Table of Content

25 July 2021, Volume 42 Issue 7

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Neuroprotective effect of cerebral ischemic preconditioning by enhancing the level of autophagy

SUN Yuan, HOU Xiao-dong, YANG Yan-wen, LI Yan-ling, LI Hong, SHI Qiu-yan

2021, 42(7):  750-753,764,封三.  doi:10.3969/j.issn.1007-3205.2021.07.002

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Objective To explore the neuroprotective mechanism of autophagy involved in cerebral ischemic preconditioning. 
Methods The model of cerebral ischemia and reperfusion in rats was made by the thread plug method. A total of 100 adult SD rats were randomly divided into sham operation group(group A), ischemia-reperfusion group(group B), ischemic preconditioning group(group C), ischemia-reperfusion+autophagy inhibitor 3-Methyladenine(3-MA) group(group D), and ischemic preconditioning+3-MA group(groupE). The rats in groups D and E were injected with 3-MA(7.5 μg) into the lateral ventricle, and the rats in the other three groups were injected with the same volume of normal saline. The cerebral infarction volume, neurological deficit score, autophagy system expression level and neuronal apoptosis in each group were observed. 
Results The scores of cerebral infarction volume and neurological dysfunction in group A were both 0; the cerebral infarction volume and neurological dysfunction scores of group C were smaller or lower than those of group B; the cerebral infarction volume and neurological dysfunction scores of group D were greater than those of group B and smaller than those of group C; cerebral infarction volume and neurological dysfunction scores in group E were greater than those of group C and smaller than those of group D, suggesting significant difference(P＞0.05). Observation of neurons under an optical microscope showed that a large number of neurons and complete morphology in group A; the remaining four groups had a small number, with morphological damage, rupture and pyknosis of the nucleus, the most serious of which were group B and C. The number of neurons in group D and E was more than that in group B and C, and cell edema and nuclear damage were less. There was less expression of Beclin-1, LC3-Ⅱ and TUNEL staining-positive cells in group A, while Beclin-1, LC3-Ⅱ and TUNEL staining-positive cells in the remaining 4 groups had more expression. The number of Beclin-1, LC3-Ⅱ positive cells in group C was greater than that of group B, and the number of TUNEL staining-positive cells was less than that of group B; the number of Beclin-1, LC3-Ⅱ positive cells and the number of TUNEL staining-positive cells in group D were less than those of group B and C. The number of TUNEL staining-positive cells was greater than that of groups B and C; the number of Beclin-1 and LC3-Ⅱ positive cells in group E was less than that of group C, and the number of TUNEL staining-positive cells was less than that of group D, suggesting significant difference(P＜0.05). 
Conclusion After ischemic preconditioning, the ability of cell autophagy is strengthened, inhibiting neuronal apoptosis, and protecting intracranial neurons after ischemia-reperfusion. 





The protective effect of N-acetylcysteine against PM2.5-induced testicular toxicity

TIAN Shuo, ZHANG Ning, NIU Shu, LI Shen, SU Li, PING Fen

2021, 42(7):  754-758,778.  doi:10.3969/j.issn.1007-3205.2021.07.003

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Objective To investigate the effect of N-acetylcysteine(NAC) on ameliorating testicular injury of rats caused by subacute exposure to atmospheric fine particulate matter(PM2.5). 
Methods A total of 30 Wistar rats were randomly divided into three groups:saline control group, PM2.5 exposure group and PM2.5+NAC group. The rats in PM2.5 exposure group were exposed to a dose of 5.0 mg/kg PM2.5 suspension by intratracheal instillation, once a week for 8 weeks. Rats in the PM2.5+NAC groups were given 150 mg·kg-1·d-1 NAC by intragastric gavage continuously on the basis of PM2.5 exposure. Saline control group was given the same volume of saline(1 mL/kg). After modeling, the pathological sections of testicular tissue were prepared by hematoxylin-eosin staining(HE). Terminal deoxynucleotidyl transferase dUTP nick end labeling(TUNEL) method was used to detect testicular apoptosis in rats. Superoxide dismutase(SOD), glutathione(GSH) and malondialdehyde(MDA) indicators were measured using spectrophotometer method. The levels of interleukin-10(IL-10) and testosterone were measured by enzyme-linked immunosorbent assay(ELISA) method.
Results Serum testosterone levels and testicular tissue GSH, SOD, IL-10 levels of rats in the PM2.5 exposure group and PM2.5+NAC group were lower than those in the saline control group, while MDA levels in the testicular tissue were increased; The testosterone levels and testicular tissue GSH, SOD, IL-10 levels were higher in the PM2.5+NAC group than in PM2.5 exposure group, while MDA level in testicular tissue was decreased(P＜0.05). In the PM2.5 exposure group, multiple nuclei in the seminiferous tubules showed obvious dark brown staining, and the TUNEL positive cell count was significantly higher than that of the saline control group and the PM2.5+NAC group(P＜0.05). The number of apoptotic cells in the PM2.5+NAC group was significantly lower than that of the PM2.5 control group, but higher than that of the saline control group(P＜0.05). The apoptosis index of testicular cells in the PM2.5 exposure group and PM2.5+NAC group was higher than that of the saline control group, and the index was lower in the PM2.5+NAC group than in the PM2.5 exposure group(P＜0.05). 
Conclusion Subacute exposure to PM2.5 can induce pathological injury of testicular tissue, testicular cell apoptosis, and changes in indicators of inflammation and oxidative stress. NAC, as an antioxidant, can obviously ameliorate PM2.5-induced testicular injury, and has an antagonistic effect on the PM2.5-induced toxic effects on the testis of rats. 





