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Table of Content

    25 February 2023, Volume 44 Issue 2
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    Effects of different concentrations of CB on the reconstruction of egg cytoskeleton and embryo development after spindle transplantation in mice
    WANG Qi-hang, WANG Wei, WANG Wei-zhou, SHANG Wei
    2023, 44(2):  129-136.  doi:10.3969/j.issn.1007-3205.2023.02.002
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    Objective To investigate the effects of different concentrations of cytochalasin B (CB) on the reconstruction of egg cytoskeleton and embryo development after oocyte spindle transplantation in mice, and to screen out the better CB concentration. 
    Methods Eight-week-old C57BL/6 female mouse eggs were transplanted using conventional, low, medium, and high doses of CB. The efficiency of spindle transplantation in mice was measured. The fertilization rate of in vitro fertiliazation (IVF), cleavage rate, blastocyst rate and hatching rate of reconstructed mouse eggs were calculated. The blastocysts of each group were stained by immunofluorescence and calculated by fluorescence microscope. Mouse eggs were reconstructed and stained with immunofluorescence. The cytoskeleton was observed and analyzed by confocal microscopy. 
    Results ①Compared with the conventional group, there was no difference in the efficiency of spindle transplantation in the low dose, medium dose and high dose groups (P＞0.05). ②The fertilization rate of high dose group was lower than that of conventional group (P＜0.05), and the blastocyst rate and hatching rate of high dose group were lower than those of conventional group and medium dose group (P＜0.05). ③The total number of blastocyst cells in the high dose group was less than that in the conventional group (P＜0.05), and the total number of blastocyst cells in the medium dose group was more than that in the conventional group (P＜0.05). ④Compared with the conventional group, there was no difference in the positive ratio of microfilaments of reconstructed mice eggs in low-dose, medium-dose, high-dose groups at different time points (P>0.05). The average optical density values of microfilaments in different time groups were different (P< 0.05), there were significant differences between time points (P<0.05), and the time variation trend was different among groups (P<0.05). That is, different concentrations of CB and different observation time had significant effects on the recovery of reconstructed egg cytoskeleton in mice, and there were significant differences. 
    Conclusion In the concentration range of CB selected in this study, the medium dose group was better than the conventional group.

    MicRNA-320c-5p regulates SERPINA1 gene expression in COPD
    REN Jie, ABUDUREHEMAN Zulipikaer, GONG Hui, ZHONG Xue-mei, ZHENG Ai-fang, LI Li
    2023, 44(2):  137-141.  doi:10.3969/j.issn.1007-3205.2023.02.003
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    Objective To verify the targeting regulatory relationship of MicR-320c-5p to SERPINA1 gene by dual luciferase reporter system. 
    Methods The 3′UTR sequence of SERPINA1 gene was obtained from the genome of human normal lung epithelial cells. Candidate miRNAs were identified by sequence matching. 3% cigarette smoke extract （CSE） was used to induce human bronchial epithelial cells(BEAS-2b cells) to establish a chronic obstructive pulmonary disease （COPD） cell model as the experimental group, and the normally cultured BEAS-2b cells as the control group. The expression levels of SERPINA1 and candidate miRNAs in the two groups were detected by real time flurocent qualitative polymerase chain reaction (RT-qPCR). Wild-type and mutant double luciferase reporter gene vector was constructed. Dual-luciferase reporter plasmids (psiCHECK-2-SERPINA1-3′UTR and psiCHECK-2-SERPINA1-3′UTR ) and miRNA plasmids (miR-320-5p mimic) were co-transfected into 293 T cells respectively for fluorescence activity determination. 
    Results By sequence matching, the candidate miR-26, miR-210, miR-320c and miR-96 were set as targeted miRNAs. Compared with the control group, the mRNA expression level of SERPINA1 gene in the experimental group was significantly increased (P＜0.05), while the expression levels of four candidate miRNAs were significantly decreased (P＜0.01), of which miR-320c and miR-96 were more significant (P＜0.001). Based on the correlation between miR-320c and the prognosis of COPD, miR-320c was selected for the subsequent double luciferase experiment. The relative luciferase activity of the construct carrying MicR-320c-5p mimic and SERPINA1 wild type 3, UTR was significantly decreased(P＜0.001), while the relative luciferase activity of the construct carrying SERPINA1 mutant 3′UTR was not significantly decreased (P＞0.05).
    Conclusion SERPINA1 expression is up-regulated in BEAS-2b cells induced by 3% CSE, and miR-320c-5p expression is down-regulated. miR-320c-5p may play an important role in the occurrence and development of COPD by negatively regulating SERPINA1 expression.

    Expression of RBP, miR-126, and SIRT1 in acute cerebral infarction and their correlation with carotid atherosclerotic plaque stability
    LIU Zi-chen, LI Ke-jiao, CHANG Sha, SONG Xue, LI Fang
    2023, 44(2):  142-147.  doi:10.3969/j.issn.1007-3205.2023.02.004
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    Objective To study the changes of serum retinol binding protein (RBP), microRNA-126 (miR-126) and silent information regulator1 (Sirt1) levels in patients with acute cerebral infarction (ACI) compared with healthy subjects, and to analyze the correlation between the changes of the three indexes and the stability of carotid atherosclerotic plaques in patients with ACI. 
    Methods A total of 140 patients with ACI who presented to our hospital were selected as the case group, and 60 healthy physical examinees during the same period were selected as the control group. Patients in the case group underwent color Doppler ultrasonography and were divided into stable plaque group (n=78) and unstable plaque group (n=62) according to the ultrasound results. Clinical data of subjects were collected. The expression of serum RBP and Sirt1 was detected by enzyme-linked immunosorbent assay, and the expression of serum miR-126 was detected by real-time fluorescence quantitative PCR. Spearman was used to analyze the relationship between the expression of serum RBP, miR-126, Sirt1 and the stability of carotid atherosclerotic plaque. Receiver operating characteristic curve analysis was performed to evaluate the predictive value of serum RBP, miR-126, and Sirt1 expression on the stability of carotid atherosclerotic plaques in patients. 
    Results Compared with control group, the expression of serum RBP in case group was increased, while the expression of miR-126 and Sirt1 was decreased (P＜0.05). The expression of serum RBP in unstable plaque group was increased compared with that in stable plaque group, while the expression of miR-126 and Sirt1 was decreased compared with that in stable plaque group (P＜0.05). The expression of serum RBP was positively correlated with the stability of carotid atherosclerotic plaque (r=0.423, P＜0.05), and the expression of serum miR-126 and Sirt1 was negatively correlated with the stability of carotid atherosclerotic plaque (r=-0.514, -0.366, P＜0.05). The AUC of RBP, miR-126, Sirt1 and their combination in prediction was 0.746, 0.798, 0.712, and 0.892, respectively, with a sensitivity of 59.7%, 75.8%, 75.8%, 74.2%, respectively, and specificity of 84.6%, 70.5%, 64.1%, and 92.3%, respectively. The combined prediction value of the three indexes was superior to that of the single one. 
    Conclusion The increased expression of serum RBP and the decreased expression of miR-126 and Sirt1 in patients with ACI are correlated with the stability of carotid atherosclerotic plaque. Serum RBP, miR-126 and Sirt1 have good predictive value for the stability of carotid atherosclerotic plaque. 

