Table of Content

25 March 2023, Volume 44 Issue 3

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Study on the mechanism of miR-124-3p.2 regulating apoptosis and ferroptosis of oral squamous cell carcinoma cells by CMTM6

DU Shan-shan, YE Shuang, XIE Long-chuan, XIA Ling-yun

2023, 44(3):  252-258,278.  doi:10.3969/j.issn.1007-3205.2023.03.002

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Objective To observe regulatory mechanism of miR-124-3p. 2 in apoptosis and ferroptosis of oral squamous cell carcinoma cells, and to explore the potential mechanism. 
Methods Real-time fluorescence quantitative reverse transcription polymerase chain reaction (RT-qPCR) was used to detect the expression of miR-124-3p.2 and CKLF like MARVEL transmembrane domain gene 6 (CMTM6) in human normal oral epithelial cells NHOK, and oral squamous cell carcinoma cell lines Cal27, SCC-25, HSC-3, and Tca81132, and Cal27 were used to screen the optimal cells. NC group (without any treatment), miR-con group (transfected miR-con), miR-124-3p.2 group (transfected miR-124-3p.2 mimics), si-con group (transfected si-con), si-CMTM6 group (transfected si-CMTM6), miR-124-3p.2+pcDNA group (co-transfected miR-124-3p.2 mimics and pcDNA), and miR-124-3p.2+pcDNA-CMTM6 group (co-transfected miR-124-3p.2 mimics and pcDNA-CMTM6) were transfected into Cal27 by liposome method. Cell proliferation was detected by cell counting kit (CCK8). The protein expressions of CMTM6, recombinant solute carrier family 7, member 11 (SLC7A11), glutathione peroxidase (GPX4) and ferritin, heavy polypeptide 1(FTH1) were detected by Western blot (WB). The content of reactive oxygen species (ROS) was detected by immunofluorescence, and apoptosis was detected by flow cytometry. Double luciferase assay was used to detect the fluorescence activity of cells. 
Results Compared with NHOK, the expression of miR-124-3p.2 in Cal27, SCC-25 and HSC-3 cells was decreased, while the expression of CMTM6 was increased (P＜0.05). The difference of interaction between groups, time points and time points between groups was statistically significant with respect to cell activity in miR-con group and miR-124-3p.2 group (P＜0.05). Compared with the miR-con group, the ROS of cells in the miR-124-3p.2 group, the protein expression of SLC7A11, GPX4 and FTH1, and the apoptosis rate were significantly increased (P＜0.05). The fluorescence activity of CMTM6-WT cells in the miR-124-3p.2 group was significantly decreased, while the fluorescence activity of CMTM6-WT cells in the anti-miR-124-3p.2 group was significantly increased (P＜0.05). The difference of interaction between groups, time points and time points between groups was statistically significant with respect to cell activity in si-con group and si-CMTM6 group (P＜0.05). The difference of interaction between groups, time points and time points between groups was statistically significant with respect to cell activity in miR-124-3p.2+pcDNA group and miR-124-3p.2+pcDNA-CMTM6 group (P＜0.05). 
Conclusion miR-124-3p. 2 promotes apoptosis and ferroptosis of OSCC cells, which may be related to targeting CMTM6.





Comparative study of morphologic changes of vertebrobasilar artery in anterior and posterior circulation infarction

LI Jia-min, FENG Jun-qi, ZHANG Zi-han

2023, 44(3):  259-263.  doi:10.3969/j.issn.1007-3205.2023.03.003

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Objective To study the unique correlation between vertebrobasilar artery dominance (VAD), basilar artery dolichoectasia (BADE) and posterior circulation infarction, and to explore various imaging indicators of morphological changes of vertebrobasilar artery system to distinguish patients with new posterior circulation infarction(PCI) and anterior circulation infarction (ACI). 
Methods Fifty patients with new PCI were selected as the research group, and 50 inpatients with new ACI during the same period were selected as the control group. The related indexes of VAD and BADE in the two groups were retrospectively analyzed, risk factors related to PCI were screened, and the screened indexes were inserted into ROC curve to identify the optimal cut-off value to distinguish the patients with new ACI and PCI. 
Results There was a significant difference between PCI group and ACI group in the basic artery length (BAL), the proportion of patients with VAD or basal curvature (P＜0.05). Logistic analysis showed that grade 2 and grade 3 of the diameter difference (D value) of bilateral vertebral artery were independent risk factors for PCI (P＜0.05). The ROC curve showed that the D value could distinguish the new ACI and PCI, with the optimal cutoff value of 0.41 mm, AUC of 0.753, specificity of 0.78, and sensitivity of 0.66. 
Conclusion VAD increases the risk of PCI, and the risk is greatly increased when D value is above level 2. Patients with cerebral infarction when his D value is greater than 0.41 mm are more likely to experience PCI. 