Inhibitory effect of aloin-chlorogenic acid mixture on Streptococcus mutans： an in vitro study

XUE Jing-xiu, LI Tao, MA Zhe, JIN Kai-lu, ZHAO Sha, ZHANG Yan-ning

2021, 42(7):  759-764.  doi:10.3969/j.issn.1007-3205.2021.07.004

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Objective To investigate the effects of a combination of aloin and chlorogenic acid on the growth, acid production, adhesion and biofilm formation of Streptococcus mutans(SM). 
Methods The minimum inhibitory concentration(MIC)  of aloin and chlorogenic acid against S.mutans were determined by liquid double micro-dilution method. MIC of mixed solution of aloin and chlorogenic acid against S.mutans was determined by the checkerboard dilution method. Fractional inhibitory concentration(FIC) index was used to evaluate the combined inhibitory effect of aloin and chlorogenic acid against S.mutans. The effect of mixed solution of aloin and chlorogenic acid, with 5 concentration gradients concentrations lower than MIC on the acid production of S.mutans, was also observed. The 24 h biofilm model of S.mutans was constructed in vitro, and MTT method was used to determine the amounts of biofilm adhesion after the above-mentioned mixture were applied for 24 h. The effects on biofilm structure and bacterial activities were observed by confocal laser scanning microscope(CLSM). 
Results When aloin and chlorogenic acid were used alone, the MIC was 0.63 g/L and 5 g/L respectively, respectively. Aloin 0.31 g/L combined with chlorogenic acid 2.5 g/L could reach MIC, with an FIC of 1. As the concentration of the mixture increased, the △pH and OD values of S.mutans was decreased(P＜0.05). CLSM showed that the structure of S.mutans biofilm became thinner and the number of live bacteria decreased with the increase of the concentrations of the mixed solution.   
Conclusion The combination of aloin and chlorogenic acid has an additive effect on the in vitro antibacterial activity of S.mutans, which can effectively inhibit the growth, acid production and adhesion of S.mutans at a lower concentration than the single component.





Experimental study of EPO on proliferation and protection of dental pulp cells under hypoxia

YIN Liang-liang, LI Chun-nian

2021, 42(7):  765-769.  doi:10.3969/j.issn.1007-3205.2021.07.005

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Objective To explore the methods of proliferation and protection of dental pulp cells under hypoxia by observing the effect of erythropoietin(EPO) on the proliferation and differentiation of dental pulp cells under hypoxic conditions, in order to provide experimental reference for the protection of dental pulp cells under hypoxia.  
Methods Pulp cells were isolated and subcultured from healthy intact teeth of patients under 18 years of age requiring tooth extraction due to orthodontics or impaction by modified tissue enzyme digestion. The patients were divided into two groups under hypoxic conditions. In the experimental group, 10% FBS DMEM medium containing 20 U/mL EPO was used to culture dental pulp cells, while in the control group, DMEM with 10% FBS was used. The oxygen concentration of the incubator was set to 1%, and CCK-8 was employed to detect the effects of EPO on the proliferation of dental pulp cells at 24 h, 48 h, 72 h after culture. Alkaline phosphatase(ALP) activity was used to detect the effects of EPO on the mineralization of dental pulp cells. 
Results Dental pulp cells were cultured under hypoxic conditions. The results of CCK-8 showed that the CCK-8 values of the EPO group were higher than those of the control group at 24 h, 48 h, and 72 h, and the difference was statistically significant(P＜0.05). The results of ALP for detecting the differentiation ability of dental pulp cells showed that there was no significant difference in absorbance between the experimental group and the control group at 24 h, 48 h and 72 h. 
Conclusion EPO can protect dental pulp cells under hypoxia, promote their proliferation and anti-inflammatory effects, which, therefore, can be used as a protective drug for dental pulp cells under hypoxia in clinical practice. 





Effect of thrombus aspiration during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction on myocardial reperfusion and clinical prognosis

ZHANG Fei-fei, SONG Xue-lian, XIE Yue-tao, LIU Li-tian, DANG Yi, QI Xiao-yong

2021, 42(7):  770-778.  doi:10.3969/j.issn.1007-3205.2021.07.006

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Objective To investigate the effect of thrombus aspiration during primary percutaneous coronary intervention(PPCI) in patients with ST-segment elevation myocardial infarction(STEMI) on myocardial reperfusion and clinical prognosis. 
Methods We retrospectively analyzed the clinical data of STEMI patients who underwent PPCI in Hebei General Hospital. Patients were divided into non-thrombus aspiration group(n=230) and thrombus aspiration group(n=216). Clinical data and incidence of postoperative slow blood flow/no-reflow were collected, and major adverse cardiovascular events(MACE), including cardiac death, re-myocardial infraction, target vessal revascularization, and stroke were recorded during 12-month follow-up. 
Results Compared with non-thrombus aspiration group, thrombus aspiration group showed higher use rate of thrombolysis in myocardial infarction(TIMI) thrombus load≥grade 4, preoperative TIMI blood flow <grade 3, intraoperative tirofiban and prourokinase, more intraoperative contrast agent, and lower rate of multivessel lesions(P＜05). Binary Logistic regression analysis showed that TIMI thrombus load ≥grade 4 and TIMI blood flow <grade 3 were the influencing factors of thrombus aspiration during PPCI(P＜0.05). Age(OR= 1.03,95%CI: 1.004-1.056, P=0.023) and contrast agent dosage(OR=1.004,95%CI: 1-1.008, P=0.047) were independent risk factors for no-reflow. The rate of thrombus aspiration in patients with slow flow/no-reflow was lower than that in patients with normal blood flow. Multivariate analysis showed that thrombus aspiration was not associated with slow flow/no-reflow in the whole population. Killip ≥ 2 and left main coronary artery disease were independent risk factors for MACE, while statins were protective factors for MACE; Killip ≥ 2 was an independent risk factor for cardiac death, while statins and ejection fraction were protective factors for cardiac death. Thrombus aspiration was a protective factor for no-reflow in patients with high thrombus load; Age and dosage of contrast agent were the risk factors of no-reflow in the population with high thrombus load. There was no-significant difference in MACE, cardiac death, recurrent myocardial infarction, target vessel reconstruction and ischemic stroke between the two groups at 12 months after operation(P＞0.05). There was no-significant difference in MACE and cardiac death by Kaplan Meier survival analysis between two groups. Cox regression analysis showed that thrombus aspiration was not the influencing factor of MACE and cardiac death in the population with high thrombus load. 
Conclusion Thrombus aspiration could reduce the incidence of slow flow/no-reflow in patients with high thrombus load, but could not improve clinical prognosis at 12 months after operation.