    Efficacy and safety evaluation of levosimendan, dobutamine and milrinone in the treatment of septic myocardial injury
    SUN Tao, ZHANG Nan, WANG Sheng-hai, CUI Na, CHEN Ning, YU Zhan-biao
    2023, 44(2):  148-151,178.  doi:10.3969/j.issn.1007-3205.2023.02.005
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    Objective To investigate the efficacy and safety of levosimendan, dobutamine and milrinone in the treatment of septic myocardial injury. 
    Methods In total, 84 patients with septic myocardial injury were selected and divided into levosimendan group, dobutamine group, and milrinone group according to the random number table method, with 28 patients in each group. Total effective rate, soluble myeloid cell trigger receptor-1 (sTREM-1), soluble cluster of differentiation antigen 14 (sCD14), soluble cluster of differentiation antigen 163 (sCD163), cardiac troponin I (cTnI), brain natriupeptide (BNP), left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), left ventricular ejection fraction (LVEF) and adverse reactions were compared in the three groups. 
    Results The total effective rate of levosimendan group was higher than that of dobutamine group and milrinone group (P＜0.05). One-way analysis of variance showed that before treatment, there was no significant difference in sTREM-1, sCD14, sCD163, cTnI, BNP, LVEF, LVEDVI, and LVESVI among three groups (P＞0.05). The comparison of sTREM-1, sCD14, sCD163, cTnI, BNP, LVEF, LVEDVI, and LVESVI was statistically significant among three groups (P＜0.05). Comparison between two groups showed that sTREM-1, sCD14, sCD163, cTnI, BNP, LVEDVI, and LVESVI in levosimendan group were lower than those in dobutamine group and milrinone group, while LVEF was higher than that of dobutamine group and milrinone group (P＜0.05). The total incidence of adverse reactions in levosimendan group and dobutamine group was lower than that in milrinone group (P＜0.05), which, however, were not significantly different between levosimendan group and dobutamine group (P＞0.05). 
    Conclusion Levosimendan is more effective than dobutamine and milrinone in the treatment of sepsis myocardial injury, with good safety and no serious adverse reactions.

    Study on the correlation between thyroid peroxidase antibody and vascular disease of lower extremities in patients with type 2 diabetes mellitus
    YANG Jie, DING Wen-cui, WANG Hai-ying, SHI Ya-nan
    2023, 44(2):  152-156.  doi:10.3969/j.issn.1007-3205.2023.02.006
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    Objective To investigate the effect of thyroid peroxidase antibody (TPO-Ab) on vascular disease of lower extremities in patients with type 2 diabetes mellitus (T2DM). 
    Methods The clinical data of 500 patients with T2DM who were admitted to Cangzhou Central Hospital were retrospectively collected. According to the level of TPO-Ab, the patients were divided into the positive group (TPO-Ab≥34 U/mL, n=73) and negative group (TPO-Ab＜34 U/mL, n=427), and the incidence of vascular disease of lower extremities in two groups was recorded. According to presence or absence of vascular disease of lower extremities in patients with T2DM, they were divided into the occurrence group (n=186) and the non-occurrence group (n=314), and the correlation between TPO-Ab and vascular disease of lower extremities in patients with T2DM was analyzed. 
    Results The incidence of vascular disease of lower extremities was 56.16% (41/73) in the positive group, which was higher than that ［33.96% (145/427)］ in the negative group (χ2=13.160, P＜0.01). Univariate analysis was performed, and further Logistic regression analysis showed that coronary heart disease (OR=10.345), history of cerebral infarction (OR=26.942), duration of T2DM (OR=1.921), TPO-Ab (OR=2.080), triglycerides (OR=1.531), low density lipoprotein cholesterol (OR=1.559), glycosylated hemoglobin (OR=1.703), 2h postprandial blood glucose (OR=1.519) were the influencing factors of vascular disease of lower extremities in patients with T2DM. 
    Conclusion The incidence of vascular disease of lower extremities in T2DM patients with TPO-Ab≥34 U/mL is higher than that of T2DM patients with TPO-Ab ＜34 U/mL. Clinicians should strengthen the screening of TPO-Ab, as well as evaluation and control of the above influencing indicators in T2DM patients, so as to prevent or slow down the progression of vascular disease of lower extremities in T2DM patients.

