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    25 April 2021, Volume 42 Issue 4
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    Changes of serum VE-Cad and Ang-2 levels in patients with sepsis complicated by ARDS and their relationship with prognosis
    WEN Jun, ZHANG Yong-jun, CHEN Qun, TAN Yong-ping
    2021, 42(4):  376-379，385.  doi:10.3969/j.issn.1007-3205.2021.04.002
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    Objective  To investigate the changes of serum vascular endothelial cadherin(VE-Cad) and angiopoietin-2(Ang-2) levels in patients with sepsis complicated by acute respiratory distress syndrome(ARDS) and their relationship with prognosis. 
    Methods   A total of 79 patients with sepsis complicated by ARDS diagnosed and treated in our hospital were selected as the research subjects. According to the oxygenation index(PaO2/FiO2), patients were divided into mild group(n=28), moderate group(n=30) and severe group(n=21); they were divided into survival group(n=46) and death group(n=46) according to prognosis after 4 weeks. The levels of VE-Cad and Ang-2 in each group were compared. Pearson correlation analysis was used to analyze the correlation between VE-Cad and Ang-2, and binary Logistic regression analysis was used to analyze the factors affecting the prognosis of patients with sepsis and ARDS. Receiver operating characteristic(ROC) curve was used to analyze the diagnostic value of VE-Cad and Ang-2 in prognosis of septic patients with concurrent ARDS. 
    Results  Serum VE-Cad and Ang-2 levels were the lowest in mild group, followed by moderate group and severe group, and the difference was statistically significant(P＜0.05). The levels of VE-Cad and Ang-2 in the survival group were significantly lower than those in the death group(P＜0.05). After Pearson analysis, VE-Cad was positively correlated with Ang-2(r=0.632, P＜0.001). Binary logistic regression analysis indicated VE-Cad as an independent influencing factor for the prognosis of sepsis complicated with ARDS(P＜0.05). ROC curve analysis showed that the AUC of VE-Cad, Ang-2, and the combination diagnosis of sepsis and ARDS for the prediction of diagnosis were 0.906, 0.690, and 0.912, respectively. The diagnostic value of VE-Cad and the combination diagnosis of the two was higher; both The AUC of combination diagnosis and VE-Cad was significantly higher than that of Ang-2(Z=3.266, 3.071, P=0.001, 0.002). The corresponding sensitivity and specificity of VE-Cad and Ang-2 with respect to the optimal cut-off values were 87.9%, 84.8% vs. 45.5%, 89.1%, respectively, and those of the combination of the two were 84.8% and 80.4%, respectively. 
    Conclusion  Serum VE-Cad and Ang-2 levels in patients with sepsis complicated by ARDS increase with the aggravation of the disease. The VE-Cad and Ang-2 levels in dead patients are higher than those in surviving patients, and VE-Cad and the combination of the two have a higher diagnostic value for the prognosis of sepsis complicated by ARDS. Specifically, VE-Cad combined with Ang-2 has the highest diagnostic value.


    Effects of alogliptin combined with different insulin intensive regimens on the expression of miR-144 and miR-142 in patients with type 2 diabetes mellitus
    ZHANG Li-na, WU Hong-bo, CHENG Xue-zhe, MEN Xiao-yan, YAN Qiu-yan, GAO Jian
    2021, 42(4):  380-385.  doi:10.3969/j.issn.1007-3205.2021.04.003
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    Objective  To explore the effects of alogliptin combined with different insulin intensive regimens on the expression of microRNA-144(miR-144) and microRNA-142(miR-142) in patients with type 2 diabetes mellitus(T2DM). 
    Methods  A total of 106 patients with T2DM treated in our hospital were selected as the research subjects, and they were divided into insulin pump group(n=53) and basic treatment group(n=53)according to the random number table method. Both groups were treated with alogliptin. In addition, the insulin pump group was treated with an insulin pump, and the basic treatment group was treated with subcutaneous insulin. A blood glucose meter was used to detect fasting blood glucose(FBG) and  2 h postprandial blood glucose(2 hBG) levels. Hb201+ fast hemoglobin detector was employed to detect hemoglobin(HbAlc) levels. Enzyme-linked immunosorbent assay was used for detection of C-reactive protein(CRP), tumor necrosis factor-α(TNF-α), and interleukin-6(IL-6) levels. Real-time fluorescent quantitative PCR method was applied to detect expression levels of miR-144 and miR-142. The total treatment cost, therapeutic effect and occurrence of adverse reactions between two groups were observed and compared. 
    Results  After treatment, the levels of FBG, 2 hBG and HbAlc in the two groups were lower than those before treatment, and the levels of FBG, 2 hBG and HbAlc in the insulin pump group and the total treatment cost were lower than those in the basic treatment group(P＜0.05). After treatment, the levels of inflammatory factors in the two groups were lower than those before treatment, and the levels of inflammatory factors in the insulin pump group were lower than those in the basic treatment group(P＜0.05). After treatment, the expression of miR-144 in the two groups was lower than that before treatment, while the expression of miR-142 was higher than that before treatment. The expression of miR-144 in the insulin pump group was lower than that in the basic treatment group, while the expression of miR-142 was higher than that in the basic treatment group(P＜0.05). The total effective rate in the insulin pump group was higher than that in the basic treatment group(P＜0.05). There was no significant difference in the incidence of adverse reactions between two groups(P＞0.05). 
    Conclusion  Alogliptin combined with insulin pump can effectively alleviate the clinical symptoms of patients with T2DM, reduce the expression of miR-144 and the incidence of complications, increase the expression of miR-142, shorten the treatment cycle, and reduce the treatment cost, showing a significant therapeutic effect.

