Table of Content

25 October 2022, Volume 43 Issue 10

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Effect and mechanism of iso-suillin on apoptosis of human gastric cancer BGC-823 cells based on ROS/PI3K/Akt signaling pathway

XU Yan-nan, ZHAO Jun-xia, ZHOU Na-jing, GAO Pin, ZHOU Chen-ming

2022, 43(10):  1121-1126.  doi:10.3969/j.issn.1007-3205.2022.10.002

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Objective To explore the effect and mechanism of iso-suillin on the apoptosis of human gastric cancer BGC-823 cells based on the ROS/PI3K/Akt signaling pathway. 
Methods Human gastric cancer BGC-823 cells were cultured in vitro and treated with iso-suillin at different concentrations of 7 μmol/L, 14 μmol/L, and 28 μmol/L for 48 h. The intervention with iso-suillin at a concentration of 7 μmol/L was defined as the low-dose group, the intervention with iso-suillin at a concentration of 14 μmol/L was defined as the medium-dose group, and the intervention with iso-suillin at a concentration of 28 μmol/L was defined as the high-dose group. In the meantime, a control group was set up(intervention with the same amount of normal saline for 48 h). The Hoechst 33342 fluorescent staining method was used to observe the morphological changes of human gastric cancer BGC-823 cells after treatment with iso-suillin, and Western blot was used to detect the expression level of apoptosis-related protein in human gastric cancer BGC-823 cells after treatment with iso-suillin. 2,7-dichlorofluorescin diacetate(DCFH-DA) fluorescent probe was used to detect the level of reactive oxygen species(ROS) in human gastric cancer BGC-823 cells treated with iso-suillin, and western blot was used to detect the expression levels of PI3K/Akt signaling pathway-related proteins. 
Results Hoechst 33342 fluorescent staining showed that an increase in iso-sullin concentration led to more bright blue cells, chromatin condensation, and appearance of apoptotic bodies. Compared with the control group, the apoptosis rate of low-dose group, medium-dose group and high-dose group increased(P＜0.05). The relative expression of Caspase-3, Caspase-8, Caspase-9 and Bax increased in low-dose group, medium-dose group and high-dose group, while the relative expression of Bcl-2 decreased(P＜0.05). Compared with the control group, the ROS level of BGC-823 cells in low-dose group, medium-dose group and high-dose group increased(P＜0.05). The relative expression of PI3K, Akt and mTOR proteins in PI3K/Akt signaling pathway decreased with the increase of iso-sullin concentration(P＜0.05). 
Conclusion Iso-suillin can induce apoptosis of human gastric cancer BGC-823 cells, and its mechanism may be related to the up-regulation of ROS and down-regulation of PI3K, Akt and mTOR proteins in the PI3K/Akt signaling pathway.





The diagnostic value of detection of RBP4, HbA1c and miR-1-3p levels in STEMI patients and their relationship with the disease severity

SUN Qian, SU Yan, ZHANG Ya-lan, LI Xiao-lin

2022, 43(10):  1127-1132.  doi:10.3969/j.issn.1007-3205.2022.10.003

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Objective To study the diagnostic value of detection of retinol-binding protein 4(RBP4), glycated hemoglobin(HbA1c) and microRNA(miRNA)-1-3p levels in patients with ST-segment elevation myocardial infarction(STEMI) and their relationship with the disease severity. 
Methods A total of 136 STEMI patients admitted to the Second Hospital of Baoding City were selected as STEMI group, and divided into three subgroups according to SYNTAX score:mild lesion group(n=55), moderate lesion group(n=43) and severe lesion group(n=38). Anther 65 healthy people who underwent physical examination during the same period were selected as the control group. Clinical data of the study subjects were collected. Serum RBP4 and HbA1c levels were measured by enzyme-linked immunosorbent assay, and serum miR-1-3p levels were measured by quantitative real-time polymerase chain reaction(qRT-PCR). Spearman′s correlation coefficient analysis was used to analyze the correlation of STEMI serum RBP4 and HbA1c with miR-1-3p levels and SYNTAX score. Multivariate logistic regression analysis was used to analyze the risk factors for the development of STEMI. Receiver operating characteristic(ROC) curve was used to analyze the diagnostic value of serum RBP4, HbA1c and miR-1-3p levels for STEMI. 
Results Compared with the control group, the STEMI group had an increased proportion of smoking history and increased levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol(LDL-C), C-reactive protein(CRP), RBP4, HbA1c, and miR-1-3p and decreased levels of high-density lipoprotein cholesterol(HDL-C)(t/Z=2.459-9.608, all P＜0.05). Serum RBP4, HbA1c and miR-1-3p levels were sequentially increased in the mild, moderate and severe lesion groups(F=18.202-48.798, all P＜0.001). STEMI serum RBP4, HbA1c and miR-1-3p levels were positively correlated with SYNTAX scores(r=0.588-0.647, all P＜0.001). Smoking history, CRP, LDL-C, RBP4, HbA1c and miR-1-3p were independent risk factors for the development of STEMI(OR= 1.037-1.646, all P＜0.05). The area under the ROC curve of the combined detection of serum RBP4, HbA1c and miR-1-3p for the diagnosis of STEMI was higher than that of each indicator alone (Z=3.025-4.213, all P＜0.05). 
Conclusion Elevated levels of serum RBP4, HbA1c and miR-1-3p in STEMI patients are positively correlated with the degree of coronary artery lesion, which can be used as diagnostic indicators of STEMI.