Comparison of the effect of allogeneic hematopoietic stem cell transplantation between human leucocyte antigen-matched donor and haploidentical donor on patients with transfusion-dependent non-severe aplastic anemia 

WANG Ying, WANG Fu-xu, MA Fu-tian, WEN Shu-peng, NIU Zhi-yun, ZHANG Xue-jun

2021, 42(7):  779-783.  doi:10.3969/j.issn.1007-3205.2021.07.007

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Objective To compare the effect of allogeneic hematopoietic stem cell transplantation(allo-HSCT) between human leucocyte antigen(HLA)-matched donor and haploidentical donor(HID) in the treatment of transfusion-dependent non-severe aplastic anemia(TD-NSAA). 
Methods Clinical data of 14 TD-NSAA patients treated with allo-HSCT were retrospectively analyzed, and they were divided into HID group and HLA-matched donor related or unrelated donor(MR/UD) group according to donor origin. Implantation rate, implantation time, transplantation-related death, transplantation-related complications, and overall survival(OS) of two groups were compared, and the efficacy of two methods in the treatment of TD-NSAA was evaluated. 
Results The incidence of acute graft-versus-host-disease(aGVHD) in HID group was higher than that in MR/UD group(P＜0.05), which was mainly reflected in aGVHD of Ⅰ-Ⅱ. There were no significant differences in medical history, hematopoietic stem cell count, survival time after hematopoietic stem cell transplant, chimeric status, transplant-related complications(except Ⅰ-Ⅱ aGVHD), 3-year OS,OS and disease-free survival between two groups(P＞0.05). 
Conclusion The efficacy of HID allo-HSCT in TD-NSAA is comparable to that of MR/UD, and HID allo-HSCT should be considered in patients who were not successfully matched in the myeloid bank or sibling donor. 





The relationship of the characteristics of bacterial infection of diabetic foot with lower extremity vascular disease and disease outcome

LIN Yang, YANG Wei-guang, ZHANG Bin, WANG Li-li, LI Ting-ting, WANG Xu-hong

2021, 42(7):  784-788.  doi:10.3969/j.issn.1007-3205.2021.07.008

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Objective To explore the relationship of the severity of diabetic foot infection with the severity of lower extremity vascular disease and disease outcome. 
Methods A total of 113 patients with diabetes and foot infection who were selected. According to the severity of the disease, the patients were divided into four groups: groups A, B, C and D, and the bacteria infection characteristics and disease outcome in four groups were analyzed. 
Results The comparison of age, diabetes course, ABI, and TBI of the four groups of patients was statistically significant(P＜0.05), and as the degree of lower extremity lesions worsened, age, diabetes course, neutrophil levels increased, and ABI and TBI levels decreased. Correlation analysis showed that the degree of lower extremity lesions was positively correlated with age, diabetes course and neutrophils, and negatively correlated with ABI and TBI. The gram-negative bacterial infections of the four groups were different(P＜0.05), and the gram-negative bacterial infections of group C and D were significantly more than those of group A and B(P＜0.05). The infections of group A were mainly non-gram-negative bacteria, and the infections of group B were mainly non-gram-negative bacteria. The comparison of the number of patients with mild infections and severe infections in four groups was statistically different(P＜0.05); the number of mild infections in group A was significantly higher than that in groups B, C and D(P＜0.05). The number of severe infections in group B and D was significantly higher than that in group A(P＜0.05). The number of mixed infections in four groups was statistically different(P＜0.05); the number of mixed infections in group A was significantly lower than that in groups C and D(P＜0.05), and the mixed infection in group B was significantly lower than that in group D(P＜0.05). The number of patients with healing, minor amputation, major amputation and death outcome of four groups was statistically significant(P＜0.05). The number of healed patients in group A was significantly higher than that in group B, C and D(P＜0.05), and the number of small amputations in group A was significantly lower than that in group C and D. 
Conclusion As the degree of vascular disease in the lower limbs of diabetic foot patients increases, the bacterial infection of the foot with gram-negative bacteria increases, the mixed infection increases, the chance of healing decreases, and the chances of small amputation, large amputation and death will increase.





Analysis of relationship between immune-related LncRNA and prognosis of breast cancer and establishment of prognostic risk model

