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    25 February 2024, Volume 45 Issue 2
    Association between CagA-antibody-positive helicobacter pylori infection and carotid intima-media thickness in middle-aged asymptomatic population
    WANG Ming-hu1, MIAO Li-hui2, LIU Jing-xin3, ZHONG Yu4
    2024, 45(2):  130-134.  doi:10.3969/j.issn.1007-3205.2024.02.002
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    Objective To examine the association between CagA-antibody-positive helicobacter pylori (Hp) infection and carotid atherosclerosis (CAS) in middle-aged asymptomatic population. 
    Methods A total of 578 CAS patients treated in our hospital were selected for this study, and 578 patients without CAS were selected as the control group. CagA-antibody-positive Hp infection was compared between two groups, and logistic regression analysis was conducted. Carotid intima-media thickness(CIMT) was compared between patients with CagA-antibody-positive Hp infection and those with CagA-antibody-negative Hp infection. 
    Results The CAS group had significantly higher frequency of CagA-antibody-positive Hp infection than the controls (P<0.05). CagA-antibody-positive Hp infection was an independent risk factors for CAS (OR=1.813, 95% CI: 1.379-2.384, P<0.05). CIMT was significantly greater in patients with CagA-antibody-positive Hp infection than in those with CagA-antibody-negative Hp infection (t=28.046, P<0.05). 
    Conclusion In middle-aged asymptomatic population, CagA-antibody-negative Hp infection is an independent risk factor for CAS. The levels of CIMT in patients with CagA-antibody-positive Hp infection are significantly higher than those of patients with CagA-antibody-negative Hp infection. Thus, CagA-antibody-positive Hp infection has been implicated in the development and progression of CAS. 

    Analysis of 3-year survival of 550 patients with colon cancer and construction of regression model of prognostic factors
    ZHAO Shu-qiao, FAN Hong-wei, GUO Zheng-rong, JIA Yan-hong, NIU Xue-min
    2024, 45(2):  135-140.  doi:10.3969/j.issn.1007-3205.2024.02.003
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    Objective To investigate the 3-year survival and prognostic factors of 550 patients with colon cancer, and to construct a regression model. 
    Methods The clinical data of 550 patients with colon cancer who was discharged from our hospital after surgical treatment were retrospectively analyzed.  They were divided into the poor prognosis group (death, n=134) and the good prognosis group (survival, n=416) according to whether they survived at 3 years after follow-up. The 3-year survival was recorded, and the clinical data of the two groups were compared. Multivariate Cox regression analysis was used to analyze the risk factors affecting the prognosis of colon cancer patients, and a Cox regression model was constructed. 
    Results At 3 years after follow-up, 416 of the 550 patients with colon cancer survived, and the 3-year survival rate was 75.64%. The proportion of patients with age >60 years, low differentiation, adenosquamous cell carcinoma, undifferentiated carcinoma, Dukes stage C and D, right colon cancer, family history, presence of complications, lymph node metastasis, the abnormal level of serum carcinoembryonic antigen, intermediate surgical approach, number of lymph node dissections <12, and intraoperative bleeding ≥ 200 mL in the good prognosis group were 79.85%, 48.25%, 14.18%, 10.45%, 33.58%, 65.67%, 85.82%, 22.39%, 95.52%, 59.96%, 71.64%, 67.16%, 58.96%, and 89.55%, respectively, which were higher than those (52.40%, 16.59%, 1.20%, 1.44%, 2.64%, 0.00%, 41.83%, 9.13%, 84.62%, 28.37%, 31.25%, 33.17%, 41.11%, and 9.86%) in the poor prognosis group; the proportion of married patients was 24.63%, which was lower than that (75.48%) in the poor prognosis group (P<0.05). Multivariate Cox regression analysis showed that age >60 years, Dukes stage C and D, right colon cancer, lymph node metastasis and intraoperative bleeding ≥ 200 mL were independent risk factors for poor prognosis of patients with colon cancer (P<0.05). The results of the prediction model constructed showed that the internal validation consistency index (C-inex) was 0.852 (95%CI: 0.819-0.885), and the correction curve showed that the predicted value was in good agreement with the observed value. 
    Conclusion Age >60 years, Dukes stage C and D, right colon cancer, lymph node metastasis, number of lymph node dissections <12, and intraoperative bleeding ≥ 200 mL are risk factors for poor prognosis in patients with colon cancer. The Cox regression model is effective and has a good fitting effect. The patients with the above conditions can be given corresponding treatment and intervention measures to improve the prognosis.