Clinical effect of continuous positive pressure ventilation in the treatment of OSAHS patients with diabetes

SONG Tao, LI Xiao-dong, JIA Zhe

2022, 43(10):  1133-1136.  doi:10.3969/j.issn.1007-3205.2022.10.004

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Objective To analyze the effect of continuous positive pressure ventilation(CPPV) on blood glucose and serum macrophage migration inhibitory factor(MIF) in the treatment of obstructive sleep apnea hypopnea syndrome(OSAHS) patients with diabetes. 
Methods Clinical data of 68 patients with OSAHS and diabetes were collected. All patients were treated with CPPV. At 3 months after consecutive treatment, the improvement of fasting blood glucose (FBG) and the levels of inflammatory factors including serum MIF were observed to discuss the feasibility of CPPV. 
Results At 3 months after treatment, the total effective rate of OSAHS patients with diabetes was 95.59%(65/68). Compared with that before treatment, the apnea-hypopnea index(AHI) of patients decreased significantly after treatment, and the lowest arterial oxygen saturation(LSpO2) increased significantly(both P＜0.05). Compared with those before treatment, the levels of glucose metabolism indexes, and the levels of inflammatory factors including serum MIF significantly decreased after treatment(all P＜0.05). MIF was positively correlated with AHI and FBG(r=0.501, 0.457, both P＜0.05), and negatively correlated with LSpO2(r=-0.423, P＜0.05). 
Conclusion CPPV has favorable curative effect in the treatment of patients with OSAHS and diabetes, which can significantly improve the inflammatory factors and glucose metabolism indicators of the patients.








Effect of rehabilitation exercise prescription based on HRR method on improving exercise ability and physical symptoms of COPD patients

LIAN Xue-mei, LI Ya-nan, ZHANG Jun, SUN Meng, GAO Yong-hong

2022, 43(10):  1137-1141.  doi:10.3969/j.issn.1007-3205.2022.10.005

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Objective To explore the effect of rehabilitation exercise prescription based on heart rate reserve(HRR)on the improvement of exercise ability and physical symptoms of patients with chronic obstructive pulmonary disease(COPD). 
Methods In total, 106 COPD patients were randomly divided into control group and observation group, with 53 cases in each group .Both groups were given general treatment such as airway expansion and oxygen inhalation, and the observation group was given rehabilitation exercise treatment based on HRR method, twice a week for 12 weeks. Before and after treatment, the patients' static pulmonary function, respiratory function, severity of dyspnea and quality of life were observed, and the quality of life was scored. 
Results After treatment, there were no significant differences in RV, TLC and IC between two groups compared with those before treatment(P＞0.05). FEV1/FVC and MVV in two groups were higher than those before treatment, and higher in the observation group than in the control group(P＜0.05). RFmax was decreased,while VEmax and VTmax were increased, as compared with those before treatment, which were higher in the observation group than in the control group(P＜0.05). △BG/△VO2 and △BG/△W in two groups were lower than those before treatment, and lower in the observation group than in the control group(P＜0.05). The activity limitation, respiratory symptoms, influence on daily life and total score in both groups were lower than those before treatment, and lower in the observation group than in the control group(P＜0.05). 
Conclusion The rehabilitation exercise prescription based on HRR method can obviously improve the respiratory function, reduce the severity of dyspnea, and improve the quality of life of patients. 





Predictive value of GNRI in postoperative complications and survival of elderly patients with gastrointestinal tumor

