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Table of Content

    25 November 2021, Volume 42 Issue 11
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    Effects of different doses of methylprednisolone on TLR4/NF-κB pathway in lung tissue of mouse model with Mycoplasma pneumoniae pneumonia
    ZHANG Jun-guang, ZHANG Shu-li, ZHANG Hui-ying, SU Yan-wen
    2021, 42(11):  1245-1250.  doi:10.3969/j.issn.1007-3205.2021.11.002
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    Objective To investigate the effects of different doses of methylprednisolone on Toll-like receptor 4(TLR4)/nuclear factor κB (NF-κB) pathway in lung tissue of mouse model with Mycoplasma pneumoniae pneumonia. 
    Methods  Forty healthy male SD mice were selected, of which 10 were randomly selected as normal mice group, and the remaining 30 were used to establish mouse model of Mycoplasma pneumoniae pneumonia. After successful modeling, 10 were randomly selected as model group, and the remaining 20 were selected as low-dose intervention group and high-dose intervention group. Low-dose intervention group was injected with low-dose methylprednisolone, while high-dose intervention group was injected with high-dose methylprednisolone. The expression of TLR4 and NF-κB was compared among groups. The levels of TLR4 and NF-κB were detected by immunohistochemistry. The levels of tumor necrosis factor-α(TNF-α) and interleukin 1β(IL-1β) were detected by enzyme-linked immunoassay. Superoxide dismutase(SOD) was detected by xanthine oxidase method and malondialdehyde(MDA) was detected by thiobarbituric acid method. 
    Results Compared with normal mice group, the expression of TLR4 and NF-κB was higher in model group, low-dose intervention group and high-dose intervention group, the expression of TLR4 and NF-κB in low-dose intervention group and high-dose intervention group was lower than that in model group, and the expression of TLR4 and NF-κB in high-dose intervention group was lower than that in low-dose intervention group(P＜0.05). Compared with normal mice group, the expression of TLR4 and NF-κB in model group, low-dose intervention group and high-dose intervention group was higher.The levels of TLR4 and NF-κB were lower in the low-dose intervention group and the high-dose intervention group than in the model group, and the levels of TLR4 and NF-κB in the high-dose intervention group were lower than those in the low-dose intervention group(P＜0.05). Compared with the normal mice group, the levels of TNF-α and LI-1β in the model group. The low-dose intervention group and the high-dose intervention group was higher, and the levels of TNF-α and LI-1β in the low-dose intervention group and the high-dose intervention group were lower than those in the model group. The level of TNF-α and IL-1β in the high-dose intervention group was lower than that in the low-dose intervention group(P＜0.05). Compared with the normal mice group, the MDA level was higher and SOD level was lower in the model group, the low-dose intervention group and the high-dose intervention group. The MDA level was lower and SOD level was higher in the low-dose intervention group and the high-dose intervention group, as compared with the model group, and the MDA level was lower and SOD was higher in the high-dose intervention group than in the low-dose intervention group(P＜0.05). 
    Conclusion In mouse model of Mycoplasma pneumoniae pneumonia, methylprednisolone can significantly improve the lung tissue damage, inhibit the expression of TLR4/NF-κB pathway, reduce the degree of inflammatory response, and improve oxidative stress, and the high-dose effect is more significant.

    Impact of radiofrequency catether ablation on atrial function and BNP in patients with idiopathic and frequent ventricular premature contractions of different origins
    MA Li-heng, XIE Rui-qin, WU Jing-lan
    2021, 42(11):  1251-1255.  doi:10.3969/j.issn.1007-3205.2021.11.003
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    Objective To evaluate the changes of function and structure of left and right atrium and brain natriuretic peptide(BNP) level after radiofrequency catheter ablation(RFCA) in patients with idiopathic and frequent ventricular premature contractions(VPCs) of different origins before and after operation, and to explore the impact of RFCA on left and right atria of patients with normal cardiac function and VPCs of different origins. 
    Methods A total of 62 inpatients undergoing successful RFCA in the Second Hospital of Hebei Medical University were enrolled, and divided into left ventricle origin group and right ventricle orgin group. Two-dimensional echocardiographic speckle tracking technology was used to observe the left atrial diameter(LAD), right atrial ejection fraction(RAEF) and left atrial ejection fraction(LAEF) before and at 1 day, 1 month, 3 months, and 9 months after RFCA, and BNP detection was performed. The relevant data were compared within and between groups. 
    Results The indicators in both groups were increased except BNP, as compared with those before operation. Strain(S) and strain rate(SR) of the left atrium after operation were significantly better in the right ventricle origin group than in the left ventricle origin group. The S and SR of the right atrium in the left ventricle origin group was significantly higher than those of the right ventricle origin group, however, the two groups were only statistically significant at different time points(P＜0.05). No significant difference was found in interaction between groups, and time points between groups(P＞0.05). After operation, BNP in right ventricle origin group and left ventricle origin group was decreased gradually. 
    Conclusion After RFCA treatment of simple VPCs, the recovery of left atrial function of the right ventricle origin group was more obvious than that of the left ventricle origin group, and the recovery of right atrial function of the left ventricle origin group was more significant than that of the right ventricle origin group. After effective treatment of VPCs by RFCA, the plasma BNP was reduced. It may be of significance to use BNP to judge the severity and development of patients with VPCs when the cardiac function or structure changes are not obvious by echocardiography.