WU An-shan, AI Hong-yan, LIAO Ni, YI Jian-sheng, TAN Mi-duo

2021, 42(7):  789-794.  doi:10.3969/j.issn.1007-3205.2021.07.009

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Objective To investigate the relationship between the expression of immune-related LncRNA and the prognosis of breast cancer, and to construct an immune-related LncRNA risk model for predicting prognosis of breast cancer. 
Methods The transcriptome data and clinicopathological information of breast cancer from the TCGA public database were downloaded, and the expression matrix of breast cancer data was extracted using Perl software. Immune-related LncRNA was extracted using the co-expression method via R language, and the prognosis-related LncRNA was screened by univariate and multivariate Cox regression analyses. According to the optimal AIC value, immune-related LncRNA for predicting prognosis was determined to construct a prognostic risk model, and the patients were divided into low-risk group and high-risk group according to the risk value. Kaplan-Meier analysis method was used for survival analysis and survival curves of patients in the two groups were drawn. ROC curve was used to evaluate the accuracy of the prognostic risk model, while univariate and multivariate Cox regression analyses were used to evaluate the correlation between the prognostic risk model and tumor prognosis. 
Results A total of 1 041 breast cancer samples were downloaded from TCGA data, and 14 142 LncRNA expression profiles were extracted. In addition, 644 immune-related LncRNAs were obtained by co-expression method. Fourteen LncRNAs were screened by the univariate Cox regression analysis of immune-related LncRNAs. The 14 LncRNAs were subjected to multivariate Cox regression analysis, and 6 LncRNAs were screened according to the optimal AIC value to construct a prognostic risk model. Patients were divided into low-risk and high-risk groups according to the risk value. Survival analysis showed that there were differences between the two groups of patients, and the AUC value of the prognostic risk model was 0.703, indicating that the model had good accuracy. Multivariate Cox regression analysis revealed that patient age and risk score were independent risk factors for breast cancer. 
Conclusion The immune-related LncRNA prognostic risk model is an independent risk factor for prognosis of breast cancer, which can effectively predict the survival prognosis of breast cancer patients and can be used as an independent prognostic biomarker for breast cancer.





Analysis of influencing factors of mental health of patients with breast cancer undergoing radiotherapy after breast-conserving surgery

WANG Xin, WANG Jin-hui, WANG Jian-hua, LI Jia, LIU Hao-ran

2021, 42(7):  795-798,836.  doi:10.3969/j.issn.1007-3205.2021.07.010

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Objective To investigate the influencing factors of mental health of breast cancer patients undergoing radiotherapy after breast-conserving surgery. 
Methods A total of 120 patients with breast cancer undergoing breast-conserving surgery were selected as the research subjects. All patients received radiotherapy after operation. The patients were investigated with Eysenck Personality Questionnaire(EPQ) before and after radiotherapy, and the changes of mental health status before and after radiotherapy were evaluated. Univariate and multivariate Logistic regression models were used to analyze the factors influencing the mental health status of patients after radiotherapy. 
Results The scores of P scale, N scale and L scale after radiotherapy were significantly lower than those before radiotherapy, while the score of E scale was significantly higher than that before radiotherapy, with significant difference(P＜0.001). P scale, E scale, N scale and L scale were used as dependent variables, and multivariate regression analysis was performed. It was shown that marital status, economic income, religious belief, tumor stage, tumor size, lymph node metastasis and family history were factors affecting the mental health of breast cancer patients after breast-conserving surgery. 
Conclusion Radiotherapy after breast-conserving surgery can help improve the mental health of patients with breast cancer. Marital status, economic income, religious belief, tumor stage, tumor size, lymph node metastasis and family history are the influencing factors of mental health status of breast cancer patients undergoing radiotherapy after breast-conserving surgery. 








Efficacy analysis of microvascular decompression for primary trigeminal neuralgia

TANG Xiao-yu, WU Jian-dong, MA Mian, DENG Peng, WU Gang

2021, 42(7):  799-802.  doi:10.3969/j.issn.1007-3205.2021.07.011

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Objective To investigate the therapeutic effect of microvascular decompression(MVD) for the patients with primary trigeminal neuralgia(PTN) and related factors leading to postoperative complications. 
Methods The clinical data of 30 patients undergoing MVD for PTN in our hospital were retrospectively analyzed. 
Results The pain of 26 patients was completely relieved after the procedure of MVD, and the overall remission rate was 86.67%. The compressive vessels confirmed during the procedure were superior cerebellar arteries(SCAs)（14/30), anterior inferior cerebellar arteries (AICAs) (7/30), superior petrosal veins(SPVs) and its branches（6/30). Neurovascular compression absence was found in 3 cases. In terms of complications, low intracranial pressure syndrome occurred in 5 cases postoperatively and cerebrospinal fluid rhinorrhea was found in 1 case. Recurrence rate was 3.33%(1/30) during an average follow-up of (20.53±12.41) months. 
Conclusion MVD is a convenient and effective strategy for PTN patients with a low rate of recurrence. SCAs and AICAs are the most common responsible vessels. The responsible vessels should be carefully identified and the trigeminal nerve should be decompressed totally. Postoperative complications such as low intracranial pressure syndrome and cerebrospinal fluid rhinorrhea should be avoided.





The effect of pattern of cortical support on functional prognosis in patients with proximal humeral fractures

WANG Kai, LI Ning, GUO Jia-liang, SONG Zhao-hui

2021, 42(7):  803-806，831.  doi:10.3969/j.issn.1007-3205.2021.07.012

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Objective To compare different medial cortical support patterns after operation for proximal humeral fracture, and to determine the effect of medial cortical support on the functional recovery by recording functional prognosis. 
Methods A total of 87 patients with proximal humeral fracture(non-comminuted fracture ofmedial column) were enrolled, including 38 patients in positive support group, and 49 patients in negative support group. Oxford shoulder score(OSS), disabilities of arm, shoulder and hand(DASH) and visual analogue scale(VAS) scores were evaluated after operation. 
Results There were no significant differences in OSS, DASH and VAS score in positive and negative cortical support groups at 6 and 12 months after operation. 
Conclusion After proximal humeral surgery, positive or negative support will not significantly affect the postoperative functional prognosis of patients with non-comminuted fracture of medial column. Therefore, for the non-weight-bearing joint of the proximal humerus, medial cortical support should permit anatomical reduction. If not, short-term follow-up shows that it will not have a serious impact on the functional prognosis. 





