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Table of Content

    25 May 2021, Volume 42 Issue 5
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    The establishment of an animal model for vaginal reconstruction in rats
    ZHANG Ning, QIN Xi-jing, ZHANG Zhi-qiang, ZHANG Jing-kun, HUANG Xiang-hua, ZHU Yu-lin
    2021, 42(5):  501-504,封三.  doi:10.3969/j.issn.1007-3205.2021.05.002
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    Objective  To establish an animal model for vagina reconstruction in rats. 
    Methods  The vagina of female rats was surgically removed, and the small intestinal submucosal(SIS) matrix was placed in the cavity formed after the resection to reconstruct the vagina of the rat. Six rats were randomly sacrificed at 14 days, 1 month, and 3 months after the operation. The entire vagina was taken out to detect the growth of epithelial tissue, smooth muscle tissue and nerve tissue in the reconstructed vaginal tissue. Four rats were sacrificed at 3 months for functional evaluation by means of tissue bath assay. Different electrical field stimulation(EFS) was used to detect changes in the tension of the reconstructed vaginal tissue. 
    Results  The rat model for vagina reconstruction was successfully established. At 14 days after reconstruction, the texture of neovagina was relatively tough and inelastic, which, however, gradually became softer with time. It became significantly softer and had a certain degree of elasticity at 3 months.Colposcopy after reconstruction revealed that at 14 days, some epithelial tissues could be seen crawling up from the entrance of the neovagina, accompanied by more inflammatory cell infiltration; the epithelial tissue could cover the entire neovagina at 1 month, and the epithelial tissue was more mature at 3 months. Regenerate epithelial tissues expressed AE1/AE3, and a small amount of tissues in neovaginal tissues expressed α-SMA at one month after reconstruction, suggesting the regeneration of smooth muscles. At 3 months, the expression of α-SMA increased and formed bundles. PGP9.5-positive nerve tissue was occasionally seen in the vagina reconstruction group at 3 months. In the tissue bath assay, slight contraction of neovagina was found under the EFS. The contraction pattern and change trend were similar to those of normal vagina, but the contraction intensity was significantly smaller than normal vagina. 
    Conclusion  The rat model for vagina reconstruction was readily established. It can be used to evaluate the effects of various tissue materials for vaginal reconstruction, laying a foundation for a better vaginal reconstruction.


    Relationship of cerebral blood flow velocity to severity and cognitive function in patients with depression
    GOU Xian-na, ZHAO Li-li, WU Jing-yue, SUN Sai-nan, TANG Xiang-dong
    2021, 42(5):  505-508,535.  doi:10.3969/j.issn.1007-3205.2021.05.003
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    Objective  To investigate the correlation of the cerebral blood flow velocity with the severity of depression and cognitive function of patients with depression.
    Methods  A total of 68 patients with depression were selected as the observation group and 80 healthy people who underwent physical examination were enrolled as the control group. Transcranial Doppler(TCD) was used to analyze the cerebral artery blood flow velocity of basilar artery(BA), left and right cerebral vertebral artery(VA), left and right anterior cerebral artery(ACA), left and right middle cerebral artery(MCA), and left and right posterior cerebral artery(PCA).  The Hamilton depression scale(HAMD) was used to assess the severity of depression in the patients. The cognitive function of the two groups was assessed by the cancellation test(CT) and the Wisconsin cardsorting test(WCST). Pearson correlation analysis was used to analyze the correlation of cerebral blood flow velocity with depression severity and cognitive function of patients with depression.
    Results  The HAMD score of the observation group was significantly higher than that of the control group, with significant differences(P＜0.05). The net scores and total net scores of CT evaluations of patients in the observation group were significantly lower than those of the control group. The total number of WCST score responses, the number of error responses, the number of persistent errors, and the completion of the first classification response were significantly higher than those of the control group, suggesting significant difference between the groups( P＜0.05). The blood flow velocities of the BA, left and right MCA, and left and right ACA of the observation group were significantly lower than those of the control group, and the difference between the groups was statistically significant(P＜0.05). There was no significant difference in the blood flow velocities of the VA and left and right PCA(P＞0.05). According to the Pearman correlation analysis results, the blood flow velocity of BA and right MCA was significantly positively correlated with the total net score of CT, while the blood flow velocity of left ACA and right ACA was significantly negatively correlated with the total CT score. The blood flow velocity of BA, left ACA, and right ACA was significantly negatively correlated with the total number of WCST responses, the blood flow velocity of left ACA and right ACA was negatively correlated with the number of persistent errors, and that of right ACA was negatively correlated with the number of the completion of the first classification response(P＜0.05).
    Conclusion  The cerebral artery blood flow velocity of depression patients was lower than that of healthy groups, and their attention and executive function were also significantly reduced, which, however, were not significantly correlated with the severity of depression. The influencing factors of the changes in cerebral blood flow velocity can be explored from the perspective of the degree of cognitive impairment of depression patients.

     

    Changes and significance of miR-326 levels in peripheral blood mononuclear cells in patients with ACS after PCI
    QIANG Yu-wei, HAO Ming-hui, GUO Ming
    2021, 42(5):  509-513,530.  doi:10.3969/j.issn.1007-3205.2021.05.004
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    Objective  To investigate the changes and significance of microRNA-326(miR-326) in peripheral blood mononuclear cells in patients with acute coronary syndrome(ACS) after percutaneous coronary intervention(PCI). 
