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Table of Content

    25 March 2021, Volume 42 Issue 3
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    Protective role and mechanism of berberineagainst hypoxia/reoxygenation-induced injury in H9c2 cells via miR-29b
    LU Yu-run, TANG Yu-fan
    2021, 42(3):  256-261,267.  doi:10.3969/j.issn.1007-3205.2021.03.002
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    Objective  To investigate the protective role and mechanism of berberine(Ber) against hypoxia/reoxygenation(H/R)-induced injury in H9c2 cells via miR-29b.
    Methods  The H9c2 cells cultured in vitro were divided into control group(normal culture), H/R group(H/R treatment) and H/R+Ber group(treated with 150 μmol/L Ber before H/R treatment). Cell viability was detected by MTT assay, and LDH release from cell supernatant was detected by LDH kit. Apoptosis was detected by flow cytometry, Caspase-3 activity was detected by Caspase-3 kit, and the expression level of miR-29b was detected by RT-PCR. The H9c2 cell line with low expression of miR-29b was established, and the effects of Ber and miR-29blow expression on H/R-induced injury in H9c2 cells were observed by the above methods. The bioinformatics prediction and dual luciferase reporter gene were used to verify the targeting relationship between miR-29b and PTEN, and the effect of miR-29b on PTEN protein expression was detected by Western blot.
    Results  Compared with the control group, the cell survival rate and miR-29b expression level of H9c2 were significantly decreased in H/R group, while the LDH release in the cells upernatant, apoptosis rate and Caspase-3 activity were significantly increased(P＜0.05). Compared with H/R group, the above changes caused by H/R were significantly inhibited after Ber treatment(P＜0.05). miR-29b down-regulation significantly alleviated the protective effect of Ber on H/R-induced H9c2 cell injury(P＜0.05). The dual luciferase reporter gene assay confirmed that PTEN was a target gene of miR-29b. Western blot analysis confirmed that miR-29b could negatively regulate the expression of PTEN protein.
    Conclusion  miR-29b plays an active role in the protective effect of Ber on H/R-induced H9c2 cell injury, and its mechanism may be related to the targeted regulation of PTEN expression.
    The predictive value of fibrinogen-albumin ratio in major cardiac adverse events in NSTE-ACS patients
    SHI Lei, LI Wan-peng, AN Jun-yu, JI Wang-long, CAO Yun-shan, HUANG Yan
    2021, 42(3):  262-267.  doi:10.3969/j.issn.1007-3205.2021.03.003
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    Objective  To investigate the predictive value of fibrinogen to albumin ratio(FAR) in major adverse cardiac events(MACEs) in patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS)during hospitalization.
    Methods  The clinical data of 284 patients with NSTE-ACS were collected retrospectively. According to the FAR at admission, they were divided into low FAR group(FAR≤8.0, n=94), medium FAR group(FAR＞8.0-9.6, n=101), and high FAR group(FAR＞9.6, n=89)using tertile method. The general data ［gender, age, resting heart rate, history of diabetesand hypertension, body mass index (BMI)］, laboratory indicators［serum creatinine(SCr), fasting blood glucose(FBG), troponin I(TnI), aspartate aminotransferase(AST), alanine aminotransferase(ALT), triglyceride(TG), total cholesterol (TC), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C)］, left ventricular ejection fractions(LVEF), Gensini score, Grace score, and MACEs occurrence in three groups were compared. Logistic multivariate regression analysis was used to analyze the influencing factors of MACEs during hospitalization in NSTE-ACS patients, and ROC curve was used to analyze the predictive value of FAR in MACEs during hospitalization in patients with NSTE-ACS.
    Results  Male proportion, BMI, TnI, AST, and Gensin scores were significantly higher in high FAR group than in medium and low FAR groups, and LVEF was significantly lower than medium and low FAR groups. Male proportion, BMI, TnI, AST, and Gensin scores were significantly higher and LVEF was significantly lower in medium FAR group than in low FAR group, with significant difference(P＜0.05). The total incidence of MACEs during hospitalization in high FAR group was higher than that of medium and low FAR groups. The total incidence of MACEs in medium FAR group was significantly higher than that of low FAR group, and the difference was statistically significant(P＜0.05). Multivariate Logistic regression analysis showed that Gensin score and FAR are influencing factors of occurrence of MACEs during hospitalzation in NSTE-ACS patients. ROC curve results showed that the area under the curve(AUC) of FAR in predicting MACEs during hospitalization in NSTE-ACS patients was 0.725, with a sensitivity of 64.3% and a specificity of 83.1%.
    Conclusion  FAR and Gensin scores are independent risk factors for the occurrence of MACEs, which provide new early predictors for NSTE-ACS patients.
    Research on changes of brachial artery elasticity and Tei index for left ventricular function and their correlation in patients with internal arteriovenous fistula undergoing hemodialysis
    GUO Wei-dong, ZHANG Xiao-ling, ZHAO Gang, CAO Ya-kun, ZHANG Li-hua, WANG Yun-tao
    2021, 42(3):  268-272.  doi:10.3969/j.issn.1007-3205.2021.03.004
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    Objective  To evaluate the changes of brachial artery elasticity by echo- tracking technique and left ventricular Tei Index obtained by tissue Doppler imaging in patients undergoing hemodialysis, and to evaluate the correlation between two parameters.
