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    25 November 2023, Volume 44 Issue 11
    Lavender essential oil improves post-stroke depression in rats by inhibiting apoptosis and up-regulating BDNF/proBDNF expression in hippocampus
    CHENG Hui-fang, LIU Zhi-gang, LEI Xue-heng, ZHANG Zhao-qing
    2023, 44(11):  1248-1254.  doi:10.3969/j.issn.1007-3205.2023.11.002
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    Objective To explore the effect of lavender essential oil on the expression of brain-derived neurotrophic factor (BDNF)/pro-brain-derived neurotrophic factor (proBDNF) and the recovery of depression in the ischemic hippocampus of rats after stroke. 
    Methods A total of 45 male SD rats were randomly divided into a control group, a model group, and an intervention group, with 15 rats in each group. Rats in the control group raised under conventional conditions were subjected to intraperitoneal injection of physiological saline as a control experiment. In the model group, middle cerebral artery occlusion/reperfusion (MCAO/r) model was established and rats were given intraperitoneal injection of physiological saline. In the intervention group, rats were given lavender essential oil and exercise intervention after MCAO/r. The anxiety and depression behaviors of rats were tested through outdoor venues, forced swimming, and sucrose preference. The levels of oxidative stress biomarkers in rats were detected using commercial kits, and the expression of BDNF/proBDNF signaling pathway was analyzed by reverse transcription-polymerase chain reaction (RT-PCR). The ratio of BDNF/proBDNF in CA1 region, CA3 region and dentategyrus (DG) regions of ischemic hippocampal tissue was analyzed by Western blotting (WB). The correlation analysis was performed between the BDNF/proBDNF ratio and behavioral tests for depression. Neurobehavioral (sensory and motor) testing was used to detect neural defects in rats. 
    〖MM(〗〖HT6SS〗〖CM10-8〗河北医科大学学报第44卷第11期〖MM)〗
    Results The stationary time of the model group was longer than that of the control group, and the sucrose preference, climbing frequency, and exercise distance were lower than those of the control group. The static time of the intervention group was longer than that of the control group and shorter than that of the model group, while the sucrose preference, climbing frequency, and exercise distance were lower than those of the control group and higher than those of the model group (P<0.05). The levels of superoxide dismutase (SOD), glutathione,r-glutamyl cysteingl + glycine (GSH) and fluoride resistant acid phosphatase (FRAP) in the model group were lower than those in the control group, and the levels of malondialdehyde (MDA) were higher than those in the control group. The levels of SOD, GSH and FRAP in the intervention group were higher than those in the model group, while the level of MDA was lower than that in the control group and the model group (P<0.05). The mRNA expressions of BDNF, neurotrophic receptor (TrkB) and microtubule-associated protein (DCX) in the model group were lower than those in the control group, while the mRNA expressions of proBDNF and neurotrophic receptor P75 (p75NTR) were higher than those in the control group. The mRNA expressions of BDNF, TrkB, and DCX in the intervention group were lower than those in the control group and higher than those in the model group, while the mRNA expressions of proBDNF and p75NTR were higher than those in the control group but lower than those in the model group (P<0.05). The BDNF/proBDNF ratio in the CA1, CA3, and DG regions of the model group was lower than that of the control group, which was higher in the intervention group than in the model group (P<0.05). The BDNF/proBDNF ratio was negatively correlated with resting time during forced swimming (r=-0.74, P<0.01), while the BDNF/proBDNF ratio was positively correlated with sucrose preference (r=0.63, P<0.01). The neurological deficit score in the model group was higher than that in the control group, which was higher in the intervention group than in the control group and lower than that in the model group (P<0.05). The expression of Bcl-2 related X protein (Bax)/B-cell lymphoma-2 gene (Bcl-2) in the model group was higher than that in the control group, while the expression of Bcl-2 was lower than that in the control group. The expression of Bax and Bax/Bcl-2 in the intervention group was lower than that in the model group, while the expression of Bcl-2 was higher than that in the model group (P<0.05). 
    Conclusion Lavender essential oil may improve neurological function, enhance endogenous antioxidant defense, inhibit oxidative stress pathway and nerve apoptosis by regulating the relative level of BDNF and proBDNF, and then improve the depressive behavior of PSD rats.

    The relationship of expression of MUC and EGFR in gastric cancer, gastric precancerous state and mucosal lesions with Hp infection
    GU Pei, CHANG Li-li, NIU Xiao-lei, ZHANG Hai-ling, WANG Jun-li, LIU Hong-fen
    2023, 44(11):  1255-1259.  doi:10.3969/j.issn.1007-3205.2023.11.003
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    Objective To investigate the relationship between the expression of mucoprotein2 (MUC2), mucoprotein6 (MUC6) and epidermal growth factor receptor (EGFR) in gastric cancer, precancerous state and mucosal lesions with Helicobacter pylori (Hp) infection. 
    Methods Fifty patients with gastric adenocarcinoma and 50 patients with precancerous state and lesions were selected. Pathological examination showed atrophy of glands, dysplasia or intestinal metaplasia. In addition, 50 patients with chronic non-atrophic gastritis under gastroscope were selected as the control group. Pathology showed no gland atrophy, dysplasia, or intestinal metaplasia. EGFR, MUC2 and MUC6 expression levels were detected by immunohistochemistry, and rapid urease test and histologically modified Giemsa staining were used to detect Hp. The relationship between the expression of EGFR, MUC2, MUC6 and Hp infection was analyzed. 