Expression of ING4 protein in hydatidiform mole and its relationship with microvessel density

XU Xiao-yan, PANG Yi-cun, MA Xiao-lin, HAO Hong-juan

2021, 42(7):  807-812.  doi:10.3969/j.issn.1007-3205.2021.07.013

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Objective To explore the relationship between expression of inhibitor of growth family member 4（ING4） protein and microvessel density in hydatidiform mole(HM) and the clinical significance. 
Methods Immunohistochemistry(PV method) was performed to detect the expression of the ING4 protein and microvessel density in HM tissue and the tissues of chorionic villi of normal early pregnancy. They were divided into hydatidiform mole group(n=30) and chorionic villi of normal early pregnancy group(n=20). 
Results The expression of ING4 protein was lower in HM group than in chorionic villi of normal early pregnancy group, and significantly lower in complete hydatidiform mole(CHM) group and partial hydatidiform mole(PHM) group than in chorionic villi of normal early pregnancy group(P＜0.05). There was no significant difference in ING4 protein expression between CHM group and PHM group(P＞0.05). The expression of ING4 protein in the groups with and without high-risk factors was lower than that in the chorionic villi of normal early pregnancy group(P＜0.05). There was no significant difference in ING4 protein expression between the groups without high-risk factors and those with high-risk factors(P＞0.05). The results of univariate analysis showed that the expression of ING4 protein in HM tissue was not related to clinical high-risk factors(P＞0.05). The MVD value of the chorionic villi of normal early pregnancy group was higher than that of the HM group, and lower in the PHM group and the CHM group than in chorionic villi of normal early pregnancy group, and the value in the PHM group was higher than that of the CHM group(P＜0.05). The MVD values of the groups with or without high-risk factors were lower than those in chorionic villi of normal early pregnancy group, and the value in the group with high-risk factors was higher than that of the group without high-risk factors(P＜0.05). The results of univariate analysis showed that the MVD value in HM tissue was not associated with clinical high-risk factors(P＞0.05). The expression of ING4 protein in HM tissue was not correlated with MVD(r=0.137, P=0.470). 
Conclusion The ectopic and downregulated expression of ING4 protein promotes the occurrence of HM. ING4 protein expression is not associated with clinical risk factors. The absence of blood vessels in HM tissue is involved in the development of HM, and is not related to clinical high-risk factors. ING4 protein expression in HM tissue has no significant correlation with MVD.





Dosimetry and efficacy study of Rapid Arc plan and 5F-IMRT plan in postoperative radiotherapy for cervical carcinoma in elderly patients

LU Hong, WU Xia, ZHANG Can

2021, 42(7):  813-817.  doi:10.3969/j.issn.1007-3205.2021.07.014

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Objective To explore the dosimetry and efficacy of Rapid Arc plan and 5-field intensity-modulated radiotherapy(5F-IMRT) plan in postoperative radiotherapy for cervical carcinoma in elderly patients. 
Methods A total of 102 elderly patients with cervical cancer were selected. All patients underwent radical resection of cervical cancer, and they were divided into observation group(n=51) and control group(n=51) according to the random number table method. Patients in the control group were given Rapid Arc plan, while patients in the observation group were given 5F-IMRT plan. The indexes of dosimetry, 3-year survival rate and adverse reactions were compared between two groups. 
Results The average target dose, maximum target dose and minimum target dose in the observation group were significantly higher than those in the control group(P＜0.05), but there was no significant difference in uniformity index and conformal index between two groups(P＞0.05). The values of percentage of volume receiving more than 20 Gy(V20) and V30 of the left and right femoral head in the observation group were significantly lower than those in the control group, while the V30, V40 and V50 values of rectum, small intestine and bladder in the observation group were significantly higher than those in the control group(P＜0.05). The number of machine jumps and duration of treatment in the observation group were significantly lower than those in the control group(P＜0.05). During the treatment, adverse reactions such as nausea and vomiting, leukopenia, radiation enteritis and radiation cystitis occurred in both groups, but there was no significant difference between two groups(P＞0.05). All patients were followed up, and the 3-year survival rate was 86.27%(44/51) in the observation group and 82.35%(42/51) in the control group(P＞0.05). 
Conclusion The application of Rapid Arc technology in postoperative radiotherapy for cervical cancer can optimize the linear accelerator and shorten the duration of treatment on the basis of obtaining the same dose distribution and reducing the organ-at-risk dose, which is worthy of further clinical promotion and research.





Expression of miRNA-107 in ovarian cancer tissues and its effect on VEGFA

MENG Tong-yu, ZHAO Tao, SONG Yu-xia, ZHAO Fang, LI Pan, ZHAO Jian

2021, 42(7):  818-822.  doi:10.3969/j.issn.1007-3205.2021.07.015

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Objective To detect the expression levels of miRNA-107(miR-107)in ovarian cancer tissues and its impact on vascular endothelial growth factor A(VEGFA). 
Methods A total of 56 patients with ovarian cancer were enrolled as case group,and 60 patients who underwent total hysterectomy and bilateral adnexectomy for uterine prolapse, cervical cancer or uterine leiomyoma during the same period were selected as control group. Real-time quantitative PCR(RT-qPCR) was carried out to detect the expression levels of miR-107 and VEGFA mRNA, and the correlation between the expression levels of miR-107 and VEGFA mRNA in the ovarian cancer tissues was analyzed. ROC curves were applied to analyze the diagnostic value of miR-107 levels in ovarian cancer tissues for ovarian cancer. 
Results RT-qPCR showed that the expression levels of miR-107 were significantly lower in ovarian cancer tissues than in the control group, and relative expression levels of VEGFA mRNA were significantly higher in ovarian cancer tissues than in the control group(P＜0.05). Moreover, the expression levels of miR-107 and VEGFA mRNA were significantly correlated with FIGO stages and lymph node metastasis of patients with ovarian cancer(P＜0.05). Pearson correlation analysis revealed that the expression levels of miR-107 was significantly negatively correlated with the expression levels of VEGFA mRNA in the ovarian cancer tissues(r=-0.498， P＜0.001). The area under the ROC curve of miR-107 expression level in predicting ovarian cancer was 0.936(P＜0.001), the optimal cut-off value for ovarian cancer was 1.639, and the sensitivity and specificity were 94.6% and 76.7%respectively. 
Conclusion The decreased expression of miR-107 may promote the invasion and metastasis of ovarian cancer cells by targeting up-regulation of VEGFA expression, thereby playing an important role in the development of ovarian cancer. 





