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Table of Content

    25 May 2023, Volume 44 Issue 5
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    Effect of adipose derived mesenchymal stem cells on autophagy in rats with intracerebral hemorrhage and its mechanism of action
    FAN Yu-tong, BAI Zhao-rong, ZHANG Yao-guo, LI Peng-fei, GAO Jun-ling, ZHOU Hong-xia
    2023, 44(5):  502-511.  doi:10.3969/j.issn.1007-3205.2023.05.002
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    Objective To investigate the effect of adipose derived mesenchymal stem cells (ADSCs) on autophagy in rats with intracerebral hemorrhage (ICH) and to explore the possible mechanism of action. 
    Methods The periinguinal fat of healthy SD rats was isolated in a sterile environment, and ADSCs were cultured in vitro and cultured to the fourth generation. The surface markers of ADSCs were measured by flow cytometry. Male SD rats were randomly divided into three groups: Sham operation group (Sham group), ICH group, and ADSCs group. ICH models were established in the ICH group and ADSCs group, and the same method was used for model establishment for Sham group, but autologous blood was not injected. At 2 h after successful modeling surgery, the ADSCs group was given a 5 μL cell suspension (1×105 cells) by injection into the right striatal region, while an equal volume of saline was given in the Sham and ICH groups. Rats received nerve function evaluation by the Longa scores at 12 h, 1 d, 3 d, 5 d, and 7 d after successful modeling. After the rats were sacrificed, the pathological changes of brain tissue were observed by hematoxylin-eosin staining, the number of undamaged neurons was observed by Nissl staining, and the water content of brain tissue was measured. Intracellular autophagy-related proteins were detected by immunohistochemical staining, including recombinant human Beclin 1 (Beclin1) and microtubule-Associated Protein 1 Light Chain 3 (LC3), as well as the expression of the phosphorylation of the serine/threonine protein kinase AKT/mammalian target of rapamycin (AKT/mTOR) signaling pathway. Western Blot was used to detect the expression of LC3, Beclin1 and AKT/mTOR signaling pathway-related proteins in the brain tissue at 1 d and 3 d after modeling. 
    Results The flow cytometry found positive expression of adhesion molecules CD29 and CD90 and negative expression of CD45 in ADSCs of cultured rats. Compared with the Sham group, the histopathological symptoms of the rat brain were significantly increased, Longa score, brain water content, number of damaged neurons, autophagy-related proteins LC3 and Beclin1 in ICH group were significantly up-regulated, and the expression of AKT/mTOR signaling pathway phosphorylation positive cells and the protein expression were significantly increased. Compared with ICH group, the histopathological symptoms of the rat brain were significantly relieved, while Longa score, brain water content and the number of damaged neurons in ADSCs group were decreased significantly (P＜0.05). The expression of autophagy-related proteins LC3 and Beclin1 was decreased significantly (P＜0.05), while the expression of AKT/mTOR signaling pathway phosphorylation positive cells and the protein expression were increased significantly (P＜0.05). 
    Conclusion ADSCs transplantation can exert a neuroprotective effect in the treatment of ICH, which may inhibit the level of autophagy in ICH rats by activating AKT/mTOR signal pathway, so as to reduce the degree of brain injury in rats. 

    Expression levels of FGF23, orexin A and BMP-7 in patients with renal failure and their relationship with clinical prognosis
    HAN Li-li, ZHANG Ping, WANG Fang, CHEN Shan-shan, HU Rui-chun, ZHANG Shao-ju
    2023, 44(5):  512-516,546.  doi:10.3969/j.issn.1007-3205.2023.05.003
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    Objective To investigate the expression levels of fibroblast growth factor 23 (FGF23), orexin A and bone morphogenetic protein-7 (BMP-7) in patients with renal failure and their relationship with clinical prognosis. 
    Methods A total of 65 patients with renal failure were selected as the research group, and 65 healthy people who underwent physical examination during the same period were selected as the control group. The levels of FGF23, orexin A and BMP-7 in the blood of all subjects were detected, compared and analyzed. After 1-year follow-up, the clinical data of patients with different clinical prognoses were compared, and the correlation between FGF23, orexin A, BMP-7 and poor clinical prognosis of renal failure patients was analyzed. COX regression analysis was used to analyze prognostic factors in patients with renal failure, and the receiver operating characteristic curve (ROC) curve of FGF23, orexin A and BMP-7 in predicting poor prognosis in patients with renal failure was analyzed. 
    Results Compared with the control group, FGF23 and orexin A expression levels, blood creatinine(CREA), uric acid (UA), blood urea nitrogen (BUN) levels and C-reactive protein (CRP)were higher, while BMP-7 expression levels were lower in the research group (P<0.05). There were 48 cases in the good prognosis group and 17 cases in the poor prognosis group. Compared with the good prognosis group, patients in the poor prognosis group had higher expression levels of CREA, UA, BUN, CRP, FGF23 and orexin A and lower expression levels of BMP-7 (P＜0.05). FGF23 and orexin A were positively correlated with poor clinical prognosis in patients with renal failure, while BMP-7 was negatively correlated with poor clinical prognosis in patients with renal failure (P＜0.05). FGF23 and orexin A were independent risk factors for poor prognosis in patients with renal failure, and BMP-7 was a protective factor (P＜0.05). The AUC of FGF23, orexin A, and BMP-7 was 0.920, 0.697, and 0.849, respectively. 
    Conclusion The expression levels of FGF23 and orexin A in patients with renal failure are higher, and the expression level of BMP-7 is lower, which has predictive value for the prognosis of patients with renal failure.