Expression and significance of G-17, SOX-2 and HSP70 in Hp-infected gastritis

DU Bing-jie, SU Wei-xian, LIU Qian, GAO Zhen-wei, HE Di, ZHAO Jun-jing

2023, 44(3):  264-267,273.  doi:10.3969/j.issn.1007-3205.2023.03.004

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Objective To investigate the expression and significance of gastrin-17 (G-17), sex-determining region Y box protein-2 (SOX-2), and heat shock protein 70 (HSP70) in Helicobacter pylori (Hp)-infected gastritis. 
Methods Ninety patients with chronic gastritis were selected and divided into Hp-positive group (n=45) and Hp-negative group (n=45) according to whether they were combined with Hp infection. The general data, G-17 and HSP70 levels and SOX-2 and HSP70 expressions of the two groups were compared. The correlation between G-17, SOX-2 and HSP70 in Hp-positive patients with various indexes was analyzed. Multivariate logistic regression analysis was performed to analyze risk factors for Hp-infected gastritis. 
Results The proportion of shared meals and clinical symptom scores in the Hp-positive group were higher than those in the Hp-negative group, and the levels of pepsinogen Ⅰ (PG-Ⅰ) and pepsinogen Ⅱ (PG-Ⅱ) were lower than those in the Hp-negative group (P＜0.05). The G-17 level in the Hp-positive group was lower than that in the Hp-negative group, while the expression  level of HSP70, SOX-2 positive and HSP70 positive expression were higher than those in the Hp-negative group (P＜0.05). In Hp-positive patients, G-17 was positively correlated with PG-Ⅰ and PG-Ⅱ and negatively correlated with clinical symptom scores, while SOX-2 and HSP70 were negatively correlated with PG-Ⅰ and PG-Ⅱ and positively correlated with clinical symptom scores (P＜0.05). The results of logistic regression analysis showed that dietary style, PG-Ⅱ, G-17, SOX-2 and HSP70 were risk factors affecting patients with Hp-infected gastritis (P＜0.05). 
Conclusion G-17 is low in patients with Hp-infected gastritis, while positive expression of SOX-2 and HSP70 is higher, and dietary style, PG-Ⅱ, G-17, SOX-2 and HSP70 are risk factors affecting patients with Hp-infected gastritis. 





Analysis of influencing factors related to the occurrence of cognitive dysfunction in patients with acute organophosphorus pesticide poisoning

CHANG Xiao-wei, WANG Yong-xing, ZHAO Pan-pan

2023, 44(3):  268-273.  doi:10.3969/j.issn.1007-3205.2023.03.005

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Objective To investigate the influencing factors associated with the occurrence of cognitive dysfunction in patients with acute organophosphorus pesticide poisoning (AOPP). 
Methods One hundred and fifty-six patients with AOPP were selected and divided into the observation group (n=60) and the control group (n=96) according to occurrence of cognitive dysfunction. Clinical data such as duration from poisoning to hospital admission, degree of poisoning, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, and recovery time of cholinesterase (CHE) were collected from the two groups to analyze the factors influencing the occurrence of cognitive dysfunction and to construct a prediction model. 
Results There were statistically significant differences in age, poisoning dose, degree of poisoning, CHE recovery time, APACHEⅡ score, and length of hospitalization between observation group and control group (P＜0.05).Logistic regression analysis showed that age, degree of poisoning, recovery time of CHE, APACHEⅡ score, and length of hospitalization were independent risk factors for the development of cognitive dysfunction in AOPP patients (P＜0.05). A logistic regression risk prediction model for the occurrence of cognitive dysfunction in AOPP patients was constructed: -4.782 + age × 2.507 + degree of poisoning × 2.778 + CHE recovery time × 2.646 + APACHEⅡ score × 2.905 + length of hospitalization ×2.320, with a good model fit (P＜0.05).The area under the curve of the model in predicting the occurrence of cognitive dysfunction in AOPP patients was 0.931, with a sensitivity of 83.33% and a specificity of 86.46%. 
Conclusion AOPP patients are prone to cognitive dysfunction, which is mainly influenced by age, degree of poisoning, CHE recovery time, APACHEⅡ score, and length of hospitalization. It is of high value to establish a logistic regression prediction model to predict the occurrence of cognitive dysfunction based on the above factors, and clinical attention should be paid to CHE recovery time and APACHEⅡ score, which is helpful to guide the follow-up treatment and improve the prognosis. 





Prediction of preoperative vertebral compression degree combined with bone mineral density in re-loss of vertebral body height after pedicle screw internal fixation for thoracolumbar fractures

ZHANG Lin, CHEN Xiao-gang, JI Mu-fan, DING Jing, LIU Qing-bai

2023, 44(3):  274-278.  doi:10.3969/j.issn.1007-3205.2023.03.006

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Objective To investigate the predictive value of preoperative vertebral compression degree combined with bone mineral density in the re-loss of vertebral body height after pedicle screw internal fixation for thoracolumbar fractures. 
Methods To investigate the predictive value of preoperative vertebral compression degree combined with bone mineral density in the re-loss of vertebral body height after pedicle screw internal fixation for thoracolumbar fractures. 
Results By the end of follow-up, the incidence of vertebral body height re-loss was 36.05%. The loss group had higher intraoperative screw insertion, early postoperative weight-bearing ratio, and preoperative vertebral body compression than the non-loss group (P＜0.05), and preoperative bone mineral density was lower than that of the non-loss group (P＜0.05). Logistic regression analysis showed that multiple intraoperative screw insertions (OR=2.869, 95%CI: 1.045-4.183), early postoperative weight-bearing (OR=2.956, 95%CI: 1.632-5.279), preoperative vertebral compression degree (OR=3.615, 95%CI: 2.873-9.418) and preoperative bone mineral density (OR=3.284, 95%CI: 2.084-7.436) were risk factors affecting the re-loss of vertebral body height after pedicle screw internal fixation for thoracolumbar fractures (P＜0.05). The results of ROC curve analysis showed that the preoperative vertebral compression degree, bone mineral density, and their combination for predicting the re-loss of vertebral body height after pedicle screw internal fixation had the sensitivity of 70.97% (95%CI: 51.76%-85.11%), 74.19% (95%CI: 55.07%-87.46%), and 70.97% (95%CI: 51.76%-85.11%) ,respectively, the specificity of 76.36% (95%CI: 62.67%-86.35%), 72.73% (95%CI: 58.81%-83.46%), and 93.36% (95%CI: 86.39%-99.37%), respectively, and AUC of 0.706 (95%CI: 0.598-0.801), 0.757 (95%CI: 0.653-0.841), and 0.883 (95%CI: 0.793-0.945), respectively. 
Conclusion The combination of preoperative vertebral compression degree and bone mineral density has a higher predictive value for re-loss of vertebral body height after thoracolumbar fractures.





