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    25 December 2022, Volume 43 Issue 12
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    Mechanism of metformin inhibiting malignant cell phenotype of hepatocellular carcinoma cells through miR-194-5p/RBM6 pathway
    WANG Yi-gang, HUANG Ting, WANG Jun-zhou, TANG Rong-xing, LI Su, XIONG Yong
    2022, 43(12):  1371-1377,1427.  doi:10.3969/j.issn.1007-3205.2022.12.002
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    Objective To observe the effect of metformin on the proliferation and apoptosis of hepatocellular carcinoma (HCC) cells HepG2, and to explore the relationship between its potential mechanism and miR-194-5p/RNA binding motif protein 6 (RBM6) pathway. 
    Methods A total of 100 patients with HCC undergoing surgery were randomly divided into control group and experimental group, with 50 cases in each group. The control group was given placebo orally and the experimental group was given metformin orally. Antigomirna, antigomiR-194-5p, pcDNA 3.1, pcDNA 3.1-RBM6, metformin+si-NC, metformin+si-RBM6, antigomiR-194-5p+si-NC and antigomiR-194-5p+si-RBM6 were transfected into HepG2 cells by liposome method. The expressions of miR-194-5p and RBM6 in serum, tissues and cells were detected by fluorescence quantitative polymerase chain reaction (FQ-PCR).  MTT assay and 5-bromo-2-deoxyuracil staining were used to detect cell proliferation, and apoptosis was detected by flow cytometry. Double luciferase reporter gene assay was used to detect the fluorescence activity of cells, and RBM6 protein was detected by Western blot. 
    Results The two-year disease-free survival (DFS) of the experimental group was significantly prolonged, and the expression of serum miR-194-5p decreased significantly after treatment (P＜0.05). In vitro cell study showed that the expression of miR-194-5p decreased, the proliferation ability decreased and the apoptosis ability increased significantly in HepG2 cells treated with metformin (P＜0.05). The expression of miR-194-5p in cancer tissues and HepG2 cells was significantly higher than that in adjacent tissues or normal hepatocytes. Inhibition of miR-194-5p weakened the proliferation and enhanced the apoptosis of HepG2 cells (P＜0.05). miR-194-5p negatively regulated the expression of RBM6. There was a significant negative correlation between miR-194-5p and RBM6 in hepatocellular carcinoma tissues (r=0.672, P＜0.05). Overexpression of RBM6 had a similar function with inhibition of miR-194-5p. Knockdown of RBM6 significantly inhibited metformin and the regulation of miR-194-5p on proliferation and apoptosis of HepG2 cells. 
    Conclusion Metformin inhibits the proliferation of hepatocellular carcinoma cells, promotes apoptosis and improves DFS of patients. Its potential mechanism may be related to miR-194-5p/RBM6 pathway.

    Analysis of the relationship of LP-PLA2 and S100-β in peripheral blood of elderly patients with H-type hypertension and acute cerebral infarction with the severity and prognosis of the disease
    ZHANG Hong-jin, GU Jin-tao, XU Hong-mei
    2022, 43(12):  1378-1383.  doi:10.3969/j.issn.1007-3205.2022.12.003
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    Objective To investigate the relationship of peripheral blood lipoprotein-related phospholipase A2 (LP-PLA2) and central nervous system specific protein (S100-β)in peripheral blood with the severity and prognosis of elderly patients with H-type hypertension（HHT） and acute cerebral infarction (ACI). 
    Methods Ninety-six elderly patients with HHT and ACI and 85 elderly patients with HHT treated in Geriatric Hospital of Changzhou City, Jiangsu Province, as well as 80 healthy patients who underwent physical examination in the hospital during the same period were selected as HHT + ACI group, HHT group, and healthy group, respectively. The clinical data and peripheral blood LP-PLA2 and S100-β levels of the three groups were compared. According to the area of cerebral infarction, elderly patients with HHT and ACI were divided into three subgroups: mild infarction group, moderate infarction group, and severe infarction group. According to the prognosis, the elderly patients with HHT and ACI were divided into poor prognosis group and good prognosis group. The peripheral blood LP-PLA2 and S100-β levels of elderly patients with HHT and ACI with different infarction degrees were compared. The clinical data in good prognosis group and poor prognosis group were compared. Multivariate Logistic regression analysis was used to analyze the risk factors affecting the prognosis of elderly patients with HHT and ACI. The receiver operating characteristic (ROC) curve was drawn to analyze the value of peripheral blood LP-PLA2, S100-β and the combination of the two in predicting the poor prognosis of elderly patients with HHT and ACI. 
    Results The systolic blood pressure, diastolic blood pressure, homocysteine (Hcy), LP-PLA2 and S100-β levels of the HHT + ACI group and HHT group were higher than those of the healthy group (P＜0.05). LP-PLA2 and S100-β in the HHT + ACI group and HHT group were higher than those in the healthy group (P＜0.05). LP-PLA2 and S100-β were higher in HHT + ACI group than in HHT group (P＜0.05). The levels of peripheral blood LP-PLA2 and S100-β in the severe infarction group were higher than those in the mild and moderate infarction groups (P＜0.05). The peripheral blood LP-PLA2 and S100-β in the moderate infarction group were higher than those in the mild infarction group (P＜0.05). The incidence of poor prognosis in elderly patients with HHT and ACI was 33.33%. The proportion of hypertension grade Ⅲ, glycosylated hemoglobin (HbA1c), peripheral blood LP-PLA2 and S100-β levels in the poor prognosis group were higher than those in the good prognosis group (P＜0.05), while the uric acid (UA) level in the poor prognosis group was lower than the good prognosis group (P＜0.05). Logistic regression analysis showed that UA, peripheral blood LP-PLA2 and S100-β levels were all risk factors affecting the prognosis of elderly patients with HHT and ACI (OR=2.861, 3.370, 3.483, P＜0.05). ROC analysis showed that the area under the ROC curve (AUC) of combined detection of peripheral blood LP-PLA2 and S100-β in predicting poor prognosis of elderly patients with HHT and ACI was 0.851, which was higher than that of peripheral blood LP-PLA2 and S100-β alone (P＜0.05). 
    Conclusion Peripheral blood LP-PLA2 and S100-β are related to the severity and prognosis of elderly patients with HHT and ACI. In addition, peripheral blood LP-PLA2 and S100-β have higher efficiency in predicting the prognosis of elderly patients with HHT and ACI, which can be used as important reference indexes for evaluating the prognosis of these patients.

