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Table of Content

    25 May 2022, Volume 43 Issue 5
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    Effect and mechanism of lidocaine pretreatment on alleviating doxorubicin-induced acute myocardial injury in mice
    LIU Hai-bo, LIU Yue-peng, ZHU Xia, LIU Wen-tao, CHENG Yue, HE Xue-ming
    2022, 43(5):  506-511.  doi:10.3969/j.issn.1007-3205.2022.05.002
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    Objective  To explore the effect of pre-treatment with lidocaine(LIDO) on alleviating doxorubicin(DOX)-induced myocardial injury and the underlying mechanism.

    Methods  A total of 30 mice obtained from Institute of Cancer Research(ICR) were selected and randomly assigned into control group(a single intraperitoneal injection of 1 mL/100 g normal saline, n=10), DOX group(a single intraperitoneal injection of 10 mg/kg DOX, n=10) and DOX+LIDO group(tail vein injection of 6 mg/kg LIDO, followed by a single intraperitoneal injection of 10 mg/kg DOX 30 min later, n=10). Body weight, survival rate and electrocardiogram(ECG) findings of the mice among three groups were observed. In addition, serum levels of cardiac troponin-T(cTn-T), interleukin-1β(IL-1β), interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α), as well as relative levels of phosphorylated adenosine phosphate activated protein kinase（ p-AMPK） and phosphorylated connexin 43（p-Cx43） in myocardial tissues of mice were measured and compared.

    Results  Compared with those in control group, mice in DOX group presented significantly reduced body weight at 2-7 d, increased 7-day mortality, and lowered heart rate. In addition, significantly higher serum levels of cTn-T, IL-1β, IL-6 and TNF-α, as well as downregulated p-AMPK and upregulated p-Cx43 in myocardial tissues were detected in DOX group, as compared with those of control group. Notably, compared with those in DOX group, LIDO pre-treatment significantly reversed DOX-induced reduction of body weight, increase in 7-day mortality, and decline of heart rate, which also reversed increased serum levels of cTn-T, IL-1β, IL-6 and TNF-α, downregulated p-AMPK and upregulated p-Cx43 in myocardial tissues.

    Conclusion  LIDO pre-treatment effectively alleviates DOX-induced myocardial injury of mice possibly by activating AMPK and inhibiting p-Cx43.

    Effect of prehospital emergency system on duration of thrombolysis in patients with acute ischemic stroke and its influencing factors
    XU Fang-meng, XU Jian-hua, YUE Yun-hua, LIN Quan-hong, XU Yao-wei
    2022, 43(5):  512-516.  doi:10.3969/j.issn.1007-3205.2022.05.003
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    Objective  To explore the efficacy of prehospital emergency system in duration of thrombolysis for patients with acute ischemic stroke(AIS), and to analyze the influencing factors of arrival by ambulance.

    Methods  A retrospective analysis was made on the stroke patients undergoing thrombolytic therapy in Emergency Department. The patients were divided into arrival by ambulance group(n=86) and self-visiting group(n=138) according to their method of visiting the hospital. The basic information(gender,age,marital status,and medical insurance payments) and the risk factors for previous stroke［hypertension,diabetes,coronary heart disease(CHD),dyslipidemia,history of cardiac valvular disease,atrial fibrillation(AF),and stroke)］, the symptoms at onset(limb weakness/weakness,slurred speech,visual disturbances,gaze,dizziness,headache,disturbance of consciousness), blood pressure at admission,heart rate,blood glucose,National Institute of Health Stroke Scale(NHISS) score,primary outcome［onset to needle time(ONT)］, secondary outcomes［onset to door time(ODT), onset to CT time(OCT),door to CT time(DCT), door to needle time(DNT) ］ betweem two groups, and the influencing factors of arrival by ambulance were analyzed.

    Results  There were significant differences in the two groups with respect to history of AF,limbweakness/weakness,slurred speech,visual disturbances,gaze,dizziness,presence of multiple symptoms(≥4 symptoms),ODT,OCT,ONT and NHISS scores before thrombolysis(P＜0.05). There were no significant differences in the two groups with respect to gender,age,household register,marital status,use of medical insurance payments, hypertension,diabetes, hyperlipidemia,CHD,cardiac valvular disease,stroke history,smoking history,drinking history,dizziness and headache,systolic blood pressure,diastolic blood pressure,heart rate,blood glucose,DCT and DNT(P＞0.05). Multivariate Logistic regression analysis showed AF(95%CI: 0.127-0.834, P＜0.05),limb weakness/weakness(95%CI: 0.018-0.399, P＜0.05),and slurred speech(95%CI: 0.117-0.924, P＜0.05) were protective factors for arrival by ambulance in patients with ischemic stroke.

    Conclusion  Arrivial by ambulance for stroke patients can significantly shorten ONT. For patients at risk of stroke, daily chronic disease management and health education should be strengthened, and ideas should be further clarified to optimize the established stroke treatment network process.

    Observation of the effect and adverse reactions of drug-coated balloon in the treatment of small coronary artery lesions in patients
    WANG Ya-ling, RAO Ming-yue, GUO An-jun, ZHANG Yang, MENG Jian-kang
    2022, 43(5):  517-520.  doi:10.3969/j.issn.1007-3205.2022.05.004
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    Objective  To explore the efficacy and safety of paclitaxel drug-eluting balloon in the treatment of small coronary artery lesions.

    Methods  A total of 84 patients with small coronary artery lesions admitted to this hospital were selected as the subjects of this study. They were divided into the control group(n=42) and the research group(n=42) according to the numerical randomization method. The control group was given drug-eluting stent therapy, while the research group was given paclitaxel drug-eluting balloon therapy. The target angiography and adverse cardiovascular events at different time points were compared between two groups of patients with small coronary artery lesions.