The effect of 3D printing-assisted surgery on postoperative functional recovery and bone metabolism index levels in patients with tibial Pilon fracture

ZHANG Hong-jian, ZAHNG Yao-hua, LIU Xiao-lei

2023, 44(3):  279-283,289.  doi:10.3969/j.issn.1007-3205.2023.03.007

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Objective To observe the effect of 3D printing-assisted surgery on postoperative functional recovery and bone metabolism index levels of patients with tibial Pilon fracture. 
Methods In total, 87 patients with tibial Pilon fracture in our hospital were selected and divided into 3D printing group (n=43) and conventional group (n=44) according to different treatment plans. The conventional group underwent traditional open reduction and internal fixation with steel plate, and the 3D printing group underwent 3D printing-assisted open reduction and internal fixation with steel plate. The surgical conditions, surgical satisfaction, serum bone metabolism indexes ［bone alkaline phosphatase (BALP), osteocalcin (BGP), tartrate resistant acid phosphatase-5b (TRACP-5b), β isomer of C-terminal telopeptide of type Ⅰ collagen (β-CTX)］ level before operation, at 1 week and 1 month after operation, as well as ankle function score (Olerud-Molander) and visual analogue scale (VAS) for pain before operation, at 6 months and 1 year after operation of the two groups were compared. 
Results The duration of operation and fracture healing time of the 3D printing group were shorter than those of the conventional group, and the number of fluoroscopy and intraoperative blood loss were less than those of the conventional group, suggesting significant differences (P＜0.05). The levels of serum BALP and BGP in the two groups at 1 week and 1 month after the operation were higher than those before the operation, which were higher in the 3D printing group than in the conventional group; The levels of TRACP-5b and β-CTX were lower than those before operation, which were lower in the 3D printing group than in the conventional group, suggesting significant differences (P＜0.05). The Olerud-Molander scores in the two groups at 6 months and 1 year after the operation were higher than those before the operation, which were higher in the 3D printing group than in the conventional group, while the VAS score was lower than that before the operation, which was lower in the 3D printing group than in the conventional group, suggesting significant differences (P＜0.05). The surgical satisfaction of patients in the 3D printing group was higher than that in the conventional group, suggesting significant differences (P＜0.05). 
Conclusion 3D printing-assisted surgical treatment of tibial Pilon fracture has little effect on bone metabolism, which helps to promote postoperative functional recovery and improve patient satisfaction.





Effect of dynamic arthrodesis combined with shockwave on the improvement of blood rheology, cervical physiological curvature and function in patients with cervical spondylosis

LI Tai-hang, YANG Ji-wen, QIN Chun, SUN Xian-ze

2023, 44(3):  284-289.  doi:10.3969/j.issn.1007-3205.2023.03.008

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Objective To investigate the application of dynamic arthrodesis combined with shock waves in patients with cervical spondylosis and their effects on the improvement of blood rheology, cervical physiological curvature and function. 
Methods A total of 100 patients with cervical spondylosis were selected and randomly divided into two groups, with 50 patients in each group. The control group was treated with dynamic arthrodesis and the observation group was treated with dynamic arthrodesis combined with shock wave. The clinical efficacy, the 20-point scale of cervical spondylosis symptoms and the clinical assessment scale for cervical spondylosis (CASCS), the pain rating index (PRI) score, the cervical physiological curvature, and neck disability index (NDI) score, blood rheology (whole blood high-cut viscosity, whole blood low-cut viscosity, erythrocyte volume), Japanese Orthopaedic Association (JOA) scores and Activity of Daily Living (ADL) scale before and after treatment were observed in the two groups. 
Results The total clinical efficacy of the observation group was 92.00%, significantly higher than that (78.00%) of the control group (P＜0.05); The 20-point scale score of cervical spine symptoms and CASCS score were higher in the observation group than in the control group at the end of the treatment course and at 3 months of follow-up (P＜0.05). The PRI index (sensory score, emotional score and total score) was lower in the observation group than in the control group at the end of the treatment course and at 3 months of follow-up (P＜0.05). The cervical physiological curvature was significantly better in the observation group than in the control group at the end of the treatment course and at 3 months of follow-up, and the NDI score was lower than that of the control group (P＜0.05). The whole blood high-cut and low-cut viscosity and erythrocyte volume were lower in the observation group than in the control group at the end of the treatment course and at 3 months of follow-up (P＜0.05); The JOA and ADL scores were higher in the observation group than in the control group at the end of the treatment course and at 3 months of follow-up (P＜0.05). 
Conclusion Dynamic arthrodesis combined with shock wave therapy for cervical spondylosis is effective in regulating patients′ blood rheology, reducing cervical spondylosis symptoms, improving cervical and lumbar spine functions, and enhancing ADL. 





The relationship between sCD14, Ang2, CRP and the prognosis of emergency traumatic fracture patients with multiple injuries

GENG Xin, YAO Li-Jun, WEI Li-You, LI Chun-jiang, WU Chun-yun, ZHANG Yan

2023, 44(3):  290-294,318.  doi:10.3969/j.issn.1007-3205.2023.03.009

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Objective To investigate the relationship of soluble cluster of differentiation antigen 14 (sCD14), angiopoietin 2 (Ang2), and C-reactive protein (CRP) with the prognosis of emergency traumatic fracture patients with multiple injuries and their significance. 
Methods A total of 324 patients with traumatic fractures and multiple injuries were selected and divided into the good outcome group (n=275) and the poor outcome group (n=49) according to their disease outcomes at the time of discharge. The general data and the levels of sCD14, Ang2, and CRP were compared between two groups. The relationship between sCD14, Ang2, and CRP and the injury severity score (ISS) was analyzed by Pearson analysis. Cox regression analysis was used to analyze the relevant factors affecting the prognosis of patients with emergency traumatic fracture and multiple injuries. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of sCD14, Ang2 and CRP for disease outcome. 
Results The ISS score of the poor outcome group was higher than that of the good outcome group (P＜0.05). The sCD14, Ang2 and CRP in the poor outcome group were higher than those in the good outcome group (P＜0.05). sCD14 (r=0.785), Ang2 (r=0.778), and CRP (r=0.842) were positively correlated with ISS score (P＜0.05), and sCD14, Ang2 and CRP were all independent risk factors related to prognosis (P＜0.05). The area under ROC (AUC) of sCD14, Ang2, and CRP for predicting disease outcome was 0.813, 0.757, and 0.749, respectively. The two indicators with the highest predictive sensitivity (sCD14) and the highest specificity (Ang2) were selected for ROC analysis of the combination of sCD14+Ang2, showing that the AUC of the two combined in predicting disease outcome was 0.935, which was greater than any single index (P＜0.05). 
Conclusion sCD14, Ang2 and CRP are related to the severity and prognosis of emergency traumatic fracture patients with multiple injuries, and can be used as markers for predicting the prognosis of the disease. However, the combined detection of sCD14 and Ang2 can improve the prediction reliability and provide more accurate reference information for clinical diagnosis and treatment.