ZHANG Dan, JING Wen-jiang, ZHANG Shu-lian, FAN Zhi-gang, LUO Jv-dong

2022, 43(10):  1142-1146,1152.  doi:10.3969/j.issn.1007-3205.2022.10.006

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Objective To investigate the effect of geriatric nutritional risk index (GNRI) on postoperative complications and prognosis of elderly patients with gastrointestinal tumor. 
Methods A total of 255 elderly patients with gastrointestinal tumor(age ≥ 65 years) were divided into normal GNRI group(GNRI ＞ 98) and abnormal GNRI group(GNRI ≤ 98), including 85 elderly patients with liver cancer(70 in normal GNRI group and 15 in abnormal GNRI group), 90 elderly patients with esophageal squamous cell carcinoma(ESCC)(70 in normal GNRI group and 20 in abnormal GNRI group), and 80 elderly gastric cancer patients(60 in normal GNRI group and 20 in abnormal GNRI group). According to the inclusion and exclusion criteria, the clinical data of patients were collected and analyzed retrospectively. The survival rate was calculated by Kaplan Meier method, and the survival rate was compared by Log-rank test. The impact of GNRI on postoperative complications and prognosis of elderly cancer patients was evaluated. 
Results Within two months after liver cancer operation, 23 patients(27.06%) had complications. Body mass index(BMI), duration of operation, albumin content and GNRI were the risk factors for postoperative complications in patients with liver cancer. The 1, 3 and 5-year survival rates of normal GNRI group(n=15) were 82.85%, 68.57% and 57.14%, respectively, which were significantly better than those(73.33%, 53.33%, 40.00%) of abnormal GNRI group(n=70), and the difference was statistically significant(P＜0.05). Within two months after operation for ESCC, 29 patients(32.22%) had complications. BMI, FVE 1.0% and GNRI were the risk factors for postoperative complications of ESCC. The 1, 3 and 5-year survival rates of normal GNRI group(n=70) were 85.71%, 71.43% and 55.71%, respectively, which were significantly higher than those(75.00%, 55.00%, 40.00%) of abnormal GNRI group(n=20), and the difference was statistically significant(P＜0.05). Within two months after operation for gastric cancer, 16 patients(20.00%) had complications. BMI, arrhythmia and GNRI were the risk factors for postoperative complications in patients with gastric cancer. The 1, 3 and 5-year survival rates of normal GNRI group(n=60) were 83.33%, 70.00% and 58.33%, respectively, which were significantly higher than those in abnormal GNRI group(n=20), and the difference was statistically significant(P＜0.05). 
Conclusion Preoperative GNRI is related to the biological behavior of elderly patients with gastrointestinal cancer, which can be used to effectively predict the postoperative complications and survival rate.





Correlation between serum uric acid, neutrophil-to-lymphocyte ratio and γ -glutamyl transpeptidase in patients with type 2 diabetes mellitus complicated with hyperuricemia and the influencing factors of hyperuricemia

YAO Fei, YU Qiu-rong, GONG Ye, KONG Ying-hong

2022, 43(10):  1147-1152.  doi:10.3969/j.issn.1007-3205.2022.10.007

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Objective To explore the correlation between serum uric acid(UA), neutrophil-to-lymphocyte ratio(NLR), and γ-glutamyl transpeptidase(γ-GT) in patients with type 2 diabetes mellitus(T2DM) complicated with hyperuricemia and the influencing factors of hyperuricemia. 
Methods A total of 270 outpatients and inpatients with T2DM treated in the Second People′s Hospital of Changshu City, Jiangsu Province were selected. According to presence or absence of hyperuricemia, the patients were divided into diabetic group and combination group. Another 60 healthy volunteers who underwent physical examination in our hospital during the same period were selected as the control group. The expression of serum UA, NLR and γ-GT in the three groups was compared, and the correlation between serum UA, NLR and γ-GT was analyzed by Pearman method. Univariate and unconditional Logistic regression analyses were used to determine the independent influencing factors of hyperuricemia. 
Results The differences in serumUA, NLR and γ-GT were statistically significant in three groups(F=451.351, 78.706, 314.433, P＜0.001). SerumUA, NLR and γ-GT were significantly higher in the combination group than in the diabetic group and the control group, and serum UA, NLR and γ-GT in the diabetic group were significantly higher than those in the control group. Blood UA was positively correlated with NLR and γ-GT(r=0.423, 0.730, P＜0.001). There were significant differences in the two groups with respect to hypertension(χ2=89.708, P＜0.001), hyperlipidemia(χ2=5.575, P=0.018), fatty liver(χ2=7.614, P=0.006), retinopathy(χ2=110.174, P＜0.001), lower limb vascular disease(χ2=14.110, P＜0.001), coronary atherosclerotic heart disease(χ2=35.042, P＜0.001), course of disease(t=8.242, P＜0.001), glycated hemoglobin(t=10.697, P＜0.001), fasting glucose(t=11.510, P＜0.001), triacylglycerol(t=22.108, P＜0.001), high-density lipoprotein(t=4.488, P＜0.001 ), low-density lipoprotein(t=2.006, P=0.048), blood creatinine(t=5.691, P＜0.001) and diastolic blood pressure(t=7.835, P＜0.001). Logistic regression showed that the differences in age(OR=1.208, 95%CI:1.013-1.441), course of disease(OR=1.536, 95%CI:1.188-1.985), glycosylated hemoglobin(OR=2.184, 95%CI:1.473-3.238), NLR(OR=2.977, 95%CI:1.889-4.691) and γ-GT(OR=1.655, 95%CI:1.363-2.010) were independent influencing factors of hyperuricemia(P＜0.05). 
Conclusion Serum UAis positively correlated with NLR and γ-GT in patients with T2DM complicated with hyperuricemia. Age, course of disease, glycosylated hemoglobin, NLR and γ-GT are independent risk factors for hyperuricemia, which is worthy of further clinical study and promotion.