    Methods  A total of 205 ACS patients treated in Beijing Luhe hospital affiliated to Capital Medical University were selected prospectively as the study subjects. Density gradient centrifugation was performed to obtain mononuclear cells in peripheral blood; real-time fluorescence quantitative PCR was used to detect the level of miR-326 in mononuclear cells. Cox regression analysis and restrictive cubic spline were used to analyze the relationship between miR-326 and the prognosis of ACS patients. 
    Results  The level of miR-326 in the poor prognosis group and the good prognosis group showed an increasing trend with time(P＜0.05). The area under the receiver operating characteristic(ROC) curve(AUC) of the prognosis of ACS patients diagnosed with miR-326 at 7 d after PCI was higher than that before PCI and at 3 d after PCI, and  the differences were statistically significant(P＜0.05). The mean survival time of the high miR-326 group was higher than that of the low miR-326 group, and the difference was statistically significant(P＜0.05). Cox regression analysis showed that miR-362［HR=0.039, 95%CI: 0.016-0.098, P＜0.05］ was an independent protective factor for the prognosis of ACS patients(P＜0.05). miR-362 was related to the prognosis of ACS patients(P＜0.05), and had a nonlinear relationship(P＜0.05). When miR-326<0.24, as compared with miR-326=0.24, the risk of poor prognosis was increased; when miR-326>0.24, as compared with miR-326=0.24, the risk of poor prognosis was decreased.
    Conclusion  miR-326 at 7 d after PCI is associated with the prognosis of ACS patients. Low miR-326 levels at 7 d after PCI suggest a higher risk of poor prognosis.
    The prognostic value of pre-treatment systemic immune-inflammation index and fibrinogen in the prognosis of patients with non-small cell lung cancer
    LI Ying, LIU Miao-miao, HE Yan-lu-qi, ZHANG Hong-zhen
    2021, 42(5):  514-519.  doi:10.3969/j.issn.1007-3205.2021.05.005
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    Objective  To evaluate the prognostic value of pre-treatment system immune-inflammation index(SII) and fibrinogen(FIB) in patients with non-small cell lung cancer(NSCLC).
    Methods  The clinical data of patients with pathologically diagnosed NSCLC were collected, and receiver operating characteristic(ROC) curve was used to calculate the optimal cut-off value of pre-treatment SII and FIB as the basis.
    Results  The area under the ROC curve(AUC) of pre-treatment SII was 0.748, and the optimal cut-off value was 743.384; the sensitivity and specificity were 57.1% and 90.5% respectively. The AUC of pre-treatment FIB was 0.812, and the optimal cut-off value was 3.070 g/L;the sensitivity and specificity were 85.7% and 64.3% respectively. NSCLC patients in SII>743.384 group and SII≤743.384 group had lower tumor differentiation, late TNM staging, lower KPS score, and different weight loss rate, and there was significant difference(P＜0.05). There were statistically significant differences in age, KPS score, and weight loss of NSCLC patients between the FIB>3.070 g/L group and the FIB≤3.070 g/L group(P＜0.01). The median survival time of SII≤743.384 group and SII＞743.384 group was 34 months and 10 months, respectively, and the difference was statistically significant(P＜0.001). The median survival time was shorter in the FIB≤3.070 g/L group, and was 14 months in the FIB>3.070 g/L group, and the difference was statistically significant(P＜0.01). Combined detection of SII and FIB indicated that the survival time of the group with two indexes increased was shorter than that with one index increased and that without an increase in the two indexes, and the difference was statistically significant(P＜0.01). Cox multivariate analysis showed that weight loss and pre-treatment fibrinogen level were independent risk factors for the prognosis of NSCLC patients(P＜0.05).The results of Spearman correlation analysis suggested that there was a weak positive correlation between SII and FIB(P＜0.05).
    Conclusion  Pretreated SII and FIB are closely related to NSCLC, and the increase of SII and FIB indicates poor prognosis.
    The role of the spleen in progression of hepatic carcinoma induced by chronic stress
    JIANG Wei, LI Yu, WEI Wei, ZHANG Shu-qun, LI Zong-fang
    2021, 42(5):  520-524.  doi:10.3969/j.issn.1007-3205.2021.05.006
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    Objective  To investigate the role of the spleen in the progression of hepatic carcinoma induced by chronic stress.
    Methods  The murine H22 subcutaneous hepatoma model was established. Chronic restraint stress(CRS) model was used to explore the role of chronic stress in the progression of hepatic carcinoma. The proportion of CD11b+Ly6C+CCR2+ monocytes in peripheral blood and tumor tissue was detected by flow cytometry, and the role of the spleen in the progression of hepatic carcinoma induced by chronic stress was investigated by splenectomy.
    Results  The tumor weight was significantly greater, and the proportion of CD11b+Ly6C+CCR2+ monocytes in peripheral blood were significantly increased in stress group, as compared with control group, suggesting significant differences(P＜0.05). However, the proportion of CD11b+Ly6C+CCR2+ monocytes in tumor tissue of stress group did not change significantly compared with control group(P＞0.05). The tumor weight and the proportion of CD11b+Ly6C+CCR2+ monocytes in peripheral blood in sham operation stress group were significantly higher than those in sham operation group and splenectomy stress group(P＜0.01) while there were no significant differences in the tumor weight and the proportion of CD11b+Ly6C+CCR2+ monocytes in the peripheral blood between sham operation stress group and splenectomy stress group(P＞0.05). The proportion of CD11b+Ly6C+CCR2+ monocytes in tumor tissue in sham operation stress group and splenectomy stress group did not change significantly compared with sham operation group(P＞0.05).
