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    25 July 2024, Volume 45 Issue 7
    The value of stimulation training semicircular canal in the treatment of sudden deafness complicated with vertigo
    ZHAO Ying, SUN Yi-jun
    2024, 45(7):  750-755.  doi:10.3969/j.issn.1007-3205.2024.07.002
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    Objective To evaluate the role of stimulation training of semicircular canal of SRM-IV vertigo diagnosis and treatment system in the rehabilitation treatment and efficacy evaluation of sudden deafness complicated with vertigo. 
    Methods A total of 38 patients with sudden deafness and vertigo were selected and divided into control group (n=12), treatment group one (n=13) and treatment group two (n=13) according to random envelope method. The control group was treated with drugs, treatment group one was treated with drugs and vestibular rehabilitation training, and treatment group two was treated with stimulation training of semicircular canal on the basis of drug treatment and vestibular rehabilitation training. At 1 week, 2 weeks and 4 weeks after treatment, positive-to-negative conversion rate of rotation test, dizziness handicap inventory (DHI) score and self-rating anxiety scale (SAS) score of the three groups was compared. 
    Results Compared with the control group and treatment group one, the positive-to-negative conversion rate of rotation test in treatment group two significantly increased at 2 and 4 weeks after treatment (P<0.05). With the prolongation of treatment time, the DHI scores and the SAS scores of the three groups showed a gradually decreasing trend, with treatment group two showing the most significant decrease, and the differences in interaction between groups, time points, and time points between groups were statistically significant (P<0.05). 
    Conclusion The high-intensity vestibular function training of the SRM-IV vertigo diagnosis and treatment system plays a certain role in the treatment and evaluation of sudden deafness complicated with dizziness, showing good therapeutic effect and patient compliance, which is, therefore, worthy of popularization and application in clinical practice.

    Serum AGR2 expression and its predictive value for efficacy in advanced nasopharyngeal carcinoma patients treated with IMRT combined with TP regimen
    HAN Ming-ming1, WANG Li-li1, ZHANG Peng-ju1, YAO Wei-li1, YUAN Jing1, ZHANG Ling2
    2024, 45(7):  756-760.  doi:10.3969/j.issn.1007-3205.2024.07.003
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    Objective To investigate the changes of serum anterior gradient-2 (AGR2) before and after intensive modulated radiation therapy (IMRT) combined with simultaneous TP regimen (paclitaxel, cisplatin) in patients with advanced nasopharyngeal carcinoma (NPC) and its predictive value. 
    Methods A total of 51 patients with advanced NPC were treated with TP chemotherapy and IMRT radiotherapy for 4 cycles. The toxic reactions during simultaneous radiotherapy and chemotherapy and the short-term and long-term effects after treatment were recorded and compared. In the meantime, 30 healthy people were selected as the control group to observe the effect of serum AGR2 level on the prognosis of patients with advanced NPC before and after treatment. 
    Results After simultaneous radiotherapy and chemotherapy, the total effective rate of patients with advanced NPC was 80.39%, of which complete remission (CR) was 41.18% and partial remission (PR) was 39.22%. The main adverse reactions were oropharyngeal damage (90.2%), myelosuppression (74.5%), leukopenia (68.6%), and thrombocytopenia (33.3%). After simultaneous radiotherapy and chemotherapy, the serum AGR2 level of the patients decreased significantly, which, however, was still significantly higher than that of the normal control group [(13.28±4.17) μg/L vs. ( 8.85±1.98) μg/L](P<0.001). The serum AGR2 level of the effective group was significantly lower than that before treatment (13.28 μg/L vs. 24.18 μg/L) (P<0.05). There was no significant difference between the ineffective group before treatment [(33.81±8.12) μg/L] and after treatment [(24.77±6.93) μg/L]. The Kaplan-Meier curve showed that the median survival time of the patients in the low level AGR2 group was significantly longer and the prognosis was better than that in the high level AGR2 group (35.24 months vs. 31.73 months, P=0.039). 
    Conclusion The level of AGR2 in the effective group of patients with advanced NPC treated with IMRT and TP regimen is significantly lower, and the prognosis of patients with low expression of AGR2 is better. 

    The effect of low-temperature plasma therapy on the treatment of inverted papilloma of the maxillary sinus and the influencing factors of recurrence
    ZHOU Rong-jin
    2024, 45(7):  761-765.  doi:10.3969/j.issn.1007-3205.2024.07.004
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    Objective To investigate the effect of low-temperature plasma therapy on the treatment of inverted papilloma of the maxillary sinus and the influencing factors of recurrence. 
    Methods A total of 331 patients with inverted papilloma of the maxillary sinus were selected and underwent low-temperature plasma surgery. The surgical effects and recurrence were statistically analyzed. The clinical data of the recurrence group (n=48) and non-recurrence group (n=273) were compared, and the factors affecting recurrence were analyzed using multivariate analysis. The Logistic regression model was evaluated for its predictive value for recurrence, and individual values were verified. 
    Results The total effective rate of 331 patients with inverted papilloma of the maxillary sinus undergoing low-temperature plasma surgery was 85.80% (284/331), the total complication rate was 4.83% (16/331), and the recurrence rate was 14.95% (48/321). The levels of vascular endothelial growth factor (VEGF), human papillomavirus infection, Krouse classification, degree of atypical hyperplasia, history of nasal surgery, and number of mitotic figures in the recurrence group were higher than those in the non-recurrence group, and the difference were statistically significant (P<0.05). The results of Logistic multivariate analysis showed that increased VEGF levels (OR=9.167, 95%CI: 4.456-18.857), Krouse grade Ⅲ (OR=7.280, 95%CI: 2.267-23.381), obvious atypical hyperplasia (OR=10.608, 95%CI: 5.611-20.054), and mitotic figures >10 (OR=8.121, 95%CI: 3.762-17.531) were independent risk factors for recurrence in patients with inverted papilloma of the maxillary sinus after surgery (P<0.05). The Logistic regression model analysis of the predictive value for recurrence showed that the optimal critical value was 4.30, with an AUC of 0.919 and a 95%CI of 0.884-0.947. Verification by individual patients showed that under the condition of an accuracy rate of 89.72%, the patient had no risk of recurrence and was in line with clinical reality. 
    Conclusion The application of low-temperature plasma surgery in the treatment of inverted papilloma of the maxillary sinus has significant efficacy, but its postoperative recurrence is affected by multiple factors, such as VEGF levels, Krouse classification, atypical hyperplasia, and mitotic figures. A comprehensive consideration of these factors and active intervention are beneficial to prevent recurrence. 

