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    25 August 2023, Volume 44 Issue 8
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    Study on the mechanism of BMSC-exos inhibiting hypertrophic scar through TGF-β1/smad2/3 signal pathway
    FAN Long-kun, LIU Chun-hui, ZHAO Yu-jia, MA Chao
    2023, 44(8):  876-882,899.  doi:10.3969/j.issn.1007-3205.2023.08.002
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    Objective To study the effect of bone marrow mesenchymal stem cell-derived exosomes (BMSC-exos) on the proliferation and migration ability of hypertrophic scar-derived fibroblasts (HSFs), and to verify the signaling pathway of BMSC-exos inhibiting collagen synthesis by HSFs. 
    Methods Bone marrow mesenchymal stem cells (BMSCs), BMSC-exos and HSFs in SD rats  were isolated and cultured. They were divided into blank control group (PBS group), experimental group (BMSC-exos group), and negative control group (exocrine mesenchymal stem cell concentrated supernatant group). The effect of exosomes on proliferation and migration of HSFs was detected by flow cytometry and cell scratch test. The mRNA expressions of TIMP-1, matrix metalloproteinase 1 (MMP-1), type Ⅰ collagen (Col-Ⅰ) and type Ⅲ collagen (Col-Ⅲ) in cells of the three groups were detected by fluorescence quantitative polymerase chain reaction (FQ-PCR) method. The protein levels of transforming growth factor-β1 (TGF-β1), α-smooth muscle actin (α-SMA) and Col-Ⅰ, and the phosphorylation level of smad2/3 in the three groups were detected by Western blot. 
    Results BMSC-exos inhibited the proliferation and migration ability of HSFs. The mRNA expression of TIMP-1, Col-Ⅰ, and Col-Ⅲ in BMSC-exos group were significantly decreased, while the mRNA expression of MMP-1 was significantly increased, showing significant difference (P＜0.05). The protein levels of TGF-β1, α-SMA and Col-Ⅰand the phosphorylation level of smad2/3 in BMSC-exos group were decreased significantly, suggesting significant difference (P＜0.05). 
    Conclusion BMSC-exos inhibit the proliferation and migration of HSFs, and inhibit the collagen synthesis of HSFs through TGF-β1/smad2/3 signal pathway, thus playing a role in inhibiting the development of hypertrophic scar.

    Effects of mandibular advancement device on inflammatory factors in palatopharyngeal tissue and plasma of OSAHS
    ZHAO Yuan, YANG Lin, SUN Chao-ran, YANG Ting, PENG Wen-tao, LIU Chun-yan
    2023, 44(8):  883-887,940.  doi:10.3969/j.issn.1007-3205.2023.08.003
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    Objective To investigate the effects of mandibular advancement device (MAD) on interleukin 1β (IL-1β), interleukin 6 (IL-6)and tumor necrosis factor α (TNF-α) in palatopharyngeal tissue and plasma of rabbits with obstructive sleep apnea hypopnea syndrome (OSAHS), and to provide a theoretical basis for the clinical treatment of OSAHS. 
    Methods A total of 30 male New Zealand rabbits were randomly divided into three groups. The OSAHS model was induced in OSAHS group and MAD group. The animals were equipped with MADs in MAD group and no treatment was given in the control group. All the animals were kept to sleep in supine position for 8 weeks (4-6 h/d). The expression of inflammatory factors in plasma was determined by enzyme linked immunosorbent assay (ELISA), and the expression of inflammatory factors in palatopharyngeal tissue was determined by immunohistochemistry (IHC) and real-time quantitative polymerase chain reaction (qRT-PCR). 
    Results The results of ELISA showed that the levels of IL-1β, IL-6 and TNF-α in OSAHS group were significantly higher than those in the control group and MAD group (P＜0.05). There was no significant difference in levels of IL-1β, IL-6 and TNF-α between the control group and MAD group (P＞0.05). The results of qRT-PCR showed that the gene expression of inflammatory factors in palatopharyngeal tissues was significantly higher in OSAHS group than in the control group and MAD group. IHC showed that positive cells for TNF-α in palatopharyngeal tissue were significantly higher in OSAHS group than those in the control group and MAD group. 
    Conclusion MAD can rescue the systemic and palatopharyngeal inflammation caused by OSAHS.

