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    25 May 2024, Volume 44 Issue 5
    Investigation intokey genes and pathways of pneumonia in children based on gene expression profile
    GONG Wei-hua, SUN Hong-qi, SHAN Zhi-ming, FANG Pan-pan, ZHOU Juan-juan, YANG Jun-mei
    2024, 44(5):  501-507.  doi:10.3969/j.issn.1007-3205.2024.05.002
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    Objective Pneumonia in children is a common inflammatory disease of the respiratory system and the most common cause of death in children under 5 years worldwide. Exploring the key genes and pathways of early diagnosis of pneumonia in children is of great significance for studying the pathogenesis of pneumonia. 
    Methods The dataset was screened from Gene Expression Omnibus (GEO) database, and differentially expressed genes were screened by GEO2R. Key genes and core genes of DEGs were analyzed and screened. Finally, the receiver operating characteristic (ROC) curve analysis was conducted using GSE42834 dataset. 
    Results A total of 375 DEGs were obtained, of which 96 were up-regulated and 279 were down-regulated. Geneontology (GO) analysis revealed that DEGs were mainly enriched in immune effector process, cell activation, cell secretion, immune molecule binding, and complement receptor activity. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis suggested that DEGs were mainly enriched in immune and infectious disease pathways. The top 5 key genes were identified through Protein Protein Interaction (PPI) analysis, namely HLA-A, MAPK14, CD8A, HIST2H2AC, and IL2RB. The areas under ROC curve of MAPK14, CD8A, HIST2H2AC and IL2RB were all greater than 0.7, which showed good diagnostic value. Further analysis suggested that IL2RB might be the core gene involved in the pathogenesis of pneumonia by regulating the JAK-STAT signaling pathway. 
    Conclusion HLA-A, MAPK14, CD8A, HIST2H2AC and IL2RB are key genes for early diagnosis of pneumonia in children. IL2RB, the core gene, participates in the pathogenesis of pneumonia in children by regulating the JAK-STAT signaling pathway.

    Clinical application of bedside ultrasound combined with pulmonary arterial partial pressure of oxygen in septic shock children undergoing fluid resuscitation
    LIU Shuai1, WANG Ze-xi2, SHI Hai-yan1, GENG Wen-jin3, XU Mei-xian1
    2024, 44(5):  508-512.  doi:10.3969/j.issn.1007-3205.2024.05.003
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    Objective To investigate the clinical value of bedside ultrasound combined with alveolar-arterial oxygen gradient (PA-aO2) in children with septic shock undergoing fluid resuscitation. 
    Methods A total of 38 children with septic shock admitted to the First Department of Intensive Care Medicine, Hebei Children′s Hospital were selected and divided into conventional group (n=19) and experimental group (n=19) by random number table method. After admission, all the children were given comprehensive treatment including initial anti-shock (20 mL/kg sodium acetate ringer′s injection), anti-infecion treatment and respiratory support. The conventional group continued fluid resuscitation after initial fluid resuscitation according to the International Guideline for Management of Sepsis and Septic Shock (6 h target of early target-oriented treatment), and the experimental group was given dynamic evaluation of hemodynamics after initial fluid resuscitation based on bedside ultrasound and PA-aO2 monitoring, to guide subsequent fluid resuscitation. General data, PA-aO2 at 6 h, 24 h and 48 h after fluid resuscitation and heart rate (HR) and mean arterial pressure (MAP) at 6 h after fluid resuscitaion, lactic acid clearance rate at 24 h after fluid resuscitaion,vasoactive drug score at 48 h after fluid resuscitaion, total fluid intake at 48 h after fluid resuscitaion, and the number of patients undergoing blood purification therapy at 48 h after fluid resuscitaion were compared between the two groups. 
    Results There was no statistical significance in gender, age, weight, warning score, critical illness score, HR and MAP at admission, blood lactic acid and PA-aO2 in the two groups. The difference of interaction between groups, time points and time points between groups were statistically significant with respect to PA-aO2  at 6 h, 24 h, and 48 h after fluid resuscitation in the two groups (P<0.05). There was no statistical significance in HR, MAP, lactate clearance at 24 h after fluid resuscitation and vasoactive drug score at 48 h after fluid resuscitation. The total fluid intake at 48 h after fluid resuscitation in experimental group was significantly less than that in conventional group, and the number of patients undergoing blood purification therapy was less than that in conventional group, showing significant differences. 
    Conclusion Bedside ultrasound combined with PA-aO2 can accurately guide fluid management in children with septic shock, optimize volume status, reduce fluid intake and the risk of pulmonary edema, avoid invasive treatment of blood purification, relieve pain and benefit children. 