    Prediction value of myoglobin, creatine kinase and myoglobin/creatine kinase ratio in acute renal failure in patients with rhabdomyolysis syndrome
    GAO Tian, WANG Gan-nan, WANG Wei, ZHANG Jin-song
    2021, 42(4):  386-389，400.  doi:10.3969/j.issn.1007-3205.2021.04.004
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    Objective  To analyze the prediction value of myoglobin, creatine kinase(CK) and the myoglobin/CK ratio in acute renal failure(ARF) in patients with rhabdomyolysis syndrome(RM). 
    Methods  The clinical data of 120 RM patients who were treated in People′s Hospital of Jiangsu Province and Pukou Hospital of Nanjing City were retrospective analyzed. Serum CK and myoglobin values and the myoglobin/CK ratio were compared between AKI patients and non-AKI patients, and classified into quartiles from the lowest to highest values. The incidence rate of AKI, mortality rate and the corresponding AKI distribution were calculated, and Spearman analysis was used to analyze the relevance between myoglobin, CK, and AKI. Univariate and multivariate Logistic regression analysis were used to explore the risk factors for predicting AKI. 
    Results  A total of 47 cases(39.16%) of RM patients were complicated with AKI, of whom 42 patients were treated with hemodialysis. Of them, 2 patients died(death rate of 4.76%) and the remaining patients survived. Serum myoglobin concentration and CK activity in AKI patients were significantly higher than those in non-AKI patients(P＜0.05); Spearman analysis showed that the correlation coefficients of serum myoglobin concentration, serum CK activity and AKI were 0.51(P=0.003) and 0.22(P=0.019), respectively. Multivariate Logistic regression analysis showed that the serum myoglobin was a significant predictor of AKI, and the third and fourth quantiles of the myoglobin/CK ratio were all significant predictors of AKI(P＜0.05). 
    Conclusion  Serum myoglobin and the myoglobin/CK ratio are significant risk factors for predicting AKI. Therefore, the test is recommended to be performed at admission. 

    A randomized controlled clinical study of electromagnetic extracorporeal shock wave on shoulder dysfunction after arthroscopic repair of rotator cuff degeneration
    ZHU Wei-wei, CHEN Wei, ZHOU Jing-jie, ZHANG Ming, LU Xin-yu, LI Xiu-yan
    2021, 42(4):  390-394.  doi:10.3969/j.issn.1007-3205.2021.04.005
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    Objective  To observe the clinical effect of electromagnetic extracorporeal shock wave on shoulder dysfunction after arthroscopic repair of rotator cuff degeneration. 
    Methods  A total of 40 patients with degenerative rotator cuff injury who underwent arthroscopic repair were randomly divided into two groups, with 20 patients in each group. Rehabilitation exercise was performed at 6-8 weeks after operation. Both groups were treated with conventional exercise methods. The observation group was supplemented with electromagnetic extracorporeal shock wave therapy on the basis of conventional rehabilitation exercises. The Constant-Murley Shoulder Function Score Scale(CMS), the university of California at Los Angeles shoulder rating scale(UCLA), visual analogue scale(VAS) pain score and ioint range of motion(ROM) were used for evaluation before treatment, at 3 weeks and 6 weeks after treatment. 
    Results  The CMS score of the two groups showed an increasing trend before and after treatment, and the score was higher in the observation group than in the control group; the difference of interaction between groups, time points and time points between groups were statistically significant with respect to activities of daily living and active ROM scores(P＜0.05). There were significant differences between groups and time points with respect to pain score(P＜0.05), between time points and time points between groups with respect to muscle strength(P＜0.05). The UCLA score of the two groups showed an increasing trend before and after treatment, and the score was higher in the observation group than in the control group; there was significant difference between time points in all scores(P＜0.05). The difference was statistically significant between groups with respect to pain score(P＜0.05). There were significant differences between groups and time points with respect to pain score and forward flexion score. VAS score of the two groups before and after treatment showed a decreasing trend, which was lower in the observation group than in the control group, while the scores of function, range of forward flexion, forward flexion strength and satisfaction showed an increasing trend, which were higher in the observation group than in the control group, suggesting significant differences between time points and time points between groups(P＜0.05). There were significant differences in pain, function, forward flexion strength and satisfaction between groups(P＜0.05). 
    Conclusion  After degenerative rotator cuff injury repair, electromagnetic extracorporeal shock waves can significantly relieve postoperative pain of the patient and have a significant effect on improving shoulder joint function.

    Effects of personalized neuromuscular training on knee function, pain, stiffness and quality of life in patients with knee osteoarthritis
    WANG Xin-tong, ZHOU Chao-bo, YANG Li-hui, YAN Li-qiang, WANG Kai, WANG Qian
    2021, 42(4):  395-400.  doi:10.3969/j.issn.1007-3205.2021.04.006
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    Objective  To explore the effect of personalized neuromuscular training on knee function, pain, stiffness and quality of life in patients with knee osteoarthritis(KOA). 
    Methods  A total of 150 KOA patients treated in our hospital were selected and divided into observation group(n=75) and control group(n=75) by random number table method. The control group received resistance training, and the observation group received personalized neuromuscular training(including warm-up exercise, neuromuscular training, and cool-down exercise). The duration of treatment was 6 weeks. The total effective rate, pain and stiffness before and after treatment ［as assessed by the Western Ontario and McMaster University Osteoarthritis Index(WOMAC)］, 30 s chair-rising test, 40 m brisk walking test, the rate of analgesic use within 2 weeks before enrollment, serum tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), interleukin-1β(IL-1β) levels, the rate of analgesic use within 2 weeks after treatment, knee function before and after treatment ［assessed by knee society score(KSS)］, quality of life ［measured by arthritis impact measurement scale 2-short form(AIMS2-SF)］. 
    Results  The total effective rate of the observation group was higher than that of the control group(P＜0.05). The pain symptom score, stiffness symptom score, daily activity difficulty score, and total WOMAC score were decreased in both groups after treatment, as compared with those before treatment, and the scores were lower in the observation group than in the control group(P＜0.05). After treatment, 30 s chair-rising test, 40 m brisk walking test, and the rate of analgesic use within 2 weeks before enrollment were better than those before treatment, which were better in the observation group than in the control group(P＜0.05). After treatment, serum TNF-α, IL-6, and IL-1β levels of the two groups were lower than those before treatment, and the levels were lower in the observation group than in the control group(P＜0.05). The KSS scores and AIMS2-SF scores showed an increasing trend, which were higher in the observation group than in the control group, and there were significant differences between groups, time points and time points between groups(P＜0.05). 
    Conclusion  Personalized neuromuscular training can improve the stability and coordination of the lower limbs, inhibit inflammation, improve the pain and stiffness of patients, and help improve the patient′s physical function, knee function and quality of life.

