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Table of Content

    25 February 2022, Volume 43 Issue 2
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    Screening of differential metabolites in plasma of mice due to lethal acute poisoning with chlorpromazine hydrochloride
    LIU Xin-xin, BAI Rui, LIU Wen-qiao, XIE Bing, WEN Di, MA Chun-ling
    2022, 43(2):  130-134.  doi:10.3969/j.issn.1007-3205.2022.02.002
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    Objective To analyze and screen out differential metabolites related to lethal acute poisoning with chlorpromazine hydrochloride by non-targeted metabolomics. 
    Methods Twenty-four ICR mice were randomly selected and divided into saline control group(n=12) and chlorpromazine hydrochloride test group(n=12). Plasma samples of the two groups were detected by ultra-high performance liquid chromatography-high resolution mass spectrometry(UPLC-HRMS). The differential metabolites related to lethal acute poisoning with chlorpromazine hydrochloride between two groups were screened by orthogonal partial least squares-discriminant analysis(OPLS-DA), t-test and fold change statistical methods and compared with the database, thereby identifying statistically significant differential metabolites. 
    Results The results of OPLS-DA analysis of plasma samples showed significant differences between the two groups. A total of 29 differential metabolites containing 11 categories such as fatty acyl groups and carboxylic acids and their derivatives were identified. 
    Conclusion The metabolomics technology based on UPLC-HRMS can screen differential metabolites related to lethal acute poisoning with chlorpromazine hydrochloride, which may provide a reference for future forensic determination of the cause of death from chlorpromazine hydrochloride poisoning.

    The effect of macrophages depletion by clodronate liposome on homing of hematopoietic stem/progenitor cells
    YANG Xiao, YANG Xin, ZHANG Xiao-long
    2022, 43(2):  135-139,192.  doi:10.3969/j.issn.1007-3205.2022.02.003
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    Objective To explore the effect of macrophage depletion on the homing process of hematopoietic stem/progenitor cells(HSPC). 
    Methods Mouse HSPCs were obtained by immunomagnetic bead sorting, and labeled with carboxyfluorescein diacetate succinimide ester(CSFE). A mouse model of macrophage depletion was established by clodronate liposomes(Clod), and the efficiency of HPSC homing was detected by flow cytometry.The mRNA and protein expression levels of CXCL12, SCF and vascular adhesion molecule 1(VCAM1) molecules in bone marrow niche after macrophage depletion were detected by real-time RT polymerase chain reaction(qRT-PCR) and enzyme linked immuno sorbent assay(ELISA) assay. 
    Results The number of CD11b+F4/80+ macrophages in the bone marrow of mice was significantly decreased at the 24 and 48 h after the injection of Clod(P＜0.05). After transplantation of mouse HSPC, the homing efficiency of HSPC in the mice in the Clod group was significantly reduced, as compared with the control group(P＜0.05). In the meantime, the mRNA and protein expressions of CXCL12 and SCF in the bone marrow niche of the mice in the Clod group were significantly lower than those in the control group(P＜0.05), while there was no significant change in VCAM1 expression between Clod and control group. 
    Conclusion Macrophage depletion can reduce the homing efficiency of HSPC, which may be related to the reduction of CXCL12 and SCF levels in the bone marrow niche after macrophage depletion.

    The impact of the whole course of rehabilitation management during the perioperative period based on Omaha theory on the psychological stress, 6-min walking distance and complications of TAVR patients
    LI Lan-xiang, LYU Xiang-ni, HAN Dong-mei, ZHANG Ning
    2022, 43(2):  140-144,149.  doi:10.3969/j.issn.1007-3205.2022.02.004
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    Objective To investigate the effects of the whole course of rehabilitation management during the perioperative period based on Omaha theory on psychological stress, 6-min walking distance(6MWD) and complications of patients undergoing transcatheter aortic valve replacement(TAVR). 
    Methods A total of 74 TAVR patients in our hospital were selected and grouped according to the random number table method, with 37 cases in each group. The control group was given traditional perioperative care, and on the basis of the control group, the observation group was given the whole course of rehabilitation management during the perioperative period based on the Omaha theory. The complications, the degree of nursing satisfaction, psychological stress before and after nursing, cardiac function index, health promotionlifestyle profile-Ⅱ(HPLP-Ⅱ), 6MWD and quality of life were calculated in the two groups. 
    Results After the intervention, the left ventricular end-diastolic diameter and transvalvular pressure difference in the observation group were lower than those in the control group, and the aortic valve area and left ventricular ejection fraction were higher than those in the control group(P＜0.05). The scores of trait anxiety inventory(T-AI) and state anxiety inventory(S-AI) in the observation group after intervention were lower than those in the control group(P＜0.05). The scores of 6 dimensions of HPLP-Ⅱ scale in the observation group were higher than those in the control group after intervention(P＜0.05). The quality of life and 6MWD in the observation group were higher than those in the control group at 3 and 6 months after operation(P＜0.05). The complications in the two groups were not significantly different(P＞0.05). 
    Conclusion The application of whole course of rehabilitation management during the perioperative period based on Omaha theory to TAVR patients can alleviate their psychological stress, improve the health and lifestyle of patients, and prevent complications. It has positive significance in improving patients′ cardiac function and exercise endurance, and increasing the satisfaction degree of patients. 

