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    25 April 2024, Volume 45 Issue 4
    Effect of isoniazid on nerve conduction velocity in pulmonary tuberculosis complicated with diabetic peripheral neuropathy
    FENG Yan-jing1, YIN Zhi-ye1, LI Yan-jun2, WANG Xian-lei3, HOU Yong-Hua1, YU Li-wei1
    2024, 45(4):  378-382.  doi:10.3969/j.issn.1007-3205.2024.04.002
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    Objective To observe the effect of anti-tuberculosis drug isoniazid on nerve conduction velocity in patients with pulmonary tuberculosis complicated with diabetic peripheral neuropathy (DPN). 
    Methods Patients admitted to our hospital were selected and grouped according to the case-control study. The patients were divided into simple initial treatment of non-drug-resistant pulmonary tuberculosis (TB) group (n=39), type 2 diabetic peripheral neuropathy (T2DPN) group (n=39), T2DPN combined with initial treatment of non-drug-resistant pulmonary tuberculosis (DPNTB) group (n=39). According to the specific conditions of patients, appropriate hypoglycemic regimens were given to patients, and the target blood glucose level was reached. All cases were newly diagnosed with secondary non-drug resistant pulmonary tuberculosis, and all received the first-line standardized intensive treatment regimen HRZE: Isoniazid (H) 0.3 g/time, once daily; Rifampicin (R) 0.45 g/time, once daily; Pyrazinamide (Z) 0.5 g/time, 3 times/day; Ethambutol (E) 0.75 g/time, once daily; They were all taken orally for 2 months. The sensory nerve conduction velocity of superficial peroneal nerve and sural nerve, and the motor nerve conduction velocity of deep peroneal nerve, superficial peroneal nerve, common peroneal nerve, tibial nerve and femoral nerve were compared among the three groups before and after treatment. 
    Results After treatment, the sensory nerve conduction velocity of superficial peroneal nerve and sural nerve in the lower limbs of TB group and DPNTB group was significantly slower than that before treatment, and the sensory nerve conduction velocity of superficial peroneal nerve and sural nerve in DPNTB group was slower than that in TB group and DNP group, showing significant difference (P<0.05). There was no significant change in motor nerve conduction velocity of deep peroneal nerve, superficial peroneal nerve, common peroneal nerve, tibial nerve and femoral nerve among the three groups before and after treatment (P>0.05). 
    Conclusion Isoniazid can cause sensory nerve conduction velocity to slow down in patients with pulmonary tuberculosis and DPN. especially in the lower limbs of pulmonary tuberculosis patients with DPN. Isoniazid had no significant effect on the motor nerves of the lower limbs. 

    The correlation of CD4+/CD8+, Th17/Treg with the condition and short-term prognosis of elderly chronic obstructive pulmonary disease
    WU Qing-hua, WANG Pei-pei, WANG Wei, CUI Na-juan
    2024, 45(4):  383-388.  doi:10.3969/j.issn.1007-3205.2024.04.003
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    Objective To explore the value of CD4+/CD8+, and helper T cells 17 (Th 17)/ regulatory T cells (Treg) in the evaluation of disease severity and prognosis in elderly patients with chronic obstructive pulmonary disease (COPD). 
    Methods In total, 288 elderly patients with COPD (COPD group) and 70 healthy elderly undergoing physical examination (control group) were selected. CD4+, CD8+, Th17, Treg, CD4+/CD8+, Th17/Treg were compared between the COPD group and the control group and between patients with different disease severity in the COPD group. The COPD group was followed up for 6 months, the clinical data of patients with different prognosis were compared. Multivariate Logistic regression was used to analyze the influencing factors of the short-term adverse prognosis of elderly COPD patients. The receiver operating characteristic(ROC) curve was drawn to analyze the clinical value of CD4+/CD8+ Th17/Treg in predicting the short-term adverse prognosis of elderly COPD. 