    Exploratory analysis of short-term prognostic risk factors in patients with tuberculous meningitis
    CHEN Jin-song, ZHENG Jun-feng, ZHOU Qian-wu
    2021, 42(11):  1256-1260.  doi:10.3969/j.issn.1007-3205.2021.11.004
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    Objective To investigate the short-term prognostic risk factors for patients with tuberculous meningitis（TBM）. 
    Methods Designed as a retrospective study, this study included a total of 310 patients with TBM. The outcome indicators for short-term prognosis were defined as the disease status(improvement or death) when the patients were discharged from the hospital. Additionally, the univariate and multivariate binary Logistic regression analyses were performed including the baseline characteristics, laboratory examination, neuroimaging examination and other factors to identify the risk factors that might contribute to the short-term prognostic risk factors for patients with TBM. 
    Results The incidence of consciousness disturbance, positive Kremer′s sign and positive pyramidal tract sign were higher in death group than those in disease improvement group(P＜0.05). The white blood cell(WBC) count of peripheral blood in death group was higher than that in disease improvement group, and the percentage of peripheral blood lymphocytes was significantly lower than that in the disease improvement group(P＜0.05). The incidence of color(light yellow, yellow or cloudy) of cerebrospinal fluid in death group was higher than that in disease improvement group(P＜0.05). And the incidence of positive hydrocephalus in death group was higher than that in disease improvement group, and the incidence of positive cerebral tuberculoma was lower than that in disease improvement group(P＜0.05).  Results of multivariate analysis suggested that the WBC counts, percentage of peripheral blood lymphocytes  and blood glucose at admission were independent risk factors for the short-term prognosis of patients with TBM(P＜0.05). 
    Conclusion Elevated WBC counts, decreased  percentage of peripheral blood lymphocytes and elevated blood glucose at admission TBM patients are associated with relatively worse short-term prognosis. 

    The influencing factors of hyperuricemia in patients with type 2 diabetes treated with single oral antidiabetic drug
    TIAN Li-hua, ZHAO Xiang-jun, YU Hong-lei
    2021, 42(11):  1261-1265,1297.  doi:10.3969/j.issn.1007-3205.2021.11.005
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    Objective To investigate the influencing factors of hyperuricemia(HUA)in patients with type 2 diabetes mellitus(T2DM)treated with single oral antidiabetic drug. 
    Methods A total of 912 patients taking single oral antidiabetic drug in the Department of Endocrinology, Qinhuangdao Military Hospital were selected and divided into normal uric acid group(NUA group, n=741) and HUA group(n=171)according to SUA level. The indexes of glucose and lipid metabolism and the use of oral antidiabetic drug were compared in each group, and the influencing factors of HUA in T2DM patients were analyzed. 
    Results The incidence of HUA in T2DM patients was 18.8%(171/912). Compared with NUA group, the level of total cholesterol(TC) in HUA group was higher, the proportion of male, family history of HUA, and the use of Gliquidone were increased(P＜0.05 or P＜0.001), and the proportion of using Dapagliflozin was lower(P＜0.001). Multivariate Logistic regression analysis showed that the use of Dapagliflozin(OR=0.414, 95%CI: 0.205-0.848) was the protective factor of HUA in T2DM patients, while male(OR=2.033, 95%CI: 1.054-3.921) and family history of HUA(OR=9.631, 95%CI: 4.113-22.452) were risk factors for HUA in T2DM patients. 
    Conclusion The T2DM patients with HUA treated with single oral antidiabetic drug may be related to their male gender and family history of HUA, and may have a higher level of TC. The use of Dapagliflozin may reduce the risk of HUA in such patients.