    Changes of serum Th1/Th2 cytokines in children with viral encephalitis complicated with myocardial damage and their diagnostic efficacy
    WANG Lei1, MEN Xin-yi1, YUAN Xiao-hui1, ZHAO Hui1, WANG Wei2
    2024, 44(5):  513-518.  doi:10.3969/j.issn.1007-3205.2024.05.004
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    Objective To investigate the changes of serum Th1/Th2 cytokines in children with viral encephalitis (VE) complicated with myocardial injury and their diagnostic efficacy. 
    Methods In total, 102 children with VE complicated with myocardial injury in our hospital were selected as the research group, and following the 1〖DK〗∶1 allocation principle, 102 patients with VE and 102 healthy children were included as control group and normal control group respectively. Serum Th1 cytokines [interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α)], Th2 cytokines [interleukin (IL)-4, IL-10], myocardial zymogram indicators [lactate dehydrogenase (LDH), myocardial injury markers creatinine I (cTnI), and creatine kinase isoenzymes (CK-MB)] were calculated in the three groups. The serum Th1/Th2 cytokines of different degrees of myocardial injury in the research group was compared, and Spearman was used to analyze the correlation between serum Th1/Th2 cytokines and the degree of myocardial injury. Receiver operating characteristic (ROC), decision curve analysis (DCA), and clinical impact curve (CIC) were drawn to analyze the diagnostic value of serum Th1/Th2 cytokines in VE combined with myocardial injury. 
    Results The levels of serum IFN-γ, TNF-α, CK-MB, cTnI and LDH were the highest in the research group, followed by the control group and normal control group, and the levels of serum IL-4 and IL-10 were the lowest in the research group, followed by the control group and normal control group (P<0.05). The levels of serum IFN-γ and TNF-α in the research group were the highest in those with severe myocardial injury, followed by those with moderate injury and those with mild injury, and the levels of serum IL-4 and IL-10 were the lowest in patients with severe myocardial injury, followed by those with moderate injury and those with mild injury (P<0.05). In children with VE complicated with myocardial injury, the degree of myocardial injury was positively correlated with IFN-γ and TNF-α (r=0.599, 0.634) (all P<0.05), and negatively correlated with IL-4 and IL-10 (r=-0.602, -0.587) (all P<0.05). The area under the curve (AUC) of serum Th1/Th2 cytokines in combination and myocardial zymogram in combination in the diagnosis of VE complicated with myocardial injury was 0.928 (95%CI: 0.883-0.959) and 0.933 (95%CI: 0.890-0.963) respectively, showing similar diagnostic efficacy. DCA and CIC curves showed that the model combined with Th1 and Th2 cytokines in the diagnosis of VE combined with myocardial injury had higher net yield and clinical effective rate. 
    Conclusion The serum Th1/Th2 cytokine level in children with VE complicated with myocardial injury is obviously abnormal, which is closely related to the degree of myocardial injury. The combination of IFN-γ, IL-10, TNF-α and IL-4 in combination in the diagnosis of VE complicated with myocardial injury has high diagnostic efficacy and clinical benefit. 

    Perioperative treatment of congenital heart disease in infants and young children weighing less than 10 kg
    LYU Ying, YU Ding, LIU Ling, YU Jie, WANG Jun, HUANG Jian-cheng
    2024, 44(5):  519-523.  doi:10.3969/j.issn.1007-3205.2024.05.005
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    Objective To evaluate the surgical effect of congenital heart disease (CHD) in infants and young children with low body weight (≤10 kg), and to summarize the clinical experience. 
    Methods The clinical data of 1 382 infants and young children with CHD and low body weight (≤10 kg) in Department of Cardiac Surgery were retrospectively analyzed. There were 665 males and 717 females, and the age ranged from 6 days to 3 years, with a mean of (9.58±1.84) months; The average body weight was (8.82±1.13) kg. Of all patients, 1 305 patients underwent radical resection of heart malformations under general anesthesia, and 77 patients underwent palliative surgery. 
    Results The operation was successful in the whole group, and 13 cases died after operation, accounting for 0.94%. The causes of death included low cardiac output syndrome in 7 cases, malignant arrhythmia in 1 case, hypoxemia in 5 cases (including severe pulmonary infection in 2 cases). 
    Conclusion Surgical treatment is safe, feasible and valuable for CHD infants and youny children with low body weight, suggesting good clinical effect. However, it is necessary to correctly control the timing of the surgery, shorten the duration of operation, strictly manage the perioperative period, and improve the surgical efficacy.

    Changes in MMP-16, Claudin-18 and CC16 before and after non-invasive transcutaneous blood gas+postural management+protective ventilation in neonatal respiratory distress syndrome and their correlation with concurrent BPD
    TIAN Jin-feng, YANG Hua-lei, WANG Xiao-lei, NIE Jun-hong
    2024, 44(5):  524-529.  doi:10.3969/j.issn.1007-3205.2024.05.006
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    Objective To investigate the effects of noninvasive transcutaneous blood gas+postural management+protective ventilation intervention for neonatal respiratory distress syndrome (NRDS) on matrix metalloproteinase-16 (MMP-16), Claudin-18, and Clara cell secretory protein 16 (CC16) in children, and to analyze the correlation between the above indicators and bronchopulmonary dysplasia (BPD). 
    Methods A total of 106 neonates with NRDS were selected prospectively for the study, and all children received noninvasive transcutaneous blood gas+postural management+protective ventilation intervention. The changes of MMP-16, Claudin-18, and CC16 in neonates were observed before and after intervention. The incidence of BPD in neonates was calculated within two weeks of intervention, and children were divided into BPD group and non-BPD group, to analyze the relationship between MMP-16, Claudin-18, CC16 and BPD. 
    Results After intervention, MMP-16 levels were lower than those before intervention, while Claudin-18 and CC16 levels were higher than those before intervention (P<0.05). BPD occurred in 57 of 106 children with NRDS, accounting for 53.77%. Compared with the non-BPD group, MMP-16 levels were higher and Claudin-18 and CC16 levels were lower in the BPD group (P<0.05). By point-biserial correlation analysis, the results showed that MMP-16 was positively correlated with the occurrence of BPD (r=0.542, P<0.05), and Claudin-18 and CC16 levels were negatively correlated with the occurrence of BPD (r=-0.526, -0.639, P<0.05). By logistic regression analysis, the results showed that MMP-16 was a risk factor for the complication of BPD in children with NRDS (OR>1, P<0.05), and Claudin-18 and CC16 were protective factors (OR<1, P<0.05). Receiver operating characteristic (ROC) curve was drawn, which showed that the area under the ROC curve (AUC) of MMP-16, Claudin-18 and CC16 for the assessment of BPD in children with NRDS was all >0.7, showing assessment value. The value of the combined assessment was higher (AUC=0.902). 
    Conclusion Noninvasive transcutaneous blood gas+postural management+protective ventilation can improve the reduction of MMP-16 levels and increase Claudin-18 and CC16 levels in children with acute respiratory distress syndrome, and the changes of the above three indexes are closely related to the occurrence of BPD. 