    Results The levels of CD4+, CD4+/CD8+ and Treg in peripheral blood of COPD group were lower than those of the control group (P<0.01), while the levels of CD8+, Th17 and Th17/Treg in peripheral blood of COPD group were higher than those of the control group (P< 0.01). The levels of CD4+, CD4+/CD8+ and Treg in peripheral blood of grade Ⅲ  group were lower than those of grade Ⅰ, and Ⅱ groups, while the levels of CD8+, Th17 and Th 17/Treg in peripheral blood were higher than those of grade Ⅰ and Ⅱ groups; The levels of CD4+, CD4+/CD8+and Tregin peripheral blood of the grade Ⅱ group were lower than those of grade Ⅰ group, while the levels of CD8+, Th17 and Th17/Treg were higher than those of grade Ⅰ group (P<0.05). Pearson correlation analysis showed that CD4+/CD8+ in COPD patients was negatively correlated with the disease grades (P<0.05), and that Th17/Treg was positively correlated with the disease grade (P<0.05). The levels of CD4+, CD4+/CD8+ and Treg in peripheral blood of the poor prognosis group was lower than those of the good prognosis group. The levels of CD8+, Th17, Th17/Treg, serum IL-6 and CRP were higher than those of the good prognosis group (P<0.05). Multivariate Logistic regression analysis showed that CD4+/CD8+, Th17/Treg, IL-6, and CRP are the factors affecting the recent poor prognosis in elderly COPD patients. The ROC curve analysis showed that the areas under the ROC curve (AUC) of CD4+/CD8+ and Th17/Treg in predicting the short-term adverse prognosis of elderly COPD patients were 0.813 (95%CI: 0.730-0.896) and 0.852 (95%CI: 0.730-0.896), respectively. 
    Conclusion CD4+/CD8+and Th17/Treg have high clinical values in the evaluation of the severity of disease and short-term prognosis of elderly COPD patients.

    Changes in Th17/Treg immune balance and FeNO level in AECOPD patients before and after treatment and their effect on prognosis
    LI Xing-hong, LI Zhen-sheng, LONG Xue-juan, ZHANG Le-tian, TANG Qian
    2024, 45(4):  389-394.  doi:10.3969/j.issn.1007-3205.2024.04.004
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    Objective To investigate the changes in Th17/Treg immune balance and fraction of exhaled nitric oxide (FeNO) level in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) before and after treatment and their effect on prognosis. 
    Methods A total of 126 patients with AECOPD were selected, and forced expiratory volume in one second (FEV1), the percentage of predicted value of FEV1(FEV1%), forced vital capacity (FVC), the percentage of predicted value of FVC (FVC%), and FEV1/FVC were measured by pulmonary function detector. FeNO levels were detected using nitric oxide analyzer, and the scores were assessed using systemic inflammaton response syndrome (SIRS) scores. Serum T help 17cells (Th17) and Tregulatory cells (Treg) were detected using flow cytometry. The changes in pulmonary function index, FeNO level, SIRS score and Th17/Treg level before and after treatment were compared. 
    Results At 3 months after treatment, the levels of FEV1%, FEV1/FVC, Th17 and Th17/Treg in AECOPD patients were significantly higher than those before treatment, while FeNO, serum Treg level and SIRS score were significantly lower than those before treatment (P<0.05). Of 126 AECOPD patients, 94 (74.60%) survived and 32 (25.40%) died at 3 months after treatment. The levels of FEV1%, FEV1/FVC and Treg in survival group were significantly higher than those in death group, while the scores of FeNO, Th17, Th17/Treg and SIRS in survival group were significantly lower than those in death group (P<0.05). Multivariate Logistic regression analysis showed that FEV1%, FEV1/FVC and Treg were the risk factors for prognosis of AECOPD patients before treatment (P<0.05), where as FeNO, Th17, Th17/Treg and SIRS scores were protective factors for the prognosis of AECOPD patients (P<0.05). 
    Conclusion After treatment, the pulmonary function of patients with AECOPD is improved, while Th17/Treg and FeNO are decreased. Pulmonary function, Th17/Treg immune balance and FeNO level are of great significance for the efficacy evaluation and prognosis judgment of patients with AECOPD.

    The correlation between carotid intima-media thickness and left cardiac structure in patients with obstructive sleep apnea hypopnea syndrome
    ZHANG Zhi-bin, XIE Yun-ping, CHEN Xing-rong, YANG Xiao-ling
    2024, 45(4):  395-399.  doi:10.3969/j.issn.1007-3205.2024.04.005
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    Objective To analyze changes in left heart structure and function in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and its correlation with carotid intima-media thickness (CIMT). 
    Methods A total of 90 patients with OSAHS were divided into mild group (n=28), moderate group (n=36) and severe group (n=26) according to the apnea hypopnea index. The general data, left ventricular structure and function indexes [left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), left ventricular posterior wall thickness (LVPWT), interventricular septal thickness (IVST),left ventricular mass index(LVMI),left ventricular ejection fractions (LVEF), eject decel time (EDT)] and carotid artery function indexes [pulmonary artery (PA), aortic diameter (AO), dilatancy (DC), compliance (CC), distension (Dis)] and CIMT were compared among the three groups. The correlation between carotid CIMT and left ventricular structure and function in OSAHS patients was analyzed. 