    Study on the correlation between omentin-1 level and degree of coronary heart disease
    MA Hui-huang, LI Yao-na, WANG Kang, YANG Hui-yu
    2023, 44(8):  888-893.  doi:10.3969/j.issn.1007-3205.2023.08.004
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    Objective To investigate the correlation of plasma omentin-1 with the degree of coronary heart disease (CHD). 
    Methods A total of 114 patients who underwent coronary angiography during hospitalization and were diagnosed with CHD were enrolled, including 43 cases of unstable angina (UA), 27 cases of stable angina (SA), and 44 cases of acute myocardial infarction (AMI). Another 29 patients without stenosis by coronary angiography during the same time period were selected as the control group. The general data and laboratory tests of patients were compared, and plasma omentin-1 levels were measured by enzyme-linked immunosorbent assay (ELISA). The coronary artery disease score (Gensini) was used to assess the degree of stenosis of coronary artery disease. Logistic regression was used to analyze the factors influencing the degree of stenosis of coronary artery lesions. Pearson correlation analysis was used to analyze the correlation between Gensini scores and plasma Omentin-1 levels. 
    Results Compared with the control group, the proportion of males, age and smoking in the UA and AMI groups were higher, while HDL-C was lower; The proportion of hypertension in the SA, UA and AMI groups was higher, the proportion of diabetes and LDL-C in the AMI group was higher, while the LVEF and omentin-1 were lower, suggesting significant difference (P＜0.05).Compared with the SA group, the proportion of males and smoking history in the UA and AMI groups was higher, and the LDL-C was higher, while LVEF and omentin-1 were lower in the AMI group, suggesting significant difference (P＜0.05). Compared with the UA group, the proportion of males, LVEF, and omentin-1 in the AMI group was lower, while the proportion of diabetes history and LDL-C were higher in the AMI group, suggesting significant difference (P＜0.05). Compared with the mild stenosis group, the proportion of diabetes and LDL-C were higher, while LVEF was lower in severe stenosis group, and omentin-1 was lower in the moderate and severe stenosis groups, with significant difference (P＜0.05). Compared with the moderate stenosis group, patients with severe stenosis had higher LDL-C and lower omentin-1, suggesting significant difference (P＜0.05).The results of logistic regression analysis showed that sex, smoking history, diabetes history, LDL-C, LVEF, and plasma omentin-1 were risk factors for coronary artery stenosis in patients with CHD(P＜0.05). Pearson correlation analysis showed that plasma omentin-1 levels in the CHD group were negatively correlated with Gensini score (r=-0.766,  P＜0.05). 
    Conclusion There is a negative correlation between plasma omentin-1 levels and degree of coronary artery disease, and high levels of plasma omentin-1 play a protective role in the pathogenesis of coronary artery disease. Therefore, plasma omentin-1 can be used for predicting the occurrence and progression of CHD, assessing the severity of coronary artery lesions, and becoming a potential biomarker for CHD progression. 

    Study on the expression of energy metabolism pathway TNAP in patients with type 2 diabetes and its mechanism of regulating adipocyte function
    LI Fang, LI Zhi-hong, YAO Ming-yan, YIN Fei
    2023, 44(8):  894-899.  doi:10.3969/j.issn.1007-3205.2023.08.005
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    Objective To investigate the expression of alkaline phosphatase (TNAP) in patients with type 2 diabetes mellitus (T2DM) and its mechanism of regulating uncoupling protein 1 (UCP1) / Irisin in adipocytes. 
    Methods A cohort study was performed on 80 outpatients and inpatients with T2DM in the First Central Hospital of Baoding City, and 80 healthy volunteers were collected as controls. The expression levels of serum TNAP and energy metabolism molecules UCP1 and Irisin in the two groups were detected by enzyme linked immunosorbent assay （ELISA）. In terms of cytological test, 3T3-L1 adipocytes were divided into three groups: control group, NC group (transfected with NC plasmid) and experimental group (transfected with Si TNAP plasmid), and 3T3-L1 adipogenic differentiation was induced. The adipogenic differentiation ability of cells in each group was detected by oil red O staining, and the glucose consumption level and triglyceride consumption level of cells in each group were detected. The expression levels of energy metabolism pathway molecule UCP1 and Irisin mRNA were detected by qPCR, and the protein expression levels of UCP1 and Irisin were detected by Western blot. 
    Results For cohort study, compared with the control group, the expression level of serum TNAP in the experimental group increased, while the expression levels of UCP1 and Irisin decreased significantly (P＜0.01). Cytological test showed that compared with the control group, the adipogenic capacity of cells in the experimental group increased, and glucose consumption and triglyceride production increased significantly (P＜0.01). qPCR results showed that compared with the control group, the expression levels of UCP1 and Irisin mRNA in the experimental group increased (P＜0.01), and Western blot results showed that the expression levels of UCP1 and Irisin protein in the experimental group increased (P＜0.01). 
    Conclusion TNAP may affect the energy metabolism of adipocytes by inhibiting the energy metabolism pathway UCP1/Irisin, and participate in the occurrence and development of T2DM.