    Methods  We randomly selected 55 patients with autologous internal arteriovenous fistula(IAF) undergoing hemodialysis, and 40 healthy subjects were recruited as controls. The parameters of brachial artery elasticity, including stiffness parameter(β), elastic coefficient(Eρ), compliance(AC), pulse wave velocity(PWVβ), swelling index(AI), were measured by ET technique; in the meantime, left ventricular function was measured by tissue Doppler ultrasound， including isovolumic contraction time(ICT), isovolemic diastolic time(IRT)， and ejection time(ET). Tei index(ICT+IRT)/ET, isometric contraction index ICT/ET and isometric relaxation index IRT/ET were calculated.
    Results  ①The levels of β, Ｅρ, and PWVβ were higher in the hemodialysis group than in the normal control group, while the AC was lower in the hemodialysis group than in the normal control group(P＜0.05). No significant difference was found in AI between two groups(P＞0.05). ②The levels of IRT/ET and Tei index were higher in the dialysis group than in the normal control group(P＜0.05), whereas no significant difference was found in the ICT/ET and ET between two groups(P＞0.05). ③Correlation analysis showed that IRT/ET in hemodialysis group was positively correlated with arterial elastic indexes including β,Ｅρ, and PWVβ(r=0.789, 0.777, 0.739, P＜0.05) , while IRT/ET in hemodialysis group was negatively correlated with AC(r=-0.442， P＜0.05). Tei Index was positively correlated with β, Ｅρ and PWVβ(r=0.667, 0.617, 0.979, P＜0.05).
    Conclusion  Ultrasound could be used to detect the changes of arterial elastic function and left ventricular function in patients undergoing hemodialysis,  and the changes of arterial elastic function are positively correlated with the changes of left ventricular diastolic function. The global function of the left ventricle decreased with the decrease of vascular elasticity, and the decrease of diastolic function of the left ventricle is more significant. The changes of brachial artery elasticity after fistulectomy can be used to predict the risk of cardiovascular complications, and the intervention process of heart and vascular disease should be performed early and effectively, thereby reducing morbidity and mortality of patients with cardiovascular disease undergoing hemodialysis.
    Clinical study of new treatment approaches for patients with valvular heart disease complicated by atrial fibrillation
    LIANG Hui-qing, LIU Zi-teng, LIU Li-ying, ZHANG Jing-bo, SHI Jian, HE Lu-yu
    2021, 42(3):  273-277.  doi:10.3969/j.issn.1007-3205.2021.03.005
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    Objective  To evaluate the clinical value of hybrid surgery in the treatment of atrial fibrillation(AF) by comparing the therapeutic effects of three methods: hybrid surgery, surgery alone and radiofrequency ablation(RFA) alone.
    Methods  Seventy-nine patients with valvular disease complicated by AF who were admitted to department of cardiovascular surgery, the first central hospital of Baoding were enrolled in this study. All patients underwent valve replacement. According to the treatment methods for AF, they were divided into hybrid surgery group, Cox-Maze procedure alone group(Maze group) and interventional ablation alone group. Hybrid surgery group and Maze group were treated with valve replacement and maze procedure under direct vision. Hybrid surgery group and interventional ablation alone group were treated in Department of Internal Medicine with interventional RFA at 3 months after operation. The patients were followed up for 1 year. ECG and echocardiography were reexamined at 3, 6, 9 and 15 months after valve replacement(at 1, 3, 6, and 12 months after intervention in hybrid surgery group and interventional ablation alone group). The recovery of the two groups was compared.
    Results  The duration of medical intervention was shorter in hybrid surgery group than in interventional ablation alone group(P＜0.05). The cure rate of AF at 9 and 15 months was higher in hybrid surgery group than in Maze group and interventional ablation alone group, and the cure rate of AF at 9 and 15 months was higher in Maze group than in interventional ablation alone group(P＜0.05). All patients were reexamined by echocardiography and EF values were recorded. The differences in time points and time points between any two groups were statistically significant in the three groups(P＜0.05).
    Conclusion  In the treatment of AF, hybrid surgery has a higher cure rate and a higher application value in clinical practice.
    Correlation between low-density lipoprotein and coronary artery disease in young and middle-aged patients with coronary heart disease
    ZHAO Jie, LI Shu-ying, ZHANG Ying, SHAN Wei-chao, HAN Leng, DING Zhen-jiang
    2021, 42(3):  278-280,285.  doi:10.3969/j.issn.1007-3205.2021.03.006
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    Objective  To analyze the correlation between the degree of coronary artery disease(CAD) and low-density lipoprotein(LDL) in young and middle-aged patients with coronary heart disease(CHD).
    Methods  A total of 387 patients with CHD planned to be diagnosed were included in the study. According to the imaging findings, they were divided into non-CHD group(n=124) and CHD group(n=263). The levels of total cholesterol （TC）, triacylglycerol, LDL and high-density lipoprotein(HDL) in non-CHD group and CHD group were detected. In addition, patients with CHD were divided into acute myocardial infarction group, unstable angina group and stable angina group, LDL levels were compared. Syntax score was used to evaluate the degree of CAD in CHD group, and the correlation between various biochemical indexes and syntax score was analyzed.