    Conclusion  Chronic stress could promote the progression of hepatic carcinoma and inhibit the activity of anti-tumor immunity. Splenectomy could slow down the progression of hepatic carcinoma induced by chronic stress possibly by reducing the proportion of CD11b+Ly6C+CCR2+ monocytes.
    Efficacy and safety of cyclosporine A versus tacrolimus treatment for nephrotic idiopathic membranous nephropathy
    CHEN Ya-kun, REN Rui-hua, WANG Xiao-rong, ZHANG Chun-xia, FU Shu-xia
    2021, 42(5):  525-530.  doi:10.3969/j.issn.1007-3205.2021.05.007
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    Objective  A retrospective cohort study was conducted to evaluate the efficacy and safety of cyclosporine combined with prednisone(CsA/GC) in tacrolimus combined with prednisone(TAC/GC) in the treatment of idiopathic membranous nephropathy(IMN) with nephrotic syndrome.
    Methods   A total of 139 patients with IMN patients with nephrotic syndrome confirmed by renal biopsy were enrolled in this study. Seventy eight patients were in the CsA/GC group and sixty one belong TAC/GC group. The therapeutic effect and adverse events in the two groups were assessed.
    Results   The median follow-up time was(13.5 vs 16.0) months in the CsA/GC group and TAC/GC group. Two cases(2.6%) in CsA/GC group were lost to follow-up. At the end of follow-up, the overall remission rates were similar between two groups(89.7% vs 85.4%, P＞0.05). Compared with the CsA/GC group, the TAC/GC group needed less time to achieve partial remission and larger doses to maintain remission was significantly lower［(6.0 vs 8.5) months and (21.3% vs 38.5%), both P＜0.05］, respectively. No gingival hyperplasia(0.0% vs 7.7%, P＜0.05). The relapse rates were similar between two groups(19.2% vs 26.2%, P＞0.05). The incidence of renal damage in two groups was 25.6% and 24.6%, and there were no statistically significant differences between two groups in infection of requiring hospitalization, and liver enzyme elevation(all P＞0.05). Two cases of drug diabetes mellitus in TAC/GC group. There were 2 cases of deep vein thrombosis in CsA/GC group.
    Conclusion  Both low dose cyclosporine and tacrolimus can effectively treat IMN. Tacrolimus had a faster partial remission, a lower proportion of patients who needed a larger dose to maintain remission, and no gingival hyperplasia. But its effect on glucose metabolism should cause clinical concern.
    Relationship between β-CTX, UA, FGF-23 and mineral bone abnormality in patients with chronic renal failure undergoing hemodialysis
    TAO Xiao-yang, LI Hua, YU Sheng-qiang
    2021, 42(5):  531-535.  doi:10.3969/j.issn.1007-3205.2021.05.008
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    Objective  To investigate the relationship between type I collagen carboxy terminal peptide β special sequence(β-CTX), uric acid(UA), fibroblast growth factor 23(FGF-23) and mineral bone abnormalities in patients with chronic renal failure(CRF) undergoing hemodialysis.
    Methods  A total of 80 patients with CRF undergoing hemodialysis in our hospital were included in the study, and the retrospective analysis was carried out. The general data of the patients were collected, including age, body mass index, primary disease, usage of phosphate bond, dialysis duration and laboratory indexes such as β-CTX, UA, FGF-23, etc., and the incidence of mineral bone abnormality was investigated. Multivariate Logistic regression analysis was used to analyze the independent influencing factors of mineral bone abnormality in CRF patients undergoing hemodialysis, and the relationship between β-CTX, UA, FGF-23 and mineral bone abnormality in CRF patients undergoing hemodialysis was analyzed.
    Results  Among 80 patients with CRF undergoing hemodialysis, there were 44 cases with mineral bone abnormality, which were set as mineral bone abnormality group, and 36 cases with non-mineral bone abnormality, which were set as non-mineral bone abnormality group. The age, dialysis duration, serum albumin(SA), UA, FGF-23 in the mineral bone abnormality group were significantly higher than those in the non-mineral bone abnormality group（P＜0.05）, and the β-CTX was significantly lower than that in the non-mineral bone abnormality group（P＜0.05）. Multivariate Logistic regression analysis showed that age（OR=1.364，P=0.034）, dialysis duration （OR=1.534，P＜0.001）, UA（OR=1.502，P=0.165）, β-CTX（OR=1.486，P＜0.001）and FGF-23（OR=1.385，P=0.001） were the independent influencing factors of mineral bone abnormality in CRF patients undergoing hemodialysis（P＜0.05）. 
    Conclusion  Age, dialysis duration, UA, β-CTX and FGF-23 are independent influencing factors of mineral bone abnormalities in patients with CRF undergoing hemodialysis, and special attention should be paid to this in clinical practice.