    Efficacy and safety of transcranial alternating current stimulation in the treatment of primary insomnia complicated by anxiety
    ZHAO Xin, WU Han, WANG Dan, JIN Wen-qing, WANG Wen, REN Yan-ping
    2023, 44(8):  900-904,928.  doi:10.3969/j.issn.1007-3205.2023.08.006
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    Objective To investigate the efficacy and safety of transcranial alternating current stimulation (tACS) in the treatment of primary insomnia complicated by anxiety. 
    Methods Sixty-two patients with primary insomnia were randomly divided into treatment group and control group. The patients in the treatment group received real tACS while the patients in the control group were treated with sham tACS. The treatment session was 20 times in both groups. The treatment site was prefrontal and bilateral mastoid regions, with a frequency of 77.5 Hz and an intensity of 15 mA. Pittsburgh sleep quality index (PSQI) and Hamilton Anxiety Scale (HAMA) were used to evaluate the clinical symptoms at baseline, and at the end of treatment (4 weeks) and follow-up (8 weeks). Adverse reactions were assessed using Treatment Emergent Symptom Scale and recorded. 
    Results The scores of PSQI and HAMA in the treatment group and the control group at baseline, 4 weeks after treatment and 8 weeks after follow-up were compared using repeated measurement analysis of variance. The total scores of PSQI and HAMA in the two groups decreased gradually with the extension of treatment and follow-up time (Ptime＜0.05). The decrease in the treatment group was greater than that in the control group (Pgroup＜0.05), and the effect of treatment increased with the extension of observation time (Pinteraction＜0.05). The total score of HAMA in both groups decreased gradually with the extension of treatment and follow-up time (Ptime＜0.05), and the effect of treatment increased with the extension of observation time (Pinteraction＜ 0.05); However, there was no significant difference between two groups (Pgroup＞0.05). 
    Conclusion tACS is effective and safe in the treatment of primary insomnia complicated by anxiety. It can be used as a new option for the treatment of primary insomnia, especially for those patients with anxiety. 

    Comparative analysis of mid-term therapeutic effects of two kinds of one-stage radical treatment of tetralogy of Fallot
    SONG Hai-long, ZHANG Hui-jun
    2023, 44(8):  905-909,914.  doi:10.3969/j.issn.1007-3205.2023.08.007
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    Objective To compare the mid-term surgical effects of the two kinds of one-stage radical treatment of tetralogy of Fallot. 
    Methods A retrospective analysis was performed on 101 patients with tetralogy of Fallot. According to the way of right ventricular outflow tract stenosis, the patients were divided into pulmonary valve transannular patch combined with autologous pericardium to make a single pulmonary artery valve group (group A, n=49) and simple trans-annular pulmonary artery patch group (group B, n=52). The clinical effects after one-stage radical treatment and at 5 years after surgery were compared between two groups. 
    Results After one-stage radical treatment, the duration of ventilator assistance and length of intensive care unit (ICU) stay in group A were shorter than those in group B, and the degree of pulmonary valve regurgitation was better than that in group B (P＜0.05). At 5 years after follow-up, there were no significant differences in postoperative survival rate and surgical reintervention rate between two groups (P＞0.05). 
    Conclusion One-stage radical treatment of tetralogy of Fallot with pulmonary valve transannular patch combined with autologous pericardium to make a single artificial pulmonary artery valve is better than that with transannular patch in shortening the duration of ventilator assistance and length of ICU stay, but there are no statistically significant differences in the 5-year survival rates after surgery and surgical re-intervention rates of the two groups. 

    Feasibility analysis of carbon nanoparticles combined with intraoperative palpation in selective central neck dissection for unifocal cN0 T1-T2 papillary thyroid carcinoma
    LIANG Xin-ke, WANG Peng-fei, JIANG Xia-yun, LIU Yang, ZHAO Rui-li
    2023, 44(8):  910-914.  doi:10.3969/j.issn.1007-3205.2023.08.008
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    Objective To investigate the feasibility of frozen lymph node biopsy with carbon nanoparticles combined with palpation in selective central neck dissection for unifocal cN0 T1-T2 papillary thyroid cancer (PTC) based on the biopsy results. 
    Methods A total of 217 patients with unifoal cN0 T1-T2 PTC initially treated in the Fourth Hospital of Hebei Medical University were selected. Lymph nodes with carbon black staining and palpated hard lymph nodes without black staining were sent for frozen pathology, and the remaining dissected tissues were sent for paraffin pathology to analyze lymph node metastasis of the three specimens in the central neck, and matched into two groups for comparison. The lymph nodes with carbon nanoparticles black staining were defined as the control group. The lymph nodes with carbon nanoparticles black staining combined with palpation were defined as the experimental group. The detection rate and false negative rate between the two groups, as well as the influencing factors of lymph node metastasis in the remaining dissected tissues in the experimental group, were compared. 
    Results The detection rate, accuracy rate and false negative rate of intraoperative lymph node biopsy were 96.8%, 95.2% and 11.6% in control group, respectively, and 97.7%, 98.6% and 3.4% in the experimental group, respectively. There were significant differences in accuracy rate and false negative rate between two groups (χ2=3.958， 4.250, all P＜0.05). Multivariate analysis of the experimental group showed that intraoperative frozen lymph node metastasis and the number of negative intraoperative frozen lymph nodes were independent factors influencing metastasis of the remaining dissected tissue in the central neck (OR values=14.195， 0.652, all P＜0.01).
    Conclusion In the treatment of unifocal cN0 T1-T2 PTC in the central neck, lymph nodes with carbon black staining and palpated hard lymph nodes sent for frozen biopsy can ensure high detection rate and accuracy rate, and low false negative rate. Central neck dissection should be carried out when intraoperative lymph nodes frozen are found to have metastasis. The fewer negative numbers of frozen lymph nodes, the more vigilant doctors should be of lymph node metastasis in the remaining central region.

