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Table of Content

    25 June 2021, Volume 42 Issue 6
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    Protective effects of hydrogen gas on acute kidney injury induced by subarachnoid hemorrhage in rats
    SONG Jing-hua, JIA Hong-yan, SHAO Tian-peng, LIU Zhi-bao, ZHAO Yuan-ping
    2021, 42(6):  624-630.  doi:10.3969/j.issn.1007-3205.2021.06.002
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    Objective  To explore the protective effects and mechanism of hydrogen gas against acute kidney injury(AKI) induced by subarachnoid hemorrhage(SAH) in rats. 
    Methods  SPF-grade male Sprague Dawley(SD) rats(weighing 350-400 g), were divided into control group(n=12), model group(n=12) and hydrogen treatment group(n=12) according to random number table method. In the model and hydrogen treatment group, SAH was induced by endovascular perforation combined with contrast agent and mannitol transfusion. At 24 h and 48 h after successful SAH modeling, the rats in the hydrogen treatment group were placed into anesthesia induction box filled with 2.9% hydrogen for 2 h, but the rats in the model group were only placed into the induction box filled with air. The rats in the control group were treated in the same fashion as model group except that the intracranial vessels were not punctured. At 72 h after SAH, 0.7-1.0 mL of blood samples was collected from aorta to measure the levels of blood urea nitrogen(BUN) and serum creatinine(SCr). After sampling via cardiac perfusion, the pathological changes of kidney, reactive oxygen species, expressions of B-cell lymphoma-2(bcl-2), bcl-2 associated-k(bak) and cleaved caspase-3, renal apoptosis were assessed by hematoxylin eosin staining, enzyme linked immunosorbent, western blot and TdT-mediated dUTP Nick-End Labeling(TUNEL) assays, respectively. In the cell experiment, renal tubular epithelial cells(NRK52E) were treated with 300 μmol/L hydrogen peroxide for 24 h to prepare an oxidative stress model. At 24 h, 48 h after intervention, the cells were treated with 2.9% hydrogen gas for 2 h. Then the contents of malondialdehyde(MDA), superoxide dismutase(SOD), and apoptotic rate of renal epithelial cells were detected. 
    Results  The levels of BUN and SCr were higher in the model group and hydrogen treatment group than in the control group, which, however,were lower in hydrogen treatment group than in the model group(P＜0.05). The renal tubule injury scores were higher in the model group and hydrogen treatment group than in the control group, which, however, were lower in hydrogen treatment group than in the model group(P＜0.05). The ratio of bcl-2/bak protein in renal tissues of rats was lower, while the expression of cleaved caspase-3 was higher in the model group and hydrogen treatment group, as compared with those in the control group; the ratio of bcl-2/bak protein in renal tissues of rats was higher, while the expression of cleaved caspase-3 was lower in hydrogen treatment group, as compared with those in the model group(P＜0.05). The renal apoptosis significantly higher in the model group and hydrogen treatment group than in the model group, which was lower in hydrogen treatment group than in the model group(P＜0.05). In vitro, compared with control group, the MDA level and apoptosis rate of renal tubular epithelial cells were increased, but the SOD level and survival rate were decreased in the model group and hydrogen treatment group; the MDA level and apoptosis rate of renal tubular epithelial cells were lower, but the SOD level and survival rate were higher in the hydrogen treatment group, as compared with those in the model group(P＜0.05). 
    Conclusion  Hydrogen gas exhibits a protective effect against SAH-induced AKI in rats, and the mechanism may be associated with the inhibition of ROS-induced renal cell apoptosis under hydrogen treatment. 
    Neuroprotective role of microRNA-326  in depression model rats by targeting KLK7 to regulate MAPK signal pathway
    LIU Tao, ZHANG Wang, ZHONG Yan-li, WU Hong-wei
    2021, 42(6):  631-636,645.  doi:10.3969/j.issn.1007-3205.2021.06.003
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    Objective  To explore the effect of microRNA-326 by targeting Kallikrein 7(Klk7) to regulate the mitogen activated protein kinase(MAPK) signaling pathway on depression model rats. 
    Methods  A total of 20 SD rats were randomly divided into blank control group and chronic unpredictable mild stress(CUMS) group, with 10 rats in each group. CUMS was used to induce and prepare a rat model of depression. Sucrose preference test, open field test and forced swimming test were used to detect the behavioral changes of rats. Immunohistochemical was employed to detect Klk7 expression and TUNEL staining was used to detect apoptosis. Luciferase reporter gene experiment was used to verify the targeted binding between miR-326 and Klk7, and CCK-8 was used to detect the cell viability of hippocampal neurons. Real-time quantitative PCR and Western blot were used to detect the expression of miR-326 and Klk7, and Western blot was used to detect protein expression of Klk7 and MAPK signaling pathway related gene. 
    Results  Compared with the blank control group, the sucrose preference value and the number of crossings of the CUMS group were significantly down-regulated(P＜0.05), while the resting time, Klk7 expression and apoptosis were significantly up-regulated(P＜0.05). Klk7 was a target gene of miR-326. Compared with the negative control(NC) group, miR-326 inhibited the activation of MAPK signaling pathway by targeting Klk7, thereby promoting the proliferation of hippocampal neurons in CUMS rats and inhibiting apoptosis(P＜0.05). Compared with miR-326 inhibitor group, miR-326 and Klk7 were simultaneously down-regulated to inhibit the activation of MAPK signaling pathway, promote the proliferation of hippocampal neurons in CUMS rats, and inhibit apoptosis(P＜0.05). 
    Conclusion  MicroRNA-326 exerts a neuroprotective effect on depression model rats by targeting Klk7 to regulate MAPK signaling pathway.