    Application value of the ratio of the tibial tubercle-trochlear groove distance to maximumaxis diameter of the tibial plateauin patellar instability
    ZHANG He, ZHAO Hong-bo, LAN Zhi-heng, ZHAO Zhi-guang, LIU Wei, HAN Shou-jiang
    2021, 42(4):  401-405.  doi:10.3969/j.issn.1007-3205.2021.04.007
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    Objective   To explore the application value of the ratio of the tibial tubercle-trochlear groove(TT-TG) distance to the tibial plateau maximum axis(TPMA) in patellar instability. 
    Methods  A total of 45 patients with patellar instability as well as healthy people were collected and analyzed by MRI. The TT-TG distance, TPMA, the radio of the TT-TG distance to TPMA(TT-TG/TPMA ratio) were compared between the two groups. 
    Results  The TT-TG distance was(12.133±3.226) mm in healthy control group and(18.638±3.228) mm in patellar instability group, and the difference between the two groups was statistically significant(P＜0.05). The TPMA between two groups was(71.933±8.751) mm in healthy control group, and(68.442±6.091) mm in patellar instability group, and the difference between the two groups was statistically significant(P＜0.05). The TT-TG/TPMA ratio was(0.167±0.031) in healthy control group, which was smaller than that(0.263±0.040) of patellar instability group(P＜0.05). There were 14 cases in the healthy control group whose TT-TG distance were from 15 to 20 mm, of which 1 case had TT-TG/TPMA ratio＞0.23, accounting for 1.5%(1/66) of the total.There were 27 cases in patellar group whose TT-TG distance were from 15 to 20 mm, of which 2 cases had TT-TG/TPMA ratio< 0.23, accounting for 4.4%(2/45) of the total. There were 52 cases with TT-TG distance less than 15 mm, of which 0 case had TT-TG/TPMA ratio＞0.23 in healthy control group. There were 6 cases with TT-TG distance less than 15 mm， of which 3 cases had TT-TG/TPMA ratio＜0.23, accounting for 6.7%(3/45) of the total. 
    Conclusion  The TT-TG/TPMA ratio of knee joint is a reliable method to evaluate patellar instability, which reduces the false positive rate of the patellar instability only by TT-TG distance. The TT-TG/TPMA ratio＞0.23 indicates patellar instability.

    Application of enhanced recovery after surgery in perioperative period of elective cesarean section
    YAO Yu-yun, SU Qing-hong
    2021, 42(4):  406-409.  doi:10.3969/j.issn.1007-3205.2021.04.008
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    Objective  To explore the application effect of enhanced recovery after surgery in perioperative period of elective cesarean section(C-section). 
    Methods  A total of 220 patients undergoing elective C-section in our hospital were enrolled in this study. According to the random number table, 110 cases were divided into control group(n=110) and research group(n=100). The control group was treated with the traditional rehabilitation mode, while the research group was treated with the ERAS. The differences of postoperative pain, postoperative urination time, postoperative exhaust time, postoperative complications, time of off-bed activity, length of hospital stay and satisfaction were observed between two groups. 
    Results  The pain of the two groups was relieved at 2 d after operation compared with that at 1 d after operation. The difference between time points was statistically significant(P＜0.05), while the difference between groups and time points between groups was not statistically significant(P＞0.05). The time of urination and the first time of anal exhaust in the research group were less than those in the control group(P＜0.05). The postoperative complications and hospitalization days of the research group were fewer than those of the control group(P＜0.05). The satisfaction of the research group was higher than that of the control group(P＜0.05). 
    Conclusion  The application of ERAS in the perioperative period of elective C-section can ensure the removal of urinary tube and off-bed activity within 6 h after operation, early urination, promote the recovery of gastrointestinal function, reduce postoperative complications, accelerate postoperative recovery, and improve patient satisfaction. Therefore, it is worthy of clinical promotion.

    Analysis of the results of hypermethioninemia in neonatal screening by tandem mass spectrometry and MAT1A gene mutations
    FENG Ji-zhen, JIA Li-yun, WANG Xi, MA Cui-xia, FENG Lu-lu
    2021, 42(4):  410-414.  doi:10.3969/j.issn.1007-3205.2021.04.009
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    Objective  To analyze the screening of neonatal hypermethionemia in Shijiazhuang City retrospectively, and to detect the incidence and MAT1A gene mutation. 
    Methods  A total of 149 094 cases neonates born in Shijiazhuang were screened by tandem mass spectrometry-non-derivative method to detect the methionine concentration in dried blood spots of filter paper. Next-generation sequencing technology was used to detect positive children, and the MAT1A gene mutations were verified by Sanger sequencing. 
    Results  Among 149 094 neonates, 13 were confirmed positive, with an incidence of 1/11 469. All 13 patients had isolated hypermethioninemia, except for 1 patient with elevated homocysteine. The mutations in the MAT1A gene were identified in 9 children with simple hypermethionine, including 7 heterozygous mutations, 1 compound heterozygous mutation, and 1 loss of heterozygosis. Nine types of point mutations were found by gene sequencing, including 4 types that had been reported, namely, c.791G＞A, c.769G＞A, c.1070C＞T and c.874C＞T, and 5 types that had not been reported, namely, c.1086-3C＞G, c.712G＞A, c.188G＞T, c.757G＞A and c.178T＞C. 
    Conclusion  The incidence of hypermethioninemia in neonates in Shijiazhuang is 1/11 469; 5 unreported gene mutations were found by gene sequencing, which enriched the database. 