Logistic regression analysis of the efficacy of hysteroscopic treatment of uterine diverticulum and its influencing factors

XIA Qin-jian, HUANG Sen, CHEN Li-qin

2023, 44(3):  295-299.  doi:10.3969/j.issn.1007-3205.2023.03.010

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Objective To investigate the efficacy of hysteroscopic treatment of uterine diverticulum, and to analyze the factors influencing its efficacy using logistic regression analysis.  
Methods Eighty patients with uterine diverticulum were selected and given hysteroscopic treatment, and the therapeutic effects were recorded. The patients were divided into non-disappearance of uterine diverticulum group (non-disappearance group, n=24) and disappearance of uterine diverticulum group (disappearance group, n=56) according to the therapeutic effects. The influencing factors related to the efficacy of hysteroscopic treatment of uterine diverticulum were analyzed by multivariate logistic regression, and the receiver operating characteristic (ROC) curve was used to analyze the influencing factors and the constructed logistic regression equation was used to predict the value of efficacy. 
Results Eighty patients with uterine diverticulum received hysteroscopic surgery successfully without complications such as infection and organ bleeding. 70.00% (56/80) patients had disappearance of uterine diverticulum after surgery, 30.00% (24/80) patients had uterine diverticulum that still existed but were significantly smaller than that before surgery, and all patients shortened their menstrual period to different degrees. The number of cesarean section was higher in the non-disappearance group than in the disappearance group, the depth of uterinediverticulum was higher than that in the disappearance group, and the thickness of residual myometrium was lower than that in the disappearance group (P＜0.05). The number of cesarean section and the depth of uterine diverticulum were the risk factors related to efficacy, and the thickness of residual myometrium was the protective factor related to efficacy (P＜0.05). Logit (P)=-5.296 + 3.129×number of cesarean section +2.857×depth of diverticulum -0.920 thickness of residual myometrium.Compared with each related factor alone, the constructed logistic regression equation had the largest area under the ROC curve (AUC) for predicting efficacy. 
Conclusion Hysteroscopic surgery can promote the disappearance of uterine diverticulum and improve patients' clinical symptoms. Its postoperative efficacy is influenced by the number of cesarean sections, the depth of the diverticulum, and the thickness of residual myometrium. Therefore, the preoperative assessment of these three factors can provide objective quantitative reference for the choice of clinical surgical modality, which can ensure the maximum therapeutic effect while avoiding overtreatment. 





Predictive value of combined determination of serum PTX3 and copeptin in prognosis of children with severe pneumonia

YU Hai-ming, WANG De-xing, LIU Xiao-meng, ZHANG He, SONG Yi-qin

2023, 44(3):  300-304.  doi:10.3969/j.issn.1007-3205.2023.03.011

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Objective To study the predictive value of serum pentraxin 3 (PTX3) and copeptin in prognosis of children with severe pneumonia. 
Methods A total of 100 children with severe pneumonia admitted to our hospital were selected. According to the prognosis of children at 6-month follow-up, they were divided into poor prognosis group (n=35) and good prognosis group (n=65). After admission, the basic information of the children, including gender, age, blood and urine routine and course of disease, were recorded routinely, and targeted oxygen inhalation, anti-infection treatment and symptomatic support treatment were given. The disease severity and complications of the children were collected. After entering the pediatric Intensive Care Unit (PICU), the heart rate, respiratory rate, pH value, arterial oxygen partial pressure, blood potassium, urea nitrogen/serum creatinine, blood sodium, and hemoglobin were monitored for 24 h, and pediatric critical illness score (PCIS) was performed according to the measured results of the children. The serum copeptin level and PTX3 level were measured by enzyme-linked immunosorbent assay (ELISA) within 24 h after admission to NICU. Univariate analysis and multivariate Logistic regression analysis of the prognosis of children with severe pneumonia were compared, and receiver operating characteristic (ROC) curve was used to evalute the predictive value of combined determination of serum PTX3 and copeptin in prognosis of children with severe pneumonia. 
Results There was no significant difference in gender, the proportion of children with heart failure, average age, respiratory rate and heart rate between two groups (P＞0.05). There were statistically significant differences between two groups in PCIS score, numbers of patients with critical disease, serum PTX3 and copeptin levels (P＜0.05). According to the results of univariate analysis, the factors that had significant influence on the prognosis of children with severe pneumonia were included in multivariate analysis. The results showed that PCIS score, serum PTX3 and copeptin levels were independent influencing factors for the prognosis of children with severe pneumonia. The are under the ROC curve (AUC) of PTX3 were 0.861 (95%CI： 0.804-0.911, P＜0.001), the sensitivity was 71.12% and the specificity was 62.32%. The AUC of the serum copeptin was 0.841 (95%CI： 0.801-0.900, P＜0.001), with a sensitivity of 69.43% and a specificity of 65.21%. The AUC of the combined determination was 0.888 (95%CI： 0.853-0.943, P＜0.001), with a sensitivity of 78.66% and a specificity of 69.66%, suggesting that the combined determination of serum PTX3 and copeptin had certain predictive value for the prognosis of children with severe pneumonia, suggesting that the combined determination of serum PTX3 and copeptin had certain predictive value for the prognosis of children with severe pneumonia. 
Conclusion The combined determination of serum PTX3 and copeptin has a good predictive value for the prognosis of children with severe pneumonia.