    Results  There were no significant differences in target lesion length, minimum lumen diameter, reference lumen diameter, and lumen stenosis before surgery and after pre-dilation of intravascular ultrasound between two groups(P＞0.05). Comparison of coronary angiography before and after surgery showed that the minimum lumen diameter and the degree of residual stenosis of two groups were improved after operation(P＜0.001). The degree of lumen stenosis in the research group at 6 months after operation was significantly lower than that in the control group(P＜0.05). The minimum lumen diameter  increased from (0.536±0.132) mm to (2.155±0.272) mm in the control group and from (0.517±0.127) mm to (2.212±0.264) mm in the research group(P＜0.05) at 6 months after operation, as compared with those before operation, and the difference was statistically significant. In addition, the degree of residual stenosis reduced from (78.50±4.87) % to (13.50±10.56) % in the control group and from (78.62±5.48) % to (8.93±8.43) % in the research group, and the difference was statistically significant(P＜0.05). At 12 months after operation, the incidence of adverse cardiovascular events in the research group was lower than that in the control group, and the difference was statistically significant(P＜0.05).

    Conclusion  The use of paclitaxel drug-eluting balloon to treat small coronary artery lesions has significant effects on reducing late target vessel reconstruction and residual stenosis, which can effectively reduce adverse cardiovascular events and improve clinical safety.

    Observation on the effect of dense ligation combined with low-dose lauromacrogol injection in the treatment of gastroesophageal varices
    HUO Xiao-xia, WANG dong, SHI Xiao-dong, NIU Wei-wei, HAN Xu, ZHANG Xiao-lan
    2022, 43(5):  521-524,549.  doi:10.3969/j.issn.1007-3205.2022.05.005
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    Objective  To investigate the clinical efficacy of dense ligation combined with low-dose lauromacrogol injection in the treatment of gastroesophageal varices of patients with liver cirrhosis and portal hypertension.

    Methods  A total of 110 liver cirrhosis patients with type 1 gastroesophageal varice(GOV1) were randomly divided into the control group(n=55) and the observation group(n=55). The control group was treated with spiral ligation combined with tissue glue injection, and the observation group was treated with dense ligation combined with lauromacrogol injection. The efficacy, the frequency of ligation, incidence of adverse reactions and recurrence rate of postoperative varices in the two groups were compared.

    Results  The total effective rate of the initial treatment in the observation group was higher than that in the control group, the average frequency of ligation in the observation group was lower than that in the control group, and the incidence of postoperative rebleeding, postoperative pain, and postoperative adverse reactions including fever was lower in the observation group than in the control group, suggesting significant difference(P＜0.05). The recurrence rate of varices by gastroscopy was lower in the observation group than in the control group at 6 months and 12 months after completion of treatment, and the difference was statistically significant(P＜0.05); The difference was more significant with time.

    Conclusion  Dense ligation combined with lauromacrogol injection is safe and effective in the treatment for GOV1, which can reduce the frequency of ligation, postoperative complications and recurrence rate of varices.

    Role of the hepcidin/ferritin ratio in predicting heart failure in patients undergoing maintenance hemodialysis
    ZHANG Wen-chuan
    2022, 43(5):  525-529.  doi:10.3969/j.issn.1007-3205.2022.05.006
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    Objective  To evaluate the application value of serum hepcidin and serum ferritin(SF) in predicting heart failure in patients undergoing maintenance hemodialysis, and to provide theoretical basis for clinical diagnosis and treatment.

    Methods  A total of 110 heart failure patients undergoing maintenance hemodialysis were selected as heart failure group according to the Chinese guidelines for the diagnosis and treatment of heart failure. Meanwhile, 110 patients without heart failure undergoing maintenance hemodialysis admitted to this hospital were selected as non-heart failure group. Spearman method was used for correlation analysis, multivariate Logistic regression was used to analyze risk factors, and receiver operating characteristic curve(ROC) was used to evaluate the predictive value of hepcidin/SF ratio in cardiac function of patients undergoing maintenance hemodialysis.

    Results  Compared with the non-heart failure group, the duration of dialysis, proportion of smoking and history of hyperlipidemia, hypersensitive C-reactive protein(hs-CRP), N-terminal pro-B-type natriuretic peptide(NT-proBNP), hepcidin, hepcidin/SF ratio, left ventricular end-diastolic diameter(LVEDD) and left atrial diameter(LAD) were higher, while hemoglobin, SF, and left ventricular ejection fraction(LVEF) were lower, with significant difference(P＜0.05). There were no significant differences in body mass index(BMI), serum calcium, serum phosphorus, albumin(ALB), fasting blood glucose(FBG) and interventricular septal thickness(IVS) between two groups(P＞0.05). In patients undergoing maintenance hemodialysis, serum hepcidin/SF ratio was positively correlated with NT-proBNP(r=0.706, P＜0.001). Multivariate Logistic regression analysis showed that duration of dialysis, smoking history, history of hyperlipidemia, hs-CRP and hepcidin/SF ratio were independent risk factors for heart failure in patients undergoing maintenance hemodialysis. In addition, ROC curve analysis showed that hepcidin/SF ratio could well distinguish patients undergoing maintenance hemodialysis who had heart failure(area under the curve was 0.929, 95%CI: 0.897-0.961, P＜0.001).

    Conclusion  Hepcidin/SF ratio is significantly increased in heart failure patients undergoing maintenance hemodialysis, which can well predict the occurrence of heart failure in patients undergoing maintenance hemodialysis, and can be used as a biomarker for the early diagnosis and treatment of heart failure in patients undergoing maintenance hemodialysis.