    Changes of inflammatory factors in diabetic peripheral neuropathy and their correlation with nerve conduction velocity
    ZHANG Tong-yu, YANG Chuan-hui, XU Ning
    2023, 44(5):  517-520,571.  doi:10.3969/j.issn.1007-3205.2023.05.004
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    Objective To analyze the changes of inflammatory factors in diabetic peripheral neuropathy (DPN) and their correlation with nerve conduction velocity. 
    Methods A total of 114 patients with type 2 diabetes (T2DM) admitted to the First People′s Hospital of Lianyungang City were selected and divided into T2DM group (n=34) and DPN group (n=80)according to the Michigan Neuropathy Screening Form. The patient′s general information was collected, and glucose related indexes［fasting plasma glucose (FPG), 2 h postprandial blood glucose (2 hPG), glycosylated hemoglobin (HbA1c)］, inflammatory factors［tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-10 (IL-10), macrophage inflammatory protein-1 (MIP-1)］, and nerve conduction velocity (motor and sensory conduction velocity of median nerve and peroneal nerve) were detected. The general information, inflammatory factors and nerve conduction velocity of the two groups of patients were compared. The correlation between inflammatory factors and nerve conduction velocity and the influencing factors of nerve conduction abnormalities were analyzed. 
    Results The course of disease, FPG, 2 hPG, HbA1c, TNF-α, and MIP-1α in the DPN group were higher than those in the T2DM group, while the motor and sensory conduction velocity of IL-1β, IL-10, median nerve and peroneal nerve were lower than those in the T2DM group (P＜0.05). IL-1β was positively correlated with motor and sensory conduction velocity of median nerve and peroneal nerve (P＜0.05), whereas TNF-α and MIP-1α are negatively correlated with motor and sensory conduction velocity of median nerve and peroneal nerve (P＜0.05). Course of disease, HbA1c, and TNF-α were influencing factors of motor conduction velocity of median nerve(P＜0.05), and age, TNF-α and HbA1c were the influencing factors of conduction abnormalities of median nerve and peroneal nerve (P＜0.05). 
    Conclusion The nerve conduction of DPN patients is closely related to the changes of TNF-α, MIP-1α, and IL-1β. 

    Effects of dulaglutide on total load of myocardial ischemia and endothelial function in patients with type 2 diabetes mellitus complicated with coronary heart disease
    WANG Wen-qi, DING Hai-xia, ZHANG Tao
    2023, 44(5):  521-525.  doi:10.3969/j.issn.1007-3205.2023.05.005
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    Objective To investigate the effect of dulaglutide, glucagon-like peptide-1 receptor agonist (GLP-1RA) weekly preparation, on total load of myocardial ischemia and endothelial function in patients with type 2 diabetes mellitus (T2DM) complicated with coronary heart disease (CHD). 
    Methods One hundred and twelve patients with T2DM complicated with CHD were randomly divided into two groups: conventional treatment group (n=56) and dulaglutide treatment group (n=56). The conventional treatment group was treated with standard hypoglycemic, hypotensive, lipid-lowering and antiplatelet therapy, while the dulaglutide treatment group was treated with dulaglutide injection (1.5 mg, subcutaneously, once a week) in addition to the conventional treatment. The clinical manifestations, body mass index (BMI), blood pressure, fasting blood glucose (FPG) , blood lipids and glycosylated hemoglobin (HbA1c) were observed before treatment and at 3 months after treatment in both groups respectively. In the meantime, the total load of myocardial ischemia, vascular endothelial function, and inflammatory indicators ［endothelin-1(ET-1), nitric oxide (NO) and hypersensitive C-reactive protein (hs-CRP)］ were measured. 
    Results After treatment, FPG and LDL-C in both groups were lower than those before treatment. BMI, HbA1c, TG, and ACR in the dulaglutide treatment group were lower than those before treatment, while BMI, LDL-C, and ACR in the dulaglutide treatment group were lower than those in the conventional treatment group (P＜0.05) . The daily dose of insulin glargine and the incidence of hypoglycemia in the conventional treatment group were lower than those in the conventional treatment group (P＜0.05) . The total load of myocardial ischemia in both groups was significantly lower than that before treatment, which was significantly lower in dulaglutide treatment group than that in conventional treatment group after treatment (P＜0.05) . The levels of ET-1 and hs-CRP in two groups were lower than those before treatment, while the levels of NO were higher than those before treatment. The levels of ET-1 and hs-CRP were lower and the levels NO were higher in the  dulaglutide treatment group than in the conventional treatment group (P＜0.05). 
    Conclusion Dulaglutide has multiple benefits in T2DM patients by lowering blood glucose, regulating lipid and reducing body weight, and has cardiovascular protective effects by anti-inflammation and protecting endothelial function. It can also improve myocardial blood supply, decrease total load of myocardial ischemia and improve prognosis by reducing and delaying the progression of coronary atherosclerosis in patients with T2DM complicated with CHD. 

