale(VAS) score of resting pain at 2, 6, 12, 24, 48 hours after operation, the time of first pressing analgesia pump, the effective pressing times of analgesia pump within 48 hours, the total amount of sufentanil used and the number of cases of remedial analgesia with flurbiprofen axetil, the incidence of adverse reactions at 48 hours after operation. 
    Results The VAS score of resting pain at each time point in the two groups showed a gradual increase and then a downward trend. The most severe pain occurred 24 hours after operation, and the QLB group was lower than the TAP group. The differences between intergroup, time point and interaction of intergroup and time point of two groups had the statistically significant(P＜0.05). Compared with the TAP group, the first pressing time of analgesia pump in the QLB group was significantly longer(P＜0.05), the effective pressing times of analgesia pump within 48 hours, the total use of sufentanil and the number of cases of rescue analgesia with flurbiprofen axetil were significantly decreased in the QLB group (P＜0.05), and the incidence of adverse reactions at 48 hours after operation in the QLB group was significantly lower than that in the TAP group(P＜0.05). 
    Conclusion Compared with transversus abdominis plane block, quadratus lumborum block has more perfect analgesic effect, longer action time and less opioid application, which is more suitable for multimodal analgesia after gynecological laparoscopic surgery.

    Effects of dexmedetomidine on the balance of Th1/Th2 in pediatric patients under cardiopulmonary bypass
    GUO Qiong-mei, LIU Xiu-ye, LU Xue-zi, WANG Ling
    2020, 41(12):  1455-1459.  doi:10.3969/j.issn.1007-3205.2020.12.020
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    Objective To investigate the effects of dexmedetomidine on the balance of Th1/Th2 in pediatric patients under cardiopulmonary bypass. 
    Methods Eighty pediatric patients，aged 4-8 years，of American Society of Anesthesiologists(ASA) physical statusⅡ or Ⅲ，scheduled for elective repair of ventricular septal defect under CPB, were randomly divided into 2 groups(n=40 each) using a random number table：control group(group C) and dexmedetomidine groups(group D). Anesthesia was induced with midazolam 0.15 mg/kg, sufentanyl 1 μg/kg, etomidate 0.3 mg/kg and rocuronium 0.6 mg/kg．The patients were endotracheally intubated and mechanically ventilated．In group D， dexmedetomidine 1 μg/kg(initial dose) 〖JP2〗was given over more than 10 min，followed by continuous infusion at 0.5 μg·kg-1·〖JP〗h-1, until the end of operation．The equal volume of normal saline was given instead of dexmedetomidine in group C． Before CPB(T1)， 30 min after begainning of CPB(T2), at the immiadiately of the end of CPB(T3), at 24 and 72 h after the end of CPB(T4, T5)， blood samples were collected for determination of plasma tumor necrosis factor-a(TNF-α)， interleukin-6(IL-6), interferon-γ（IFN-γ） and interleukin-4(IL-4) concentrations. 
    Results The plasma IL-4 levels showed ascending and descending trends, and were decreased in group D compared to that in group C at T2-4, there were statistically difference between groups, time points and their interaction(P＜0.05). The plasma IFN-γ and IFN-γ/ IL-4 levels showed descending and ascending trends in two groups, and were increased in group D compared to that in group C at T2-4, there were statistically difference between groups, time points and their interaction(P＜0.05). The plasma TNF-α and IL-6 levels show ascending and descending trends in two groups, and were decreased in group D compared to that in group C at T2-4, there were statistically difference between groups, time points and their interaction(P＜0.05). 
    Conclusion Dexmedetomidine can inhibit immunomodulatory effects shifting the Th1/Th2 balance toward Th2 induced by CPB, alleviate perioperative inflammatory response.
    Current status and influencing factors of psychological distress in middle-aged and elderly patients with colorectal cancer undergoing permanent stoma
    WU Wei, MA Bing, ZHANG Yu, WANG Xiao-chun
    2020, 41(12):  1460-1464.  doi:10.3969/j.issn.1007-3205.2020.12.021
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    Objective To explore the current status of psychological distress in middle-aged and elderly patients with colorectal cancer(CRC) undergoing permanent stoma, and to further analyze its influencing factors. 
    Methods A total of 560 middle-aged and elderly CRC patients undergoing permanent stoma who were diagnosed and treated in our hospital were enrolled in this study. Clinical data of patients were recorded. Distress thermometer(DT) and problem list(PL) were used to assess the degree of psychological distress. Multivariate linear regression was used to analyze the influencing factors of psychological distress in middle-aged and elderly CRC patients undergoing permanent stoma. 
    Results A total of 560 middle-aged and elderly patients with permanent stoma of CRC had a DT score of（6.12±2.06), which was moderate to severe pain, and the positive rate of psychological pain symptoms was 52.3%. In the PL scale score, the score of communication problems (1.72±0.36) was the highest, followed by the score of physical problems(1.50±0.32), and religion/belief problems(1.03±0.25). Univariate analysis results showed that DT scores were different in patients with respect to different age groups, education level, time of stoma, means of payment for medical expenses, monthly household income, self-care degree of stoma, and presence or absence of depression, pain, sleep disorders, and stoma complications（P＜0.05). There was no significant difference in DT scores in patients of different genders, marital status, and daily nursing time for stoma（P＞0.05). The multiple linear regression analysis showed that age（β=-3.122, P=0.006), depression（β=2.380, P＜0.001), sleep disorders（β=1.189, P=0.012), combined pain（β=2.676, P＜0.001), ostomy complications（β=3.352, P＜0.001), family monthly income per capita（β=-2.067, P＜0.001) were the influencing factors of psychological distress. 
    Conclusion The degree of psychological distress in elderly CRC patients undergoing permanent stoma is moderate to severe, and its occurrence is associated with the family's average monthly income, age, psychological status, sleep status, and presence of pain and stoma complications.