    Results  The levels of total cholesterol, triacylglycerol, and LDL in the CHD group were higher than those in the non-CHD group, and the high-density and low-lipoprotein levels were lower than those in the non-CHD group. The difference was statistically significant(P＜0.05). The level of LDL in acute myocardial infarction group was higher than that in unstable angina group and stable angina group, the difference was statistically significant(P＜0.05). Correlation analysis results show that TC and triacylglycerol in patients with CHD are not related to the syntax score(P＞0.05); High density and low lipoprotein levels are negatively correlated with the syntax score(P＜0.05), and LDL levels are related to syntax. The score was positively correlated(P＜0.05).
    Conclusion  LDL levels are closely related to the degree of CAD in young and middle-aged patients with CHD, and they are also risk factors. The increase in the level is of high value in assessing the degree of coronary artery disease.
    Analysis of related factors affecting the efficacy of noninvasive positive pressure ventilation in the treatment of sepsis-induced ARDS
    ZHU Lin-ling, LI Ping
    2021, 42(3):  281-285.  doi:10.3969/j.issn.1007-3205.2021.03.007
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    Objective  To analyze the related factors that affect the efficacy of noninvasive positive pressure ventilation(NPPV) in the treatment of sepsis-induced acute respiratory distress syndrome(ARDS).
    Methods  A retrospective study was performed to collect the clinical data of 180 patients with sepsis-induced ARDS. All patients were treated with NPPV. Univariate analysis and multivariate Logistic regression analysis were used to analyze the related factors affecting the clinical efficacy.
    Results  The treatment was effective in 153(85.00%) of 180 patients but ineffective in the remaining 27(15.00%). Compared with the ineffective treatment group, the platelet count of the effective treatment group was significantly increased, while the serum procalcitonin, C-reactive protein and sequential organ failure assessment(SOFA) score were significantly decreased(P＜0.05). Compared with the ineffective treatment group, the oxygenation index(arterial partial pressure of oxygen/arterial partial pressure of carbon dioxide, PaO2/FiO2) of the ineffective treatment group was increased significantly, while the proportion of the patients who converted to invasive positive pressure ventilation was decreased significantly(P＜0.05). Multivariate logistic regression analysis revealed that platelet count ＜50×109/L, PaO2 / FiO2＜150, and SOFA≥10 were independent risk factors for clinical efficacy.
    Conclusion  Platelet count, PaO2/FiO2 and SOFA score are all related factors that affect the clinical efficacy of NPPV in the treatment of sepsis-induced ARDS.
    Expression and clinical significance of Tfh cell-related factors in peripheral blood of patients with esophageal squamous cell carcinoma
    HAO He, YANG Chun-wang, CAO Jing, GUO Xiao-jin, LI Xing, WANG Zhi-yu
    2021, 42(3):  286-289,303.  doi:10.3969/j.issn.1007-3205.2021.03.008
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    Objective  To analyze the expression levels of CXC receptor 5（CXCR5)，chemokine C-X-C motif ligand-13（CXCL-13）and IL-21 in the peripheral blood of patients with esophageal squamous cell carcinoma(ESCC) and to evaluate their correlation with clinicopathological characteristics.
    Methods  A total of 65 patients with ESCC and 30 healthy people were enrolled in this research. The peripheral blood samples were collected and the expression levels of soluble CXCR5（sCXCR5）, soluble CXCL13（sCXCL13）and IL-21 were detected by enzyme-linked immunosorbent assay(ELISA).
    Results  The levels of sCXCR5, sCXCL13 and IL-21 were increased in the ESCC group, as compared with normal control group(P＜0.05); the expression levels of sCXCR5, sCXCL13 and IL-12 had no remarkable difference in the ESCC group before and after surgery(P＞0.05). The expression levels of sCXCL13 and IL-21 were not statistically different between groups with different clinicopathological characteristics(P＞0.05), but the expression levels of sCXCR5 were statistically different between groups with different tumor volumes(P＜0.05). There were no significant correlation between the levels of sCXCR5, sCXCL13 and IL-21.
    Conclusion  The expression levels of Tfh cell-related factors sCXCR5, sCXCL13 and IL-21 were higher in ESCC patients than in healthy people. Moreover, sCXCR5 expression was associated with tumor volume, suggesting that Tfh cells might be involved in the occurrence and development of ESCC.
    A single-center observation on the effect of Duckett′s procedure in the treatment of severe hypospadias
    GUO Ping-ying, QI Jin-chun, CHEN Hui, ZHAO Bin, JIA Jiang-hua, XUE Wen-yong
    2021, 42(3):  290-293.  doi:10.3969/j.issn.1007-3205.2021.03.009
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    Objective  To summarize the effect and complications of Duckett′s procedure to repair and reconstruct the urethra in the treatment of severe hypospadias.
    Methods  A retrospective analysis was performed on the clinical data of 997 patients with severe hypospadias who underwent Duckett′s procedure to repair and reconstruct the urethra.