    Effect of manual hyperinflation on quality of life in stroke patients undergoing tracheotomy
    ZHU Yu, SHI Ya-li, HAO Jia-li, WANG Ya-ping, GUO Wen-jie
    2023, 44(5):  526-530.  doi:10.3969/j.issn.1007-3205.2023.05.006
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    Objective To analyze the effect of manual hyperinflation(MHI) on the quality of life of stroke patients undergoing tracheotomy. 
    Methods A total of 100 stroke patients undergoing tracheotomy after admission to the Department of Rehabilitation Medicine of Linfen Central Hospital, Shanxi Province were selected and divided into two groups. The control group (n=50) received conventional tracheotomy airway management, and the experimental group (n=50) received MHI on the basis of the control group. The total length of hospital stay before and after the intervention, the length of intensive care unit (ICU) stay, time to extubation, lung function, quality of life, activities of daily living (ADL), motor function, swallowing function classification and the incidence of complications were compared between two groups. 
    Results After intervention, forced vital capacity (FVC%) and forced expiratory volume in one second (FEV1%) in both groups were significantly increased, which were higher in the experimental group than in the control group (P＜0.05). The scores of physiology, psychology, independence, social relationship, environment and spirit of the two groups were significantly increased, which were higher in the experimental group than in the control group (P＜0.05). Barthel index (BI) and Fug1-Meyer motorassessment (FMA) score in both groups were significantly increased, which were higher in the experimental group than in the control group (P＜0.05). The classification of swallowing function in the two groups was significantly improved, which were better in the experimental group than in the control group (P＜0.05). The total incidence of complications in experimental group (10.00%) was significantly lower than that in control group (P＜0.05). The total length of hospital stay, length of ICU stay and time to extubation in the experimental group were significantly shorter than those in control group (P＜0.05). 
    Conclusion MHI can effectively improve the lung function of stroke patients undergoing tracheotomy, and significantly improve the motor function, swallowing function and the quality of life, reduce the incidence of complications, and promote the early recovery of patients. Therefore, it is worthy of clinical application. 

    Expression and significance analysis of CEACAM6, miR-146b and S100A6 in thyroid cancer
    LAI Sheng-lian, MAO Min, HUANG Lin
    2023, 44(5):  531-535,552.  doi:10.3969/j.issn.1007-3205.2023.05.007
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    Objective To investigate the relationship between the expression of carcinoembryonic antigen related cell adhesion molecule 6 (CEACAM6), miR-146b and calcium-binding protein A6 (S100A6) and clinicopathological features and prognosis in thyroid cancer. 
    Methods A total of 165 thyroid cancer patients who underwent thyroidectomy in our hospital were selected. The expressions of CEACAM6, miR-146b and S100A6 were detected by real-time fluorescence quantitative polymerase chain reaction (RT-PCR) in cancer tissues and adjacent tissues, respectively. A t-test was used to examine the expression differences of CEACAM6, miR-146b and S100A6 among different clinicopathological features of thyroid cancer patients. Kaplan-Meier and Cox proportional risk models were used to analyze the relationship between CEACAM6, miR-146b, S100A6 expression and prognosis of thyroid cancer patients. 
    Results The expressions of CEACAM6, miR-146b and S100A6 in cancer tissues were higher than those in adjacent tissues (P＜0.05). The expressions of CEACAM6, miR-146b and S100A6 in patients with tumor diameter ＞1 cm, low differentiation, T3- T4b and N1a-N1b were higher than those in patients with tumor diameter ≤1 cm, high differentiation, T1- T2 and N0 (P＜0.05). The overall survival rate of patients with high expression of CEACAM6, miR-146b and S100A6 were lower than those with low expression of CEACAM6, miR-146b and S100A6 (P＜0.05). High expression of N1a-N1b, CEACAM6, miR-146b and S100A6 were risk factors for poor prognosis of thyroid cancer patients (P＜0.05). 
    Conclusion CEACAM6, miR-146b and S100A6 are highly expressed in thyroid cancer tissues, which are related to the clinicopathological features and poor prognosis of thyroid cancer. 