Association of chronic low-grade inflammation with obesity and androgen with PCOS

SUN Miao, ZHANG Xiao-ying, LI Yang-yang, HOU Li-hui, MENG Xiao-yu

2021, 42(7):  823-826.  doi:10.3969/j.issn.1007-3205.2021.07.016

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Objective To study the clinical relationship between peripheral blood leukocytes, obesity in patients with polycystic ovary syndrome(PCOS).
Methods 126 PCOS patients were retrospectively analyzed. According to body mass index(BMI), the patients were divided into normal weight group(n=69), overweight group(n=57). Statistical analysis of general clinical data, testing including levels of sex hormones, glucose and lipid metabolism factors and inflammatory factors. 
Results Compared with normal weight group, the levels of body weight, BMI, waist circumference（WC）, hip circumference（HC）, WHR, fasting plasma glucose, fasting insulin, HOMA-IR, triglyceride, cholesterol total, low density lipoprotein, white blood cell, lymphocyte, monocyte and neutrophil are higher in overweight group, while the levels of luteinizing hormone（LH）, follicle stimulating hormone（FSH）, LH/FSH,sex hormone binding globulin, high density lipoprotein, apolipoprotein A and apolipoprotein B decreased significantly(P＜0.05). 
Conclusion The pathogenesis of PCOS is not clear, the chronic low-grade inflammation plays a key role in the pathogenesis of PCOS. The severity of chronic low-grade inflammation in PCOS is closely related to overweight or obesity. 





Effects of atomization inhalation of hypertonic saline combined with phlegm-reducing drugs on the clinical effect and adverse reactions of severe bronchiolitis

LIU Ying-hui, YU Dong-hui, LI Yong-hong, YU Li-ying

2021, 42(7):  827-831.  doi:10.3969/j.issn.1007-3205.2021.07.017

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Objective To investigate the effects of atomization inhalation of hyperosmotic saline combined with phlegm-reducing drugs on the clinical effects and adverse reactions of severe bronchiolitis. 
Methods A total of 80 children with severe bronchiolitis were selected and divided into sinple group and combination group according to envelope method, with 40 cases in each group. The sinple group was treated with intravenous infusion of the expectorant ambroxol, while the combination group was treated with atomization inhalation of hypertonic saline on the basis of the sinple group. Clinical efficacy, time of symptom elimination, inflammatory cells, blood gas indexes and the incidence of adverse reactions were compared between two groups. 
Results The total effective rate of combination group was higher than that of single group(P＜0.05). The disappearance time of shortness of breath, wheeze, cough and asthma in combination group were all lower than those in single group(P＜0.05). After treatment, the cell count, neutrophils, eosinophils and lymphocytes in two groups were lower than those before treatment, and the cell count, neutrophils, eosinophils and lymphocytes in the combination group were lower than those in the single group(P＜0.05). Arterial partial pressure of oxygen(PaO2) and blood oxygen saturation(SpO2) in both groups were higher than those before treatment, and PaCO2 was lower than that before treatment. PaO2 and SpO2 in combination group were higher, while PaCO2 in group 2 was lower, as compared with those in the single group(P＜0.05). There was no significant difference in the incidence of adverse reactions between two groups(P＞0.05). 
Conclusion Atomization inhalation of hypertonic saline combined with ambroxol hydrochloride is more effective in the treatment of children with severe bronchiolitis, which can improve cough and asthma symptoms, reduce the level of neutrophils, and improve oxygen content, with good safety.


The value of two-dimensional real-time shear wave elastography in the diagnosis of various stages of liver fibrosis in chronic liver disease

LI Jie, YANG Xiao-qing, QI Su-yan, WANG Li-mei, FENG Su

2021, 42(7):  832-836.  doi:10.3969/j.issn.1007-3205.2021.07.018

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Objective To study the value of real-time two-dimensional shear wave elastography(2D-SWE) in the diagnosis of various stages of liver fibrosis in patients with chronic liver disease(CLD). 
Methods Eighty-seven CLD patients with liver fibrosis were selected as the pathological group, and 86 healthy physical examinees during the same period served as the control group. The pathological group was divided into groups according to the stage of liver fibrosis. Both groups received real-time 2D-SWE to compare the liver stiffness measurement(LSM) values of the pathological group and the control group as well as the serological indexes of the pathological group. The correlation between real-time 2D-SWE and the diagnostic efficiency was analyzed. 
Results The LSM values of S1, S2, S3, and S4 were significantly higher than those of the control group, and the value of S4 was significantly higher than that of S0, S1, S2, and S3; the value of S3 was significantly higher than that of S0, S1, and S2, and the value of S2 was significantly higher than that of S0, S1; the value of S1 was significantly higher than that of S0(P＜0.05). After detection, Ⅳ collagen(Ⅳ-C), laminin(LN), serum hyaluronic acid(HA) were significantly higher in S4 than in S0, S1, S2, and S3, and the indicators in S3 were significantly higher than those of S0, S1, and S2; the indicators in S2 were significantly higher than those of S0 and S1; the indicators in S1 were significantly higher than those of S0(P＜0.05). Correlation analysis showed that real-time 2D-SWE was positively correlated with fibrosis staging, Ⅳ-C and HA. According to the pathological results as the gold standard, the AUC results of each pathological stage were 0.800, 0.792, 0.773, and 0.812, respectively; the threshold of S1, S2,S3 and S4 was 80.59, 88.37, 90.75, and 94.57, respectively. 
Conclusion Real-time 2D-SWE can effectively determine the degree of liver fibrosis in patients with CLD, and there is a positive correlation between LSM and the stage of fibrosis.