    Effects of modified uvulopalatopharyngoplasty on sleep and cognitive function in patients with OSAHS
    CHENG Lei-lei, XU Yan-hong
    2024, 45(7):  766-770.  doi:10.3969/j.issn.1007-3205.2024.07.005
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    Objective To explore the effect of modified uvulopalatopharyngoplasty (H-UPPP) in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS), and to observe the changes of sleep and cognitive function. 
    Methods A total of 118 patients with OSAHS were included in the study and divided into observation group (n=59) and control group (n=59) according to different treatment methods. The control group received behavioral treatment, including weight control, quitting smoking and drinking, keeping a lateral position during nighttime sleep, and the observation group received H-UPPP treatment. The clinical efficacy of the two groups was observed at 6 months after treatment, and the sleep conditions [apnea hypopnea index (AHI), lowest oxygen saturation (LSaO2), snore index (SI), Ep-worth sleepiness scale (ESS) score] and cognitive function [Rey-Osterrieth complex figure test (CFT) score, mini-mental state examination (MMSE) score, Montreal cognitive assessment (MoCA) score, event-related potential P300] of the two groups were compared before and at 6 months after treatment. 
    Results The therapeutic effect of observation group was better than that of control group (P<0.05). At 6 months after treatment, AHI, SI, ESS scores and P300 latency of observation group and control group were lower than those before treatment, while LSaO2, CFT, MMSE, MoCA scores and P300 amplitude were higher than those before treatment (P<0.05). AHI, SI, ESS scores and P300 latency were lower in the observation group than in the control group, whereas LSaO2, CFT, MMSE, MoCA score and P300 amplitude of observation group were higher than those of control group (P<0.05). 
    Conclusion H-UPPP has a good effect in the treatment of OSAHS patients, which can significantly ameliorate clinical symptoms, improve the degree of cognitive impairment, and has application value in clincial practice.

    CNN model based on multi-parameter MR in predicting microvascular invasion of HCC
    WANG Qian1, WANG Hui-zhe2, LU Shuang-dong3, SHEN Dan-ping4, LIU Long-yan5
    2024, 45(7):  771-778.  doi:10.3969/j.issn.1007-3205.2024.07.006
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    Objective To explore convolutional neural network (CNN) based on multi-parameter magnetic resonance (MR) sequences, combined with traditional radiomics signature and clinical indicators, in predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC) preoperatively.  
    Methods Two hundred and seventy-five patients with pathologically confirmed HCC were enrolled in this study. The data set was randomly divided into a training set (n=192) and a test set (n=83). A MVI predictive classifier for HCC was developed by using CNN technique, which fused 2D multi-parameter MR tumor images, 3D traditional radiomics signature and clinical indicators. Using the receiver operating characteristic (ROC) curve, the performance of combined model (ModelCom), CNN model (ModelD), radiomics model (ModelR) and clinical model (ModelC) were compared. 
    Results The area under the ROC curve (AUC) of ModelD was 0.914 in the training set and 0.842 in the test set, which was better than that of ModelC (training set: P<0.001; test set: P=0.032) and ModelR (training set: P<0.001; test set: P=0.044). The AUC of ModelCom in the training set and test set were 0.951 and 0.881, respectively, which was better than that of ModelD in the training set (P=0.012), but there was no significant difference in the test set (P=0.157). The calibration curve showed that ModelCom had a good goodness of fit (Hosmer-Lemeshow test, P=0.402 for training set, P=0.689 for test set). Decision curve analysis showed that the net benefit of ModelCom in identifying positive MVI and negative  MVI was higher than that of other models. 
    Conclusion The ModelCom based on CNN can accurately predict the MVI status of HCC.