    Results There were no significant differences in sex, age, course of disease, heart rate, diastolic blood pressure and systolic blood pressure among the three groups (P>0.05). Body mass index (BMI) in moderate and severe groups was higher than that of mild group, and higher in severe group than in moderate group, and the difference was statistically significant (P<0.05). LVESD, LVEDD, LVPWT, IVST, LVMI, peak A and EDT in moderate and severe group were significantly higher than those in mild group, while LVEF, peak E and E/A were significantly low than those in mild group; LVESD, LVEDD, LVPWT, IVST, LVMI, peak A and EDT in severe group were significantly higher than those in moderate group, while LVEF, peak E and E/A were significantly lower than those in moderate group (P<0.05). PA, AO, DC, CC, Dis and IMT in moderate and severe group were significantly higher than those in mild group, and PA, AO, DC, CC, Dis and CIMT in severe group were significantly high than those in mild group (P<0.05). The carotid CIMT was positively correlated with left ventricular structure and function indexes LVESD, LVEDD, LVPWT, IVST and LVMI respectively (r=0.334, 0.318, 0.416, 0.316, 0.438, P<0.05), and negatively correlated with LVEF (r=-0.356, P<0.05). 
    Conclusion The left heart structure and function and carotid CIMT of OSAHS patients will change obviously with the aggravation of the disease, and there is a significant correlation between them, which can provide evidence for the prevention and treatment of cardiovascular diseases in OSAHS patients.

    Relationship of serum iron-regulated protein 2 and decoy receptor 3 levels with disease outcome in elderly patients with acute exacerbation of chronic obstructive pulmonary disease
    LYU Rui-bing, WANG Wen-ju, SHI Xiang-qun, LI Xin
    2024, 45(4):  400-405.  doi:10.3969/j.issn.1007-3205.2024.04.006
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    Objective To investigate the relationship of serum iron-regulated protein 2 (IRP2) and decoy receptor 3 (DcR3) levels with disease outcome in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). 
    Methods In total, 88 patients with AECOPD (AECOPD group) were selected, and serum IRP2 and DcR3 levels of subjects were detected. Clinical disease outcomes of AECOPD patients were tracked and they were divided into aggravation group (n=22) and improvement group (n=66) according to clinical disease outcomes. Multivariate Logistic regression analysis was used to analyze the factors influencing disease outcome of AECOPD patients. The value of IRP2 and DcR3 in predicting the outcome of AECOPD patients was analyzed by receiver operating characteristic curve (ROC). 
    Results The number of AECOPD attacks, acute physiological and chronic health status scores, combined shock and dyspnea scores, and modified medical research council (mMRC) grades 3-4 in the aggravation group were better than those in the improvement group (P<0.05). The serum IRP2 and DcR3 levels in the aggravation group were higher than those in the improvement group before and at 2 weeks after treatment, and the serum IRP2 and DcR3 levels in the improvement group at 2 weeks after treatment were lower than those before treatment (P<0.05). There was no significant difference in serum IRP2 and DcR3 levels in the aggravation group compared with those before treatment (P>0.05). Multivariate Logistic regression analysis showed that the number of AECOPD attacks within 1 year, mMRC grade, IRP2 before treatment, DcR3 before treatment were risk factors for disease deterioration in patients with AECOPD (P<0.05). The area under the ROC curve (AUC) of IRP2 and DcR3 before treatment in predicting disease outcome of AECOPD patients was 0.781 and 0.795 respectively, and the AUC of IRP2 and DcR3 in combination was 0.918, which was greater than that predicted by IRP2 and DcR3 alone (P<0.05). 
    Conclusion Serum levels of IRP2 and DcR3 are significantly increased in AECOPD patients, and are associated with decreased lung function and disease deterioration. Detection of serum levels of IRP2 and DcR3 is helpful to predict the disease outcome in AECOPD patients. 