    Regulatory effect of metformin combined with dapagliflozin on the body′s glycolipid index, visceral adipose, and chronic inflammatory stimulation in patients with poorly controlled T2DM
    LI Li-li, FENG Cui-juan, FENG Ke-na
    2022, 43(12):  1384-1389.  doi:10.3969/j.issn.1007-3205.2022.12.004
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    Objective To investigate the regulatory effect of metformin combined with dapagliflozin on the body′s glycolipid index, visceral adipose and chronic inflammatory stimulation in the treatment of poorly controlled type 2 diabetes mellitus (T2DM). 
    Methods A total of 100 obese/overweight T2DM patients with poor response to metformin alone were selected and divided into control group (n=50) and observation group (n=50) by random number table method. The control group was given metformin combined with acarbose, and the observation group was given metformin combined with dapagliflozin. The blood glucose levels ［fasting plasma glucose (FPG), 2 h postprandial blood glucose (2 hPG), glycosylated hemoglobin A1c (HbA1c)］, homeostatic model assessment insulin resistance (HOMA-IR), blood lipids ［total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C)］, fat regulation indexes ［Nesfatin-1, adiponectin (APN), visfatin, leptin, resistin］, waist circumference, waist-to-hip ratio, body weight, visceral adipose (VA) on the umbilical plane, chronic inflammatory response indexes ［C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1)］ and adverse reactions were compared between the two groups. 
    Results Two cases were lost to follow-up in the observation group and one case in the control group. The difference of interaction between groups, time points and time points between groups were statistically significant with respect to FPG, 2 hPG, HbA1c, HOMA-IR, TC, TG, HDL-C, LDL-C, Nesfatin-1, APN, visfatin, leptin, resistin, waist circumference, waist-to-hip ratio, body weight, VA, CRP, IL-6, TNF-α and MCP-1 was statistically significant (P＜0.05). There was no significant difference in the incidence of adverse reactions between two groups (P＞0.05). 
    Conclusion Dapagliflozin adjuvant treatment has a good effect on improving the lipid metabolism, visceral adipose, and chronic inflammatory stimulation in obese/overweight T2DM patients with poor response to metformin. It can effectively relieve insulin resistance with good safety, and has broad clinical application prospects.

    The expression and clinical significance of VNN1 in acute myeloid leukemia
    WU Ba-lu, LIANG Yu-xing, ZHOU Fu-ling
    2022, 43(12):  1390-1396,1438.  doi:10.3969/j.issn.1007-3205.2022.12.005
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    Objective To analyze the expression and clinical significance of VNN1 gene in acute myeloid leukemia(AML) through online database mining. 
    Methods In this study, we analyzed the expression level of VNN1 gene in AML patients and normal control groups based on the cancer genome atlas (TCGA), the genotype-tissue expression (GTEx), and gene expression omnibus (GEO) databases. The correlation of VNN1 gene expression level with clinical characteristics and overall survival was analyzed with TCGA and GEO datasets by downloading the data information of AML patients. The STRING database was used to analyze VNN1 protein-protein interaction (PPI)network, and GO gene enrichment and KEGG pathway enrichment were analyzed. The correlation between VNN1 and immune cell infiltration was evaluated by single-sample gene set enrichment analysis (ssGSEA). 
    Results Compared with healthy controls (0.025±0.053), VNN1 was significantly highly expressed in AML (3.306±1.991) (P＜0.001), and its expression level was closely associated with AML patients′ cytogenetic risk, FLT3 mutation status, and NPM1 mutation (P＜0.05). The receiver operating characteristic (ROC) curve showed that the expression level of VNN1 could accurately distinguish the normal population and AML patients (AUC=0.969). The K-M curve showed that the median survival time of AML patients with low VNN1 expression was 27.4 months, which, however,was only 10.1 months in the high expression group, suggesting significant differences (P＜0.001). Univariate and multivariate COX regression analyses showed that high expression of VNN1 was an independent risk factor for the overall prognosis of AML (HR=1.998, 1.763) (P＜0.05). STRING database showed that the proteins interacting with VNN1 included PANK1, PANK3, PANK2, VNN2, VNN3, SERPIN2, TAAR2, TAAR5, TAAR1 and STX7. The enrichment analysis of GO function and KEGG pathway showed that VNN1 mainly participated in biological processes including SNARE interactions in vesicular transport, pantothenate and CoA biosynthesis, complement and coagulation cascades, and platelet activation. 
    Conclusion Through the analysis of online databases, NN1 is significantly highly expressed in AML and negatively correlated with the overall survival of patients, which provides a theoretical basis for further in-depth study of the pathogenesis and targeted treatment of AML.

    The application value of 3D printing technology in improving the pituitary function and complication of patients undergoing pituitary adenoma resection via transnasal transsphenoidal approach
    WU Lei, HAN Ying, ZHAO Jin-cheng, LI Qi-chao
    2022, 43(12):  1397-1401.  doi:10.3969/j.issn.1007-3205.2022.12.006
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    Objective To explore the application value of 3D printing technology in improving the pituitary function and complication of patients undergoing pituitary adenoma resection via transnasal transsphenoidal approach. 
    Methods A total of 96 patients with pituitary adenoma were selected and divided into 3D group and traditional group according to the random number table method, with 48 patients in each group. The traditional group was treated with endoscopic transnasal transsphenoidal resection, and on this basis, 3D group was treated with 3D printing technology. The perioperative conditions, pituitary function ［serum prolactin (PRL), growth hormone (GH), adrenocorticotropic hormone (ACTH)］ and complications of the two groups were compared between two groups. 
    Results The total tumor resection rate in 3D group was significantly higher than that in traditional group (P＜0.05). After operation, the levels of serum PRL, GH and ACTH in the two groups were significantly lower or shorter than those before operation, and significantly longer in the 3D group than in the traditional group, with a significant difference (P＜0.05). The amount of intraoperative bleeding, time of off-bed activity, and length of hospital stay in the 3D group were significantly lower or shorter than those in the traditional group, while the duration of operation was significantly longer than that in the traditional group (P＜0.05). The incidence of complications in the 3D group was significantly lower than that in the traditional group (P＜0.05). 
    Conclusion The 3D printing technology can effectively improve the removal effect of pituitary adenoma resection via transnasal transsphenoidal approach, which is helpful to improve the pituitary function of patients, and can reduce the surgical trauma and complications. Therefore, it′s worthy of clinical promotion.