    Results  A total of 997 cases underwent Duckett′s procedure of one-stage urethroplasty to reconstruct the urethra, and 708 patients were cured(the cure rate was 71.01%). There were 241 cases suffering urethral stricture, with an incidence of 24.17%, of whom 229 cases whose urethral stricture was mild were able to maintain unobstructed urine flow after intermittent urethral dilatation under local anesthesia.Nine patients experienced unsuccessful urethral dilatation, and then under general anesthesia, the urethra was expanded retrogradely through the internal orifice of the urethra, and the catheter was retained. After removing the urinary tube, intermittent urethra dilatation was performed to successfully solve the dysuria. There were 3 cases of urethral atresia after urinary tract infection and necrosis. The narrow segment of the urethra was opened under general anesthesia. Six months later, the urethra was reconstructed by snodgrass longitudinal rolling tube operation to allow smooth urination. Forty-five cases of urethral fistula occurred, with an incidence of 4.51%. For children with a small fistula,the urethra was retained again to drain urine, epidermal growth factor was applied to the fistula, and 5 cases were cured. Another 38 children with fistula could not heal themselves, and six months later, it was successfully resolved by urethral fistula repair. Two cases of urethral fistula reoccurred, and the urethral fistula was successfully resolved again by urethral fistula repair. There were 3 cases of urethral diverticulum, with an incidence of 0.30%; 2 cases had large diverticulum, which affected urination, and the urethra was cured by re-forming the diverticulum; 1 case who had small diverticulum was not treated temporarily, and regular follow-up was performed. All children were followed up for 6 to 36 months, and the end point of observation was unbostructed urination and absence of urethral dilation for 3 months.
    Conclusion  Duckett′s procedure of one-stage urethro plasty for repair and reconstruction of the urethra is effective in the treatment of patients with severe hypospadias, and the clinical complications can be corrected by corresponding methods. Therefore, it is worthy of clinical promotion.
    Biomechanical experiment of a new suture fixation method for tibial eminence fracture
    WANG Jiang-tao, BU Jian-li, CHANG Han, QIAN Yu-hang, LUO Tao, LIU Yu-jie
    2021, 42(3):  294-297,338.  doi:10.3969/j.issn.1007-3205.2021.03.010
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    Objective  To study the biomechanical stability of reticular loop ligature fixation for tibial eminence fractures.
    Methods  A total of 24 fresh porcine knee joints were involved in this experiment. After type Ⅲ fracture model was established in uniform size, the 24 samples were divided into reticular loop ligature group(group A, n=12) and neck knot loop group(group B, n=12) by computer random method. Each specimen was subjected to cyclic test and pull-out test. The maximum failure load, yield load, stiffness and displacement were compared between two groups.
    Results  The failure mode: Twelve cases in group A had displacement exceeding the predetermined limit. In group B, 7 specimens failed as a result of displacement exceeding the predetermined limit, 3 cases failed because of bone tilted up, and 2 cases experienced failure for bone rotated. The biomechanical results showed that the maximum failure load and yield load of group A were higher than those of group B, and the average displacement after cycle loads of group A was lower than that of group B, suggesting significant differences between two groups(P＜0.05). The difference of average stiffness value between two groups had no statistically significance(P＞0.05). 
    Conclusion  The biomechanical property of reticular loop ligature fixation for type Ⅲ tibial eminence fracture may be superior to that of neckwear knot loop ligature fixation.
    Effect of somatostatin combined with indomethacin suppository on the incidence of pancreatitis after ERCP for cholangiocarcinoma
    ZHANG Pei-jian, LIU Meng-dong, LIU Ke-xia, WANG Ya-qi, LIU Xu-guang
    2021, 42(3):  298-303.  doi:10.3969/j.issn.1007-3205.2021.03.011
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    Objective  To study the effect of somatostatin combined with indomethacin suppository in reducing the incidence of pancreatitis after endoscopic retrograde cholangiopancreatography(ERCP) for cholangiocarcinoma.
    Methods  A total of 160 patients with cholangiocarcinoma treated by ERCP were randomly selected as the study subjects, and divided into four groups according to random number table method, with 70 patients in each group. ERCP was performed in all patients. Group A was given somatostatin, group B was given indomethacin, group C was given somatostatin combined with indomethacin, and group D did not receive any of the above treatment. The incidence of acute pancreatitis and hyperamylaseemia after ERCP, as well as the levels of serum amylase(AMS), lipase(LPS) and white blood cell(WBC) at 5 h and 24 h after operation, was compared among the four groups.
    Results  The incidence of postoperative pancreatitis in groups A, B and C was lower than that in group D(P＜0.05), and the incidence in group C was lower than that in groups A and B(P＜0.05). There was no statistical significance in the incidence between groups A and B(P＞0.05). No significant difference was noted in the incidence of hyperamylasemia among groups A, B and C(P＞0.05), which, however, was lower than that in group D. There was no statistical significance in both AMS and LPS among groups A, B, C and D before surgery(P＞0.05). At 5 h and 24 h after operation, there were no statistically significant differences between group A and B(P＞0.05); there were statistically significant differences between any other two groups(P＜0.05), that is, the levels of AMS and LPS in groups A, B and C were lower than those in group D, while the levels in group C were lower than those in group A and B. There was no significant difference in WBC indexes between groups A, B, C and D before and at 5 h after operation(P＞0.05). At 24 h after surgery, there was no statistically significant difference between group A and group B(P＞0.05); there was statistically significant difference between any other two groups(P＜0.05), that is, the WBC level of groups A, B and C was lower than that of group D, and the level of group C was lower than that of group A and group B.
    Conclusion  The combination of somatostatin and indomethacin suppository can significantly reduce the incidence of pancreatitis after ERCP for cholangiocarcinoma.