    The relationship between serum PCT, NT-proBNP, mtDNA levels and early complications after cardiac surgery involving CPB and their predictive value
    LI Su-hua, MIAO Yi, ZHANG Ai-min
    2023, 44(5):  536-540,595.  doi:10.3969/j.issn.1007-3205.2023.05.008
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    Objective To analyze the changes of serum procalcitonin (PCT), N-terminal natriuretic peptide precursor (NT-proBNP) and mitochondrial DNA (mtDNA) levels in patients undergoing cardiopulmonary bypass (CPB) and to explore its value in predicting early complications. 
    Methods A total of 108 patients undergoing cardiac surgery involving CPB were selected as the observation group, and 108 healthy people undergoing physical examination during the same period were selected as the control group. The levels of serum PCT, NT-proBNP and mtDNA were measured by enzyme-linked immunosorbent assay (ELISA) and compared. The incidence of early complications after surgery was calculated and the general data of patients with or without complications were compared. The factors affecting early complications after surgery were analyzed by logistic regression analysis. The value of serum PCT, NT-proBNP and mtDNA in predicting early complications was analyzed by receiver operating characteristic (ROC) curve, and the interaction among the three was evaluated by additive model. 
    Results The serum levels of PCT, NT-proBNP and mtDNA in patients undergoing cardiac surgery involving CPB were higher than those in healthy people (P＜0.05), and the complication rate of 108 patients was 37.96%. There were significant differences in emergency surgery, preoperative cardiac function classification, duration of operation, duration of cardiopulmonary bypass, duration of aortic block, serum PCT, NT-proBNP, and mtDNA levels between patients undergoing cardiac surgery involving CPB with early complications and those without early complications (P＜0.05). The levels of serum PCT, NT-proBNP and mtDNA were the influencing factors of early complications in patients undergoing cardiac surgery involving CPB (P＜0.05). ROC curve showed that area under the ROC curve (AUC) of PCT, NT-proBNP and mtDNA in combination to predict early complications in patients undergoing cardiac surgery involving CPB was the largest, the corresponding sensitivity was 77.61%, and the specificity was 82.98%. Serum PCT, NT-proBNP and mtDNA had a synergistic effect on the occurrence of early complications in patients. 
    Conclusion Serum PCT, NT-proBNP, and mtDNA are highly expressed in patients undergoing cardiac surgery involving CPB. The high levels of the three are independent risk factors for early postoperative complications, and there is a synergistic effect among them, which is of high value in predicting early complications. In addition, it has a positive effect on guiding clinical intervention measures as soon as possible. 

    Short-term effect of femoral neck system assisted by an orthopaedic robot "TINAVI" in femoral neck fracture in middle-aged and elderly people
    LONG Yu-bin, LI Yi-ran, CHEN Wei, JIA Hong-wei, HAN Bao-jun, AN Ming
    2023, 44(5):  541-546.  doi:10.3969/j.issn.1007-3205.2023.05.009
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    Objective To investigate the short-term effect of orthopaedic robot "TINAVI" assisted femoral neck system (FNS) in the treatment of femoral neck fracture in middle-aged and elderly people. 
    Methods A retrospective analysis was conducted on 72 patients with femoral neck fracture. Among them, 34 cases were treated with FNS assisted by an orthopaedic robot "TINAVI" under C-arm guidance for femoral neck fracture (observation group), and 38 cases were treated with FNS only under C-arm guidance (control group). The time to surgical reduction, time to fracture healing, fluoroscopy times, duration of operation, intraoperative blood loss, as well as femoral neck shortening degree immediately after operation and at 12 months after operation, Harris score of affected hip joint function at 3, 6 and 12 months after operation, and incidence of venous thrombosis of lower extremities were compared between two groups. 
    Results The duration of operation, intraoperative fluoroscopy times after intraoperative reduction and intraoperative blood loss in the observation group were significantly shorter or less than those in the control group (P＜0.05). There was no significant difference in time to fracture reduction and time to fracture healing between the two groups (P＞0.05). All patients were followed up for a mean of 15.5 months. Immediately after surgery, there was no significant difference in the degree of femoral neck shortening between the two groups (P＞0.05). No significant difference was found in the degree of femoral neck shortening in the observation group at 12 months after surgery, as compared with that immediately after surgery (P＞0.05), and the degreein the control group wasinferior to that immediately after surgery (P＜0.05). The degree of femoral neck shortening in the observation group was superior to that in the control group, showing significant difference (P＜0.05). The Harris score of the affected hip in the observation group was significantly higher than that in the control group at 3 months after operation (P＜0.05). At 12 months after surgery, the Harris score of hip function in the two groups was higher than that at 3 months after surgery, and the difference was statistically significant (P＜0.05); However, there was no statistically significant difference in the Harris score of hip function between two groups (P＞0.05). 
    Conclusion Robot "TINAVI" -assisted FNS fixation for femoral neck fracture is simple to operate, which can not only play the advantages of a single minimally invasive incision, but also provide reliable fixation and precise positioning. So that the internal fixation can reach the most reasonable and optimal position, with good short-term efficacy. 