    Analysis of the current status and influencing factors of adverse drug reactions in patients with newly-treated smear-positive pulmonary tuberculosis
    ZHANG Su-juan, HAN Yan-zhou, LI Hua, JIAN Shi-ning, ZHENG Zhi-qing, WANG Li-yuan
    2021, 42(5):  536-540.  doi:10.3969/j.issn.1007-3205.2021.05.009
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    Objective  To investigate the current status of the adverse reactions of anti-tuberculosis treatment in patients with smear-positive pulmonary tuberculosis(SPPT) and to analyze the influencing factors.
    Methods  The clinical data of 280 patients with newly-treated SPPT who were diagnosed and completed standardized treatment were analyzed retrospectively. The incidence, time and type of adverse reactions of anti-tuberculosis treatment were summarized. The influencing factors were analyzed by multivariate Logistic regression analysis.
    Results  There were 67 cases of adverse reactions in 280 patients receiving anti-tuberculosis treatment, with an incidence of 23.93%; the main adverse reactions were single symptom adverse reactions, involving 60 cases(89.55%), and most of them occurred in the intensive phase of tuberculosis treatment, involving 52 cases(77.61%). Most adverse reactions were bone joint damage, liver function damage, blood system abnormality and gastrointestinal reaction. Significant differences were found in the adverse reaction group and non-adverse reaction group with respect to the age, body mass index(BMI), smoking history, drinking history and liver disease history(P＜0.05 or P＜0.01). 〖JP2〗Multivariate Logistic regression analysis showed that age>〖JP〗60 years, BMI ＜18.5, smoking history, drinking history and liver disease history were the risk factors of the adverse reactions in patients with newly-treated SPPT during anti-tuberculosis treatment(P＜0.05 or P＜0.01).
    Conclusion  The main adverse reactions were single symptom adverse reactions in patients with newly-treated SPPT during the anti-tuberculosis treatment, and most of them occurred in intensive phase of tuberculosis treatment, mainly involving the bone joint damage, liver function damage, blood system abnormality and gastrointestinal reaction. Close attention should be paid to patients with newly-treated SPPT who were aged >60 years, and had BMI ＜18.5, smoking history, drinking history and liver disease history in the regular anti-tuberculosis treatment, and the occurrence of treatment-related adverse reactions should be reduced or prevented, thereby improving the treatment compliance and the cure rate.
    The influence of intra-articular injection of glucocorticoids on blood glucose, blood lipids and HPA axis
    LIU Jun-peng, HAN Wen-biao, LIU Xiao-hui, LIU Guang-zhao, REN Yu-e
    2021, 42(5):  541-546.  doi:10.3969/j.issn.1007-3205.2021.05.010
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    Objective  To observe the effect of intra-articular injection of different doses of betamethasone and dexamethasone palmitate on blood glucose, blood lipids and hypothalamus pituitary adrenal(HPA) axis.
    Methods  A total of 60 patients aged 45~70 years with a body mass index(BMI) of 18.5~32.0 and visual analogue score(VAS) ≥7 who were planned to undergo intra-articular injection for  knee osteoarthritis(KOA) were enrolled in this study. They were divided into 4 groups according to random number table method, including BL group(compound betamethasone 3.5 mg), BH group(compound betamethasone 7 mg), DL group(dexamethasone palmitate 4 mg) and DH group(dexamethasone palmitate 8 mg). Each group was injected with corresponding doses of glucocorticoids(GCs). VAS scores of four groups before injection(T0) and at 2 d(T1), 4 d(T2), 6 d(T3), 14 d(T4) and 21 d(T5) after injection were recorded. The fasting and 2 h postprandial venous blood were collected from antecubital vein at T0, T1, T2, T3, T4 and T5. Fasting blood glucose(FBG), 2-hour postprandial blood glucose(2 hPG), total cholesterol(TC), triglyceride(TG), and adrenocorticotropic hormone(ACTH) were measured.
    Results  Compared to T0, the VAS was decreased at T1, T2, T3, T4, and T5 in the four groups(P＜0.05), comparison between groups was statistically significant(P＜0.05); there was significant difference in the four groups(P＜0.05).  Compared to T0, the 2 hPG was increased at T1, T2, T3, and T4 in the four groups, and there was significant difference(P＜0.05). The 2 hPG was higher in BL group than in BH group, and higher in DL group than in DH group at T3, and there was significant difference(P＜0.05). The 2 hPG was higher in BH group than in BL group, and higher in DH group than in DL group at T4, and there was significant difference(P＜0.05). Compared to T0, the blood cortisol and ACTH were decreased at T1, T2, T3 and T4, suggesting significant difference(P＜0.05), and comparison between groups was statistically significant(P＜0.05).
    Conclusion  Intra-articular injection of compound betamethasone (3.5 mg or 7 mg) and dexamethasone(4 mg and 8 mg) can relieve pain caused by KOA, affect the metabolism of 2 hPG within 2 weeks, has no significant effect on FBG and lipid metabolism, and inhibit HPA axis within 2 weeks.
    Efficacy analysis of vascutrak balloon combined with drug-coated balloon in the treatment of femoral-popliteal atheroclesrotic occlusive disease
    YUAN Tao, GAO Xiang, CHI Kui, SUN Huan-huan, LIU Yang, LI Xue-yan
    2021, 42(5):  547-550,567.  doi:10.3969/j.issn.1007-3205.2021.05.011
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    Objective  To explore whether the use of vascutrak balloon to pretreat lesions will affect the efficacy of drug-coated balloon(DCB) in the treatment of femoral-popliteal atheroclesrotic occlusive disease.