    Effects of EUS, white light endoscopy and ME-NBI in the diagnosis of depth of invasion of early gastric cancer
    LIANG Hui-xia, HU Ying-hua, QI Mei-ya, YAN Zai-hong, WANG Xing, DONG Xiao-lin
    2024, 45(2):  141-146.  doi:10.3969/j.issn.1007-3205.2024.02.004
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    Objective To explore the effect of endoscopic ultrasonography (EUS), white light endoscopy (WLE), magnifying endoscopy combined with narrowb and imaging (ME-NBI) in the diagnosis of depth of invasion of early gastric cancer. 
    Methods A total of 78 patients with early gastric cancer treated in Hebei Petro China Central Hospital were selected, 60 normal examiners were selected as controls, and the accuracy of EUS, WLI, ME-NBI alone and in combination in diagnosing the depth of invasion was compared. Logistic regression analysis was used to analyze the factors affecting the accuracy of EUS, WLI and ME-NBI in combination in the diagnosis of infiltration depth. 
    Results Pathological results showed that there were 50 patients with T1a and 28 patients with T1b. In patients with T1a lesions, the combined diagnostic accuracy of EUS, WLI and ME-NBI was 92.00%, which was significantly higher than that of EUS and WLI alone (P<0.05). In patients with T1b lesions, the combined diagnostic accuracy of EUS, WLI and ME-NBI was 92.86%, which was significantly higher than that of WIL alone (P<0.05). The accuracy rate of EUS, WLI and ME-NBI in combination in diagnosing the depth of invasion in patients with lesion size ≥2 cm was 77.29%, which was significantly lower than that in patients with lesion size <2 cm (P<0.05). The accuracy rate of EUS, WLI and ME-NBI in combination in the diagnosis of the depth of infiltration in patients with depressed form was 66.67%, which was significantly lower than that in patients with raised and flat form (P<0.05). The accuracy rate of EUS, WLI and ME-NBI incombination in the diagnosis of the depth of invasion in the lesions of the cardia and fundus of the stomach was 76.92%, which was significantly lower than that in the lesions of the gastric body and the gastric antrum and pylorus (P<0.05). Multivariate logistic regression analysis showed that the size, shape and location of the lesion were the influencing factors of the accuracy of EUS, WLI and ME-NBI in combination in the diagnosis of the depth of invasion (P>0.05). 
    Conclusion The combined detection of EUS, WLI and ME-NBI has high value in the diagnosis of the depth of invasion of early gastric cancer, and the accuracy of the combined diagnosis of EUS, WLI and ME-NBI is affected by the size and shape of the lesion. 

    The relationship between FGF21, PERK and APACHE Ⅱ score in patients with mild acute pancreatitis and the risk assessment of disease progression
    QU Shao-lei, HAN Fang, ZHAO Jing, TANG Jing-gang
    2024, 45(2):  147-152.  doi:10.3969/j.issn.1007-3205.2024.02.005
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    Objective To investigate the relationship between fibroblast growth factor-21 (FGF-21), protein kinase R-like endoplasmic reticulum kinase (PERK) and acute physiology and chronic health system Ⅱ (APACHE Ⅱ) score in patients with mild acute pancreatitis (MAP), and to analyze the value of the two in evaluating the risk of disease progression after conservative treatment. 
    Methods A total of 169 patients with MAP were selected and divided into a progression group (n=32) and a non-progression group (n=137) according to whether they progressed to moderately severe AP (MSAP) or severe AP (SAP) within 24 h after admission.The serum FGF-21 and PERK levels were detected at admission and 24 h after admission, and the APACHE II score was evaluated. The relationship between serum FGF-21 and PERK levels and APACHE Ⅱ score and their effects on disease progression were analyzed. Receiver operating characteristic curve (ROC) and decision curve analysis (DCA) were used to evaluate the value of serum FGF-21 and PERK in the progression of MAP patients. 
    Results The levels of serum FGF-21 [(2.37±0.33) vs. (2.05±0.31),(2.57±0.36) vs. (1.89±0.32)ng/L], PERK[(24.68±4.35) vs. (20.43±4.08), (27.19±4.54) vs. (17.81±4.03)μg/L] and APACHE Ⅱ score [(12.54±2.62) vs. (9.87±2.58), (13.94±2.54) vs. (8.45±2.29)] in the progression group at admission and 24 h after admission were higher than those in the non-progression group (t=5.194, 10.566, 5.239, 11.569, 5.256,  11.958, P<0.001). The levels of serum FGF-21, PERK and APACHE Ⅱ score in the progression group at 24 h after admission were higher than those at admission, while these indicators in the non-progression group were lower than those at admission (P<0.05). The serum FGF-21 (r=0.872, 0.445, P<0.001) and PERK (r=0.852,0.372, P<0.001) levels were positively correlated with the APACHE Ⅱ score at admission and 24 h after admission (P<0.05). Logistic regression analysis model showed that FGF-21 and PERK were independent risk factors for disease progression (P<0.05). The area under the ROC curve (AUC) value of the combined assessment of FGF-21 and PERK for disease progression was 0.872, which was greater than that of FGF-21 (χ2=2.746, P=0.006) and PERK alone (χ2=2.784, P=0.005). Within the threshold range of 0.10 to 0.88, the net benefit rate of FGF-21 and PERK in combination to assess disease progression was superior to that of single detection. 
    Conclusion The changes of serum FGF-21 and PERK levels in MAP patients are closely related to the APACHE Ⅱ score, and they are independent risk factors for the progression of MAP. They can provide a reference for clinical assessment of the risk of MAP progression.