    The relationship between RDW, PLT, HCT and the risk degree of ANVUGIB and the effectiveness of their combination in predicting prognosis
    LIU Wei, WANG He, XU Li-li, MENG Li-jun, TAO Ping, LI Jian-hui
    2022, 43(2):  145-149.  doi:10.3969/j.issn.1007-3205.2022.02.005
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    Objective To investigate the relationship between red blood cell distribution width(RDW), platelet count(PLT), hematocrit(HCT) and the risk degree of acute nonvariceal upper gastrointestinal bleeding(ANVUGIB) and the effectiveness of their combination in the prediction of prognosis. 
    Methods A total of 300 ANVUGIB patients admitted to our hospital were selected and divided into death group(n=26) and survival group(n=274) according to the prognosis during hospitalization. The general data, RDW, PLT, and HCT levels in the two groups were compared. Pearson analysis was used to analyze the correlation between RDW, PLT, HCT and Glasgow-Blatchford scoring system(GBS), and partial correlation was used to further analyze the relationship between each index and GBS. Receiver operating characteristic curve(ROC) and the area under ROC curve(AUC) were used to analyze the effectiveness of RDW, PLT, HCT and their combination in predicting prognosis. 
    Results The GBS score of the death group was higher than that of the survival group(P＜0.05), and the difference in the distribution of blood loss between the two groups was statistically significant(P＜0.05). The RDW of the death group was higher than that of the survival group, while the PLT and HCT were lower than those of the survival group(P＜0.05). RDW was positively correlated with GBS score(r=0.601, P＜0.001), PLT(r=-0.592, P＜0.001), and HCT(r=-0.697, P＜0.001), and were negatively correlated with GBS score. After controlling the bleeding volume, RDW, PLT and HCT were still correlated with GBS score(P＜0.05). The AUC of RDW+PLT+HCT in predicting prognosis was 0.900, which was higher than that predicted by each index alone. 
    Conclusion RDW, PLT, and HCT are all related to the risk classification and prognosis of patients with ANVUGIB. Combined detection can improve the prognostic value and provide a basis for timely, effective and individualized treatment. 

    Epidemiological characteristics and changing trends of esophageal cancer diagnosed by gastroscopy in Xijing Hospital, the First Affiliated Hospital of Air Force Military Medical University from 2016 to 2020
    LEI Shu-lin, YANG Li-ping, LI Yan-yan
    2022, 43(2):  150-154.  doi:10.3969/j.issn.1007-3205.2022.02.006
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    Objective To clarify the epidemiological characteristics and changing trends of esophageal cancer in the past five years, and to provide scientific data support for the current prevention and treatment of esophageal cancer in China. 
    Methods The clinical data of 15 661 patients undergoing gastroscopy in Xijing Hospital, the First Affiliated Hospital of Air Force Military Medical University were collected for retrospective analysis, and the detection rate and distribution characteristics by gastroscopy for esophageal cancer were calculated. 
    Results The detection rate of esophageal cancer in this study was 4.70%. From 2016 to 2020, the detection rate of esophageal cancer was 3.79%, 4.03%, 4.10%, 5.23%, and 5.42%,respectively, showing a trend of a gradual increase(P＜0.05). The proportion of males and females was 70.79% and 29.21% respectively, and the number of males was larger than that of females(P＜0.05). The age distribution of esophageal cancer was mainly in the group over 50 years(29.89%) and over 60 years(34.92%), and the composition ratio was higher than other age groups(P＜0.05). The distribution of lesion sites and tissue types of esophageal cancer was mainly in the middle portion of the esophagus(63.99%) and squamous cell carcinoma(88.99%), and the composition ratio was higher than other lesion sites and tissue types(P＜0.05). The regions and occupations of esophageal cancer were mainly in rural areas(82.20%) and farmers(69.70%), and the composition ratio was higher than other regions and occupations(P＜0.05). 
    Conclusion From 2016 to 2020, the detection rate of esophageal cancer in Xijing Hospital, the First Affiliated Hospital of Air Force Military Medical University is increasing year by year. It is more likely to occur in the middle portion of the esophagus, and the main pathological type is squamous cell carcinoma. Rural men over 50 years of age are the high-risk population. Therefore, it is of significance to strengthen early screening.
    Predictive factors of death within 2 years after following lower extremity fracture surgery in elderly patients
    ZHANG Jian-gang, NI Kun
    2022, 43(2):  155-159,182.  doi:10.3969/j.issn.1007-3205.2022.02.007
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    Objective To investigate the predictive factors of death within 2 years  after lower extremity fracture surgery in elderly patients. 
    Methods Clinical data were collected from patients aged ≥65 years who underwent elective lower extremity fracture surgery. According to the survival status after operation within 2 years, patients were assigned into survival group and death group. Multivariate Cox regression analysis was performed on the factors with statistically difference between the two groups and predictive factors of death within 2 years were screened out. Receiver operation characteristic(ROC) curves and calculation of area under the ROC curve(AUC) were used to assess the predictive ability of the above factors.  
    Results The data of 372 patients were eventually included for statistical analysis. Among them, 55 deaths occurred within 2 years and the overall mortality was 14.7%. Cox regression analysis revealed that age ≥75 years(HR:2.155, 95%CI:1.093-4.247), American Society of Anesthesiologists(ASA) grade ≥3(HR:2.978, 95%CI:1.242-7.183), Charlson Comorbidity Index(CCI) score≥2(HR:4.649, 95%CI:2.467-8.761), preoperative anemia(HR:2.050, 95%CI:1.066-3.943), cardiocerebral vascular events during postoperative hospital stay(HR:3.026, 95%CI:1.491-6.140) were the predictive factors of death within two years after operation. The AUC was 0.677, 0.733, 0.700, 0.584 and 0.658, respectively. The AUC of the combination of the above five predictive factors was 0.858, which was significantly higher than the AUC of each factor alone. ASA grade  ≥3 was the most sensitive with a sensitivity of 87.3% and CCI≥2 was the most specific with a specificity of 92.7%. 
    Conclusion Age≥75 years, ASA grade ≥3, CCI score ≥2, preoperative anemia and postoperative cardiocerebral vascular events can be predictive factors of death within 2 years after following lower extremity fracture surgery in elderly patients. The combined use of these five predictive factors was superior for death prediction than each factor alone. It is suggested that targeted perioperative intervention may help improve long-term quality of life of elderly patients.