The mechanism of IL-17/IL-23 inflammatory axis in the pathogenesis of neonatal hypoxic-ischemic encephalopathy

ZOU Liang, HE Qiu-hong, CHEN Qiu-yang, XIAO Qian, LI Xing-yang, JIN De-hua

2023, 44(3):  305-309.  doi:10.3969/j.issn.1007-3205.2023.03.012

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Objective To explore the mechanism of interleukin-17 (IL-17)/interleukin-23 (IL-23) inflammatory axis in the pathogenesis of neonatal hypoxic-ischemic encephalopathy (HIE). 
Methods We selected 90 children with HIE from Mianyang People′s Hospital, Sichuan Province, as the research group, and another 90 full-term normal newborns as the control group. The general data (sex, gestational age, age, birth weight, delivery mode), and serum IL-17 and IL-23 levels of the two groups were compared, and the serum IL-17 and IL-23 levels of children with different disease severity in the research group were compared. Spearman correlation coefficient model was used to analyze the correlation between the serum levels of IL-17 and IL-23 and the disease severity of children with HIE. Neonatal behavioral neurological assessment (NBNA) was used to assess whether the children in the research group suffered from neurological impairment, and the levels of IL-17 and IL-23 in the serum of children with and without neurological impairment were compared. The receiver operating characteristic (ROC) curve was used to analyze the value of the serum levels of IL-17 and IL-23 in the diagnosis of neurological impairment in children with HIE. 
Results The serum levels of IL-17 and IL-23 in the research group were higher than those in the control group (P＜0.05). The serum levels of IL-17 and IL-23 in severe HIE children were higher than those in moderate and mild HIE children, and higher in moderate HIE children than in mild HIE children (P＜0.05). The serum levels of IL-17 and IL-23 were positively correlated with the severity of HIE (r=0.826, 0.845, P＜0.05). The serum levels of IL-17 and IL-23 in children with neurological impairment were higher than those in children without neurological impairment (P＜0.05). The area under the ROC curve (AUC) of serum IL-17 and IL-23 levels for the diagnosis of neurological impairment in HIE children was 0.829 (95%CI: 0.735-0.900) and 0.744 (95%CI: 0.641-0.830), respectively. The AUC of combined diagnosis of the two levels was 0.934 (95%CI: 0.641-0.830), and the diagnostic sensitivity and specificity were 92.31% and 90.62%, respectively. 
Conclusion The IL-17/IL-23 inflammatory axis is activated in children with HIE, and the serum levels of IL-17 and IL-23 increase, which can promote the aggravation of the disease in children with HIE and lead to neurological impairment. 





Therapeutic effect and safety of cold light source phototherapy in full-term neonatal jaundice and its effect on oxidation and antioxidant system

LIU Xue, WANG Zhan-hui, GAO Wei, LI Ke-quan

2023, 44(3):  310-314.  doi:10.3969/j.issn.1007-3205.2023.03.013

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Objective To investigate the therapeutic effect and safety of cold light source phototherapy in full-term neonatal jaundice and its effect on oxidation and antioxidant system. 
Methods A total of 480 full-term infants with neonatal jaundice in our hospital were selected and divided into the control group (n=240) and the observation group (n=240) according to the random number table method. The control group was given ordinary blue light phototherapy, and the observation group was given cold light source phototherapy. The therapeutic effect, rehabilitation process, bilirubin indexes ［total serum bilirubin (TSB), conjugated bilirubin (DBIL), indirect bilirubin (IBIL)］, serum transferrin (TRF), oxidation and antioxidant system indicators ［malondialdehyde (MDA), superoxide dismutase (SOD), 8-hydroxy-2-deoxyguanosine (8-OHdG)］, children′s growth and development and adverse reactions were compared between two groups. 
Results The total effective rate of the observation group was 96.25%, which was higher than that (90.00%) of the control group (P＜0.05). Time to jaundice subsidence, time to bilirubin recovery, and length of hospitalization in the observation group were shorter than those in the control group (P＜0.05). Compared with the control group, the serum levels of DBIL,TSB and IBIL in the observation group were lower, and the TRF was higher (P＜0.05) at 3 d and 5 d after treatment. The serum levels of 8-OHdG and MDA in the observation group were lower than those in the control group, while the serum SOD level was higher than that in the control group at 3 d and 5 d after treatment (P＜0.05). The incidence of fever, rash, diarrhea, dehydration, irritability and crying in the observation group was lower than that in the control group (P＜0.05). Body weight, length and head circumference of the observation group were higher than those of the control group at 3 months after treatment (P＜0.05). 
Conclusion Cold light source phototherapy can improve the therapeutic effect of full-term neonatal jaundice, reduce the oxidative damage in the body, accelerate the metabolism of bilirubin in the body, and has few adverse reactions, which is helpful to promote the physical development of children. 





Effects of combined treatment of two drugs on EEG and serum IL-6 and TNF-α level in children with viral encephalitis-related seizures

YU Deng-rong, CHEN Jian-chun, LYU Huan-huan, JI Rui-rui

2023, 44(3):  315-318.  doi:10.3969/j.issn.1007-3205.2023.03.014

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Objective To investigate the effects of levetiracetam and oxazepine on EEG background activity, serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels in children with viral meningitis-related seizures. 
Methods A total of 118 patients with seizure due to viral encephalitis were selected and divided into the control group and the research group according to random number table method. The research group was given oxazepine, and the control group was given levetiracetam. Both groups were treated for 6 consecutive months. The seizure control rate of the two groups at 1 month, 3 months and 6 months after treatment were recorded, and the EEG discharge function before treatment, at 3 months and 6 months after treatment were evaluated and analyzes. The changes in TNF-α and IL-6 levels were recorded. 
Results The complete control rate and total effective rate in the research group were significantly higher than those in the control group at 1 month, 3 months and 6 months after treatment (P＜0.05). After treatment, α and θ power in both groups was significantly higher than that before treatment (P＜0.05). At 3 months and 6 months after treatment,α and θ power in the research group was significantly higher than that of the control group (P＜0.05). The levels of TNF-α and IL-6 in both groups were lower than those before treatment, and lower in the research group than in the control group (P＜0.05). 
Conclusion Oxazepine can effectively reduce the level of serum inflammatory factors in children with viral meningitis-related seizures, and its effect on the background activity of EEG is smaller than that of levetiracetam, with good safety . Therefore, it is worthy of popularization and clinical application. 