    Relationship between DWI, DCE-MRI quantitative parameters of breast MRI and molecular subtypes and Ki-67 expression in breast cancer
    LIU Lei, XU Hui-hui, WANG Jia, LI Xiu-ping, HAO Yong-xin
    2024, 45(7):  779-784.  doi:10.3969/j.issn.1007-3205.2024.07.007
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    Objective To explore the relationship of diffusion weighted imaging (DWI) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) quantitative parameters with molecular subtypes of breast cancer, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), and Ki-67 expression. 
    Methods In total, 116 patients with breast cancer were selected, and all patients received DWI DCE-MRI examination. Different molecular subtypes of breast cancer were analyzed, and differences in ER, PR, HER-2, Ki-67 expression tissue apparent diffusion coefficient (ADC) values, volumetric transfer constants (Ktrans), and reverse rate constants (Kep) were analyzed. 
    Results The ADC value of patients with clinical stage Ⅲ-Ⅳ was (0.92±0.23) × 10-3 mm2/s, which was significantly lower than that of patients with stage Ⅰ-Ⅱ breast cancer (P<0.05), while Ktrans was (1.47±0.22) min-1, which was significantly higher than that of patients with stage Ⅰ-Ⅱ breast cancer (P<0.05). The ADC value of patients with triple negative type was (0.87±0.19) × 10-3 mm2/s, which was significantly lower than that of Luminal A type, Luminal B type and Her-2 type (P<0.05). The Ktrans of the triple negative type was (1.94±0.28) min-1, which was significantly higher than that of the Luminal A type, Luminal B type and Her-2 type (P<0.05). The Kep of triple negative type was (1.76±0.21) min-1, which was significantly higher than Luminal A type and Luminal B type (P<0.05). The ADC value of ER negative expression tissue was (0.96±0.21) ×10-3 mm2/s, which was significantly lower than that of ER positive expression tissue (P<0.05). The ADC value of Ki-67 high expression tissue was (0.99±0.19) × 10-3 mm2/s, which was significantly lower than that of Ki-67 low expression tissue (P<0.05). The Ktrans and Kep values of ER negative expression tissues were (1.41±0.26) min-1 and (1.63±0.26) min-1, respectively, which were significantly higher than those of ER positive expression tissues (P<0.05). The Ktrans and Kep values of PR negative expression tissues were (1.53±0.27) min-1 and (1.68±0.25) min-1, respectively, which were significantly higher than those of PR positive expression tissues (P<0.05). The Ktrans of Ki-67 high expression tissue was (1.30±0.22) min-1, which was significantly higher than that of Ki-67 low expression tissue (P<0.05). There was no significant difference in ADC values and DEC-MRI quantitative parameters among different HER-2 expression tissues (P>0.05). 
    Conclusion DWI and DCE-MRI quantitative parameters are correlated with molecular subtypes, ER, PR and Ki-67 expression of breast cancer, but are not significantly correlated with Her-2 expression, which is worthy of further study. 

    The value of DWI combined with IVIM in assessing the severity of cerebral infarction in young and middle-aged people and predicting hemorrhagic transformation after thrombolytic therapy
    XUE Ming-chen, CHEN Zhi-tian, DING Chao, XIN Yi
    2024, 45(7):  785-790.  doi:10.3969/j.issn.1007-3205.2024.07.008
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    Objective To investigate the value of magnetic resonance diffusion weighted imaging (MR-DWI) combined with intravoxel incoherent motion (IVIM) in assessing the severity of cerebral infarction in young and middle-aged people and predicting hemorrhagic transformation (HT) after thrombolytic therapy, with the aim of providing a reference for early clinical targeting and intervention planning. 
    Methods A retrospective study was conducted on 96 middle-aged and young patients with acute ischemic stroke (AIS). DWI and IVIM examinations were performed on admission, apparent diffusion coefficient (ADC), perfusion fraction (f), pseudo-diffusion coefficient (D*), diffusion coefficient of pure diffusion (D) were obtained from healthy and affected side, and all parameters were standardized. rADC, rf, rD* and rD of patients with different disease severity were compared to analyze the correlation between each parameter and the disease severity of AIS in young and middle-aged people. After intravenous thrombolytic therapy, rADC, rf, rD*, rD and HT-related biological indicators [cystatin C (Cys-C), fibrinolytic protein 3 (Ficolin-3), complement C1q/ tumor necrosis faction-associated protein-3 (CTRP-3)] were compared between patients with and without HT at admission. Receiver operating characteristic (ROC) curve was used to evaluate the value of each parameter in predicting HT after thrombolytic therapy for AIS in young and middle-aged adults. 
    Results ADC, f, D* and D on the affected side were all lower than those on the healthy side at admission (P<0.05). The rADC, rf, rD* and rD of severe patients were all lower than those of moderate and mild patients at admission, and lower in moderate patients than in mild patients at admission (P<0.05). rADC, rf, rD*, rD were negatively correlated with AIS severity at admission (P<0.05). The levels of rADC, rf, rD*, rD and serum Ficolin-3 and CTRP-3 levels in patients with HT were lower than those without HT, while the levels of Cys-C were higher than those without HT (P<0.05). rADC, rf, rD* and rD were negatively correlated with serum Cys-C levels and positively correlated with serum Ficolin-3 and CTRP-3 levels in patients with HT at admission (P<0.05). At admission, the area under the ROC curve (AUC) of the combination of rADC, rf, rD* and rD in predicting HT in young and middle-aged people with AIS after thrombolytic therapy was 0.943, which was greater than that predicted by the combination of serum Cys-C, Ficolin-3 and CTRP-3 (Z=0.195, P=0.043). 
    Conclusion DWI combined with IVIM can be used to evaluate the severity of cerebral infarction in young and middle-aged adults, providing reference for clinical prediction of the occurrence of HT after thrombolytic therapy, so as to carry out targeted follow-up treatment and reduce the risk of HT. 