    Results Compared with the control group, the positive rates of MUC2, Hp, and EGFR in the gastric cancer group and precancerous state and lesion group were higher, while the positive rates of MUC6 were lower, with statistically significant differences (P<0.05). Compared with the precancerous state and lesion group, the gastric cancer group had a higher positive rate of MUC2, Hp, and EGFR, and a lower positive rate of MUC6, with a statistically significant difference (P<0.05). The positive rates of MUC2 and EGFR in the Hp positive gastric cancer group and precancerous state and lesion group were higher than those in the Hp negative group, while the positive rates of MUC6 were lower than those in the HP negative group, with statistical significance (P<0.05). The positive expression rates of MUC2 and EGFR were positively correlated with Hp infection, while the positive expression rates of MUC6 were negatively correlated with Hp infection (P<0.05). 
    Conclusion Hp infection can increase the expression of MUC2 and EGFR in vivo and decrease the expression of MUC6, which plays a very important role in the development of gastric cancer. Detecting Hp and the expression of MUC2, MUC6, EGFR can identify high-risk groups of gastric cancer.

    The expression profile analysis of microRNAs in oral lichen planus tissues and the serological expression of three miRNAs
    ZHANG Jin-hong, LI Tian-cui, WU Jing-jing, YAO Man-man, XU Yan-zhi, LIU Jian
    2023, 44(11):  1260-1266.  doi:10.3969/j.issn.1007-3205.2023.11.004
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    Objective It has been found that microRNAs (miRNAs) play an important role in immune regulation of oral lichen planus(OLP). This study aimed to obtain the expression profile of miRNAs in OLP and to explore the possible role of miRNAs in the pathogenesis of OLP and whether they can be used as potential diagnostic markers of OLP. 
    Methods Three pathologically confirmed OLP lesions(sequencing OLP group) and three normal oral mucosa(sequencing control group) were collected. The differentially expressed miRNAs between two groups were screened by Illumina high-throughput sequencing. Three miRNAs with large differential multiples and high expression abundance were selected for target gene prediction and functional enrichment analysis. Moreover, 30 patients with OLP (validation OLP group) and 20 healthy volunteers (validation control group) were recruited. The expression levels of three miRNAs in serum were detected by real-time quantitative PCR (RT-PCR). Then validation OLP group was divided into erosion group (n=20) and non-erosion group (n=10). The relationship between the expression of three miRNAs and the severity of OLP was analyzed. Pearson correlation coefficient was used to analyze the correlation of the three miRNAs, and receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of the three in OLP. 
    Results A total of 61 differentially expressed miRNAs between two groups were screened by DESeq software, including 23 up-regulated and 38 down-regulated miRNAs. Eighty-seven target genes (LIMD1, MOB1B, and TEAD1) co-acted by miR-142-3p, miR-146a-5p and miR-150-5p were predicted by Miranda database. Gene ontology (GO) analysis showed that these target genes were closely related to intercellular connectivity components and signal transmission.Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis showed that these target genes were significantly enriched in the Hippo signaling pathway. Consistent with the sequencing results, the expressions of miR-142-3p, miR-146a-5p and miR-150-5p in the validation OLP group were higher than those of the validation control group (P<0.05). The validation OLP group was further divided into erosion group and non-erosion group. The expression levels of miR-146a-5p and miR-150-5p in the non-erosion group were higher than those in the validation control group, and the difference was statistically significant (P<0.05). There was no statistically significant difference in the expression levels of miR-142-3p between two groups (P>0.05). The expression levels of miR-142-3p, miR-146a-5p, and miR-150-5p in the erosion group were higher than those in the validation control group (P<0.05), and there was no significant difference in the expression levels of three miRNAs between the erosion group and the non-erosion group (P>0.05). Pearson analysis showed that there was a high positive correlation between the expression of the three (r=0.865, 0.822 and 0.875, respectively (P<0.01). The ROC curve analysis showed that the AUC under the ROC curve (AUC) of serum miR-142-3p, miR-146a-5p and miR-150-5p were 0.711, 0.818 and 0.767 respectively, and the AUC of combined diagnosis of OLP was 0.834. 
    Conclusion Differentially expressed miRNAs are present between DLP and normal oral mucosa. The expressions of miR-142-3p, miR-146a-5p and miR-150-5p are up-regulated in OLP, and their expression levels are related to the severity of OLP. miR-142-3p, miR-146a-5p and miR-150-5p can be used as potential diagnostic markers of OLP. 

    Expression and significance of omentin-1, lipid metabolism and oxidative stress in peripheral blood of diabetic patients with different BMD levels
    ZHU Ming-ming, LI Zong-hu, ZHENG Xian-ling, WANG Ying-xia, ZHANG Shu-jie, ZHANG Rui-qing
    2023, 44(11):  1267-1273.  doi:10.3969/j.issn.1007-3205.2023.11.005
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    Objective To explore the expression and significance of peripheral blood omentin-1 (Omentin-1) level, lipid metabolism and oxidative stress in peripheral blood of diabetic patients with different bone density levels. 