    Observation of the effect of alendronate sodium combined with calcium supplements in preventing secondary fractures after PVP for OVCF
    ZHANG Kai, ZHANG Ying-min, KANG Shao-ying, YANG Wu-yan, ZHANG Jin-pan
    2023, 44(8):  915-919,933.  doi:10.3969/j.issn.1007-3205.2023.08.009
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    Objective To investigate the effect of alendronate sodium combined with calcium supplements in preventing secondary fractures after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures(OVCF). 
    Methods In total, 128 patients with OVCF undergoing PVP were selected. According to different antiosteoporosis medication schemes after operation, patients were divided into the control group (calcium carbonate D3+calcitriol, n=71) and the research group (calcium carbonate D3+calcitriol+alendronate sodium, n=57). The bone metabolic indicators, imaging parameters and incidence of secondary vertebral fracture in the two groups during different periods were analyzed.  
    Results The levels of serum type Ⅰ collagen carboxy terminal peptide β special sequence （β-CTX） and type Ⅰ procollagen N-terminal prepetide (PINP) in both groups showed a downward trend with time, and the downward trend of the research group was more obvious than that of the control group; There were significant differences in the interaction between groups, time points, and time points between groups (P＜0.05). The height ratio of the anterior edge of the injured vertebral body, the Cobb angle in the sagittal plane, and the bone density of the femoral neck in both groups showed an increasing trend with time. The increasing trend in the research group was more obvious than that in the control group, and there were significant differences in the interaction between groups, time points, and time points between groups (P＜0.05).The total incidence of postoperative secondary fracturesof vertebral body in the research group was lower than that in the control group (P＜0.05). 
    Conclusion Combination of alendronate sodium and calcium supplements can improve bone metabolism, increase bone mineral density, and reduce the incidence of secondary vertebral fractures in patients undergoing PVP. Therefore, it is worthy of clinical promotion. 

    Construction of postoperative prediction model for colorectal cancer patients based on preoperative NLR and NHR
    YANG Chi, LUO Chang-jiang
    2023, 44(8):  920-928.  doi:10.3969/j.issn.1007-3205.2023.08.010
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    Objective To analyze and explore the risk factors affecting the prognosis of CRC patients based on the preoperative neutrophil-to-lymphocyte ratio (NLR) and neutrophil-to-high-density lipoprotein ratio (NHR), and to establish a prognostic prediction model. 
    Methods The clinical data of 160 patients who underwent radical resection of CRC in the Department of General Surgery, the Second Hospital of Lanzhou University were collected, and 137 patients with colorectal polyps or adenomas were selected as controls. Nonparametric rank-sum tests were used to determine baseline-level differences between groups. Receiver operating characteristic (ROC) curve drawn by SPSS 26.0 software was used to ascertain the optimal cut-off value of NLR and NHR. Multivariate analyses of overall survival (OS) and disease-free survival (DFS) were performed using COX hazard regression models. Survival analysis was performed using the Kaplan-Meier method. R4.2.1 software was used to build the Nomogram model and evaluate its differentiation, consistency, and decision curve. 
    Results ①The baseline levels of NLR (P＜0.001) and NHR (P=0.004)in the cancer group were significantly higher than those in the polyp or adenoma group. ②The optimal cut-off values of NLR and NHR for OS were 3.26 and 2.95, respectively. ③In terms of clinicopathological features, NLR was only statistically significant with tumor site (P=0.002); there was significant difference between NHR and total cholesterol (P=0.04) and Ki67 protein (P=0.042). ④Multivariate COX analysis showed that CEA (P=0.036), NLR (P=0.001)，  and NHR (P＜0.039) were the independent risk factors for OS; NHR (P=0.007) and lymph node (P=0.023) invasion were the independent risk factors for DFS. ⑤Survival analysis showed that the prognosis of patients in the low NLR and NHR group was better than that of the high NLR and NHR group(P＜0.05). ⑥Two nomogram models built around OS and DFS had good accuracy and practicability in long-term survival prediction, which were consistent with the evaluation of different iation and consistency, and decision curve analysis. 
    Conclusion The postoperative prediction model for OS and DFS of CRC patients constructed based on NLR and NHR integrates the effects of factors such as inflammation, immunity and cholesterol metabolism on the behavioral characteristics of malignant tumors, and is more comprehensive and balanced in the prognosis evaluation.