    Correlation analysis of serum GLP-1 and hs-CRP with metabolic syndrome and cognitive function in patients with type 2 diabetes mellitus
    LIAO Su-dan, ZHANG Chi, SU Gang
    2023, 44(2):  157-160,183.  doi:10.3969/j.issn.1007-3205.2023.02.007
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    Objective To investigate the correlation of glucagon-like peptide-1 (GLP-1) and high-sensitivity C-reactive protein in serum. hs-CRP) with metabolic syndrome (MS) and cognitive function in patients with type 2 diabetes mellitus (T2DM). 
    Methods A total of 122 T2DM patients (observation group) and 61 healthy physical examinees (control group) were selected as the research subjects. The observation group was divided into MS group (T2DM combined with MS, n=81) and non-MS group (T2DM alone, n=41) according to presence of MS. According to the Montreal Cognitive Assessment Scale (MoCA), MS group was subdivided into cognitive normal group (MoCA score≥26, n=41) and cognitive dysfunction group (MoCA score ＜26, n=40). Serum GLP-1, hs-CRP, waist circumference, blood lipid and blood pressure were compared among all groups. Pearson method was used to analyze the correlation between GLP-1, hs-CRP and MS index. Binary Logistic regression model was used to analyze the effects of serum GLP-1 and hs-CRP on cognitive function in T2DM patients with MS. 
    Results GLP-1, high density lipoprotein cholesterol (HDL-C) and MoCA scores in the observation group were lower than those in the control group, while hs-CRP, waist circumference, systolic blood pressure (SBP), diastolic blood pressure (DBP), triacylglycerol (TG) and fasting blood glucose (FBG) were higher than those in control group (P＜0.05).GLP-1, HDL-C and MoCA scores in MS group were lower than those in control group, while hs-CRP, waist circumference, SBP, DBP, TG and FBG in MS group were higher than those in non-MS group (P＜0.05).The GLP-1, HDL-C and MoCA scores in the cognitive dysfunction group were lower than those in the control group, while hs-CRP, waist circum ference, SBP, DBP, TG and FBG in the cognitive dysfunction group were higher than those in the cognitive normal group (P＜0.05).Pearson correlation analysis showed that GLP-1 was negatively correlated with waist circumference, SBP, DBP and FBG, but positively correlated with HDL-C (P＜0.05). hs-CRP was positively correlated with waist circumference, SBP, DBP, TG, and FBG, and negatively correlated with HDL-C (P＜0.05).Logistic regression model analysis showed that decreased GLP-1 level and increased hs-CRP level were risk factors for cognitive dysfunction in T2DM patients with MS (P＜0.05). 
    Conclusion Serum GLP-1 level is significantly decreased and hs-CRP level is significantly increased in T2DM patients with MS, and decreased serum GLP-1 level and increased hs-CRP level are risk factors for cognitive dysfunction in T2DM patients with MS. 

    Expression and correlation analysis of LncRNA AC005479.2 in papillary thyroid carcinoma based on bioinformatics
    LIANG Xin-ke, WANG Peng-fei, HUO Sheng-nan, LI Jian-ying, HOU Qing-tian
    2023, 44(2):  161-166.  doi:10.3969/j.issn.1007-3205.2023.02.008
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    Objective To investigate the key genes and their potential regulatory molecular targets of papillary thyroid carcinoma (PTC) through bioinformatics analysis, and to explore the molecular regulatory mechanism in PTC. 
    Methods The gene expression profiles of PTC were retrieved and downloaded from the TCGA database, and the "Limma" software package in Rstudio was used to find out whether there was differential long non-coding RNA (lncRNA) between PTC and adjacent tissues. WGCNA was used for construction and clinical correlation analysis was performed. Enrichment analysis and annotation were performed by GSEA. 
    Results After screening by the TCGA database, a total of 510 tumor tissues and 58 paracancerous tissues of PTC were included in the analysis, and a total of 58 differentially expressed lncRNAs were obtained, including 36 highly expressed genes and 22 lowly expressed genes. We used the dynamic tree cutting method to identify gene modules, set the minimum number of genes in the module to be 100, and finally obtained 11 corresponding modules. The results showed that the blue module was significantly associated with PTC. There were 34 differential lncRNAs in the blue module. Univariate and multivariate Cox regression analyses were performed on the 34 differential lncRNAs in the Blue module, and AC005479.2 was obtained. Then the receiver operating characteristic (ROC) curve was drawn for AC005479.2, with an area under the ROC curve (AUC) value of 0.838. GO and KEGG analysis revealed the potential pathways and functions of AC005479.2. The results showed that AC005479.2 might participate in cell adhesion through adipocytokine signaling pathway, MAPK signaling pathway, and cadherin binding, and positively regulate apoptosis signaling pathway, thus being involved in the pathological process of PTC. 
    Conclusion There are significant differences in the expression of AC005479.2 in the thyroid tissue of PTC, patients and healthy people. The AC005479.2 gene is expected to become a biomarker gene for PTC， providing an important basis for subsequent PTC research. 

    Roles of size ratio and bleb formation in the rupture of intracranial mirror aneurysms
    TANG Xiao-yu, WEN Li-li, WU Qi, ZHANG Xin
    2023, 44(2):  167-172.  doi:10.3969/j.issn.1007-3205.2023.02.009
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    Objective To investigate the morphological and hemodynamic characteristics of intracranial mirror aneurysm and their effect on aneurysm rupture. 
    Methods The data of 92 aneurysms in 46 patients with intracranial mirror aneurysms by digital subtraction angiography were analyzed retrospectively. Fifteen morphological parameters and 5 hemodynamic parameters of aneurysms were collected by computational fluid dynamics simulation.The difference of parameters between ruptured and unruptured aneurysms was compared, and the risk factors for ruptured aneurysms were determined by multivariate Logistic regression analysis. Receiver operating characteristic (ROC) curve was used to analyze each parameter to predict the area under ROC curve (AUC) and threshold of aneurysm rupture. 
    Results The incidence of irregular shape and bleb formation in ruptured group were higher than that in unruptured group. Maximum diameter, height, width, maximum height(Hmax), bottle neck factor (BNF),aspect ratio (AR),size ratio (SR),height/width (H/W) and Hmax/width(Hmax/W) were higher than those in the unruptured group, and the average wall shear stress (WSS) and  normalized wall shear stress(NWSS) were lower than those in the unruptured group, with statistical significance (P＜0.05). There were no significant differences in the bifurcation, tumor neck width, diameter of parent vessel (DV), inflow angle, maximum wall shear stress (MWSS), average oscillatory shear index (OSI) and wall shear stress of parent artery (PTWSS) between two groups (P＞0.05). Multiple Logistic regression analysis showed that SR and bleb formation were risk factors for aneurysm rupture. ROC analysis results showed that the maximum diameter, height, Hmax and SR had high AUC values of 0.841, 0.820, 0.847 and 0.873, respectively. 
    Conclusion Ruptured intracranial mirror aneurysms are more common in aneurysms with irregular shape and bleb formation, and have larger maximum diameter, height, width, Hmax, AR, SR, H/W, Hmax/W, and smaller WSS and NWSS. SR and bleb formation are independent risk factors for the rupture of intracranial mirror aneurysms. 