    The curative effects of PEG-rhGH on children with growth hormone deficiency and its effect on blood lipid metabolism
    ZHANG Qiang, LIU Li-jun, ZHANG Xiao-jun, HOU Xiao-na, CUI Jia, LIU Hai-jing
    2021, 42(4):  415-419，434.  doi:10.3969/j.issn.1007-3205.2021.04.010
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    Objective  To investigate the clinical effect of pegylated recombinant human growth hormone(PEG-rhGH) in the treatment of children with growth hormone deficiency(GHD) and its effect on lipid metabolism. 
    Methods  Sixty children with GHD were randomly divided into observation group(n=31) and control group(n=29). The control group was treated with conventional nutrition therapy, and the observation group was supplemented with PEG-rhGH on the basis of conventional nutrition therapy by subcutaneous injection of 0.16-0.17 mg/kg per week for 6 months. The changes in height, weight and thyroid function ［thyrotropic hormone(TSH), free thyroxine index(FT4), free triiodothyronine（FT3), total thyroxine(T4), total triiodothyronine(T3)］, blood lipid profile total cholesterol(T-CHO), high density lipoprotein cholesterol(HDL-C) and low density lipoprotein cholesterol(LDL-C), triglyceride(TG), insulin-like growth factor 1(IGF-1) and insulin-like growth factor binding protein 3(IGF-BP3) of the two groups were measured before and at 6 months after treatment. 
    Results  At 6 months after treatment, the height and weight of the observation group were significantly higher than those before treatment, and significantly higher than those of the control group, and the difference was statistically significant(P＜0.05). There was no significant difference in height and weight between two groups(P＞0.05). There was no significant intra-group or inter-group difference in TSH, FT4, FT3, T4, T3 levels before and after treatment(P＞0.05). The levels of TG, T-CHO, and LDL-C in the observation group were significantly lower than those before treatment, and significantly lower than those in the control group, with statistical significance(P＜0.05); No significant difference was noted in the HDL-C in the observation group before and after treatment(P＞0.05). The levels of TG, T-CHO, HDL-C, and LDL-C in the control group had no statistical significance compared with those before treatment(P＞0.05). The levels of IGF-1 and IGF-BP3 in the observation group were significantly higher than those before treatment and those in the control group(P＜0.05). The levels of IGF-1 and IGF-BP3 in the control group were not significantly different from those before treatment(P＞0.05). 
    Conclusion  PEG-rhGH has obvious clinical effect in the treatment of children with GHD. It can improve height and weight, promote growth, improve lipid metabolism, and has no obvious adverse effect on thyroid function, with good safety.