    Effect of TCD combined with neuroelectrophysiological monitoring on individualized blood pressure management and postoperative cognitive function in patients undergoing CEA
    LI Dan1, LI Jun-qing1, WANG Yan2, PENG Hong-bing1, WU Qing-ju1
    2024, 45(7):  791-798.  doi:10.3969/j.issn.1007-3205.2024.07.009
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    Objective To explore the effect of transcranial doppler ultrasound (TCD) combined with neurophysiological monitoring technology sensory evoked potential(SEP) on intraoperative individualized blood pressure management, myocardial oxygen consumption and postoperative cognitive function in patients undergoing carotid endarterectomy (CEA). 
    Methods One hundred and twenty elderly patients undergoing elective CEA were enrolled as research subjects, and divided into research group (n=60) and control group (n=60) according to random number table method. The control group was treated with vasoactive drugs to increase blood pressure, and the research group was guided by the combined monitoring results of TCD and SEP during the operation. Mean velocity of middle cerebral artery (Vm) values and peripheral arterial systolic pressure before anesthesia (T00), at 10 min after anesthesia (T0), at 5 min before carotid artery occlusion (T1), immediately before and after carotid artery occlusion (T2), immediately after carotid artery occlusion (T3) and at 1 h after carotid artery occlusion (T4) were collected. The intraoperative general conditions (myocardial oxygen consumption, dosage of vasoactive drugs), the incidence of postoperative cognitive dysfunction (POCD) and the results of ultrasound reexamination at 6 months after operation were compared between the two groups. 
    Results The consumption of ephedrine, nicardipine and norepinephrine, myocardial oxygen consumption and the proprtion of patients developing intraoperative bradycardia in the research group were lower than those in the control group (P<0.05). Vm and peripheral arterial systolic pressure on the surgical side of the two groups showed a downward fluctuation trend, and the fluctuation range of Vm and peripheral arterial systolic pressure in the research group was smaller than that in the control group; The difference of interaction between groups, time points, and time points between groups were statistically significant (P<0.05). There was no significant difference in the total incidence of POCD between the two groups (P>0.05). The levels of C-reactive protein (CRP) and malondialdehyde in the two groups increased first and then decreased, while the level of superoxide dismutase decreased first and then increased. The levels of CRP and malondialdehyde in the research group were significantly higher than those in the control group, while the level of superoxide dismutase was significantly lower than that in the control group; There were significant differences in interactions between groups, time points, and time points between groups (P<0.05). In 60 patients in the research group, TCD monitoring indicated that 25 patients reached the shunting standard after carotid artery occlusion during operation, and 7 patients reached the shunting standard of decreased SEP amplitude simultaneously and were given shunting operation. The positive rate of TCD monitoring was higher than that of SEP monitoring (P<0.05), and the consistency of the proportion of shunting standards by the two methods was general (Kappa=0.243, P<0.05). The number of patients with postoperative restenosis and secondary thrombosis in the research group was significantly less than that in the control group (P<0.05). 
    Conclusion TCD combined with SEP has a high guiding value for individualized intraoperative blood pressure management in patients with CEA, which can significantly reduce intraoperative myocardial oxygen consumption and reduce the risk of postoperative adverse events. TCD has a better monitoring effect on cerebral blood flow hyperperfusion during CEA, while SEP has a higher guiding significance for the implementation of intraoperative shunting. 

    Effect of 1-h, 3-h and 6-h cluster therapy on the short-term prognosis of patients with septic shock
    ZHOU An-qi1, MENG Shu-ting2, WU Ying-dong1, ZHANG Xian3
    2024, 45(7):  799-803.  doi:10.3969/j.issn.1007-3205.2024.07.010
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    Objective To explore the effect of 1-h, 3-h and 6-h cluster therapy on the short-term prognosis of patients with septic shock.  
    Methods A retrospective study was conducted on case data of 249 patients with septic shock. Baseline characteristics and pathological data of enrolled patients were collected and categorized into survival and non-survival groups based on prognosis outcomes. The completion status of 1-h, 3-h and 6-h cluster therapy between the two groups was analyzed. Logistic multivariate regression analysis was performed to screen for prognostic factors of patients with septic shock. 
    Results Among the 249 patients with septic shock, there were 74 deaths within 28 days, resulting in a mortality rate of 29.72%. Specifically, the number of patients with completion rates of 1-h, 3-h, and 6-h cluster therapy were 18 (24.32%), 44 (59.46%), and 12 (16.22%), respectively. Survival was observed in 175 (70.28%) patients. In the non-survival group, the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score was higher, and the initiation of antibiotic use was later compared with that of the survival group. Additionally, the proportion of patients with completion of 1-h cluster therapy, reevaluation of elevated lactate levels, and normal central venous pressure values was lower than that in the survival group (P<0.05). The results of multivariate Logistic regression analysis indicated that APACHEⅡ score (OR=3.777, 95%CI: 2.133-6.689), duration of antibiotic use (OR=3.053, 95%CI: 1.723-5.406), reevaluation of elevated lactate levels (OR=0.337, 95%CI: 0.185-0.613), completion of 1-h cluster therapy (OR=0.404, 95%CI: 0.219-0.745), and normal central venous pressure values (OR=0.291, 95%CI: 0.165-0.511) were all factors influencing the prognosis of patients with septic shock (P<0.05). 
    Conclusion The completion of 1 h cluster therapy is helpful to improve the short-term prognosis of patients with septic shock. 