    Clinical application and strategy analysis of prenatal molecular screening in spinal muscular atrophy
    LIU Chun-miao, SUN Dong-lan, YU Mei, ZHANG Jing, YANG Yu-xiu, MENG Yan-xin
    2021, 42(3):  304-308,329.  doi:10.3969/j.issn.1007-3205.2021.03.012
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    Objective  To investigate the clinical value of molecular biology in prenatal screening of spinal muscular atrophy(SMA) and its related strategies.
    Methods  A total of 4 568 samples of patients that presented to prenatal diagnosis center of our hospital were collected as the research subjects. The denaturing high performance liquid chromate graphy(DHPLC) was used to detect copy number variation of survival motor neuron(SMN1/SMN2), and Sanger sequencing technique was used to detect SMN point mutation.
    Results  Of 3 SMA patients in 4 568 samples, there were 2 with homozygous deletion of SMN1 exon 7/8. Both parents were verified as typical SMA carriers, carrying aheterozygous deletion of one copy of SMN1 exon 7/8. Another patient was clinically diagnosed as “type 1+1” SMA patient carrying aheterozygous deletion of one copy of SMN1 exon 7/8, and point mutation site in SMN1 p.Q164X.2. There were 126 SMA carriers, with a carrying rate of approximately 1/36; 84 carriers with one copy of SMN1 exon 7/8; 31 carriers with one copy of SMN1 exon 7, and 11 carriers with one copy of SMN1 exon 8.3. On the basis of identifying the SMA proband and carrier genotype, we performed SMA prenatal diagnosis of amniotic fluid puncture on both 25 couples who were carriers at 18 weeks of pregnancy, including 3 fetus carrying a homozygous deletion of SMN1 exon 7/8(SMA patient), and 1 fetus carrying aheterozygous deletion of SMN1 exon 7/8(SMA carrier). There was no abnormal SMN1 copy number in the remaining fetuses. Sanger sequencing 1 fetal carrying p.Q164x point mutation site, while the remaining samples had no abnormal SMN copy number.
    Conclusion  DHPLC combined point mutation sequencing was used to detect the pathogenesis of SMA, which fully confirmed their significant value in the detection of genetic diseases such as SMA. The newly reported SMN mutation site of pathogenic gene p.Q164X enriched the database of SMA pathogenic genes in Chinese population. Carrier screening for single-gene disorder is the basis of prenatal diagnosis, which can identify the types of variant and possible pathogenic sites in carriers, select accurate molecular means for targeted prenatal diagnosis of fetal disease, reduce the family and social economic burden as well as the psychological burden of patients and their families.
    Analysis of screening results of tandem mass spectrometry for neonates with primary carnitine deficiency in Shijiazhuang area
    JIA Li-yun, FENG Ji-zhen, WANG Xi, MA Cui-xia, FENG Lu-lu
    2021, 42(3):  309-313.  doi:10.3969/j.issn.1007-3205.2021.03.013
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    Objective  To determine the prevalence of primary carnitine deficiency(PCD) in neonates in Shijiazhuang area, and to further analyze the genetic mutations.
    Methods  Tandem mass spectrometry was used to detect the blood free carnitine and acylcarnitine in neonates,and carnitine transporter gene mutation was detected in suspected children.
    Results  A total 160 061 neonates, 17 were diagnosed, including 9 children with PCD(prevalence rate was 1/17 785), and 8 children with maternal carnitine deficiency. 〖JP2〗Nine children with PCD had a primary screening value of blood free carnitine of 4.47(1.77-6.78) μmol/L, and a recall of 4.83(2.80-7.32) μmol/L,〖JP〗 accompanied by a decrease in the levels of various acylcarnitines. Among 9 children with PCD, 4 cases were tested for SLC22A5 gene, 〖JP2〗including 1 compound heterozygous, 1 homozygous and 2 heterozygous. Gene mutation analysis revealed 4 mutation sites: c.865C>T, c.1400C>G, c.428C>〖JP〗T and c.1462C>T.
    Conclusion  Application of tandem mass spectrometry in neonatal disease screening can detect PCD early. The prevalence of PCD in Shijiazhuang area is 1/17 785; 4 mutation sites of SLC22A5 gene are found.
    Construction of individualized diagnosis and prediction model for children with influenza A complicated with severe pneumonia and risk factor mining
    ZHANG Lei, TIAN Li-yuan, LI Qin, LI Qing-tao, ZHANG Man, WANG Ya-kun
    2021, 42(3):  314-319.  doi:10.3969/j.issn.1007-3205.2021.03.014
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    Objective  To build an individualized prediction model for children with influenza A complicated with severe pneumoniausing machine learning technology ,and to fully explore high-risk factors, in order to improve the prognosis of children by early implementation of accurate preventive measures and treatment methods.
    Methods  The clinical data of children with influenza A infected pneumonia were collected. Two sets of diagnosis and prediction models were constructed based on full clinical indexes and commonly used clinical indexes by using machine learning XGBoost algorithm, and the diagnostic value of the two models and the importance ranking of the corresponding indexes for prediction were compared.