    Effect of Ubenimex capsules combined with radiotherapy in the treatment of cervical cancer and its effect on prognosisof patients
    ZHANG Li-ting, WANG Xu-ping, SHI Huan-li, ZHAO Li, WU Jin-feng, LI Huan-huan
    2022, 43(2):  160-165.  doi:10.3969/j.issn.1007-3205.2022.02.008
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    Objective To explore the therapeutic effect and prognostic effect of Ubenimex capsule combined with radiotherapy in patients with cervical cancer. 
    Methods A total of 60 patients with cervical cancer admitted to our hospital were randomly divided into radiotherapy group and combination group, with 30 cases in each group. Patients in the radiotherapy group received radiotherapy, and patients in the combination group received Ubenimex capsule combined with radiotherapy. Human telomerase reverse transcriptase(hTERT) and human papillomavirus(HPV) were detected by mucus assay. Receptor for activated C kinase 1(RACK1), microRNA-198(miR-198), microRNA-329-3p(miR-329-3p), classⅡ transactivators(CIITA), gamma-interferon-inducible lysosomal thiol reductase(GILT), and asparagine endopeptidase(LGN) were detected by RT-PCR. The quality of life between two groups was compared. Serum carbohydrate antigen 724(CA724), carcinoembryonic antigen(CEA) and squamous cell carcinoma associated antigen(SCC-Ag) were detected by enzyme-linked immunosorbent assay(ELISA). Clinical efficacy, adverse reactions and survival were evaluated. 
    Results Compared with the radiotherapy group, the levels of HPV, hTERT, RACK1, miR-198, CIITA, GILT, FACT-G score, FACT-CX score, CA724, CEA and SCC-Ag in the combination group were lower, while the expression levels of miR-329-3p and LGMN were higher(P＜0.05). Compared with the radiotherapy group, the total response rate, median survival time and survival rate were higher in the combination group(P＜0.05). 
    Conclusion Ubenimex capsule combined with radiotherapy can improve the expression of RACK1, miR-198, miR-329-3p and the level of tumor markers in patients, and promote the recovery of patients, ensuring long survival of patients and good therapeutic effect.