    Methods  The clinical data of 40 patients with femoral-popliteal atheroclesrotic occlusive disease treated in our center were retrospectively analyzed. Twenty cases underwent plain balloon angioplasty(PBA) combined with DCB(control group), while 20 cases received dual-wire balloon angioplasty and DCB(observation group). All patients were classified according to TASC grading standards, and the occurrence of perioperative adverse events was recorded. The ankle brachial index(ABI) was monitored before and at 3 months, 6 months, and 1 year after operation respectively. Rutherford classification was performed at 1-year follow-up.
    Results  In both groups, the lesions were opened surgically in the true cavity and the surgery was performed. There was no significant difference in the length and stenosis of target vascular lesions between two groups(P＞0.05). The residual stenosis rate after pretreatment was less than 30%. There were 2 cases of distal embolization, one case in the observation group and one in the control group who was amputated ultimately. One patient in the control group had a restrictive dissection after balloon expansion, and received bail-out stenting. All 40 patients were followed up. The ABIs of the two groups were higher than those before operation, but gradually decreased at 3, 6, and 12 months after operation. The difference of interaction between groups, time points and time points between groups were statistically significant in two groups(P＜0.05).
    Conclusion  For femoral-popliteal atheroclesrotic occlusive disease, vessel preparation with dual-wire balloon angioplasty and subsequent DCB, as compared with PBA combined with DCB, can decrease reintervention rate, and does not increase the incidence of complications, However, this conclusion still needs to be confirmed by large samples and long-term follow-up data.
    Analysis of risk factors related to contrast-induced nephropathy in endovascular treatment
    LUO Chang-zhi, HOU Pei-yong, SU Yi-ming, XU Tai-fu
    2021, 42(5):  551-554,596.  doi:10.3969/j.issn.1007-3205.2021.05.012
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    Objective  To investigate the risk factors related to contrast -induced nephropathy(CIN) in endovascular surgery.
    Methods  The clinical data of 279 patients who underwent endovascular surgery were retrospectively analyzed. According to the changes of renal function before and after endovascular treatment, they were divided into CIN group and non-CIN group. The gender, age, weight, comorbidities(hypertension, diabetes, coronary heart disease), major diagnosis, type and dose of contrast, preoperative renal function, and excessive use of contrast compared, and the risk factors for CIN in endovascular treatment were analyzed.
    Results  There were 37 cases(13.3%) of CIN in 279 patients during endovascular treatment, and 3 cases required temporary hemodialysis treatment. The univariate analysis showed significant difference between two groups with respect to gender, major diagnosis, type and dose of contrast, preoperative renal function, and excessive use of contrast(P＜0.05). Multivariate regression analysis showed that the excessive use of contrast was a risk factor for CIN after endovascular treatment(P＜0.05).
    Conclusion  Excessive use of contrast is an independent risk factor for CIN in endovascular treatment, and the risk of disease onset is 3.8 times that of non-overdose users. The maximal acceptable contrast dose should be calculated individually before surgery to avoid over-use, and preventive measures should be taken more actively for patients with overdose.
    Clinical observation of recombinant human granulocyte macrophage colony stimulating factor gel combined with functional dressing for sequential treatment of medium-thickness skin donor site wounds
    CHEN Jian-li, LI Gui-xuan, JIANG Liang, LI Lei
    2021, 42(5):  555-558,581.  doi:10.3969/j.issn.1007-3205.2021.05.013
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    Objective  To observe the clinical application of recombinant human granulocyte macrophage colony stimulating factor(rhGM-CSF) gel combined with functional dressings for sequential treatment of medium-thickness skin donor site wounds.
    Methods  A total of 78 patients with medium-thickness skin grafts were randomly divided into experimental group and control group. The skin donor area of the experimental group was treated with rhGM-CSF gel, and combined with alginate dressing and lipid hydrocolloid dressing to repair the wound on the second day after surgery. The control group used traditional petroleum jelly gauze and sterile dressing on the second postoperative day to cover and repair the wound. The postoperative wound infection, dressing change pain score, wound dressing frequency and comfort, wound healing time, and wound healing effect were compared between two groups.
    Results  ①The healing time and the number of dressing changes in the experimental group were shorter or lower than those in the control group(P＜0.05). ②The pain grade of dressing change in the experimental group was significantly lower than that in the control group(P＜0.05). ③The patient comfort and wound healing quality of the experimental group were higher than those in the control group, while nursing difficulty and wound infection rate were lower than those of control group(P＜0.05).
    Conclusion  The rhGM-CSF gel combined with alginate and lipid hydrocolloid dressings can be used on the wound surface of the medium-thickness skin donor site, which can reduce the infection rate of the wound surface, alleviate the pain, improve the comfort and the quality of wound healing, and the clinical effect is ideal.
    Analysis of the influencing factors and predictive models of early electrophysiological abnormalities of pelvic floor in primiparas after vaginal delivery
    ZHANG Ping, LU Qiong-fang
    2021, 42(5):  559-567.  doi:10.3969/j.issn.1007-3205.2021.05.014
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    Objective  To explore the influencing factors and predictive models of electrophysiological abnormalities of pelvic floor in primiparas after vaginal delivery.