    Therapeutic effect of percutaneous needle puncture combined with external fixator in older children undergoing minimally invasive treatment of proximal humeral fractures
    BAI Lei-peng, LYU Jia-xing, WANG Yu, KONG Qing-zhu, JIN Yu, ZHAO Jing-xin
    2021, 42(4):  420-424.  doi:10.3969/j.issn.1007-3205.2021.04.011
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    Objective  To analyze the clinical effects of two minimally invasive fixation methods in the treatment of proximal humeral fractures(PHF) in adolescents aged 10 to 14 years. 
    Methods  We performed a retrospective analysis of clinical efficacy of 52 children aged 10-14 years with PHF. Twenty-four patients in the observation group received percutaneous Kirschner wire internal fixation combined with external fixation for maintenance treatment, while 28 patients in the control group received percutaneous Kirschner wire fixation combined with plaster external fixation. The duration of operation, intraoperative blood loss, intraoperative fluoroscopy times, length of hospitalization, time of affected limb movement after operation, visual analogue scale(VAS) score of upper arm pain at 3 and 7 d after operation, fracture healing time, shoulder joint function Neer score and elbow Mayo score, postoperative complications and hospitalization expenses were analyzed. 
    Results  All patients had Neer type Ⅱ and Ⅲ fractures. They were followed up for 15 months. There was no significant difference in general condition between  two groups(P＞0.05). There was no significant difference in duration of operation, intraoperative blood loss, intraoperative fluoroscopy times, VAS score at 3 and 7 d after operation, fracture healing time and postoperative complications between two groups(P＞0.05). Compared with the control group, the length of hospitalization and time of affected limb movement after operation were significantly shorter in the observation group, but the hospitalization expenses were higher(P＜0.05). The Neer scores and Mayo scores of the shoulder joints of the two groups showed a gradual upward trend at 3 months, 6 months and 15 months after surgery. The difference of interaction between groups, time points, and time points between groups were statistically significant(P＜0.05). All the patients had stageⅠhealing without infection, vascular or nerve injury. At the last follow-up, all patients had no growth disorder and angular deformity caused by epiphyseal plate closure or bone bridge for mation. 
    Conclusion  The two fixation methods can achieve good results in the treatment of PHF in older children. Compared with plaster external fixation, external fixator for maintenance treatment after percutaneous Kirschner wire fixation can significantly shorten the length of hospitalization of patients and the time of affected limb movement after operation. It is a safe and effective scheme of minimally invasive fixation, but it will increase the hospitalization expenses of patients. 
    Correlation analysis of IL-1β, TNF-α, TSLP levels in tear fluid with BUT value, FL score in patients with dry eye
    HUANG Rui-sheng, LIN Li-min, JIN Tai, LI Hong-ni, HUANG Yi-xia, SU Dan
    2021, 42(4):  425-428.  doi:10.3969/j.issn.1007-3205.2021.04.012
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    Objective  To investigate the correlation of the levels of interleukin-1β(IL-1β), tumor necrosis factor-α(TNF-α) and thymic stromal lymphopoietin(TSLP) in tear fluid of patients with dry eye with tear film break-up time(BUT) value and corneal fluorescein staining(FL) score. 
    Methods  A total of 120 patients with dry eye were selected as the research group, and 100 healthy volunteers during the same period were selected as the control group. Tear fluid was collected, IL-1β, TNF-α, TSLP levels were detected, and the BUT value and FL score of the two groups were compared. The correlation of IL-1β, TNF-α, TSLP levels in tear fluid with BUT value and FL score was analyzed. 
    Results  The levels of IL-1β, TNF-α and TSLP in tear fluid of the research group were significantly higher than those of the control group, and the difference was statistically significant(P＜0.05). The BUT value of the research group was significantly lower than that of the control group, while the FL score was significantly higher than that of the control group, with significant difference(P＜0.05). Pearson correlation analysis results showed that IL-1β, TNF-α, TSLP levels in  tear fluid were significantly and negatively correlated with BUT values(P＜0.01), but significantly and positively correlated with FL scores(P＜0.01). The ROC curve revealed that the levels of IL-1β, TNF-α, and TSLP in tear fluid had a certain diagnostic value for dry eye(AUC=0.830, 0.885, 0.838, P＜0.01), and the diagnostic value of the combination of the three was higher(AUC=0.920, P＜0.01). 
    Conclusion  The levels of IL-1β, TNF-α and TLSP in the tear fluid of patients with dry eye are significantly correlated with the BUT value and FL score. Increased levels of IL-1β, TNF-α and TLSP lead to a decrease in tear film stability and ocular surface damage. Combination detection of the levels of IL-1β, TNF-α and TLSP in tear fluid can be used for the auxiliary diagnosis of dry eye.
    Qualitative and quantitative analysis of contrast-enhanced ultrasonography in the diagnosis of superficial cervical lymphadenopathy
    WU Shi-ji, QIU Ya, Nur Aili·Mutailifu, FAN Ming-jiang, MA Ai-lin, LIU Huan
    2021, 42(4):  429-434.  doi:10.3969/j.issn.1007-3205.2021.04.013
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    Objective  To analyze the value of qualitative and quantitative analysis of contrast-enhanced ultrasonography in the diagnosis of superficial cervical lymphadenopathy. 
    Methods  For this prospective study, a total of 50 patients with superficial cervical lymphadenopathy were prospectively selected as the research subjects, and fine-needle aspiration biopsy was performed under the guidance of contrast-enhanced ultrasonography. The qualitative and quantitative analysis of contrast-enhanced ultrasonography was used to diagnose the superficial lymph node lesions in the neck. The value of qualitative and quantitative analysis of contrast-enhanced ultrasonography in diagnosing benign and malignant lesions of superficial lymph nodes in the neck was compared. 
    Results  Pathological diagnosis showed that among the 50 patients, 17 had benign lymph nodes and 33 had malignant lymph nodes. The results of ultrasound-guided fine-needle aspiration examination were consistent with surgical and pathological examination results(Kappa=0.868, P＜0.05). There were statistically significant differences in the contrast-enhanced perfusion pattern, lesion enhancement characteristics, boundary definition, and peak intensity grading of benign and malignant lymph nodes(P＜0.05). The time to peak(TP), peak intensity(PI), and mean transit time(mTT) values of the benign group were significantly shorter or smaller than those of the malignant group, and the difference was statistically significant(P＜0.05). 〖JP2〗No significant difference was found in the speed parameter(β) value between the two groups(P＞0.05). Receiver operator characteristics curve（ROC） curve analysis showed that the AUC for the diagnosis of malignant superficial cervical lymph nodes by quantitative analysis and qualitative analysis was 0.829 and 0.939 respectively. According to the optimal cut-off value, when the quantitative analysis result was lower than 85.44,〖JP〗 the sensitivity and specificity were 84.8% and 82.4% respectively; when the qualitative analysis result was lower than 3.51, the sensitivity and specificity were 90.9% and 82.4% respectively. 
    Conclusion  The results of ultrasound-guided fine needle aspiration are in good agreement with those of surgical and pathological examination. The qualitative analysis of contrast-enhanced ultrasonography is superior to the quantitative analysis in the diagnosis of superficial cervical lymphadenopathy.

    Diagnostic value of TI-RADS grades and tumor invasion into thyroid capsule in papillary thyroid carcinoma with cervical lymph node metastases
    XUE Kun, QI Zheng-qin, SHI Wen-zong, JIA Su-hua, WANG Hui-juan
    2021, 42(4):  435-438,443.  doi:10.3969/j.issn.1007-3205.2021.04.014
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    Objective  To explore the diagnostic value of thyroid imaging reporting and data system(TI-RADS) and tumor invasion into thyroid capsule for papillary thyroid carcinoma(PTC) with central lymph node metastasis (CLNM). 
    Methods  A total of 279 patients with single PTC that was surgically removed and pathologically confirmed in our hospital were enrolled in this study. The gender, age, echo of PTC nodules, boundary, aspect ratio, microcalcifications and the relationship between nodules and thyroid capsule were recorded. According to ultrasound characteristics, each nodule was graded based on the TI-RADS grading. Combined with the pathological results of cervical lymph node in each patient, we retrospectively analyzed the value of TI-RADS grading and tumor invasion into thyroid capsule in the diagnosis of PTC with CLNM. 
    Results  The univariate analysis showed that male PTC patients with TI-RADS 4c/5, poorly-defined boundary, and the tumor invasion into thyroid capsule are more likely to experience CLNM(P＜0.05). The multivariate analysis showed that male gender, poorly-defined boundary and the tumor invasion into thyroid capsule were independent risk factors for CLNM（OR=0.437, 2.260, 3.603， all P＜0.05）. 
    Conclusion  Male gender, poorly-defined boundary and the tumor invasion into thyroid capsule were independent risk factors for CLNM. Meanwhile, the higher the TI-RADS grades, the greater the possibility of CLNM. Therefore, the TI-RADS 4c/5 has predictive values for CLNM.