    Evaluation of therapeutic effect of interventional occlusion for perimembranous ventricular septal defect with moderate to severe tricuspid regurgitation
    LIU Ling, CHEN Yu, ZHENG Qing-hou, ZHANG Ning, LYU Ying, WANG Zhen
    2021, 42(6):  637-640.  doi:10.3969/j.issn.1007-3205.2021.06.004
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    Objective  To observe the therapeutic effect and long-term prognosis of interventional occlusion for perimembranous ventricular septal defect(PMVSD) with moderate to severe tricuspid regurgitation. 
    Methods  Fifty-three patients with PMVSD complicated by moderate to severe tricuspid regurgitation were selected by echocardiography, and none of them had organic tricuspid valve disease. The therapeutic effect of interventional occlusion for PMVSD and the changes of tricuspid regurgitation were observed. 
    Results  PMVSD of all patients was successfully occluded. The area, velocity and pressure difference of tricuspid regurgitation in 52 patients were reduced or decreased with the time of intervention(P＜0.05). One patient had severe tricuspid regurgitation because of occluder intertwined with tendinous cord of tricuspid valve after intervention, and underwent ventricular septal defect repair and tricuspid valvuloplasty. He recovered well after operation. 
    Conclusion  After strict preoperative screening, interventional occlusion is safe and effective for some PMVSD patients with moderate to severe tricuspid regurgitation. 

    Value of combined detection of  hs-CRP, Hcy and blood coagulation function in evaluating the severity of acute cerebral infarction
    CHEN Hao, HU Jing-jing
    2021, 42(6):  641-645.  doi:10.3969/j.issn.1007-3205.2021.06.005
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    Objective  To analyze the value of combined detection of hypersensitive C-reactive protein(hs-CRP), homocysteine(Hcy) and blood coagulation function in evaluating the severity of acute cerebral infarction(ACI). 
    Methods   A total of 106 patients with ACI were enrolled as the case group, and were divided into progression group(n=50) and non-progression group(n=56) according to presence or absence of progressive aggravation of the neurological symptoms within 96 hours of onset of the disease. In the meantime, 45 healthy persons who underwent physical examination were selected as control group. The serum hs-CRP, Hcy, lipid metabolism and blood coagulation function were compared in each group. 
    Results  There were significant differences in serum hs-CRP, Hcy, lipid metabolism and blood coagulation function indexes in each group(P＜0.05). The levels of serum hs-CRP, Hcy, total cholesterol(TC), triglyceride(TG), low-density lipoprotein cholesterol(LDL-C), and D-dimer(DD) and fibrinogen(Fib) were significantly higher in the case group than in the control group(P＜0.05), while the level of high-density lipoprotein-cholesterol(HDL-C) was significantly lower in the case group than in the control group(P＜0.05). The levels of serum hs-CRP, Hcy, TC, TG, LDL-C, DD, and Fib in the progression group were significantly higher than those in the non-progression group(P＜0.05), whereas the level of HDL-C in the progression group was significantly lower than that in the non-progression group(P＜0.05). 
    Conclusion  The patients with ACI may have obvious coagulation dysfunction and dyslipidemia. The levels of serum hs-CRP, Hcy, TC, TG, LDL-C, Fib and DD in patients with ACI in the progression group are remarkably increased, while the level of HDL-C is significantly decreased, which is of certain value in evaluating the severity of ACI.

    Clinical characteristics of acute cerebral infarction complicated by dysphagia in elderly patients and the effect of dysphagia on in-patient outcome in Xi′an area
    LU Qing-li, WANG Jing, LIU Zhong-zhong, LIN Xue-mei, WANG Fang, WU Song-di
    2021, 42(6):  646-650.  doi:10.3969/j.issn.1007-3205.2021.06.006
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    Objective  To investigate the clinical characteristics of acute cerebral infarction(ACI) complicated by dysphagia in elderly patients and the effect of dysphagia on in-hospital outcome in Xi′an area. 
    Methods  By means of stroke registration study in Xi′an area, a total of 1 116 elderly patients with ACI admitted to four first-class tertiary hospitals in Xi′an were included. According to the score of water swallowing test within 24 h after admission, they were divided into good swallowing group(grade 1-2) (n=1 004)and dysphagia group(grade 3-5) (n=112). The baseline clinical characteristics of the two groups were compared. Multivariate Logistic regression model was used to analyze the impact of dysphagia on in-hospital outcomes［stroke-associated pneumonia(SAP), parenteral nutrition and poor prognosis］ of elderly patients with ACI complicated by dysphagia. 
    Results  Compared with good swallowing group, patients in the dysphagia group were older, and had a higher proportion of atrial fibrillation, national institute of health stroke scale score on admission, and inability to walk within 48h after admission, as well as a higher admission heart rate, fasting blood glucose, blood urea nitrogen, and white blood cell levels(P＜0.05). The rate of in-hospital SAP, parenteral nutrition and poor prognosis of dysphagia group were all higher than those of good swallowing group(26.8% vs. 4.0%, 11.6% vs. 1.9%, 46.4% vs. 17.8%, P＜0.001). After adjusting for related confusions, multivariate Logistic regression analysis showed that the risk of in-hospital SAP(OR=3.835, 95%CI: 2.005-7.335, P＜0.001) and probability of parenteral nutrition(OR=4.909, 95%CI: 1.991-12.102, P＜0.001) in elderly ACI patients with dysphagia were significantly increased. 
    Conclusion  The risk of in-hospital SAP and probability of parenteral nutrition of elderly ACI patients with dysphagia were significantly increased in Xi'an area.Therefore, it is necessary to arouse the attention and early response of clinicians. 