    Expression and clinical significance of LncRNA-MAFG-AS1 in colorectal cancer
    HAO Ying-hao, LIN Lin
    2023, 44(2):  173-178.  doi:10.3969/j.issn.1007-3205.2023.02.010
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    Objective To investigate the expression and clinical significance of LncRNA-MAFG-AS1 in colorectal cancer (CRC). 
    Methods A total of 80 cases of CRC tissues that were surgically removed in our hospital and corresponding adjacent normal tissues were selected. The expression levels of LncRNA-MAFG-AS1 in CRC tissues and adjacent normal tissues were detected by qRT-PCR, and their relationship with the clinicopathological features of CRC was analyzed. All patients were followed up until December 31, 2019. Kaplan-Meier (K-M) method was used for survival analysis, and Cox regression model was used for risk factor analysis of the prognosis of CRC.  
    Results The relative expression of LncRNA-MAFG-AS1 in CRC tissues was 2.398±0.214, which was higher than that in adjacent normal tissues 1.032±0.132, with a statistical difference (P＜0.05). The overexpression of LncRNA-MAFG-AS1 was associated with higher TNM stage, moderate and high differentiation, and the presence of lymph node metastasis and long-term metastasis (P＜0.05). K-M survival analysis showed that the progression-free survival (PFS) was (20.36±3.21) months in patients with high expression, and (29.71±4.23) months in patients with low expression; the overall survival (OS) was (38.69±6.24) months in patients with high expression, and (54.26±5.14) months in patients with low and high expression; the difference in PFS and OS between two groups was statistically significant (P＜0.05). Cox multivariate regression analysis showed that higher TNM stage, moderate and high differentiation, presence of lymph node metastasis, long-term metastasis and high expression of LncRNA-MAFG-AS1 were independent risk factors for the prognosis of CRC. 
    Conclusion LncRNA-MAFG-AS1 is highly expressed in CRC tissue, and is related to the degree of differentiation, TNM stage, lymph node metastasis and long-term metastasis of CRC patients, which are independent risk factors affecting the prognosis of CRC patients. 

    Efficacy of 5-aminoketovaleric acid photodynamic therapy in the treatment of VLS and its effect on the expression levels of TGF-β1 and p16
    FAN Hong-he, SUN Shu-hong, WANG Xiao-wei, LIU Rui
    2023, 44(2):  179-183.  doi:10.3969/j.issn.1007-3205.2023.02.011
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    Objective To investigate the efficacy of 5-aminoketovaleric acid photodynamic therapy (5-ALA-PDT) in the treatment of vulvar lichen sclerosus (VLS) and its effect on the expression levels of transforming growth factor-β1 (TGF-β1) and p16. 
    Methods A total of 146 patients with VLS admitted to the Department of Gynecology, Chengde Maternal and Child Health Hospital in Hebei Province were selected and divided into two groups according to the random number table method: 73 cases in the observation group received 5-ALA-PDT and 73 cases in the control group received Halometasone cream. Clinical efficacy, Cattaneo scores, TGF-β1 mRNA and p16 mRNA expression in VLS tissues and recurrence rates between two groups were compared. 
    Results Compared with the control group, the observation group had a higher total effective rate (P＜0.05).Compared with the control group after treatment, pruritus, skin elasticity, skin colour, lesion extent score,TGF-β1 mRNA expression in VLS tissue was lower and p16 mRNA expression was higher in the observation group (P＜0.05). At 6-month follow-up, the recurrence rate was lower in the observation group than in the control group (P＜0.05).No serious adverse reactions were observed in either group.
    Conclusion 5-ALA-PDT is effective in the treatment of VLS, which can improve both subjective and objective symptoms, and reduce TGF-β1 mRNA, p16 mRNA expression and recurrence rate in VLS tissues. 