    Application of dapagliflozin combined with metformin in obese/overweight T2DM and its effect on intestinal microbiota, adropin, chemerin, and irisin
    LI Li-li, FENG Cui-juan, FENG Ke-na
    2021, 42(11):  1266-1271.  doi:10.3969/j.issn.1007-3205.2021.11.006
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    Objective To investigate the application effect of dapagliflozin combined with metformin in obese/overweight type 2 diabetes mellitus(T2DM) and its effect on intestinal microbiota, adropin, chemerin, and irisin. 
    Methods According to the computerized random number table method, 112 obese/overweight T2DM patients were divided into two groups in a 1∶1 ratio, with 56 cases in each group. The control group was treated with metformin, and the observation group was treated with dapagliflozin combined with metformin. The blood glucose levels［fasting blood glucose(FPG), 2 h postprandial blood glucose(2 hPG), glycosylated hemoglobin A1c(HbA1c)］, homeostasis model assessment-insulin resistance(HOMA-IR), waist circumference, body mass index(BMI), blood lipid indexes［high density lipoprotein(HDL-C), triacylglycerol(TG), low density lipoprotein(LDL-C), total cholesterol(TC)］, intestinal microbiota, serum adropin, chemerin, irisin and adverse reactions were compared between the two groups. 
    Results The FPG, 2 hPG, HbA1c and HOMA-IR of the observation group were lower than those of the control group at 3 months and 6 months after treatment(P＜0.05). The waist circumference and BMI of the observation group were lower than those of the control group at 6 months after treatment(P＜0.05). At 3 and 6 months after treatment, TG was lower in the observation group than in the control group, and HDL-C was higher than that of the control group(P＜0.05). The number of Enterococcus and Enterobacter in the observation group at 6 months after treatment was lower than that of the control group, while the number of Bacteroides and Lactobacillus was higher than that of the control group(P＜0.05). In the observation group, adropin and irisin were higher than those in the control group at 3 and 6 months after treatment, while chemerin was lower than that in the control group(P＜0.05). 
    Conclusion Dapagliflozin combined with metformin in the treatment of obesity/overweight T2DM can effectively reduce blood glucose levels, improve insulin resistance, blood lipid metabolism and intestinal microecology, relieve obesity/overweight, and have high safety. Decreasing chemerin and increasing adropin and irisin may be a molecular mechanism for the combined anti-T2DM effect of the two. 

    Study on the mechanism of action of MiR-151a-3p in alcohol-related liver cancer
    JIAO Wen-peng, JIAO Wen-jing, GUO Xiu-juan, FENG Jun-hua, ZHANG Jin-yan
    2021, 42(11):  1272-1276,1281.  doi:10.3969/j.issn.1007-3205.2021.11.007
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    Objective To provide reference for early diagnosis by searching for tumor markers in the progression of alcoholic hepatitis to liver cancer. 
    Methods The medical records of patients with alcohol-related liver cancer were retrieved and analyzed. Alcoholic hepatitis/liver cancer patients and alcoholic hepatitis/cirrhosis patients were selected to screen target MicroRNA(miRNA).The role of miR-151a-3p in cancer cells was tested in liver cancer cell lines, and their mechanism was studied. 
    Results Patients with alcoholic hepatitis who did not undergo the stage of liver cirrhosis and directly progressed to liver cancer were younger than those who experienced the stage of liver cirrhosis(P＜0.05); the expression level of miR-151a-3p in patients with alcoholic hepatitis/liver cancer was significantly higher than that in patients with alcoholic hepatitis/liver cirrhosis. The expression level of miR-151a-3p in liver cancer cell lines was significantly higher than that in normal liver cell lines, and HepG2 had the highest expression. In HepG2 and Bel-7402, the expression level of miR-151a-3p was down-regulated, showing an increase in the G0/G1 phase and a decrease in the G2/M phase. In Si-miR-151a-3p(HepG2) and Si-miR-151a-3p(Bel-7402) cells, mRNA and protein expression levels of ATM increased, mRNA expression levels of P53 increased, and protein expression levels of P-P53 increased, while mRNA and protein expression levels of Cyclin D1 decreased. 
    Conclusion Some patients with alcoholic hepatitis can directly progress to liver cancer without going through the stage of cirrhosis, in which miR-151a-3p plays an important role, by directly targeting ATM to inhibit P53, thereby promoting the expression of cyclin D1,  and leading to the occurrence and development of liver cancer.