    Mid-term follow-up evaluation of arthroscopic in situ suture repair through Endobutton suspension fixation for partial injury of anterior cruciate ligament
    WANG Jiang-tao, BU Jian-li, AN Ming-yang, ZHU Juan-li, LI Chun-bao, LIU Yu-jie
    2022, 43(12):  1402-1406.  doi:10.3969/j.issn.1007-3205.2022.12.007
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    Objective To investigate the clinical effectiveness of arthroscopic in situ suture repair through Endobutton suspension fixation for partial injury of anterior cruciate ligament (ACL). 
    Methods Thirty-eight patients with ACL partial injury were treated by arthroscopic in situ suture repair through Endobutton suspension fixation. The pre- and post-operative evaluation of knee stability was performed using anterior drawer test and Lachman test. Lysholm score and the international knee documentation committee (IKDC) score were used for assessment of knee function, and Likert five-level scale was used for postoperative patient satisfaction. 
    Results The average duration of operation was (65.08±13.67) min. All patients achieved one-stage healing of incision, and no complications were reported, such as vascular injury, nerve damage and articular infect. All patients were followed up, and the duration ranged from 2.1 to 5.6 years, with an average of (3.10±0.89) years. At the last follow-up, Lachman test was degreeⅠpositive and anterior drawer test was negative in two patients. The other cases were negative for Lachman test and anterior drawer test. The Lysholm score and IKDC score were increased compared with those before operation (P＜0.05). For the evaluation of patient satisfaction, 16 cases were very satisfied, 20 cases were relatively satisfied, and 2 case was satisfied. The total patient satisfaction rate was 94.7%. 
    Conclusion The arthroscopic in situ suture repair through Endobutton suspension fixation for ACL partial injury can effectively restore the function and stability of the knee joint, and can yield good mid-term clinical results. 

    Effect of different concentrations of ropivacaine for PENG block on multimodal analgesia after femoral head replacement in the elderly
    WU Shao-ping, HUANG Xiao-yu, WU Li-ping, ZHANG Yong-fa
    2022, 43(12):  1407-1411,1422.  doi:10.3969/j.issn.1007-3205.2022.12.008
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    Objective To compare the effects of different concentrations of ropivacaine for hip pericapsular nerve group(PENG) block on multimodal analgesia after femoral head replacement in the elderly, and to explore the most appropriate concentration of ropivacaine. 
    Methods Sixty patients who underwent elective femoral head replacement in our hospital were selected. They were randomly divided into low concentration ropivacaine group(group L), medium concentration ropivacaine group(group M) and high concentration ropivacaine group(group H), with 20 cases in each group. They were treated with PENG block combined with low-dose ropivacaine subarachnoid block. PENG block was performed at 30 min before subarachnoid block. Patient controlled intravenous analgesia was used after operation. During PENG block, group L was injected with 20 mL of 0.25% ropivacaine, group M with 20 mL of 0.375% ropivacaine and group H with 20 mL of 0.5% ropivacaine. The pain visual analogue scale (VAS) scores of the three groups were recorded immediately after entering the operation room, immediately before, during and immediately after postural placement. VAS pain scores at rest and during exercise at 6, 12, 24 and 48 h after operation were recorded. The time of pressing the analgesic pump for the first time, the total number of pressing the analgesic pump within 48 h and the number of cases of remedial analgesia with flurbiprofen axetil were recorded. The adverse reactions of anesthesia and analgesia in the three groups were recorded. 
    Results VAS pain scores in the three groups decreased gradually and then increased immediately after entering the operation room, immediately before, during and immediately after postural placement, and the difference between time points was statistically significant (P＜0.05). There was no significant difference in interaction between groups, and time points between groups (P＞0.05). The VAS pain score at rest and during exercise in group L increased initially and then decreased, which, however, decreased initially and then increased in group M and H. Compared with group L, the VAS pain scores at rest and during exercise in group M and group H decreased significantly at 12 h and 24 h after operation (P＜0.05). There were significant differences in interaction between groups, time points, and time points between groups (P＜0.05). Compared with group L, the time of pressing the analgesic pump for the first time in group M and group H was significantly prolonged (P＜0.05), and the total number of pressing the analgesic pump within 48 h was significantly reduced (P＜0.05). There was no significant difference in the number of cases of remedial analgesia with flurbiprofen axetil among the three groups (P＞0.05). No adverse reaction of anesthesia and analgesia occurred in the three groups. 
    Conclusion Different concentrations of ropivacaine for PENG block can reduce the VAS pain score of elderly patients undergoing femoral head replacement in lateral position and reduce the postoperative VAS pain score. Compared with 0.25% ropivacaine, 0.375% and 0.5% ropivacaine have better analgesic effect and longer duration, and reduce the application of postoperative analgesic drugs. Their effects are similar, but considering the safety, 0.375% ropivacaine is recommended.