    Application of PICCO to monitor the impact of different time points to achieve resuscitation goal on prognosis of septic shock patients
    DING Sheng1, XIE Yong-peng2, WU Meng-di1, SUN Cheng-dong1
    2024, 45(7):  804-809.  doi:10.3969/j.issn.1007-3205.2024.07.011
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    Objective To explore the application of pulse indicator continuous cardiac output (PICCO) to monitor the impact of different time points to achieve resuscitation goals on the prognosis of septic shock patients. 
    Methods In total, 56 patients with septic shock treated in the intensive care unit (ICU) were selected as the research subjects. According to the time points when the intrathoracic blood volume index (ITBVI) reached 850-1 000 mL/m2, they were divided into the early standard reaching group (0-6 h, n=31) and the late standard reaching group (7-12 h, n=25). Oxygenation index, lactate, infection-related sequential organ failure assessment (SOFA), liver and kidney function indicators [total bilirubin (TBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and serum creatinine (SCr)] of two groups at 0 h, 6 h, 12 h, 24 h, and 48 h, and the length ofICU stay, mechanical ventilation time, and 7-day and 28-d aymortality rate in the two groups were compared. 
    Results There was no statistically significant difference in the interaction between groups, time points, and time points between groups with respect to the oxygenation index between the two groups (P>0.05). The lactate concentration in both groups showed a gradually decreasing trend, and the lactate concentration in the early standard reaching group was significantly lower than that in the late standard reaching group; there were statistically significant differences in the interaction between groups, time points, and time points between groups (P<0.05). The SOFA scores of both groups showed a gradually decreasing trend, and the lactate concentration in the early standard reaching group was significantly lower than that in the late standard reaching group; there were statistically significant differences in the interaction between groups, time points, and time points between groups (P<0.05). The levels of SCr, ALT, AST, and TBIL in two groups showed a gradually decreasing trend, and the lactate concentration in the early standard reaching group was significantly higher than that in the late standard reaching group; the differences in interaction between groups, time points, and time points between groups were statistically significant (P<0.05). There was no significant difference in length of ICU stay, mechanical ventilation time, and 7-day mortality rate between the two groups (P>0.05), while the 28-day mortality rate of the early standard reaching group was significantly lower than that of the late standard reaching group; the difference was statistically significant (P<0.05). 
    Conclusion Under the guidance of PICCO monitoring, implementing fluid resuscitation treatment for septic shock patients can improve patient prognosis in both early and late standard reaching groups. However, the early standard reaching group can significantly decrease SOFA scores and reduce 28-day mortality rate compared with the late standard reaching group. 

    Construction and validation of a predictive model for the risk of severe multiple injuries in emergency patients complicated with persistent inflammation immuo-suppression catabolism syndrome
    YANG Xiao-qing, ZHU Yu-ning, MEN Mao-ying, WANG Ying
    2024, 45(7):  810-815.  doi:10.3969/j.issn.1007-3205.2024.07.012
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    Objective To explore the influencing factors of emergency patients with severe multiple injuries complicated with persistent inflammation immuno-suppression catabolism syndrome (PICS), and to construct a prediction model of PICS. 
    Methods A total of 200 patients with severe multiple injuries were selected, and the occurrence of PICS within 15-20 d after injury was statistically analyzed. According to presence of PICS, they were divided into PICS group (n=31) and non-PICS group (n=169). The clinical data of the two groups were compared, and a multivariate logistic model was used to analyze the influencing factors of PICS in patients with severe multiple injuries. Based on the influencing factors, a Nomogram prediction model for the risk of PICS occurrence was constructed, and the predictive value and clinical utility of the Nomogram prediction model were validated. 
    Results The incidence of PICS in patients with severe multiple injuries within 15-20 d after injury was 15.50% (31/200). The proportion of patients aged ≥60 years, the incidence of acute respiratory distress syndrome (ARDS), and the levels of serum interleukin-6 (IL-6) and interleukin-10 (IL-10) at admission were higher in the PICS group than in the non-PICS group, while the Glasgow Coma Scale (GCS) score and serum CD4+/CD8+ levels at admission were lower in the PICS group than in the non-PICS group (P<0.05). Logistic regression analysis showed that age, ARDS, IL-6, and IL-10 at admission were risk factors for PICS in patients with severe multiple injuries, while GCS score and serum CD4+/CD8+ levels at admission were protective factors for PICS in patients with severe multiple injuries (P<0.05). The forest plot showed that age ≥60 years, concurrent ARDS, and serum IL-6 and IL-10 levels at admission were positively correlated influencing factors for the occurrence of PICS in patients with severe multiple injuries, while GCS score and serum CD4+/CD8+ levels at admission were negatively correlated influencing factors (P<0.05). Based on the influencing factors, a Nomogram prediction model for the risk of PICS in patients with severe multiple injuries was constructed. The concordance index (C-index) of this model was 0.856, indicating good discrimination. The calibration curve showed good consistency between the prediction model and the actual observation results, and the decision curve analysis (DCA) showed that the prediction model had good clinical utility. 
    Conclusion The factors influencing the occurrence of PICS in emergency patients with severe multiple injuries include age, GCS score at admission, ARDS, serum IL-6, IL-10, sPD-L1, and CD4+/CD8+ levels, and the construction of a Nomogram prediction model for the risk of PICS according to the influencing factors can provide a reliable reference basis for clinical screening of patients at high risk of concurrent PICS. 