    Effect of percutaneous cross Kirschner wire internal fixation on children with Gartland type Ⅲ humeral supracondylar fracture
    MO Huan-peng, HU Dong-hui, DENG Miao-fang, ZHANG Ya-zhong, HE Hui
    2023, 44(2):  184-188,235.  doi:10.3969/j.issn.1007-3205.2023.02.012
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    Objective To investigate the clinical effect of percutaneous cross Kirschner wire internal fixation for children with Gartland type Ⅲ humeral supracondylar fracture. 
    Methods A total of 149 children with Gartland type Ⅲ humeral supracondylar fracture were retrospecitvely analyzed, and divided into internal fixation group (n=76) and external fixation group (n
    =73) according to different treatment regimens. The internal fixation group was treated with percutaneous cross Kirschner wire internal fixation, and the external fixation group received plaster or small splint external fixation. At 6 weeks after operation, the elbow joint range of motion (ROM) and lifting angle of the two groups were compared. They were followed up for 6 months after operation. The Flynn elbow scoring standard was used to evaluate the excellent and good rates of the two groups at 6 months after operation. The fracture healing time, incidence of cubitus varus deformity and overall incidence of poor prognosis were observed in the two groups, and the Baumann Angle was measured before operation, after plaster removal and at the last follow-up. 
    Results At 6 weeks after operation, the improvement of elbow joint ROM and lifting angle in the internal fixation group was significantly better than that in the external fixation group (P＜0.05). At 6 months after operation, the excellent and good rate of Flynn elbow score in the internal fixation group was significantly higher than that in the external fixation group (P＜0.05). Baumann Angle measured in the internal fixation group after plaster removal and at the last follow-up was obviously lower than that in the external fixation group (P＜0.05). And the fracture healing time in the internal fixation group was distinctly shorter than that of the external fixation group (P＜0.05). The incidence of cubitus varus deformity and the total incidence of poor prognosis in the internal fixation group were visibly lower than those in the external fixation group (P＜0.05). 
    Conclusion Percutaneous cross Kirschner wire internal fixation in the treatment of children with Gartland type Ⅲ humeral supracondylar fracture has a definite clinical effect, which can effectively improve the prognosis of children and is conductive to the early recovery of elbow joint function. 
    Correlation between serum CMKLR1 and FSTL1 levels and the severity of diabetic retinopathy
    WU Su-min, ZHOU Xin, WANG Li-bo
    2023, 44(2):  189-193,213.  doi:10.3969/j.issn.1007-3205.2023.02.013
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    Objective To explore the correlation between serum chemokine-like receptor 1 (CMKLR1), follistatin-like protein-1 (FSTL1) levels and the severity of diabetic retinopathy (DR). 
    Methods A total of 206 patients with type 2 diabetes (T2DM) who were admitted to our hospital were selected as the research subjects. According to the severity of DR, they were divided into diabetes without DR group (n=67), background stage DR group (n=82) and the proliferative stage DR group (n=57). Another 50 healthy volunteers who underwent physical examination in our hospital during the same period were selected as the control group. The clinical data and serum CMKLR1 and FSTL1 levels of the four groups were compared. Logistic multivariate regression analysis was used to analyze the factors affecting the occurrence of DR. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of serum CMKLR1 and FSTL1 for DR. 
    Results The course of diabetes in the background stage DR group and the proliferative stage DR group was longer than that of the diabetes without DR group (P＜0.05), and longer in the proliferative stage DR group than in the background stage DR group (P＜0.05). The levels of fasting blood glucose (FPG), 2 h postprandial blood glucose (2 hFPG), glycosylated hemoglobin (HbA1c), CMKLR1 and FSTL1 levels were compared among research subjects in the four groups, and the differences were statistically significant (P＜0.05). The levels of FPG, 2 hPG, HbA1c, CMKLR1 and FSTL1 in the diabetes without DR group, background stage DR group and proliferative stage DR group were higher than those in the control group (P＜0.05). The levels of FPG, HbA1c, CMKLR1 and FSTL1 in the background stage DR group and the proliferative stage DR group were higher than those in the diabetes without DR group (P＜0.05), and higher in the proliferative stage DR group than in the background stage DR group (P＜0.05). The duration of diabetes, the proportion of combined DR, the proportion of combined macrovascular disease, urine microalbumin, HbA1c, C-reactive protein, tumor necrosis factor-α (TNF-α), CMKLR1 and FSTL1 in the DR group were higher than those in the non-DR group (P＜0.05). Logistic regression analysis showed that the course of diabetes, combined DR, serum CMKLR1 and FSTL1 levels were all risk factors for DR in diabetic patients (OR=3.330, 2.746, 2.762, 2.724, P＜0.05).ROC analysis showed that the optimal cut-off points of serum CMKLR1 and FSTL1 for diagnosing DR in diabetic patients were 49.39 μg/L and 11.64 μg/L respectively. The specificity and area under the ROC curve (AUC) of the combination of serum CMKLR1 and FSTL1 were 97.01% and 0.903 respectively, which were higher than those of the serum CMKLR1 and FSTL1 levels evaluated alone. 
    Conclusion There is a certain correlation between the serum CMKLR1 and FSTL1 levels and the severity of DR, and the serum CMKLR1 and FSTL1 levels have high diagnostic efficiency for the occurrence of DR in diabetic patients, and can be used as important reference indicators for clinical evaluation of the occurrence of DR. 

    Relationship between IVUS-VH plaque characteristics and CTRP9, SAA and Hcy in cardiovascular diseases
    HU Zhi-shuang, WANG Jian-mei, ZHAO Yan-liang
    2023, 44(2):  194-198.  doi:10.3969/j.issn.1007-3205.2023.02.014
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    Objective To investigate the relationship between plaque characteristics of intravascular ultrasound virtual histology (IVUS-VH) and serum adipocytokine C1q/tumor necrosis factor associated protein 9 (CTRP9), serum amyloid A (SAA) and homocysteine (Hcy) in patients with coronary heart disease (CHD). 
    Methods A total of 120 patients with CHD treated in our hospital were selected, including 65 patients with acute coronary syndrome (ACS group) and 55 patients with stable angina pectoris (SAP group). Another 50 volunteers were selected as control group, the levels of serum CTRP9, SAA and Hcy in ACS and SAP group were detected, and IVUS-VH was performed in the meantime in both ACS group and SAP group. 
    Results The serum CTRP9 in the ACS group was (3.02±0.45)×10-2mg/L, which was significantly lower than that in the SAP group, with statistical significance (P＜0.05), while the levels of SAA and Hcy were (4.45±1.01) mg/L and (24.42±3.36) μmol/L, which were significantly higher than those in the SAP group (P＜0.05). The serum levels of CTRP9, SAA and Hcy in the control group were significantly lower than those in the ACS group and the SAP group (P＜0.05). The IVUS-VH parameter necrotic tissue area and the incidence of thin cap of fibroatheroma (TCFA) in the ACS group were (32.20±7.78)% and 49.23%, respectively, which were significantly higher than those in the SAP group, with statistical significance (P＜0.05). The tissue area was (44.65±11.02)%, which was significantly lower than that of the SAP group (P＜0.05). Necrotic tissue area was negatively correlated with CTRP9 (P＜0.05), but positively correlated with SAA and Hcy (P＜0.05); fibrous tissue area was negatively correlated with SAA (P＜0.05). The serum CTRP9 of TCFA patients was (2.89±0.58)×10-2mg/L, which was significantly lower than that of the non-TCFA group (P＜0.05), while the levels of SAA and Hcy were (4.89±1.12) mg/L and (26.62±3.12) μmol/L, respectively significantly higher than those in the non-TCFA group (P＜0.05).The areas under ROC curve of CTRP9, SAA and Hcy in predicting TCFA were 0.712, 0.815 and 0.844, respectively (P＜0.05). 
    Conclusion There are significant differences in serum CTRP9, SAA and Hcy between ACS patients and SAP patients, which are correlated with IVUS-VH parameters, and worthy of further study.