    A Meta-analysis of the effects of radiotherapy on cardiac injury indicators in breast cancer patients
    ZHENG Guo-hong, CAO Gang, YANG Hai-fang, MI Rui, WNAG Xiao-hong
    2022, 43(5):  530-535.  doi:10.3969/j.issn.1007-3205.2022.05.007
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    Objective  To investigate the effect of radiotherapy on the radiation-induced heart disease(RIHD) indicators in patients with breast cancer.

    Methods  The literature was searched in the PubMed data base, Wanfang medicine, domestic medical research journals and biomedical literature, and the effect of radiotherapy regimen on evaluation indicators of RIHD was searched. The key indicators were cardiac troponin I(cTnI), creatine kinase isoenzyme-MB(CK-MB), N-terminal pro-B-type natriuretic peptide(NT-pro BNP) and brain natriuretic peptide(BNP).Meta-analysis was performed using Rev Man 5.2 software based on the collected literature.

    Results  The retrieved literature was screened according to the criteria of research subject, method and disease type, and finally 8 literature meeting the criteria was included, with low publication bias. The results of meta-analysis showed that cTnI, CK-MB and BNP after radiotherapy were significantly higher than those before radiotherapy, suggesting significant differences(P＜0.05). There was no significant difference in NT-pro BNP before and after radiotherapy(P＞0.05). The results of sensitivity test revealed that the literature had little heterogeneity and high reference value.

    Conclusion  Radiotherapy can significantly change the cTnI, CK-MB and BNP of patients with breast cancer, resulting in RIHD. The progress of research on the optimization of radiotherapy regimen for breast cancer patients should be further followed up to minimize RIHD. CTnI, CK-MB and BNP can be used as good predictors of RIHD in radiotherapy for breast cancer patients, thereby providing reference for timely diagnosis and prevention of RIHD in patients with breast cancer.

    A Meta-analysis of the brain glutamate levels in high-risk people with schizophrenia measured by magnetic resonance spectroscopy
    WANG Qiang, ZHOU Shuang, FENG Yue, REN Hui-peng
    2022, 43(5):  536-543.  doi:10.3969/j.issn.1007-3205.2022.05.008
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    Objective  To explore the effects of the levels of glutamine(Glx) and glutamate(Glu) on the early identification of neurobiochemical abnormalities in high-risk people with schizophrenia through Meta-analysis.

    Methods  The literature was retrieved from Chinese and English databases from the establishment to October 31,2020, and the differences of Glx and Glu concentrations in the brain measured by magnetic resonance spectroscopy(MRS) were collected and compared between high-risk group of schizophrenia and the normal control group.

    Results  A total of 27 articles, 43 groups of data and a sample size of 3 875 were included. Meta-analysis results showed that the concentration of Glu in the thalamus, dorsolateral prefrontal lobe and temporal lobe in the high-risk group of schizophrenia was lower than that in the normal control group, while no difference in Glx or Glu was found in other brain regions or the whole brain between two groups.

    Conclusion  Glu concentration in the thalamus may be a risk marker before the onset of schizophrenia.

    Construction of a prediction model of postoperative mortality risk for elderly patients with hip fractures based on CRP/Hb TLC, and Na+
    WANG Xu, HU Jin-long, ZHANG Liang, SUN Hao, HU Jun, WANG Ye
    2022, 43(5):  544-549.  doi:10.3969/j.issn.1007-3205.2022.05.009
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    Objective  To construct a prediction model of postoperative mortality risk in elderly patients with hip fractures based on the C-reactive protein/hemoglobin(CRP/Hb), the total lymphocyte count(TLC), and blood sodium(Na+), so as to provide reference for clinical decision-making and intervention.

    Methods  A total of 415 elderly patients undergoing hip fracture surgery were selected and divided into mortality group(n=10) and survival group(n=405) according to presence or absence of mortality within 3 months after surgery. The baseline data, CRP/Hb, TLC, and Na+ were compared between two groups, and the multivariate Logistic regression equation was used to analyze the influencing factors of the prognosis. Receiver operating characteristic(ROC) and the area under the ROC curve(AUC) were used to construct a model for predicting the mortality risk by various indicators, and the Kaplan-Meier(KM) survival curve was used to analyze the survival rate of high-risk and low-risk patients with each indicator.

    Results  The proportion of the American Society of Anesthesiologists(ASA) classification, chronic lung disease, intraoperative blood transfusion in the mortality group was higher than that in the survival group, and the difference was statistically significant(P＜0.05). CRP/Hb showed an upward trend, while TLC and Na+ showed a downward trend in the mortality group; the change trend of CRP/Hb, TLC and Na+ was not significant in the survival group. CRP/Hb in the mortality group was higher than that in the survival group, while TLC and Na+ were lower than that in the survival group. There was significant difference in the interaction between groups, time points and time points between groups(P＜0.05). Multivariate Logistic regression equation analysis showed that CRP/Hb, TLC, and Na+ at 1 and 2 weeks after operation were influencing factors of the prognosis(P＜0.05). At 2 weeks after operation, the AUC of CRP/Hb, TLC, Na+ and their combined detection in predicting the mortality was 0.838, 0.844, 0.852, and 0.947, respectively; The survival rate of CRP/Hb, TLC, Na+ high-risk patients was lower than that of low-risk patients(P＜0.05).

    Conclusion  CRP/Hb, TLC, and Na+ are influencing factors of mortality of elderly patients after hip fracture surgery. They can be used as markers to predict the prognosis of patients and provide reference information for clinical decision-making and intervention.