    Methods  A retrospective analysis was performed on pregnancy and childbirth related data of primiparas who underwent regular antenatal examination, delivery and regular examination for rehabilitation of pelvic floor function at 6-8 weeks after vaginal delivery at People′s Hospital of Guigang City. The data of the parturient and the results of early postpartum pelvic floor detection were statistically analyzed, to ascertain the influencing factors and prediction models of electrophysiological abnormalities of the pelvic floor.
    Results  Among the 664 primiparous women with vaginal delivery, there was an abnormal rate of type Ⅰ muscle fiver strength(70.03%) and of type Ⅱ muscle fiber strength(69.27%), as well as typeⅠand Ⅱpelvic floor muscle fiber fatigue(69.73% and 31.02% respectively), and abnormal vaginal dynamic pressure(92.02%). Maternal age, height, perineal lateral incision, perineal laceration, weight gain in the third trimester, duration of the second stage of labor, and newborn′s weight, newborn′s length, and gender were related to early electrophysiological abnormalities of pelvic floor of the primiparas after vaginal delivery. The greater maternal height, newborn′s length, and the second stage of labor of less than 3 h were protective factors. Weight gain during pregnancy had a significant impact on the electrophysiology of the pelvic floor. A receiver operating characteristic curve(ROC) of the weight gain during pregnancy and electrophysiological test results of pelvic floor was delineated to predict early electrophysiological abnormalities of pelvic floor in some parturients after delivery. In the early pregnancy, the area under ROC(AUC) of pregnant women with 25≤BMI＜30, abnormality of type Ⅰ muscle fiber strength and weight gain in the third trimester of pregnancy was 0.725(P=0.044, 95%CI: 0.523-0.927), and the optimal weight gain was 4.75 kg during third trimester.
    Conclusion  The incidence of electrophysiological abnormalities in pelvic floor muscles is high in primiparous women after vaginal delivery. There are various influencing factors for early electrophysiological abnormalities of pelvic floor after delivery. Weight gain during pregnancy can predict early electrophysiological abnormalities of pelvic floor in some primiparas after delivery.
    Meta-analysis of the relationship between Coxsackie virus infection and the risk of type 1 diabetes
    YANG Sen, DAI Xiao-ling, ZHANG Zhen, ZHAO Bi-ying, ZHANG Yi-li, CUI Lan-wei
    2021, 42(5):  568-574,602.  doi:10.3969/j.issn.1007-3205.2021.05.015
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    Objective  To systematically evaluate the risk relationship between Coxsackie virus(CV) infection and type 1 diabetes mellitus(T1DM).
    Methods  According to the principle of PICOs, the retrieval scheme was constructed, and PubMed, EmBase, Sinomed, CNKI, Wanfang database, and VIP were searched comprehensively with subject words and free words from the inception until May 28 2020. Newcastle Ottawa scale was used to evaluate the quality of included documents; Revman 5.3 software package was used to draw forest map and funnel map. The odds ratio(or) and 95% confidence interval(CI) were calculated by random effect model(I2>50%) or fixed effect model(I2<50%). The evaluation results included the risk relationship of CV, subtypes(1-6) and type 1 diabetes, and the influence of different study areas, different age and different CV detection methods on the risk relationship of CV and T1DM.
    Results  According to the inclusion and exclusion criteria, 372 articles were retrieved. Of them, 312 papers that were not related to the research topic were excluded, and 36 papers that were not rigorously designed were excluded after browsing the full text. Finally, 24 literature was selected for systematic evaluation and meta-analysis, one of which had no data available. The total sample size was 3 163, including 1 693 in case group and 1 613 in control group. The results showed that the risk of CVB infection in T1DM patients was 5 times higher than that in the control group(OR=4.49, 95%CI:2.65-7.50, P＜0.05). The risk of CVB infection in T1DM patients was 1.56 times higher than that in the control group(OR=1.56,95%CI:1.20-2.03, P＜0.05). The detection method of CVB had a great influence on the results.
    Conclusion  The present evidence suggests that CVB infection has a statistical correlation with T1DM. Therefore, CVB infection may be a cause of T1DM or promote the occurrence of T1DM.
    Correlation between parameters of quantitative coronary CT angiography and platelet function indexes in peripheral blood and their diagnostic value for coronary artery stenosis
    TIAN Jian, LIU Jun
    2021, 42(5):  575-581.  doi:10.3969/j.issn.1007-3205.2021.05.016
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    Objective  To explore the correlation between quantitative coronary computed tomography angiography(CTA) parameters and peripheral blood platelet function indexes, and to analyze its diagnostic value in coronary artery stenosis and its relationship with disease severity.
    Methods  A total of 183 patients with suspected CAS were selected as the research subjects. According to the results of coronary CTA, patients with confirmed CAS were enrolled as the observation group(n=125), and those without CAS were enrolled as the control group(n=58). The parameters of quantitative coronary CTA［minimum lumen diameter(MLD), percentage of area stenosis(%AS), percentage of diameter stenosis(%DS), minimum lumen area(MLA)］ between two groups and the observation group of patients with different conditions were compared. The platelet function indexes in peripheral blood of patients with different conditions in the observation group［mean platelet volume(MPV), thrombelastography maximum(TEG-MA), platelet-derived growth factor BB(PDGF-BB)］ were compared. The correlation between parameters of quantitative coronary CTA and platelet function indexes in peripheral blood and their diagnostic value for CAS were analyzed.