    Effect of Nd:YAG laser combined with fluorine varnish on preventing redemineralization of dentine caries in deciduous incisors in vitro
    HAN Ning, PING Ya-kun, ZHANG Run, FENG Yi-fan, FAN Wei-xiao, ZHOU Yong-chuan
    2024, 45(4):  418-423.  doi:10.3969/j.issn.1007-3205.2024.04.009
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    Objective To evaluate the combined effect of Nd:YAG laser treatment and fluorine varnish on the prevention of redemineralization of dentine caries in deciduous incisors using confocal laser scanning microscope (CLSM). 
    Methods Thirty deciduous incisors were collected and randomly divided into three groups, group A (n=10), group B (n=10), and group C (n=10), according to the different treatment methods. Each tooth was divided into mesial and distal parts, which were used as the experimental group and the control group, respectively, in the self-controlled study. Group A received only Nd:YAG laser treatment, including group A1 as the experimental group and group A2 as the control group. Group B was treated with fluorine varnish only, including group B1 as the experimental group and group B2 as the control group, while group C received the combined Nd:YAG laser and fluorine varnish treatment, including group C1 as the experimental group and group C2 as the control group. The artificial superficial dentine caries models were redemineralized after treatment, stained with a solution of fluorescein sodium in ethanol, and ground using grinding plates. The depth of demineralization in longitudinal sections of the teeth was evaluated by CLSM. 
    Results The depth of demineralization differed significantly between groups A1 and A2, between groups B1 and B2, and between groups C1 and C2 (P<0.01). No significant differences in the demineralization depths were found among groups A2, B2, and C2 (P>0.05). The depth of demineralization differed significantly between groups A1 and C1, and between groups B1 and C1 (P<0.01), which was smaller in group C1 than in groups A1 and B1 (P<0.01). 
    Conclusion While individual administration of the Nd:YAG laser treatment and fluorine varnish are effective in alleviating the redemineralization of dentine caries in deciduous incisors, the combined treatment is significantly more effective. 

    Predictive value of VEGF, MMP-13 and TIMP-1 levels in wound exudate on the effect of VSD combined with artificial dermis repair in the treatment of refractory wounds
    SUI Lei1, XIE Qiang1, KONG Yu1, HAO Yu1, WANG Xiao-xue2, LI Xiao-dong1
    2024, 45(4):  445-450.  doi:10.3969/j.issn.1007-3205.2024.04.013
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    Objective To observe the levels of vascular endothelial growth factor (VEGF) and matrix metalloproteinase -13 (MMP-13) and tissue inhibitor of matrix metalloproteinases-1 (TIMP-1) in wound exudate of patients with refractory wounds, and to analyze their predictive value for the clinical effect of negative pressure vacuum sealing drainage (VSD) combined with artificial dermal repair in the treatment of refractory wounds. 
    Methods Sixty patients with refractory wounds were selected to be included in the refractory group, and 60 patients with common wounds in the same period were selected as the control group. VEGF, MMP-13 and TIMP-1 were detected in wound exudate of all people enrolled, and MMP-13/TIMP-1 values were calculated. Patients with refractory wounds were treated with VSD combined with artificial dermal repair, and the clinical effect was observed. The patients were subdivided into effective subgroup and ineffective subgroup according to the clinical effect. The levels of VEGF, MMP-13, TIMP-1 and MMP-13/TIMP-1 in wound exudate between the effective group and the ineffective group were compared. Logistic regression was used to analyze the impact of the above indexes on the efficacy of VSD combined with artificial dermal repair in the treatment of refractory wounds, and receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of the above indexes on the efficacy of VSD combined with artificial dermal repair in the treatment of refractory wounds. 
    Results The levels of MMP-13 and MMP-13/TIMP-1 in refractory group were higher than those in control group, while VEGF and TIMP-1 levels were lower than those in control group (P<0.05). In 60 patients with refractory wounds, VSD combined with artificial dermal repair was effective in 49 patients (81.67%) and ineffective in 11 patients (18.33%). The values of MMP-13 and MMP-13/TIMP-1 in the ineffective group were higher than those in the effective group, and the levels of VEGF and TIMP-1 were lower than those in the effective group (P<0.05). Logistic regression analysis showed that MMP-13 (95%CI: 1.037-1.165) and MMP-13/TIMP-1 value (95%CI: 1.410-3.458) were risk factors for therapeutic effect in patients with refractory wounds (P<0.05), while VEGF (95%CI: 0.972-0.995) and TIMP-1 (95%CI: 0.264-0.756) were protective factors (P<0.05). By point two-line correlation analysis, the results showed that VEGF and TIMP-1 levels were positively correlated with the efficacy of VSD combined with artificial dermal repair in patients with refractory wounds (r=0.410, 0.448, P<0.05), and that the MMP-13 level and MMP-13/TIMP-1 value were negatively correlated with the therapeutic effect (r=-0.477, 0.570, P<0.05). ROC curve was drawn, and the results showed that VEGF (95%CI: 0.643-0.908), MMP-13 (95%CI: 0.706-0.986), TIMP-1 (95%CI: 0.712-0.943) levels and MMP-13/TIMP-1 values (95%CI: 0.712-0.943) levels and MMP-13/TIMP-1 values (95%CI: 0.829-0.981) had a certain predictive value in the treatment effect of refractory wounds (AUC=0.776, 0.846, 0.827, 0.905). 