    Effect of behavioral factors on serum uric acid level in physical examinees in Chongqing
    LI Tuo-jian, ZHANG Chao, CHEN Zong-tao
    2021, 42(11):  1277-1281.  doi:10.3969/j.issn.1007-3205.2021.11.008
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    Objective To investigate the related factors of serum uric acid level in physical examinees in Chongqing City in 2019, so as to provide reference for preventing the increase in serum uric acid level. 
    Methods People who underwent  physical examination in Department of Physical Examination of our hospital from January 2019 to June 2019 were enrolled as research subjects, and questionnaires were conducted to investigate the related influencing factors of the serum uric acid level in the population. 
    Results The Chi-square test results showed that there were statistically significant differences in the detection rates of hyperuricemia between different genders and among different age groups. The t test results showed that as compared with the group with normal blood uric acid level, the group with increased blood uric acid had higher blood uric acid level, higher systolic blood pressure, higher diastolic blood pressure, higher BMI, higher triglyceride, lower HDL cholesterol, increased white blood cell(WBC) count, increased red blood cell(RBC) count and increased hemoglobin. The results of binary Logistic regression analysis showed that smoking, consumption of alcohol, tea, coffee and drinking less than 1 500 mL of water each day and preference for meat were risk factors for increased serum uric acid(OR＜1), while milk intake more than or equal to 3 times a week and seafood intake less than 3 times a week were protective factors for increased serum uric acid(OR＞1). 
    Conclusion The increaed blood uric acid level is associated with increased blood pressure, increased WBC count, increased RBC count, and increased triglyceride level. The goal of reducing serum uric acid levels can be achieved by quitting smoking, quitting alcohol, no tea consumption, no coffee consumption and consumption of more water, more milk and less seafood.

    Effect of psychological intervention of ADOPT problem-solving model on alcohol withdrawal, mental flexibility and adaptability in patients with chronic alcoholic liver disease
    XIE Jing, LIU Long
    2021, 42(11):  1282-1288.  doi:10.3969/j.issn.1007-3205.2021.11.009
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    Objective To explore the effect of psychological intervention of ADOPT problem-solving model on alcohol withdrawal, mental flexibility and adaptability in patients with chronic alcoholic liver disease(ALD). 
    Methods A total of 142 patients with chronic ALD were selected as the research subjects, and were divided into control group(n=71) and research group(n=71) according to the order of admission. The control group received routine nursing intervention, and on this basis, the research group was supplemented with psychological intervention of the ADOPT problem-solving model. The alcohol dependence［Michigan alcoholism screening test(MAST) scale evaluation］, Barratt impulsivity, self-efficacy［referring to general self efficacy scale(GSES) evaluation］, psychological resilience［connor-Davidson resilience scale(CD-RISC) assessment, including the three dimensions of toughness, optimism, and self-improvement］, and psychosocial adaptability［psychosocial adaptability scale(SPAS) evaluation, including three dimensions of continuous worry, acceptance, and positive attitude towards life］ scores and alcohol compliance and nursing satisfaction before and after intervention of the two groups were compared. 
    Results After the intervention, the MAST and Barratt impulsivity scores of the research group were lower than those before intervention, and the above indicators were lower in the research group than in the control group(P＜0.05). The GSES score was higher in both groups, which was higher in the research group than in the control group; there were significant difference in interaction between groups, time points, and time points between groups(P＜0.05). After the intervention, the CD-RISC scores of toughness, optimism, and self-improvement were higher than those before the intervention, which were higher in the research group than in the control group(P＜0.05). After the intervention, the SPAS scores of continuous worry, acceptance, and positive attitude towards life were higher than those before the intervention, which were higher in the research group than in the control group(P＜0.05). The alcohol compliance rate and nursing satisfaction were higher in the research group than in the control group(P＜0.05). 
    Conclusion The psychological intervention of the ADOPT problem-solving model can improve the self-efficacy, mental flexibility and adaptability of chronic ALD patients, reduce alcohol dependence and impulsivity, and have a high rate of compliance with alcohol withdrawal and nursing satisfaction. 