    Predictive effects of multiple serum indicators for post-stroke depression in elderly patients with ischemic stroke
    TANG Jia-fan, ZHAI Wan-qing, SONG Li-yan, HE Xiao-yan, ZHOU Yi
    2021, 42(6):  651-655,660.  doi:10.3969/j.issn.1007-3205.2021.06.007
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    Objective  To explore the predictive value of serological indicators for post-stroke depression(PSD) in elderly patients with ischemic stroke. 
    Methods  The clinical data of 560 elderly patients with acute ischemic stroke(AIS) diagnosed and treated in our hospital were retrospectively analyzed. Based on presence or absence of depression at 6 months after stroke, they were divided into PSD group(n=221) and non-PSD group(n=339). The clinical data and serological indicators of the two groups were compared. The multivariate Logistic regression analysis was used to analyze the risk factors of PSD. The ROC curve was used to analyze the clinical value of each serum indicator in predicting the occurrence of PSD. 
    Results  The results of univariate analysis showed that total serum cholesterol, serum creatinine, uric acid(UA), serum amyloid A(SAA), interleukin(IL)-1, IL-2, IL-6, IL-17, hypersensitive C-reactive protein(hs-CRP), tumor necrosis factor alpha(TNF-α), neutrophil to lymphocyte ratio(NLR), platelet to lymphocyte ratio(PLR) were higher than those in the non-PSD group(P＜0.05), while TNF-α, and SAA levels, as well as NLR and PLR calculated by routine blood tests, were lower than those in non-PSD group(P＜0.05). There was no significant difference in alanine aminotransferase and aspartate aminotransferase between two groups(P＞0.05). The results of multivariate Logistic regression analysis showed that IL-6(OR=1.48, 95%CI : 1.06-1.97, P=0.026), IL-17(OR=1.26, 95%CI: 1.03-1.56, P=0.038), NLR(OR=2.45, 95%CI: 1.52-4.89, P＜0.001), SAA(OR=1.87, 95%CI: 1.22-2.65, P＜0.001), UA(OR=2.68, 95%CI: 1.72-5.68, P＜0.001) were influencing factors of PSD in elderly patients with AIS. The AUC of UA, NLR, SAA, IL-6, and IL-17 for predicting the occurrence of PSD at 6 months in elderly patients with AIS was 0.838, 0.826, 0.759, 0.732, and 0.569, respectively. 
    Conclusion  Increased serum levels of IL-6, IL-17, SAA, NLR, and UA are risk factors for PSD in elderly patients with AIS. They can predict the risk of PSD, and UA and NLR have the highest predictive value.

    Application value of HEART score in predicting short-term MACE of acute non-traumatic chest pain
    ZHANG Cong-yan, ZHENG Zhi-yuan, ZHAO Ya-jing, ZHOU Ling-feng, DING Jun-li, XIU Ming-wen
    2021, 42(6):  656-660.  doi:10.3969/j.issn.1007-3205.2021.06.008
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    Objective  To explore the clinical value of HEART score in predicting 30-day major adverse cardiovascular events(MACE) of acute non-traumatic chest pain. 
    Methods  Of 645 patients with acute non-traumatic chest pain, 84 patients with pain caused by tumors and rheumatism and 11 patients who were lost to follow-up were excluded. Thus, a total of 550 patients were included in the study. HEART score and GRACE score were calculated respectively in all patients, and the incidence of MACE was recorded at 30-d follow-up. 
    Results  Of all 550 patients with acute non-traumatic chest pain, 82(14.9%) developed MACE within 30 days. There were significant differences in age, smoking rate, combined hypertension rate, coronary heart disease rate, diabetes rate, HEART score and GRACE score between MACE group and non-MACE group(P＜0.05). Logistic regression analysis showed that age, HEART score and GRACE score were independent risk factors for 30-day MACE in patients with acute non-traumatic chest pain. ROC curves of HEART score and GRACE score were drawn to predict 30-day MACE in patients with chest pain. The area under the curve of HEART score was higher than that of GRACE score(P＜0.05). The incidence of MACE in high-risk group by HEART score was higher than that in high-risk group by GRACE score, the incidence of MACE in moderate-risk group by HEART score was higher than that in moderate-risk group by GRACE score, and the incidence of MACE in low-risk group was lower than that in low-risk group by GRACE score(P＜0.05). This suggested that patients rated as low risk according to the HEART score had a lower risk of MACE, and those rates as moderate or high risk had a higher risk of MACE. 
    Conclusion  HEART score has a high clinical value in predicting 30-day MACE in the patients with acute non-traumatic chest pain. 