    Mechanism of lncRNA LINC00943 regulating TLR4/NF-κB pathway against macrophage activity in Mycobacterium tuberculosis infection
    JIN Hui-min, WANG Huan
    2024, 45(7):  816-822.  doi:10.3969/j.issn.1007-3205.2024.07.013
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    Objective To explore the role of macrophage autophagy induced by Mycobacterium tuberculosis (TB) infection. 
    Methods Peripheral blood samples were collected from 15 active TB patients and 15 healthy volunteers respectively. The expression of LINC00943 was detected by real time quantitative reverse transcription polymerase chain reaction (qRT-PCR). Autophagy was detected by immunofluorescence and transmission electron microscopy. Expressions of LC3-Ⅰ, LC3-Ⅱ and Toll-like receptor 4 (TLR4)/ nuclear factor kappa-B (NF-κB) pathway-related proteins were detected by Western blot. Cell viability was detected by cell counting kit-8 (CCK-8), and apoptosis was detected by flow cytometry. 
    Results Compared with the healthy control group, monocyte apoptosis was reduced and autophagy was enhanced in TB patients. Compared with the monocytes of healthy controls, the expression of LINC00943, TLR4 and MyD88 in the monocytes of TB patients was significantly upregulated. Overexpression of LINC00943 induced macrophage autophagy, and LINC00943 regulated macrophage autophagy by modulating the TLR4/NF-κB pathway. TLR4/NF-κB pathway inhibitor treatment could reverse the promotion of macrophage autophagy by LINC00943. 
    Conclusion LINC00943 inhibits macrophage autophagy in tuberculosis by modulating the TLR4/NF-κB pathway, suggesting a new strategy for treating the occurrence of active TB caused by immune escape from Mycobacterium tuberculosis. 

    Liraglutide ameliorates renal tissue damage in diabetic rats by inhibiting the PERK/eIF2α/ATF4/CHOP pathway mediated by endoplasmic reticulum stress
    TIAN Ying
    2024, 45(7):  823-831.  doi:10.3969/j.issn.1007-3205.2024.07.014
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    Objective To investigate the effect of liraglutide on ameliorating renal tissue damage of diabetic rats by inhibiting kinase R-like ER kinase (PERK)/phosphorylation of eukaryotic initiation factor-2α(eIF2α)/activated transcription factor 4 (ATF4) /C/ EBP-homologous protein (CHOP) pathway mediated by endoplasmic reticulum stress and its mechanism. 
    Methods A rat model of type 2 diabetes mellitus (T2DM) was induced by a high-carbohydrate, high-fat diet and intraperitoneal injection of low-dose Streptozotocin (STZ) (30 mg/kg). At 5 weeks after STZ injection, diabetic rats were randomly treated with subcutaneous injection or no subcutaneous injection of Liraglutide (0.2 mg/kg/12 h) for 8 weeks. The rats were divided into NC group, DN group and DN+Lira group. Diabetes-related physical and biochemical indexes, renal histopathology and ultrastructural changes were measured. The levels of superoxide diamutase (SOD), reactive oxygen species (ROS) level, malondialdehyde (MDA) and myeloperoxidase (MPO) were detected by corresponding kits, respectively. The expression of endoplasmic reticulum stress-related proteins and PERK/eIF2α/ATF4/CHOP pathway were analyzed by Western blotting. 
    Results At 5 weeks after STZ injection, the fasting blood glucose (FBG) in the DN group was consistently higher than that in the NC group. At 13 weeks after STZ injection (8 weeks after Liraglutide administration), the DN group and DN+Lira group showed significantly higher FBG, hemoglobin A1c (HbA1c), renal body mass index, serum creatinine (SCr), and blood urea nitrogen (BUN) compared with the NC group, but significantly lower body weight compared with the NC group; The FBG, HbA1c, renal body mass index, SCr, and BUN in the DN+Lila group were significantly lower than those in the DN group (P<0.05). At 5 weeks after STZ injection (0 week after Liraglutide administration), the urinary albumin/creatinine ratio (ACR) in the DN group and DN+Lira group was significantly higher than that in the NC group, and the difference was statistically significant (P<0.05). At the end of the study (8 weeks after administration of Liraglutide), the urinary ACR in the DN group and DN+Lira group was significantly higher than that in the NC group, while the urinary ACR in the DN+Lila group was significantly lower than that in the DN group (P<0.05). The mesangial matrix index of DN group and DN+Lira group was significantly higher than that of NC group, while the mesangial matrix index of DN+Lira group was significantly lower than that of DN group, with statistical significance (P<0.05). The protein levels of glucose regulated protein 78 (GRP78), phosphorylated inositol requiring enzyme 1 α (p-IRE1 α), activating transcription factor 6 (ATF6), and caspase-12 in the DN group were significantly higher than those in the NC group, while the protein levels of GRP78, p-IRE1 α, ATF6, and Caspase-12 in the DN+Lira group were significantly lower than those in the DN group (P<0.05). The levels of MDA, ROS, and MPO in the DN group were significantly higher than those in the NC group, while the levels of SOD were lower than those in the NC group. In the DN+Lira group, the levels of MDA, ROS, and MPO were significantly lower than those in the DN group, and the levels of SOD were higher than those in the DN group (P<0.05). The levels of p-PERK, p-eIF2 α, ATF4, and CHOP in the renal cortex of the DN group were significantly higher than those of the NC group, while the levels of p-PERK, p-eIF2 α, p-ATF4, and CHOP in the renal cortex of the DN+Lira group were significantly lower than those of the DN group (P<0.05). 
    Conclusion Liraglutide may play a renal protective role by inhibiting the PERK/eIF2α/ATF4/CHOP pathway mediated by endoplasmic reticulum stress. 