    Diagnostic value of microRNA-26a and microRNA-663 combined with Helicobacter pylori in precancerous lesionsin elderly patients with gastric cancer
    XIE Zhi-fang1, SHEN Yi-hui2, YANG Hong-xue2
    2024, 45(2):  153-158.  doi:10.3969/j.issn.1007-3205.2024.02.006
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    Objective To explore and analyze the diagnostic value of microRNA-26a (miR-26a) and microRNA-663 (miR-663) combined with Helicobacter pylori in the diagnosis of precancerous lesions in elderly patients with gastric cancer. 
    Methods In total, 136 elderly patients with benign gastric lesions, precancerous lesions or early gastric cancer who were admitted to our hospital and diagnosed by gastroscopic and pathological examinations were consecutively selected as the research subjects. The expression of serum miR-26a and miR-663 was detected by real-time fluorescence quantitative polymerase chain reaction (RT-qPCR), and the positive status of Helicobacter pylori was detected by 13C urea breath test. The diagnostic value of miR-26a, miR-663, and Helicobacter pylori detected alone and in combination for different degrees of gastric benign lesions, precancerous lesions and early gastric cancer was analyzed, and the receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic accuracy. 
    Results There were no significant differences in gender, age, body mass index, smoking history, and drinking history among patients with benign gastric lesions, precancerous lesions, and early gastric cancer (P>0.05), and the family history of gastric cancer in patients with gastric precancerous lesions and early gastric cancer was higher than that in patients with benign lesions (P<0.05). There was no significant difference in the family history of gastric cancer between patients with precancerous lesions and early gastric cancer (P>0.05). The expression levels of serum miR-26a and miR-663 in patients with gastric precancerous lesions and early gastric cancer were lower than those in patients with benign gastric lesions, and the serum miR-26a and miR-663 expression levels in patients with early gastric cancer were lower than those in patients with precancerous lesions, while the positive rate of Helicobacter pylori was higher than that in patients with benign gastric lesions(P<0.05). There was no significant difference in the positive rate of Helicobacter pylori between patients with precancerous lesions and early gastric cancer (P>0.05). The sensitivity of combined detection of the three was significantly higher than that of miR-26a detection alone (χ2=4.680,P=0.031), miR-663 detection alone (χ2=8.223,P=0.004), and Helicobacter pylori detection alone (χ2=6.363,P=0.012). When the cut-off value of serum miR-26a was 2.63, the area under the ROC curve (AUC) for diagnosing precancerous lesions in elderly patients with gastric cancer was 0.79 (95%CI: 0.774-0.856), and the sensitivity and specificity at this time were 75.43% and 79.85%, respectively. When the cut-off value of serum miR-663 was 4.35, the AUC for the diagnosis of precancerous lesions in elderly patients with gastric cancer was 0.83 (95%CI: 0.796-0.875), and the sensitivity and specificity were 81.37% and 78.56%, respectively. The AUC of Helicobacter pyloriin the diagnosis of precancerous lesions in elderly patients with gastric cancer was 0.72 (95%CI: 0.648-0.769), and the sensitivity and specificity were 68.93% and 78.45%, respectively. The AUC of the combined detection of the three above indicators in the diagnosis of precancerous lesions in elderly patients with gastric cancer was 0.89 (95%CI: 0.815-0.873), and the sensitivity and specificity were 89.72% and 74.43%, respectively. 
    Conclusion miR-26a, miR-663 combined with Helicobacter pylori has high diagnostic value for the precancerous lesions of gastric cancer in the elderly, and the combined diagnosis helps to improve the diagnostic sensitivity, thereby providing guidance for the early diagnosis of gastric cancer in the elderly.  

    Surgical effect and complications of ESD and EMR in the treatment of colorectal cancer and precancerous lesions
    YANG Liu, ZHENG Shu-dan
    2024, 45(2):  159-164.  doi:10.3969/j.issn.1007-3205.2024.02.007
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    Objective To explore the effects of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) on the surgical results and complications of patients with early colorectal cancer (CRC) and precancerous lesions. 
    Methods Retrospective analysis was performed on 120 patients with early CRC and precancerous lesions treated in our hospital, who were divided into a control group (n=55) and an observation group (n=65) according to surgical methods. Patients in the control group underwent EMR, and patients in the observation group underwent ESD. The surgical indicators of the two groups were compared, the oxidative stress level of the two groups before surgery and at 7 d after surgery was observed. The patients were followed up for 6 months after surgery, and the quality of life before and after surgery was compared. The occurrence of perforation, infection and bleeding after surgery and presence of recurrence of patients within 6 months after surgery were recorded. 
    Results Compared with the control group, the duration of operation and intraoperative bleeding was longer or more, and the thickness of the resected specimen and the wound diameter were greater than those in the control group, suggesting significant difference (P<0.05). The total resection rate and curative resection rate (58.46%) were higher than those in the control group (60.00%, 46.63%), but the difference was not statistically significant (P>0.05). After treatment, the malondialdehyde (MDA), glutathione disulfide (GSSG), cortisol (Cor) levels all increased, which were statistically different (P<0.05), but the difference between two groups was not statistically significant (P>0.05). The differences in the evaluation results of various dimensions of quality of life between two groups before surgery were not statistically significant (P>0.05). After treatment, the quality of life of the patients at 3 months after surgery was evaluated again; the quality of life score was improved, and the increase in the observation group was higher than that in the control group (P<0.05). The incidence of perforation, intraoperative bleeding and infection in the observation group was 12.31%, which was lower than that in the control group (34.55%). Within 6 months after surgery, 1 case (1.54%) in the observation group had recurrence, which was significantly different from that (8, 14.55%) in the control group (P<0.05). 
    Conclusion Compared with EMR, it is more difficult to perform ESD for patients with early CRC and precancerous lesions, with longer duration of operation. However, the level of oxidative stress of patients after surgery changes fairly, which can effectively reduce the recurrence rate of patients after surgery, reduce the occurrence of postoperative complications, and improve the quality of life of patients. 