Study on autophagy gene benlin-1 expression in peripheral blood combined with APACHEⅡ score in predicting 28-day mortality of sepsis patients

WANG Jia, GAO Heng-bo, LIN Xue-rong, LUO Xiao-yu, CHEN Li-jun, HAN Shu-chi

2022, 43(10):  1153-1157,1182.  doi:10.3969/j.issn.1007-3205.2022.10.008

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Objective To study the value of autophagy gene benlin-1 expression in peripheral blood combined with Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) score in predicting 28-day mortality of sepsis patients. 
Methods In total, 238 patients with sepsis were selected as the sepsis group, and 104 healthy people undergoing physical examination during the same period were selected as the control group. The expression of Beclin-1 in peripheral blood lymphocytes was detected by Western blot. According to the 28-day mortality of sepsis patients, they were divided into the survival patients and the dead patients. Kaplan-Meier curve and receiver operating characteristic(ROC) curve were used to analyze the predictive value of Beclin-1 expression and APACHEⅡ score in 28-day mortality. COX regression model was used to analyze the influencing factors of 28-day mortality of sepsis patients. 
Results The expression level of Beclin-1 in peripheral blood of sepsis group was lower than that of control group(P＜0.05). The expression level of Beclin-1 in peripheral blood of dead patients in sepsis group was lower than that of survival patients, while APACHEⅡ score was higher than that of survival patients(P＜0.05). Kaplan-Meier curve and ROC curve analysis showed that Beclin-1 expression and APACHEⅡ score had predictive value for 28-day mortality of sepsis patients. COX analysis results showed that Beclin-1 expression and APACHEⅡ score were the influencing factors of 28-day mortality of sepsis patients. The new index of Beclin-1 combined with APACHEⅡ score(-0.566-2.238×Beclin-1+0.065×APACHEⅡ Score) was generated in Logistic model. The area under ROC curve of this index in predicting 28-day mortality was 0.6452, which was better than single index. 
Conclusion The expression of Beclin-1 and APACHEⅡ score are the influencing factors of 28-day mortality of sepsis patients. The predictive value of Beclin-1 combined with APACHEⅡ score in predicting 28-day mortality is superior to single index.





Expression and correlation of HMGB1, GM-CSF and LDH in children with chronic pneumonia

WU Hui-fang, ZHANG Jing-li, LIU Xiao-juan, WU Xiao-jie, DUAN Chen-chu, ZHANG Zhong-ping

2022, 43(10):  1158-1162.  doi:10.3969/j.issn.1007-3205.2022.10.009

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Objective To study the changes and correlation of serum high mobility group protein B1(HMGB1), granulocyte-macrophage colony-stimulating factor(GM-CSF) and lactate dehydrogenase(LDH) in children with chronic pneumonia, so as to provide reference for the diagnosis and treatment of the disease. 
Methods A total of 66 children with chronic pneumonia were selected as the pneumonia group, and another 80 healthy children were selected as the control group. The serum HMGB1, GM-CSF and LDH levels of the two groups were detected and compared. Children in the pneumonia group were divided into the severe pneumonia group and the mild pneumonia group according to the severity of the disease, and the levels of HMGB1, GM-CSF and LDH were compared between two groups. The relationship between serum HMGB1, GM-CSF and LDH in the pneumonia group was analyzed by Pearson correlation analysis. The receiver operating characteristic(ROC) curve was used to evaluate the value of serum HMGB1, GM-CSF and LDH in assessing the severity of children with chronic pneumonia. 
Results The levels of serum HMGB1, GM-CSF and LDH in the pneumonia group were higher than those in the control group, and the difference was statistically significant(P＜0.001). The levels of serum HMGB1, GM-CSF and LDH in the severe pneumonia group were higher than those in the mild pneumonia group, and the difference was statistically significant(P＜0.001). Pearson correlation analysis showed that serum HMGB1 was positively correlated with GM-CSF and LDH levels(r=0.340, 0.508)(P＜0.05), and LDH was positively correlated with GM-CSF level(r=0.553)(P＜0.05). ROC results showed that cut-off value of HMGB1, GM-CSF and LDH was 11.26 μg/mL, 116.89 μg/mL and 335.41 U/L, respectively. The area under the ROC curve(AUC) of HMGB1, GM-CSF and LDH in evaluating chronic severe pneumonia was 0.790, 0.787 and 0.781, respectively, and the AUC of the combination of the three was 0.906. The AUC of combined evaluation was higher than that of single indicator, and the difference was statistically significant(P＜0.05). 
Conclusion The increased levels of HMGB1, GM-CSF and LDH in peripheral blood are related to the occurrence and development of chronic pneumonia in children, and the levels of the three are positively correlated with each other in children with chronic pneumonia. The combined detection has good efficacy for disease assessment.





Correlation analysis of visual function recovery with changes in blood flow of capillaries in the macula after idiopathic macular hole surgery