    Effects of thymosin β4 combined with hydrocolloid dressing on wound healing and p38 mitogen-activated protein kinase signal transduction pathway in rats with deep Ⅱ degree burn
    LI Shu-song1, MA Ying2, WU Xiao-ming3, ZHAO Xiao-yu1, LI Li3
    2024, 45(7):  832-838.  doi:10.3969/j.issn.1007-3205.2024.07.015
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    Objective To investigate the effect of thymosin β4 (Tβ4) combined with hydrocolloid dressing on early wound healing and p38 mitogen-activated protein kinase (MAPK) signal transduction pathway in rats with deep Ⅱ degree burn. 
    Methods Forty healthy Wister male rats with conventional adaptive feeding were selected as the research subjects. Ten rats were randomly selected as the control group, and the remaining 30 animals were divided into burn group (n=10), Tβ4+hydrocolloid dressing group (n=10) and p38MAPK agonist group (n=10) according to the random number table method. Except the control group, the remaining rats were made into deep Ⅱ degree burn models for subsequent experiments. The Tβ4+ hydrocolloid dressing group was given external application of 6 μg Tβ4+ Ampu patch, the p38MAPK agonist group was given external application of 6 μg Tβ4 + AMP patch + external application of p79350 (1 μg/kg), and the burn group was given an equal amount of 0.9% sodium chloride solution for external application. The wounds were photographed on the 3rd, 7th, 10th, and 14th days of administration, and the pictures were processed by MoticMed6 software and Photoshop software;the early wound healing rates of the rats in each group were calculated. The levels of inflammatory factors tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10) in the wound were detected by immunohistochemistry, and reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the expression of transforming growth factor β1 protein (TGF-β1) mRNA and vascular endothelial growth factor (VEGF) mRNA expression in wounds. Western blot (WB) was used to detect the expression of key proteins of p38MAPK signaling pathway p38MAPK, nuclear factor kappa B (NF-κB), cysteine protease 3 (caspase-3). 
    Results At 3, 7, 10 and 14 d after administration, the wound healing rate of Tβ4+ hydrocolloid dressing group was higher than that of burn group and p38MAPK agonist group (P<0.05). Compared with the control group, the levels of TNF-α and IL-10 at each time point in the burn group, Tβ4+hydrocolloid dressing group and p38MAPK agonist group were higher (P<0.05). At 12, 24, and 48 h after administration, the levels of TNF-α in the burn group and p38MAPK agonist group were higher than those in the Tβ4+hydrocolloid dressing group (P<0.05), while the IL-10 level was lower than that in the Tβ4+hydrocolloid dressing group (P<0.05). However, there was no significant difference in the levels of TNF-α and IL-10 between the burn group and the p38MAPK agonist group at each time point (P>0.05). Compared with the control group, the expressions of TGF-β1 mRNA and VEGF mRNA were all up-regulated at each time point in the burn group, Tβ4+ hydrocolloid dressing group and p38MAPK agonist group (P<0.05). Compared with the burn group, the expression of TGF-β1 mRNA was down-regulated at each time point in the Tβ4+ hydrocolloid dressing group (P<0.05), while the expression of VEGF mRNA was up-regulated (P<0.05). There was no significant difference in the expressions of TGF-β1 mRNA and VEGF mRNA at each time point between the burn group and the p38MAPK agonist group (P>0.05). Compared with the control group, the expression levels of p38MAPK, NF-κB and caspase-3 in the burn group, Tβ4+hydrocolloid dressing group and p38MAPK agonist group were all higher (P<0.05); Compared with the burn group, the expression levels of p38MAPK, NF-κB and caspase-3 in the Tβ4+hydrocolloid dressing group were all lower (P<0.05). However, there was no significant difference in the expression of p38MAPK, NF-κB and caspase-3 between the burn group and the p38MAPK agonist group (P>0.05). 
    Conclusion Adrenaline β4 combined with hydrocolloid dressing helps to promote the healing of deep Ⅱ degree burn wounds, and the mechanism may be related to the inhibition of p38 mitogen-activated protein kinase signal transduction pathway and the reduction of inflammatory factor expression. 

    A study on the interleukin-10 gene polymorphism and genetic susceptibility to polycystic ovary syndrome
    HAO Ya-li, WANG Cong-min, LYU Cui-ting, GUO Li-na, JIA Xin-zhuan, ZHEN Xiu-li
    2024, 45(7):  839-843.  doi:10.3969/j.issn.1007-3205.2024.07.016
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    Objective To explore interleukin-10 (IL-10) gene rs1800871 A/G single nucleotide polymorphism (SNP) and rs1800872 T/G SNP  and genetic susceptibility to polycystic ovary syndrome (PCOS). 
    Methods The SNP of IL-10 gene rs1800871 A/G and rs1800872 T/G were analyzed by SNaPshot SNP typing method in 121 PCOS patients and 158 healthy controls. 
    Results The level of body mass index, family history of obesity and T level in case group were higher than those in control group, while FSH level was lower than that in healthy control group (P<0.05). Polymorphic loci of Rs1800871 A/G SNP and rs1800872 T/G SNP of IL-10 were analysed by using SHEsis software, and results showed that complete linkage exists between these two SNPs (D'=1). There were significant differences in genotype composition and alleles between the case group and the healthy control group (P<0.05). Logistic regression analysis showed that family history of obesity and rs1800871A/G SNPof IL-10 gene were risk factors for PCOS (P<0.05). 
    Conclusion The IL-10 rs1800871 A/G increases genetic susceptibility to PCOS, and carrying AG and GG genotypes may increase the risk of PCOS. 