    Effects of arthroscopic-assisted closed reduction and percutaneous internal fixation on AOFAS score, bone metabolic markers and trauma response after ankle fracture surgery
    YAN Tian-yuan, ZHANG Guo-hui, LI Hua
    2022, 43(5):  550-555.  doi:10.3969/j.issn.1007-3205.2022.05.010
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    Objective  To investigate the effect of arthroscopic-assisted closed reduction and percutaneous internal fixation in ankle fracture and its effect on the postoperative American Orthopedic foot and Ankle Society(AOFAS) score, bone metabolic markers and trauma response.

    Methods  The clinical data of 109 patients with ankle fracture in our hospital were analyzed retrospectively. According to different surgical methods, they were divided into arthroscopy group(n=55) and conventional group(n= 54). The conventional group was given conventional open reduction and internal fixation, and the arthroscopic group was given arthroscopic-assisted closed reduction and percutaneous internal fixation. The operation-related indexes, trauma response indexes ［C-reactive protein(CRP), interleukin-8(IL-8), cortisol(Cor), norepinephrine(NE)］ before operation, and at 1 d and 3 d after operation, and the levels of bone metabolic markers［bone γ-carboxyglutamic acid-containing protein(BGP),bone alkaline phosphatase(BALP), β-collagen degradation products(β-CTX)］ before operation, and at 2 weeks and 4 weeks after operation were compared between two groups.The incidence of complications, muscle strength of ankle plantar flexion and dorsiflexion, active range of motion(AROM), AOFAS score and Generic Quality of Life Inventory-74(GQOL-74) were calculated before operation, and at 3 months and 6 months after operation.

    Results  The amount of intraoperative bleeding in arthroscopy group was lower than that in conventional group, and the duration of operation, length of hospital stay and fracture healing time were shorter than those in conventional group(P＜0.05). The serum CRP, IL-8, Cor and NE at 1 d and 3 d after operation and serum β-CTX level at 2 weeks and 4 weeks after operation were lower in arthroscopy group than in the conventional group, while the levels of serum BGP and BALP were higher than those in the conventional group at 2 and 4 weeks after operation(P＜0.05). The incidence of postoperative complications in arthroscopy group was 3.64%, which was lower than that (16.67%) in conventional group(P＜0.05). At 3 and 6 months after operation, the muscle strength of ankle plantar flexion and dorsiflexion, AROM and AOFAS and GQOL-74 scores in arthroscopy group were higher than those in conventional group(P＜0.05).

    Conclusion  Arthroscopic-assisted closed reduction and percutaneous internal fixation in the treatment of ankle fracture can reduce surgical trauma, promote postoperative recovery, reduce complications, improve bone metabolism, and improve ankle function and quality of life. Therefore, it is of high application value.

    The efficacy of early rehabilitation in minimally invasive treatment for closed Achilles tendon rupture
    ZHANG Hao, LIANG Dong-xing, LIU Tao, TIAN Yuan, SHI Xiao-lin, YANG Yong-ming
    2022, 43(5):  556-559.  doi:10.3969/j.issn.1007-3205.2022.05.011
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    Objective  To explore the efficacy of early rehabilitation in minimally invasive treatment for closed Achilles tendon rupture.

    Methods  A retrospective analysis was performed on the clinical data of 80 patients with acute closed Achilles tendon rupture treated by minimally invasive percutaneous Achilles tendon repair. According to different postoperative rehabilitation plans, they were divided into early rehabilitation group(n=44) and traditional rehabilitation group(n=36). The patients were followed up for 12 months. The efficaccy, Achilles tendon total rupture score(ATRS) and American Orthopaedic Foot & Ankle Society(AOFAS) score, the rate of muscle strength recovery and the difference in complications were compared during the postoperative period to the last follow-up.

    Results  The effective rate of early rehabilitation patients was significantly higher than that of traditional rehabilitation group, and the difference between groups was statistically significant(P＜0.05); the effective rate of patients at different time points was significantly different(P＜0.05). Repeated measurement variance analysis showed that ATRS score and AOFAS score at 6 months and 12 months after operation were higher in both groups, and higher in early rehabilitation group than in the traditional rehabilitation group(P＜0.05). Moreover, the excellent rate of muscle strength recovery at last follow-up was significantly higher in early rehabilitation groups than in the traditional rehabilitation group(P＜0.05). No postoperative infection occurred in both group, without Achilles tendon rupture until the last follow-up and with no differences in the incidence of complications during the follow-up(P＞0.05).

    Conclusion  The application of early rehabilitation in minimally invasive treatment for closed Achilles tendon rupture is effective, which can effectively promote the postoperative muscle recovery and improve the functional score. Therefore, it is worthy of clinical promotion and application.

    Clinical observation of sling exercise training combined with pelvic floor exercise in the treatment of postpartum pelvic organ prolapse
    LIU Pei-pei, CHENG Fang, LI Xiao-wei, ZHU Liao-yuan, LIU Su-shan, CHEN Wei
    2022, 43(5):  560-563,569.  doi:10.3969/j.issn.1007-3205.2022.05.012
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    Objective  To investigate the clinical effect of sling exercise training(SET) combined with pelvic floor function exercise in the treatment of postpartum pelvic organ prolapse(POP) in primipara.

    Methods  A total of 100 primiparas who underwent vaginal delivery for the first time and underwent in physical examination at 42 d after delivery were selected and divided into control group(electric stimulation biofeedback therapy+Kegel exercise, n=50) and experimental group(electric stimulation biofeedback therapy+Kegel exercise+SET, n=50) according to the random number table method. The POP-Q stage, pelvic floor muscle strength grading, transverse abdominis thickness and clinical efficacy were compared between two groups at different time points.