LIN Xiao-li, WEI Hao-dong, LIU Wei-xian

2022, 43(10):  1163-1166,1196.  doi:10.3969/j.issn.1007-3205.2022.10.010

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Objective To observe and analyze the changes in blood flow of capillaries in the macula and their correlation with the visual function recovery in IMH patients after surgery. 
Methods A total of 75 patients with monocular IMH were selected as the observation group, with the affected eye as group A, and the contralateral healthy eye as group B. Another 75 eyes of healthy physical examinees were selected as the control group. The area of foveal avascular zone(FAZ) and blood flow area and blood flow density of superficial retinal capillaries(RSCP), deep retinal capillaries(RDCP), and superficial choroidal capillaries(CSCP) in the center of FAZ before treatment were observed and compared in the three groups, The correlation between related indicators and best corrected visual acuity(BCVA) recovery in group A before treatment and at 3 months and 6 months after treatment was observed. 
Results Before operation, FAZ of group B and control group was lower than that of control group. RDCP blood flow density, CSCP blood flow area and blood flow density were higher than those of group A, the operations of the patients in group A were successfully completed. The patients were followed up for 6 months after the operation. The macular hole closure rate was 100%. The patient's BCVA was (1.14±0.27) LogMAR before surgery, (0.87±0.15) LogMAR at 3 months after operation, and (0.84±0.13) at 6 months after operation. The FAZ at 3 and 6 months after the operation was lower than before the operation, RDCP blood flow density, CSCP blood flow area, and blood flow density were higher than those before surgery, and the differences were statistically significant(P＜0.05). The postoperative visual acuity recovery was negatively correlated with FAZ(P＜0.05), and positively correlated with RDCP blood flow density, CSCP blood flow area and blood flow density(P＜0.05).
Conclusion The occurrence of macular hole in IMH patients is closely related to FAZ and changes in macular blood flow. The area of FAZ and the blood flow density and blood flow area of RDCP and CSCP of the patients after the operation have been significantly improved. There is a significant negative correlation between the patient′s long-term vision recovery and postoperative FAZ area, and a positive correlation with blood flow density and blood flow area, which can be used as a good prognostic indicator for postoperative vision recovery in IMH patients.





The relationship between expression levels of plasma miR-let-7e-5p and LncRNA NEAT1 and type 2 diabetic retinopathy

WANG Yan-xin, JIA Guan-ying, CAO Lang, CAO Shun-yi, ZHANG Shi-hong

2022, 43(10):  1167-1171.  doi:10.3969/j.issn.1007-3205.2022.10.011

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Objective To detect the expression levels of minute RNA-let-7e-5p(miR-let-7e-5p-p) and long-chain non-coding nuclear-rich transcript 1(LncRNA NEAT1) in the plasma of patients with type 2 diabetes(T2DM), and to discuss its relationship with diabetic retinopathy(DR). 
Methods In total, 126 T2DM patients admitted to our hospital were selected and included in the study. They were divided into DR group(n=84) and non-DR group(n=42) according to presence of DR, and non-proliferative DR(NPDR) group(n=31) and proliferative DR(PDR) group(n=53) according to DR classification criteria. The expression levels of miR-let-7e-5p and LncRNA NEAT1 in plasma of T2DM patients were detected by fluorescent quantitative polymerase chain reaction（PCR）, and the difference in miR-let-7e-5p and LncRNA NEAT1 expression levels were compared between the groups. Pearson correlation coefficient analysis was used to analyze the correlation of miR-let-7e-5p and LncRNA NEAT1 in the DR group, and diagnostic value of miR-let-7e-5p and LncRNA NEAT1 in DR was detected by receiver operating characteristic(ROC) curve. 
Results Compared with the non-DR patients, both PDR and NPDR patients had reduced expression levels of plasma miR-let-7e-5p , and increased expression level of LncRNA NEAT1(P＜0.05). Compared with the NPDR group, plasma miR-let-7e-5p expression levels were decreased in the PDR group, while LncRNA NEAT1 expression level was increased(P＜0.05). Plasma miR-let-7e-5p was inversely associated with LncRNA NEAT1 in DR patients(r=-0.534, P＜0.05). The area under the ROC curve(AUC) of the miR-let-7e-5p in the diagnosis of DR was 0.856(95%CI: 0.789-0.924), the sensitivity was 77.38%, and the specificity was 80.95%. The AUC of LncRNA NEAT1 in the diagnosis of DR was 0.844(95%CI: 0.778-0.910), with the sensitivity of 69.05% and the specificity of 95.24%. The AUC of the combined detection of the two in the diagnosis of DR was 0.935(95%CI: 0.891-0.978), with the sensitivity of 88.10% and the specificity of 92.86%. The combined detection had a high diagnostic efficacy for DR patients. 
Conclusion miR-let-7e-5p and LncRNA NEAT1 are related to the occurrence and progression of DR in T2DM patients, and may serve as potential biomarkers for the diagnosis of DR, and the combination has better diagnostic efficacy. 





Clinical observation of onlays made by CEREC digital all-ceramic restorative system for the restoration of severely worn teeth in the elderly