    lncRNA SNHG12 promotes mirgation, invasion and suppresses apoptosis of cervical cancer SiHa cells
    WANG Xu, XU Jing, HUA Fang, WANG Yu-jing, DU Zhi-xiang
    2023, 44(5):  547-552.  doi:10.3969/j.issn.1007-3205.2023.05.010
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    Objective To investigate the regulation of lncRNA small nucleolar host gene12 (SNHG12) on proliferation, cell cycle, invasion, migration and apoptosis of cervical cancer SiHa cells. 
    Methods RT-PCR was performed to detect SNHG12 expression in cervical cancer tissues and cell lines HaCaT, C33A, SiHa and CasKi. CCK8, flow cytometry assay, Transwell, cell wound scratch assay and Tunel cell apoptosis were adopted to detect the regulatory abilities of SNHG12 on proliferation, cell cycle, invasion, migration and apoptosis of SiHa cells, and also to detect the subcutaneous tumor growth of cervical cancer. Immunohistochemistry was used to detect Ki67 antibodies. 
    Results Overexpressed SNHG12 was obviously elevated in cervical cancer tissues and all cell lines. SNHG12 up-regulation could promote proliferation, cell cycle, invasion, migration and inhibit apoptosis of SiHa cells. SNHG12 could promote subcutaneous tumor growth, while interference with SNHG12 could generate inhibitory effects. The positive signal of SNHG12 was highly enhanced, while silencing SNHG12 produced the opposite result. 
    Conclusion SNHG12 could facilitate SiHa cell proliferation, cell cycle, invasion, migration and suppress apoptosis, thereby participating in the pathological process of cervical cancer. 

    The effect of abnormal glucose metabolism and vitamin d deficiency of pregnant women on the thyroid functions of their offspring
    YU Quan-ping, YANG Jian-bao, ZHAI Hong-ran, HOU Feng-xiang, FU Xiao-kang, SUN Zi-mei
    2023, 44(5):  553-556,578.  doi:10.3969/j.issn.1007-3205.2023.05.011
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    Objective To explore the effect of blood glucose and 25-hydroxyvitamin D ［25-(OH)D］ level of pregnant women with gestational diabetes mellitus (GDM) on the thyroid functions of their offspring newborns. 
    Methods A total of 186 pregnant women with GDM were divided into GDM intervention group (n=102) and GDM non-intervention group (n=84) according to their blood glucose control. Another 98 healthy pregnant women in the same period were randomly selected as the control group. The levels of fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), 25-(OH)D, thyroid function indexes and corresponding neonatal thyroid function indexes were compared in the three groups. All pregnant women were divided into vitamin D deficiency group and vitamin D non-deficiency group according to their 25-(OH)D levels, and the corresponding incidence rate of neonatal congenital hypothyroidism (CH) was compared between two groups. 
    Results The levels of FPG and HbA1c of pregnant women in GDM non-intervention group were higher than those in other two groups. The blood 25-(OH)D level of pregnant women was the lowest in GDM non-intervention group, followed by GDM intervention group, and the highest in control group. The thyroid stimulating hormone (TSH) of pregnant women was the highest in GDM non-intervention group, followed by GDM intervention group, and the lowest in control group. The free triiodothyronine (FT3) and free thyroxin (FT4) in GDM non-intervention group were lower than those of the other two groups. The TSH of the offspring of GDM non-intervention group was higher than those of GDM intervention group and control group. The FT3 and FT4 of the offspring of GDM non-intervention group were lower than those of the other two groups, and the corresponding incidence rate of neonatal CH of vitamin D deficiency group was higher than that of vitamin D non-deficiency group. 
    Conclusion Abnormal glucose metabolism and vitamin D deficiency of pregnant women can cause hypothyroidism of their offspring. According to the blood glucose and vitamin D related monitoring indexes of pregnant women with GDM, targeted intervention has great clinical significance in preventing thyroid dysfunction and abnormal development of newborns. 

    Effect of goals-activity-motor enrichment therapy combined with postural control on motor function in children with severe cerebral palsy
    WU De-ping, DUAN Jun, CUI Zhen-zhen, TANG Jiu-lai, WU De, ZHAO Kai
    2023, 44(5):  557-561.  doi:10.3969/j.issn.1007-3205.2023.05.012
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    Objective To investigate the effects of goals-activity-motor enrichment (GAME) therapy combined with postural control on motor function in children with severe cerebral palsy (CP), and to provide evidence-based medical basis for improving motor function in children with severe CP. 
    Methods In this prospective case-control study, 92 children with severe CP were included and randomly divided into research group (n=46) and conventional treatment group (n=46) according to random number table. The research group was treated with GAME therapy combined with postural control training, while the conventional treatment group was treated with neurodevelopmental therapy. Supine and prone position (area A) and sitting position(area B) in Gross Motor Function Measure-88 (GMFM-88), eye tracking (area A) and upper limb joint activity (area B) in Fine Motor Function Measure (FMFM), Level of Sitting Scale (LSS),Face-Legs-Activity-Cry-Consolability (FLACC) and Activities of Daily Living (ADL) scores were compared before treatment, and at 6 months and 12 months after treatment. 
    Results The scores of GMFM-88 (area A and area B), FMFM (areaA andarea B), LSS and ADL in the two groups were gradually increased, while the scores of FLACC were gradually decreased. The scores of GMFM-88 (area A and area B), FMFM (area A andarea B), LSS and ADL in the research group were higher than those in the conventional treatment group, while FLACC scores were lower than those of conventional treatment group; the difference of interaction between groups, time points and time points between groups was statistically significant (P＜0.05). 
    Conclusion GAME therapy combined with postural control can improve gross motor function, sitting ability and fine motor function,relieve pain and improve the ADL in children with severe CP. 