    Conclusion VEGF, MMP-13, TIMP-1 and MMP-13/TIMP-1 values in wound exudate can have an important impact on the efficacy of VSD combined with artificial dermal repair in the treatment of refractory wounds, and the therapeutic effect can be predicted early by measuring VEGF, MMP-13, TIMP-1 and MMP-13/TIMP-1 values in clinical practice. 

    Clinical characteristics and risk factors of HBV reactivation in women with inactive HBsAg during pregnancy and postpartum
    FU Guo-ji1, WANG Hua2, XU Shao-zhen3
    2024, 45(4):  451-457.  doi:10.3969/j.issn.1007-3205.2024.04.014
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    Objective To analyze the clinical characteristics and risk factors of hepatitis B virus (HBV) reactivation in women with non-active hepatitis B virus surface antigen (HBsAg) during and after pregnancy. 
    Methods In total, 116 pregnant women who were non-active HBV carriers were retrospectively selected. Baseline data of HBV reactivation during pregnancy and non-HBV reactivation during pregnancy were analyzed to construct a clinical prediction model of baseline data and evaluate the scientificity of the model. The levels of liver function, immune function, liver fibrosis indexes and inflammatory factors during HBV activation were analyzed in pregnant women with HBV reactivation during pregnancy, after pregnancy as well as during pregnancy and after pregnancy. In the meantime, the factors influencing HBV reactivation during pregnancy on all-cause postpartum HBV reactivation was evaluated. 
    Results Baseline HBV deoxyribonucleic acid (DNA) level, total cholesterol (TC), low density lipoprotein (LDL), and proportion of primipara in HBV reactivation during pregnancy group were significantly higher than those in non-HBV reactivation during pregnancy group, while age and family monthly income level were significantly lower than those in non-HBV reactivation during pregnancy group. Most HBV reactivation patients during pregnancy were primiparas (χ2/t=7.004, 5.934, 4.805, 3.853, 10.561, 7.289, P<0.05). Baseline HBV DNA level, age and monthly family income had certain predictive value for HBV reactivation during pregnancy (cindex=0.653, AUC five month=0.679, AUC ten month=0.742, P<0.05). HBV DNA levels, serum hyaluronic acid, laminin, N-terminal peptide of type Ⅲ procollagen, type Ⅳ collagen, C-reactive protein, interleukin-6, and tumor necrosis factor α in HBV reactivation during pregnancy group than in HBV reactivation after pregnancy group, while the levels of CD4+, CD4+/CD8+ in pregnant HBV reactivation group were significantly higher than those in HBV reactivation after pregnancy group and those in HBV reactivation during and after pregnancy group (F=5.123, 4.835, 5.035, 17.329, 14.924, 16.392, 14.320, 7.852, 14.824, 6.392, P<0.05). All-cause HBV reactivation was more likely to occur in younger pregnant women (P<0.05). 
    Conclusion Patients with younger age, higher baseline HBV DNA level and lower monthly family income are prone to HBV reactivation during pregnancy, and the immune damage caused by HBV reactivation after pregnancy may be more serious than that during pregnancy, and all-cause HBV reactivation after childbirth is more likely to occur in younger patients. 

    Effect of sampling time and site on the pH of umbilical cord venous blood
    MENG Qing-ju1, LI Yan-qiu1, YE Feng-ying1, WU Jing2, HUANG Wan-jun3
    2024, 45(4):  458-462.  doi:10.3969/j.issn.1007-3205.2024.04.015
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    Objective To investigate the effect of sampling time and site on the pH value of umbilical cord venous blood. 
    Methods A total of 170 pregnant women who met the criteria were randomly selected and included in the study. Free and connected placental cord venous blood were collected at 5 min, 15 min and 30 min after fetal delivery, and the pH of the corresponding blood samples was measured. 