    Analysis of high-risk human papillomavirus infection in patients with different cervical lesions and influencing factors of recurrence after cervical conization
    BIAN Lei, HAN Jie, XU Dong-lei, GAO Jian-hong, WANG Ya-juan
    2021, 42(11):  1289-1293.  doi:10.3969/j.issn.1007-3205.2021.11.010
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    Objective To investigate the high-risk human papillomavirus(HR-HPV) infection in patients with different cervical lesions and the influencing factors of recurrence after cervical conization. 
    Methods A total of 287 patients with cervical lesions were selected as the research subjects. According to the pathological examination results after cervical conization, they were divided into cervical inflammation group(n=34) and low-grade squamous intraepithelial lesions(LSIL) group(n=58), high-grade squamous intraepithelial lesion(HSIL) group(n=180), and cervical invasive carcinoma group(n=15). Human papillomavirus(HPV) infection rate, HPV single infection and multiple infections, and HR-HPV infection subtype distribution in the four groups were compared, and the recurrence rate of the HSIL group at 12 months after cervical conization was calculated. According to the recurrence, they were divided into recurrent patients and non-recurrent patients.The baseline data and HPV infection subtypes of patients with different recurrences were compared, and the influencing factors of recurrence after cervical conization in HSIL patients were analyzed. 
    Results There were statistically significant differences in the total HRV infection rate and multiple HRV infection rates in the four groups(P＜0.05); the differences in the HRV 52, 58, 16, 18 infection rates in the four groups were statistically significant(P＜0.05).There were statistically significant differences in the postoperative resection margin status, menopausal status, multi-quadrant involvement, postoperative HR-HPV persistent infection, postoperative HR-HPV persistent infection subtypes, and cervical transformation types in the HSIL group with and without recurrence(P＜0.05).Postoperative resection margin positive status, menopausal status, multi-quadrant involvement, postoperative HR-HPV persistent infection, postoperative HPV 52 infection, HPV 58 infection, and cervical transformation type Ⅲ were the influencing factors for the recurrence of HSIL patients after cervical conization(P＜0.05). 
    Conclusion There is a statistically significant difference in HPV 52 and 58 infection rates among patients with different cervical lesions, which is helpful to guide clinical evaluation of the efficacy and prognosis of cervical conization, provide scientific reference for the prevention and treatment of cervical cancer and its precancerous lesions and the search for more reasonable clinical diagnosis and treatment strategies.

    Application of three packing materials in endoscopic dacryocystorhinostomy
    SU Rui-feng, QI Zhi-wei, ZHANG Qi, DONG Wei-li, TAN Xiao-bo
    2021, 42(11):  1294-1297.  doi:10.3969/j.issn.1007-3205.2021.11.011
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    Objective To investigate the application effect of three different packing materials in endoscopic dacryocystorhinostomy. 
    Methods Ninety patients(90 eyes) with chronic dacryocystitis were included in the prospective single-blind study and were randomly divided into nasopore group, merocel group and vaseline gauze group, with 30 cases(30 eyes) in each group. All patients underwent endoscopic dacryocystorhinostomy. The patients in the three groups were filled with nasopore, merocel and vaseline gauze to stop bleeding separately. The visual analogue scale(VAS), surgical efficacy and complications were observed. 
    Results The VAS of nasopore group was lower than that of merocel group and vaseline gauze group, and effective rate was higher than that of merocel group and vaseline gauze group, suggesting significant difference(P＜0.05). There was no significant difference in the incidence of postoperative complications among three groups(P＞0.05). 
    Conclusion Nasopore used in endoscopic dacryocystorhinostomy can reduce postoperative discomfort, accelerate the regeneration of nasal mucosa epithelium, reduce the occurrence of granuloma and adhesion, and improve the success rate of operation. 

    Effect of intensive nursing based on solution-focused model on negative emotion, compliance and visual function of patients with diabetic retinopathy
    BAI Jie, SONG Ni-juan
    2021, 42(11):  1298-1301,1306.  doi:10.3969/j.issn.1007-3205.2021.11.012
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    Objective To explore the effect of intensive nursing based on solution-focused model on negative emotion, compliance and visual function of patients with diabetic retinopathy(DR). 
    Methods A total of 84 patients with DR in our hospital were divided into two groups according to random number table method. The conventional group received conventional nursing, while the intensive group was given conventional nursing and intensive nursing based on solution-focused model. The changes of negative emotions, compliance and visual function before and after nursing were compared between two groups. 
    Results Before nursing, there was no significant difference in Self-rating Depression Scale(SDS), Self-rating Anxiety Scale(SAS) scores, vision and poor vision rates between two groups(P＞0.05), while after nursing, SDS, SAS scores and poor vision rates of the two groups were lower than those before nursing(P＜0.05), and vision was higher than that before nursing(P＜0.05). The SDS, SAS scores and poor vision rate of the intensive group were lower than those of the conventional group(P＜0.05), and the vision of the intensive group was higher than that of the conventional group(P＜0.05). There was a significant difference in the distribution of compliance between two groups during the nursing period(P＜0.05), and the excellent and good rate of compliance in the intensive group was higher than that in the conventional group(P＜0.05). 
    Conclusion Intensive nursing based on solution-focused model can help to alleviate negative emotions, improve compliance and enhance visual function of DR patients.