    Effect of aerobic exercise on immunity and circulation of patients with chronic obstructive pulmonary disease at stable stage
    ZHANG Zi-nan, LI Kun-peng, CHEN Hao, XIAO Lin, FENG Ying
    2021, 42(6):  661-664.  doi:10.3969/j.issn.1007-3205.2021.06.009
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    Objective  To investigate the effect of aerobic exercise on peripheral blood T and B lymphocyte subsets，pulmonary circulation and systemic circulation of patients with chronic obstructive pulmonary disease(COPD) at stable stage. 
    Methods  A total of 98 patients with COPD at stable stage treated were selected as the research subjects, and they were randomly divided into control group（routine intervention group） and observation group（routine intervention and aerobic exercise group）, with 49 cases in each group. Then the peripheral blood T lymphocyte subsets（CD3+， CD4+ and CD8+） and B lymphocyte subsets（CD19+， CD5+ and CD20+）， pulmonary circulation indexes（mean pulmonary arterial pressure and pulmonary vascular resistance） and systemic circulation indexes（mean systemic arterial pressure and peripheral vascular resistance） of two groups at different time points before and after the intervention were compared. 
    Results  The peripheral blood T lymphocyte subsets，peripheral blood B lymphocyte subset，pulmonary circulation indexes and systemic circulation indexes SVR of observation group at 6 and 12 weeks after the intervention were all significantly better than those of control group，and there were statistically significant differences（P＜0.05）. 
    Conclusion  The effect of aerobic exercise on peripheral blood T and B lymphocyte subsets，pulmonary circulation and systemic circulation of patients with COPD at stable stage is relatively better，and it has a higher application value in the patients with COPD at stable stage. 

    Diagnostic value of combined detection of four coagulation indices and serum tumor markers in hepatitis B-related liver cancer
    LIN Ling, YU Shan-chun, LIU Cong-yao
    2021, 42(6):  665-670.  doi:10.3969/j.issn.1007-3205.2021.06.010
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    Objective  To analyze the diagnostic value of combined detection of four coagulation  indices and serum tumor markers in hepatitis B-related liver cancer. 
    Methods  A total of 20 patients with hepatitis B-related liver cancer(liver cancer group), 35 patients with liver cirrhosis(cirrhosis group), and 76 patients with hepatitis B(hepatitis B group) were selected as the research subjects. The baseline data, hepatitis B virus infection-related indicators, detection results of four coagulation indices［prothrombin time(PT), activated partial thromboplastin time(APTT), thrombin time(TT), fibrinogen(FIB)］, liver function ［total bilirubin(TBIL), alanine aminotransferase(ALT), aspartate aminotransferase(AST), alkaline phosphatase(ALP), glutamyl transpeptidase(GGT)］, serum tumor markers ［alpha fetoprotein(AFP), carbohydrate antigen 199(CA199), α-L-fucosidase(AFU), thrombin-sensitive protein, tumor necrosis factor-α(TNF-α), vascular endothelial growth factor(VEGF)］ were collected. The receiver operating characteristic curve(ROC) was used to analyze the diagnostic efficiency of four coagulation indices and serum tumor markers. 
    Results  The positive rate of HBeAg and HBV-DNA were lower in liver cancer group than in cirrhosis group and hepatitis B group, and lower in cirrhosis group than in hepatitis B group, suggesting significant difference(P＜0.05). TBIL, ALT, ALP and GGT were higher in liver cancer group than in cirrhosis group and hepatitis B group, and higher in cirrhosis group than in hepatitis B group, while AST was lower in liver cancer group than in cirrhosis group and hepatitis B group, and lower in cirrhosis group than in hepatitis B group, with significant difference(P＜0.05). The PT, APTT and TT of liver cancer group were shorter than those of liver cirrhosis group and longer than hepatitis B group. FIB in liver cancer group was higher than that of liver cirrhosis group and lower than that of hepatitis B group. The PT, APTT and TT of liver cirrhosis group were longer, and the FIB was lower, as compared with those of hepatitis B group, suggesting significant difference(P＜0.05). The serum AFP, CA199, AFU, TNF-α, and VEGF levels in liver cancer group were higher than those in cirrhosis group and hepatitis B group; serum AFP in liver cirrhosis group was higher and CA199 and VEGF levels were lower than those in hepatitis B group, with significant difference(P＜0.05). ROC curve analysis showed that four coagulation indices and serum tumor markers alone had predictive value for hepatitis B-related liver cancer(AUC＞0.5). The sensitivity, specificity and accuracy of combined detection of  four coagulation indices and five serum tumor markers were the best, which were 0.83, 0.79 and 0.80 respectively, and AUC was 0.865. 
    Conclusion  The four coagulation indices and serum tumor markers have good predictive value for hepatitis B-related liver cancer, which is worthy of clinical promotion and practice.