    Clinical value of transvaginal color Doppler ultrasound combined with colposcopy in the diagnosis of cervical cancer
    BAI Fang-fang, DI Hai-yan, ZHANG Na, LIU Wei, YANG Zhen, HU Wen-yu
    2021, 42(4):  439-443.  doi:10.3969/j.issn.1007-3205.2021.04.015
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    Objective  To explore the value of transvaginal color Doppler ultrasound, colposcopy and their combination in the diagnosis of cervical cancer, and to provide assistance for clinical diagnosis. 
    Methods  Clinical data of 62 patients with early cervical cancer and 28 patients with non-cervical cancer(19 cases of precancerous lesions and 9 cases of normal cervix) diagnosed by pathology were retrospectively analyzed. All patients were examined by transvaginal color Doppler ultrasound and colposcopy. The results of pathological examination were taken as the gold standard to compare the diagnostic value of transvaginal color Doppler ultrasound, colposcopy and their combination in cervical cancer. 
    Results  A total of 61 cases of cervical cancer and 29 cases of non-cervical cancer were detected by color Doppler ultrasound, and Kappa coefficient was 0.769 compared with pathological results; 55 cases of cervical cancer and 35 cases of non-cervical cancer were detected by colposcopy,and Kappa coefficient was 0.588 compared with pathological results. Sixty cases of cervical cancer and 30 cases of non cervical cancer were detected by combination detection of color Doppler ultrasound and colposcopy and Kappa coefficient was 0.949 compared with pathological results.The sensitivity, specificity and coincidence rate of color Doppler ultrasound in the diagnosis of cervical cancer were 91.94%, 85.71% and 90.00%, respectively; the sensitivity, specificity and coincidence rate of colposcopy in the diagnosis of cervical cancer were 80.65%, 82.14% and 81.11%, respectively; the sensitivity, specificity and coincidence rate of colposcopy combined with colposcopy in the diagnosis of cervical cancer were 96.77%, 100.0% and 97.78%, respectively. PSV of cervical cancer patients was significantly lower than that of patients with precancerous lesions and normal cervix, RI was significantly higher than that of precancerous lesions and normal cervix, and the difference was statistically significant(P＜0.05). The AUC of PSV in diagnosis of cervical cancer was 0.908, and sensitivity and specificity were 90.3% and 85.7%respectively.The AUC of RI in diagnosis of cervical cancer was 0.819, with sensitivity and specificity of 77.4% and 67.9% respectively. 
    Conclusion  Transvaginal color Doppler ultrasound and colposcopy have certain value in the diagnosis of cervical cancer, but the value of combination of the two in the diagnosis is higher. The combination diagnosis can effectively distinguish cervical cancer and precancerous lesions. In the meantime, transvaginal color Doppler ultrasound can also reveal blood flow of lesions, which can provide assistance for surgical treatment.


    Comparison of application of DCE-MRI and apparent diffusion coefficient to classification diagnosis of prostate cancer
    ZHANG Jie, GUO Ying, HUO A-wei, ZHANG Duo
    2021, 42(4):  444-447,453.  doi:10.3969/j.issn.1007-3205.2021.04.016
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    Objective  To compare the application of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) and apparent diffusion coefficient(ADC) in the classification diagnosis of prostate cancer. 
    Methods  A total of 76 patients with prostate cancer treated in our hospital were retrospectively analyzed. According to the Gleason score, prostate cancer patients were divided into low-to-moderate-risk group(Gleason score ＜8 points, n=50) and high-risk group(Gleason score≥8 points). All patients underwent prostate DCE-MRI and diffusion-weighted imaging(DWI) examinations. DCE-MRI parameters, ADC levels, and DWI signal strength values under different diffusion sensitivity coefficients were compared between the two groups of patients. The receiver operating characteristics(ROC) curve was used to analyze clinical value of DCE-MRI parameters and ADC for classification diagnosis of prostate cancer. 
    Results  Under different diffusion sensitivity coefficients, the DWI signal strength values and ADC values in the low-to-moderate-risk group were significantly higher than those in the high-risk group(P＜0.05). The levels of Kep and Ve in patients with low-to-moderate-risk group were significantly higher than those in high-risk group(P＜0.05), but there was no significant difference in Ktrans and Kep values between two groups(P＞0.05). The ROC curve was used to analyze the difference in the levels of Ktrans, Vp, and ADC between two groups. The results showed that the areas under the curve of Ktrans, Vp, and ADC were 0.738, 0.294, and 0.645, respectively, and the optimal cutoff values were 1.720（min）, 0.366, and 85.825（10-5mm2/s）, respectively. The sensitivity was 92.1%, 89.6%, and 93.1%, respectively and the specificity was 55.0%, 62.7%, and 80.2%, respectively. 
    Conclusion  Both DCE-MRI and ADC have higher diagnostic value for the classification of prostate cancer, and the diagnostic value of ADC is better than DCE-MRI.