    Analysis of pregnancy outcome of blastocysts in different developmental stages and with different quality during cryo-resuscitation and transplantation cycle
    LI Peng-tao, YIN Chen-xing, WANG Na, XING Peng, MENG Na-na, GUO Zhan-kun
    2022, 43(2):  166-172.  doi:10.3969/j.issn.1007-3205.2022.02.009
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    Objective To analyze blastocyst development stage and the effects of its inner cell mass and trophoblast quality on pregnancy outcome, so as to provide help for the timing of blastocyst freezing and the selection of thaw embryos during frozen-thawed embryo transfer（FET） cycle. 
    Methods This study retrospectively analyzed the data of patients who received the single blastocyst FET cycle in the Department of Reproductive Medicine,Maternal and Child Health Hospital of Baoding City. According to blastocyst expansion/hatch status and blastocyst quality, blastocysts were divided into A1 group(stage 4 high-quality blastocyst group),A2 group(stage 4 non-high-quality blastocyst group),B1 group(stage 5 high-quality blastocyst group),B2 group(stage 5 non-high-quality blastocyst group),C1 group(stage 6 high-quality blastocyst), and C2 group(stage 6 non-high-quality blastocyst).The difference in pregnancy outcome of FET cycle of blastocysts of the same quality at different developmental stages, and the difference in pregnancy outcome of FET cycle of blastocysts of different quality at the same developmental stage were compared. 
    Results Compared with the high-quality blastocyst groups, the pregnancy rate and implantation rate of the FET cycle in the A1 group were significantly higher than those in the B1 group(P＜0.05), while there was no significant difference in the pregnancy rate and implantation rate of the FET cycle between the A1 group and the C1 group(P＞0.05). However,the pregnancy rate and implantation rate of the C1 group showed a downward trend,and there was no statistical difference in parameters such as abortion rate,live birth rate, male/female ratio, gestational age, and newborn weight during the FET cycle among the three groups(P＞0.05). Compared with non-high-quality blastocyst groups, there was no statistical difference in pregnancy rate, implantation rate, miscarriage rate, live birth rate, male/female ratio, gestational age and newborn weight during FET cycle in A2, B2, and C2 groups(P＞0.05). Compared with theblastocyst groups of different qualityat the same developmental stage, the pregnancy rate, implantation rate, and live birth rate of A1 group were significantly higher than those of A2 group(P＜0.05), but there was no statistics between the two groups with respect to miscarriage rate,male/female ratio,gestational age and newborn weight(P＞0.05); There were no significant differences in pregnancy rate, implantation rate, miscarriage rate,live birth rate, male/female ratio,gestational age, and newborn weight during FET cycle in group B1, as compared with group B2, and in group C1, as compared with group C2(P＞0.05). 
    Conclusion The developmental stage of the blastocyst has a certain impact on the outcome of the blastocyst following FET. The pregnancy rate and implantation rate of stage 4 high-quality blastocyst after FET are significantly better than clinical outcome of stage 5 high-quality blastocyst after FET,which, however, are not significantly different from those of stage 6 high-quality blastocyst during FET cycle. However, the pregnancy rate and implantation rate of stage 6 blastocysts have a downward trend. The clinical outcome of stage 4 high-quality blastocyst during FET at the same developmental stage is significantly higher than pregnancy rate and implantation rate of stage 4 non-high-quality blastocyst during FET. Therefore,as for the blastocyst FET cycle, we should give priority to stage 4 high-quality blastocyst.

    Study on reduction of birth defects by analysis of amniotic fluid karyotype
    SONG Jing-lan, YU Jun-na, TIAN Jing-ru, LI Wei, YANG Jian, LI Qiang
    2022, 43(2):  173-176,217.  doi:10.3969/j.issn.1007-3205.2022.02.010
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    Objective To explore the types and distribution of abnormal karyotypes of amniotic fluid chromosomes, and detection rate of abnormal karyotypes with different prenatal diagnostic indications. 
    Methods A total of 1 305 pregnant women with the prenatal diagnostic indications were selected for amniocentesis and analysis of amniotic fluid karyotype in the Maternal and Child Health Care Hospital of Baoding City. 
    Results In 1 305 amniotic fluid samples, 92 abnormal karyotypes were detected, with the detection rate of 7.05%. Among them, 68 cases(73.91%) had abnormal number of chromosomes, and 24(26.09%) had structural abnormalities. The most common abnormal karyotypes were 21 trisomy(48.91%), followed by abnormal number of sex chromosome（23.91%). Among the single indications, the detection rate was the highest in high risk of non-invasive prenatal testing(NIPT)(50.00%), followed by chromosomal abnormalities in one spouse(38.46%). The group with advanced age combined with high risk of NIPT had a higher detection rate than that with only advanced age(P<0.001). 
    Conclusion The karyotype analysis of amniotic fluid cells in pregnant women with different prenatal diagnosis indications in the second trimester could help to find the abnormal karyotype of the fetus and reduce the incidence of fetal birth defects. NIPT has a higher accuracy in screening fetal chromosome abnormalities. NIPT screening strategy should be considered as the first choice for advanced maternal age.