    Correlation between serum osteosclerotin and mineral and bone disorder in patients with chronic kidney disease
    WANG Han, CHEN Wei-dong, DING Zhi-zhen, CHEN Yan
    2021, 42(6):  671-675,694.  doi:10.3969/j.issn.1007-3205.2021.06.011
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    Objective  To explore the correlation between serum sclerostin(SOST) and CKD-mineral and bone disorder(CKD-MBD) in patients with chronic kidney disease(CKD). 
    Methods  A total of 120 patients with CKD stage 3-5 were selected and divided into CKD stage 3 group(n=40), CKD stage 4 group(n=40) and CKD stage 5 group(n=40) according to different stages of CKD. In addition, 40 age-and gender-matched healthy subjects who underwent physical examination were selected as the control group. The estimated glomerular filtration rate(eGFR), serum creatinine(SCr), blood urea nitrogen(BUN), hemoglobin(Hb) levels were compared in each group. The blood calcium(Ca), blood phosphorus(P), calcium phosphorus product(Ca·P), alkaline phosphatase(AKP), albumin(ALB) levels, and bone mineral density(BMD) were compared. The SOST, levels of intact parathyroid hormone(iPTH), 25-hydroxy vitamin D3［25-（OH）D3］ were observed, and the correlation between SOST and laboratory indexes was analyzed. 
    Results  Compared with the control group, eGFR, Hb, and 25-（OH）D3 were significantly decreased, while SCr, BUN, SOST, and iPTH were significantly increased in CKD stage 3-5 groups(P＜0.05). Compared with CKD stage 3 group, eGFR, Hb, and 25-（OH）D3 were significantly decreased and SCr, BUN, SOST, and iPTH were significantly increased in CKD stage 4 and 5 groups(P＜0.05). Compared with CKD stage 4 group, eGFR, Hb, and 25-（OH）D3 were significantly decreased and SCr, BUN, SOST, and iPTH were significantly increased in CKD stage 5 group(P＜0.05). Compared with the control group, Ca, ALB and BMD in CKD stage 3 group were significantly decreased(P＜0.05). Ca, ALB and BMD in CKD stage 4 group were significantly decreased, and P, and Ca·P were significantly increased, as compared with the control group(P＜0.05). Ca, ALB and BMD in CKD stage 5 group were significantly lower and P, Ca·P, and AKP were significantly higher than those in the control group(P＜0.05). Compared with CKD stage 3 group, Ca and BMD in CKD stage 4 group was significantly decreased, while P, Ca·P, and AKP were significantly increased(P＜0.05). Ca and BMD were significantly lower and P and Ca·P were significantly higher in CKD stage 5 group than in CKD stage 3 group(P＜0.05). Ca and BMD decreased significantly and P, Ca·P, and AKP increased significantly in CKD stage 5 group, as compared with CKD stage 4 group(P＜0.05). SOST in patients with CKD stage 3-5 groups was negatively correlated with eGFR, Hb, Ca, 25-（OH）D3 and BMD(r=- 0.910, -0.660, -0.426, -0.393, -0.223, P＜0.05), and positively correlated with SCr, P, Ca·P, and iPTH(r=0.610, 0.640, 0.548, 0.404, P＜0.05). 
    Conclusion  The serum level of SOST in patients with CKD stage 3-5 is increased with the increase of clinical stage, and is closely related to BMD and bone mineral metabolism indexes, such as Ca, P, Ca·P, iPTH and 25-（OH）D3, suggesting that it can be used as a reliable index to predict CKD-MBD.

    Analysis on effect of laparoscopic bariatric and metabolic surgery on metabolic syndrome
    HAN Xiao-kai, HAN Xiao-hua, ZHANG Jian-e, LI Tao, XUE Han-yue, KANG Jian-sheng
    2021, 42(6):  676-679,685.  doi:10.3969/j.issn.1007-3205.2021.06.012
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    Objective  To explore the efficacy of laparoscopic bariatric and metabolic surgery for patients with metabolic syndrome and itseffect. 
    Methods  The clinical data of 100 patients with metabolic syndrome who underwent laparoscopic bariatric and metabolic surgery were retrospectively analyzed. Body weight, body mass index(BMI), percentage of excess body weight, triglyceride(TC), high density lipoprotein(HDL), fasting plasma glucose(FPG), glycosylated hemoglobin(HbA1c), homeostasis model assessment insulin resistance index(HOMA-IR), Epworth sleepiness scale(ESS), lowest arterial O2 saturation(LSaO2), as well as improvement of type 2 diabetes mellitus(T2DM), hypertension, fatty liver and knee joint degeneration were recorded before and at 1 year after surgery. 
    Results  The surgery was successfully completed for all 100 patients. The body weight, BMI, TC, FPG, HbA1c, HOMA-IR, and ESS scores of patient were gradually decreased after operation. The body weight and BMI at 3, 6 and 12 months after operation were significantly lower than those before operation. The TC at 6 and 12 months after operation was significantly lower than that before operation. FPG, HbA1c and HOMA-IR at 1, 3, 6 and 12 months after operation were significantly lower than those before operation. The ESS scores at 3, 6 and 12 months after operation were significantly lower than those before operation, and the difference was statistically significant(P＜0.05). HDL and LSaO2 of patient were increased gradually after operation; HDL at 6 and 12 months after operation was significantly higher than that before operation, and LSaO2 at 3, 6 and 12 months after operation was significantly higher than that before operation, suggesting significant differences(P＜0.05). At 12 months after operation, the incidence of T2DM, hypertension, fatty liver and degenerative change of joint were significantly lower than that before operation, and the difference was statistically significant(P＜0.05). 
    Conclusion  Laparoscopic bariatric and metabolic surgery are safe, reliable and effective in the treatment of obesity-associated metabolic syndrome.