    Integrated identification of the chemokine-related key genes underlying the progression of nonalcoholic steatohepatitis via bioinformatics and machine learning
    MO Shuang-yang1, WU Wen-hong1, WEI Hai-xiao1, QIN Hai-yan1, LI Liang2
    2024, 45(2):  165-171.  doi:10.3969/j.issn.1007-3205.2024.02.008
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    Objective To integratedly identify the chemokine-related  key genes underlying the progression of nonalcoholic steatohepatitis (NASH) via bioinformatics and machine learning. 
    Methods The differentially expressed genes (DEGs) after download of NASH datasets GSE49541 from public database the Gene Expression Omnibus (GEO) were identified via R studio software. Further, the Gene Ontology (GO) functional annotation and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed. The DEGs and chemokine-related gene sets were intersected to identity the differentially expressed chemokine-related genes. Identification of the key genes was applied via machine learning LASSO regression and support vector machines-recursive feature elimination (SVM-RFE). The key gene interaction network was  established via the GeneMANIA database. Then the key gene nomogram models in prediction were constructed and the effectiveness of nomograms was validated by receiver operator characteristic (ROC) curve. 
    Results A total of 148 DEGs were identified. GO and KEGG analyses revealed that DEGs were mainly enriched in fatty acid  metabolic process, chemokine signaling pathway, and extracellular matrix. Moreover, four key genes, including CCL19, CD24, ROBO1, and SLC12A2, were identified, and a key gene interaction network diagram was constructed. Based on the key genes, a NASH nomogram prediction model was established, with the area under the ROC curve (AUC) of 997 and 95% confidence interval (CI) of 0.988-1.000.
    Conclusion CCL19, CD24, ROBO1, and SLC12A2 might be closely related to the occurrence and development of NASH, and are expected to become potential targets for its early diagnosis and precise treatment. 

    Effects of different balloon dilation time on stone clearance rate, liver function, stress level and postoperative pancreatitis in elderly patients with bile duct stones undergoing EST
    LIANG Guang-jin1, HUANG Bo1, YU Shao-ming1, WANG Chun-feng1, JIN Yun2
    2024, 45(2):  172-177.  doi:10.3969/j.issn.1007-3205.2024.02.009
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    Objective To investigate the effect of different balloon dilation time on the stone clearance rate, liver function, stress level and postoperative pancreatitis in elderly patients with bile duct stones undergoing endoscopic sphincterotomy (EST) of the duodenal papilla, so as to guide the optimal balloon dilation time in clinical practice. 
    Methods A total of 116 elderly patients with bile duct stones were selected and divided into a 1-min group (n=58) and a 3-min group (n=58) according to the random number table method. Both groups received EST treatment, with balloon dilation times of 1 min and 3 min for the 1-min and 3-min groups, respectively. The general surgical conditions, stone removal, and liver function [γ-glutamyltransferase (γ-GT), alanine aminotransferase (ALT), alkaline phosphatase (ALP), direct bilirubin (DBIL), total bilirubin (TBIL)], stress level [cyclooxygenase-2 (COX-2), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), cortisol (Cor)], and complications of the two groups were compared. 
    Results The duration of operation in the 3-min group was shorter than that in the 1-min group, and the intraoperative blood loss was lower than that in the 1-min group, showing significant difference (P<0.05). There was no significant difference in length of postoperative hospital stay and X-ray exposure time between the 3-min group and the 1-min group (P>0.05), as well as in the mechanical lithotripsy rate, one-time stone clearance rate and stone removal time between the 3-min group and the 1-min group (P>0.05).At 1 d and 3 d after operation, γ-GT, ALP, ALT, DBIL and TBIL in the two groups showed a decreasing trend, and there were significant differences in interaction between groups, time points, and time points between groups (P<0.05), but there was no significant difference between two groups (P>0.05). COX-2 and TNF-α, CRP and Cor of the two groups at 1 d and 3 d after operation showed an increasing trend, and there were significant differences in interaction between time points, and time points between groups (P<0.05), but there was no significant difference between the two groups (P>0.05). The levels of serum amylase and lipase in two groups showed an increasing trend at 1 d and 3 d after operation, and the differences of interaction between time points and time points between groups were statistically significant (P<0.05). The levels of serum amylase and lipase in the 3-min group were lower than those in the 1-min group at 1 d and 3 d after operation (P<0.05). The incidence of pancreatitis and bleeding in the 3-min group was lower than that in the 1-min group, and the difference was statistically significant (P<0.05). The difference between the incidence of biliary tract infection in the 3-min group and the 1-min group was not statistically significant (P>0.05). 
    Conclusion Intraoperative balloon dilation for 3 min in EST applied to elderly patients with bile duct stones can effectively reduce intraoperative bleeding, shorten the duration of operation, and effectively avoid the occurrence of pancreatitis and bleeding while ensuring the stone removal effect without affecting liver function and the degree of traumatic stress. 