    Results  Before the first treatment, there was no significant difference in POP-Q stage and pelvic floor muscle strength between two groups(P＞0.05). Before the 10th treatment and after the 15th treatment, there were significant differences in POP-Q stage and pelvic floor muscle strength between two groups(P＜0.05). The thickness of the transversus abdominis in both groups showed an increasing trend, and the increase of the experimental group was greater than that of the control group; the differences of interaction were statistically significant between groups, time points, and time points between groups(P＜0.05). The clinical efficacy of the two groups was better than that of the control group, and the total effective rate was significantly higher than that of the control group(P＜0.05).

    Conclusion  SET combined with pelvic floor function exercise in the treatment of postpartum POP in primipara can effectively improve symptoms, restore pelvic floor muscle strength faster and better, increase the thickness of transverse abdominis, and improve clinical efficacy.

    Biomolecules and immune cell infiltration affecting the prognosis of cervical cancer
    SU Ya-ni, YANG Ming-yi, HE Chang-jun, LEI Xia, CHANG Yu, HU Yun-feng
    2022, 43(5):  564-569.  doi:10.3969/j.issn.1007-3205.2022.05.013
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    Objective  To study the potential biomarkers and immune cell infiltration that can predict the prognosis of cervical cancer, and to provide theoretical basis and research direction for the research of cervical cancer treatment and prognosis.

    Methods  The microarray dataset(GSE9750) of cervical cancer tissue was downloaded from Gene Expression Omnibus(GEO), and the “limma” package of R was used to identify differentially expressed genes(DEGs). The “clusterProfiler”package of R was used for gene ontology(GO) and kyoto encyclopedia of genes and genomes(KEGG) enrichment analyses. STRING was used to construct a protein-protein interaction network(PPI). The gene expression profiling interactive analysis(GEPIA) platform was used to verify the expression level of inhibin beta A(INHBA) in cervical cancer tissues and normal samples and predict the prognosis. The “CIBERSORT” software was used to obtain the expression of immune infiltrating cells in cervical cancer tissue samples through the three packages “e1071”, “parallel” and “preprocess Core” of R.

    Results  Ultimately, the key gene INHBA, which was highly correlated with the prognosis of cervical cancer, was identified. The expression level of INHBA in cervical cancer tissues was significantly increased, and the life cycle of the high expression INHBA was significantly shorter than that of the low expression group. Compared with normal cervical tissue samples, native CD4+ T cells, unactivated natural killer(NK) cells, and M0 and M1 macrophages were all elevated in cervical cancer samples, while unactivated memory CD4+ T cells, monocytes, and unactivated dendritic cells were significantly reduced in cervical cancer samples.Unactivated dendritic cells were positively correlated with unactivated CD4+ T cells and negatively correlated with plasma cells.

    Conclusion  In this study, the highly expressed gene INHBA, which is highly correlated with the prognosis of cervical cancer, is obtained. Immune infiltrating cells in cervical cancer, native CD4+ T cells, unactivated NK cells, M0 and M1 macrophages are upregulated, while unactivated memory CD4+ T cells, monocytes, and unactivated dendritic cells are downregulated. In addition, unactivated dendritic cells are positively correlated with unactivated memory T cells, and negatively correlated with plasma cells. The results of this study provide a new basis for the treatment and prognosis of cervical cancer.

    Expression of GDF15 and TK1 in serum of patients with ovarian cancer and Cox regression analysis of prognosis
    WANG Qing-ling, WANG Bin, LI Qiu-fen, YI Li-sha
    2022, 43(5):  570-573,582.  doi:10.3969/j.issn.1007-3205.2022.05.014
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    Objective  To explore the expression of recombinant growth differentiation factor 15(GDF15) and thymidine kinase 1(TKI) in the serum of patients with ovarian cancer and their correlation with prognostic Cox regression.

    Methods  Prospect selection was performed on 50 healthy physical examinees(control group), 52 patients with ovarian benign disease(benign group), and 51 patients with ovarian cancer(ovarian cancer group) who underwent serum testing. Serum GDF15 and TK1 were tested, and the expression levels of GDF15 and TK1 in the three groups were compared. In the meantime, patients with ovarian cancer were followed up for 2 years, and they were divided into two groups according to survival or death of patients, namely survival group(n=41) and death group(n=10). The clinicopathological characteristics of the two groups were compared, and their crelationship with survival status was analyzed by Cox regression model.

    Results  The serum GDF15 expression (816.65±88.46) ng/L and the TK1 expression level (1.46±0.65) pmol/L of the ovarian cancer group were higher than those of the benign group and the control group (P＜0.05). According to ROC curve analysis, the AUC of GDF15, TK1 and the combination of the two in predicting ovarian cancer was 0.879, 0.813, and 0.884, respectively. Patients with ovarian cancer were followed up for 2 years. The follow-up survival time of the survival group was (22.56±1.15) months, which was longer than that ［(14.16±2.65) months］ of the death group, and the difference was statistically significant (t=15.473, P＜0.001). The Cox regression model showed that the regression coefficient values of TK1 and GDF15 were -2.208 and -1.687 respectively, and the RR values were 0.110 and 0.185 respectively. Both had a negative impact on survival time. The regression coefficient value of FIGO staging was 3.059, which had a positive impact on survival time.

    Conclusion  Serum GDF15 and TK1 levels are highly expressed in patients with ovarian cancer, and are closely related to the occurrence, development and prognosis of ovarian cancer, which have certain guiding significance for prognostic prediction.