    Effects of different pneumoperitoneal pressures in LC on the incidence of complications and endothelial cell damage-related factors in patients with acute calculous cholecystitis
    WEI Lai-yan, HE Qi-gui, LI Jiao, LIU Jin-jun, HOU Zhi-rong
    2022, 43(12):  1412-1416.  doi:10.3969/j.issn.1007-3205.2022.12.009
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    Objective To investigate the effect of different pneumoperitoneal pressures in patients with acute calculous cholecystitis (ACC) during laparoscopic cholecystectomy (LC). 
    Methods A total of 60 ACC patients admitted to our hospital were selected as the research subjects, and they were divided into the observation group (n=30) and the control group (n=30) by random number table method. Both groups were treated with LC. The control group maintained conventional pneumoperitoneal pressure (12-15mmHg) during operation, while the observation group maintained low pneumoperitoneal pressure (7-8 mmHg). The perioperative indicators, postoperative pain severity, and complication rate were compared between two groups. Before operation and at 24 h after operation, the liver function and endothelial cell damage-related factors were detected and compared between two groups. 
    Results The first anal exhaust time and the first time of food intake in the observation group were shorter than those in the control group (P＜0.05). The pain severity in the observation group at 1 h-24 h after operation was lower than that in the control group (P＜0.05). Alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin(TBIL), gamma-glutamyl transferase (GGT), von Willebrand factor (vWF) , thrombomodulin (TM), and endothelin-1 (ET-1) increased in the two groups at 24 h after operation, but the above indexes in the observation group were lower than those in the control group(P＜0.05). There was no significant difference in the incidence of complications between the observation group and the control group (P＞0.05). 
    Conclusion Maintaining low pneumoperitoneal pressure during LC surgery is equivalent to normal pneumoperitoneal pressure in terms of operative field clarity, efficacy, and safety, and it helps to promote recovery of postoperative gastrointestinal function, reduce postoperative pain, and has a positive effect on protecting liver function and inhibiting endothelial cell damage. 

    Prognostic value of positive lymph node ratio in upper tract urothelial carcinoma
    ZHAO Lun, FU Yang, ZHANG Kun, NIU Xiao-bing
    2022, 43(12):  1417-1422.  doi:10.3969/j.issn.1007-3205.2022.12.010
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    Objective To investigate the prognostic value of positive lymph node ratio (LNR) in patients with upper tract urothelial carcinoma (UTUC). 
    Methods A total of 188 UTUC patients who met inclusion criteria were selected from SEER database. X-tile software was used to select the optimal cut-off point of LNR. Kaplan-meier method was used to calculate 3-year overall survival (OS) and 3-year cancer-specific survival (CSS) of UTUC patients, and COX proportional hazard models was used to analyze the prognostic value of LNR in patients with UTUC. Finally, the area under the receiver operating characteristic (ROC) curve was calculated and the calibration curve was drawn to compare the predictive performance of LNR with traditional N staging. 
    Results The optimal cut-off point of LNR was 0.6 (LNR ＜ 0.6 vs. LNR≥0.6) after X-tile software screening. Univariate and multivariate COX regression analyses showed that tumor stage, distant metastasis and tumor size were independent risk factors affecting the 3-year OS of UTUC (P＜0.05), and LNR, distant metastasis and tumor size were independent risk factors for 3-year CSS (P＜0.05). The prognosis of UTUC in LNR＜0.6 group was significantly better than that in LNR ≥ 0.6 group (P＜0.05). In the meantime, the area under the ROC curve was calculated to compare the accuracy of LNR and N staging in evaluating the prognosis of patients. LNR (LNR＜0.6, LNR ≥ 0.6) was significantly better than the traditional N staging in evaluating the value of 3-year OS and 3-year CSS (P＜0.05). 
    Conclusion LNR≥0.6 is an independent prognostic risk factor for 3-year CSS in UTUC patients, and the prognostic evaluation value of LNR was significantly better than that of traditional N staging. 

    Effect of the albumin to fibrinogen ratio on the prognosis of breast cancer
    CHEN Li, REN Yu-yan, HAN Ling, ZHANG Bao-liang
    2022, 43(12):  1423-1427.  doi:10.3969/j.issn.1007-3205.2022.12.011
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    Objective To explore the role of albumin to fibrinogen ratio (AFR) in the prognosis assessment of patients with breast cancer. 
    Methods Clinical data of 736 breast cancer patients treated in our hospital were retrospectively analyzed. AFR was detected before surgery, and they were grouped according to AFR. The overall survival (OS) and survival rate of patients were recorded, and Cox regression was used for survival analysis. 
    Results The follow-up period ranged from 12 to 81 months, with a median follow-up period of 65 months. Eighty-three patients (11.28%) died, and the overall survival period was (66.23 ± 12.38) months. The receiver operating characteristic (ROC) curve showed that the area under the ROC curve (AUC) of preoperative AFR in predicting the death of breast cancer patients was 0.727 (95%CI: 0.663-0.781, P＜0.001), and the cut-off value was 13.15. In addition, 736 patients were divided into high AFR group (＞13.15, n=538) and low AFR group (≤13.15, n=198). The OS, survival rate, age, albumin, leukocytes, and platelets of the low AFR group were lower than those of the high AFR group, while fibrinogen (FIB), TNM stage Ⅲ, nuclear grade 3, and vascular tumor thrombus were higher than those of the high AFR group, suggesting significant differences (P＜0.05). Univariate analysis showed that FIB, AFR, platelet, TNM staging, nuclear grade, presence or absence of vascular tumor thrombus, and difference in positive estrogen receptor/progesterone receptor (ER/PR) were statistically significant (P＜0.05). The results of multivariate Cox regression analysis showed that AFR≤13.15, vascular tumor thrombus and TNM stage Ⅲ were the risk factors for the prognosis of breast cancer patients, and positive ER/PR was the protective factor. 
    Conclusion The decrease in AFR indicates a poor prognosis for breast cancer patients. AFR with 13.15 as a critical value has a good predictive effect on breast cancer survival rate. 