    Diagnostic value of MSCT combined with DCE-MRI in osteosarcoma
    JI Si-xuan, WU Di,
    2023, 44(2):  199-202,223.  doi:10.3969/j.issn.1007-3205.2023.02.015
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    Objective To investigate the diagnostic value of multi-slice spiral CT (MSCT) combined with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in osteosarcoma. 

    Methods A total of 200 patients with suspected osteosarcoma admitted to our hospital were retrospectively analyzed. All patients were examined by MSCT and DCE-MRI, and the clinical diagnosis and pathological examination results were taken as the gold standard. The imaging findings of the two examinations were analyzed, and the examination results, diagnostic value and pathological features of osteosarcoma of MSCT and DCE-MRI alone and in combination were compared. 
    Results MSCT scan showed irregular destruction of cortical bone, relatively clear boundary, infiltration in bone marrow, and uneven density of surrounding soft tissue mass. There could be high density of tumor bone in the bone, and the tumor bone could be seen at the articular cartilage surface, protruding into the articular cartilage surface to form an intra-articular mass. DCE-MRI showed bone destruction, periosteal hyperplasia, cortical bone thinning, interruption or absence, and the destruction area that was occupied by soft tissue mass invading the muscle, presenting as medium to high mixed signal mass. When invading the epiphyseal plate and joint, it was clearly shown. The invasion of tumor in bone marrow showed a clear boundary with the normal bone marrow and a tendency to jump and spread. Ktrans was 0.967 min-1, and Kep was 3.548 min-1. The consistency between the results of MSCT combined with DCE-MRI and pathological examination (kappa=0.755) was significantly higher than that of MSCT (kappa=0.416) and DCE-MRI (kappa=0.439) (P＜0.05). The negative predictive value, positive predictive value, sensitivity, specificity and accuracy of MSCT combined with DCE-MRI were higher than those of single detection (P＜0.05). The accuracy of MSCT combined with DCE-MRI in the pathological features of osteosarcoma was higher than that of single detection (P＜0.05). 
    Conclusion The negative predictive value, positive predictive value, sensitivity, specificity and accuracy of MSCT combined with DCE-MRI are higher than those of single detection, which has high diagnostic value for osteosarcoma.

    Evaluation of imaging features and predictive value of penetrating and pernicious placenta previa based on MRI and color Doppler ultrasonography
    QIN Cong-ying, LIU Li-juan, CAO Shu-xin, LI Juan
    2023, 44(2):  203-207,240.  doi:10.3969/j.issn.1007-3205.2023.02.016
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    Objective To investigate the imaging features and predictive value of penetrating and pernicious placenta previa (PPP) based on magnetic resonance imaging (MRI) and color Doppler ultrasonography (CDUS). 
    Methods In total, 70 pregnant and parturient women with PPP who were admitted to our hospital were selected as the research subjects, and all of them underwent MRI and CDUS examination. The diagnostic value of MRI and CDUS alone and in combination for PPP was analyzed.The characteristics of MRI and CDUS in non-penetrating PPP and penetrating PPP in pregnant and parturient women were compared, and the prognostic factors of penetrating PPP in pregnant and parturient women were analyzed.Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of MRI and CDUS scores for the prognosis of pregnant and parturient women with penetrating PPP. 
    Results Among the 70 PPP patients, 52 had non-penetrating PPP and 18 had penetrating PPP. The diagnostic accuracy of MRI combined with CDUS was higher than that of single detection, but data comparison showed no statistical significance (P＞0.05). Compared with pregnant and parturient women with non-penetrating PPP, those with penetrating PPP had higher hysterectomy rate and more severe asphyxia in neonates (P＜0.05). Compared with the good prognosis group, the poor prognosis group had more cesarean sections, shorter delivery cycle, longer duration of operation, more intraoperative blood loss, and higher MRI and color Doppler scores (P＜0.05). Intraoperative blood loss, MRI score, and CDUS score were independent risk factors for poor prognosis of pregnant women with penetrating PPP (P＜0.05).The area under the ROC curve (AUC)of intraoperative bleeding, MRI score, and CDUS score were 0.806, 0.854, and 0.806, respectively, and the differences were statistically significant when compared with the AUC of combined detection (P＜0.05). 
    Conclusion MRI and CDUS have high diagnostic value for penetrating PPP, and have certain predictive value for the prognosis of pregnant and parturient women and neonates. 

    Correlation between skeletal muscle thickness of the extremities measured by ultrasound and MRC score in elderly ICU-AW patients and analysis of ROC curve for prognosis
    ZHAO Kun, TONG Fei, LI Xuan, CHEN Hui, ZHANG Man-li, WANG Yi
    2023, 44(2):  208-213.  doi:10.3969/j.issn.1007-3205.2023.02.017
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    Objective To investigate the correlation between the skeletal muscle thickness of the extremities and the British Medical Research Council (MRC) scale scores in elderly patients with ICU-acquired myasthenia (ICU-AW) and to draw the receiver operating characteristic (ROC) curve to evaluateits predictive value for prognosis. 
    Methods A total of 60 elderly ICU-AW patients in our hospital were selected as the research group, and 60 elderly ICU patients without ICU-AW who received mechanical ventilation during the same period were selected as the control group. The skeletal muscle thickness of the extremities measured by ultrasound, and MRC score were compared between two groups, and their correlation was analyzed. Clinical data, skeletal muscle thickness of the extremities, and MRC score of patients with different prognosis were compared, and the relationship between skeletal muscle thickness, MRC score and the prognosis of elderly ICU-AW patients as well as their value in predicting prognosis was analyzed.  
    Results The thickness and MRC score of the biceps brachii, flexor carpi radialis, quadriceps femoris, and tibialis anterior in the research group were lower than those in the control group (P＜0.05). The thickness ofthe biceps brachii, flexor carpi radialis, quadriceps femoris, and tibialis anterior was positively correlated with the MRC score (P＜0.05). The number of days of mechanical ventilation at 28 d in the deceased was higher than that of surviving patients, while the thickness of the biceps brachii, flexor carpi radialis, quadriceps femoris, and tibialis anterior and MRC score were lower than those of surviving patients (P＜0.05). The thickness of the biceps brachii, flexor carpi radialis, quadriceps femoris, and tibialis anterior and MRC scores were all prognostic protective factors for elderly ICU-AW patients (P＜0.05). The area under the curve (AUC) of MRC scores, the biceps brachii, flexor carpi radialis, quadriceps femoris, and tibialis anterior in predicting the prognosis of elderly ICU-AW patients was 0.805, 0.837, 0.648, 0.785, and 0.799, respectively. The AUC of combined prediction of each index was the largest (0.873). 
    Conclusion There is a positive correlation between the skeletal muscle thickness of the extremities and MRC score in elderly ICU-AW patients. The combination of skeletal muscle thickness of the extremities and MRC score has certain value in predicting the prognosis of patients. 