    Predictive value of body temperature formortality risk in children with sepsis: A retrospective study of 152 children with sepsis
    XU Mei-xian, LIU Gang, CAO Li-jing, BAI Xin-feng, KANG Lei, ZHAO Xin
    2022, 43(2):  177-182.  doi:10.3969/j.issn.1007-3205.2022.02.011
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    Objective To explore the predicative value of body temperature for mortality risk of children with sepsis in PICU. 
    Methods A total of 152 children with sepsis were included and divided into three groups based on the body temperature at 24h before and after PICU admission: ultrahyperpyrexia(39.5-41 ℃) group，fever(37.5-39.5 ℃) group and apyrexia(＜37.5 ℃) group. Pediatric critical illness score(PCIS), mortality rate(overall and at 7 d after admission), inflammation and immune function, multiple organs function were compared.They were also divided into the survival group and the death group according to condition at 7 d after PICU admission, and temperature distribution and PCIS score were compared. The risk factors of 7-day mortality was analyzed by Logistic regression analysis. 
    Results Of 152 children with sepsis,the number of children that died within 7 d accounted for 82.2%(37/45). The 7-day mortality of the three groups were 36.4%, 16.7% and 42.9%, respectively, with the lowest mortality rate in the fever group(P＜0.05). In the ultrahyperpyrexia group, 11 children received blood purification, accounting for 50.0%; In the fever group, 34 children received blood purification, accounting for 33.3%; In the apyrexia group, 3 children received blood purification, accounting for 10.7%. There was significant difference in the proportion of children receiving blood purification among the three groups(χ2=9.242, P=0.010). There was no significant difference in the proportion of children receiving blood purification between ultrahyperpyrexia group and fever group(χ2 =0.109, P=0.741). The proportion of children receiving blood purification in the ultrahyperpyrexia group was higher than that in the apyrexia group, and the difference was statistically significant(χ2 =9.432, P=0.002). The proportion of children receiving blood purification in the fever group was higher than that in the apyrexia group, and the difference was statistically significant(χ2=5.520, P=0.019). There was no significant difference in the related inflammatory indexes［white blood cells(WBC), C-reactive protein(CRP), procalcitonin(PCT) and naive lymphocytes］ among three groups(P＞0.05). However, there was significant difference in the lymphocyte count of the three groups at 48-72 h(P＜0.05), and the values of apyrexia group and ultrahyperpyrexia group were lower than those of fever group(P＜0.05). The abnormal rates of CK, CK-MB, Cr and LDH in the three groups were not statistically significant(P＞0.05). The abnormal rates of ALT in the ultrahyperpyrexia group and fever group were lower than those in the apyrexia group(P＜0.05). All patients were divided into survival group and death group according to 7-day survival. In the death group, the proportion of children without fever was the highest, up to 40.5%; In the survival group, the proportion of children with fever was the highest, up to 76.5%(P＜0.001). The PCIS score of children in the survival group was higher than that in the death group, and the absolute lymphocyte count at 48-72 h was higher than that in the death group(P＜0.05). There was no significant difference in CRP and PCT between two groups(P＞0.05). Multivariate Logistic regression analysis showed that PCIS score in children and the absolute lymphocyte count at 48-72 h were the risk factors of death(P＜0.05). 
    Conclusion The proportion of septic children with fever is high in PICU, and children with fever have a higher survival rate than those with ultrahyperpyrexia or with apyrexia. However, body temperature is not the independent risk factor for mortality.  

    Efficacy of intravitreal injection of aflibercept combined with pan-retinal photocoagulation in the treatment of diabetic macular edema induced by proliferative diabetic retinopathy
    LI Shuang, ZHANG Hai-zhao, JIANG Xiao-dan, JIANG Yan-ni
    2022, 43(2):  183-186,197.  doi:10.3969/j.issn.1007-3205.2022.02.012
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    Objective To study the effect of intravitreal injection of aflibercept combined with pan-retinal photocoagulation(PRP) in the treatment of diabetic macular edema(DME) induced by proliferative diabetic retinopathy(PDR). 
    Methods Sixty patients(60 eyes) with PDR and DME were randomly divided into control group and experimental group. The former was treated with PRP alone, and the latter was treated with intravitreal injection of arbasip combined with PRP. At one month after treatment, the best corrected visual acuity(BCVA), central macular thickness(CMT), intraocular pressure and the incidence of complications were compared between  two groups. 
    Results Before treatment, there was no significant difference in BCVA, intraocular pressure and CMT between two groups(P＞0.05). After treatment, BCVA in the experimental group was better than that in the control group, while intraocular pressure and CMT were lower than those in the control group(P＜0.05). Compared with those before treatment, BCVA increased while CMT decreased in both groups, and intraocular pressure increased in the control group(P＜0.05). The regression rates of neovascularization and non-perfusion area in the experimental group were better than those in the control group, and the incidence of complications in the experimental group was lower than that in the control group(P＜0.05). 
    Conclusion Compared with PRP alone in the treatment of DME in the proliferative stage of DR, aflibercept combined with PRP can more effectively eliminate macular edema, better improve vision, and reduce the incidence of complications. Therefore, this combined treatment is a treatment method worthy of popularization.

    Effectiveness of multimodal cardiovascular imaging in the diagnosis of diabetic cardiomyopathy
    LI Yong, YIN Xiao-xia, CUI Shu-jun, YANG Fei, HU Li-mei
    2022, 43(2):  187-192.  doi:10.3969/j.issn.1007-3205.2022.02.013
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    Objective To investigate the effectiveness of different cardiovascular imaging techniques in detecting ventricular volume and cardiac function in patients with diabetic cardiomyopathy(DCM). 
    Methods A total of 120 patients with DCM diagnosed in our hospital were collected. Echocardiography, cardiac computed tomography(CCT) and cardiac magnetic resonance(CMR) were used to detect the left and right ventricular end diastolic volume(EDV), end systolic volume(ESV), stroke volume(SV) and ejection fraction(EF). Statistical analysis was used to detect the difference of the results of the three detection methods. 
    Results After comparing the patient′s cardiac function parameters, there was no significant difference in the left ventricular volume of DCM patients detected by echocardiography, but the ESV of the right ventricle was significantly smaller than that of CMR(P＜0.05). For all of the patients, the EF detected by echocardiography was generally higher than that of CMR(P＜0.05). When EF＞50%, there was no significant difference between the results of echocardiography and CMR, but when EF＜50%, the results of echocardiography were significantly higher than those of CMR(P＜0.05). CCT and CMR showed good consistency in the detection of ventricular volume and cardiac function in patients with DCM; When EF＜35%, the detection result of CCT was significantly higher than that of CMR(P＜0.05). The three methods showed good consistency between and within observers. 
    Conclusion Echocardiography, CCT imaging and CMR have certain differences in the detection results of patients′ cardiac function, which, therefore, should be used by clinicians according to the actual situation.