    Correlation of VEGF and ET-1 levels with airway inflammation and lung function in children with different degrees of bronchial asthma
    WANG Jing-jing1, WANG Yan-hui2, HUANG Xin3, ZHAO Xue-jiao4, LI Hui3
    2024, 44(5):  530-536.  doi:10.3969/j.issn.1007-3205.2024.05.007
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    Objective To investigate the correlation of the levels of vascular endothelial growth factor (VEGF) and endothelin-1 (ET-1) with airway inflammation and lung function in children with different degrees of bronchial asthma, in order to provide a reference for early clinical assessment and development of intervention plans. 
    Methods A total of 80 children with bronchial asthma were selected for the study, including 44 with mild and 36 with moderate-to-severe bronchial asthma.  Clinical data, lung function [peak expiratory flow rate (PEF), forced expiratory volume within 1 second (FEV1), FEV1 as a percentage of expected value (FEV1%)], sputum airway inflammatory markers [interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α)], VEGF and ET-1 levels were recorded, to analyse the correlation of VEGF and ET-1 levels with airway inflammation and lung function, their impact on the condition of children with bronchial asthma and their value in disease evaluation. 
    Results There were significant differences in pulmonary function indexes (FEV1, FEV1%, PEF), airway inflammation indexes (sputum IL-6, IL-10, TNF-α) and serum levels of VEGF and ET-1 in children with different disease severity (P<0.05). In children with bronchial asthma, serum VEGF and ET-1 were negatively correlated with lung function indexes FEV1, FEV1%, PEF and sputum airway inflammation index IL-10 (P<0.05), but positively correlated with sputum airway inflammation indexes IL-6 and TNF-α (P<0.05). The area under the receiver operating characteristic (ROC) curve (AUC) value of the combined assessment of VEGF and ET-1 was 0.912, which was higher than that of single index detection. When VEGF and ET-1 levels were high in children with bronchial asthma, the risk of disease exacerbation was 2.922 times (95%CI: 1.678-5.089) and 2.641 times (95%CI: 1.514-4.608) of those with low levels respectively. Results of Logistic regression analysis showed that VEGF and ET-1 were risk factors for exacerbation of the severity of bronchial asthma (P<0.05). VEGF and ET-1 have positive additive interaction in the risk of exacerbation in children with bronchial asthma, and the effect was enhanced when both are present simultaneously. 
    Conclusion VEGF and ET-1 are significantly correlated with airway inflammation and lung function in children with bronchial asthma. The changes in their levels can be used for early assessment of the disease, so as to carry out targeted follow-up treatment and improve the prognosis. 

    The relationship of GDM intestinal flora with neonatal immunity and pneumonia susceptibility
    ZHANG Li, ZOU Liang, AN Jing
    2024, 44(5):  537-542.  doi:10.3969/j.issn.1007-3205.2024.05.008
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    Objective To investigate the relationship between the intestinal flora in the third trimester of pregnancy and the immune function of neonates in patients with gestational diabetes mellitus (GDM), and its impact on the susceptibility of neonates to infectious pneumonia. 
    Methods A total of 245 patients with GDM in the third trimester of pregnancy admitted to our hospital were  selected, and divided into infection group (n=27) and non-infection group (n=218) according to the incidence of neonatal infectious pneumonia. Baseline data, maternal intestinal flora in the third trimester of pregnancy (Chao1 index, Shannon index, Bray Curtis distance), and neonatal immune function [CD3+ T cells, CD4+ T cells, CD8+ T cells, immunoglobulin A (IgA) , immunoglobulin G (IgG), immunoglobulin M (IgM)] of the two groups were compared. Pearson analysis was used to analyze the correlation between the intestinal flora in the third trimester of pregnancy and the neonatal immune function, and the multivariate Logistic regression equation was used to analyze the influencing factors related to neonatal infectious pneumonia. The receiver operating characteristic curve (ROC) and area under the ROC curve (AUC) were used to analyze the value of each index in predicting neonatal infectious pneumonia. 
    Results There was a significant difference in blood glucose levels between the infection group and the non-infection group before delivery (P<0.05). Chao1 index, Shannon index, CD3+ T cells, CD4+ T cells, CD8+ T cells, and IgG were lower in the infection group than in the non-infection group, while Bray Curtis distance was greater than that of the non-infection group (P<0.05). After controlling the blood glucose level before delivery, the Chao1 index, Shannon index, Bray Curtis distance, CD3+ T cells, CD4+ T cells, CD8+ T cells, and IgG were still associated with the susceptibility to neonatal infectious pneumonia (P<0.05). The AUC of Chao1 index, Shannon index, Bray Curtis distance, CD3+ T cells, CD4+ T cells, CD8+ T cells, and IgG in predicting neonatal infectious pneumonia was 0.754, 0.814, 0.771, 0.779, 0.817, 0.775, and 0.840, respectively (P<0.05). 
    Conclusion The intestinal flora of patients with GDM in the third trimester of pregnancy can affect the cellular and humoral immune functions of neonates, which are related to the susceptibility to neonatal infectious pneumonia, and can be used as a new method to predict neonatal infectious pneumonia. 