    Clinical value of serum miRNA-210 and miRNA-223 in predicting the prognosis of neonatal hypoxic ischemic encephalopathy
    ZHAO Ying, MA Tong-hui, HAO Shu-juan
    2023, 44(5):  562-566,588.  doi:10.3969/j.issn.1007-3205.2023.05.013
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    Objective To explore the clinical value of serum miRNA-210 and miRNA-223 in predicting the prognosis of neonatal hypoxic-ischemic encephalopathy (NHIE). 
    Methods A total of 124 newborns with NHIE were collected as the observation group. According to the severity of neonatal MRI, they were divided into the mild group (n=51), the moderate group (n=40) and the severe group (n=33), and 60 healthy newborns during the same period were selected as the control group. According to the prognosis within 28 days after birth, the children were divided into a survival group (n=81) and a death group (n=43). Serum microRNA-210 (miRNA-210) and microRNA-223 (miRNA-223) levels were detected by real-time fluorescence quantitative PCR, and the clinical value of its level in predicting the prognosis of NHIE was analyzed. 
    Results The expression levels of serum miRNA-210 and miRNA-223 in newborns with NHIE were higher than those in the healthy control group (P＜0.05). and higher in the severe group than in the mild group and the moderate group, and the difference between the groups was statistically significant (P＜0.05). Univariate analysis showed that age at the initation of treatment, Apgar score, severity of hypoxic ischemic encephalopathy, interleukin-6, C-reactive protein, serum miRNA-210 expression, and serum miRNA-223 expression were associated with the prognosis of newborns with NHIE (P＜0.05). The results of multivariate analysis showed that the age at the initation of treatment that was higher than 2.25 days (OR=3.554, 95%CI: 1.300-9.713), non-severity based on the severity of the disease (OR=4.450, 95%CI: 2.189-9.048), and an increase in serum miRNA-210 (OR=3.117, 95%CI: 1.598-6.082) and an increase in serum miRNA-223 (OR=3.384, 95%CI: 1.790-6.398) were independent risk factors affecting the prognosis of newborns with NHIE (P＜0.05). Receiver operating characteristic (ROC) curve analysis showed that when the optimal cut-off value of serum miRNA-210 was 1.71, the area under the ROC curve (AUC) for predicting the prognosis of NHIE was 0.76, the sensitivity was 78.62%, and the specificity was 76.35%. When the optimal cutoff value of miRNA-223 was 1.48, the AUC for predicting the prognosis of NHIE was 0.79, the sensitivity was 81.54%, and the specificity was 76.18%. The AUC of the two indicators in combination for the prognosis of newborns with NHIE was 0.85, with a sensitivity of 86.73% and a specificity of 75.49%. 
    Conclusion miRNA-210 and miRNA-223 are elevated in newborns with NHIE, which are closely related to the severity and prognosis of newborns. Increased miRNA-210 and miRNA-223 have good predictive value in the prognosis of children with NHIE. 

    Clinical study of local brain tissue oxygen monitoring combined with multi-mode magnetic resonance examination in early diagnosis of premature infants with brain injury
    HONG Fei, ZHANG Wei-yan, ZHU Yuan-yuan, SONG Lei
    2023, 44(5):  567-571.  doi:10.3969/j.issn.1007-3205.2023.05.014
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    Objective To investigate the value of local brain tissue oxygen monitoring combined with multimodal magnetic resonance imaging (MRI) examination in the early diagnosis of preterm infants with brain injury. 
    Methods A total of 250 preterm infants born in our hospital were selected as the research subjects. Local brain tissue oxygen monitoring and multimodal MRI were performed for all preterm infants. The results of criteria for brain injury in preterm infants examination were used as the gold standard for the diagnosis of brain injury. The consistency of local brain tissue oxygen monitoring and multimodal MRI alone and in combination in the diagnosis with the results of criteria for brain injury in preterm infants was analyzed. 
    Results After local brain tissue oxygen monitoring, 250 preterm infants with brain injury were diagnosed as follows: 120 preterm infants with brain injury and 130 preterm infants without brain injury. By consistency analysis, the sensitivity, specificity, accuracy and Kappa value of local brain tissue oxygen monitoring in the diagnosis of preterm brain injury were 0.850, 0.862, 0.856, and 0.712, respectively. The diagnosis results of 250 preterm infants with brain injury were as follows: 122 preterm infants with brain injury and 128 normal preterm infants. By consistency analysis, the sensitivity, specificity, accuracy and Kappa value of multimodal MRI in the diagnosis of preterm brain injury were 0.900, 0.892, 0.896 and 0.792, respectively. By local brain tissue oxygen monitoring combined with multimodal MRI examination, the diagnosis results of 250 preterm infants with brain injury were as follows: 122 preterm infants with brain injury and 128 normal preterm infants. Through consistency analysis, the sensitivity, specificity, accuracy and Kappa value of local brain tissue oxygen monitoring combined with multimodal MRI in the diagnosis of preterm brain injury were 0.950, 0.938, 0.944, and 0.888, respectively. 
    Conclusion Local brain tissue oxygen monitoring combined with multimodal MRI has good application value in early diagnosis of premature brain injury. 