    Results  According tothe accuracy of the full index prediction model,the model diagnosis results and consistency of the observation results,Kappa value, area under curve(AUC), sensitivity, positive predictive value and negative predictive value of full index prediction modelwere better than those of commonly used clinical indexes. Based on full index prediction model,the main predictors of the model according to importance rankingwere respiratory failure, severity of cough and asthma(severe wheezing), total B cells, monocytes,duration offever(>15 d) andhelper T cells(CD4). The main predictors of the diagnostic prediction model based on commonly used clinical indexesaccording to ranking importance were respiratory failure, chest X-ray(pneumonia), mixed bacteria or virus. The gain value(X axis) of each index of the full index prediction model was significantly better than that of indexes inthe commonly used clinicalindexprediction model.
    Conclusion  Based on the clinical data of children with influenza A complicated with pneumonia, using machine learning technology, children with influenza A complicated with critical pneumonia serveas variables, and all indexessuch asbasic clinical data and biochemical, immune,and imaging indexes serveas predictors. The individualized diagnostic prediction model has a higher diagnostic value, which could predict the probability of individuals complicated with critically ill pneumonia, and target high-risk factors for individuals, thereby preventing and treating children with influenza A complicated with critically ill pneumonia early and improving the prognosis.
    Analysis of the effect of endoscopic assisted periodontal therapy
    QI Ya-li, LIANG Xiang-yang, LI Shu-juan, LI Ya, LIU Bing, YANG Dong-ru
    2021, 42(3):  320-323.  doi:10.3969/j.issn.1007-3205.2021.03.015
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    Objective  To compare the changes in the probing depth（PD） and mobility of different teeth positions before and after periodontal endoscope assisted treatment for removing residual subgingival calculus, and to explore the application scope of periodontal endoscope assisted basic periodontal treatment.
    Methods  According to the inclusion criteria, 12 patients with chronic periodontitis were selected. The residual periodontal pocket ≥ 4 mm at the 3-month follow-up after basic periodontal treatment was found in all patients, and then given periodontal endoscope assisted treatment. The periodontal condition was recorded by Florida probe system at the 3-month follow-up, including PD, bleeding on probing(BOP), tooth mobility, etc. A 3-month trial period after basic periodontal treatment was taken as the baseline, and they were grouped according to the root shape, PD and tooth mobility. The changes in each group at baseline and at 3 months after endoscopic treatment were analyzed.
    Results  At 3 months after endoscopic treatment, PD value and percentage of BOP sites in single and multiple teeth with moderate residual periodontal pocket(4 mm≤PD＜6 mm) were significantly lower than those at baseline, with significant difference. However, for severe periodontal pocket(6 mm≤ PD＜8 mm), the PD value and percentage of BOP sites of single root teeth and multiple root teeth were lower than those at baseline, and the decrease of single root teeth was more obvious than that of multiple root teeth, suggesting significant difference. At PD≥8 mm, the imrovement in the PD value and percentage of BOP sites of single root teeth and multiple root teeth was not significant, with no significant difference. The total improvement rate of tooth mobility was 55.29%(47/85), and the improvement rate decreased with the increase of tooth mobility.
    Conclusion  Periodontal endoscopic assisted basic periodontal treatment can improve the depth of periodontal pocket, detect bleeding and mobility, which is especially effective when PD of single tooth is less than 8 mm, and can avoid periodontal surgery to a certain extent.
    Effect of B-ultrasound guided paravertebral block and general anesthesia on cognitive function and early recovery quality of elderly patients after thoracoscopic lobectomy
    MU Yan, LIU Xin-yan, QI Sheng-juan
    2021, 42(3):  324-329.  doi:10.3969/j.issn.1007-3205.2021.03.016
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    Objective  To explore the effect of B-ultrasound-guided paravertebral block and general anesthesia on the cognitive function and early recovery quality of elderly patients after thoracoscopic lobectomy.
    Methods  A total of 100 elderly patients undergoing thoracoscopic lobectomy were selected and divided into observation group(n=50) and control group(n=50) according to the random number table method. The control group underwent general anesthesia, and the observation group underwent B-ultrasound-guided paravertebral block and general anesthesia. The mini-mental state examination(MMSE) scores, visual analogue scale(VAS) scores for pain at rest and during cough, surgery-related indicators, recovery quality, and occurrence of adverse reactions were compared between two groups.
    Results  After anesthesia, the MMSE scores of the two groups were decreased initially and then increased, and the change was slight in the observation group. The difference of interaction between groups, time points and time points between groups was statistically significant(P＜0.05). The VAS scores of the observation group were increased initially and then decreased at rest and during cough. The control group showed a gradually decreasing trend. The VAS scores of the observation group at rest and during cough were lower than those of the control group. The difference of interaction between groups, time points and time points between groups was statistically significant(P＜0.05). The length of ICU stay, extubation time, time to first oral food intake, off-bed time, and length of hospital stay in the observation group were significantly shorter than those in the control group, and the difference was statistically significant(P＜0.05). The scores of pain, self-care ability, psychological and physical comfort, and emotional status of the observation group were significantly higher than those of the control group, and the difference was statistically significant(P＜0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group, and the difference was statistically significant(P＜0.05).
    Conclusion  B-ultrasound-guided paravertebral block and general anesthesia can effectively improve the cognitive function of elderly patients after thoracoscopic lobectomy and improve their early recovery quality.