    Application value of ketorolac tromethamine combined with low-dose dexmedetomidine in patients with hypertension undergoing upper abdominal surgery under general anesthesia and its effect on perioperative blood pressure control
    MAO Zhen-zhou1, LI Fan2, ZHANG Zhe-zhe1, FENG Yu1, MA Dong-yang3
    2024, 44(5):  543-548.  doi:10.3969/j.issn.1007-3205.2024.05.009
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    Objective To analyze the application value of ketorolac tromethamine combined with low-dose dexmedetomidine in patients with hypertension undergoing upper abdominal surgery under general anesthesia and its effect on perioperative blood pressure control. 
    Methods In total, 100 hypertensive patients undergoing upper abdominal surgery treated were selected and divided into different groups according to randomized controlled principles. Group A (n=50) was given combined conventional general anesthesia, group B (n=50) was given intravenously 60 mg ketorolac tromethamine at 10 min before anesthesia induction, and a small dose of dexmedetomide (0.5 μg·kg-1·h-1) was injected in the meantime until 25 min before suture. The duration of surgery, duration of anesthesia, time to recovery and time to extubation of the two groups were recorded and compared. The mean arterial pressure (MAP), heart rate (HR), blood pressure, cerebral metabolic indexes and serum marker levels of patients at different time points were compared. 
    Results There was no significant difference in duration of surgery, duration of anesthesia and time to extubation between the two groups (P>0.05). The time to recovery of group B was shorter than that of group A (P<0.05). The differences of interaction between groups, time points and time points between groups were statistically significant in terms of MAP, HR, systolic blood pressure (SBP) and diastolic blood pressure (DBP) between the two groups (P<0.05). The difference of interaction between groups, time points and time points between groups were statistically significant with respect to CERO2 and Da-jvO2 between the two groups (P<0.05). The difference of interaction between groups, time points and time points between groups were statistically significant with respect to S100-β and BDNF between the two groups (both P<0.05). The difference of interaction between groups, time points and time points between groups were statistically significant with respect to VAS and Ramsay scores between the two groups (P<0.05). There was no significant difference in the incidence of adverse reactions between group A and group B (12.00% vs. 16.00%) (P>0.05). 
    Conclusion Ketorolac tromethamine combined with low-dose dexmedetomidine can maintain stable hemodynamics and blood pressure in patients with hypertension undergoing upper abdominal surgery, and has few effects on brain metabolism and cranial nerves, which is safe and reliable. 
    Effect of IGF-1 on myocardial necroptosis in rats undergoing cardiopulmonary resuscitation via TLR4/NF-κB signaling pathway
    HU Zhen-fei, LI Fan, DAI Xiao-wen
    2024, 44(5):  549-554.  doi:10.3969/j.issn.1007-3205.2024.05.010
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    Objective To explore the effect of cardiopulmonary resuscitation (CPR) on the expression of insulin-like growth factor-1 (IGF-1) and its regulatory mechanism on myocardial injury in rats. 
    Methods Thirty Sprague-Dawley rats were selected and randomly divided into five groups, with 6 rats in each group. One group was randomly selected as sham operation group, and in the other four groups, cardiac arrest due to ventricular fibrillation/CPR models were established. After the successful modeling, one group was randomly selected as I/R, and the other three groups were divided into IGF-1 supplementation group, TAK-242 [Toll-like receptor 4 (TLR4)/nuclear factor κB (NF-κB) supplementation] inhibitor supplementation group and IGF-1 and TAK-242 supplementation group. The myocardial injury of rats in different treatment groups was detected by Evans blue staining. The expression level of IGF-1 was detected by real-time fluorescence quantitative reverse transcription-polymerase chain reaction (RT-qPCR). The expression levels of TLR4, NF-κB, myeloid differentiation primary response protein 88 (MyD88), receptor-interacting protein kinase 3 (RIPK3) and mixed-lineage kinase domain-like (MLKL) were detected by Western blot. The expression levels of interleukin-1β (IL-1β) and interleukin-18 (IL-18) were detected by enzyme-linked immunosorbent assay (ELISA). 
    Results Compared with the sham operation group, the myocardial tissue of rats was seriously damaged after cardiac arrest and CPR, among which the model group had the most severe damage, and the IGF-1 and TAK-242 supplementation group had the least severe damage. Compared with sham operation group, the expression of IGF-1 in myocardial tissue of rats in model group was decreased significantly (P<0.05). Compared with sham operation group, the expression levels of IL-1β and IL-18 in myocardial tissue of model rats were significantly increased, among which the expression levels of IL-1β and IL-18 were the highest in the model group and the lowest in IGF-1 and TAK-242 supplementation group (P<0.05). Compared with sham operation group, the expression levels of TLR4, MyD88 and NF-κB p65 in model rats were significantly increased, among which the expression levels were the highest in the model group, and the lowest in IGF-1 and TAK-242 supplementation group (P<0.05). Compared with the sham operation group, the expression levels of RIPK3 and MLKL in model rats were significantly increased, among which the expression levels of model rats were the highest in the model group and the lowest in IGF-1 and TAK-242 supplementation group (P<0.05). Conclusion After cardiac arrest and restoration of autonomous circulation, the expression level of IGF-1 will decrease, and IGF-1 can inhibit necroptosis of myocardial cells by inhibiting TLR4/NF-κB signaling pathway, thereby reducing myocardial injury in rats.