    Methods A total of 120 patients with type 2 diabetes mellitus (T2DM) admitted were retrospectively included. According to the level of bone mineral density, they were divided into normal bone mass group (n=38), osteopenia group (n=45), and osteoporosis group (n=37), and another 80 physical examinees with normal bone mass during the same period were selected as the control group. The peripheral blood Omentin-1 levels and lipid metabolism indexes [total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C)] and oxidative stress indicators [superoxide dismutase (SOD), malondialdehyde (MDA), glutathione catalase (GSH-Px)] levels were measured respectively. Pearson correlation was used to analyze the correlation of Omentin-1, lipid metabolism, and expression of oxidative stress indicators in T2DM patients. Ordered multi-class Logistic regression was used to analyze the influencing factors of bone metabolism in T2DM patients. 
    Results Pearson correlation analysis showed that peripheral blood Omentin-1 levels in T2DM patients were significantly and negatively correlated with TC, TG, LDL-C, and MDA (r=-0.407, -0.437, -0.440, -0.460, P<0.01), while peripheral blood Omentin-1 levels in T2DM patients were significantly and positively correlated with HDL-C, SOD, and GSH-Px (r=0.602, 0.578, 0.650, P<0.01). There was no difference in gender, age, BMI, WHR, FBG, TC, TG, HDL-C and LDL-C levels in different bone density subgroups of T2DM patients (P>0.05). The course of disease, HOMA-IR and MDA levels in osteoporosis group and osteopenia group were significantly higher than those in normal bone mass group, and higher in osteoporosis group than in the osteopenia group (P<0.05). SOD, GSH-Px, and Omentin-1 levels in osteoporosis group and osteopenia group were significantly lower than those in normal bone mass group, and lower in osteoporosis group than in osteopenia group (P<0.05). The glycated hemoglobin (HbA1c) levels in osteoporosis and osteopenia groups were significantly higher than those in normal bone mass group (P<0.05), but there was no difference between osteoporosis group and osteopenia group (P>0.05). The FINS level of osteoporosis group was significantly higher than that of the normal bone group (P<0.05), but was not significantly different from that in osteopenia group (P>0.05). Ordered multi-class Logistic regression analysis showed that the course of disease and HOMA-IR were independent risk factors affecting the bone metabolism status of T2DM patients (P<0.05), while GSH-Px and Omentin-1 were independent protective factors affecting the bone metabolism status of T2DM patients (P<0.05); However, HbA1c, FINS, SOD, and MDA were not related to the bone metabolism status of patients with T2DM (P>0.05). 
    Conclusion The level of Omentin-1 in peripheral blood of T2DM patients decreases with the decrease of bone density, and is related to abnormal lipid metabolism and oxidative stress. It may play a key role in the progression of T2DM and abnormal bone metabolism. Therefore, increasing the level of Omentin-1 may be one of the approaches to prevention and treatment of diabetic osteoporosis.

    Correlation of type 2 diabetes mellitus with macroangiopathy with plasma NGAL expression and pretibial pigmentation spot
    WANG Chen-ting, LYU Cui-jun, AN Xiang-lian, YUAN Min, LIU Jian-feng
    2023, 44(11):  1274-1278.  doi:10.3969/j.issn.1007-3205.2023.11.006
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    Objective To analyze the correlation of type 2 diabetes mellitus (T2DM) with macroangiopathy with the expression of neutrophil gelatinase related lipid transporter (NGAL) and pretibial pigmentation spot. 
    Methods A total of 400 T2DM patients in our hospital were selected and divided into the observation group (n=103) and the control group (n=297) according to presence of combined macroangiopathy. The plasma NGAL expression and pretibial pigmentation spots were compared between two groups. The Spearman correlation analysis was used to analyze the correlation of T2DM with macroangiopathy with NGAL and pretibial pigmentation spots. The clinical data of all patients were collected, and binary logistic regression analysis was used to analyze the factors influencing macroangiopathy in T2DM patients. The receiver operating curve (ROC) was established to evaluate the combined diagnostic value of plasma NGAL level and pretibial pigmentation spot in T2DM patients with macroangiopathy. 
    Results Compared with the control group, the level of NGAL in the observation group was higher, and the incidence of pretibial pigmentation spot (64.08%) was higher, with a statistically significant difference (P<0.05). T2DM with macroangiopathy was positively correlated with pretibial pigmentation spot (P<0.05). Compared with the control group, the observation group had a higher proportion of smoking and drinking, and higher levels of hemoglobin A1c (HbA1C), fasting plasma glucose (FPG), 2 hour postprandial blood glucose (2 hPG),  triglyceride (TG), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C), with a significant difference (P<0.05). Logistic regression analysis showed that the incidence of pretibial pigmentation spot, NGAL level, alcohol consumption, TG, TC, and LDL-C were the factors influencing T2DM with macroangiopathy (P<0.05). ROC results showed that the incidence rate of pretibial pigmentation spot and NGAL level alone and in combination in diagnosing T2DM with macroangiopathy were 0.719, 0.896, and 0.911, respectively, the sensitivity was 0.641, 0.757, and 0.777, respectively, and the specificity was 0.798, 0.902, and 0.936, respectively. 
    Conclusion The occurrence of macroangiopathy in T2DM patients is related to NGAL and pretibial pigmentation spot. The combination of the two indicators can provide certain reference for clinical diagnosis and prevention of T2DM with macroangiopathy.