    Analysis of abnormalities of low QRS voltage in electrocardiogram of patients with mental disorders and its influencing factors
    ZHOU Cui-ping, HONG Xia
    2023, 44(2):  214-217,229.  doi:10.3969/j.issn.1007-3205.2023.02.018
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    Objective To investigate the abnormalities of low QRS voltage (LQRSV)inelectrocardiogram (ECG) in patients with mental disorders and the influencing factors. 
    Methods In total, 300 patients with mental disorders were selected as the research subjects, and their general data and abnormalities of LQRSV in ECG were collected to analyze the influencing factors of LQRSV abnormalities in ECG in patients with mental disorders. 
    Results Of 300 patients with mental disorders, there were 120 cases (40.00%) of abnormal QRS voltage in ECG, including 65 cases (54.17%) of LQRSV in limb leads, 45 cases (37.50%) of LQRSV in chest leads, and 10 cases (8.33%) of LQRSV infull leads.All 120 patients with LQRSV abnormalities in ECG were accompanied by different abnormal ECG changes, such as sinus tachycardia, sinus arrhythmia, sinus bradycardia, preterm contraction, incomplete right bundle branch block, T-wave changes, ST-segment changes, Q-T interval prolongation, and left ventricular hypervoltage, which could be single or multiple manifestations. Duration of illness, age, duration of medication, dose index, and antipsychotics were all influencing factors for abnormal LQRSV in ECG in patients with mental disorders (P＜0.05). 
    Conclusion Abnormal LQRSV in ECG in patients with mental disorders is as high as 40.00%, and age, duration of illness, duration of medication, dose index, and antipsychotics are the influencing factors of abnormal LQRSV in ECG in patients with mental disorders.

    Clinicopathological characteristics and prognosis of large-duct subtype and small-duct subtype intrahepatic cholangiocarcinoma
    YAO Ping, RUAN Ping, LIU Ying, ZHENG Ling, LIN Guo-biao
    2023, 44(2):  218-223.  doi:10.3969/j.issn.1007-3205.2023.02.019
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    Objective To analyze the clinicopathological features and prognostic factors of large duct type and small duct type intrahepatic cholangiocarcinoma (ICCA). 
    Methods The clinical data of 91 patients with ICCA were analyzed retrospectively, and the pathological features of large duct type ICCA and small duct type ICCA were compared. Kaplan-Meier survival analysis was used to analyze the recurrence-free survival (RFS) curve and overall survival (OS) curve, and Log-rank method was used to compare the survival rate between groups. Cox proportional hazard model was used to analyze the prognostic factors of patients with large duct type ICCA.
    Results Among the 91 patients with ICCA, there were 52 cases with large duct type, 32 cases with small duct type and 7 cases with undetermined type. Compared with the small duct type, patients with large duct type had the characteristics of lymph node metastasis, vascular invasion, high level of serum CA199, high TNM stage and history of hepatolithiasis (P＜0.05). The 1-, 3-and 5-year OS rates in patients with large duct type were significantly lower than those of small duct type (P＜0.05). There was no significant difference in 1-, 3-and 5-year RFS rates between large duct type and small duct type ICCA (P＞0.05). Multivariate survival analysis showed that lymph node metastasis and TNM stage were poor prognostic factors for OS of large duct type ICCA, while vascular invasion and TNM staging were poor prognostic factors for RFS. 
    Conclusion There are certain differences in clinicopathological features between large duct type and small duct type ICCA. Patients with large duct type have worse prognosis than those with small duct type. In addition, lymph node metastasis, vascular invasion and TNM stage are factors affecting the OS and RFS.

    Clinical significance of digital PCR in detecting EGFR mutation in circulating tumor DNA of lung adenocarcinoma
    TANG Tao, CHEN Xi, CHEN Tong-bing , WANG Hui
    2023, 44(2):  224-229.  doi:10.3969/j.issn.1007-3205.2023.02.020
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    Objective To investigate the clinical significance of droplet digital polymerase chain reaction (ddPCR) in detecting epidermal growth factor receptor (EGFR) mutation in circulating tumor DNA (ctDNA) of lung adenocarcinoma. 
    Methods The ddPCR was used to analyze EGFR mutation (EGFR-L858R and EGFR-19Del mutations) in plasma ctDNA in 102 patients with lung adenocarcinoma. The relationship between ctDNA and clinical parameters was analyzed. The ROS curves were drawn to evaluate the predictive effect of ctDNA on prognosis and metastasis of patients. 
    Results The area under the ROC curve of ddPCR in detecting EGFR mutation in ctRNA for evaluation of EGFR mutation was 0.964, and the sensitivity and specificity were 40.2% and 88.6% respectively. Compared with early-stage lung adenocarcinoma, advanced-stage lung adenocarcinoma had higher AUC (0.837 vs. 0.498) and sensitivity (75.2% vs. 10.2%). Tumor metastasis and fractional abundance of ctDNA showed a strong correlation (r=0.51, P＜0.001). There was a significantly shorter progression-free survival (PFS) and overall survival (OS) in the ctDNA-positive group than in the ctDNA-negative group (13.8 months vs. 42.2 months, P＜0.05, 34.4 months vs. 66.8 months, P＜0.05). PFS of ctDNA-positive group treated with human epidermal growth factor receptor tyrosine kinase inhibitor was shorter than that of ctDNA-negative group (12.0 months vs. 24.0 months, P＜0.05). In addition, OS was shorter in ctDNA-positive patients than in ctDNA-negative patients (34.4 months vs. 66.8 months, P＜0.05). 
    Conclusion DdPCR can be used to detect EGFR mutation in ctDNA of patients with advanced lung adenocarcinoma. EGFR mutation-positive lung adenocarcinoma in ctDNA indicates that patients may have distant metastasis and poor prognosis.