Clinical efficacy of combined surgery for angle-closure neovascular glaucoma secondary to proliferative diabetic retinopathy

LI Xue-jing, CHEN Dong-mei, DUAN Jia-liang, YAO Yi-min, SHANG Qing-li

2023, 44(3):  319-323.  doi:10.3969/j.issn.1007-3205.2023.03.015

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Objective To observe the clinical efficacy of pars plana vitrectomy (PPV) combined with endoscopic cyclophotocoagulation (ECP) and panretinal photocoagulation (PRP) for angle-closure neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy (PDR). 
Methods  Twenty-one patients (21 eyes) diagnosed with angle-closure NVG secondary to PDR were enrolled in this study. Intravitreal injection of anti-vascular endothelial growth factor （anti-VEGF） was performed after completing the relevant examinations, which led to regression of neovascularizations (NVs)on the iris and in the angle,and all the eyes underwent PPV combined with ECP and PRP, and also combined with phacoemulsification (PHACO), intraocular lens (IOL) implantation, if the patients were complicated with cataract. The duration of follow-up was more than 12 months. The best corrected visual acuity(BCVA)， intraocular pressure (IOP), the mean number of IOP-lowering drugs, changes in the anterior segment, surgical success rate, and the occurrence of complications were comparatively observed and recorded at 1 week, 1 month, 3 months, 6 months, and 12 months after surgery. 
Results Compared with that before surgery, the log MARBCVA of the affected eyes at 12 months after surgery was improved in 9 eyes(43%), stabled in 12 eyes (57%), and decreased in no eyes. Eight patients were followed up for 18 months, 6 of them (75%) maintained their visual acuity, while 2 of them (25%) decreased at the last follow-up compared with that at 12 months. The mean IOP at 1 week, 1 month, 3 months, 6 months, and 12 months after surgery was lower than that before surgery, and the mean IOP at 1 month, 3 months, 6 months, and 12 months was lower than that at 1 week after surgery, suggesting significant differences(P＜0.05). The number of IOP-lowering drugs used at 1 month, 3 months, 6 months, and 12 months after surgery was less than that before surgery, and the difference was statistically significant(P＜0.05). At 12-month follow-up,10 eyes were a complete success, 7 eyes were a conditional success, while 4 eyes were a failure at 12 months after surgery, and the overall success rate was 81%. Inflammatory exudation of the anterior chamber occurred in 3 eyes, but it was fully absorbed after local treatment. 
Conclusion PPV combined with ECP and PRP in the treatment of angle-closure NVG secondary to PDR is safe and effective.





Effect of Er：YAG laser by photon-initiated photoacoustic streaming on penetration of root filling paste into dentinal tubules of primary teeth in vitro

ZHANG Run, ZHOU Yong-chuan, PING Ya-kun, FENG Yi-fan, HAN Ning, FAN Wei-xiao

2023, 44(3):  324-328,337.  doi:10.3969/j.issn.1007-3205.2023.03.016

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Objective To evaluate the effect of root filling paste penetrating into dentinal tubules after erbiumytrium aluminium garnet laser (Er:YAG) photon-initiated photoacoustic streaming (PIPS) irrigating primary teeth root canals by confocal laser scanning microscope (CLSM). 
Methods Twenty primary incisors and 20 primary molars were randomly divided into four groups according to final irrigation techniques and tooth positions: They were primary incisors through needle irrigation (Group A, n=10), primary incisors through Er:YAG-PIPS (Group B, n=10), primary molars through needle irrigation (Group C, n=10) and primary molars through Er:YAG-PIPS (Group D, n=10). After the conventional root canal preparation and different methods of root canal irrigation in vitro, Vitapex root canal filling paste mixed with rhodamine (fluorescent agent) was used for root canal filling. The cross sections of 3 mm (1/3 of the apex) and 5 mm (1/3 of the middle of the root) from the apex were observed by CLSM. The length of root canal filling paste penetrating into dentin tubules was measured to compare the effects of different irrigation methods on the penetration depth of root canal filling paste for primary teeth. 
Results The penetration depth of root filling paste in Group B and Group D was greater than that in Group A and Group C, and the penetration depth of root filling paste in Group A and Group B was greater than that in Group C and Group D, respectively. The penetration depth of root filling paste in the root canal of primary teeth at 5 mm of the root apex was greater than that at 3 mm of the root apex in each group, and the difference was statistically significant (P＜0.05). 
Conclusion The Er:YAG laser by PIPS-activated irrigation is more effective than traditional needle irrigation alone, which can significantly increase the penetration depth of root canal filling paste of primary teeth. However, the root canal morphology would have an impact on the effect of irrigation.