    Comparison of efficacy and safety of three sequential hypoglycemic regimens in overweight/obese type 2 diabetes mellitus after short-term intensive hypoglycemic therapy
    XI Wei, YAO Li-jun, WANG Lin-jiao
    2023, 44(11):  1279-1284.  doi:10.3969/j.issn.1007-3205.2023.11.007
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    Objective To explore the efficacy and safety of three sequential hypoglycemic regimens in overweight/obese type 2 diabetes mellitus (T2DM) after short-term intensive hypoglycemic therapy. 
    Methods A total of 99 overweight/obese T2DM patients admitted to the Department of Endocrinology of Hai′an People′s Hospital were selected. All patients were treated with continuous subcutaneous insulin infusion (CSII), followed by sequential hypoglycemic therapy after intensive hypoglycemic therapy. They were divided into three groups according to different sequential hypoglycemic regimens, with 33 cases in each group. Group A was given glimepiride + metformin, group B was given subcutaneous injection of dulaglutide 1.5 mg (once a week) + metformin, and group C was given insulin aspart 30 + metformin for a total course of 12 weeks. The body weight, blood glucose and C-peptide levels at 12 weeks after treatment were measured, and the patients′ medication compliance and hypoglycemia within 1 year were calculated. 
    Results After treatment, body mass index (BMI) in group A was increased, BMI, and waist to hip ratio (WHR) in group B were decreased, and BMI and WHR in group C were increased (P<0.05). BMI and WHR in group B were lower than those in groups A and C (P<0.05). The levels of fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c) in the three groups were decreased after treatment (P<0.05), and the levels of FBG in groups A and B after treatment were higher than those in group C (P<0.05). There was no significant difference in HbA1c level and HbA1c compliance rate among the three groups after treatment (P>0.05). The level of fasting c-peptide (F-CP) was decreased and the level of postprandial 2 h C peptide (2 h P-CP) was increased in group B after treatment (P<0.05). The level of F-CP in group B was lower than that in groups A and C, while the level of 2 hP-CP in group B was higher than that in groups B and C (P<0.05). The total compliance rates of patients in groups A, B and C were 70.97% (22/31), 96.77% (30/31) and 83.87% (26/31), respectively. The total compliance rate of patients in group A was lower than that in group B (P<0.05). The incidences of hypoglycemia during sequential treatment in T2DM patients in groups A, B, and C were 19.35% (6/31), 9.68% (3/31), and 48.39% (15/31), respectively, and the incidence of hypoglycemia in groups A and B was lower than that in group C (P<0.05).  
    Conclusion Compared with three sequential hypoglycemic regimens, dulaglutide combined with metformin has obvious advantages in weight, blood sugar control and improvement of islet B cell function after short-term intensive hypoglycemic therapy in overweight/obese T2DM. In addition, the regimen has higher medication compliance during treatment, lower incidence of hypoglycemia, and higher efficacy and safety. 

    Correlation between NLR and the level of T cell immunity in patients with bronchopneumonia
    ZHOU Ying-chun, JIANG Rong, JIANG Zhong
    2023, 44(11):  1285-1288.  doi:10.3969/j.issn.1007-3205.2023.11.008
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    Objective To investigate the correlation between neutrophil/lymphocyte ratio (NLR) and the level of T cell immunity in patients with bronchopneumonia. 
    Methods A total of 104 patients with bronchopneumonia were selected as the research group and 50 patients with bronchial foreign body were selected as the control group. According to the clinical examination results, the patients in the research group were divided into mild group (n=61) and severe group (n=43). The levels of NLR, cytokines [interferon-γ (INF-γ)], interleukin-4 (IL-4), INF-γ/IL-4 and T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) were detected in all patients. The correlation between NLR and the level of T cell immunity in patients with bronchopneumonia was analyzed.  
    Results NLR, INF-γ and INF-γ/IL-4 in mild and severe groups were higher than those in control group, and higher in severe group than in mild group (P<0.05). CD3+, CD4+ and CD4+/CD8+ in mild and severe groups were lower than those in control group, and CD8+ was higher than that in control group; CD3+, CD4+ and CD4+/CD8+ in severe group were lower than those in mild group, and CD8+ was higher than that in mild group (P<0.05). NLR was positively correlated with INF-γ and INF-γ/IL-4 in patients with bronchopneumonia (P<0.05), and negatively correlated with CD4+ and CD4+/CD8+ (P<0.05), which, however, had no correlation with IL-4, CD3+ and CD8+ (P>0.05). 
    Conclusion NLR is correlated with INF-γ, INF-γ/IL-4 and T lymphocyte subsets such as CD3+ and CD4+/CD8+. NLR can reflect the level of T cell immunity in patients with bronchopneumonia to a certain extent.

    Correlation between knee femur condylar cartilage thickness and clinical features of rheumatoid arthritis
    SUN Chao, HAN Cheng-xu, QI Xuan, TIAN Yu, GAO Li-xia, GUO Hui-fang
    2023, 44(11):  1289-1294.  doi:10.3969/j.issn.1007-3205.2023.11.009
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    Objective To observe the ultrasonic features of knee lesions in rheumatoid arthritis (RA) patients and to explore the relationship between the thickness of femoral condylar cartilage (FCC) and clinical features of RA. 