    The application value of ultrasound-guided PENG block in elderly patients with TKA and its impact on postoperative comfort
    HUANG Li1, GU Pu-jie2, XU Zhi-yun1
    2024, 44(5):  555-559.  doi:10.3969/j.issn.1007-3205.2024.05.011
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    Objective To investigate the application effect of ultrasound-guided pericapsular nerve group (PENG) block in elderly patients undergoing total knee arthroplasty (TKA). 
    Methods A total of 120 patients with TKA who were treated in our hospital and the Affiliated Hospital of Nantong University were selected and divided into the observation group (n=60) and the control group (n=60) by envelope method. The observation group was given ultrasound-guided PENG block and general anesthesia, and the control group was given general anesthesia, to observe the anesthesia effects of the two groups. 
    Results There was no significant difference between the observation group and the control group with respect to duration of operation, intraoperative bleeding and anesthesia time (P>0.05). There was a significant difference in the interaction between time points and time points between groups in terms of mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) between the two groups (P<0.05), while there was no significant difference between groups (P>0.05). There was no significant difference in interaction between groups, time points and time points between groups with respect to blood oxygen saturation (SpO2) (P>0.05). There was a significant difference in interaction between groups, time points and time points between groups in terms of visual analogue scale (VAS) score for pain and comfort. 
    Conclusion Ultrasound-guided PENG block has a good application effect in elderly TKA, with the advantages of less postoperative pain, and good comfort. 

    Effect of different doses of remimazolam tosilate on hemodynamic parameters and immune function after laparoscopic surgery in elderly patients
    LI Xian-rui, WU Hao, XU Huan-xi
    2024, 44(5):  560-565.  doi:10.3969/j.issn.1007-3205.2024.05.012
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    Objective To analyze the effect of different doses of remimazolam tosilate on hemodynamic parameters and immune function in elderly patients after laparoscopic surgery. 
    Methods Ninety elderly patients admitted to our hospital for laparoscopic surgery were selected. All patients received endotracheal intubation combined with inhalation anesthesia. According to different doses of remimazolam tosilate, they were divided into low-dose group (n=30, 0.1 mg/kg), medium-dose group (n=30, 0.15 mg/kg) and high-dose group (n=30, 0.2 mg/kg). The mean arterial pressure (MAP) and heart rate before induction of anesthesia (T0), at the time of section (T1), at 30 min after operation (T2) and at the end of operation (T3) were compared among the three groups. The levels of mini-mental state examination (MMSE) scale score, malondialdehyde (MDA), superoxide dismutase (SOD), CD4+ and CD8+ before and at 24 h after operation were compared among the three groups, and the anaesthesia-related adverse reactions were compared among the three groups. 
    Results The heart rate and MAP of the three groups were increased with the prolongation of time, and there were significant differences in interactions between groups, time points and time points between groups (P<0.05). At 24 h after operation, the MMSE score of the three groups was decreased (P<0.05), the MMSE score of the high-dose group was higher than that of the low-dose and medium-dose groups (P<0.05), and the MMSE score of the medium-dose group was higher than that of the low-dose group (P<0.05). At 24 h after operation, MDA in all three groups was increased (P<0.05), while SOD in all three groups was decreased (P<0.05). MDA was the lowest in the high-dose group, followed by medium-dose group and low-dose group (P<0.05), and SOD was the highest in the high-dose group, followed by medium-dose group and low-dose group (P<0.05). At 24 h after operation, CD4+ was increased in all three groups (P<0.05), while CD8+ was decreased in all three groups (P<0.05). CD4+ was the highest in the high-dose group, followed by medium-dose group and low-dose group (P<0.05), while CD8+ was the lowest in the high-dose group, followed by medium-dose group and low-dose group (P<0.05). There were no difference in the total incidence of anaesthesia-related adverse reactions among the three groups (P>0.05). 
    Conclusion 0.2 mg/kg remimazolam tosilate is more effective in maintaining hemodynamics, improving immune function and cognitive function, and reducing oxidative stress in elderly patients after laparoscopic surgery, which is safe and reliable.