    Evaluation value of superb micro-vascular imaging for internal carotid artery occlusion and analysis of risk factors for plaque neovascularization plaque formation of new blood vessels
    MA Li-feng, WANG Yi-cheng, XU Le, ZHANG Li-wei, WEN De-hui, YUAN Gui-li
    2022, 43(2):  193-197.  doi:10.3969/j.issn.1007-3205.2022.02.014
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    Objective To explore the evaluation value of superb micro-vascular imaging(SMI) for internal carotid artery occlusion(ICAO) and to analyse the risk factors of plaque neovascularization. 
    Methods  A total of 120 young and middle-aged obese patients with diabetes who had homogeneous iso-echo or hypoechoic plaques in the carotid artery detected in the Department of Ultrasound Medicine of our hospital were selected and detected by SMI and Digital subtraction angiography(DSA) for ICAO. They were divided into neovascularization group(n=98) and non-neovascularization group(n=22) according to the results of SMI detection. The clinical data of patients in two groups were collected for univariate analysis, and risk factors for plaque neovascularization were analyzed using multivariate unconditioned Logistic regression analysis. 
    Results The probability of ICAO among 120 patients detected by SMI and DSA was 13.33% and 18.33% respectively, and the test results were in good consistency(Kappa=0.814, P=0.023). Smoking history, history of coronary heart disease(CHD), history of cerebral infarction as well as increased serum low-density lipoprotein cholesterol(LDL-C) and C-reactive protein(CRP) levels were the independent risk factors for plaque neovascularization in young and middle-aged obese patients with diabetes(OR=1.047, 1.388, 2.319, 2.094, 1.951, P＜0.05 or P＜0.01). 
    Conclusion SMI has a high diagnostic value for ICAO, which in good consistency with DSA examination results. Smoking history, history of CHD, history of cerebral infarction and increased serum LDL-C and CRP levels are the independent risk factors for plaque neovascularization in young and middle-aged obese patients with diabetes.

    Diagnostic value of whole-body diffusion weighted imaging in multiple myeloma
    WANG Ming, LIU Ying, WANG Ya-li, ZHANG Wei, CUI Feng-zhen, LI Yu-qing
    2022, 43(2):  198-202.  doi:10.3969/j.issn.1007-3205.2022.02.015
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    Objective To explore the diagnostic value of whole-body diffusion weighted imaging(WB-DWI) in multiple myeloma.
    Methods In total, 31 patients with multiple myeloma diagnosed initially were collected as the experimental group, and 98 healthy subjects were selected as the control group. Before treatment, WB-DWI was performed, the ADC value of the lesion was measured, and the correlation between ADC value and clinical laboratory indexes was analyzed. 
    Results The lesions showed high signal intensity with focal or diffused distribution on DWI(b=800 s/mm2) images and low signal intensity on the ADC maps. Extramedullary lesions were found in 3 cases. The mean ADC value of the lesions in the whole body was(0.77±0.21)×10-3 mm2/s and was significantly different from that of the normal bone marrow(P＜0.05). The mean ADC value of the lesions in iliac bone was positively correlated with the percentage of myeloma cells(rs=0.560，P=0.008). The mean ADC value of the lesions in the whole body was negatively correlated with the blood HBG(rs=-0.490， P=0.011), and positively correlated with the serum and urine β2-MG and serum CRP(rs=0.557,  0.517，P=0.05, 0.004, 0.014). 
    Conclusion WB-DWI has an important value in the diagnosis and monitoring of initially diagnosed multiple myeloma, which, therefore, should be used as a routine imaging method for patients initially diagnosed with multiple myeloma.

    The application value of ultra-low-dose wide-detector CT scan mode in patients undergoing coronary CTA
    SHEN Tai-zhong, LI Bao, XIE Ling-zheng, WANG Shu-li
    2022, 43(2):  203-207.  doi:10.3969/j.issn.1007-3205.2022.02.016
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    Objective To explore the effect of ultra-low-dose wide-detector CT scanning mode on the radiation dose and excellent and good rate of image by coronary CT angiography(CTA) and its diagnostic value for coronary stenosis. 
    Methods A total of 85 patients with suspected coronary heart disease(CHD) were selected as the research subjects, all of whom underwent Toshiba′s 320-slice spiral CT examination. The conventional group was tested with 100 kV tube voltage, and the ultra-low-dose group was tested with 70 kV tube voltage. The mean heart rate during the examination and radiation dose［CT dose index-volume(CTDIvol), dose-length product(DLP), effective dose(ED)］, objective evaluation parameters of image［optimal signal-to-noise ratio(SNR), contrast-to-noise ratio(CNR)］, image quality score, the excellent and good rate of image were compared between two groups. Digital subtraction angiography(DSA) was used as the gold standard, the consistency of the degree of coronary artery stenosis in ultra-low dose examination with DSA was evaluated, and its diagnostic value for coronary artery stenosis degree≥50%(moderate and above) was analyzed. 
    Results CTDIvol, DLP, and ED in the ultra-low-dose group were lower than those in the conventional group, while SNR and CNR were higher than those in the conventional group, with significant difference(P＜0.05). After two senior diagnostic imaging physicians assessed the image quality with a double-blind method, there was no statistically significant difference between two groups in the image quality score and the excellent and good rate of image(P＞0.05). The agreement of the two doctors on the image quality assessment was high(Kappa value=0.772). With DSA examination as the gold standard, the ultra-low-dose wide-detector CT scan mode was consistent with DSA in the diagnosis of coronary stenosis(Kappa value=0.943). With DSA as the gold standard, the AUC of ultra-low-dose wide-detector CT scan mode in the diagnosis of coronary stenosis ≥50%(moderate and above) was 0.939. The sensitivity, specificity, and accuracy were 88.89%, 98.87%, and 98.16%, respectively. 
    Conclusion The ultra-low-dose wide-detector CT scan mode has the advantages of higher objective evaluation of images and less impact on the excellent and good rate of image quality. It is helpful to reduce the radiation dose of patients undergoing coronary CTA examination, guide clinical assessment of coronary stenosis degree, and implement personalized treatment plan. 