ZHU Yu-long

2022, 43(10):  1172-1177.  doi:10.3969/j.issn.1007-3205.2022.10.012

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Objective To explore the clinical effect of onlays made by chairside economic restoration of esthetic ceramics(CEREC) digital all-ceramic restorative system for the restoration of severely worn teeth in the elderly. 
Methods The clinical data of 92 elderly patients with severe worn teeth(92 teeth in total) were selected for retrospective study. According to different restoration schemes and patients' wishes, they were divided into control group and research group, with 46 cases in each group. The control group was repaired with traditional hot-pressed porcelain, and the research group was repaired with CEREC digital all-ceramic restorative system. The impression preparation time, success rate of one-time tooth wearing, restoration effect, restoration satisfaction, incidence of adverse events, masticatory function before and after restoration, quality of life ［oral health impact profile-14(OHIP-14)］, oral health index ［simplified calculus index(CI-S),simplified debris index(DI-S)］ were compared between two groups. 
Results The time of impression preparation in the research group was shorter than that in the control group, and the success rate of one-time tooth wearing(100.00%) was higher than that of the control group(86.96%)(P＜0.05).The edge fitness, gum health, and restoration loosening or the success rate of shedding(95.65%, 93.48%, 100.00%) were higher than those of the control group(82.61%, 78.26%, 86.96%)(P＜0.05). Compared with those before repair, the masticatory efficiency of the two groups was significantly improved at 6 and 24 months after repair, and higher in the research group than in the control group(P＜0.05). The OHIP-14 scores of the two groups at 6 and 12 month safter repair were lower than those before repair , and lower in the research group than in the control group(P＜0.05). Compared with those before repair, the CI-S and DI-S scores of the two groups were significantly reduced at 6 and 12 months after repair, and lower in the research group than in the control group(P＜0.05). The incidence of adverse events(6.52%) was lower in the research group than in the control group(21.74%)(P＜0.05).The scores on the comfort, appearance, masticatory function and satisfaction with overall treatment experience were higher than those in the control group(P＜0.05). 
Conclusion Onlay made by CEREC digital chairside all-ceramic restorative system in the treatment of elderly patients with severely worn teeth can achieve better restoration effects, which can reduce the incidence of related adverse events, and further improve the masticatory function, oral hygiene and quality of life of patients, with good patient satisfaction.





The influence of thyroid nodule size on the accuracy of fine needle aspiration cytology and multimodal ultrasound diagnosis

HUA Xia, ZHAO Yan-hong, LU Dan-dan, LIANG Yan

2022, 43(10):  1178-1182.  doi:10.3969/j.issn.1007-3205.2022.10.013

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Objective To investigate the accuracy of fine needle aspiration cytology(FNAC), multimodal ultrasound and the combination of the two in the diagnosis of thyroid nodules of different sizes. 
Methods We retrospectively selected 152 patients(160 nodules) with thyroid nodules. All patients underwent FNAC, multimodal ultrasound and histopathological examinations, and divided into different groups according to the size of the nodules: group A(≤10 mm, 64 nodules), group B(10-30 mm, 61 nodules), and group C(≥30 mm, 35 nodules). Histopathology was used as the gold standard, to analyze and compare the diagnostic accuracy of FNAC, multimodal ultrasound and the combination of the two. 
Results There were 75 malignant nodules detected in 160 thyroid nodules by histopathology, and 5 grade I nodules, 45 grade Ⅱ nodules, 25 grade Ⅲ nodules, 23 grade Ⅳ nodules, 27 grade Ⅴnodules and 35 grade VI nodules detected by FNAC examination. The accuracy and sensitivity of FNAC in groups B and C were significantly higher than those of group A, and the specificity in group B was significantly higher than that of groups A and C(P＜0.05). The accuracy, specificity, and sensitivity of the three groups of multimodal ultrasound were not statistically different(P＞0.05). The accuracy, specificity, and sensitivity of combined detection in group A were significantly higher than those of FNAC(P＜0.05); The accuracy and specificity of combined detection in group C were significantly higher than those of FNAC(P＜0.05). 
Conclusion Thyroid nodules ≤10 mm and ≥30 mm in size will reduce the accuracy of FNAC in the diagnosis of benign and malignant thyroid nodules. Combination with multimodal ultrasound diagnosis is beneficial to improve the accuracy of FNAC in the diagnosis of benign and malignant thyroid nodules ≤10 mm and ≥30 mm in size.





Expression level and clinical application value of human serum exosomal Glypican-1 in breast cancer

GUO Yi-yang, MA Wei-li, CAO Shi-ru, GUO Xiu-juan, DENG Yan-li, ZHANG Jin-yan

2022, 43(10):  1183-1187.  doi:10.3969/j.issn.1007-3205.2022.10.014

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Objective To explore the expression level of serum exosomal Glypican-1 (GPC-1) in patients with breast cancer and its clinical application value. 
Methods A total of 48 patients diagnosed with breast cancer, and 18 patients diagnosed with benign breast mass in the Fourth Hospital of Hebei Medical University were selected. Another 17 healthy subjects undergoing physical examination during the same period were selected as healthy control group. Serum exosomes were extracted by polyethylene glycol 8000 precipitation method, and the morphology and molecular phenotype of exosomes were identified by transmission electron microscopy and western blotting. Western blotting was used to detect the expression level of serum exosomal GPC-1 in each group. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of serum exosomal GPC-1 for breast cancer. With the best cut-off value of 0.961, the breast cancer group was divided into GPC-1 positive group and GPC-1 negative group, to analyze the relationship between GPC-1 and clinical characteristics. The Wilcoxon rank sum test was used to analyze the changes of serum exosomal GPC-1 expression in breast cancer group before and after treatment. Taking pathological diagnosis as the gold standard, Kappa consistency test was used to evaluate the diagnostic value of four diagnostic methods, serum exosomal GPC-1, serum tumor markers, B-ultrasound, and mammography, for breast cancer. 
Results The expression level of serum exosomal GPC-1 in the breast cancer group ［1.065(0.501)］ was higher than that of the benign breast mass group ［0.652(0.117)］ and the healthy control group ［0.625(0.139)］, and the difference was statistically significant(H=32.051, P＜0.05). The area under the ROC curve (AUC) was 0.900 (95%CI:0.833-0.967), and the optimal cut-off value was 0.961, which could be used to effectively screen breast cancer patients. GPC-1 positivity in breast cancer group was significantly correlated with TNM stage, lymph node invasion and Ki-67 high expression(all P＜0.05). The expression level of serum exosomal GPC-1 in the breast cancer group before treatment ［1.065(0.501)］ was higher than that at 20 d after treatment ［0.844(0.195)］, and the difference was statistically significant. The Kappa value of the serum exosomal GPC-1 detection method was 0.485＞0.4, which was moderately consistent with pathological examination and was superior to the other three detection methods. 
Conclusion The expression of serum exosomal GPC-1 in the breast cancer group is up-regulated, which is associated with multiple adverse clinical characteristics, and significantly decreases after treatment. Therefore, it has the potential to be used as an index for the diagnosis and treatment of breast cancer.