    Between visceral fat and liver fibrosis in patients with metabolic associated fatty liver disease and type 2 diabetes mellitus
    HE Jia, WEI Feng, LIU Mei-lan, ZHOU Kun
    2024, 44(5):  566-572.  doi:10.3969/j.issn.1007-3205.2024.05.013
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    Objective To explore the relationship between visceral fat area (VFA) and liver fibrosis in patients with metabolic associated fatty liver disease (MAFLD) and type 2 diabetes mellitus (T2DM). 
    Methods In total, 418 patients with T2DM were included, and divided into T2DM group (n=136) and T2DM + MAFLD group (n=282)based on abdominal ultrasound. According to non-alcoholic fatty liver disease fibrosis score (NFS), T2DM-MAFLD group was subdivided into low-risk subgroup (n=94), moderate-risk subgroup (n=154), and high-risk subgroup (n=34). VFA and related serological indexes of those patients were determined. 
    Results Compared with the T2DM group, patients in the T2DM+MAFLD group had significantly increased body mass index (BMI), waist circumference(WC), hip circumference (HC), VFA, subcutaneous fat area (SFA), triglyceride (TG), alanine transaminase(ALT), and albumin (Alb) but significantly shorter course of disease and significantly reduced high density lipoprotein cholesferol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Comparison of platelet (PLT) in T2DM+MAFLD subgroups showed the highest PLT in high-risk subgroup, followed by moderate-risk subgroup and low-risk subgroup; high-risk subgroup had significantly increased BMI and VFA, and significantly decreased TC, LDL-C and ALT, suggesting a significant difference (P<0.05). VFA and SFA in T2DM+MAFLD groups were positively correlated with weight (W), BMI, white blood cell (WBC), ALT and AST, and negatively correlated with the course of disease and HDL-C. Logistic analysis showed that BMI, VFA, PLT, ALT, and Alb were the influencing factors for developing liver fibrosis in patients with T2DM+MAFLD.  
    Conclusion The findings of this study show that the risk of liver fibrosis in patients with T2DM and MAFLD is associated with BMI, VFA, PLT, ALT, and Alb. 

    Identification of cuproptosis biomarkers and drug screening in diabetes mellitus
    ZHANG Nan-nan1, TIAN Si-si2, LIN Deng-mei3, LI Jun4
    2024, 44(5):  573-579.  doi:10.3969/j.issn.1007-3205.2024.05.014
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    Objective To explore the biomarkers of cuproptosis in diabetes mellitus (DM) for drug screening. 
    Methods The GEO database was used to obtain GSE25724 dataset of DM as a training set and screen its differentially expressed genes, and 19 cuproptosis-related genes were obtained from the literature. The intersection of the two was used to obtain cuproptosis-related genes in DM, which were then validated (GSE23343 and GSE20966 were used as a test set). Gene correlation and enrichment analyses were performed on cuproptosis-related genes in DM. Molecular docking of key genes with predicted compounds was performed using DS BIOVIA Discovery Studio 2016 software. 
    Results A total of six diabetes-associated cuproptosis-related genes (DBT, DLD, GLS, PDHB, NFE2L2, and LIPT1) were obtained, and they were involved in biological processes such as metabolic catabolism of organic acids, synthesis of pyruvate-acetyl-coenzyme A and amino acid metabolism, mainly through the regulation of the signaling pathways of the tricarboxylic acid (TCA) cycle of lipidation, pyruvate metabolism, glycolytic glucose de novo, and HIF-1. Among these six genes, DLD, DBT and NFE2L2 were significantly differentially expressed in the test set samples and had good diagnostic value. Molecular docking showed that DLD and DBT could have a high binding capacity with folic acid, NFE2L2 with Butin, and NFE2L2 with Luteolin. 
    Conclusion Cuproptosis-related genes DLD, DBT, and NFE2L2 play an important role in the occurrence and development of DM, and this study provides data support for the studies of the pathogenesis and treatment of DM. 