    Analysis of the expression levels of VEGF, OLFM4 and miR-124 in patients with cervical cancer and the value of their combination in predicting recurrence
    LI Hui-bin, ZHAO Qing-ping, YU Meng-hong, QIAN Ying, WANG Gang
    2022, 43(12):  1428-1432.  doi:10.3969/j.issn.1007-3205.2022.12.012
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    Objective To investigate the expression of olfactory mediator 4 (OLFM4), vascular endothelial growth factor (VEGF), and microRNA-124 (miR-124) in cervical cancer (CC) and cervical precancerous lesions (CIN) and their clinical significance. 
    Methods A total of 82 specimens of patients with CC undergoing surgical treatment in our hospital were selected as the CC group, 82 cases of CIN specimens were selected as the CIN group during the same period, and 82 cases of normal cervical tissue specimens were selected as the normal group. The 3 groups and the CC group were compared for VEGF,OLFM4, and miR-124 expression in tissue specimens of patients with different pathological parameters. Spearman correlation analysis was used to explore the relationship between the expression of various indicators in the tissues and the pathological parameters of the CC group, and the expression of various indicators in the tissue specimens of CC patients with different prognosis (recurrence) was observed; The value of various indicators in predicting the recurrence was analyzed. 
    Results The positive expression rate of VEGF and OLFM4 in CC group was higher than that in CIN group and normal group, while the expression level of miR-124 was lower than that in CIN group and normal group (P＜0.05). The positive rates of VEGF, OLFM4, and miR-124 expression were significantly different in patients with different stages, differentiation degree and recurrence (P＜0.05). The area under the receiver operating characteristic (ROC) curve (AUC)of VEGF, OLFM4 and miR-124 in predicting the recurrence was 0.820, 0.895 and 0.852, respectively, and the AUC of combined detection of VEGF, OLFM4 and miR-124 in prediction was 0.945, which was significantly higher than that of each indicator alone. 
    Conclusion The positive rate of VEGF and OLFM4 in cancer tissues of CC patients is significantly higher and the expression level of miR-124 is lower. The expression of each indicator is associated with the biological behavior of CC, which could be used to effectively assess tumor proliferation and invasion and to predict postoperative recurrence. 

    Expression and clinical significance of miR-103a-3p, sICAM-1 and miR-101-3p before and after treatment of uterine adenomyosis
    LI Li-juan, HOU Yan-xin, WU Xue-jing, SUN Hong-wei, JIN Hong-nan
    2022, 43(12):  1433-1438.  doi:10.3969/j.issn.1007-3205.2022.12.013
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    Objective To investigate the expression and clinical significance of miR-103a-3p, soluble intercellular adhesion molecule-1 (sICAM-1), and miR-101-3p before and after treatment of uterine adenomyosis. 
    Methods In total,125 patients with uterine adenomyosis in the Third Hospital of Chengde City were selected as the research group, and another 87 healthy physical examinees with normal menstruation and no dysmenorrhea during the same period were selected as the control group. The miR-103a-3p, sICAM-1 and miR-101-3p of the two groups were calculated, and Spearman correlation analysis was performed to analyze the correlation of each indicator with the intensity of dysmenorrhea and efficacy. The receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) were drawn to analyze the predictive value of each indiator in the efficacy of uterine adenomyosis. 
    Results Before treatment, the levels of miR-103a-3p and miR-101-3p in the research group were higher than those in the control group, while the levels of sICAM-1 were lower than those in the control group (P＜0.05). After treatment, the levels of miR-103a-3p and miR-101-3p in the research group were lower than those before treatment, while the levels of sICAM-1 were higher than those before treatment (P＜0.05). Before treatment and at 6 months after treatment, the levels of miR-103a-3p and miR-101-3p in severe patients in the research group were higher than those in mild and moderate patients, while the levels of sICAM-1 were lower than those in mild and moderate patients; the levels of miR-103a-3p and miR-101-3p in moderate patients were higher than those in mild patients, while the levels of sICAM-1 were lower than those in mild patients (P＜0.05). After treatment, the levels of miR-103a-3p and miR-101-3p in both groups were lower than those before treatment, whilethe levels of sICAM-1 were higher than those before treatment (P＜0.05). The levels of miR-103a-3p and miR-101-3p in the effective patients in the research group before treatment and at 6 months after treatment were lower than those in the ineffective patients, while the levels of sICAM-1 were higher than those in the ineffective patients (P＜0.05). MiR-103a-3p and miR-101-3p were positively correlated with the intensity of dysmenorrhea and negatively correlated with the efficacy (P＜0.05); SICAM-1 was negatively correlated with the intensity of dysmenorrhea and positively correlated with the efficacy (P＜0.05). The AUC of the combination of sICAM-1 and miR-101-3p difference in predicting the efficacy of uterine adenomyosis was 0.909 (95%CI: 0.844-0.953), the sensitivity was 84.00%, and the specificity was 81.00%, which were significantly better than the prediction of each indicator alone. 
    Conclusion Abnormal expression of miR-103a-3p, sICAM-1, and miR-101-3p in patients with uterine adenomyosis is associated with intensity of dysmenorrhea, and therapeutic effect of uterine arterial embolization(UAE), and can be used as an objective indicator for therapeutic effect evaluation of UAE. 