    Correlation analysis of quantitative parameters of ultrafast pulse wave velocity technique with serum Gal-3 and IL-33 levels in patients with metabolic syndrome
    ZHANG Jing, SUN Li-juan
    2023, 44(5):  572-578.  doi:10.3969/j.issn.1007-3205.2023.05.015
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    Objective To investigate the correlation between quantitative parameters of ultrafast pulse wave velocity (ufPWV) technique and serum galectin-3 (Gal-3) and interleukin-33 (IL-33) levels in patients with metabolic syndrome. 
    Methods In total, 150 patients with metabolic syndrome were selected as the observation group and divided into three groups: group Ⅰ: 50 patients with normal carotid intima-media thickness (IMT) (＜1.0 mm), group Ⅱ: 50 patients with thickened carotid IMT (1.0 mm ≤ IMT ＜1.5 mm) and group Ⅲ: 50 patients with carotid IMT ≥ 1.5 mm.Another 50 healthy physical examinees during the same period were selected as controls. The general data, quantitative parameters of ufPWV technique, including pulse wave velocity at the beginning of systole (PWV-BS), pulse wave velocity at the end of systole (PWV-ES), and the measurement of Gal-3 and IL-33 were compared. Gal-3 and IL-33 were detected, to evaluate the diagnostic value of quantitative parameters of ufPWV technique and serum Gal-3 and IL-33 levels for metabolic syndrome. In addition, the correlation between quantitative parameters of ufPWV technique and serum Gal-3 and IL-33 levels, and the correlation of quantitative parameters of ufPWV technique and serum Gal-3 and IL-33 levels with carotid IMT were analyzed. The impact of quantitative parameters of ufPWV technique, Gal-3 and IL-33 on the risk of carotid atherosclerotic plaque (CAP) was analyzed. 
    Results Heart rate, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) were higher in the observation group than in the control group (P＜0.05).The quantitative parameters of ufPWV technique, including PWV-BS and PWV-ES, and serum Gal-3 and IL-33 levels were higher in the observation group than in the control group (P＜0.05). The quantitative parameters of ufPWV technique, including PWV-BS, PWV-ES, and serum Gal-3 and IL-33 levels were lower in group Ⅰ than in group Ⅱ, and lower in group Ⅱ than in group Ⅲ (P＜0.05). The area under the receiver operating characteristic (ROC) curve (AUC) of quantitative parameters of ufPWV technique and serum Gal-3 and IL-33 levels for the diagnosis of metabolic syndrome was 0.836, 0.802, 0.818 and 0.823, respectively, and the AUC for the combined diagnosis was 0.901, which was significantly higher than the diagnostic value of each index alone; The quantitative parameters of ufPWV technique,including PWV-BS and PWV-ES had a positive correlation with serum Gal-3 and IL-33 levels, and the quantitative parameters of ufPWV technique, PWV-BS and PWV-ES, as well as serum Gal-3 and IL-33 levels, were positively correlated with carotid IMT (P＜0.05). The risk of CAP development was 2.490, 2.490, 2.698, and 2.212 times higher in those with high levels of the quantitative parameters of ufPWV technique, Gal-3, and IL-33, respectively, than in those with low levels. 
    Conclusion In patients with metabolic syndrome,quantitative parameters of ufPWV technique, PWV-BS and PWV-ES, are positively correlated with serum Gal-3 and IL-33 levels, and their levels are related to the development of metabolic syndrome and atherosclerosis, which can indicate the occurrence of carotid plaque and provide a reference basis for clinical diagnosis and treatment. 

    Analysis of therapeutic effect of two uterine artery embolization modes combined with dilatation and curettage under ultrasonic monitoring in the treatment of cesarean scar pregnancy
    WANG Jian-shuang, ZHANG Hai-jing, WANG Xue-song, WEN Ying, ZHOU Zi-jing
    2023, 44(5):  579-583.  doi:10.3969/j.issn.1007-3205.2023.05.016
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    Objective To compare the therapeutic effect of two uterine artery embolization (UAE) modes combined with dilatation and curettage (D&C) under ultrasonic monitoring in the treatment of cesarean scar pregnancy (CSP). 
    Methods Retrospective analysis was performed on the data of 96 patients with CSP in our hospital. According to the patient′s wishes, all patients were divided into group A (n=73) and group B (n=23). Group A was treated with uterine artery chemoembolization (UACE) combined with ultrasound-guided D&C, while group B was treated with UAE combined with ultrasound-guided D&C. Comparison was made between two groups on the proportion of negative conversion of β-HCG and menorrhagia at 5 weeks after surgery, length of hospitalization, hospitalization expenses, intraoperative blood loss, proportion of blood transfusion and proportion of secondary treatment. Salpingography was performed at three months after the operation to monitor the patency of the fallopian tubes, and a three-year telephone follow-up was conducted for the second pregnancy and the recurrence of CSP. 
    Results The level of β-HCG before D&C was significantly different between two groups (P＜0.05). The proportion of negative conversion of β-HCG and menorrhagia at 5 weeks after operation in group A was higher than that in group B (P＜0.05), and intraoperative blood loss, and the proportion of intraoperative blood transfusion and secondary treatment were lower than those in group B (P＜0.05). The rate of fallopian tube patency in group A was higher than that in group B at three months after operation (P＜0.05), and the ratio of ectopic pregnancy, CSP recurrence, normal pregnancy, abortion and live birth at three years after operation in the two groups was not significantly different (P＞0.05). No serious postoperative complications such as ectopic embolism, massive hemorrhage and uterine rupture occurred in either group. 
    Conclusion Compared with UAE combined with D&C under ultrasonic monitoring, UACE combined with D&C under ultrasonic monitoring can reduce intraoperative bleeding and improve the therapeutic effect more effectively.