    Analysis of insulin secretion, serum 25 (OH) D3, NLR, SUA levels and their clinical significance in type 2 diabetes patients with dyshidrotic nerve function
    XI Wei, YAO Li-jun, WANG Lin-jiao
    2024, 44(5):  580-584.  doi:10.3969/j.issn.1007-3205.2024.05.015
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    Objective To investigate the insulin secretion, serum 25 hydroxyvitamin D3 [25 (OH) D3], neutrophil to lymphocyte ratio (NLR), serum uric acid (SUA) levels and clinical significance in patients with type 2 diabetes mellitus (T2DM) accompanied by sudomotor dysfunction.〖KG*2〗
    Methods In total, 97 patients with T2DM and sudomotor dysfunction treated in our hospital were selected as the observation group, and 194 patients with T2DM but without sweating nerve dysfunction were selected as the control group with a gender ratio of 1〖DK〗∶2. The differences in clinical data, islet function, 25 (OH) D3, NLR and SUA levels between the two groups were analyzed and compared. The factors affecting T2DM combined with sudomotor dysfunction were analyzed by Logistic regression analysis. 
    Results The age and duration of diabetes in the observation group were (58.32±9.94) years and (11.41±2.84) years respectively, which were significantly higher than those in the control group (P<0.05). The ratio of net increase in C-peptide to glucose (ΔC-P30/ΔG30), the ratio of net increase in insulin to glucose (ΔI30/ΔG30), the area under the curve of insulin (I-AUC/G-AUC) and the AUC of corrected C-peptide under 120 min blood glucose (C-P-AUC/G-AUC) in the observation group were (0.22±0.13), (1.55±0.36), (0.09±0.03) and (2.87±0.90), respectively, which were significantly lower than those in the control group (P<0.05). The serum 25 (OH) D3 in the observation group was (22.12 ± 6.01) μg/L, which was significantly lower than that in the control group (P<0.05), while the NLR and SUA were (3.12±0.94) and (365.50±90.48) μmol/L, respectively, which were significantly higher than those in the control group (P<0.05). Logistic regression analysis showed that age, course of diabetes, ΔC-P30/ΔG30, 25 (OH) D3, NLR and SUA were the influencing factors for the sudomotor dysfunction (P<0.05). 
    Conclusion Patients with T2DM and sudomotor dysfunction have impaired insulin secretion, decreased serum 25 (OH) D3, and increased NLR and SUA levels. T2DM combined with sudomotor dysfunction is affected by early phase pancreatic secretion function and serum 25 (OH) D3, NLR, and SUA levels, which warrants further studies.

    Expression of hs-CRP, MCP-1 and IL-6 in patients undergoing maintenance hemodialysis and their predictive efficacy for vascular access infection
    WU Fu-shan, SU Hong-mei, ZHANG Xiao-liang, CHENG Li, CHEN Cong-yong
    2024, 44(5):  590-594.  doi:10.3969/j.issn.1007-3205.2024.05.017
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    Objective To explore the expression levels of high sensitive C-reactive protein (hs CRP), monocyte chemotactic protein 1 (MCP-1) and interleukin-6 (IL-6) in the peripheral blood of patients undergoing maintenance hemodialysis (MHD) and the predictive efficacy of various clinical factors for infection. 
    Methods A total of 100 patients undergoing MHD admitted to our hospital were selected and divided into infection group (n=30) and non-infection group (n=70) according to occurrence of vascular access infection during hospitalization. The expression levels of hs-CRP, MCP-1 and IL-6 in peripheral blood of the patients were detected by enzyme-linked immunosorbent assay (ELISA), and the general clinical data were statistically analyzed. The risk factors of clinical infection were confirmed by multivariate Logistic regression analysis, and the predictive efficacy of hs-CRP, MCP-1 and IL-6 for infection was analyzed by receiver operating characteristic (ROC) curve. 
    Results Compared with the non-infection group, the expression levels of serum hs-CRP, MCP-1 and IL-6 in the infection group were significantly higher (P<0.05). Multivariate logistic regression analysis showed that age>60 years, duration of dialysis >1 year, hs-CRP, MCP-1, IL-6, combined diabetes and decreased serum albumin were risk factors for infection. ROC analysis showed that the area under the ROC curve (AUC) of serum hs-CRP, MCP-1, and IL-6 was 0.815, 0.770, and 0.806, respectively, the sensitivity was 68.10%, 72.80%, 82.00%, respectively, and the specificity was 79.60%, 72.70%, and 74.09%, respectively. The AUC of the combination of the three was 0.935, and the sensitivity and specificity were 83.80% and 92.91%, respectively, and the predictive performance was significantly improved (Z=2.373). 
    Conclusion The high expressions of serum hs-CRP, MCP-1 and IL-6 in patients undergoing MHD are risk factors for infection. The combined use of hs-CRP, MCP-1 and IL-6 in serum has a significant predictive value for infection in patients undergoing MHD. 

    Relationship of the expression of VEGF and VEGFR-2 in wound with postoperative wound healing time in patients with stage Ⅱ anal fissure wound expression of VEGF and VEGFR-2 and wound healing time after stage Ⅱ anal fissure
    TAO Yi-qiu, ZHANG Dong-mei, SHEN Fei-fei, DU Jia-qi
    2024, 44(5):  595-600.  doi:10.3969/j.issn.1007-3205.2024.05.018
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    Objective To investigate the relationship of vascular endothelial growth factor (VEGF) and vascular endothelial growth factor receptor-2 (VEGFR-2) expression on the wound surface with postoperative wound healing time in patients with stage Ⅱ anal fissure. 
    Methods A total of 104 patients with stage Ⅱ anal fissure who underwent surgical treatment in our hospital were selected as the research subjects. The levels of VEGF and VEGFR-2 collected from the granulation tissue of the wound edge were detected at dressing change at one week after surgery. The postoperative wound healing time of patients was statistically analyzed, and the patients were divided into three groups according to the third percentile of postoperative wound healing time of patients. The clinical data and the levels of VEGF and VEGFR-2 on the wound surface in the three groups were compared. The correlation of VEGF and VEGFR-2 with postoperative wound healing time as well as the influencing factors of postoperative wound healing time was analyzed. 
    Results There were significant differences in VEGF and VEGFR-2 levels among the three groups (P<0.05). The lower the levels of VEGF and VEGFR-2 on the wound surface, the longer the wound healing time (P<0.05). VEGF and VEGFR-2 were negatively correlated with postoperative wound healing time (P<0.05). Constipation, duration of operation, open incision, wound longitudinal diameter and wound transverse diameter were independent risk factors for postoperative wound healing time, and VEGF and VEGFR-2 were independent protective factors for postoperative wound healing time (P<0.05). 
    Conclusion The levels of VEGF and VEGFR-2 on the wound surface are negatively correlated with the wound healing time after surgery for stage Ⅱ anal fissure. The two indexes can be used to determine the wound healing of patients, thus providing guidance for the improvement of postoperative treatment plans.  