    Comparison of the effects of nalbuphine and sufentanil in patient-controlled intravenous analgesia in patients undergoing hysterectomy
    YAN Yan, SUN Jian-xin, GUO Peng, LIANG Jun
    2021, 42(3):  330-333.  doi:10.3969/j.issn.1007-3205.2021.03.017
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    Objective  To investigate the clinical effects of nalbuphine and sufentanil for analgesia and sedation in patients undergoing total abdominal hysterectomy(TAH), so as to effectively provide more assistance for reducing the pain of patients after abdominal surgery.
    Methods  A total of 150 patients undergoing TAH in our hospital were selected as the research subjects, and were randomly divided into nalbuphine group(n=50), sufentanil group(n=50) and combination treatment group(n=50). The pain sensation score, sedation score and adverse reactions of the three groups of patients were compared.
    Results  ①The scores of pain sensation in three groups were initially increased and then decreased with time, and the differences of interaction between groups, time points and time points between groups were statistically significant(P＜0.05). ②The sedation score of nalbuphine group was better than that of the other two groups, and the difference among the three groups was significant(P＜0.05). ③The adverse reaction rate of nalbuphine group was lower than that of the other two groups, and there were significant differences among three groups(P＜0.05).
    Conclusion  It can be clearly concluded that nalbuphine can effectively improve analgesia and sedation of patients, reduce adverse reactions after surgery,and improve the patient satisfaction after TAH. Therefore, it is worthy of further promotion and application.
    Compatibility stability of dexrazoxane for injection in different infusion solvents
    ZHANG Ya-kun, LIU Jian, GONG Ying, CHEN Wei, ZHANG Zhi-qing
    2021, 42(3):  334-338.  doi:10.3969/j.issn.1007-3205.2021.03.018
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    Objective  To investigate the stability of dexrazoxane for injection in dedicated or non-dedicated infusion solvents.
    Methods  After dissolved in dedicated solvent(0.167 mol/L sodium lactate for injection) and non-dedicated solvent(sterile water for injection) respectively, dexrazoxane was placed at room temperature for 24 h, and the changes in appearance were observed. The value of pH was measured with pH meter. The number of insoluble particles was surveyed by particle analyzer. The relative percentage contents were measured by ultra-high performance liquid chromatography(UPLC), and the chromatographic conditions were as follows: chromatographic column was ACQUITY UPLC BEH C18(2.1 mm×50 mm,1.7 μm), the mobile phase was water-methanol(90〖DK〗∶10) with a flow rate of 0.4 mL/min, the detection wave length was set at 209 nm, and the column temperature was 25 ℃．
    Results  Under this condition, the appearance and pH value had no significant change within 24 h. In comparison, the pH of a compatible fluid prepared with dedicated solvents was higher than that with sterile water for injection. The number of insoluble particles in the mixture dissolved by non-dedicated solvent and expanded to the compatibility solutions in 5% glucose injection exceeded the normal range, while the other compatibility solutions were within the normal range. The linear range of dexrazoxane was 4.30-42.96 mg/L(r=0.999 9). The relative percentage of dexrazoxane in the dedicated solvent group and non-dedicated solvent group were more than 95% and less than 95% within 6 h, repectively. The relative percentage of dexrazoxane was significantly decreased after 6 h in both groups.
    Conclusion  The compatibility solution of dexrazoxane dissolved by dedicated solvent is more stable than that in non-dedicated solvent group.
    Application value of serum omentin-1 and Lp-PLA2 levels in Kawasaki disease
    LIU Yi, CHEN Wei-zhi, SHAO Ya-wang
    2021, 42(3):  340-343.  doi:10.3969/j.issn.1007-3205.2021.03.019
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    Objective  To explore the clinical application value of serum levels of omentin-1 and lipoprotein-associated phospholipase A2(Lp-PLA2) in Kawasaki disease(KD).
    Methods  A total of 93 children with KD were divided into normal coronary artery(NCA) group(n=54) and coronary artery disease(CAD) group(n=39) according to the results of echocardiography. Another 30 healthy people were selected as the control group. The serum levels of omentin-1 and Lp-PLA2 were detected by enzyme-linked immunosorbent assay(ELISA). The internal diameters of left main coronary artery(LMCA), left anterior descending coronary artery(LADC), and right proximal coronary artery(PRCA) were detected by color doppler ultrasound. The correlation between the above indexes and KD was analyzed.
    Results  The level of omentin-1 was lower whereas the level of Lp-PLA2 was higher in NCA group and CAD group, as compared with those in control group. The level of omentin-1 was lower whereas the level of Lp-PLA2 was higher in CAD group, as compared with those in NCA group(P ＜ 0.05). The internal diameters of LMCA, LADC and PRCA in CAD group were significantly higher than those in NCA group and control group(P＜0.05). There was no significant difference in the internal diameter of LMCA, LADC and PRCA between NCA group and control group(P＞0.05). Correlation analysis showed that omentin-1 was negatively correlated with the inner diameters of LMCA, LADC and PRCA in CAD group(P＜0.05). Lp-PLA2 was positively correlated with the internal diameters of LMCA, LADC and PRCA(P＜0.05). ROC curve analysis showed that the AUC of serum omentin-1 and Lp-PLA2 in the diagnosis of KD was［0.770(95%CI: 0.635-0.905, P＜0.001), and 0.805(95%CI: 0.685-0.926, P＜0.001)］ respectively, and the sensitivity and specificity were 69.0% vs. 93.7%, and 82.8% vs. 81.2%, respectively. The AUC of serum omentin-1 and Lp-PLA2 in diagnosing coronary artery injury in KD was 0.748(95%CI: 0.612-0.883, P＜0.001) and 0.756(95%CI: 0.619-0.893, P＜0.001), respectively. The sensitivity and specificity were 58.6% vs. 93.9% and 69.0% vs. 88.6%, respectively.