    Methods The lateral, middle and medial thickness of FCC was measured by ultrasound in 70 patients with RA, 50 patients with knee osteoarthritis patients (KOA) and 30 healthy controls (HC). Body mass index (BMI), erythrocyte sedimentation rate (ESR), C-reaction protein (CRP), rheumatoid factors (RF), anti-cyclic citrullinated peptide antibody (anti-CCP antibody), and 28-joint disease activity score (DAS28) were recorded,and the differences in laboratory and ultrasonic indexes in each group were compared. The correlation between FCC thickness and clinical features was analyzed by Pearson correlation coefficient test. 
    Results ①The BMI of KOA group was higher than that of RA group and HC group (P<0.05). The thickness of FCC in RA group and KOA group was thinner than that in HC group (all P<0.05). There was no significant difference in thickness of FCC between RA group and KOA group (P>0.05). ②The ultrasonic lesions of knee joint in RA group were more diverse than those in KOA group. The positive rates of cartilage lesions, joint effusion and osteophytes in RA group were lower than those in KOA group(all P<0.05). There was no significant difference in the positive rate of synovial hyperplasia and Baker′s cyst between two groups (P>0.05). In addition, the RA group had blood flow signal in synovial membrane, bone erosion, loose body, enthesitis and peritendinitis. ③Age, BMI, ESR, CRP, anti-CCP antibody and DAS28 in RA knee swollen/tender group were higher than that in RA knee without swollen/tender group (all P<0.01), and there was no significant difference in thickness of FCC between two groups (P>0.05). The lateral thickness of FCC in RA group (≤50 years of age) was thinner than that in HC group (≤50 years of age) (P<0.05). The lateral thickness of FCC in RA≥5 years group was thinner than that in RA≤2 years group (P<0.05). ④FCC lateral thickness was negatively correlated with RA duration(r=-0.301, P=0.019). 
    Conclusion Multiple ultrasound presentations of RA knee lesions may be helpful in the differential diagnosis of RA and KOA. FCC injury may occur in RA patients regardless of whether they have clinical symptoms in the knee. RA patients younger than 50 years of age have a thinning of the FCC lateral thickness. The FCC lateral thickness is thinner in RA patients with more than 5 years of duration. 

    Significance of DKK3 in early diagnosis of sepsis-associated acute renal injury
    WANG Yan, LI Zhi-yun, JIA Tie-bing, LIAO Hua, TIAN Yan-jun
    2023, 44(11):  1295-1300.  doi:10.3969/j.issn.1007-3205.2023.11.010
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    Objective To prospectively explore the predictive value of Dickkopf WNT signaling pathway inhibitor 3 (DKK3) for disease occurrence and outcome in patients with sepsis-associated acute kidney injury (SAKI). 
    Methods The inpatients who were treated in the intensive care unit (ICU) in General Hospital of North China Petroleum Administration were divided into different groups. The clinical laboratory data of the enrolled patients were collected, and the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), and the sequential organ failure assessment (SOFA) and kidney disease: improving global outcomes (KDIGO) stage were used for risk assessment of enrolled patients. SPSS 21.0 and GraphPad Prism 8.0.1 were used for statistical analysis, and significant correlation factors were compared and analyzed between groups. Receiver operating characteristic (ROC) curve was used to analyze the evaluation performance of the prediction model, and P<0.05 was considered statistically significant. 
    Results A total of 80 patients with sepsis were included in this study, including 31 (38.75%) with SAKI, and 49 (61.25%) with sepsis but without acute kidney injury (AKI). The median value of DKK3 in patients with SAKI was significantly higher than that in patients with sepsis but without AKI [843 (765.0, 998.0), 76 (40.5, 348.0); P<0.05]. The median value of DKK3 increased with the increase of KDIGO stage in SAKI patients (P<0.05). ROC showed that DKK3 had the optimal evaluation efficacy on AKI in patients with sepsis (AUC=0.978, P<0.05), and compared with DKK3 combined with serum creatinine (Scr), DKK3 combined with neutrophil gelatinase-associated lipocalin (NGAL) was more effective in treating AKI in patients with sepsis (AUC=0.989, P<0.05). In predicting disease outcome in patients with SAKI, compared with DKK3 alone, DKK3 combined with NGAL was more effective in evaluating chronic kidney disease (CKD) in SAKI patients (AUC=0.979, P<0.05). 
    Conclusion The increase of DKK3 is associated with the occurrence of AKI and the severity of AKI in patients with sepsis, and the combination of DKK3 and NGAL can better identify high risk group in early stage by evaluating the occurrence of AKI and disease progression in patients with sepsis.

    Construction of a predictive model for systemic inflammatory response syndrome after lithotripsy in patients with upper urinary calculi
    PING Yu-jie, LIU Xiu-jie
    2023, 44(11):  1301-1306.  doi:10.3969/j.issn.1007-3205.2023.11.011
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    Objective To analyze the risk factors of systemic inflammatory response syndrome (SIRS) in patients with upper urinary calculi (UUC) after lithotripsy (PCNL), to build a predictive model, and to verify the predictive value of the model. 