    Results With the extension of sampling time, the pH value of the free segment and the connected placenta segment decreased gradually; the pH value of the free segment was significantly higher than that of the connected placenta segment, and there were significant differences in interaction between groups, time points and time points between groups (P<0.05). 
    Conclusion With the extension of sampling time of cord blood, the pH value of umbilical vein blood decreases gradually. The pH value of free segment of umbilical venous blood is higher than that with connecting placental segment. Therefore, in order to ensure that the measurement results of pH value of umbilical venous blood can better reflect the actual physiological situation of the fetus, umbilical cord blood sampling should be conducted as soon as possible, and sampling should be conducted in the free segment far from the placenta.

    Value of combined detection of CRP, PCT, and γ-GT in evaluating neonatal hyperbilirubinemia complicated with infection
    LU Wen-xia, QIN Xiao-gang, YANG Lei
    2024, 45(4):  463-467.  doi:10.3969/j.issn.1007-3205.2024.04.016
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    Objective To explore the predictive efficacy of combined detection of C-reactive protein (CRP), procalcitonin (PCT), and γ-glutamyltransferase (γ-GT) for neonatal hyperbilirubinemia complicated with infection. 
    Methods Eighty children with hyperbilirubinemia were selected and divided into the infection group (n=17) and the non-infection group (n=63) according to their prognosis and outcome. The serum neutrophil ratio, serum amyloid A, platelet count, CRP, PCT, and γ-GT levels in the two groups were compared. Factors influencing the incidence of infection in children with hyperbilirubinemia were analyzed. The predictive efficacy of detection of CRP, PCT, γ-GT alone and in combination for neonatal hyperbilirubinemia complicated with infection was evaluated. 
    Results Among the 80 children with hyperbilirubinemia, 17 cases (20.99%) were complicated with infection. The serum levels of CRP, PCT, and γ-GT in the infection group were significantly higher than those in the non-infection group (P<0.05). Logistic regression analysis showed that elevated serum levels of CRP was risk factors for infection in children with hyperbilirubinemia (P<0.05). The results of receiver operating characteristic (ROC) analysis showed that the area under the ROC curve (AUC) of serum levels of CRP, PCT, and γ-GT alone or in combination in predicting infection in children with hyperbilirubinemia was 0.713 (95%CI: 0.601-0.827), 0.707 (95%CI: 0.602-0.813), 0.673 (95%CI: 0.551-0.795), and 0.802 (95%CI: 0.713-0.912), respectively. Combined detection had a higher predictive efficacy than single detection (P<0.05). 
    Conclusion Serum levels of CRP, PCT, and γ-GT are influential factors in neonatal hyperbilirubinemia complicated with infection, and combined detection exhibits higher predictive efficacy in neonatal hyperbilirubinemia complicated with infection. 

    Budesonide combined with endoscopic surgery for chronic dacryocystitis
    QI Zhi-wei1, TAN Xiao-bo2, YUAN Yu-jie1, GUAN Li-ying2, FENG Li2, SU Rui-feng2
    2024, 45(4):  468-471.  doi:10.3969/j.issn.1007-3205.2024.04.017
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    Objective To investigate the effect of budesonide combined with endoscopic surgery on chronic dacryocystitis. 
    Methods In total, 80 patients (80 eyes) with chronic dacryocystitis were enrolled in a prospective single-blind study and randomly divided in to budesonide group (n=40) and control group (n=40). All patients underwent nasal endoscopic dacryocystorhinostomy. Budesonide nasal spray was used for 3 months in the budesonide group, and physiological seawater was used for 3 months in the control group. The surgical effect, Lund-Kenndey score and complications of the two groups were compared. 
    Results At 6 months after follow-up, the effective rate of budesonide group was better than that of the control group (P<0.05). At 3 months after surgery, the Lund-Kenndey score in the two groups was lower than that before surgery, and lower in the budesonide group than in the control group (P<0.05). The incidence of complications in the budesonide group was lower than that in the control group (5% vs. 20%, P<0.05). 
    Conclusion The application of budesonide nasal spray after nasal endoscopic dacryocystorhinostomy is safe and effective, with a higher success rate, a lower probability of anastomotic adhesion and granuloma, and does not increase the risk of postoperative infection. 