    Preliminary establishment of quantitative pre-scoring system for prognostic risk for cesarean scar pregnancy
    ZHANG Xiao, YAN Lu, LI Lian-xin, YU Miao, ZHANG Jing-kun, DU Yan-fang
    2022, 43(12):  1439-1444,1448.  doi:10.3969/j.issn.1007-3205.2022.12.014
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    Objective To retrospectively analyze the outcome of different treatment methods for cesarean scar pregnancy (CSP), to explore the key factors affecting the outcome of CSP treatment, and to establish a quantitative pre-scoring system in clinical practice. 
    Methods In total, 240 patients with CSP who were treated for the first time in the Second Hospital of Hebei Medical University were retrospectively analyzed. Patients were divided into three groups according to their treatment methods, namely, ultrasound-guided uterine clearance group, uterine packing group and laparoscopic surgery (or laparotomy) group. Clinical and auxiliary examination data and treatment success rate of patients in each group were compared to find out the factors affecting the treatment outcome. The optimal scale regression method and mathematical model in statistics were used to calculate the weight of each influencing factor and assign its value. The quantitative pre-evaluation score table of CSP risk was established to carry out preliminary verification. 
    Results The differences in six variables, including the maximum diameter of the gestational sac, ultrasonic classification, thickness of the remaining muscle layer, blood flow classification, fetal heart beat and β-human chorionic gonadotropin (β-HCG level) in the clinical and ultrasonic characteristics of the patient were statistically significant (P＜0.05). The weights of the predictive value of each influencing factor in the treatment outcome were residual muscle layer thickness (50.3%), ultrasonic classification (15.0%), blood flow grade of pregnancy sac (12.4%), the maximum diameter of pregnancy sac (11.1%), presence or absence of fetal heart beat (7.1%), and preoperative blood β- HCG level (4.1%). A quantitative scoring system was established accordingly and converted into a 10 point system. The consistency test showed that the actual treatment mode was basically consistent with the predicted treatment mode, and the Kappa coefficient was 0.637. 
    Conclusion The influencing factors for the outcome of CSP treatment were residual myometrial thickness, ultrasound classification, blood flow grade of pregnancy sac, the maximum diameter of gestational sac, presence or absence of fetal heart beats and preoperative β-HCG values. A quantitative scoring system based on the weight of the above influencing factors in the overall risk can predict the severity of CSP and the surgical plan to be selected. 

    Expression and significance of vascular endothelial growth factor gene polymorphism in polycystic ovary syndrome
    HUANG Xi, HAO Ya-li, WANG Na, ZHOU Rong-miao, LI Yan
    2022, 43(12):  1445-1448.  doi:10.3969/j.issn.1007-3205.2022.12.015
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    Objective To explore the association of single nucleotide polymorphism (SNP)of vascular endothelial growth factor (VEGF) gene rs699947 and rs1570360 SNP with risk of polycystic ovary syndrome (PCOS). 
    Methods The association of SNP of VEGF gene rs699947 SNP and rs1570360 SNP with risk of PCOS in 152 PCOS patients and 160 healthy controls was analyzed by polymerase chain reaction-ligase detection reaction (PCR-LDR) method . 
    Results The women carrying CC genotype had a higher risk of PCOS compared with the women with the AA genotype. After adjustment of factors, such as age and family history of obesity, OR was 2.896 (95%CI=1.388-6.043). 
    Conclusion VEGF gene rs699947 SNP increases the genetic susceptibility of women to PCOS in north China, and the women carrying the CC genotype have a higher risk of PCOS. 

    Analysis of the relationship between plasma Th1/Th2 cells, ET, PTA, PCT and the severity and outcome of sepsis in children
    ZHANG Yun, CHEN Juan, HUANG Yao-mi
    2022, 43(12):  1449-1453.  doi:10.3969/j.issn.1007-3205.2022.12.016
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    Objective To investigate the relationship between plasma helper T cell 1 (Th1)/helper T cell 2 (Th2) cells, endotoxin (ET), prothrombin activity (PTA) and procalcitonin (PCT) and the severity and outcome of sepsis in children. 
    Methods Ninety-six children with sepsis in our hospital were selected, and the severity of sepsis was assessed by the Pediatric Critical Care Score (PCIS) and classified into non-critical group (PCIS score >80, n=39), critical group (PCIS score 71-80, n=32), and very critical group (PCIS score ≤70, n=25). The three groups were compared in terms of general data, plasma Th1/Th2 cells, ET, PTA, and PCT levels at admission, and the relationship between plasma indicators and PCIS scores of children with sepsis was analyzed. The 28 d prognosis of children with sepsis was recorded, and plasma Th1/Th2 cells, ET, PTA, and PCT levels at admission in children with different prognosis were compared, and the relationship between plasma indicators and the prognosis of children with sepsis as well as the value of plasma indicators in predicting the prognosis of children with sepsis was analyzed. 
    Results The level of Th1/Th2 cells and PTA in very critical group was lower than that in critical group and non-critical group, and lower in critical group than in non-critical group. The levels of ET and PCT in very critical group were higher than those in critical group and non-critical group, and higher in critical group than in non-critical group, and the difference was statistically significant (P＜0.05). Plasma Th1/Th2 cells and PTA levels were positively correlated with PCIS scores of children with sepsis, and plasma ET and PCT levels were negatively correlated with PCIS scores of children with sepsis (P＜0.05). Plasma Th1/Th2 cells and PTA levels at admission were lower in deceased children than in surviving children, and plasma ET and PCT levels were higher than in surviving children (P＜0.05). Plasma Th1/Th2 cells and PTA levels were positively correlated with the prognosis of children with sepsis, and plasma ET and PCT levels were negatively correlated with the prognosis of children with sepsis (P＜0.05). The area under the curve (AUC) of Th1/Th2 cells, ET, PTA, and PCT in predicting the prognosis of children with sepsis as death was 0.808, 0.836, 0.720, and 0.748, respectively, and the combined prediction had the largest AUC of 0.933. 
    Conclusion The levels of plasma Th1/Th2 cells and PTA were closely associated with the severity of sepsis in children, and the levels of plasma ET and PCT were negatively correlated with the severity of the disease and closely correlated with the prognosis of the children. The early combined detection of the levels of each index can assist in clinical prediction of the prognosis of the children. 