    The application value of MRI combined with ultrasound in the diagnosis of osteogenesis imperfecta type Ⅱ
    FU Li-man, LI Yan, CHEN Shun-jue, HAN Chun-qing, PENG Li-xuan, SONG Zhong-hua
    2021, 42(4):  448-453.  doi:10.3969/j.issn.1007-3205.2021.04.017
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    Objective  To compare the diagnostic efficacy of magnetic resonance imaging(MRI), ultrasound and MRI combined with ultrasound in the diagnosis of type Ⅱ fetal osteogenesis imperfecta(OI) type Ⅱ, so as to explore the application value of MRI combined with ultrasound in the diagnosis of fetal OI typeⅡ. 
    Methods  A retrospective analysis was performed on clinical data and imaging data of 18 patients with fetal OI type Ⅱdiagnosed during antenatal examination and confirmed by postoperative pathological examination. With pathology of induction of labor as the gold standard, sensitivity, specificity, accuracy, positive predictive value, negative predictive value of ultrasound, MRI, and ultrasound combined with MRI in the diagnosis of fetal OI were calculated and compared. 
    Results  Accuracy of MRI, ultrasound and ultrasound combined with MRI in the diagnosis of fetal OI was confirmed in 11 cases, 15 cases, and 17 cases, respectively.  The diagnostic sensitivity of ultrasound was 61.11%, and the accuracy was 78.00%. The diagnostic sensitivity of MRI was 83.33%, with an accuracy of 90.00%. Considering ultrasound examination results and MRI findings, diagnostic sensitivity and accuracy of ultrasound combined with MRI increased to 94.44% and 96.00% respectively, as compared with ultrasound. 
    Conclusion  Fetal MRI combined with ultrasound can improve the diagnostic sensitivity and accuracy of current ultrasonography, which is helpful to guide clinical practice.

    Effects of intravenous anesthesia with sufentanil combined with propofolin bone marrow mesenchymal stem cell transplantation on rats with traumatic brain injury
    WU Jie, CHEN Yan, DU Xiao-xuan
    2021, 42(4):  454-460,465.  doi:10.3969/j.issn.1007-3205.2021.04.018
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    Objective  To investigate the effect of intravenous anesthesia with propofol and sufentanil in bone marrow mesenchymal stem cell transplantation on the treatment of traumatic brain injury(TBI) in rats. 
    Methods  Bone marrow mesenchymal stem cells were isolated from young rats aged 3 weeks and cultured in vitro to 3 generations. A total of 45 healthy female SD rats were randomly divided into control group, stem cell treatment group and combination treatment group, with 15 rats in each group. TBI models were established by electric cortical contusion impactor(eCCI). After establishment of TBI modeling, the rats in stem cell treatment group were given 0.5 mL stem cell suspension(1×105/mL), the rats in combination treatment group were given stem cell suspension plus injection of 0.5 g/kg sufentanil and 2.0 mg/kg propofol, while the control group rats were given an equal volume of saline. Modified neurological function scores(mNSS) was performed to determine the degree of nerve damage in rats during treatment; morphological changes of brain tissue were observed by HE staining. The water content of brain, total calcium content and serum level of S100β were measured by dry-and-wet gravity method, spectral scanner and enzyme linked immunosorbene assay. Neuronal apoptosis in hippocampal structural region was observed by TUNEL staining, western blot was used to detected the expression of apoptosis-related proteins, and quantitative real-time(qRT-PCR) and immunohistochemistry were used to detect the expression and distribution of inflammatory factors in brain tissues. 

    Results  After passage, the cells showed the trend of radial or vortex-like colony growth, and the cell morphology gradually became stable and uniform with the increase of passage times. Finally, the cells grew stably into spindle-like fibroblasts. Within 3 days after TBI modeling, there was no significant difference in mNSS score among the three groups(P＞0.05); At 7 days after treatment, the mNSS score of the combination treatment group was significantly lower than that of the control group; At 14 and 21 days after treatment, the scores of the stem cell treatment group and the combination treatment group were significantly lower than that of the control group, and the scores were lower in combination treatment group than in the stem cell treatment group(P＜0.05). Compared with the control group, the pathological changes of the hippocampus in the stem cell treatment group and the combination treatment group were significantly improved, and the density of nerve cells in the brain tissue of the combination treatment group was significantly restored. In addition, the cells in the hippocampus were orderly arranged, the nucleus was complete and the staining was lighter, which was better than the stem cell treatment group. The brain water content, total calcium content and serum S100β content in stem cell treatment group and combination treatment group were lower than those in control group, and the indicators were lower in combination treatment group than in stem cell treatment group(P＜0.05). The number of apoptotic cells and the expression of Caspase-3, Bax and cytc protein in brain tissue of stem cell treatment group and combination treatment group were lower than those of control group, while the indicators were lower in combination treatment group than in the stem cell treatment group. The expression of Bcl-2 protein in stem cell treatment group and combination treatment group was higher than that of control group, and the expression was higher in the combination treatment group than in the stem cell treatment group(P＜0.05). The mRNA expression levels of IL-6, IL-1 β and TNF-α in the stem cell treatment group and the combination treatment group were lower than those in the control group, which were lower in the combination treatment group than in the stem cell treatment group(P＜0.05). 
    Conclusion  Intravenous anesthesia with sufentanil and propofol in bone marrow mesenchymal stem cell transplantation can promote the recovery of neurological function after TBI, by reducing brain water content, total calcium content and serum S100β accumulation in rats, and inhibiting the neuronal apoptosis and expression of inflammatory factors.