    Efficacy of low molecular weight heparin sodium on intrahepatic cholestasis of pregnancy
    QIN Jing-jing, XIN De-mei, ZHU Man-li, DENG Chun-xia
    2024, 45(2):  178-182.  doi:10.3969/j.issn.1007-3205.2024.02.010
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    Objective To observe the efficacy of low molecular weight heparin sodium in the treatment of intrahepatic cholestasis of pregnancy (ICP). 
    Methods A total of 182 pregnant women with ICP admitted to our hospital were selected as the research subjects. They were randomly divided into control group (91 cases treated with ursodeoxycholic acid) and research group (91 cases treated with low molecular weight heparin sodium on the basis of control group). The clinical effects of two groups of pregnant women were compared and analyzed. The levels of prothrombin time (PT), fibrinogen (FIB), tissue-type plasminogen activator (t-PA), total bile acid (TBA), total bilirubin (TBIL) and alanine transaminase (ALT) were statistically analyzed before and after treatment. The pregnancy outcomes of pregnant women and newborns in two groups were compared and analyzed. 
    Results After treatment, the total effective rate of the research group was significantly higher than that of the control group (P<0.05). After treatment, PT and t-PA in the research group were higher than those in the control group, and the levels of FIB, TBA, TBIL and ALT in the research group were lower than those in the control group (P<0.05). The delivery weeks of pregnant women in the research group were longer than those in the control group (P<0.05). The cesarean section rate and postpartum hemorrhage rate in the research group were lower than those in the control group, while the vaginal delivery rate was higher than that in the control group (all P<0.05). The 5-min Apgar score of newborns in the research group was higher than that in the control group (P<0.05). The premature birth rate, neonatal asphyxia rate and intrauterine distress rate in the research group were lower than those in the control group (P<0.05). 
    Conclusion Low molecular weight heparin sodium is effective in the treatment of ICP. It can not only improve the coagulation function and liver function of pregnant women, but also prolong the pregnancy time, reduce the rate of cesarean section and preterm delivery. 

    The relationship of the expression of GFAP, CPK-BB, NSE, and S-100B in serum and cerebrospinal fluid of adults with viral encephalitis with the disease severity and prognosis
    HE Jie1, KANG Yan1, WU Jian-nan1, HE Min2
    2024, 45(2):  196-201.  doi:10.3969/j.issn.1007-3205.2024.02.013
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    Objective To investigate the expression of glial fibrillary acidic protein (GFAP), creatine phosphokinase-BB (CPK-BB), neuron-specific enolase (NSE) and S-100 calcium binding protein (S-100B) in serum and cerebrospinal fluid of adults with viral encephalitis and their relationship with disease severity and prognosis. 
    Methods In total, 102 adults with viral encephalitis admitted to our hospital were selected as the observation group, and another 50 patients with migraine, upper respiratory tract infection, and neurological disorders during the same period were included as the control group. The levels of GFAP, CPK-BB, NSE, and S-100B in serum and cerebrospinal fluid in the two groups and the observation group with different disease severity were recorded, and their predictive efficacy was analyzed by plotting the receiver operating characteristic (ROC) and the area under the ROC curve (AUC). The levels of GFAP, CPK-BB, NSE, and S-100B in serum and cerebrospinal fluid of patients with different prognosis were compared, and logistic regression equations were used to analyze the correlation between them. 
    Results The GFAP, CPK-BB, NSE, and S-100B levels in serum and cerebrospinal fluid in the observation group were higher than those in the control group, which were higher in severe patients in the acute and recovery stages in the observation group, followed by moderate patients and mild patients (P<0.05). The levels of GFAP (r=0.587, 0.638, 0.552, 0.568), CPK-BB (r=0.557, 0.593, 0.540, 0.559), NSE (r=0.602, 0.655, 0.587, 0.600), and S-100B (r=0.599, 0.634, 0.575, 0.595) in serum and cerebrospinal fluid of adults with viral encephalitis were positively correlated with the disease severity in the acute and recovery stages (P<0.05). The ROC curve showed that the diagnostic value of GFAP, CPK-BB, NSE, and S-100B in cerebrospinal fluid for adults with viral encephalitis [AUC: 0.937] was superior to that of GFAP, CPK-BB, NSE, and S-100B in combination in serum [AUC: 0.908]. In the observation group, the levels of GFAP, CPK-BB, NSE, and S-100B in serum and cerebrospinal fluid of patients with sequelae were higher than those of patients without sequelae (P<0.05). The levels of GFAP (OR: 4.971, 5.311), CPK-BB (OR: 4.986, 5.292), NSE (OR: 5.001, 4.727), and S-100B (OR: 5.453, 4.492) in serum and cerebrospinal fluid of adults with viral encephalitis were closely associated with prognosis (P<0.05). 
    Conclusion GFAP, CPK-BB, NSE, and S-100Bin serum and cerebrospinal fluid are highly expressed in adults with viral encephalitis and are closely correlated with the disease severity and prognosis, providing a favorable basis for the diagnosis and management of this disease. 