Application value of carotid plaque SMI classification combined with serum hypersensitive C-reactive protein in risk assessment of acute ischemic stroke

ZHANG Li-wei, LI De-xin, WANG Yi-cheng, HAN Chao, MA Shu-ying, WANG Ai-ai

2023, 44(3):  329-333.  doi:10.3969/j.issn.1007-3205.2023.03.017

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Objective To investigate the application value of carotid plaque superb micro-vascular imaging (SMI) classification combined with serum hypersensitive C-reactive protein (hs-CRP) in risk assessment of acute ischemic stroke(AIS). 
Methods A total of 156 patients with carotid plaque in the Department of Neurology of our hospital were included. According to MRI examination results and the clinical diagnosis, they were divided into AIS group (n=72) and non-AIS group (n=84). All the patients underwent routine carotid ultrasonography examination and SMI examination, and serum hs-CRP level was measured. Based on logistic regression model and receiver operating characteristic(ROC) curve, SMI classification of neovascularization in plaque and serum hs-CRP alone or in combination were analyzed to predict the risk of AIS, and its cut-off value was determined. 
Results There was significant difference in SMI classification between two groups (P＜0.05). The level of serum hs-CRP in AIS group was significantly higher than that in NAIS group (P＜0.05). There was no significant difference in plaque thickness and area stenosis rate between two groups (both P＞0.05). SMI classification(OR=4.015, 95%CI: 2.426-6.646, P＜0.001) and serum hs-CRP (OR=1.809, 95%CI: 1.313-2.498, P＜0.001) were independent risk factors for the occurrence of AIS(both P＜0.05). Taking SMI classification≥2 as the diagnostic standard for predicting the occurrence of AIS, the area under ROC curve (AUC) was 0.787, and the sensitivity and specificity were 81.97% and 66.66% respectively. Taking serum hs-CRP ≥ 4.7 mg/L as the diagnostic standard for predicting the occurrence of AIS, the AUC was 0.699, and the sensitivity and specificity were 66.67% and 65.48% respectively. The AUC of the combined diagnosis for predicting the occurrence of AIS was 0.842, and the sensitivity and specificity were 90.28% and 66.67% respectively. 
Conclusion  Carotid plaque SMI classification combined with serum hs-CRP can improve the accuracy of predicting the risk of AIS.





Value of four-dimensional ultrasound hysterosalpingography in the evaluation of female infertility

XIA Tao, WU Min, MAO Pei-ming, YANG Qiu-shi, YAN Ru-yi, QIN Rong-xian

2023, 44(3):  334-337.  doi:10.3969/j.issn.1007-3205.2023.03.018

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Objective To investigate the value of four-dimensional ultrasound hysterosalpingogram (4D-HyCoSY) in the evaluation of female infertility. 
Methods A total of 90 female patients with suspected tubal infertility admitted to our hospital were selected as the research subjects. All patients underwent 4D-HyCoSY, hysterosalpingography (HSG) and laparoscopy, respectively. In the meantime, with the results of laparoscopy as the gold standard, the value of HSG, 4D-HyCoSy and their combination in the diagnosis of female infertility was determined by consistency analysis. 
Results There was no significant difference in tubal patency between different methods (P> 0.05). The consistency analysis confirmed that the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of HSG in the evaluation of female infertility were 0.680, 1.000, 0.822, 1.000 and 0.714, respectively(Kappa=0.654). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 4D-HyCoSy in the evaluation of female infertility were 0.720, 1.000, 0.844, 1.000, and 0.741, respectively (Kappa=0.696), and the diagnostic sensitivity, accuracy and Kappa value of 4D-HyCosy were higher than those of HSG. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the two methods were 0.760, 1.000, 0.867, 1.000 and 0.769, respectively(Kappa=0.738). 
Conclusion The diagnostic sensitivity of 4D-HyCoSy for female tubal infertility is high, and the combined diagnosis of HSG and 4D-HyCOSY has a higher value, which is worthy of application. 





Application effect of remazolam besylate combined with alfentanil in painless gastrointestinal endoscopy in elderly patients

REN Qing-zhu, YANG Shou-juan, RUAN Ding-hong, ZHOU Dan, LIU Shuang

2023, 44(3):  338-341,352.  doi:10.3969/j.issn.1007-3205.2023.03.019

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Objective To investigate the application effect of remazolam besylate combined with alfentanil in painless gastrointestinal endoscopy in elderly patients. 
Methods A total of 208 elderly patients who were admitted to the hospital and planned to undergo painless gastrointestinal endoscopy were selected and divided into the research group (n=104) and the control group (n=104) according to the random number table method. The control group was anesthetized with propofol combined with alfentanil, and the research group was anesthetized with remazolam besylate combined with alfentanil. The recovery time, examination time, and time of leaving the room, and the blood pressure, heart rate, oxygen saturation at different time points ［before administration (T1), at 5 min after administration (T2), at 10 min after administration (T3), and at 15 min after administration (T4)］, sedative effects, and adverse reactions of the two groups were compared. 
Results The recovery time and the time of leaving the room in the research group were shorter than those in the control group (P＜0.05). The systolic pressure, diastolic pressure, heart rate, and blood oxygen saturation at T2 in both groups were lower than those at T1 (P＜0.05), and the systolic pressure, diastolic pressure, heart rate, and blood oxygen saturation at T2 in the research group were higher than those in the control group (P＜0.05) . The systolic pressure, diastolic pressure, heart rate and blood oxygen saturation at T3 and T4 in the control group were higher than those at T2 (P＜0.05). The excellent and good rate of sedative effect in the research group was higher than that in the control group (P＜0.05). The total incidence of adverse reactions in the research group was lower than that in the control group (P＜0.05). 
Conclusion Remazolam besylate combined with alfentanil for painless gastrointestinal endoscopy in elderly patients can shorten the recovery time, have less impact on hemodynamics, and have a low incidence of adverse reactions in patients, which is safe and reliable.