    Comparison of efficacy between sodium acetate Ringer′s solution and sodium lactate Ringer′s solution in patients with traumatic hemorrhagic shock
    WANG Jia-hai, YANG Chun, WANG Gui-lin
    2023, 44(8):  929-933.  doi:10.3969/j.issn.1007-3205.2023.08.011
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    Objective To explore the efficacy of sodium acetate Ringer′s solution and sodium lactate Ringer′s solution in patients with traumatic hemorrhagic shock (THS). 
    Methods A total of 54 patients with THS were selected as the research subjects and randomly divided into an observation group (n=27) and a control group (n=27) using a random number table method.The observation group was resuscitated with sodium acetate Ringer′s solution, while the control group was resuscitated with sodium lactate Ringer′s solution. The resuscitation methods all involved restricted liquid resuscitation. Duration of resuscitation, total infusion volume, and mean arterial pressure (MAP) were compared between two groups. Peripheral venous blood was drawn before resuscitation, at 30 min after fluid resuscitation and at 1 h after resuscitation to detect the levels of interleukin (IL)-4, IL-6, IL-10 and tumor necrosis factor α (TNF-α) and lactic acid (Lac)value of arterial blood, peripheral platelet (PLT) count, plasma prothrombin time (PT), and fibrinogen (FIB) level. 
    Results The duration of resuscitation and total infusion volume in the observation group were significantly shorter than those in the control group, and MAP was significantly lower than that in the control group (P＜0.05). The Lac levels in the observation group were gradually decreased compared to those in the control group, and there was a significant difference in the interaction between groups, time points, and time points between groups (P＜0.05). The PLT and FIB of the two groups showed a gradually decreasing trend, while the PT showed a gradually increasing trend; the difference between time points was statistically significant (P＜0.05), but there was no significant difference in the interaction between groups or time points between groups (P＞0.05). The levels of IL-4, IL-6, IL-10, and TNF-α in both groups showed a gradual upward trend; the levels of IL-4 and IL-10 in the observation group were higher, but the levels of IL-6 and TNF-α were lower, as compared with those in the control group, and there was a significant difference in the interaction between groups and time points (P＜0.05). There was no significant difference in the interaction between time points between groups (P＞0.05). 
    Conclusion Early use of sodium acetate Ringer′s solution in patients with THS can better inhibit the expression of inflammatory factors in peripheral blood compared with sodium lactate Ringer′s solution, further reducing blood Lac levels. 

    Changes of serum Leptin and CCL26 in children with recurrent wheezing and their correlation with asthma predictive index
    LI Jia, HE Xia
    2023, 44(8):  934-940.  doi:10.3969/j.issn.1007-3205.2023.08.012
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    Objective To analyze the changes of serum leptin (Leptin) and chemokine ligand 26 (CCL26) in children with recurrent wheezing, and to explore their correlation with asthma predictive index (API). 
    Methods A total of 178 children with recurrent wheezing were selected as the observation group, and they were divided into API positive group (n=92) and API negative group (n=86) according to API, and they all received standardized management. Another 89 healthy children undergoing physical examination during the same period were selected as the control group. Serum Leptin and CCL26 levels were detected in the API positive group and API negative group at the acute stage, remission stage, and in control group at the time of enrollment. The correlation between serum Leptin， CCL26 levels and API and the influencing factors of API positivity in children with recurrent wheezing were analyzed. The children with recurrent wheezing were followed up for 1 year after discharge, and the serum levels of Leptin and CCL26 in the children with recurrent wheezing were compared during the follow-up period. 
    Results Serum Leptin and CCL26 levels in the observation group were higher than those in the control group at acute stage and remission stage (P＜0.05). Serum Leptin and CCL26 levels of API positive group were higher than those of API negative group at acute stage and remission stage (P＜0.05). Serum Leptin and CCL26 levels in API positive and API negative groups were higher at acute stage than at remission stage (P＜0.05). The levels of serum Leptin (r=0.480/0.401, P＜0.001) and CCL26 (r=0.481/0.512, P＜0.001) at acute stage and remission stage were positively correlated with API. After the binary logistic regression model was adjusted for premature infants, allergic dermatitis, tobacco exposure history, and maternal active or passive smoking during pregnancy, atopy, high expression of serum Leptin and CCL26 at acute stage still increased the risk of API positivity (P＜0.05). Logistic regression model was established: logit(P)=-7.005+1.020×atopic+1.098×serum Leptin level in acute phase+1.058×serum CCL26 level at acute stage. The Hosmer-Lemeshow goodness of fit test showed that χ2=4.249, DF=6, P=0.452, with goodness of fit. All 178 children with recurrent wheezing were followed up for 1 year, 18 children had wheezing again (10.11%), and 160 children did not have wheezing (89.89%). The positive rate of API in children with wheezing was higher than that in children without wheezing, and the levels of serum Leptin and CCL26 at acute stage and remission stage were higher than those without wheezing (P＜0.05). 
    Conclusion Serum Leptin and CCL26 significantly increase in children with recurrent wheezing. They are closely related to API and are independent risk factors for API positivity.