    Investigation into influencing factors of poor mental state of patients with differentiated thyroid cancer after operation and its intervention
    LIU Yan-bin, HU Rui-li, LI Yan-ping, LIU Ya-chao, XI Jin-yan
    2021, 42(11):  1302-1306.  doi:10.3969/j.issn.1007-3205.2021.11.013
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    Objective To investigate the influencing factors and intervention strategies for the poor mental state of patients with differentiated thyroid cancer(DTC) after surgery. 
    Methods A total of 128 DTC patients who underwent surgery in the Department of Head and Neck Surgery of our hospital were selected as the research subjects. Their anxiety status was evaluated by self-rating anxiety scale(SAS) and the influencing factors of anxiety were analyzed. 
    Results The incidence of anxiety in 128 patients was 39.84%. The SAS evaluation showed mild anxiety(54.18±3.01) points, accounting for 32.03%; moderate anxiety(64.22±3.13) points,accounting for 6.25%; severe anxiety(71.07±1.55) points, accounting for 1.56%.Logistic regression analysis showed that female, unmarried status, unawareness of the condition,family monthly income per capita＜3 000 yuan, self-paid medical expenses, and high risk of disease recurrence were the major influencing factors of anxiety after DTC(P＜0.05). 
    Conclusion Female gender, unmarried status, unawareness of the condition, family monthly income per capita＜3 000 yuan, self-paid medical expenses and high risk of disease recurrence are the major influencing factors of anxiety of patients after surgery for DTC. Nursing such as social support, psychological intervention and incentive intervention should be selectively carried out to improve the psychological state of patients.

    The value and clinical significance of ultrasonic omniview technology combined with serum AFP and ApPrx2 in the diagnosis of fetal neural tube defects
    YANG Xin-yu, YE Qian, GUO Jiang
    2021, 42(11):  1307-1311.  doi:10.3969/j.issn.1007-3205.2021.11.014
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    Objective To investigate the value and clinical significance of ultrasonic omniview technology combined with serum alpha-fetoprotein(AFP) and peroxiredoxin-2(ApPrx2) in the diagnosis of fetal neural tube defects(NTD). 
    Methods A total of 3 107 pregnant women who received regular check-ups in our hospital were selected, including 30 with fetal NTD(observation group) and 3 077 with non-fetal NTD(control group). The fetal NTD detected by ultrasonic omniview technology was calculated, and the general data, serum AFP and ApPrx2 mRNA of the two groups were compared. The Logistic regression equation was used to analyze the related influencing factors of fetal NTD, and the receiver operating characteristic curve(ROC) and area under ROC(AUC) were used to analyze the value of serum AFP and ApPrx2 in the diagnosis of fetal NTD. 
    Results Taking clinical follow-up results as the “gold standard”, the sensitivity of ultrasonic omniview technology in diagnosing fetal NTD was 90.00%(27/30), the specificity was 100.00%(3 077/3 077), and the accuracy rate was 99.90%(3 104/3 107). Serum AFP and ApPrx2 mRNA in the observation group were significantly higher than those in the control group(P＜0.05). The Logistic regression equation analysis showed that the risk of fetal NTD in patients with abnormal ultrasonic omniview results was approximately 4.230 times that of normal patients, and the risk of fetal NTD in patients with a history of radiation exposure was approximately 2.897 times that of those without exposure history. The risk of fetal NTD with AFP≥103.96 μg/L was approximately 2.148 times that of those with＜103.96 μg/L, and the risk of fetal NTD with ApPrx2 mRNA≥1.03 was approximately 1.731 times that of those with ApPrx2 mRNA≥1.03(P＜0.05). The AUC of serum AFP and ApPrx2 mRNA to diagnose fetal NTD was 0.863 and 0.900, respectively. 
    Conclusion Ultrasonic omniview technology, serum AFP, and ApPrx2 mRNA have certain diagnostic value for fetal NTD. The combination of the three is expected to improve the diagnostic efficiency and is of great value for improving the quality of the birth population. 