    Effects of cetirizine combined with salbutamol on airway remodeling, PDCD5 and S1P levels in children with acute attack of bronchial asthma
    TIAN Wen-peng, XU Bing-lei, LYU Xiu-min
    2022, 43(5):  574-577.  doi:10.3969/j.issn.1007-3205.2022.05.015
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    Objective  To observe the effects of cetirizine combined with salbutamol on airway remodeling, programmed death molecule 5(PDCD5) and sphingosine 1-phosphate(S1P) levels in children with acute attack of bronchial asthma.

    Methods  In total,200 children with acute attack of bronchial asthma were selected and randomly divided into control group(n=100) and research group(n=100). The children in the control group were treated with salbutamol, and the children in the research group were treated with cetirizine-assisted salbutamol. Both groups were treated for 7 d. The curative effect and the changes in airway remodeling［osteopontin(OPN), vascular endothelial growth factor(VEGF), matrix metalloproteinase-9(MMP-9), tissue inhibitor of metalloproteinase-1(TIMP-1)］, PDCD5 and S1P levels were compared between two groups. The incidence of adverse reactions during treatment was observed in both groups.

    Results  At 7 d after treatment, the total effective rate of the research group was higher than that of the control group(P＜0.05). At 7 d after treatment, the levels of OPN, VEGF, MMP-9, TIMP-1, PDCD5 and S1P in the two groups were lower than those before treatment, while the levels of OPN, VEGF, MMP-9, TIMP-1, PDCD5 and S1P in the research group were lower than those in the control group(P＜0.05). There was no significant difference in the incidence of adverse reactions between two groups(P＞0.05).

    Conclusion  Cetirizine combined with salbutamol in the treatment of children with acute attack of bronchial asthma can effectively inhibit airway remodeling and reduce the levels of PDCD5 and S1P. It is a safe and reliable treatment scheme.

    Clinical features of gastroesophageal reflux disease in infants less than 3 months of age and analysis of the efficacy of mosapride
    HE Ping, HU Fang-qi, WANG Fei
    2022, 43(5):  578-582.  doi:doi:10.3969/j.issn.1007-3205.2022.05.016
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    Objective  To monitor gastroesophageal reflux disease(GERD) in infants less than 3 months of age by 24-hour esophageal pH to improve its accuracy,and to relieve clinical symptoms of GERD by administering oral mosapride to children with GERD.

    Methods   For 49 children with suspected GERD(<3 months of age), 24-hour esophageal pH monitoring was used to monitor its characteristics, and children with GERD were orally administered with mosapride to evaluate its efficacy.

    Results   Of 49 children with suspected GERD, 33 were eligible for GERD, accounting for 67.3%; among children with GERD, 23 of them were neonates, which was significantly higher than that of non-neonates(P＜0.05).The clinical manifestations of GERD were vomiting, accounting for 88.2%, and coughing, accounting for 41.2%. The frequency of acid exposure and duration of continuous acid exposure in infants with neonatal GERD increased as compared with non-neonates(P＜0.05). Compared with GER-negative patients, mosapride had a significant effect on GER-positive children. The effective rate, serum gastrin and plasma motilin levels in GER-positive children were significantly higher than those in GER-negative children(P＜0.05), while the incidence of vomiting in GER-positive children was significantly lower than that in GER-negative children(P＜0.05).

    Conclusion  24-hour esophageal dynamic pH monitoring technology is still an accurate method for the diagnosis of GERD in infants. Mosapride has an obvious therapeutic effect on GERD of infants, which can promote the development and recovery of early growth and development of infants.

    CT manifestations of Warthin′s tumor and pleomorphic adenoma and analysis of differences in the proportion of smokers and smoking index
    CHENG Yuan-yuan, PENG Hai-yan, HU Li-bing
    2022, 43(5):  583-586.  doi:10.3969/j.issn.1007-3205.2022.05.017
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    Objective  To explore the computed X-ray tomography(CT) manifestations of Warthin′s tumor(WT) and polymorphic adenoma(PA), and to analyze the differences in the proportion of smokers and smoking index.

    Methods  Eighty patients with benign tumors of the parotid gland were selected and divided into WT group(n=32) and PA group(n=48) according to the results of pathological examination. All patients underwent CT examination to compare the CT manifestations, the proportion of smokers and smoking index between two groups.

    Results  The CT findings of the two groups were significantly different in location, number, boundary, and tumor diameter(P＜0.05). The lesion in WT group was mostly located in the posterior lower quadrant, with multiple occurrences, regular morphology, clear boundaries, and larger tumor diameters. The lesion in PA group was mostly located in the non-lower posterior quadrant, with very few occurrences, regular morphology, clear boundaries, and small tumor diameters. The CT value of the WT group increased initially and then decreased, and the CT value of the PA group gradually increased. The difference in the interaction between groups, time points and time points between groups with respect to CT values was statistically significant(P＜0.05). The proportion of smoking, smoking index, smoking amount, and smoking time in the WT group were higher than those in the PA group, and the difference was statistically significant(P＜0.05).

    Conclusion  WT lesions are mostly located in the posterior lower quadrant and show the pattern of “fast in and fast out” during CT enhancement. PA lesions are mostly located in the non-posterior lower quadrant and show progressive enhancement during CT enhancement. The clinical data and CT image characteristics can be used to differentiate WT and PA, and the appropriate treatment can be selected according to the results.