    Diagnostic value of ultrasonic elastography combined with serum CK19 and CEA levels in axillary lymphatic metastasis of breast cancer
    LI Qian, ZHANG Li, ZUO Yun-peng
    2024, 45(4):  472-476.  doi:10.3969/j.issn.1007-3205.2024.04.018
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    Objective To investigate the diagnostic value of ultrasonic elastography combined with serum cytokeratin 19 (CK19) and carcinoembryonic antigen (CEA) levels in axillary lymph node metastasis (ALNM) of breast cancer. 
    Methods The clinical data of 74 female patients with breast cancer were analyzed retrospectively. According to the postoperative pathological examination results of whether there was ALNM, the patients were divided into metastasis group (n=32) and non-metastasis group (n=42). The score of ultrasonic elastography was compared between the two groups. The value of ultrasound elastography in the diagnosis of ALNM of breast cancer was analyzed. The levels of CK19 and CEA were compared between the two groups. The diagnostic value of CK19 and CEA in ALNM of breast cancer was analyzed. Taking pathological diagnosis as the gold standard, the value of ultrasound elastography combined with CK19 and CEA in the diagnosis of ALNM of breast cancer was analyzed. 
    Results The proportion of ultrasound elastography scores 1 and 2 in the metastasis group was significantly lower than that in the non-metastasis group, and the proportion of scores 3 and 4 was significantly higher than that in the non-metastasis group (P<0.05). The sensitivity, specificity and accuracy of ultrasound elastography in the diagnosis of ALNM of breast cancer were 0.781, 0.952 and 0.878, respectively. The levels of CK19 and CEA in metastasis group were significantly higher than those in non-metastasis group (P<0.05). The area under the curve of CK19 and CEA in the diagnosis of ALNM of breast cancer was 0.922 and 0.916 respectively, the sensitivity was 0.875 and 0.844 respectively, and the specificity was 0.857 and 0.929 respectively (P<0.05). The sensitivity, specificity and accuracy of ultrasound elastography combined with CK19 and CEA in the diagnosis of ALNM of breast cancer were 0.938, 0.905 and 0.919, respectively. 
    Conclusion The value of ultrasound elastography combined with CK19 and CEA in the diagnosis of ALNM of breast cancer is higher than that of single diagnosis, which warrants attentionin clinical practice. 

    Study on the effect of microscopic field of view number on cell counting in blood smear
    YANG Li-miao1, YANG Hong-le1, HAO Li-ying2, ZHANG Man-na1, DU Huan-huan1, HU Rui1
    2024, 45(4):  477-484.  doi:10.3969/j.issn.1007-3205.2024.04.019
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    Objective To study the effect of number of microscope field of view  on the manual counting of white blood cells (WBC) and platelets in the blood smear, and to standardize the parameters and methods used in microscopy for cell counting. 
    Methods The WBC and platelets of 300 peripheral blood samples were calculated by three different methods: automatic hematology analyzer (AHA) method, neubauer hemocytometer and blood smear method. The WBC and platelets were calculated by microscope with field of view of 20 and 26.5 respectively, and the results were collected for comparison and cell estimation. 
    Results The platelet count per every oil field of view of the microscope and WBC count with a field of view of 20 were lower than those of the microscope with a field of view of 26.5, and the difference was statistically significant (P<0.05). The normal and high values of the WBC count estimated by a microscope with a field of view of 20 were lower than those of AHA and neubauer hemocytometer. The normal, low and high values of the WBC count estimated by a microscope with a field of view of 26.5 were lower than those of AHA and neubauer hemocytometer, and the difference was statistically significant (P<0.05). When R=10, the normal and high values of platelet count estimated by a microscope with a field of view of 20 were lower than those of AHA and neubauer hemocytometer. The normal and high and low values of platelet count estimated by a microscope with a field of view of 26.5 were lower than those of AHA and neubauer hemocytometer, and the difference was statistically significant (P<0.05). When R=15, the normal value, low value and high value of platelet count estimated by the microscope with field number of 20 and field of view 26.5 were higher than those of AHA and neubauer hemocytometer, and the difference was statistically significant significance (P<0.05). When using the platelet estimation formula for microscopes with fields of view of 20 and 26.5, compared with AHA and neubauer hemocytometer, there was no significant difference in the three concentrations of specimens (P>0.05). 
    Conclusion Different field of view microscopy has an effect on the counting of WBC and platelets. The microscope with 20 field of view has reference significance for the platelet count of low value specimens when R=10 and the microscope with 26.5 field of view when R=7.33. The microscope with 20 field of view has reference significance for WBC counting in low value specimens. The platelet estimation formula is applicable to the counting of low, normal and high value samples for microscopes with two different field of view. 