    Clinical observation on butorphanol combined with flurbiprofen axetil in the prevention of tourniquet-induced ischemia-reperfusion injury of the limbs
    LI Hai-ying, ZHANG Yu-ping, DENG Xiu-li
    2023, 44(2):  230-235.  doi:10.3969/j.issn.1007-3205.2023.02.021
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    Objective To investigate the effect of butorphanol combined with flurbiprofen axetil in preventing tourniquet-induced ischemia-reperfusion injury (IRI)of the limbs. 
    Methods A total of 120 patients undergoing unilateral artificial knee athroplasty inthe Second Hospital of Zhangjiakou City, Hebei Province, were randomly divided into four groups: control group, butorphanol group, flurbiprofen axetil group and the combination group, with 30 patients in each group. Heart rate (HR) and mean arterial pressure (MAP）, arterial oxygen saturation (SpO2), malondialdehyde (MDA), superoxide dismutase (SOD), tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), interleukin-6 (IL-6), increase rate of gastrocnemius muscle circumference of affected limb, knee joint circumference and quadriceps muscle circumference at 5 min before anesthesia (T0), at 5 min before tightening the tourniquet (T1), at 5 min before tourniquet loosening (T2), and at 30 min after tourniquet loosening (T3), and visual analogue scale (VAS) score before operation, and at 12 h, 24 h, and 72 h after operation were compared between two group. 
    Results The difference of interaction between groups, time points and time points between groups was statistically significant with respect to HR, MAP and SpO2(P>0.05). In the control group, butorphanol group and flurbiprofen axetil group, MDA at T1, T2 and T3 was higher than that at T0, while SOD was lower than that at T0 (P＜0.05). MDA at T1, T2, and T3 in the combination group were lower than those in the butorphanol group, flurbiprofen axetil group and control group, and the SOD was higher than that in the butorphanol group, flurbiprofen axetil group and control group (P＜0.05). TNF-α, IL-8, IL-6 at T1, T2, and T3 in the control group, butorphanol group, and flurbiprofen axetil group were higher than those at T0 (P＜0.05). TNF-α, IL-8 and IL-6 at T1, T2, and T3 in the combination group were lower than those in the butorphanol group, flurbiprofen axetil group and control group (P＜0.05). The increase rate of gastrocnemius muscle circumference of the affected limb, knee joint circumference and quadriceps muscle circumference in the combination group were lower than those of but orphanol group, flurbiprofen axetil group and control group (P＜0.05). The pain VAS score at 12 h, 24 h, and 72 h in the combination group was lower than that in the butorphanol group, flurbiprofen axetil group and control group (P＜0.05). 
    Conclusion Butorphanol combined with flurbiprofen axetil can reduce the inflammatory response and oxidative stress caused by tourniquet induced IRI, prevent limb IRI, relieve the swelling degree of the calf, and reduce the pain of patients, which is conducive to postoperative recovery. 

    Effects of different approaches of quadratus lumborum block on postoperative analgesia in patients undergoing laparoscopic radical rectal cancer surgery
    TAO Xiu-ting, GU Shi-xian, ZHOU Da-lei, ZHOU Yuan
    2023, 44(2):  236-240.  doi:10.3969/j.issn.1007-3205.2023.02.022
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    Objective To compare the analgesic effects of different approaches of quadratus lumbar muscle block (QLB) on patients undergoing laparoscopic radical resection of rectal cancer. 
    Methods A total of 128 patients with rectal cancer who received laparoscopic radical resection of rectal cancer in our hospital were selected and divided into anterior approach group (injection of fascia plane between QLB psoas muscle and psoas major muscle, n=32), lateral approach group (external injection of QLB, n=32), posterior approach group (posterior injection of QLB, n=32) and control group ［routine patient-controlled intravenous analgesia (PCIA), n=32］. The first compression time of PCIA, the time of first exhaust and the first time of off-bed activity were compared among the four groups. The visual analog scale (VAS)  scores were compared in the four groups at different time points after operation. The effective number of PCIA compression and the total amount of sufentanil within 24 h after surgery were compared among the four groups. The adverse reactions of the four groups were compared. 
    Results The first compression time of PCIA in the anterior approach, lateral approach, and posterior approach groups was longer than that of the control group (P＜0.05), and the first exhaust time and the first time of off-bed activity were shorter than those of the control group (P＜0.05). The differences in VAS scores in interaction between groups, time points and time points between groups were statistically significant (P＜0.05). The effective number of PCIA compression and the total amount of sufentanil within 24 h after surgery in the anterior approach, lateral approach and posterior approach groups were lower than those in the control group (P＜0.05), and lower in the anterior approach group than in the lateral approach group and the posterior approach group (P＜0.05). The total incidence of adverse reactions in the anterior approach, lateral approach and posterior approach groups was lower than that in the control group (P＜0.05). 
    Conclusion Different approaches of QLB guided by ultrasound can promote postoperative recovery of patients, improve the analgesic effect of patients after laparoscopicradical resection of rectal cancer, and reduce the dosage of opioids and the incidence of adverse reactions. However, QLB via anterior approach is superior to that via lateral approach and posterior approach in terms of analgesia and reduction of the amount of postoperative analgesics.