    Expression of Betatrophin and NF-κB in the treatment of patients with PCOS and their predictive value for pregnancy outcome
    WANG Yi1, WANG Hai-jiao1, HE Hong-mei1, CUI Yu-jiao1, QI Lin1, WANG Yan2
    2024, 44(5):  601-607.  doi:10.3969/j.issn.1007-3205.2024.05.019
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    Objective To explore the expression of β-cell trophic factor (Betatrophin) and nuclear factor-κB (NF-κB) in patients with polycystic ovary syndrome (PCOS) and their predictive value for pregnancy outcome. 
    Methods A total of 110 patients with PCOS were selected as the research subjects, and 40 healthy women of childbearing age who underwent physical examinations during the same period were selected as the control group. The related serum indexes of the two groups were compared. Risk factors for pregnancy was analyzed, and the predictive value of combined detection of Betatrophin and NF-κB for pregnancy outcomes after treatment was evaluated. 
    Results Before treatment, the levels of serum fasting blood glucose(FBG), fasting insulin (FINS), homeostasis model assessment of insulin resistance(HOMA-IR), homeostatic model assessment β cell function (HOMA-β), luteinizing hormone (LH), LH/follicle stimulating hormone (FSH), anti-mullerian hormone (AMH), NF-κB and Betatrophin in PCOS patients were higher than those in the control group (P<0.05), which were reduced after treatment. At 1-year follow-up, the ovulation rate of PCOS patients was 77.27%, and the pregnancy rate was 61.82%. Multivariate Logistic regression analysis showed that HOMA-IR, HOMA-β, LH/FSH, AMH, Betatrophin, and NF-κB were risk factors for pregnancy success, and that Betatrophin was positively correlated with HOMA-IR, HOMA-β, LH/FSH, and AMH after treatment (P<0.05). NF-κB was also positively correlated with FBG, HOMA-IR, LH/FSH, and AMH (P<0.05). The receiver operating characteristic (ROC) curve showed that the area under the ROC curve (AUC) of combined detection of Betatrophin and NF-κB in predicting the pregnancy outcome after PCOS treatment was 0.978 (0.961-0.998), the sensitivity was 86.75%, and the specificity was 90.12%. 
    Conclusion The levels of Betatrophin and NF-κB are increased in PCOS patients and significantly decreased after treatment. The serum levels of the two were positively correlated with HOMA-IR, LH/FSH, and AMH. The combined detection of Betatrophin and NF-κB has certain predictive value for pregnancy outcomes of patients with PCOS.

    Study on the construction of a model to predict adhesions after interventional recanalisation for infertility based on 2D and 3D ultrasound imaging and clinical factors
    LI Feng-xia1, BIAN Qin1, HOU Xue-tao2, LI Jun-qing1, SUN Xiao-hui1
    2024, 44(5):  608-614.  doi:10.3969/j.issn.1007-3205.2024.05.020
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    Objective To investigate the predictive value of constructing models based on two-dimensional and three-dimensional ultrasound imaging and clinical factors for adhesions after interventional recanalization for infertility, so as to determine reasonable diagnostic and treatment modalities, thereby improving clinical pregnancy rates. 
    Methods A total of 335 patients after interventional recanalisation for infertility in our hospital were selected and divided into a modeling population (n=235) and a validation population (n=100) according to the ratio of 7〖DK〗∶3. Tubal adhesions, clinical factors, 2D and 3D ultrasound imaging performance at 3 months after surgery were recorded, and logistic regression equations were used to analyse the influencing factors of adhesions after interventional recanalisation for infertility, a nomogram model was constructed, and internal and external validation was conducted. 
    Results There were significant differences in the comparison of pelvic inflammation, location of tubal occlusion, history of uterine manipulation, history of miscarriage, and 2D and 3D ultrasound imaging performance between the adhesion and non-adhesion groups (P<0.05). Pelvic inflammation, location of tubal occlusion, history of uterine manipulation, ovarian annular strong echogenicity, tubal alignment distortion, pelvic homogeneous diffusion, and ovarian encapsulation were factors influencing adhesions after recanalization intervention for infertility (P<0.05). A nomogram prediction model was constructed, which had AUCs of 0.929 and 0.919 in the modeling and validation populations, respectively, and DCA curves showed that the model had good net benefit values ranging from 0.2 to 0.9 and from 0.0 to 0.85 in the modeling and validation populations. 
    Conclusion A model based on 2D and 3D ultrasound imaging and clinical factors can be used to predict adhesions after interventional recanalization for infertility, and clinical follow-up treatment combined with relevant factors can be tailored to reduce the risk of postoperative adhesions.