    Efficacy evaluation of Erbium Yttrium-Aluminum-Garnet laser osteotomy in the extraction of low vertically impacted mandibular third molars
    GUO Tao, YANG Ting, XU Yin, ZHANG Peng-fei, ZHANG Yu-ying, XU Yun-hai
    2022, 43(5):  587-590,596.  doi:10.3969/j.issn.1007-3205.2022.05.018
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    Objective  To compare the efficacy of traditional bur and Erbium Yttrium-Aluminum-Garnet(Er：YAG) laser osteotomy in the extraction of low vertically impacted mandibular third molars, so as to provide guidance for clinical treatments.

    Methods  A total of 60 patients admitted with low vertically impacted mandibular third molars who received dental extraction were selected and randomly divided into two groups,traditional high-speed bur group(traditional bur group, n=30)and Er：YAG laser osteotomy group(laser group, n=30) according to different osteotomy methods. The visual analogue scale(VAS) score of postoperative pain at 1, 3 and 7 d after surgery, facial swelling and mouth opening limitation at 3 and 7 d after surgery were compared between two groups.

    Results  The VAS score of postoperative pain in the two groups decreased with the prolongation of time, which was lower in the laser group than in the traditional bur group; The differences of interaction between groups, time points and time points between groups were statistically significant(P＜0.05). On the 3rd day after surgery, the degree of facial swelling and mouth opening limitation in the laser group were significantly lower than those in the traditional bur group(P＜0.05), while on the 7th day, there was no difference between two groups(P＞0.05).

    Conclusion  Compared with traditional high-speed bur, Er: YAG laser osteotomy can better reduce the postoperative pain, facial swelling and mouth opening limitation after the extraction of low vertically impacted mandibular third molars, which is worthy of popularization and application in clinical practice.

    Study on the value of thrombus elastography combined with coagulation function test in the evaluation of recurrence after dual antiplatelet therapy in patients with ischemic stroke
    CHEN Yu-jia, HUANG Jia-fu, YAN Bao-juan, CHEN Xiao-gen
    2022, 43(5):  591-596.  doi:10.3969/j.issn.1007-3205.2022.05.019
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    Objective  To explore the value of thrombus elastography(TEG) combined with coagulation function test in the evaluation of recurrence after dual antiplatelet therapy in patients with ischemic stroke.

    Methods  A total of 732 patients with ischemic stroke who received clopidogrel and aspirin dual antiplatelet therapy were enrolled. Venous blood was collected at 7 d after treatment for TEG and routine coagulation index detection. The patients were followed up for 6 months, and the recurrence of ischemic stroke during the follow-up period was statistically analyzed. Clinical data were collected to analyze the relationship between TEG, coagulation function and recurrence after dual antiplatelet therapy in patients with ischemic stroke, and the value of TEG combined with coagulation function indexes in predicting recurrence.

    Results  Twenty-four cases were lost to follow-up, and among the remaining 708 cases, 226 cases experienced recurrence(recurrence group)and 482 cases did not experience recurrence(non-recurrencegroup). Coagulation reaction time(R), blood clot formation time(K), international normalized ratio(INR) were shorter or lower in recurrence group than in non-recurrence group(P＜0.05), Rate of hemagglutination(α angle), maximum intensity of blood clots(MA), blood coagulation index(CI), fibrinogen(FIB), D-dimer(DD) were higher than those in non-recurrence group(P＜0.05). Logistic stepwise regression analysis showed that diabetes mellitus, high α angle, high MA value and high D-D were risk factors for recurrence in patients with ischemic stroke after dual antiplatelet therapy(P＜0.05). After adjustment for diabetes mellitus,α angle(OR=1.411，95%CI：1.006-1.987), MA(OR=1.205, 95%CI: 1.003-1.475), D-D(OR=1.198, 95%CI: 0.101-1.387) were still risk factors for recurrence after dual antiplatelet therapy in patients with ischemic stroke(P＜0.05). Receiver operating characteristic curve(ROC) results showed that the area under the ROC curve of combined α angle, MA value and D-D in predicting the recurrence of patients with ischemic stroke after dual antiplatelet therapy was 0.910, which was higher than 0.720, 0.756 and 0.760 of detection alone(P＜0.05).

    Conclusion  α angle, MA value and D-D are related to recurrence after dual antiplatelet therapy in patients with ischemic stroke, and have certain predictive value for recurrence of stroke. Combined detection of the three indexes can improve the predictive efficacy.

    Correlation between late-arriving retrograde flow proportion and neurological deficit in symptomatic intracranial arteriosclerotic stenosis
    YAN Li-qun, YAN Jin, HOU Ya-ping, DONG Qian-bo, MU Xiao-dan, LI Xiao-guang
    2022, 43(5):  597-601,607.  doi:10.3969/j.issn.1007-3205.2022.05.020
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    Objective  To evaluate the correlation between late-arriving retrograde flow downstream of M1 segmentof unilateral middle cerebral artery(MCA) and neurological function score in patients with arteriosclerotic stenosis.

    Methods  The MRI data of 39 patients with symptomatic M1 stenosis(vascular stenosis rate of 50%-99%) of unilateral MCA were analyzed retrospectively. All patients underwent three-dimensional pseudocontinuous arterial spin labeling(3D pCASL) imaging with dual post-label delay(PLD) (1.5s and 2.5s), the mean cerebral blood flow(CBF) of two PLD downstream of the MCA on the lesion-side and normal-side was measured. The late-arriving retrograde flow proportion(LARFP) downstream of M1 segment of MCA on the lesion-side was calculated. The National Institutes of Health Stroke Scale(NIHSS) scores of patients on the day of the MRI scanning were recorded, and the stenosis ratio of lesioned local vascular lumen was measured.Pearson correlation analysis was used to evaluate the correlation between LARFP, NIHSS score and vascular stenosis ratio.