    Conclusion  The serum levels of omentin-1 and Lp-PLA2 can be used in the diagnosis of KD disease and the assessment of coronary artery injury in KD children.
    Relationship between serum uric acid concentration and blood lipids, blood glucose in patients with asymptomatic hyperuricemia
    YU Tong-fang, GUO Yong-sheng, WANG Fan, GUO Xin, ZHAO Jian-hong, CHI Hong-zhi
    2021, 42(3):  344-347,354.  doi:10.3969/j.issn.1007-3205.2021.03.020
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    Objective  To investigate the relationship between serum uric acid(SUA) concentration and blood lipids, blood glucose in patients with asymptomatic hyperuricemia, with an increase in SUA concentration.
    Methods  A total of 4 918 patients were selected, including 2 741 males and 2 177 females. The concentration of SUA at 60 μmol/L was set as the cut-off value for grouping. According to the concentration of SUA, the males and females who underwent physical examination were divided into four groups and three groups respectively. The differences in blood lipid［triglyceride(TG), total cholesterol(TC), high-density lipoprotein(HDL), low-density lipoprotein(LDL)］ and glucose(GLU) were analyzed in different groups. The relationship between SUA concentration and blood lipid, blood glucose was analyzed. Considering the effect of age on SUA concentration of women, the age of 49 years was set as a cut-off value for initial grouping. According to SUA concentration, all women were grouped, women under the age of 49 were divided into two groups and women over the age of 49 were divided into three groups. The differences in the blood lipids and blood glucose in the patients from different groups were analyzed.
    Results  In the females, the GLU, TG, and TC were significantly increased with high SUA concentration, and the higher the concentration of SUA, the higher indicators were obtained. HDL was decreased with an increase in SUA concentration. In the males, TG was also increased in parallel with SUA concentration. In addition, GLU and TC were increased, while HDL was decreased in patients with an increase in SUA concentration. In women under the age of 49 years, GLU, TG, TC, and LDL were increased significantly and HDL was decreased in patients with an increase in SUA concentration. In women over the age of 49, with an increase in SUA concentration, TG was also increased significantly and HDL was decreased. An increase in SUA concentration led to increased GLU and TC.
    Conclusion  With the increase of the SUA concentration, the blood glucose and blood lipid were increased obviously, suggesting metabolic dysfunction of the body. An increase in SUA concentration, blood glucose and blood lipid may affect each other.
    Influencing factors of self-treatment of the elderly in China——An analysis based on CHARLS data
    ZHENG Yu-hang, DENG Qing-wen, ZENG Zhi-chao, LU Jun-hong, LIU Wen-bin
    2021, 42(3):  348-354.  doi:10.3969/j.issn.1007-3205.2021.03.021
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    Objective  To explore the factors associated with self-treatment  and  its mode selection in the elderly.
    Methods  Based on the data from “China Health and Retirement Longitudinal Survey(CHARLS)” in 2015, we used Chi-square test, binary logistic regression, and disordered multi-class logistic regression to analyze the influencing factors of self-treatment and its mode selection in the elderly.
    Results  In the past month, 59.8% of the respondents had self-treatment behavior. Elderly adults having an education of middle school or above(OR=1.667, 95%CI: 1.353-2.053, P＜0.001), depression(OR=1.437, 95%CI: 1.225-1.685, P＜0.001), in poor self-rated health(OR=2.026, 95%CI:1.651-2.486，P＜0.001), being dissatisfied with the quality, cost and convenience of local medical services(OR=1.234, 95%CI:1.032-1.477, P=0.021), a history of chronic diseases(OR=2.081, 95%CI:1.787-2.425， P＜0.001) and getting disease in the past month(OR=1.182, 95%CI:1.003-1.394, P=0.046), were more likely to engage in self-treatment. However, elderly people living in rural areas(OR=0.698, 95%CI:0.602-0.810, P＜0.001), and having infrequent contact with their children(OR=0.873, 95%CI:0.763-0.999, P=0.048), were less likely to engage in self-treatment. Compared with the adoption of self-medication, the elderly with education level of high school or above, unmarried or divorced, and with better economic status were more likely to use self-care or self-nursing for self-treatment. By contrast, female elderly, and those elderly having higher education level, having a poor self-rated health, being dissatisfied with the quality, cost and convenience of local medical services, having a history of chronic diseases, and getting disease in the past month, were more likely to use both self-medication and self-care or self-nursing for self-treatment(P＜0.05).
    Conclusion  It is necessary to pay more attention to health needs of the elderly living in rural area, poorly educated or in poor health condition, and strengthen the health education on self-treatment to ensure the rationality of the self-treatment of the elderly. In addition, the provision of high-quality and efficient guidance of self-treatment for the elderly is a top priority in promoting the health status of the elderly.