    Modified strategy of anesthesia for thoracoscopic pulmonary bullae resection: ultrasound-guided rhomboid intercostal and subserratus plane block combined with general anesthesia
    ZHANG Long-sheng, ZHANG Kai-hong, YANG Duo, WEI Wu-zhi, ZHANG Huan-kai, HE Jun-bing
    2021, 42(11):  1312-1316.  doi:10.3969/j.issn.1007-3205.2021.11.015
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    Objective A total of 70 patients of either gender, aged 18-60 years, with American Society of Anesthesiologists（ASA） grade Ⅰ or Ⅱ, were selected for elective thoracoscopic pulmonary bullae resection. 
    Methods They were randomly divided into block combined with general anesthesia group (group R) and simple general anesthesia group (group G),with 35 cases in each group.Group R received rhomboid intercostal and subserratus plane block (RISS) block before anesthesia induction, while group G did not receive intervention. Patients in two groups were given general anesthesia through bronchial intubation and patient-controlled intravenous analgesia (PCIA) after operation. The visual analogue scale(VAS)scores for pain at rest and during coughing at 2, 6, 12, 24 and 48 h after operation were recorded. The total amount of propofol and remifentanil used during the operation were recorded.The times of pressing the analgesia pump, the total amount of sufentanil, the number of cases of flurbiprofen axetil remedial analgesia and the score of analgesia satisfaction were recorded. The incidence of adverse reactions including pruritus, nausea and vomiting, and vertigo were recorded within 48 h after operation. 
    Results The VAS scores for pain at rest and during cough of the two groups were gradually increased and then decreased at each time point after operation, and the increase amplitude of group R was significantly less than that of group G. The differences of interaction between groups, time points and time points between groups were statistically significant(P＜0.05). The total amount of propofol and remifentanil used in group R was significantly lower than that in group G(P＜0.05). The number of times of pressing, total amount of sufentanil and the number of flurbiprofen axetil analgesia in group R were significantly lower than those in group G(P＜0.05), and the score of satisfaction with analgesia was significantly higher than that in group G(P＜0.05). 
    Conclusion Ultrasound-guided rhomboid, intercostal and subserratus plane block combined with general anesthesia for thoracoscopic pulmonary bullae resection can provide good postoperative analgesia, reduce the use of perioperative sedative and analgesic drugs, and improve the satisfaction of analgesia.

    Study on the effect of dexmedetomidine in the perioperative period of cesarean section in elderly parturients with gestational hypertension
    LIU Xiu-ye, GUO Qiong-mei, WANG Xi-lian, ZHOU Chang-hao, WANG Li
    2021, 42(11):  1317-1322.  doi:10.3969/j.issn.1007-3205.2021.11.016
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    Objective To observe whether dexmedetomidine can increase the level of analgesia and sedation during cesarean section(C-section) in elderly parturients with gestational hypertension, maintain hemodynamics stability, reduce perioperative inflammatory response and oxidative stress injury. 
    Methods A total of 60 cases of elderly parturients with gestational hypertension who underwent C-section were selected and divided into dexmedetomidine group(group D) and control group(group C), with 30 cases in each group. Group D was given dexmedetomidine hydrochloride(the loading amount was 0.5 μg/kg, and the maintenance rate was 0.2 μg·kg-1·h-1until the end of operation) after the fetus was delivered and the umbilical vein was cut, and the constant volume of normal saline was given to group C in the same manner. After surgery, the intravenous self-controlled analgesia pump was connected, group D was given dexmedetomidine 2 μg/kg+sufentanil 2 μg/kg+ dezocine 0.3 mg/kg+tropisetron 10 mg+saline 100 mL, while group C was given sufentanil 2 μg/kg+dezocine 0.3 mg/kg+tropisetron 10 mg+saline 100 mL. The following indexes were collected: ①Ramsay sedation score and visual analogue scale(VAS) before surgery(T1), at 20 min after administration(T2) and immediately after surgery(T3), at 6 h(T4), 24 h(T5) and 48 h(T6) after surgery as well as additional times of postoperative analgesia pump; ②Hemodynamic parameters at T1-T6; ③Incidence of adverse reactions; ④Indicators of inflammatory response and oxidative stress: tumor necrosis factor-α(TNF-α), interleukin 6(IL-6), malondialdehyde(MDA) and superoxide dismutase(SOD) in venous blood at T1-T6. 
    Results Ramsay sedation score at T2-T6 in group D was significantly higher than that in group C, VAS pain score at T4-T6 in group D was significantly lower than that in group C(P＜0.05). Additional times of postoperative analgesia pump in group D was significantly lower than that in group C(P＜0.05). The levels of SBP, DBP and HR in group D at T2-T6 were significantly lower than those in group C(P＜0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05). At T2-T6, the levels of TNF-α, IL-6 and MDA in group D were significantly lower than those in group C, and the levels of SOD were significantly higher than those in group C(P＜0.05). 
    Conclusion Dexmedetomidine can maintain the stability of perioperative hemodynamics in elderly parturients with gestational hypertension, alleviate anxiety and pain, and reduce inflammatory response and oxidative stress response through analgesia and sedation, thus improving the prognosis. 