    Predictive value of blood routine parameters for catheter-related bloodstream infection in patients undergoing hemodialysis
    XU Liang, XU Yan, HU Shu-yang, GUO Meng-nan
    2024, 45(2):  202-207.  doi:10.3969/j.issn.1007-3205.2024.02.014
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    Objective To explore the predictive value of blood routine parameters for catheter-related bloodstream infection in patients undergoing hemodialysis. 
    Methods A total of 107 patients with end-stage renal disease (ESRD) who underwent maintenance hemodialysis (MHD) and suspected catheter-related bloodstream infection (CRBSI) in the wards and outpatients in Department of Nephrology of our hospital were retrospectively selected as subjects. The blood routine and procalcitonin data were obtained within 48 h of fever. The white blood cells (WBC) and procalcitonin were used as reference. The predictive value of hematocrit (HCT), mean corpuscular volume (MCV), mean corpsularhemoglobin (MCH), mean corpsularhemoglobin concentration (MCHC), red blood cell distribution width (RDW), platelet distribution width (PDW), plateletcrit (PCT), mean platelet volume (MPV), platelet-larger cell ratio (P-LCR), and derived parameters neutrophil/lymphocyte value (NLR), platelet/lymphocyte ratio (PLR), and monocyte/lymphocyte ratio (MLR) for occurrence of CRBSI was evaluated. 
    Results Compared with non-CRBSI group, WBC and procalcitonin in CRBSI group were significantly higher than those in non-CRBSI group (P<0.05). RDW, PCT, P-LCR %, NLR, PLR and PDW in CRBSI group were significantly increased (P<0.05), while MCV was significantly decreased (P<0.05). WBC, procalcitonin, RDW, PDW, P-LCR and NLR had certain predictive value for the occurrence of CRBSI (P<0.05). When NLR was> 6.78, the sensitivity and specificity of CRBSI prediction were 43.32% and 86.72% respectively, and when P-LCR was>43.67%, the sensitivity and specificity of CRBSI prediction were 70.04% and 66.72% respetively. When PDW was >8.84 fL, the sensitivity and specificity of CRBSI prediction were 56.73% and 90.03%respectively, and when RDW was >58.23, the sensitivity and specificity of CRBSI prediction were 73.45% and 66.78% respectively. When at least two of the NLR, P-LCR, PDW and RDW exceeded the corresponding truncation value, the AUC for predicting the occurrence of CRBSI was 0.829, the sensitivity was 76.67%, and the specificity was 73.33% (P=0.001). 
    Conclusion Four parameters, including RDW, PDW, P-LCR and NLR, have certain predictive value for the occurrence of CRBSI. In terms of NLR>6.78, P-LCR>43.67, PDW>8.84 fL, RDW>58.23 fL, at least two of the above four parameters have high predictive value for CRBSI.

    Effects of liraglutide on pyroptosis, inflammatory cell infiltration and NF-κB pathway in rats with type 2 diabetic nephropathy
    CHEN Ya-hui, DU Hai-bo, FENG Xiang-feng
    2024, 45(2):  208-214.  doi:10.3969/j.issn.1007-3205.2024.02.015
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    Objective To investigate the effects of liraglutide (LIR) on pyroptosis, inflammatory cell infiltration and nuclear factor-κB (NF-κB) pathway in rats with type 2 diabetic nephropathy (DN). 
    Methods A total of 45 rats were selected, from which 10 were randomly selected as control group, and the other 35 rats were used to establish DN model. A total of 30 rats were used to estabolish models sucecessfully and randomly divided into three groups (DN group, high-dose LIR group and low-dose LIR group), with 10 rats in each group. High- and low-dose LIR groups were given LIR100 and 200 g·kg-1·d-1, respectively, while control group and DN group were given the same amount of normal saline. After 2 weeks of continuous intragastolic administration, renal function indexes and the serum inflammatory factors were measured, and the inflammatory cell infiltration was evaluated by inflammatory cells. DNA damage was detected by TUNEL staining, and the expression levels of Caspase-1, interleukin-1β (IL-1β), interleukin-18 (IL-18), NF-κB pathway related proteins were detected.
    Results Compared with the control group, the levels of fasting blood glucose(FBG), 24 h urine total protein (UTP), blood urea nitrogen (BUN), tumor necrosis factor-α (TNF-α), IL-1β, interleukin-6 (IL-6), the number of inflammatory cells, and the rate of TUNEL positive cells in DN group were increased, and the protein expressions of Caspase-1, IL-1β, IL-18, Toll like receptor 4 (TLR4), P-NF-κB/NF-κB and nucleotide binding oligomerization domain-like receptor protein 3 (NLRP3) were up-regulated (P<0.05). Compared with DN group, the levels of FBG, UTP and BUN, TNF-α, IL-1β and IL-6, inflammatory cell count and TUNEL positive cell rate were decreased in low-dose and high-dose LIR groups, and the expression of Caspase-1, IL-1β, IL-18, TLR4, P-NF-κB/NF-κB and NLRP3 protein were decreased (P<0.05). Compared with low-dose LIR group, the levels of FBG, UTP and BUN, TNF-α, IL-1β and IL-6, inflammatory cell count and TUNEL positive cell rate were decreased in high-dose LIR group, and the expression of Caspase-1, IL-1β, IL-18, TLR4, P-NF-κB/NF-κB and NLRP3 protein were decreased (P<0.05). 
    Conclusion LIR can improve inflammatory cell infiltration and inhibit pyroptosis in type 2 DN rats, and its mechanism may be related to inhibition of NF-κB pathway. 