    Predictive value of blood lactate and procalcitonin clearance rates for prognosis in patients with burn shock
    XU Qi-liang, CHEN Xiao-ming, DAI Qiang, SHI Wen-juan, ZHOU Jian, JIANG Yi
    2023, 44(8):  941-944,951.  doi:10.3969/j.issn.1007-3205.2023.08.013
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    Objective To explore the predictive value of early blood lactate clearance rate and procalcitonin clearance rate (PCTc) for prognosis of patients with burn shock. 
    Methods A total of 96 patients with burn shock admitted to Liyang People′s Hospital were selected, and the 28-day survival during hospitalization was calculated. The clinical data of the survival group and the death group were compared. Multivariate Logistic analysis of factors affecting the prognosis of patients was performed. The predictive value of early blood lactate clearance rate and PCTc for death of patients with burn shock was analyzed. 
    Results The mortality rate of burn shock patients was 38.54%. The proportion of inhalation injury, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score and sequential organ failure assessment (SOFA) score in the death group were higher (P＜0.05), while the albumin, 6-h lactate clearance rate and 6-h PCTc in the death group were lower (P＜0.05). Logistic regression analysis showed that APACHE Ⅱ score (OR=2.804, 95%CI: 1.037-4.085), SOFA score (OR=2.930, 95%CI: 1.256-4.978), 6-h blood lactate clearance rate (OR=3.089, 95%CI: 1.843-6.012), and 6-h PCTc (OR=3.428, 95%CI: 2.157-7.483) were all risk factors affecting death of burn shock patients (P＜0.05). ROC analysis showed that the AUC of combination of 6-h lactate clearance rate and 6-h PCTc in predicting the death of burn shock patients was 0.816 (95%CI: 0.721-0.891), which was higher than that of 6-h lactate clearance rate ［0.654 (95%CI: 0.551-0.746)］ and 6-h PCTc ［0.703 (95%CI: 0.602-0.785)］ in predicting the death of burn shock patients alone (P＜0.05). 
    Conclusion Early blood lactate clearance rate and PCTc have high predictive value for death of burn shock patients. 

    Meta-analysis of efficacy of indocyanine green in identifying sentinel lymph nodes in melanoma
    WANG Yi-xin, ZHANG Run-dong, CAO Meng, ZHANG Guo-qiang, WANG Yan
    2023, 44(8):  945-951.  doi:10.3969/j.issn.1007-3205.2023.08.014
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    Objective To systematically assess the differences between indocyanine green (ICG) and 99Tcm in identification rates of sentinel lymph node (SLN) in melanoma by meta-analysis, and to provide an evidence-based reference for the clinical selection of lymphatic tracing methods. 
    Methods A systematic search of Chinese and English databases was performed to screen out all articles that met the inclusion criteria. Forest plots were drawn and heterogeneity was analyzed using I2 and Q test as indicators, and the corresponding model was used to analyze pooled effect sizes. Publication bias was assessed using Egger′s test, and sensitivity analysis was used to assess whether the results were stable and reliable. 
    Results A total of 15 studies were included. The final results showed that there was no significant difference in SLN identification rate between ICG and 99Tcm in melanoma (P＞0.05). Sensitivity analysis showed that the results were stable and reliable. Egger′s test showed that there was no publication bias. 
    Conclusion There is no significant difference between ICG and 99Tcm in identifying SLN in melanoma, but ICG is non-radioactive, which is safer and easier to perform. Therefore, it is expected to replace 99Tcm as an important means of identifying SLN in melanoma.

    The value of ultrasonic index combined with Framingham score in predicting cardiovascular risk in patients with ankylosing spondylitis
    HU Zhi-shuang, WANG Jian-mei, ZHAO Yan-liang
    2023, 44(8):  952-955,966.  doi:10.3969/j.issn.1007-3205.2023.08.015
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    Objective To explore the value of ultrasonic index combined with Framingham score in predicting cardiovascular risk in patients with ankylosing spondylitis (AS). 
    Methods Retrospective research methods were used, and 120 patients with AS treated in our hospital were selected. During the follow-up period, 48 patients with cardiovascular involvement were selected as the observation group, and 72 patients without cardiovascular involvement were selected as the control group. The clinical data, carotid intima thickness, carotid femoral pulse wave velocity (PWV), Framingham score, bath ankylosing spondylitis disease activity index (BASDAI) score and bath ankylosing spondylitis function index (BASFI) score of the two groups were compared. 
    Results The age and course of the patients in the observation group were greater or longer than those in the control group, and the long-term hormone treatment rate in the observation group was higher than that in the control group (P＜0.05). The carotid intima thickness, carotid femoral PWV, Framingham score, BASDAI score and BASFI score in the observation group were significantly higher than those in the control group (P＜0.05). The course of disease, long-term hormone treatment, carotid intima thickness, and Framingham score were the influencing factors of cardiovascular involvement in patients with AS (P＜0.05). The area under the receiver operating characteristic (ROC) curve (AUC) of this model in predicting cardiovascular involvement was 0.826 (95%CI：0.784-0.901, P＜0.05), and the sensitivity and specificity were 70.0% and 81.5% respectively. 
    Conclusion The occurrence of cardiovascular involvement in patients with AS is affected by the course of disease, long-term hormone treatment and other factors. In the meantime, carotid intima thickness, Framingham score and other factors in combination have good value in predicting the occurrence of cardiovascular involvement.