    Application of mivacurium in infants and young children of different ages under combined intravenous-inhalational anesthesia
    BAO Wen-juan, SHI Lei, SHI Jing, CHEN Wen-jing, ZHANG Qi
    2024, 45(7):  844-849.  doi:10.3969/j.issn.1007-3205.2024.07.017
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    Objective To investigate application of different doses of mivacurium in infants and young children under combined intravenous-inhalational anesthesia. 
    Methods A total of 120 children scheduled for surgery under general anesthesia at Hebei Children′s Hospital were selected. They were divided into group Ⅰ (aged 2 to 12 months) and group Ⅱ (aged 13 to 36 months) based on the age, and further randomly divided into subgroups based on the initial dose of mivacurium: 0.15 mg/kg and 0.2 mg/kg, resulting in subgroups Ⅰ0.15, Ⅰ0.2, Ⅱ0.15, and Ⅱ0.2, with 30 patients in each subgroup. The muscle relaxation-related indicators were observed and recorded, as well as the changes in heart rate (HR), mean arterial pressure (MAP), and blood oxygen saturation (SpO2) before the anesthesia induction and at 1, 3 and 5 min after the injection of mivacurium. 
    Results Comparison of the onset time of the different dose of micuronium: compared with group Ⅰ0.15, the ThD75, ThD90, and ThDmax of group Ⅰ0.2 were obviously shortened (P<0.05); compared with group Ⅱ0.15, the ThD75, ThD90, and ThDmax of group Ⅱ0.2 were obviously shortened (P<0.05). Comparison of the onset time of mivacurium in different age groups: compared with group Ⅰ0.15, the ThD75, ThD90, and ThDmax of group Ⅱ0.15 were obviously prolonged (P<0.05); compared with group Ⅰ0.2, the ThD75 and ThDmax of group Ⅱ0.2 were obviously prolonged (P<0.05). There was no significant difference between the groups in Th, ThR25, ThR75, RI, TOFR75, TOFR90 and satisfaction rate of tracheal intubation (P>0.05). There was no significant difference in interaction between groups, time points and time points between groups with respect to HR, MAP and SpO2 (P>0.05). 
    Conclusion The related factors affecting the neuromuscular blockade are the age of children and the first dose of mivacurium. Mivacurium (0.15 mg/kg, 0.2 mg/kg) applied in pediatric anesthesia is safe and effective. 

    Involvement of apolipoprotein D in the proliferation and differentiation of dental pulp cells by activating Wnt/β-catenin signaling pathway
    LIN Jian-sheng, KONG Ling-jia, E Jia, WANG Li-na, YAO Zhi-wen
    2024, 45(7):  850-854.  doi:10.3969/j.issn.1007-3205.2024.07.018
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    Objective To investigate the involvement of apolipoprotein D (APOD) in the proliferation and differentiation of dental pulp cells (DPCs) by activating Wnt/β-catenin signaling pathway in Drosophila melanogaster. 
    Methods Human dental pulp cells (HDPCs) were cultured in vitro and divided into blank group, low-dose APOD group, high-dose APOD group and si-APOD group. Cells in the blank group were cultured in DMEM medium without any treatment. APOD 2 nmol/L and 32 nmol/L were added to the low-dose APOD group and high-dose APOD group, respectively. HDPCs cells in the si-APOD group were transfected with APOD si-RNA. RT-qPCR was used to detect the expression of APOD mRNA, and CCK-8 was used to detect cell proliferation. Alkaline phosphatase (ALP) activity was used to detect osteogenic differentiation, and Western Blot was used to detect Wnt/β-catenin pathway protein expression. 
    Results Compared with blank group, APOD mRNA level and cell viability were increased, ALP activity was increased at 7 d and 14 d, and Wnt5a and β-catenin proteins were up-regulated in low- and high-dose APOD groups (P<0.05). In si-APOD group, APOD mRNA level and cell viability were decreased, ALP activity at 7 d and 14 d was decreased, and Wnt5a and β-catenin proteins were down-regulated (P<0.05). Compared with the low-dose APOD group, the APOD mRNA level and cell viability were increased, the ALP activity was increased at 7 d and 14 d, and the Wnt5a and β-catenin proteins were up-regulated in the high-dose group (P<0.05). In si-APOD group, APOD mRNA level and cell viability were decreased, ALP activity at 7 d and 14 d was decreased, and Wnt5a and β-catenin protein were down-regulated (P<0.05). Compared with the high-dose APOD group, the mRNA level and cell viability of APOD were significantly decreased, the activity of ALP at 7 d and 14 d was decreased, and the proteins of Wnt5a and β-catenin were down-regulated in si-APOD group (P<0.05). 
    Conclusion APOD can promote the proliferation and differentiation of HDPCs cells, and its mechanism may be related to the activation of Wnt/β-catenin signaling pathway.