Application of DCE-MRI in preoperative evaluation of fistula and fistula orifice in patients with anal fistula 

HONG Zhi-you, CHEN Yan-xin, JIANG He-li

2021, 42(7):  837-840,845.  doi:10.3969/j.issn.1007-3205.2021.07.019

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Objective To investigate the application of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) in preoperative evaluation of fistula and fistula orifice in patients with anal fistula. 
Methods A total of 90 patients with high complex anal fistula(HCAF) were selected, DCE-MRI was performed before operation, and magnetic resonance imaging(MRI) was performed 30 min after wards. The results of surgical and pathological diagnosis were taken as the gold standard to analyze its diagnostic efficacy. 
Results DCE-MRI diagnosis showed 91 primary fistulas, 135 > 5 mm branching fistulas, 121 ＜ 5 mm branching fistulas, 81 primary internal fistulas and 27 small internal fistulas in patients with HCAF. MRI gadolinium-fed fistula angiography and DCE-MRI diagnostic results showed that there were 92 main fistulas, 137 > 5 mm branching fistulas, 154 ＜ 5 mm branching fistulas, 87 main internal fistulas and 103 small internal fistulas in patients with HCAF. The accuracy rate of DCE-MRI in diagnosing primary fistula, > 5 mm branch fistula, ＜ 5 mm branch fistula and primary internal fistula in HCAF patients was 97.89%, 88.27%, 71.62% and 85.86%, respectively, and the Kappa value of consistency test with surgical pathology diagnosis was 0.657, 0.436, 0.422 and 0.454, respectively(P＜0.05). The accuracy rate of DCE-MRI in diagnosing small internal fistulas in patients with HCAF was 29.83%, and the Kappa value of consistency test with surgical pathology diagnosis was 0.040(P＞0.05). The accuracy of MRI gadolinium-contrast fistula+DCE-MRI in the diagnosis of primary fistula, ＞5 mm branch fistula, ＜5 mm branch fistula, primary internal fistula and small internal fistula in patients with HCAF was 98.95%, 89.51%, 75.55%, 89.90% and 71.82%, respectively, and the Kappa value of consistency test for surgical and pathological diagnosis was 0.795, 0.467, 0.433, 0.446 and 0.380, respectively(P＜0.05).  
Conclusion MRI gadolinium fistulography combined with DCE-MRI technology has an important application value in preoperative evaluation of small branch fistula and fistula orifice of HCAF. 





Effects of bilateral erector spinae plane block combined with intravenous analgesia on early postoperative rehabilitation in patients undergoing gastric cancer surgery

YANG Duo, ZHANG Long-sheng, LIN Xu-lin, ZHANG Huan-kai, LIN Geng-bin, HUANG Xi-yang

2021, 42(7):  841-845.  doi:10.3969/j.issn.1007-3205.2021.07.020

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Objective To investigate the effect of bilateral erector spinae plane block(ESPB) on early postoperative rehabilitation of patients with gastric cancer after comparison with continuous epidural analgesia. 
Methods A total of 60 patients undergoing elective laparoscopic radical gastrectomy were randomly divided into block group(group B, n=30) and epidural group(group E, n=30). They were American Society of Anesthesiologists(ASA) grade Ⅰ or Ⅱ. Both groups received general anesthesia. Before anesthesia induction, group B underwent bilateral ESPB under ultrasound guidance, and group E was treated with epidural puncture. After operation, group B was treated with patient-controlled intravenous analgesia and group E was treated with patient-controlled epidural analgesia. The visual analogue scale(VAS) score of resting pain at 2, 4, 8, 12, 24 and 48 h after operation was recorded. The number of cases of remedial analgesia with flurbiprofen axetil, postoperative exhaust time, first time of food intake, first time of off-bed activity, length of hospitalization and analgesic satisfaction score were recorded. The analgesia-related adverse reactions within 48 h after operation were recorded, including nausea and vomiting, skin itching, dizziness, respiratory depression, and urinary retention. 
Results The resting pain VAS scores of the two groups got higher and higher with the postoperative time(P＜0.05). There was no significant difference in the interaction between groups, groups and time points(P＞0.05) .The number of salvage analgesia in group B was 1 case(3.3%), and there were 2 cases in group E(6.7%). The difference between the two groups was not statistically significant(χ2=0.000, P=1.000).  The postoperative exhaust time, first time of food intake, first time of off-bed activity and length of hospitalization of group B were shorter than those of group E(P＜0.05), while the satisfaction of analgesia was significantly higher than that of group E(P＜0.05), and the incidence of analgesia-related adverse reactions within 48 h after operation was significantly lower than that of group E(P＜0.05). 
Conclusion Bilateral ESPB combined with intravenous analgesia or continuous epidural analgesia can provide good postoperative analgesia for patients receiving gastric cancer surgery, but the former has fewer adverse reactions and higher patient satisfaction, which is more conducive to early rapid rehabilitation and shorter hospital stay.





Effects of different anesthesia methods on postoperative cognitive function of elderly patients undergoing gynecological laparoscopic surgery