    Preliminary clinical study of preoperative evaluation of hepatic fibrosis in patients with hepatocellular carcinoma by shear wave dispersion
    WEN Li, ZHANG Tao, WANG Kun
    2023, 44(8):  956-960.  doi:10.3969/j.issn.1007-3205.2023.08.016
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    Objective To evaluate the clinical application value of shear wave dispersion (SWD) in preoperative evaluation of liver fibrosis in patients with hepatocellular carcinoma (HCC). 
    Methods A total of 152 patients with HCC from Special Care Hospital of Hebei Province and the Affiliated Hospital of Binzhou Medical University who planned to undergo hepatectomy were enrolled. SWD of liver parenchyma > 2 cm away from the tumor lesion was performed, and the median value was taken after 10 measurements. Hepatic parenchyma fibrosis was graded according to Scheuer standard, and the diagnostic value of SWD was analyzed by receiver operating characteristic (ROC) curve. 
    Results Postoperative pathological examination of liver parenchyma around tumor revealed S1 stage in 13 cases, S2 stage in 31 cases, S3 stage in 47 cases and S4 stage in 61 cases.  The SWD of liver parenchyma showed good intraobserver and interobserver consistency. SWD was positively correlated with liver fibrosis grading (r=0.570, P＜0.001). The median SWD of liver was 11.83 m/s·kHz-1，13.58 m/s·kHz-1，15.17 m/s·kHz-1， and 17.35 m/s·kHz-1 for S1-S4, respectively, and there was significant difference in SWD of the liver among all groups (P＜ 0.05). The areas under ROC curves of SWD in diagnosis at ≥S2, ≥S3,＝S4 stage were 0.875, 0.812 and 0.784, respectively. With 12.6 m/s·kHz-1 as the optimal cutoff value, the sensitivity and specificity of SWD in diagnosing S≥2 were 83.70% and 77.78%, respectively. With 13.4 m/s·kHz-1 as the optimal cutoff value, the sensitivity and specificity of S≥3 were 74.13% and 72.88%, respectively. With 14.6 m/s·kHz-1 as the optimal cutoff value, the sensitivity and specificity of S=4 were 83.95% and 62.00% respectively. 
    Conclusion WD can noninvasively measure SWD value of liver parenchyma in HCC patients, which can reflect the degree of liver parenchyma fibrosis, providing a new method for preoperative quantitative evaluation of liver fibrosis stage. 

    Anatomical features and variations of intracranial vertebrobasilar system in the healthy subjects: An analysis with 3.0T MRA
    WANG Ning, LIU Huai-jun, WU Shi-chao, ZHANG Xiao-jie, WANG Yong
    2023, 44(8):  961-966.  doi:10.3969/j.issn.1007-3205.2023.08.017
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    Objective To analyze the normal anatomical features of vertebrobasilar system (VBS), variation types and their relationship in the healthy subjects by 3.0T magnetic resonance angiography (MRA). 
    Methods The original MRA images of 120 healthy volunteers were collected for maximum intensity projection (MIP) reconstruction, and normal anatomical features and variations of VBS were observed and recorded. The diameters of branches of VBS were measured and analyzed. 
    Results Normal VBS accounted for 25% in healthy people. Types of variation included absence of the posterior inferior cerebellar artery (PICA), the anterior inferior cerebellar artery (AICA) and the posterior communicating artery (PCoA), repeated mutation of AICA and superior cerebellar artery (SCA), double origin of the posterior inferior cerebellar artery (DOPICA) on the right side, early bifurcation of SCA, anomalous origin of SCA,vertebral artery hypoplasia (VAH)，fetal posterior cerebral artery (fPCA) and basilar artery (BA) fenestration. The diameters of BA and right PCA of males were greater than those of females (P＜0.05), but there were no statistically significant difference in diameters of other blood vessels in different genders (P＞0.05). The most frequent variation was absence of the PICA, and absence of right PICA was more frequent than left PICA (P＜0.05). In cases with absence of PICA or AICA on one side, the proportion of well-developed or moderately-developed ipsilateral AICA or PICA was higher (P＜0.05). The VAH was more frequent on the right side (P＜0.05). The patency rate of bilateral PCoA in <45-year-old group were higher than ≥45-year-old group (P＜0.05). 
    Conclusion The anatomical variation of the VBS is common and diverse, there is a compensatory relationship between several absent vessels, and the patency of PCoA is associated with age. These variations should warrant attention in the diagnosis and treatment of cerebrovascular diseases. 