    Observation on the safety and effectiveness of remifentanil combined with propofol target-controlled infusion and propofol combined with sevoflurane inhalation general anesthesia in interventional procedures for children with congenital heart disease
    LIU Xin-yan, DONG Li-yun, CHEN Yong-xue, WANG Xin-bo, SUN Yan, LYU Hang-yu
    2022, 43(2):  208-212,228.  doi:10.3969/j.issn.1007-3205.2022.02.017
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    Objective To explore the safety and effectiveness of remifentanil combined with propofol target-controlled infusion and propofol combined with sevoflurane inhalation general anesthesia for interventional treatment of congenital heart disease(CHD) in children. 
    Methods A total of 120 children who underwent interventional treatment for CHD in our hospital were selected and randomly divided into the propofol and remifentanil(PR) group(n=60) and the propofol and sevoflurane(PS) group(n=60). Anesthesia induction was performed in the PR group with remifentanil(4.0 μg/L) and propofol(4.0 mg/L). Anesthesia was maintained with propofol(2.5～4.0 mg/L) and remifentanil(4.0 μg/L). The concentration of propofol was adjusted to maintain A-line ARX index at 25～30. Anesthesia induction was performed in the PS group using propofol(2 mg/kg) and sevoflurane inhalation throμgh a laryngeal mask, and the concentration was increased from 2%(maximum concentration 7%). Anesthesia maintenance was kept using propofol(6 mg·kg-1·h-1) and sevoflurane(1% to 3%). The heart rate(HR), respiratory rate(RR), mean arterial pressure(MAP), blood oxygen saturation(SpO2), jugular bulb venousoxygen saturation(S-jvO2) and cerebral arterial venous oxygen content difference(Da-jvO2) before induction(T0), at laryngeal mask insertion(T1), at 3 min after laryngeal mask insertion(T2), immediately after operation(T3), and at laryngeal mask removal(T4), as well as extubation time, recovery time, residence time in anesthesia recovery room, postoperative hospital stay, complication and rate were compared between the two groups. 
    Results ①With the change of time, HR, RR, and MAP of the two groups initially decreased and then increased. The differences between groups, time points and interactions between groups and time points were statistically significant(P＜0.05). ②With the change of time, S-jvO2 and Da-jvO2 in the two groups initially decreased and then increased. The differences between the groups, the time points, and the interaction between groups and time points were all statistically significant(P＜0.05). ③There were no significant difference in residence time in anesthesia recovery room and hospital stay between two groups(P＞0.05). The extubation time of the PS group was shorter than that of the PR group(P＜0.05). ④The total incidence of complications in the two groups was 13.33% and 10.00% respectively, and the difference was not statistically significant(P＞0.05). 
    Conclusion The intraoperative vital signs using propofol combined with sevoflurane inhalation general anesthesia for CHD in children undergoing interventional surgery are more stable than those using remifentanil combined with propofol target-controlled infusion, and it is more conducive to the balance of cerebral oxygen supply and demand.

    The correlation between serum amyloid A, vascular endothelial growth factor and rheumatoid arthritis
    YUAN Jian-sheng, ZHOU Nian, CAI Tian, DU Yan-jiao, JIA Yan, JIANG Zi-yu
    2022, 43(2):  213-217.  doi:10.3969/j.issn.1007-3205.2022.02.018
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    Objective  To investigate the expression levels of serum amyloid A(SAA) and vascular endothelial growth factor(VEGF) in patients with rheumatoid arthritis(RA) and their roles in different disease activities in RA patients. 
    Methods A total of 98 RA patients treated in our hospital and 45 healthy controls were collected. According to disease activity score 28(DAS28), RA patients were divided into a high activity group(n=43), a moderate activity group(n=34), and a low activity and disease remission group(low activity + disease remission, n=21). Spearman correlation was used to analyze the correlation between serum SAA, VEGF levels and clinical indicators. Receiver operating characteristic(ROC) curve was used to analyze the diagnostic value of SAA and VEGF in patients with moderate to high activity RA. 
    Results The expression levels of SAA and VEGF in RA group were significantly higher than those in control group. With the increase of disease activity, the expression levels of SAA and VEGF were significantly increased. The expression levels of SAA and VEGF in the high activity group were significantly higher than those in the healthy control group and the low-moderate activity group(P＜0.05). Spearman correlation analysis showed that the expression levels of SAA and VEGF were positively correlated with the number of joint tenderness, joint swelling, ESR and DAS28 scores(all P＜0.05). The ROC curve showed that SAA and VEGF had a predictive value for patients with moderate to high activity RA(P＜0.05), and the combined diagnosis of SAA and VEGF had the highest predictive value for patients with moderate to high activity RA, and the area under the ROC curve(AUC) was 0.871. 
    Conclusion Serum SAA and VEGF levels are involved in the immune-inflammatory regulation of RA, which can be used as potential biomarkers to evaluate the activity of RA and contribute to the monitoring and evaluation of RA.