    Efficacy of ultrasound-guided external oblique plane block for postoperative analgesia after upper abdominal surgeries
    ZHU Xiao-bing, WU Lun, YANG Tong, ZHANG Xi-yang
    2023, 44(5):  584-588.  doi:10.3969/j.issn.1007-3205.2023.05.017
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    Objective To evaluate the effect of ultrasound-guided external oblique plane block (EOP) on postoperative analgesia in patients undergoing upper abdominal surgery. 
    Methods In total, 120 patients receiving elective upper abdominal surgery were selected and divided into three groups(n=40): control group, low anterior serratus plane block (SSPB) group and EOP group according to random number table method. After induction of general anesthesia, SSPB group received ultrasound-guided anterior serratus plane block at the 8th rib level of bilateral axillary midline, and EOP group received ultrasound-guided EOP at the 6th rib level of bilateral clavicular midline, with 30 mL of 0.25% ropivacaine injected. The three groups were treated with general anesthesia, endotracheal intubation, intraoperative static inhalation combined anesthesia, and patient controlled intravenous analgesia (PCIA) with sufentanil after operation, to maintain the clinical effective analgesia within 48 h after operation. When the visual analogue scale (VAS) pain score was ≥ 4, the PCIA pump was pressed. When the effect was poor, intravenous sufentanil 0.1 μg/kg was injected. The dosage of sufentanil during operation and within 48 h after operation, the time to first PCIA, times of PCIA compression and times of remedial analgesia, and the occurrence of nausea, vomiting and other adverse reactions within 48 h after operation were recorded. The completion time of nerve block was recorded. 
    Results Compared with control group, the time to first PCIA in EOP group and SSPB group was prolonged, the dosage of sufentanil during operation and within 48 h after operation, the times of remedial analgesia and pump compression were significantly reduced, and the incidence of adverse reactions was significantly reduced (P < 0.05). The completion time of nerve block in EOP group was significantly shorter than that in SSPB group. 
    Conclusion Ultrasound-guided EOP is effective in postoperative analgesia, with fewer adverse reactions in patients undergoing upper abdominal surgery. 

    Application of enhanced rehabilitation after surgery in patients undergoing laparoscopic cholecystectomy
    ZHANG Min, ZHANG Fu-jie, TAN Hui-ling, CUI Tong-yang, WU Zhen-dong, LYU Yin-xiao
    2023, 44(5):  589-595.  doi:10.3969/j.issn.1007-3205.2023.05.018
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    Objective To explore the clinical significance of enhanced recovery after surgery (ERAS) in patients undergoing laparoscopic cholecystectomy (LC). 
    Methods Eighty-five patients who underwent selective LC surgery in Hebei Petro China Central Hospital were selected, and divided into ERAS group (n=43) and control group (n=42) by random number table method. Both groups of patients were given demedetomidine-assisted anesthesia. In the meantime, ERAS group was given thermal insulation and team-based interventions based on the ERAS concept. The postoperative pain score, sleep quality, stress response and inflammatory factor levels, and anesthesia-related adverse reactions were compared between two groups. 
    Results The scores of the visual analogue pain scale (VAS) in both groups at rest showed a trend of increasing initially and then decreasing, which were lower in the ERAS group than in the control group, and the VAS scores in both groups were consistently lower during cough, which were lower in the ERAS group than in the control group (P＜0.05). At 24 h after surgery, N1, N2, and arousal index in both groups were higher than those before surgery, while N3, rapid eye movement sleep (REM), and sleep efficiency were lower than those before surgery. N1 and arousal index in ERAS group were lower than those in control group, while REM and sleep efficiency values were higher than those in control group (P＜0.05). At 24 h after surgery, the levels of norepinephrine (NE), cortisol (Cor), interleukin-6 (IL-6), and C-reactive protein (CRP) in the two groups were higher than those before surgery, while the levels of NE and IL-6 in the ERAS group were lower than those in the control group (P＜0.05). The dosage of propofol in ERAS group was lower than that in the control group, the awakening time was shorter, and the number of PCA compression was lower than that in the control group (P＜0.05). The incidence of adverse anesthetic reactions in ERAS group was lower than that in control group (P＜0.05). 
    Conclusion The application of ERAS in LC patients is conductive to reducing the postoperative pain level and inflammatory stress reaction and improving the sleep quality of patients.