    Effect of dexmedetomidine combined with nalmefene hydrochloride in laryngeal mask anesthesia on the quality of resuscitation and stress indicators in children undergoing appendectomy
    HE Yong, XU Bin-bing
    2021, 42(11):  1323-1327.  doi:10.3969/j.issn.1007-3205.2021.11.017
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    Objective To investigate the effect of dexmedetomidine(DEX) combined with nalmefene hydrochloride in laryngeal mask anesthesia on the quality of resuscitation and stress indicators in children undergoing appendectomy. 
    Methods A total of 98 children who underwent appendectomy in our hospital were selected. Of them, 42 children who received DEX combined with nalmefene hydrochloride for laryngeal mask anesthesia were included in the combination group, and 56 children who underwent laryngeal mask anesthesia were included in the control group. The operative conditions, intraoperative stress response, postoperative resuscitation quality, mental status and complications were compared between two groups. 
    Results The awake time, laryngeal mask removal time, spontaneous breathing time, time of off-bed activity, anal exhaust time, and length of hospital stay in the combination group were significantly shorter than those in the control group(P＜0.05). Norepinephrine(NE), adrenaline(E), cortisol(Cor), and adrenocorticotropic hormone(ACTH) levels in two groups after surgery were significantly higher than those at T0, while the NE and E levels at T2 and T3 in the combination group were significantly lower than those in the control group at T1, suggesting no significant difference between the two groups(P＞0.05). The levels of fever Cor and ACTH at T1, T2, and T3 in the combination group were significantly lower than those in the control group(P＜0.05). There was no significant difference in Ramsay and FLACC scores between two groups of children at 5 min after the mask removal(P＞0.05). The Ramsay and FLACC scores of the two groups were significantly reduced at 30 min and 60 min after the mask removal, and the Ramsay score and FLACC score of the combination group were significantly lower than those of the control group(P＜0.05). The mental state of children in the combination group was significantly better than that of the control group(P＜0.05); The incidence of postoperative complications in two groups was not significantly different(P＞0.05). 
    Conclusion DEX combined with nalmefene hydrochloride for laryngeal mask anesthesia in children undergoing appendectomy can help shorten the anesthesia recovery time, reduce the children′s stress response, improve the quality of postoperative recovery, and ease the postoperative pain, with good safety and reliability.

    Observation of the anesthesia effect of dexmedetomidine combined with local anesthesia for percutaneous kyphoplasty in elderly patients with thoracolumbar fractures
    ZHANG Pei, DU Yuan, WANG Si-di, SUN Cheng-jun, JIN Qi
    2021, 42(11):  1328-1332.  doi:10.3969/j.issn.1007-3205.2021.11.018
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    Objective To explore the effectiveness and safety of dexmedetomidine combined with local anesthesia for percutaneous kyphoplasty(PKP) in the treatment of elderly patients(age ≥80 years) with thoracolumbar fractures. 
    Methods A total of 36 elderly patients with osteoporotic vertebral compression fractures who were selected for PKP were divided into intravenous anesthesia combined with local anesthesia group(observation group, n=19) and local anesthesia group(control group, n=17) according to presence or absence of combined intravenous anesthesia. In the observation group, intravenous pumping of dexmedetomidine was used during the operation, followed by intravenous administration at a loading dose of 0.5 μg/kg 10 min before anesthesia, and 0.4 μg·kg-1·h-1 maintenance dose until the end of the operation. Both groups were anesthetized with 1.0% lidocaine for local infiltration,with a total volume of 40 mL.The duration of operation and satisfaction score of perioperative pain management in both groups were recorded. Mean arterial pressure(MAP), heart rate(HR), blood oxygen saturation(SpO2) and pain visual analogue scale(VAS) score before operation(T0), during local anesthesia(T1), during puncture into the vertebral body(T2), during balloon expansion(T3), during injection of bone cement(T4), and at the end of surgery(T5)of the two groups were recorded. The occurrence of anesthesia-related adverse reactions and complications was recorded. 
    Results There was no statistically significant difference in duration of operation between the two groups(P＞0.05). Satisfaction score of perioperative pain management was higher in observation group than in the control group, and the difference was statistically significant(P＜0.05). The MAP, HR, and VAS scores of the two groups fluctuated. The MAP, HR, and VAS scores of the observation group were lower than those of the control group. The differences in the interaction between groups, time points, and time points between groups were statistically significant(P＜0.05); the time points in SpO2 between two groups were statistically significant(P＜0.05), and there was no statistically significant difference in SpO2 in the interaction between groups, and time points between groups(P＞0.05). During the perioperative period, there were no anesthesia-related complications such as bradycardia, hypoxemia, and blood pressure fluctuations in the two groups. There was no significant difference in the incidence of bone cement leakage between the two groups(P＞0.05). 
    Conclusion Low-dose dexmedetomidine combined with local anesthesia provides a safe and effective anesthesia program for elderly patients with PKP, which can effectively reduce the hemodynamic response during perioperative period.