LIU Ye, LI Hong, LIU Zhi, MAO Hui-min

2021, 42(7):  846-850.  doi:10.3969/j.issn.1007-3205.2021.07.021

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Objective To explore the effects of different anesthesia methods on the postoperative cognitive function of elderly patients undergoing gynecological laparoscopic surgery. 
Methods A total of 60 elderly patients were selected for elective gynecological laparoscopic hysterectomy. According to the principle of randomized control, they were divided into two groups: target-controlled infusion of propofol anesthesia group(group P) and sevoflurane inhalation anesthesia group(group S). In terms of indicators, the respiratory recovery time, recovery time and extubation time of the two groups of patients were compared. The mini-mental state examination(MMSE) was used for cognitive function measurement at 24 h before operation and at 6 h, 24 h, 72 h and 7 d after operation. At 24 h before operation, 24 h and 72 h after operation, IL-6 and S100β protein were measured by enzyme-linked immunosorbent assay（ELISA）. 
Results After operation, the MMSE scores of the two groups were decreased initially and then increased. The MMSE scores of group P were higher than those of group S at 6 h, 24 h and 72 h after operation(P＜0.05). The incidence of postoperative cognitive dysfunction（POCD） at 24 h and 72 h after operation in group P was lower than that in group S(P＜0.05). The plasma IL-6 concentration of the two groups showed a rising trend. The IL-6 concentration of group P was significantly lower than that of group S at 24 h and 72 h after surgery(P＜0.05). The S100β protein level of the two groups was increased initially and then decreased. The S100β protein level of group P was significantly lower than that of group S at 24 h after operation(P＜0.05); at 72 h after operation, the S100β protein of the two groups was decreased to the preoperative level.The incidence of adverse reactions in group P was lower than that in group S(P＜0.05). 
Conclusion Compared with sevoflurane inhalation anesthesia in elderly patients undergoing gynecological laparoscopic total hysterectomy, propofol intravenous anesthesia has fewer effects on postoperative cognitive function, with quick recovery and fewer adverse reactions. Therefore, it is more preferable for anesthesia in elderly patients.





The analysis of HBV genotyping and drug resistant mutation in Shijiazhuang area, Hebei province

HOU Jun-liang, FENG Ai-dong, LIU Teng-fei, XU Yi, ZHANG Hai-cong, YANG Li

2021, 42(7):  851-855.  doi:10.3969/j.issn.1007-3205.2021.07.022

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Objective To analyze the HBV genotype, distribution of drug-resistant mutation sites and drug resistance of chronichepatitis B(CHB) patients treated with various nucleoside(acid) analogues in Shijiazhuang area. 
Methods A total of 1 157 patients with CHB were selected, and their basic data were collected. Genotyping and gene resistance mutation sites of the patients were detected by gene sequencing technology, and the results were statistically analyzed. 
Results Genotypes of CHB patients in Shijiazhuang were mainly C-type and a small number were B-type. There was no statistical significance in the distribution proportion of HBV genotypes B and C in CHB patients in Shijiazhuang area(P＞0.05). There were statistically significant difference in the distribution proportion of HBV genotypes B and C among different ages(P＜0.05). The HBV genotype C was the highest in patients aged 41 to 60 years. There were 172 cases with no mutation, 393 cases with single mutation, 361 cases with 2 gene loci mutation,174 cases with 3 gene loci mutation, 42 cases with 4 gene loci mutation, 10 cases with 5 gene loci mutation, 3 cases with 6 gene loci mutation, 1 case with 7 gene loci mutation and 1 case with 9 gene loci mutation. There was no significant difference in genotype distribution with the proportion of B and HBV genotype C(P＞0.05). A total of 1 889 mutation loci were detected in 985 patients with mutations. Among the 14 gene loci detected, the mutation rates of M204I/V/S, L180M and A181V/T/S were the top three mutation loci. There was no significant difference in the proportion of HBV genotypes B and C among different loci(P＞0.05). In 985 patients with mutations, a total of 11 nucleoside(acid) resistance patterns were detected for lamivudine(LAM), telbivudine(LDT), adefovir(ADV) and entecavir(ETV). There were three patterns of resistance to a single drug, four patterns of resistance to two drugs, three patterns of resistance to three drugs, and one pattern of resistance to all four drugs. There was no statistical significance in the proportion of HBV genotypes B and C among patients with different drug resistance patterns(P＞0.05). 
Conclusion The genotypes of CHB patients in Shijiazhuang area are mainly type C, and the gene resistance mutations are mainly multi-drug resistance.





The value of detection of serum VitB12, folic acid and LDH in differential diagnosis of myelodysplastic syndrome and megaloblastic anemia

ZHAO Li-peng, LU Xiao-yan

2021, 42(7):  856-860.  doi:10.3969/j.issn.1007-3205.2021.07.023

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Objective To explore the value of serum Vitamins B12（VitB12）, folate and lactate dehydrogenase(LDH) detection in differential diagnosis of myelodysplastic syndrome(MDS) and megaloblastic anemia(MA). 
Methods The clinical data of 41 MDS and 66 MA patients were retrospectively analyzed. Another 50 healthy people were selected as the control group. The clinical symptoms of the three groups were observed and their serum VitB12, folic acid and LDH were compared. Its diagnostic efficiency was determined by the ROC curve. 
Results The infection rate and bleeding rate in the MA group were lower than those in the MDS group, but the rate of anemia was higher than that in the MDS group(P＜0.05). The VitB12 levels in the MA group were higher than those in the MDS and control group, while the LDH value was significantly higher than that in the MDS group and the control group(P＜0.05). No significant difference was found in folic acid among three groups(P>0.05). The area under the curve(AUC) of VitB12, folic acid, and LDH for diagnosis of MDS was 0.741, 0.531, and 0.948, respectively. When VitB12 was higher than 139.355, the sensitivity was 100.0% and the specificity was 84.0%; When folic acid was higher than 8.960, the sensitivity was 43.9% and the specificity was 94.0%; when the LDH value was higher than 200.670, the sensitivity was 98.5% and the specificity was 100.0%. The LDH value was the most valuable in diagnosing MDS patients. The AUC of VitB12, folic acid, and LDH for the diagnosis of MA was 0.868, 0.545, and 0.991, respectively. When VitB12 was higher than 139.355, the sensitivity was 100.0% and the specificity was 84.0%; when folic acid was higher than 8.960, the sensitivity was 43.9% and the specificity was 94.0%; when the LDH value was higher than 200.670, the sensitivity was 98.5%, and the specificity was 100.0%. Therefore, both VitB12 and LDH had a high diagnostic value for MA. 
Conclusion Serum VitB12 and LDH detection have a certain effect on the differential diagnosis of MDS and MA, but the diagnostic efficiency of LDH is relatively high. This is worthy of clinical application in the future and should be used reasonably according to the real situation of patients.