    Correlation between viral load of infant cytomegalovirus infectious hepatitis and γ-GGT and its predictive value for prognosis
    CHEN Si-min, LIU Peng-fei, LU Li-dong, ZHANG Xin-yu
    2022, 43(12):  1454-1458,1463.  doi:10.3969/j.issn.1007-3205.2022.12.017
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    Objective To investigate the correlation between viral load of infantile cytomegalovirus(CMV) hepatitis(CMV) and γ-glutamyltransferase(γ-GGT) and its predictive value for prognosis. 
    Methods A total of 163 children with CMV hepatitis admitted to the hospital were selected as the research subjects. The basic data of the children were collected, and the prognosis of the children was calculated at 6-month follow-up after admission. The correlation between viral load and γ-GGT in children with CMV hepatitis , and factors affecting the short-term prognosis of children with CMV hepatitis were analyzed. The value of viral load of CMV and γ-GGT in predicting the short-term prognosis of children with CMV hepatitis was analyzed. 
    Results Pearson correlation analysis showed that CMV-DNA viral load was positively correlated with γ-GGT level in children with CMV hepatitis(P＜0.05). During the follow-up period of 163 children with CMV hepatitis, 27 had poor prognosis and 136 had good prognosis. Logistic multivariate regression analysis showed that CD4+/CD8+(OR:6.019, 95%CI:2.477-14.629), γ-GGT(OR:4.486, 95%CI:1.846-10.903), and CMV-DNA load(OR:5.859, 95%CI:2.411-14.240) were risk factors for the short-term prognosis of children with CMV hepatitis(P＜0.05). The results of ROC curve analysis showed that the sensitivity of CMV-DNA load and γ-GGT in predicting the short-term prognosis of children with CMV hepatitis was 77.78%(95%CI:57.27-90.62), 74.07%(95%CI:53.41-88.13), and 74.07%(95%CI:53.41-88.13), respectively; The specificity was 79.41%(95%CI:71.45-85.67), 77.21%(95%CI:69.07-83.77), and 90.44%(95%CI:83.90-94.61), respectively, and AUC was 0.766(95%CI:0.671-0.862), 0.758(95%CI:0.656-0.861), and 0.898(95%CI:0.835-0.962) respectively. 
    Conclusion The viral load of children with CMV hepatitis is related to the level of γ-GGT, and CMV viral load and γ-GGT may affect the prognosis of children. The combination of the two has a good effect in predicting the prognosis of children with CMV hepatitis.

    Study on the risk factors of central serous chorioretinopathy and the value of VEGF, hs-CRP and ESR in the diagnosis of CSC
    SUN Ling-juan, YIN Li, WANG Hai-yan, WANG Shu-rui, MENG Ling
    2022, 43(12):  1459-1463.  doi:10.3969/j.issn.1007-3205.2022.12.018
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    Objective To investigate the risk factors of central serous chorioretinopathy (CSC), and to analyze the relationship between vascular endothelial growth factor (VEGF), high sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR) and CSC. 
    Methods A total of 109 patients with CSC were selected (CSC group), and 103 volunteers undergoing physical examination during the same period were selected as the control group. General data, underlying diseases, past medical history and medication history were collected, VEGF, hs-CRP and ESR levels were detected, and the influencing factors of CSC were analyzed by multivariate Logistic regression. Receiver operating characteristic (ROC) curve was used to analyze the value of VEGF, hs-CRP and ESR in the diagnosis of CSC. 
    Results The proportion of male gender, smoking history, drinking history, obstructive sleep apnea, hypothyroidism, combined nephropathy, helicobacter pylori infection, history of hormone use and day and night shift work were higher in CSC group than in control group (P＜0.05). The levels of VEGF, hs-CRP and ESR were higher in CSC group than in control group (P＜0.05). Male gender, day and night shift work, combined helicobacter pylori infection, hypothyroidism, VEGF, hs-CRP and ESR were risk factors for CSC (P＜0.05). The area under the receiver operating characteristic (ROC)curve of combined detection of VEGF, hs-CRP and ESR in the diagnosis of CSC was 0.886, which was higher than  that of VEGF, HS-CRP and ESR alone (0.722, 0.728 and 0.703) (P＜0.05). 
    Conclusion Male gender, day and night shift work, helicobacter pylori infection, hypothyroidism and increased VEGF, hs-CRP and ESR are risk factors for CSC, and the combined detection of VEGF, hs-CRP and ESR has high effectiveness in the diagnosis of CSC.

    Observation on the effect of orbicularis oculi muscle compound flap combined with correction of upper eyelid skin laxity in repairing large-area defect after surgery for eyelid xanthoma
    WANG Yan, WANG Min, ZHANG Wei-jie
    2022, 43(12):  1464-1467,1478.  doi:10.3969/j.issn.1007-3205.2022.12.019
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    Objective To explore the effect of orbicularis oculi muscle compound flap combined with correction of upper eyelid skin laxity in repairing large-area defect after surgery for eyelid xanthoma. 
    Methods A total of 92 patients with large-area defect after surgery for eyelid xanthoma were selected and divided into observation group(n=46) and control group(n=46) according to the random number table method. The control group was surgically resected and sutured, and the observation group was treated with the orbicularis oculi muscle compound flap combined with correction of upper eyelid skin laxity. The duration of operation, granulation growth time, healing time, residual tumor score, depressed scar score, and score of pigment abnormalities, cosmetic effect, recurrence rate and complication rate were compared between two groups. 
    Results There was no statistically significant difference in duration of operation between two groups(P＞0.05), and the granulation growth time and healing time of the observation group were shorter than those of the control group(P＜0.05). There was no significant difference in residual tumor score, depressed scar score, score of pigment abnormalities and comprehensive score in the two groups at one month after surgery(P＞0.05). At 6 months after operation, the residual tumor scores, depressed scar scores, score of pigment abnormalities and comprehensive scores of the two groups decreased(P＜0.05), which were lower in the observation group(P＜0.05). The excellent and good rates of observation group was 92.00%, which was higher than that(80.52%) in control group(P＜0.05). There was no statistically significant difference in the recurrence rate and complication rate between two groups(P＞0.05). 
    Conclusion The orbicularis oculi muscle compound flap combined with correction of upper eyelid skin laxity can repair large-area defect of patients after surgery for eyelid xanthoma, which can shorten the recovery time, and improve the cosmetic effect, with good safety and reliability. 