    Results  There was a correlation between LARFP and NIHSS(r=-0.698; P＜0.001), but no correlation between vascular stenosis rate and LARFP(r=-0.001; P=0.997) or NHISS score(r=-0.127; P=0.440).

    Conclusion  LARFP was significantly correlated with neurological deficit, but there was no significant correlation between vascular stenosis ratio and NIHSS score. The LARFP calculated from 3DpCASL imaging using two PLDs may become a new indicator for evaluating cerebral collateral circulation in patients in the future.

    Evaluation value of 3D-ASL in severity and prognosis of patients with acute ischemic stroke
    WANG Qiang, LI Hui-sheng, ZHANG Bo-hai, PAN Jian, LI Yi-ming
    2022, 43(5):  602-607.  doi:10.3969/j.issn.1007-3205.2022.05.021
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    Objective  To explore the clinical value of magnetic resonance three-dimensional arterial spin labeling(3D-ASL) in predicting the severity and prognosis of patients with acute ischemic stroke(AIS).

    Methods  According to the National Institutes of Health Stroke Scale(NIHSS) score, 128 AIS patients diagnosed in our hospital were divided into mild group, moderate group and severe group. All the subjects underwent the 3D -ASL scan examination on the day of admission to obtain the cerebral blood flow(CBF) in infarcted area. The protein level of Apelin-13 in serum was detected by enzyme-linked immunosorbent assay. At two weeks after admission, the neurological function recovery of patients was evaluated with modified Rankin Scale（mRS）, and the activity of daily life(ADL) was evaluated with the modified Barthel Index(MBI). The correlation between CBF in cerebral infarction area on the day of admission and NIHSS score, Apelin-13 protein level, mRS score, MBI index was analyzed. Receiver operating characteristic(ROC) curve was drawn to determine the CBF cut-off value for predicting the severity of AIS.

    Results  On the day of admission, the NIHSS score of moderate group and severe group was significantly higher than that of mild group, while the CBF value in cerebral infarction area and Apelin-13 protein level in serum were significantly lower than those in mild group. The NIHSS score of severe group was significantly higher than that of moderate group, while the CBF value in cerebral infarction area and Apelin-13 protein level in serum were significantly lower than those in moderate group. The CBF value in cerebral infarction area was negatively correlated with NIHSS score, and positively correlated with Apelin-13 protein level in serum. At two weeks after admission, the MBI index of moderate group and severe group was significantly lower than that of mild group, while mRS score was higher than that of mild group. The MBI index of severe group were significantly lower than that of moderate group, while mRS score was higher than that of moderate group. The CBF value in cerebral infarction area was positively correlated with MBI index, and negatively correlated with mRS score on the day of admission. The CBF cut-off value in mild group and moderate group was 20.5 mL·min-1·100 g-1, and the area under ROC curve was 0.946. The CBF cut-off value in moderate group and severe group was 13.5 mL·min-1·100 g-1, and the area under ROC curve was 0.924.

    Conclusion  Noninvasive 3D-ASL on the day of admission can be used to predict the severity and prognosis of AIS patients, which has guiding significance for the application and adjustment of treatment methods.

    The relationship between IMT in the carotid artery and the expression of plasma Hcy, IL-17, NGAL in elderly patients with type 2 diabetes mellitus and macrovascular disease
    ZHOU Hai-xia, FANG Kai-feng, ZHU Jun
    2022, 43(5):  608-613.  doi:10.3969/j.issn.1007-3205.2022.05.022
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    Objective  To investigate the relationship between the carotid intima media thickness(IMT) and the expression of plasma homocysteine(Hcy), interleukin-17(IL-17), neutrophil gelatinase-associated lipocalin(NGAL) in elderly patients with type 2 diabetes mellitus(T2DM) and macrovascular disease.

    Methods  In total, 92 elderly T2DM patients with macrovascular disease in our hospital were selected as the observation group, and 92 elderly T2DM patients without macrovascular disease were selected as the control group. The clinical data, carotid IMT, Hcy, IL-17 and NGAL levels were compared between two groups. The factors influencing the pathogenesis of T2DM and macrovascular disease in the elderly, the correlation between carotid IMT and Hcy, IL-17, NGAL levels, and the diagnostic value of carotid IMT, Hcy, IL-17, NGAL levels in the diagnosis of T2DM and macrovascular disease in the elderly patients were analyzed. The prognosis of patients with positive and negative disease by combined diagnosis was compared.

    Results  The levels of triacylglycerol（TG）, low density lipoprotein cholesterol（LDL-C） and carotid IMT, Hcy, IL-17 and NGAL in the observation group were higher than those in the control group, and the difference was statistically significant(P＜0.05). Logistic regression analysis showed that the levels of carotid IMT, Hcy, IL-17, and NGAL were all influential factors in the pathogenesis of T2DM and macrovascular disease in the elderly patients(P＜0.05). The carotid IMT of the elderly patients with T2DM and macrovascular disease was positively correlated with Hcy, IL-17 and NGAL levels(P＜0.05). The area under ROC curve(AUC) of the elderly T2DM patients with macrovascular disease diagnosed by carotid IMT, Hcy, IL-17, and NGAL levels was the largest, which was 0.951, suggesting good diagnostic efficiency. The physical health, physical role function, physical pain and overall health scores of positive patients by combined diagnosis were lower than those of negative patients, and the difference was statistically significant(P＜0.05).

    Conclusion  In elderly patients with T2DM and macrovascular disease, carotid IMT is related to the expression of plasma Hcy, IL-17, and NGAL. Each index can be used to effectively diagnose macrovascular disease, which is beneficial to clinical diagnosis and treatment.