    Comparative study of colloidal gold immunochromatography assay for rapid detection of carbapenemase-producing Enterobacterales in blood culture
    LIU Ze-shi, HU Rui, LI Jing, YIN Jian, GENG Yan, BAI Lu
    2022, 43(2):  218-222.  doi:10.3969/j.issn.1007-3205.2022.02.019
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    Objective To evaluate colloidal gold immunochromatography assay(GICA)for rapid detection of carbapenemase-producing Enterobacterales in blood culture. 
    Methods In total, 79 strains of Enterobacterales in blood culture from the Second Affiliated Hospital of Xi′an Jiaotong University were collected, including 57 carbapenem-resistant Enterobacterales and 22 carbapenem-sensitive Enterobacterales. According to NG-Test CARBA 5 kit instructions,five main carbapenemases［klebsiella pneumoniae carbapenemase(KPC),new delhi metallo-β-lactamase(NDM),verona integron-encoded metallo-β-lactamase(VIM),imipenemase metallo-β-lactamase(IMP) andoxacillinase48（OXA)-48］ of the tested strains were detected. The carbapenemase gene was confirmed by polymerase chain reaction（PCR） sequencing. 
    Results In 57 strains of Carbapenem-resistant Enterobacterales in blood culture, KPC, NDM, IMP, KPC+NDM and NDM+IMP within were detecated 15 min using NG-Test Carba 5. The sensitivity and specificity were 100% and 100% respectively. The sensitivity and specificity of KPC, NDM, IMP, KPC+NDM and NDM+IMP detected by Jinshanchuan carbapenemase resistance detection reagent were 94.74% and 100% respectively. 
    Conclusion NG-Test CARBA 5 and Jinshanchuan carbapenemase resistance detection reagents, as efficient and rapid diagnostic methods, can simplify the complex process of clinical detection of carbapenemase.

    Therapeutic effect of Diacerein capsule combined with Imrecoxib tablet on patients with knee osteoarthritis and its effect on COX-2, WNT-3α and bone metabolism
    HU Heng, PENG Wei, ZHANG Zhong
    2022, 43(2):  223-228.  doi:10.3969/j.issn.1007-3205.2022.02.020
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    Objective To investigate the effects of Diacerein capsule combined with Imrecoxib tablet on cyclooxygenase-2(COX-2), serumo sekretorinis glikoproteinase-3α(WNT-3α) and bone metabolism in patients with knee osteoarthritis(KOA). 
    Methods A total of 160 patients with KOA admitted to our hospital were selected and divided into a single drug treatment group(n=80) and a combination treatment group(n=80) according to random number table method. Patients in the single drug treatment group were treated with Imrecoxib tablets, while patients in the combination treatment group were treated with Diacerein capsule combined with Imrecoxib tablets. Bone specific alkaline phosphatase(BALP) and tartrate-resistant acid phosphatase-5B(TRACP-5b), intereukin-1β(IL-1β), chitinase 3-like protein(YKL-40), and COX-2 levels were detected by enzyme-linked immunosorbent assay(ELISA). Tumor necrosis factor-α(TNF-α) levels were detected by turbidiometry, and the levels of osteocalcin(OC) and Wnt-3α were detected by radioimmunoassay. The therapeutic efficiency of the two groups was compared. 
    Results After treatment, the levels of serum BALP and OC in the two groups were higher than those before treatment, while the levels of serum TRACP-5b, IL-1β, TNF-α, YKL-40, COX-2, and Wnt-3α were lower than those in the single drug treatment group. Compared with those in single drug treatment group, the serum BALP and OC levels in the combination treatment group increased, while the serum TRACP-5b, IL-1β, TNF-α, YKL-40, COX-2, and Wnt-3α levels decreased(P＜0.05). After treatment, both the knee function score and visual analogue scale（VAS） score of both groups were lower than those before treatment, which were lower in the combination treatment group than in the single treatment treatment group(P＜0.05). The therapeutic efficiency of the combination treatment group was higher than that of the single drug treatment group(P＜0.05). 
    Conclusion The treatment of KOA by Diacerein capsule combined with Imrecoxib tablets can effectively relieve pain, improve bone metabolism level, reduce inflammation and articular cartilage damage, and improve knee function.