    Methods A total of 78 UUC patients were selected as the research subjects, all of whom received PCNL treatment. They were divided into a SIRS group (n=21) and a non-SIRS group (n=57) based on occurrence of SIRS after surgery. Detailed records and comparisons of general information between two groups of patients were conducted. Multivariate Logistic regression analysis was used to analyze the relevant risk factors for SIRS, and a predictive model was constructed. The Bootstrap internal validation method was used to perform consistency and discrimination tests on the predictive model. The receiver operating characteristic (ROC) curve was used to determine the diagnostic cutoff point and evaluate the predictive value of the model. 
    Results The preoperative renal malformation, postoperative body temperature ≥ 38 ℃, postoperative heart rate, diabetes, recurrent urinary tract infection, white blood cell (WBC) count, neutrophil count, monocyte count, C-reactive protein (CRP) and procalcitonin (PCT) in SIRS group were higher than those in non-SIRS group. The preoperative uric acid value and high-density lipoprotein cholesterol (HDL-C) were lower than those in non-SIRS group, and the difference was statistically significant (P<0.05). Multivariate logistic regression analysis showed that diabetes, recurrent urinary tract infection, HDL-C, CRP and PCT were the risk factors for SIRS after PCNL in UUC patients (P<0.05). Based on the above five risk factors, a predictive model for the risk of SIRS after PCNL in UUC patients was established and validated using the Bootstrap internal validation method. It was found that the predicted values were basically consistent with the measured values, indicating good consistency of the predictive model. The calculated C-index was 0.955 (95%CI: 0.918-0.992), which had good discrimination, and the area under the ROC curve of the prediction model was 0.955, indicating that the prediction value of the prediction model was high. After verification, the sensitivity of the prediction model was 87.50%, the specificity was 91.11%, and the accuracy was 89.85%. 
    Conclusion Diabetes, recurrent urinary tract infection, low HDL-C level and high CRP and PCT levels are the risk factors for SIRS after PCNL in UUC patients. Building a nomogram prediction model based on influencing factors can help predict the risk of SIRS in UUC patients after PCNL, and this model has a high value. 

    Application value of anterior quadratus lumborum and pudendal nerve block combined with general anesthesia in transvaginal total hysterectomy
    WANG Ya-juan, HAN Yi, WEI Ling, GOU Xiao-juan, LI Hong-xia, HUO Zhi-ping
    2023, 44(11):  1307-1311.  doi:10.3969/j.issn.1007-3205.2023.11.012
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    Objective To investigate the application value of anterior quadratus lumborum and pudendal nerve block combined with general anesthesia in patients undergoing transvaginal total hysterectomy. 
    Methods A total of 100 patients who underwent elective transvaginal total hysterectomy + vaginal anterior and posterior wall repair in our hospital were selected, and divided into the anterior quadratus lumborum and pudendal nerve block combined with general anesthesia group (QPG group, n=50) and the anterior quadratus lumborum block combined with general anesthesia group (QG group, n=50). Anesthesia condition, visual analog scale (VAS) score during exercise and at rest were observed and compared between two groups. 
    Results The onset time of block in QPG group was (6.40±1.13) min, which was significantly faster than that in QG group (P<0.05). The doses of remifentanil, propofol and CIS atracurium in QPG group were (810.12±97.55) mg, (660.74±51.21) mg and (17.80±2.21) mg, respectively, which were significantly fewer than those in QG group (P<0.05). The cumulative dosage of patient receiving patient controlled intravenous analgesia (PCIA) within 48 h after operation, the number of effective PCIA compressions within 48 h after operation and the incidence of remedial analgesia in QPG group were (38.87±8.12) mL, (6.80±1.22) times and 4.00%, respectively, which were significantly less than those in QG group (P<0.05). The awakening time, spontaneous expiratory recovery time and laryngeal mask removal time in QPG group were (4.20±0.97) min, (5.33±1.02) min and (5.80±1.21) min, respectively, which were significantly faster than those in QG group (P<0.05). VAS scores at 2 h, 8 h, 12 h and 24 h after operation during exercise and at rest in QPG group were significantly lower than those in QG group (P<0.05). 
    Conclusion Anterior quadratus lumborum and pudendal nerve block combined with general anesthesia after transvaginal total hysterectomy is helpful to reduce the dosage of anesthetic drugs and improve the postoperative analgesic effect. 
    Study on the correlation between umbilical cord blood FTM, AGE levels and neonatal hypoglycemia in pregnant women with gestational diabetes mellitus
    YUAN Er-wei, ZHU Lei, XU Jin-li, GUO Hua-xian
    2023, 44(11):  1312-1316.  doi:10.3969/j.issn.1007-3205.2023.11.013
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    Objective To explore the correlation between the levels of fructosamine (FTM), advanced glycation end products (AGE) and neonatal hypoglycemia in pregnant women with gestational diabetes mellitus (GDM). 
    Methods A total of 94 pregnant women with GDM were selected. According to presence of hypoglycemia in the newborns, they were divided into hypoglycemia group (n=53) and normal blood glucose group (n=41). Clinical data, FTM and AGE levels of the two groups were compared. Pearson correlation analysis was conducted to analyze the relationship between FTM and AGE levels with fasting blood glucose (FBG) level and 2 h postprandial blood glucose (2 hPG) level. Risk factors of neonatal hypoglycemia were analyzed, and ROC curve was drawn to analyze the predictive value of FTM and AGE level for neonatal hypoglycemia. 