The value of echocardiography and FFR in diagnosing myocardial ischemia in coronary heart disease

ZHANG Jian-yue, WU Qiu-hua, ZHENG Yan, SHEN Yan-mei

2022, 43(10):  1188-1191.  doi:10.3969/j.issn.1007-3205.2022.10.015

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Objective To explore the clinical application value of segmental wall motion abnormalities and myocardial fraction flow reserve(FFR) in the diagnosis of myocardial ischemia in coronary heart disease(CHD). 
Methods The clinical data of 95 patients with suspected myocardial ischemia in CHD were retrospectively selected for study. A total of 52 patients were diagnosed with myocardial ischemia in CHD by coronary angiography; all received echocardiography and FFR was detected. The positive predictive value, negative predictive value, accuracy, specificity, and sensitivity of the two indicators were further analyzed and compared, and the receiver operating characteristic(ROC) curve was analyzed. 
Results The positive predictive value of 95 patients with suspected myocardial ischemia in CHD after echocardiography was 81.63%, and the negative predictive value was 73.91%, which was lower than the gold standard(P＜0.05). The positive predictive value was 96.15% after FFR detection, and the negative predictive value was 95.35%, which was not significantly different, as compared with the gold standard(P＞0.05). The sensitivity, specificity, and accuracy of FFR were higher than those of echocardiography(P＜0.05). A total of 15 cases(71.43%) of anterior descending artery disease, 12 cases(75.00%) of circumflex artery disease, and 13 cases(86.67%) of right coronary disease were detected by echocardiography. FFR detected a total of 20 cases of anterior descending artery disease(95.24%), 15 cases of circumflex artery disease(93.75%), and 15 cases of right coronary disease(100.00%). The total detection rate of the two methods showed a significant difference(P＜0.05). The area under the ROC curve(AUC) of segmental wall motion abnormalities by echocardiography was 0.780(P＜0.05), and the AUC of FFR was 0.958(P＜0.05). 
Conclusion Compared with FFR, segmental wall motion abnormalities by echocardiography have higher predictive value and can provide objective evidence for the diagnosis of myocardial ischemia in CHD.





Prediction of fetal lung maturity in late pregnancy by automatic ultrasound analysis of the fetal lung

DONG Ya-qing, GAO Zhi-min, XU Ran, CHEN Li-fang, YUAN Jing, WANG Ming-rong

2022, 43(10):  1192-1196.  doi:10.3969/j.issn.1007-3205.2022.10.016

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Objective To explore the application value of automatic ultrasound analysis of the fetal lung in predicting fetal lung maturity in late pregnancy. 
Methods A total of 80 singleton pregnant women delivered in our hospital were given automatic ultrasound analysis of the fetal lung to compare the differences of pulmonary ultrasound parameters between neonatal respiratory distress syndrome(NRDS) and non-NRDS. 
Results Among 80 newborns, 34 cases developed NRDS. The left lung volume(LLV), right lung volume(RLV), total lung volume(TLV) and fetal lung to body weight ratio(FLB) of NRDS newborns were (33.03±3.50) cm3,（44.07±3.16）cm3,（75.57±4.69）cm3and （0.25±0.04）cm3/10 g, respectively, which were significantly lower than those of non NRDS newborns ［(35.12±2.84) cm3, (46.68±3.19) cm3, (81.95±6.03) cm3 and (0.28±0.05) cm3/10 g, respectively］. (P＜0.05). The pulsatile index (PI) and resistance index (RI) of pulmonary artery blood flow parameters in NRDS newborns were (2.14±0.29) and (0.92±0.12) respectively, which were significantly higher than those in non-NRDS newborns ［(2.00±0.28) and (0.83±0.08)］(P＜0.05). There was no significant correlation between PI, RI and LLV, RLV and TLV (P＞0.05), but there was a negative correlation between PI, RI and FLB (r=-0.485 and -0.401, P＜0.05). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of automatic ultrasound of the fetal lung in predicting fetal lung maturity were 91.18%, 91.30%, 91.25%, 88.57% and 93.33%, respectively. 
Conclusion Automatic ultrasound analysis of the fetal lung can effectively predict fetal lung maturity in late pregnancy, which is worthy of clinical use.