    Clinical observation of RPVBT combined with internal iliac artery chemoembolization in the treatment of muscle-invasive bladder cancer of elderly and high-risk patients
    REN Xing-fei, FENG Jin-shun, LI Shi-xiang, FEI Xing-ye, ZHANG Tong-qing, Ge Yong-chao
    2021, 42(6):  680-685.  doi:10.3969/j.issn.1007-3205.2021.06.013
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    Objective  To investigate the clinical efficacy and safety of radical transurethral photoselective vaporization of bladder tumors (RPVBT) combined with internal iliac artery chemoembolization in the treatment of muscle-invasive bladder cancer(T2N0M0) in elderly and high-risk patients. 
    Methods  The clinical data were collected from 108 patients with muscle-invasive bladder cancer(T2N0M0), who chose to undergo RPVBT or radical transurethral resection ofbladder tumors(RTURBT) combined with internal iliac artery chemoembolization due to intolerance or reluctance to undergo radical cystectomy(RC).According to different types of surgical methods performed, they were divided into the RTURBT group(n=47) and the RPVBT group(n=61). The duration of operation, intraoperative blood loss, obturator nerve reflex, length of hospital stay, survival rate, recurrence rate and overall incidence of adverse effects after internal iliac artery chemoembolization were analyzed and compared between the two groups. Overall survival(OS)and progression-free survival(PFS) curves were drawn. 
    Results  There were no statistically significant differences between the RPVBT group and the RTURBT group in terms of age, Karnofsky score, maximum tumor diameter, tumor number, location for tumor distribution, pathological grade composition, and gender composition(P＞0.05). In the RPVBT group, the observed variables of intraoperative blood loss, duration of operation, postoperative hematuria days, and length of hospital stay were significantly less or shorter than those in the RTURBT group, and no obturator nerve reflex occurred, suggesting significant differences(P＜0.001). The 5-year cumulative survival rate, PFS rate, and cumulative recurrence rate were 68.0%, 43.3%, and 38.9% in the RPVBT group, and 69.8%, 47.8%, and 45.2% in the RTURBT group, respectively, and there was no statistically significant difference between two groups(P＞0.05). The recurrence characteristics of the two groups were mainly non-invasive recurrence(46.8% vs. 42.6%), and the recurrence rate of muscular invasive bladder cancer was lower(4.3% vs. 4.9%). The adverse reactions overall related to internal iliac artery chemoembolization were low, with good tolerance. 
    Conclusion  RPVBT combined with internal iliac artery chemoembolization is more minimally invasive, which has low complications, good tolerance, good safety and effectiveness in the treatment of muscle-invasive bladder cancer. With a satisfactory long-term OS rate, RPVBT can be used as a treatment strategy for high-risk elderly patients who are intolerant or unwilling to undergo radical surgery.

    Application of three-dimensional digital reconstruction of pelvic anatomy in the endoscopic surgery of gynecological benign tumors
    DONG Yun, ZHU Chun-li, YUAN Huan-zhang, LI Jia-shi
    2021, 42(6):  686-689.  doi:10.3969/j.issn.1007-3205.2021.06.014
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    Objective  To explore clinical application of three-dimensional(3-D) digital reconstruction of pelvic anatomy in endoscopic surgery for gynecological benign tumors. 
    Methods  A total of 80 patients with benign tumors that were treated by endoscopic surgery were enrolled, and in the control group, a retrospective analysis method was used to select 80 patients with gynecological benign tumors treated in our hospital. The patients in the control group underwent routine endoscopic surgery, while the patients in the observation group underwent endoscopic surgery on the basis of 3-D digital reconstruction of pelvic anatomy. The diagnosis rate, postoperative cure rate, duration of operation, incidence of complications, duration of hospitalization, blood loss, hospitalization expenses and patient compliance were compared between the two groups. 
    Results  The diagnosis rate and cure rate in the observation group was higher than those in the control group(P＜0.05). The duration of operation and hospitalization, blood loss during operation and the probability of complications in the observation group were lower than those in the control group, and the compliance of the patients in the observation group was good(P＜0.05). 
    Conclusion  The 3-D digital model of pelvic cavity, which can be used for preoperative evaluation and development of surgical plan of minimally invasive surgery and endoscopic surgery, can provide effective auxiliary means to shorten duration of operation, reduce blood loss and urinary system injury, and shorten duration of hospitalization, gradually ensuring the clinical guidance and assistance of core technology in digital medicine in clinical practice.

    Correlation of abnormal methylation of the IL-12B gene promoter region with the risk of ovarian endometriosis
    ZHAO Wei, LI Yan, HAO Ya-li, ZHANG Hai-bo, KANG Shan
    2021, 42(6):  690-694.  doi:10.3969/j.issn.1007-3205.2021.06.015
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    Objective  To investigate the methylation status of interleukin-12B（IL-12B） gene promoter region and its mRNA expression level in ectopic endometrium and normal endometrium, and to analyze its role in ovarian endometriosis. 
    Methods  A pyrosequencing assay was used to analyse the methylation levels of IL-12B gene promoter region in ectopic endometrium of 50 patients with role in ovarian endometriosis and normal endometrium of 44 control women. The mRNA expression of IL-12B gene was detected by quantitative real-time PCR(qRT-PCR). 
    Results  The methylation levels of the IL-12B gene promoter region in ectopic endometrium were significantly lower than those in normal endometrium(P＜0.001). mRNA levels of IL-12B gene were significantly increased in ectopic endometrium compared to those in normal endometrium(P＜0.001). Correlation analysis showed that the methylation levels of the IL-12B gene promoter region were negatively correlated with its mRNA levels(P＜0.001). 
    Conclusion  The aberrant methylation of the IL-12B gene promoter region may play an important role in the occurrence and development of ovarian endometriosis by affecting its mRNA expression level. 