    Results The birth weight of newborns in the hypoglycemia group was lower than that in the normal blood glucose group, and the proportion of premature infants, maternal body mass index, FBG, 2hPG, FTM and AGE levels were higher than those in the normal blood glucose group, with statistical significance (P<0.05). Pearson correlation analysis showed that FTM and AGE levels were positively correlated with FBG and 2 hPG levels (P<0.05). Logistic regression analysis showed that high FTM and AGE level were risk factors for neonatal hypoglycemia (P<0.05). The area under the curve (AUC) value of FTM and AGE levels in combination in predicting neonatal hypoglycemia was higher than that by single factor detection (P<0.05). 
    Conclusion The overexpression of FTM and AGE in cord blood of pregnant women with GDM is a risk factor for neonatal hypoglycemia, which can effectively predict the risk of neonatal hypoglycemia and provide theoretical reference for clinical prevention and treatment. 

    Observation on clinical effect of different repair methods on wedge-shaped defects with penetrating pulp in premolars
    CUI Yu-lan, ZHAO Chen, ZHANG Zhao, LIU Bo-yu
    2023, 44(11):  1317-1321.  doi:10.3969/j.issn.1007-3205.2023.11.014
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    Objective To compare the effects of different repair methods on different types of wedge-shaped defects with exposed pulp. 
    Methods Eighty patients receiving repair for different types of wedge-shaped defect with exposed pulp in mandibular premolars after root canal treatment in Department of Prosthodontics, School of Stomatology, Hebei Medical University, were selected. They were divided into group A1 (wedge-shaped defect within 1/3 in width, and treated with resin filling + crown restoration, n=20), group A2 (edge-shaped defect within 1/3 in width: fiber post-and-core + resin filling + crown restoration, n=20), group B1 (wedge-shaped defect more than 1/3 and less than the axial angle in width: resin filling + crown restoration, n=20) and group B2 (wedge-shaped defect more than 1/3 and less than the axial angle in width: fiber post-and-core + resin filling + crown restoration, n=20) based on the width of wedge-shaped defects and repair method. The success rate of repair treatment and the repair effect were compared in the four groups. 
    Results At 2-year reexamination after repair, there was no significant difference in the success rate of repair treatment and repair effect between group A1 and group A2 (P>0.05). The success rate of repair treatment and repair effect in group B2 was higher or better than those in group B1, and the difference was statistically significant (P<0.05). 
    Conclusion When the wedge defect is less than 1/3 in width, direct resin filling can achieve good repair effect, whereas when the wedge defect is more than 1/3 but does not exceed the axial angle in width, supplementation of fiber post can improve the success rate.

    Construction of a predictive model for the development of uterine fibroids based on ultrasonography and lipid-related indicators and validation of its value
    LIU Chen-bing, MU Zheng-qing, XU Chang-song
    2023, 44(11):  1322-1327.  doi:10.3969/j.issn.1007-3205.2023.11.015
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    Objective To construct a predictive model for the development of uterine fibroids based on ultrasonography and lipid-related indicators, and to validate its predictive value. 
    Methods A total of 6 333 female patients undergoing physical examination were selected to calculate the incidence of uterine fibroids, and they were divided into observation group and control group according to occurrence of uterine fibroids. The clinical data, ultrasound examination indicators [ultrasound characteristics, peak systolic velocity (PSV), resistance index (RI), pulsation index (PI)], and lipid-related indicators [triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), atherogenic index of plasma (AIP) and triglyceride glucose index (TyG)] were compared between two groups. A nomogram predictive model was constructed and validated. 
    Results  After screening by selection criteria, a total of 4 812 female physical examinees were included as research subjects, among whom 1 065 patients with uterine fibroids were diagnosed by ultrasound, and the incidence of uterine fibroids was 22.13%, including 854 patients with intermyometrial fibroids (80.19%), 156 patietns with subplasmaline fibroids (14.65%), and 55 patients with submucosal fibroids (5.16%). The average number of fibroids was (4.18±1.02), and  the mean maximum fibroid diameter was (6.64±1.89) cm. The observation group had higher PSV and PI than the control group, but lower RI than the control group (P<0.05). The difference in HDL-C levels between two groups was not statistically significant (P>0.05), and the levels of TG, LDL-C, TC, AIP and TyG were higher than those in the control group (P<0.05). Logistic regression analysis showed that uterine artery PSV, RI, PI, TG, LDL-C, TC, AIP, and TyG were independent influencing factors for the development of uterine fibroids (P<0.05). The nomogram predictive model for the development of uterine fibroids was constructed based on the above ultrasound and lipid-related indicators, and the calibration curve showed that the consistency index of the predictive model was 0.827, which had good consistency. The Hosmer-Lemeshow goodness-of-fit test showed P=0.710>0.05, and the predictive model had a good fit. The area under receiver operating characteristic (ROC) curve (AUC) of this predictive model for predicting the onset of uterine fibroids was 0.912 (95%CI: 0.837-0.994), with a sensitivity of 92.02% and a specificity of 90.74%. 
    Conclusion It is feasible to construct a predictive model for development of uterine fibroids based on ultrasonographic parameters, including uterine artery PSV, RI, PI, and lipid-related indicators TG, LDL-C, TC, AIP, and TyG, and the predictive value is more reliable. 