    Results  MLA and MLD in the observation group were smaller than those in the control group, and %AS and %DS were larger than those in the control group(P＜0.05). MLA and MLD were negatively correlated with the degree of stenosis and positively correlated with the plaque properties. %AS, %DS were positively correlated with the degree of stenosis and negatively correlated with the plaque properties. MPV, TEG-MA and PDGF-BB were positively correlated with the degree of stenosis and negatively correlated with the plaque properties(P＜0.05). MLA and MLD were negatively correlated with MPV, TEG-MA and PDGF-BB, and %AS and %DS were positively correlated with MPV, TEG-MA and PDGF-BB(P＜0.05). The area under the curve(AUC) of MLA and MLD in the diagnosis of CAS was 0.901, the sensitivity was 76.80%, and the specificity was 94.83%.
    Conclusion  There is a certain correlation between CTA parameters and peripheral blood platelet function. Quantitative coronary CTA examination can help improve the diagnostic value in coronary artery stenosis, and assess the properties of coronary atherosclerotic plaque, which can be used as a reliable non-invasive means to assess and judge the severity of the disease.
    Comparative study of mitral valve configuration in patients with ischemic mitral regurgitation in different infarct sites by transthoracic real-time three-dimensional echocardiography
    CHEN Yu-jiao, LIU Xin, XUE Na, MU Wei-na
    2021, 42(5):  582-586.  doi:10.3969/j.issn.1007-3205.2021.05.017
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    Objective  To investigate the changes of mitral valve configuration in patients with ischemic mitral regurgitation(IMR) in different infarct sites by transthoracic real-time three-dimensional echocardiography, and to analyze the influencing factors of the degree of regurgitation, so as to provide reference for clinical treatment.
    Methods  A total of 64 patients with myocardial infarction(MI) and IMR were included as the case group. According to the location of MI, the patients were divided into anterior MI subgroup(n=40) and inferior MI subgroup(n=24), and 45 healthy volunteers were included as the control group.The ultrasonic quantitative parameters included left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume(LVESV), left ventricular ejection fraction(LVEF), anterior-to-posterior diameter(DAP), annular height(AH), commissural diameter(CD), three-dimensional annular area(A3D ), non-planar angle(NPA), tenting volume(VTent), tenting height(HTent), three-dimensional annular circumference(AC), and posterior leaflet angle(θPost). The changes of mitral valve configuration between each group were compared and the influencing factors of the degree of IMR were analyzed by multinomial Logistic regression.
    Results  LVESV and LVEDV in anterior MI subgroup and inferior MI subgroup were all higher than those in the control group, while LVEF was significantly lower than that in the control group; LVESV and LVEDV in anterior MI subgroup were larger than those in the inferior MI subgroup, while LVEF was smaller than that in the inferior MI subgroup, and the differences were statistically significant(P＜0.05). DAP, CD, A3D, HTent, VTent, AC, NPA and θPost in anterior MI subgroup and inferior MI subgroup were all higher than those in the control group, while AH was lower than that in the control group, and the differences were statistically significant(P＜0.05). CD, A3D, VTent and HTent in anterior MI subgroup were larger than those in the inferior MI subgroup, while θPost was smaller than that in the inferior MI subgroup, and the differences were statistically significant(P＜0.05). No significant difference was found in DAP, AH, NPA and AC between anterior MI subgroup and inferior MI subgroup(P＞0.05). The incidence of severe IMR in the inferior MI subgroup was higher than that in the anterior MI subgroup, and the difference was statistically significant(P＜0.05). Multinomial Logistic regression analysis showed that VTent and θPost were risk factors for severe IMR.
    Conclusion  The formation mechanism of IMR in anterior MI subgroup and inferior MI subgroup is different. VTent and θPost are risk factors for severe IMR. This result is beneficial to the choice of surgical procedure in clinical practice.
    Evaluation of the correlation between varicose veins of the lower extremity and the blood#br# flow parameters of inferior vena cava by ultrasonography
    YIN Ning-ning, MI Ling-yu, LI Yan , ZHAO Yan-qin, XUE Li-li, ZHAO Ya-pei
    2021, 42(5):  587-591.  doi:10.3969/j.issn.1007-3205.2021.05.018
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    Objective  To explore the correlation between the clinical classification of clinical etiology anatomy pathophysiology(CEAP) of varicose veins of the lower extremity and the blood flow parameters of inferior vena cava(IVC) evaluated by ultrasonography.
    Methods  A total of 109 patients with varicose veins of the lower extremity were randomly selected as case group. According to the clinical classification of CEAP and skin lesions caused by varicose veins, the cases were divided into group A(classes C1 to C3, n=57) and group B(classes C4 to C6, n=52). And 27 matched healthy subjects during the same period were selected as the control group(group C). The gender, age, height, and body weight were recorded, and the body surface area and body mass index(BMI) of all the cases were calculated. Using Ultrasonography, the long and short diameter, circumference and cross sectional area were measured on the transversal plane of lower segment of the IVC. The maximum velocity and flow volume of IVC were calculated on its longitudinal section.