    Comparision of the clinical effect of endotracheal intubation via preinflated and reinflated BlockBuste laryngeal mask
    HU Zhen-fa, SU Kai, GAO Xue, TIAN Ming
    2023, 44(8):  967-971.  doi:10.3969/j.issn.1007-3205.2023.08.018
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    Objective To observe the clinical effect of endotracheal intubation via preinflated and reinflated BlockBuster laryngeal mask airway (LMA). 
    Methods A total of 52 patients were selected for intubation and surgery under general anesthesia, and all patients underwent preinflation and reinflation of the LMA cuff. After induction of intravenous anesthesia, a LMA was placed after the jaw had relaxed, a visual flexible endoscope was preinflated to check the grading and position of the glottis exposure, and the tip of the tracheal catheter was guided into the trachea (the flexible endoscope did not enter the glottis). After reinflating and inserting the LMA, the cuff was reflated until the pressure inside the cuff was 60 cmH2O. The other procedures were the same as those of preinflation. The grading of glottic exposure and glottic position under the visual flexible endoscope via the LMA were observed and recorded. The number and success rate of endotracheal intubation via LMA, the surface blood staining during the removal of the LMA after surgery, the blood staining at the end of the tracheal catheter during tracheal extubation, and the occurrence of adverse reactions at 24 h after surgery were recorded. 
    Results Forty patients (76.9%) had glottic exposure grade 1 and grade 2 during preinflation of the LMA cuff; Forty-eight patients (92.3%) had glottic exposure grade 1 and grade 2 during the reinflation of the LMA cuff, which were higher than those during the preinflation of the LMA cuff (P＜0.05). In the case of reinflation of the MA cuff, the proportion of glottis position in the median section was higher than that of preinflation of the LMA cuff (P＜0.05). During the preinflation of the LMA cuff, 43 patients were successfully intubated via the LMA at the first attempt, and intubation was failed in 9 patients. Among them, 3 patients were successfully intubated at the second attempt after adjusting the glottis position, and intubation was failed in 6 patients due to the high glottis position. When the LMA cuff was reinflated, 50 patients were successfully intubated via the LMA at the first attempt, and intubation was failed in 2 patients, of whom 1 case was successfully intubated at the second attempt after the rotation of the tracheal catheter. The first-attempt success rate of endotracheal intubation via LMA during the reinflation of the LMA cuff was higher than that during the preinflation of LMA cuff (P＜0.05). 
    Conclusion When endotracheal intubation is carried out via BlockBuster LMA, the method of cuff reinflation can significantly improve the glottis exposure grade, the conditions of intubation, and the first-attempt success rate of endotracheal intubation.

    Effect of micro-tab diuretics on the homeostasis, postoperative tissue edema and hypoxemia in patients undergoing shoulder arthroscopy for rotator cuff injury under general anesthesia
    LI Jie-lian
    2023, 44(8):  972-977.  doi:10.3969/j.issn.1007-3205.2023.08.019
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    Objective To investigate the effects of micro-tab diuretics on the homeostasis, postoperative tissue edema and hypoxemia in patients undergoing shoulder arthroscopy for rotator cuff injury under general anesthesia. 
    Methods A total of 78 patients undergoing shoulder arthroscopy for rotator cuff injury under general anesthesia were selected, and randomly divided into the control group (n=39)and an observation group (n=39). Thirty minutes before the end of the operation, the observation group was given furosemide 2 mg intravenously and the control group was given an equal amount of saline intravenously. The incidence of hypoxemia, intraoperative condition (intraoperative infusion volume, intraoperative lavage volume, intraoperative sufentanil dosage, intraoperative propofol dosage, intraoperative vasoactive drug dosage, and duration of operation), blood gas analysis results ［arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), pH value］ at the time of tracheal intubation, at the end of operation and 30 min after operation, electrolytes(calcium ions, potassium ions, sodium ions, chloride ions), blood glucose concentration, relative blood volume (RBV), and tissue edema at the end of operation, and at 30 min, 60 min, and 8 h after surgery were compared between two groups. 
    Results There was no statistically significant difference in intraoperative infusion volume, intraoperative lavage volume, intraoperative sufentanil dosage, intraoperative propofol dosage, and duration of operation between two groups (P＞0.05). PaO2, PaCO2, and pH value did not change with time, and there was no significant difference in interactions between groups, time points and time points between groups (P＞0.05). Calcium ion, potassium ion, sodium ion, chloride ion, RBV, and blood glucose concentration did not change with time, and there was no significant difference in interactions between groups, time points and time points between groups (P＞0.05). The tissue thickness from the surface of the second rib to the skin on the healthy side of the two groups did not change with time, and there was no significant difference in interactions between groups, time points and time points between groups (P＞0.05). The tissue thickness from the surface of the second rib to the skin on the affected side of the midclavicular line showed a trend of first increasing and then decreasing over time, and there was no significant difference in interactions between groups, time points and time points between groups (P＜0.05). The tissue thickness of the surface of the second rib to the skin on the affected side of the midclavicular line was greater than that of the healthy side during the same period in the two groups at the end of operation, and at 30 min and 60 min after surgery, and the tissue thickness of the surface of the second rib to the skin on the affected side of the midclavicular line was greater than that of the healthy side during the same period in the observation group at 8 h after surgery (P＜0.05). 
    Conclusion Microfurosemide can prevent hypoxemia and reduce postoperative tissue edema in patients undergoing shoulder arthroscopy, and is beneficial for maintaining homeostasis.