    Analysis of the expression of EPHA5 in lung adenocarcinoma based on data mining and immunohistochemistry
    LI Jie, WANG Lan
    2024, 45(2):  215-220.  doi:10.3969/j.issn.1007-3205.2024.02.016
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    Objective To investigate the expression of erythropoietin-producing hepatocellular receptor A5 (EPHA5) in lung adenocarcinoma. 
    Methods The variation of EPHA5 in different tumors was obtained through the network database, and the EPHA5 protein interaction network diagram was constructed to analyze the prognosis of EPHA5 in lung adenocarcinoma. The surgical specimens and clinical data of patients with lung adenocarcinoma were collected. The expression of EPHA5 was detected by immunohistochemistry, and the correlation between EPHA5 expression in lung adenocarcinoma and clinical characteristics of patients was analyzed. 
    Results EPHA5 has the highest mutation frequency in lung adenocarcinoma, mainly missense mutations. In addition to the ligands of EPH family, EPHA5 was closely related to RhoA and ADAM10 proteins. High expression of EPHA5 was associated with overall survival and time to first progression in patients with lung adenocarcinoma. EPHA5 expression was up-regulated in lung adenocarcinoma tissues, which was significantly correlated with lymph node metastasis, differentiation degree and TNM stage. 
    Conclusion EPHA5 is highly expressed in lung adenocarcinoma tissues, which can be used as a prognostic factor for lung adenocarcinoma. 

    Effect of bone marrow cavity puncture technique on the success rate of rescue in establishing infusion pathways for patients with traumatic hemorrhagic shock
    YANG Wei-qi, XU Hai-ting, HUANG Yan-ping, YU Da-wei
    2024, 45(2):  221-225.  doi:10.3969/j.issn.1007-3205.2024.02.017
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    Objective To explore the effect of bone marrow cavity puncture technique on the success rate of rescue in establishing infusion pathways for patients with traumatic hemorrhagic shock (THS). 
    Methods A total of 40 patients with THS were selected from January 2021 to January 2022, all of whom underwent bone marrow cavity puncture to establish vascular access, and 40 patients with THS were selected before the development of bone marrow cavity puncture technology (January 2020 to December 2020), all of whom underwent central vein puncture to establish infusion access. The therapeutic effect within 4 h, success rate of one-time puncture, time to establish infusion pathway, time of blood pressure rising and survival rate of treatment were observed in two groups. The coagulation indexes [prothrombin time (PT), activated partial enzyme thrombin time (APTT), thrombin time (TT)] and blood gas indicators [arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), lactic acid], and the incidence of adverse reactions between two groups were observed and compared. 
    Results There was no significant difference in sex, age and cause of trauma between the two groups (P>0.05). The effective rate of the observation group was significantly higher than that of the control group (P<0.05). The success rate of one-time puncture and the survival rate of treatment in the observation group were significantly higher than those in the control group, while the time to establish infusion pathway and blood pressure rising were significantly lower than those in the control group (P<0.05). After treatment, the time of APTT, PT and TT in the observation group was significantly shorter than that before treatment, which were sohorter than that after treatment in the control group (P<0.05). After treatment, the levels of lactic acid and PaCO2 in the observation group were lower than those before treatment, which were lower than those in the control group, while PaO2 was higher than that before treatment and higher than that in the control group (P<0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group (P<0.05). 
    Conclusion Using bone marrow cavity puncture technique to establish vascular pathway for patients with THS can improve the success rate of rescue, which is rapid and effective. 
    Protective mechanism of human milk oligosaccharides on radiation-induced intestinal injury
    WANG Jun, YU Li-hua, WANG Wei-na, WANG Hong
    2024, 45(2):  226-230.  doi:10.3969/j.issn.1007-3205.2024.02.018
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    Objective To explore the protective mechanism of human milk oligosaccharides (HMOs) on radiation-induced intestinal injury (RIII). 
    Methods A mouse model of RIII was constructed and treated with HMOs by gavage. HE staining was used to detect the intestinal villus length and crypt depth of mice. Spectrophotometry was used to detect the changes of serum D-lactic acid and D-xylose in mice to determine intestinal permeability, and myeloperoxidase(MPO) activity kit was used to detect neutrophil infiltration in intestinal tissue. Enzyme-linked immunosorbent assay kit was used to detect the changes of inflammatory factors in intestinal tissue, and qRT-PCR was used to detect the expression level of TLR4 mRNA in intestinal tissue. 
    Results Compared with the IR group, the IR+HMOs group prompted a significant increase in epithelial thickness (413.208±37.042)μm and crypt number (65.109±8.225) (P<0.05), a significant decrease in serum D-lactic acid level (1.799±0.158)μg/L, and a significant increase in D-xylose level (76.823±12.206) mg/L (P<0.05). Moreover, in the IR+HMOs group, the levels of tumor necrosis factor-α (TNF-α) (42.000±5.858)ng/L and interleukin-1β (IL-1β) (38.836±4.022) ng/L in the intestinal tissues of mice, and the infiltration of neutrophils (4.024±0.419) U/L were significantly decreased, while the level of anti-inflammatory factor interleukin-10 (IL-10) (24.392±2.989) ng/L was increased significantly. In addition, TLR4 expression in the intestinal tissues of mice in the IR group (3.22±0.53) was increased compared with that in the Sham group (1.00±0.09), whereas the expression level of TLR4 mRNA was significantly higher in the IR+HMOs group than that in the IR group. 
    Conclusion HMOs-mediated TLR4 plays a protective role in RIII. 