Construction of an evaluation model for the therapeutic effect of rheumatoid arthritis based on MRI image characteristics and quantitative parameters

TONG Jun

2022, 43(10):  1197-1202.  doi:10.3969/j.issn.1007-3205.2022.10.017

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Objective To explore an evaluation model for the therapeutic effect of rheumatoid arthritis(RA) based on the image characteristics and quantitative parameters of magnetic resonance imaging(MRI). 
Methods A total of 120 patients with RA were selected as the research subjects, all of whom were treated with recombinant human tumor necrosis factor receptor antibody fusion protein combined with methotrexate, and the efficacy was evaluated at 3 months after treatment. They were divided into an effective group(n=94) and an ineffective group(n=26) according to the efficacy. MRI imaging characteristics(bone erosion, bone marrow edema), quantitative parameters ［volume transfer constant(Ktrans), fractional plasma volume(Vp), flow perfusion parameters(F), vascular permeability surface(PS)］ and serum markers［cyclic citrullinated peptide(CCP) antibodies, rheumatoid factor(RF)］ levels were compared between two groups before and after treatment. The relationship between MRI image characteristics, quantitative parameters and serum markers was analyzed. The value of MRI imaging characteristics and quantitative parameters on the assessment of efficacy was evaluated. 
Results At 3 months after treatment, the scores of bone erosion, bone marrow edema, Ktrans, Vp, F and PS on MRI in both groups were lower than those before treatment, and in the effective group were lower than those in the ineffective group(P＜0.05). The levels of serum CCP antibody and RF were lower than those before treatment, and lower in the effective group than in the ineffective group(P＜0.05). Bone erosion, bone marrow edema score, Ktrans, Vp, F, and PS differences on MRI were positively correlated with serum CCP antibody and RF level before and at 3 months after treatment(P＜0.05). Logistic regression analysis showed that MRI bone erosion, bone marrow edema score, Ktrans, Vp, F, and PS difference were independent influencing factors of RA efficacy before and at 3 months after treatment(P＜0.05). Logistic regression model equation was as follows: 3.175-1.058×difference of bone erosion score -0.842×score difference of bone marrow edema -0.894×Ktrans difference value -0.606×Vp difference value -0.952×F difference -1.014×PS difference. The AUC of bone erosion, bone marrow edema score, Ktrans, Vp, F, and PS difference on MRI alone in evaluating efficacy was 0.816, 0.719, 0.769, 0.803, 0.828, and 0.778, respectively; the AUC of combined evaluation was 0.924(95%CI: 0.862-0.965), sensitivity was 88.46%, and specificity was 87.23%, which were superior to the evaluation value of each index alone. 
Conclusion The evaluation model constructed by imaging characteristics of bone erosion, bone marrow edema, Ktrans, Vp, F, PS and other quantitative parameters on MRI can be used as an important auxiliary way to evaluate the efficacy of RA, which can provide more comprehensive and reliable data support for accurate clinical evaluation of efficacy.





Analysis of the characteristics of drug resistance of CRE strain in ICU patients of a hospital based on rapid detection using PCR

HUA Hong-yan, BAO Hai-lin, DAI Hui-fen

2022, 43(10):  1203-1207.  doi:10.3969/j.issn.1007-3205.2022.10.018

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Objective To investigate the distribution and drug resistance mechanism of carbapenem-resistantenterobacter(CRE) bacilli in intensive care unit(ICU) patients of a hospital, and to analyze the expression characteristics of New Delhi metallo-β-lactamase 1(NDM-1) gene after rapid detection using polymerase chain reaction(PCR). 
Methods A retrospective analysis was made on 150 ICU patients admitted to Hai′an Hospital of Traditional Chinese Medicine in Jiangsu Province. Automatic microbiological analyzer was used to analyze the detection of CRE in ICU patients. The detection rate of main CRE and the detection situation in each specimen were calculated. The resistance of main CRE strains to antibiotics commonly used in clinical practice was analyzed. The expression characteristics of NDM-1 gene were analyzed by PCR. 
Results A total of 643 strains of enterobacteriaceae were isolated from 150 ICU patients, of which 165 were CRE strains(25.66%). The proportion of Enterobacteriaceae and CRE strains in sputum was the highest(41.06% and 44.85%, respectively). Among 165 strains of CRE isolated, Serratia marcescens was the main strain(26.06%), followed by Klebsiella pneumoniae(23.64%) and Enterobacter cloacis(20.00%). Drug sensitivity results showed that, among 165 CRE strains, tigecycline was the most sensitive(100%), followed by ciprofloxacin(80.00%) and amikacin(74.55%). Among 165 CRE strains, DNM-1 gene was the most abundant, accounting for 58.79%, followed by KPC and VIM, accounting for 23.03% and 18.18%, respectively. 
Conclusion The main strains of CRE in ICU patients in a hospital are Serratia marcescens, Klebsiella pneumoniae and enterobacter cloacei, and they have high resistance to β -lactam antibiotics commonly used in clinical practice, most of which contain NDM-1, further limiting the progress of clinical treatment.