    Effects of ulinastatin combined with dexmedetomidine on biomarkers of inflammation and lung injury during total endoscopic esophagectomy
    WANG Zhi-gang, GAO Yang, XU Peng, WANG Xiao-ru, YUAN Jin-ge, CHEN Yong-xue
    2023, 44(11):  1328-1333.  doi:10.3969/j.issn.1007-3205.2023.11.016
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    Objective To observe the effects of ulinastatin combined with dexmedetomidine (DEX) on biomarkers of inflammation and lung injury as well as on lung function during total endoscopic oesophagectomy. 
    Methods A total of 90 patients undergoing elective oesohagectomy were selected and divided into control group (Con group) ,DEX group (DEX group) and ulinastatin combined with DEX group (U+DEX group), with 30 patients in each group. DEX group was pumped with 0.5 μg· kg-1·h-1 dexmedetomidine after anesthesia induction until 1 h before surgery. The U+DEX group was given ulinastatin by intravenous infusion of 10 000 units/kg at 30 min before anesthesia, and other procedures were in consistent with the DEX group. Con group was given the same volume of normal saline. Peak airway pressure (Ppeek), thorac-pulmonary compliance (Cdyn), blood oxygen partial pressure (PaO2) and carbon dioxide partial pressure (PaCO2) were recorded before lateral decustrine position (T0), at 1 h after OLV (T1), at 1 h after recovery of double lung ventilation (T2), and before extubation at the end of surgery (T3). The levels of tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8) and Clara cell protein 16 (CC16) in serum and bronchoalveolar lavage fluid (BALF) were determined by enzyme-linked immunosorbent assay (ELISA) at T0 and T3.  
    Results Cdyn, PaCO2 and PaO2 showed a trend of first decreasing and then gradually increasing. There were significant differences in interaction between groups, time points, and time points between groups with respect to Cdyn and PaO2 (P<0.05), and there were significant differences in interaction between groups and between time points in PaCO2 (P<0.05). There was no significant difference in interaction in time points between groups (P>0.05). Compared with Con group, the levels of TNF-α and IL-8 in alveolar lavage fluid and serum of DEX group and U+DEX group were significantly decreased at T3 (P<0.05). Serum CC16 level was significantly increased, but no significant difference was found in CC16 level in alveolar lavage fluid (P<0.05). Compared with DEX group, the levels of TNF-α and IL-8 in alveolar lavage fluid and serum of U+DEX group were significantly decreased at T3, but there was no significant difference in the serum CC16 level in alveolar lavage fluid (P<0.05). 
    Conclusion Ulinastatin combined with dexmedetomidine can improve lung function and reduce intraoperative inflammation during total endoscopic oesophagectomy. 

    Advantages and efficacy of NG-Test CARBA 5 in the detection of carbapenemase in blood cultured enterobacteriaceae bacteria
    XUE Yun, LIU Xiang-qin, ZHANG Kai
    2023, 44(11):  1334-1339.  doi:10.3969/j.issn.1007-3205.2023.11.017
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    Objective To explore the application value of NG-Test CARBA 5 in the detection of carbapenemase content in blood cultured enterobacteriaceae bacteria. 
    Methods A total of 62 strains of enterobacteriaceae bacteria with known gene types were collected from clinical specimens of our hospital, including 38 strains of carbapenem resistant enterobacteriaceae bacteria and 24 strains of carbapenem sensitive enterobacteriaceae bacteria. NG-Test CARBA 5 kit, Carba NP and mCIM tests were used to detect the major carbapenemases of the strains to be tested, and PCR was used to sequence the carbapenemase gene phenotypes for confirmation and Kappa consistency test. Then 20 strains were randomly selected from 38 carbapenem resistant strains for simulated blood culture, and tested with NG-Test CARBA 5 kit, Carba NP method and mCIM method and Kappa consistency test. 
    Results The drug resistance of 38 carbapenem resistant Enterobacteriaceae strains were meropenem and/or imipenem. PCR amplification and sequencing results showed that 33 strains carried drug resistance genes, and 5 strains did not carry common drug resistance genes. The sensitivity and specificity of NG-Test CARBA 5 in detecting KPC, NDM, IMP, KPC+NDM and NDM+IMP within 15 min were 100%.The sensitivity of Carba NP method and mCIM method was 93.94% and 96.97%, respectively, and the specificity was 80.00% and 100.00%, respectively. The Kappa values were 0.857 and 0.902 (P<0.05), which were consistent with the results of gene sequencing. Twenty carbapenem resistant Enterobacteriaceae bacteria were cultured in simulated blood. There were 6, 5, 4 and 5 strains of Escherichia coli, Enterobacter cloacae, Klebsiella pneumoniae and Klebsiella acidogenes, respectively. The sensitivity and specificity of NG-Test CARBA 5 were 100.0%, and the Kappa value was 1.000, which were consistent with the results of gene sequencing. The sensitivity of Carba NP method and mCIM method were 87.50% and 93.75% respectively, and the specificity was 100%. The Kappa values were 0.812 and 0.898 (P<0.05), which were consistent with the results of gene sequencing. 
    Conclusion The detection process of NG-Test CARBA5 is simple, efficient and accurate, which greatly simplifies the complex process of clinical detection of carbapenemase, and is helpful to enhance hospital infection control and timely guide clinical treatment.