    Effects of different tube feeding methods on nutritional status, swallowing function and complications of stroke patients
    WU Lei, CHEN Hai-shan, ZHENG Qing-hua
    2021, 42(6):  695-697,703.  doi:10.3969/j.issn.1007-3205.2021.06.016
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    Objective  To investigate the effect of continuous nasogastric tube feeding and intermittent tube feeding on nutritional status, swallowing function and complications of stroke patients with dysphagia. 
    Methods  A total of 88 patients who had dysphagia after stroke were selected as the research subjects. These subjects were randomly divided into observation group(n=44) and control group(n=44). Both groups received routine swallowing function training.On this basis, the control group was given continuous nasogastric tube feeding, while the observation group was given respiratory function training and intermittent oral to esophageal tube feeding. The clinical efficacy, nutritional status and complications of the two groups were compared. 
    Results  A total of 88 patients who had dysphagia after stroke were selected as the research subjects. These subjects were randomly divided into observation group(n=44) and control group(n=44). Both groups received routine swallowing function training. On this basis, the control group was given continuous nasogastric tube feeding, while the observation group was given respiratory function training and intermittent oral to esophageal tube feeding. The clinical efficacy, nutritional status and complications of the two groups were compared. 
    Conclusion  Intermittent tube feeding combined with respiratory function training can improve the swallowing function and nutritional status of stroke patients with dysphagia, and reduce the complications of aspiration and nasal mucosa injury. 

    The value of lung ultrasound score and simplified clinical pulmonary infection score in early diagnosis and prognostic evaluation of VAP
    ZHAO Yuan-zhu, LIU Dan, LIN Ming-ming
    2021, 42(6):  698-703.  doi:10.3969/j.issn.1007-3205.2021.06.017
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    Objective  To analyze the value of lung ultrasound score(LUS) and simplified clinical pulmonary infection score(sCPIS) in early diagnosis and prognosis evaluation of VAP. 
    Methods  A total of 100 hospitalized patients in ICU with ventilator-associated pneumonia(VAP) were selected. All patients underwent evaluation by LUS and sCPIS to observe the diagnostic accuracy of LUS and sCPIS in VAP. The LUS and sCPIS at different time of treatment as well as the changes in WBC, PCT and hs-CRP were observed, and the predictive value of LUS and sCPIS in the prognosis of VAP patients was analyzed. 
    Results  LUS, sCPIS, and chest CT were of high accuracy in the diagnosis of VAP, however, there was no significant difference among them(P＞0.05). LUS and sCPIS as well as WBC, PCT and hs-CRP at 7 d after treatment were significantly lower than those at 3 d after treatment and the difference was statistically significant(P＜0.05). Within 28 d of diagnosis, 26 of 100 patients died, and 74 cases survived. Multivariate Logistic regression analysis showed that the use of antibiotics, LUS, sCPIS, respiratory failure, insertion mode, WBC, PCT and hs-CRP were all related influencing factors for VAP in patients(P＜0.05). ROC curve analysis showed that the AUC of LUS and sCPIS for prognostic prediction of VAP was 0.912, and 0.824 respectively. The LUS was 95.9% and 73.1% respectively and the sCPIS was 86.5% and 73.1%, respectively. The accuracy of LUS was higher. 
    Conclusion  LUS  and sCPIS have good application value in early diagnosis and prognosis evaluation of VAP, and the application value of LUS in prognosis evaluation of VAP patients is higher, which is worthy of promotion and popularization. 

    Comparative study of the effects of remazolam and midazolam on postoperative cognitive function of patients undergoing laparoscopic cholecystectomy under general anesthesia
    QIAN Huan-li, LI Yuan-hai, HE Chuan
    2021, 42(6):  704-707,712.  doi:10.3969/j.issn.1007-3205.2021.06.018
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    Objective  To study the effect of remazolam and midazolam on postoperative cognitive function of patients undergoing laparoscopic cholecystectomy(LC) under general anesthesia. 
    Methods  A total of 160 patients undergoing LC under general anesthesia were divided into observation group(n=80) and control group(n=80) according to random number table method. In the observation group, 0.30 mg/kg remazzolam, 0.50 μg/kg sufentanil and 0.60 mg/kg rocuronium were injected intravenously during anesthesia induction. In the control group, 0.05 mg/kg midazolam, 0.50 μg/kg sufentanil and 0.60 mg/kg rocuronium were used during anesthesia induction. The changes of mean arterial pressure(MAP) and heart rate(HR) were recorded at anesthesia induction(T0), bispectral index＜60(T1) and after intubation(T2). Eye opening time, extubation time and duration of postanesthesia care unit(PACU) stay after anesthesia, score level of mini-mental state examination(MMSE) before operation, at 24 h and 72 h after operation, and incidence of postoperative adverse reactions were recorded. 
    Results  The MAP of the two groups was decreased first and then increased, while the change range of MAP in the observation group was smaller than that in the control group, while HR in the observation group was increased gradually. There were significant differences in interaction between groups, time points and time points between groups(P＜0.05). The eye opening time, extubation time and duration of PACU stay of patients in the observation group were significantly shorter than those in the control group, suggesting significant difference(P＜0.05). The MMSE scores of the two groups were decreased initially and then increased. The change range of MMSE scores of the observation group was smaller than that of the control group, and there were significant differences in interaction between groups, time points and time points between groups(P＜0.05). The incidence of hypotension in the observation group was lower than that in the control group, and the difference was statistically significant(P＜0.05). There was no significant difference in the incidence of respiratory depression, restlessness, dizziness, headache and sleepiness between two groups(P＞0.05). 
    Conclusion  Compared with midazolam, remazolam has better safety, less influence on cognitive function, faster recovery from anesthesia and fewer adverse reactions in LC.