    Effect of sevoflurane inhalation anesthesia on postoperative recovery and delirium after endoscopic mucosal resection of elderly patients with early esophageal cancer
    GUO Hao-yu, ZHANG Chun-yan, HUANG Peng
    2024, 45(2):  231-235.  doi:10.3969/j.issn.1007-3205.2024.02.019
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    Objective To investigate the effect of sevoflurane inhalation anesthesia on the recovery and inflammatory response after endoscopic mucosal resection for elderly patients with early esophageal cancer. 
    Methods A total of 94 patients with early esophageal cancer who were admitted to the Third People′s Hospital of Suining City for endoscopic mucosal resection were selected and divided into the control group (continuous inhalation of isoflurane to maintain anesthesia, n=47) and the observation group (continuous inhalation of sevoflurane to maintain anesthesia, n=47). The condition during anesthesia recovery was compared between two groups. The levels of inflammatory factors [interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α)] at different time points [before anesthesia (T0), at 2 h after surgery (T1), 6 h after surgery (T2), and 12 h after surgery (T3)] were compared between two groups. The mini-mental state examination (MMSE) score, the postoperative 40-item Quality of Recovery Scale (QoR-40), and perioperative infection were compared between two groups.
    Results Respiratory recovery time [(6.12±1.28) min vs. (11.46±3.75) min], tracheal extubation time [(8.65±2.01) min vs. (17.24±5.68) min] and orientation recovery time [(11.26±3.84) min vs. (23.75±6.74) min] in observation group were shorter than those in the control group (t=9.239, 9.774, 11.038, all P<0.001). There were significant differences of interactions between groups, time points and timepoints between groups with respect to serum IL-1 and TNF-α levels (P<0.05). Compared with T0, the serum levels of IL-1 and TNF-α in the two groups were increased at T1, T2 and T3 (P<0.05), and the serum IL-1 [(32.75±7.43] ) ng/L vs. (36.08±8.27) ng/L, (35.28±5.32) ng/L vs. (40.15±8.46) ng/L, (40.31±6.08) ng/L vs. (45.74±7.53) ng/L], and TNF-α [(34.26±8.84) ng/L vs. (39.86±9.02) ng/L, (33.28±8.69) ng/L vs. (48.42±9.13) ng/L, (43.75±9.46) ng/L vs. (58.15±9.83) ng/L]  at T1, T2 and T3 in the observation group was lower than those in the control group (P<0.05). The QoR-40 score [(182.21±9.84) points vs. (175.68±8.43) points] and MMSE score [(28.84±5.13) points vs. (26.16±5.03) points] in the observation group at 3 d after operation were higher (t=3.455, 2.577, P=0.001, 0.012),and the incidence of delirium (2.13%) was lower than that of the control group (17.02%, P=0.014). The overall incidence of infection in the two groups (12.77% vs. 17.02%) was similar (χ2=0.336, P=0.562). 
    Conclusion Sevoflurane inhalation anesthesia is effective in endoscopic mucosal resection of elderly patients with early esophageal cancer, which can reduce the incidence of delirium and improve cognitive function. 

    Effect of serum resistin on depression in elderly patients with diabetes
    AN Guang-hua1, CHEN Ye2, YANG Fan3, QIAO Cai-xia1, GAO Jin-e1
    2024, 45(2):  236-241.  doi:10.3969/j.issn.1007-3205.2024.02.020
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    Objective To explore the effect of serum resistin on depression in elderly patients with diabetes. 
    Methods In this study, 114 elderly patients with diabetes were selected as the subjects. The Geriatric Depression Scale 15 (GDS-15) was used to assess the depression. The CDS-15 score>4 was regarded as depression, and the serum resistin level of elderly diabetic patients with depression was compared. The quartile of serum resistin level was divided into 4 groups to test the effect of serum resistin level on depression in elderly patients with diabetes. Receiver operating characteristic (ROC) curve was drawn to analyze the value of serum resistin in predicting depression in patients. 
    Results Among 114 elderly patients with diabetes, 26 were accompanied by depression, with an incidence of 22.81%. The serum resistin levels in the depression group were significantly higher than those in the non-depression group (P<0.05). There was a statistically significant difference in serum triglyceride (TG) levels among groups with different levels of serum resistin (P<0.05). The binary correlation analysis showed that depression in elderly patients with diabetes was positively correlated with serum resistin level (P<0.05). The results of bivariate Pearson correlation showed that the serum resistin level in elderly patients with diabetes was positively correlated with TG and HbA1c levels (P<0.05). Logistic regression analysis showed that serum resistin, TG and glycosylated hemoglobin levels were the influencing factors of depression in elderly patients with diabetes (P<0.05). The area under curve (AUC) of the serum resistin level in predicting depression in elderly diabetic patients at the time of enrollment was 0.808. 
    Conclusion The level of serum resistin can affect the risk of depression in elderly patients with diabetes. The higher the level of serum resistin, the higher the risk of depression in patients with diabetes, which can be used as an auxiliary indicator to predict the risk of depression in patients with diabetes.