Measurement and localiztion of the depth of internal jugular vein catheterization under the guidance of ultrasound for pediatric patients in heart surgery

LIANG Bing, XU Hui

2023, 44(3):  342-346.  doi:10.3969/j.issn.1007-3205.2023.03.020

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Objective To investigate the accuracy of measurement and localization of the depth of internal jugular vein catheterization under the guidance of ultrasound. 
Methods A total of 96 patients who underwent surgery for congenital heart disease (CHD) under general anesthesia were selected. They were divided into a research group (n=48) and a control group (n=48) according to random number table method. The patients in the research group were guided by ultrasound to locate the placement of the tip of the internal jugular vein catheter and measure the placement depth of the catheter. In the control group, the body surface landmark positioning method was used to measure the placement depth of the internal jugular vein catheter, and the differences in the placement depth of the internal jugular vein catheter were compared between two groups. After surgery, chest X-ray was used to determine whether the catheter tip located by ultrasound was within the T4 segment. The Bland-Altman method was used to analyze the consistency between two methods and the postoperative chest X-ray localization method. 
Results The catheters were successfully placed in both groups without complications. The depth of catheter placement measured in the research group was smaller than that in the control group ［(6.17±0.90) cm vs. (6.59±0.94 ) cm, P＜0.05］. The coincidence rate between the correct detection of the position of the deep venous catheter tip and the chest X-ray was 81.25% in the control group and 97.91% in the research group, and there was a statistical difference between two methods (P＜0.05). Bland-Altman consistency analysis showed that the research group had a high consistency between the depth of positioning the internal jugular vein catheter and the distance from the puncture point to the tracheal carina. 
Conclusion Ultrasound-guided  depth positioning of internal jugular vein catheterization in infants and young children can dynamically and directly guide and locate the puncture and placement position, which is more intuitive and accurate than body surface landmark positioning. 





Mechanism of dexmedetomidine in preventing postoperative anxiety in elderly patients with carotid stenosis

HAN Shan-shan, JIA Qian-qian, WU Song-tao, LIANG Shu-juan

2023, 44(3):  347-352.  doi:10.3969/j.issn.1007-3205.2023.03.021

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Objective To explore the mechanism of dexmedetomidine (Dex) in preventing postoperative anxiety in elderly patients with carotid stenosis. 
Methods A total of 90 elderly patients with carotid stenosis who underwent carotid artery stenting were recruited as the research subjects. All patients were confirmed as having carotid stenosis by cerebral angiography. The patients were randomly divided into Dex group and control group, with 45 patients in each group. The self-rating anxiety scale (SAS) was used to assess the anxiety level of patients before infusion (T0), at 1 h after operation (T1), 6 h after operation (T2) and 12 h after operation (T3). The mental state of patients was assessed by the mini-mental state examination (MMSE). The patients' pain was evaluated by visual analog scale (VAS), and the expression of autophagy-related protein and apoptosis protein was analyzed by Western blot. 
Results The SAS score of the control group increased initially and then decreased, and the SAS score of Dex group showed a decreasing trend; the SAS score of Dex group was lower than that of control group, and there were statistically significant differences  in interaction between groups, time points, and time points between groups (P＜0.05). The MMSE scores of patients in both groups showed a trend of decreasing initially and then increasing, and the MMSE score of Dex group was higher than that of the control group; There were statistically significant differencess in interaction between groups, time points, and time points between groups (P＜0.05). The VAS scores of patients in both groups showed a trend of initial increasing and then decreasing, the VAS score of Dex group was lower than that of the control group, and there were statistically significant differences in interaction between groups, time points, and time points between groups (P＜0.05). The expression of LC3B-Ⅱ/LC3B-Ⅰand Beclin protein in Dex group was lower than that in control group, while the expression of p62 protein was higher than that of control group (P＜0.05). The Bcl-2 protein expression in Dex group was higher than that in control group, while the expression of Bax and caspase-3 protein was lower than that in control group (P＜0.05). 
Conclusion Dex can reduce postoperative anxiety of elderly patients by inhibiting excessive autophagy of cells and achieve enough sedation effect without causing anxiety. 





Comparative analysis of four different methods for diagnosis of Mycobacterium tuberculosis in bronchoalveolar lavage fluid of pulmonary tuberculosis

KONG Xiang-long, SUN Hong-mei, XING Zhi-wei, XU Mei-li, ZHAI Qian

2023, 44(3):  353-357,368.  doi:10.3969/j.issn.1007-3205.2023.03.022

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Objective To compare the positive detection rates of Mycobacterium tuberculosis (MTB) and the rate of rifampicin resistance in bronchoalveolar lavage fluid (BALF) of patients with pulmonary tuberculosis by different diagnostic methods, and to evaluate the application value of different detection techniques in the clinical diagnosis of pulmonary tuberculosis (PTB). 
Methods A retrospective analysis was performed on 297 patients with PTB treated in Hebei Chest Hospital. BACTEC MGIT960 rapid culture system (culture method), modified acid-fast staining method (staining method), Gene Xpert MTB/RIF system (Xpert method) and TB-DNA PCR-fluorescent probe method (PCR method) were used to detect MTB and rifampicin resistance in BALF samples from the same patient, and to analyze the differences in the results of different diagnostic methods. 
Results The positive detection rates of MTB by culture method, staining method, Xpert method and PCR method were 46.465% (138/297), 30.640% (91/297), 55.556% (165/297) and 36.0364% (108/297), respectively, and the difference was statistically significant (χ2=44.336, P＜0.001). The positive detection rate of MTB by Xpert method was significantly higher than that by the other three methods, and the difference was statistically significant (χ2=4.911, 37.592,  P＜0.05). The positive detection rate of MTB by culture method was significantly higher than that by staining and PCR, and the difference was statistically significant (χ2=15.698, 6.245, P＜0.05). However, staining and PCR showed no difference in positive rates of MTB (P＞0.05). The results of rifampicin resistance detection by culture method, Xpert method and PCR method were 10.145% (14/138), 9.091% (15/165) and 10.185% (11/108), respectively, and the difference was not statistically significant (P＞0.05). 
Conclusion The four detection methods showed great differences in the detection rate of MTB positive in the BALF samples of pulmonary tuberculosis patients. The BACTEC MGIT960 rapid culture system and the Gene Xpert MTB/RIF system can be better applied to the detection of MTB and rifampicin resistance in the BALF of pulmonary tuberculosis patients. In addition, the positive detection rate of MTB by Xpert method is higher and faster, whereas there is no significant difference in the detection rate of rifampicin resistance.