    Results  There was no significant difference in gender, age and height among the three groups(P＞0.05). The body weight, body surface area and BMI of group A and group C were obviously lower than those of group B(P＜0.05), whereas the differences of the above parameters between group A and group C were not statistically different(P＞0.05). In group A and B, the long diameter, circumference of IVC were remarkably larger than those of group C(P＜0.05), while there was no significant difference between group A and B(all P＞0.05). The flow volume of IVC in group B was higher than that in group C(P＜0.05), while compared with groups B and C, no significant difference was found in group A(P＞0.05). There were no markedly difference in short diameter, cross sectional area and the maximum velocity of IVC among the three groups(P＞0.05). The clinical classification of CEAP was positively correlated with the body weight, body surface area and BMI(P＜0.05), but not correlated with gender, age and height(P＞0.05). And it was positively correlated with the long diameter, circumference and flow volume of IVC(P＜0.05), but was not correlated with short diameter, cross sectional area and the maximum velocity(P＞0.05).
    Conclusion  Varicose vein of lower extremity is related to body weight, body surface area and BMI. In the early stage of CEAP clinical classification, the morphology of IVC is changed, specifically long diameter and circumference of transverse section that are increased obviously, while the blood flow volume is increased significantly in the higher grade with skin lesions.
    Evaluation of echocardiography in improving ectopic tip of PICC in right heart of children
    ZHAO Ning, HE Xin-jian, LI Yi-ming
    2021, 42(5):  592-596.  doi:10.3969/j.issn.1007-3205.2021.05.019
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    Objective  X-ray examination has some limitations in the tip positioning of peripherally inserted central catheter(PICC) in children, especially in patients with ectopic tip in right heart. The purpose of this study is to explore the value of echocardiography in improving the display of ectopic tip of PICC in right heart system in children.
    Methods  A total of 96 patients who underwent PICC catheterization successfully were selected. Self-control trial was applied and chest X-ray and echocardiography were used respectively to confirm the tip position of PICC. The value of echocardiography in improving the evaluation of ectopic tip of PICC in right heart system was observed.
    Results  The detection rate of ectopic tip of PICC in right heart by echocardiography and chest X-ray was 22.9% and 7.3% respectively. The results of Chi-square test showed that there was significant difference in dispersion between two methods(χ2=9.13, P=0.003). The detection rate of ectopic tip of PICC in right heart system by echocardiography was higher than that by chest X-ray. The consistency result of Kappa test showed that the consistency of the two methods was low(Kappa=0.16). The sensitivity of echocardiographic localization of ectopic tip of PICC in right heart system was 79%, the area under ROC 〖JP2〗curve was 0.830(P＜0.05) and the 95% confidence interval was(0.692-0.968). 〖JP〗
    Conclusion  Echocardiography can significantly improve the detection rate of ectopic tip of PICC in right heart in children.During PICC catheterization in children, routine echocardiographic examination should be performed if the patient is suspected of having ectopia in right heart system by chest X-ray examination.
    Comparison of the efficacy of different administration frequency of ceftazidime for complicated urinary tract infections and cost-effectiveness analysis
    BAI Jing, ZHANG Pei-fang, ZHENG Hui-xiao, ZHAO Xiao-fei
    2021, 42(5):  597-602.  doi:10.3969/j.issn.1007-3205.2021.05.020
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    Objective  To explore the efficacy comparison and cost-effectiveness analysis of different administration frequency of ceftazidime for complicated urinary tract infections(UTI).
    Methods  A total of 153 patients with complicated UTI admitted to the Department of Nephrology were randomly divided into groups A, B, and C, with 51 cases in each group. Group A was given 1 g of ceftazidime for injection by intravenous infusion every 12 h, group B was given 1 g of ceftazidime for injection intravenously every 8 h, and group C was given 2 g of ceftazidime for injection intravenously every 12 h. Each group was treated for 1 week as a course of treatment. The clinical efficacy, laboratory examination, negative conversion rate of midstream urine bacteria culture and adverse reaction rate of the three groups were observed. The pharmacoeconomics of three treatment schemes was evaluated by cost-effectiveness analysis.
    Results  There was no statistically significant difference in the total effective rate of the three groups in terms of clinical efficacy(P＞0.05); the rank sum test showed that the difference in the clinical efficacy of the three groups was statistically significant(P＜0.05). The time to clinical symptom resolution, negative conversion time of white blood cell in urine test and antifebrile time were significantly shorter in group B than in group A and group C, and shorter in group C than in group A(P＜0.05). After treatment, the levels of procalcitonin(PCT), interleukin-6(IL-6), serum hypersensitive C-reactive protein(hs-CRP) and interleukin-8(IL-8) in three groups were significantly decreased(P＜0.05), among which the level of group B was the lowest, followed by group C, and group A. The negative conversion rate of midstream urine bacteria culture was 88.24% in group A, 94.12% in group B and 90.20% in group C. The PK/PD compliance rates of ceftazidime in groups A, B, and C were 72.55%, 84.31%, and 76.47%, respectively. There was no statistically significant difference in the incidence of adverse reactions among three groups(P＞0.05). After the cost-effectiveness analysis of the three treatment options, it was concluded that group B had the optimal treatment options. The results of incremental cost-effectiveness analysis in the three groups showed that, according to the advantages of group B, if the drug price dropped by 15%, the results of sensitivity analysis supported the cost-effectiveness analysis results.
    Conclusion  The optimal clinical efficacy can be achieved at a dose of 1g ceftazidime and administration frequency of every 8 h, when the body's inflammatory response is significantly reduced, and the time to clinical symptom resolution, negative conversion time of white blood cell in urine test and antifebrile time are the shortest, with the highest negative conversion rate of urine culture. Therefore, it is the optimal treatment plan.