    Effects of lumbar paraspinal nerve block combined with total intravenous general anesthesia on hemodynamics, stress response and postoperative recovery in patients undergoing hip replacement
    PENG Yi, WANG Fu-gang, DING Qing-min
    2021, 42(4):  461-465.  doi:10.3969/j.issn.1007-3205.2021.04.019
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    Objective  To investigate the effects of lumbar paraspinal nerve block combined with total intravenous anesthesia on hemodynamics, stress response and postoperative awakening in patients undergoing hip replacement. 
    Methods  A total of 115 patients undergoing hip replacement were selected and divided into observation group(n=60) and control group(n=55) according to different anesthesia methods. The observation group was given lumbar paraspinal nerve block combined with total intravenous general anesthesia, and the control group was given total intravenous general anesthesia alone. Before anesthesia(T0), at 10 min after anesthesia(T1), at 30 min after anesthesia(T2) and at the end of operation(T3), the mean arterial pressure(MAP), heart rate(HR), norepinephrine and epinephrine levels of the two groups were compared; The postoperative awakening time, conscious sedation effect and adverse reactions during operation of the two groups were compared. 
    Results  The changes of MAP and HR in the observation group were not obvious, while the MAP and HR in the control group were increased initially and then decreased, and there were significant differences in the interaction between groups, time points and time points between groups(P＜0.05). The levels of norepinephrine and epinephrine were increased in both groups, and the changes in the levels were smaller in the observation group than in the control group. There were significant differences in the interaction between groups, time points and time points between groups(P＜0.05). The postoperative awakening time of the observation group was significantly shorter than that of the control group, and the postoperative vigilance/sedation score at wake-up was lower in the observation group than in the control group(P＜0.01). There was no significant difference in the incidence of adverse reactions between two groups(P＞0.05). 
    Conclusion  Compared with total intravenous general anesthesia alone, lumbar paraspinal nerve block combined with total intravenous general anesthesia for hip replacement can effectively prevent the fluctuation of hemodynamic indexes, and reduce the degree of surgical stress response, with short awakening time and good quality of postoperative recovery and without increasing the incidence of adverse reactions during the operation.

    Application effect of preoperative preemptive analgesia combined with nerve block guided by B-mode ultrasound for analgesia in children undergoing abdominal surgery during perioperative period
    ZHANG Ming-min, PANG Bo
    2021, 42(4):  466-469.  doi:10.3969/j.issn.1007-3205.2021.04.020
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    Objective  To investigate the application effect of preoperative preemptive analgesia combined with nerve block guided by B-mode ultrasound for analgesia in children undergoing abdominal surgery during perioperative period. 
    Methods  A total of 120 children undergoing abdominal surgery were selected as the research subjects， and then randomly divided into group A（preoperative preemptive analgesia group, n=30）， group B（nerve block guided by B-mode ultrasound for analgesia group, n=30）， group C（preoperative preemptive analgesia combined with nerve block guided by B-mode ultrasound for analgesia group, n=30） and group D（physiological saline group, n=30). The opioid dosage and pain severity at 2 h， 4 h， 12 h， 24 h and 48 h after surgery， hemodynamic indexes［mean arterial pressure(MAP) and heart rate（HR)］ before and after skin incision， resuscitation time and adverse reactions of four groups were compared. 
    Results  The opioid dosage of four groups was increased over time，withe the lowest dosage in group C and the highest dosage in group D; the interaction between groups, time points and time points between groups showed statistically significant differences（P＜0.05）. The FLACC score increased initially and decreased afterward，with the minimal change in groups C and the maximal change in group D; the interaction between groups, time points and time points between groups showed statistically significant differences(P＜0.05). The MAP and HR of four groups after skin incision were all higher than those before skin incision; The MAP and HR of group C were significantly lower than those of groups A， B and D; the MAP and HR of groups A and B were significantly lower than those of group D, and there were statistically significant differences（P＜0.05）. No significant difference was found in the resuscitation time and adverse reaction rates of four groups(P＞0.05).  
    Conclusion  The application effect of preoperative preemptive analgesia combined with nerve block guided by B-mode ultrasound for analgesia in children undergoing abdominal surgery during perioperative period is better， which is conductive to stabilization of hemodynamics and pain control. Therefore， it is of higher application value. 

    Study on the diagnostic value of serum TNF-α, SAA and ADA in children with EBV-related infectious mononucleosis
    LIU Wen-tian, TANG Fang-hua, LIU Yu-hua, ZHANG Lin, SHI Gui-xiang
    2021, 42(4):  470-473,486.  doi:10.3969/j.issn.1007-3205.2021.04.021
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    Objective  To investigate the value of serum tumor necrosis factor-α（TNF-α）, serum amyloid A(SAA) and adenosine deaminase(ADA) in the diagnosis of EBV-related infectious mononucleosis(IM) in children. 
    Methods  A total of 201 children with EBV-related IM (infection group) and 200 healthy children (control group) were selected. The serum levels of TNF-α, SAA and ADA were measured, and the correlation between TNF-α, SAA, ADA and blood routine, biochemical indexes, heteromorphic lymphocyte, epstein-barrvirus deoxyribonucleic acid(EBV-DNA) copy number in EBV-related IM of children was analyzed. Receiver operator characteristics curve (ROC) was used to analyze the value of TNF-α, SAA and ADA in the diagnosis of EBV-related IM. 
    Results  The serum levels of TNF-α, SAA and ADA in the infection group were higher than those in the control group(P＜0.05). The levels of TNF-α, SAA and ADA were positively correlated with lymphocytes, heteromorphic lymphocyte, EBV-DNA copy number and ALT(P＜0.05). ROC analysis showed that the area under the ROC(AUC) of TNF-α, SAA and ADA in the diagnosis of EBV-related IM was 0.752, 0.787, 0.788 and 0.931, respectively; the sensitivity was 70.65%, 77.61%, 76.12% and 92.04%, respectively, and the specificity was 76.50%, 82.00%, 84.50% and 96.00%, respectively. 
    Conclusion  The serum levels of TNF-α, SAA and ADA in EBV-related IM children are significantly higher, which are closely related to the levels of heteromorphic lymphocyte, EBV-DNA copy number and liver function. Combined detection of TNF-α, SAA and ADA can improve the accuracy of EBV-related IM diagnosis.