    HR-MRI study of plasma lipoprotein-associated phospholipase A2 levels and the risk of intracranial atherosclerotic plaque stabilization
    YAN Xue-jiao, GAO Jie, ZHANG Dong-sheng, ZHANG Xiao-ling, TANG Min
    2022, 43(12):  1468-1473.  doi:10.3969/j.issn.1007-3205.2022.12.020
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    Objective To evaluate the relationship between plasma lipoprotein-associated phospholipase A2(Lp-PLA2) concentration and characteristics of intracranial atherosclerotic plaque stability. 
    Methods Eighty-three patients with acute ischemic stroke (AIS)were retrospectively enrolled. Plasma Lp-PLA2 concentration was determined in all patients. High resolution magnetic resonance imaging(HR-MRI) was used to determine the stenosis rate of intracranial vessels and plaque stability characteristics, including plaque enhancement, regularity of the plaque surface and T1WI hyperintensity in the plaque. A binary Logistic regression model was established to evaluate the relationship between high LP-PLA2 concentration and characteristics of intracranial plaque stability by adjusting for demographic and related lipid confounders. 
    Results There were significant differences in total cholesterol(TC), low density lipoprotein(LDL) and dyslipidemia in patients with high Lp-PLA2 level. After adjustment for demographic and related lipid factors, increased Lp-PLA2 concentration was independently associated with plaque enhancement (P=0.005,OR=21.347, 95%CI 2.645-177.604) and plaque surface irregularity (P=0.044,OR=3.008,95%CI 1.030-8.780). 
    Conclusion Increased Lp-PLA2 concentration is associated with intracranial plaque stability.

    Diagnostic value of hydrogen proton magnetic resonance spectroscopy imaging combined with PET/MRI in epilepsy
    LI Jian, PAN Wei-ling, ZHAO Xiao-yang, SONG Dong-mei
    2022, 43(12):  1474-1478.  doi:10.3969/j.issn.1007-3205.2022.12.021
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    Objective To investigate the diagnostic value of hydrogen proton magnetic resonance spectroscopy imaging (1H-MRS) combined with positron emission tomography/magnetic resonance imaging (PET/MRI) in epilepsy. 
    Methods Seventy-four epilepsy patients admitted to our hospital were selected as the epilepsy group, while 50 healthy people undergoing physical examination during the same period were selected as the control group. Using stereotactic electroencephalography (SEEG) and surgical and pathological methods as the “gold standard”, the diagnostic value of the 3 modalities, including 1H-MRS examination alone, PET/MRI fusion imaging, 1H-MRS combined with PET/MRI fusion imaging, in detection and lesion localization was evaluated. 
    Results Compared with the ratios of N-acetyl aspartate (NAA)/Creatine (Cr), NAA/choline compounds (Cho), NAA/(Cr+Cho) in the affected hippocampus, the ratios of NAA/Cr, NAA/Cho, NAA/(Cr+Cho) in the healthy hippocampus were higher (P＜0.05). The combined detection rate and the coincidence rate of positive lesion localization were higher than those of 1H-MRS and PET/MRI fusion imaging (P＜0.05). With SEEG and surgical and pathological methods as the “gold standard”, the sensitivity of 1H-MRS, PET/MRI fusion and combined detection of the two was 44.59%, 55.41% and 94.59% respectively, the specificity was 54.05%, 59.45% and 78.29% respectively, and the accuracy was 49.32%, 57.43% and 95.39% respectively. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.764, 0.788 and 0.812 respectively. The specificity and AUC of combined detection were the highest. 
    Conclusion Diagnosis of epilepsy patients by 1H-MRS combined with PET/MRI can improve the accuracy of epilepsy with good diagnostic efficacy. 

    Effect of posterior urethral curvature angle on urine flow rate and its significance in predicting bladder outlet obstruction in patients with lower urinary tract symptoms
    JIA Xu-dong, HE Wen, ZHANG Ming
    2022, 43(12):  1479-1484.  doi:10.3969/j.issn.1007-3205.2022.12.022
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    Objective To study the clinical value of posterior urethral curvature (PUC) in evaluating bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia (BPH). 
    Methods A total of 253 male patients treated in the Department of Urology,the Second Hospital of Hebei Medical University were enrolled in this study. According to presence or absence of lower urinary tract symptoms (LUTS), the patients were divided into LUTS group (n=193) and control group (n=60). The PUC of all enrolled people was collected by pelvic floor ultrasound. The data collected included total prostate volume (TPV), transition zone volume (TZV), transition zone index (TZI), degree of intravesical prostatic protrusion (IPP), prostate urethral angle (PUA), prostatic specific antigen (PSA), international prostate symptom score (IPSS) and urethral length (UL). The maximum urinary flow rate (Qmax) and bladder outlet obstruction index (BOOI) were collected with the urodynamic detector. The sensitivity, specificity and cut-off point of PUC in predicting BOOI were further analyzed by receiver operating characteristic (ROC) curve. Multiple linear regression was used to analyze the impact of TPV, TZV, TZI, IPP, PUA, PUC, UL, PSA, Qmax and IPSS on BOOI. 
    Results The mathematical simulation showed that when the PUC angle increased from 0 °to 90 °, the urinary flow rate decreased by 50.9%. When the PUC angle increased from 30 ° to 90 °, the urinary flow rate decreased by 27%. The area under the ROC curve of PUC in diagnosing BOOI was 0.867. The optimal PUC value for diagnosing BOO was 48 °, the sensitivity was 88.1%, and the specificity was 75.8%. Based on comparison between PUC ≤48 ° group and PUC ＞48 ° group, patients with large PUC had larger TPV, TZV, TZI, IPP, PUA, IPSS and lower Qmax (P＜0.05). PUC was significantly correlated with TPV (r=0.268, P＜0.001), TZV (r=0.257, P＜0.001), TZI (r=0.241, P＜0.001), IPP (r=0.305, P＜0.001), PUA (r=0.335, P＜0.001), IPSS (r=0.357, P＜0.001), and BOOI (r=0.154, P=0.014). PUC was negatively correlated with Qmax (r=-0.358, P＜0.001). Multiple linear regression analysis showed that TPV, TZV, Qmax, PUA and PUC were the major influencing factors of BOOI. 
    Conclusion In this theoretical model, PUC is negatively correlated with urinary flow rate. PUC is positively correlated with TPV, TZV, TZI, IPP, PUA, IPSS, and negatively correlated with Qmax, which may make PUC a new indicator for evaluating LUTS.