    Study on the drug resistance of Pseudomonas aeruginosa from the respiratory tract in the ICU and its drug resistance genotyping
    WANG Li-xia, WANG Yun-chang, LI Rong-rong, ZHANG Jie-li, AN Jing, LI Yu-rong
    2021, 42(6):  708-712.  doi:10.3969/j.issn.1007-3205.2021.06.019
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    Objective  To investigate the drug resistance of Pseudomonas aeruginosa(PA) infection and characteristics of drug resistance genotyping in intensive care unit(ICU), and to provide reference for clinical treatment. 
    Methods  The PA isolated from clinical specimens submitted for examination in the ICU ward of the Second Affiliated Hospital of Xingtai Medical College was collected. The sensitivity test was used to detect the sensitivity of PA to antibacterial drugs, and the drug-resistant genotype was detected by polymerase chain reaction(PCR). 
    Results  A total of 42 strains of PA strains from lower respiratory tract were screened for this study. The resistance rate of PA to amikacin, tobramycin, imipenem and polymyxin B was less than 30%. The resistance rate to gentamicin, levofloxacin, piperacillin, tazobactam, cefepime and ceftazidime was between 30.0% and 40.0%, the resistance rate to ciprofloxacin, meropenem and aztreonam was more than 40.0%, and to polymyxin B was 0.0%, and the sensitivity rate was 100%. The blaCTX-M-1 gene carrying rate of the extended-spectrum β-lactamase-related resistance gene was 7.1%(3/42), the blaIMP gene carrying rate of the carbapenem-related resistance genes was 19.0%(8/42) ), and blaOXA-1 gene carrying rate was 16.7%(7/42). Carrying rate of Aminoglycoside-related drug resistance gene carrying aac(6′)-Ⅰb gene was 23.8%(10/42), and that carrying ant(2″)-Ⅰa was 19.0%(8/42). The efflux pump gene OprD2 deletion rate was 19.0%(8/42), and the classⅠintegron carrying rate was 23.8%(10/42). 
    Conclusion  PA infections in ICU wards are mainly found in the respiratory tract. Except for amikacin, tobramycin, imipenem and polymyxin B, the resistance rate to other drugs is relatively high, and antibacterial drugs should be used rationally based on drug sensitivity tests. PA-related drug resistance genes are mainly aac(6′)-Ⅰb and class Ⅰ integrons, which are conducive to the study of resistance reversal mechanisms.

    Analysis on the distribution of pathogen and characteristics of infection with resistant bacteria in bile culture
    LU Yan-fei, JIN Fei, ZHANG Xiao-hui, NI Fang , XIA Wen-ying
    2021, 42(6):  713-717.  doi:10.3969/j.issn.1007-3205.2021.06.020
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    Objective  To analyze the distribution and characteristics of drug resistanceof pathogenic bacteria in bile culture in the First Affiliated Hospital of Nanjing Medical University, so as to provide evidence for diagnosis and treatment of biliary tract infection. 
    Methods  A total of 1 264 strains of pathogenic bacteria isolated from clinical bile specimens and clinical data of patients with infected by drug-resistant bacteria in our hospital were analyzed retrospectively. VITEK-2 Compactautomatic microbial identification and drug susceptibility systemwas used for the identification of bacteria and drug susceptibility test, and the drug sensitivity analysis was performed by WHONET 5.6 software, while SPSS 22.0 software was used to analyze the prognosis of resistant bacterial infection. 
    Results  A total of 1 264 positive strains were isolated from clinical bile culture with a positive culture rate of 32.1%. 780(61.7%) gram-negativestrains and 417(33.0%) and gram-positive strains were identified, with 67(5.3%) strains of fungi. Escherichia coli(25.9%), Klebsiella pneumoniae(10.9%), Enterococcus faecalis(11.7%) and Enterococcus faecalis(8.9%) were the main strains. Drug sensitivity test results showed that the sensitivity of Enterobacteriaceae bacteria to carbapenems, aminoglycosides and piperacillin/tazobactam was high(>59.9%); Pseudomonas aeruginosa was highly sensitiveto the remaining antibacterial drugs(>52.6%) except for ampicillin/sulbacillin and cotrimoxazole; the sensitivity of Acinetobacter baumannii to common antibiotics was less than 47.4%; Enterococcus is highly sensitive to high concentration of gentamicin, high concentration of streptomycin, linezolid and vancomycin(>63.3%).No vancomycin-resistant enterococcus was found except for Enterococcus naturally resistant to vancomycin. A total of 50 strains of Carbapenem-Resistant Enterobacteriaceae(CRE)were isolated, of which 62.0% were klebsiella pneumoniae and 26.0% were Escherichia coli. Most of the patients with biliary tract infection of CRE were male, aged over 50 years, with malignant tumor, liver transplantation, trauma and other serious primary diseases, with a history of surgery and bile drainage, and combinedbloodstream infection. The prognosis of patients with positive CRE cultured in bile was affected by the type of CRE bacteria and presence or absence of gastrointestinal hemorrhage, among which Carbapenem-Resistant Klebsiella pneumoniae(CR-KPN) was an independent risk factor for poor prognosis in patients with CRE cultured from bile. 
    Conclusion  Enterobacteriaceae bacteria and Enterococcus bacteria are the main pathogens for biliary tract infection in our hospital, and biliary infections of CRE are severe. In clinical practice, clinicians should focus on the prevention of multiple drug-resistant bacteria，evaluate the prognosis according to the type of CRE and provide timely intervention. In addition,high-risk patients should be actively screened forearly removal of colonization resistant bacteria, to reduce the mortality of biliary tract infections.