    Regulatory effect of dexmedetomidine on anxiety and hippocampal neuro in flammation in a rat fracture model
    YANG Miao-miao, XU Yun
    2024, 45(4):  485-492.  doi:10.3969/j.issn.1007-3205.2024.04.020
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    Objective To establish a rat fracture model to study the regulatory effects of dexmedetomidine on anxiety and hippocampal neuroinflammation caused by fracture in rats. 
    Methods A total of 40 adult male Wistar rats were randomly divided into control group, dexmedetomidine group, operation group (right femur osteotomy), and operation + dexmedetomidine group (12 μg/ kg intraperitoneal injection of dexmedetomidine after fracture) using free drinking water mode. The rat fracture model was established. On 6 h, 24 h, and 7 d after the successful establishment of the model, the anxiety of the rats was tested by scare-response, and the expression levels of inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and interleukin-6 (IL-6)] in the serum and hippocampal tissue of the rats were detected by enzyme-linked immunosorbent assay (ELISA). Apoptotic cells in hippocampal tissues were quantitatively analyzed by TUNEL staining, and the expressions of TNF-α, IL-1β, IL-6, reactive oxygen species (ROS), neuronal nitric oxide synthase(nNOS), nicotinamide adenine dinucleotide phosphate (NOX2), 4-hydroxynonenal (4-HNE), BCL2-Associated X (Bax) and B-cell lymphoma-2 (Bcl-2) in hippocampal tissues were detected by Western blot. Results As the intensity of acoustic stimulation increased from sub-threshold (74 dB) to near threshold (90 dB) to over threshold (110 dB), the acoustic startle response(ASR) increased significantly. At the threshold of 74, 90 and 100 dB, the ASR of dexmedetomidine group was lower than that of control group, but higher in operation group than in control group and dexmedetomidine group; The ASR was higher in operation + dexmedetomidine group than in dexmedetomidine group but lower than that of operation group (P<0.05). The serum levels of TNF-α, IL-6 and IL-1β in dexmedetomidine group were lower than those in control group, but significantly higher in operation group than in control group and dexmedetomidine group; the serum levels of TNF-α, IL-6 and IL-1β in operation + dexmedetomidine group were higher than those in dexmedetomidine group, but lower than that in operation group (P<0.05). The expression levels of TNF-α, IL-6 and IL-1β in the hippocampus of dexmedetomidine group were significantly lower than those of control group, but significantly higher in operation group than in control group and dexmedetomidine group. The expression levels of TNF-α, IL-6 and IL-1β in the hippocampus of operation + dexmedetomidine group were higher than those of operation group, but lower than those of operation group (P<0.05). TUNEL staining showed that the number of apoptotic cells in dexmedetomidine group decreased significantly, and the number in operation group increased significantly. The expression level of Bax in dexmedetomidine group was significantly lower than that in the control group, while the expression level of Bcl-2 was higher than that in the control group; the expression level of Bax in operation group was significantly higher than that in the control group and dexmedetomidine group, while the expression level of Bcl-2 was significantly lower than that in the control group and dexmedetomidine group. The expression level of Bax in the operation group + dexmedetomidine group was higher than that in the dexmedetomidine group, but lower than that in the operation group. The expression level of Bcl-2 was lower than that of dexmedetomidine group but higher than that of operation group (P<0.05). The hippocampal ROS level was lower in dexmedetomidine group than in control group, lower in operation group than in control group and dexmedetomidine group, and higher in operation + dexmedetomidine group than in operation group, but lower than that of operation group, with statistical significance (P<0.05). The expression of NOX2 and 4-HNE protein in hippocampus of dexmedetomidine group was lower than that of control group, while the expression of nNOS protein was higher than that of control group. The expression of NOX2 and 4-HNE protein in hippocampus of operation group was higher than that of control group and dexmedetomidine group, while the expression of nNOS protein was lower than that of control group and dexmedetomidine group. The expression of NOX2 and 4-HNE protein in hippocampus of operation + dexmedetomidine group was higher than that of dexmedetomidine group, but lower than that of operation group, while the expression of nNOS protein was lower than that of dexmedetomidine group but higher than that of operation group, with statistical significance (P<0.05). 
    Conclusion Dexmedetomidine can significantly improve the anxiety state, reduce neuroinflammation and neuronal apoptosis in rats with fracture.