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    25 September 2024, Volume 45 Issue 9
    Clinical observation on the combination of stellate ganglion block and YS1001P therapeutic instrument in the treatment of acute cerebral infarction with dysphagia
    ZHAO Peng1, YAO Yu-ting1, JIA Xian-da2, XIAO Zhi-juan1, LI Yan3, SHEN Wen1
    2024, 45(9):  1002-1006.  doi:10.3969/j.issn.1007-3205.2024.09.003
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    Objective To explore the clinical efficacy of stellate ganglion block combined with YS1001P therapeutic instrument in the treatment of acute cerebral infarction (ACI) with dysphagia. 
    Methods In total, 80 patients with ACI and dysphagia of the Second Affiliated Hospital of Hebei North University were enrolled in this study, and then divided into two groups according to the random number table method, with 40 patients in each group. Both groups received symptomatic treatment after stroke, including control of blood pressure and blood sugar, anti-platelet aggregation, regulation of lipid metabolism, improvement of cerebral circulation, nutrition of cranial nerves, and prevention and treatment of complications. On this basis, swallowing and neuromuscular electrical stimulator YS1001P was used for treatment. The research group received additional stellate  ganglion block treatment. After 20 d, Kubota Water Swallowing Test was used to evaluate the clinical efficacy of patients. The swallowing function of patients in the two groups before and after treatment was compared with the score of Fujishima Ichiro Dysphagia scale and videofluoroscopic swallowing study (VFSS), and the changes of serum nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) before and after treatment were compared between the control group and the research group. 
    Results After treatment, the score of Fujishima Ichiro Dysphagia scale in the research group was higher than that in the control group (P<0.05). After treatment, the scores of oral phase, pharyngeal phase, aspiration, and total VFSS scores in the research group were higher than those in the control group (P<0.05), and the grading of Kubota Water Swallowing Test in the research group was better (P<0.05). The total effective rate of 95.00% in the research group was significantly higher than 77.50% in the control group (P<0.05), and the serum NGF and BDNF levels in the research group were higher than those in the control group (P<0.05). 
    Conclusion The combination of stellate ganglion block and YS1001P treatment instrument has a good clinical efficacy in the treatment of ACI with dysphagia. The swallowing function of patients has significantly improved, and its mechanism of action may be related to the improvement of neurotrophic levels. 

    Effect of niergoline combined with indobuprofen in the treatment of acute cerebral infarction
    ZHANG Na, YANG Cai-qin, WANG Ying
    2024, 45(9):  1007-1011.  doi:10.3969/j.issn.1007-3205.2024.09.004
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    Objective To study the effect of niergoline combined with indobuprofen in the treatment of acute cerebral infarction (ACI). 
    Methods A total of 122 patients with ACI admitted to the First Affiliated Hospital of Huaian were selected and divided into research group (n=61) and control group (n=61) by random number table method. Both groups received basic treatment, the control group was additionally given indobuprofen, and the research group was additionally given niergoline. Both groups were treated for 14 d. National Institute of Health Stroke Scale (NIHSS) score, Modified Rankin Scale (mRS) score, clinical efficacy, serum levels of heart-type fatty acid-binding protein (H-FABP), β-actin (β-actin), insulin-like growth factor-1 (IGF-1), plasma specific viscosity, whole blood high shear viscosity, plasma fibrinogen, whole blood low shear viscosity and safety of the two groups were compared. 
    Results After treatment, both groups showed a decrease in NIHSS scores and mRS scores, with the research group being lower than the control group (P<0.05). The total effective rate of the research group (91.80%) was higher than that of the control group (77.05%) (P<0.05). After treatment, the levels of serum H-FABP and β-actin in both groups decreased, with the research group being lower than the control group (P<0.05). After treatment, the serum IGF-1 levels in both groups increased, with the research group being higher than the control group (P<0.05). After treatment, both groups showed a decrease in plasma specific viscosity, whole blood high shear viscosity, plasma fibrinogen, and whole blood low shear viscosity, with the research group being lower than the control group (P<0.05). There was no significant difference in the total incidence of adverse reactions between the two groups (P>0.05). 
    Conclusion Niergoline combined with indobuprofen is effective in the treatment of ACI, and can improve the neurological function, serum biochemical indexes and hemorheology, and has few adverse reactions. 

    Effect of early goal-directed sedation on intracranial pressure and cerebral oxygen metabolism after serious cerebral hemorrhage surgery
    HU Long1, SHI Shu-juan2, HUANG Cong-ling2, XIANG Xin-yuan2
    2024, 45(9):  1012-1017.  doi:10.3969/j.issn.1007-3205.2024.09.005
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    the effect of early goal-directed sedation (EGDS) on intracranial pressure and cerebral oxygen metabolism after serious cerebral hemorrhage (SCH), and to provide a new idea for the follow-up treatment of SCH.  
    Methods A total of 105 patients with SCH who were admitted to People′s Hospital of Xiangxi Tujia and Miao Autonomous Prefecture were included, and randomly divided into the observation group (n=53) and the control group (n=52). The control group was given routine sedation, and the observation group was given EGDS. The indexes related to cerebral oxygen metabolism before sedation (T1), at 24 h after sedation (T2), at 48 h after sedation (T3), at 72 h after sedation (T4) were compared between the two groups. The heart rate (HR), mean arterial pressure (MAP), cerebral perfusion pressure (CPP) and intracranial pressure (ICP) at each time point were compared between the two groups. 
    Results Arterial blood lactate (Lac) of the two groups showed a decreasing trend over time, while cerebral extraction rate of oxygen (CERO2) and cerebral arteriovenous blood oxygen content difference (a-vDO2) showed a fluctuating trend, first decreasing, then increasing, and then decreasing. Juglar venous oxygen saturation (SjvO2) and cerebral arterial oxygen content (CaO2) showed an increasing trend, and the observation group showed more significant changes than the control group. There was a significant difference in the interaction between groups, time points and time points between groups (P<0.05). Over time, the HR of the observation group showed a fluctuating trend, first decreasing, then increasing, and then decreasing. The HR of the control group showed a decreasing trend, while the MAP of the two groups showed a fluctuating trend. The changes in HR and MAP of the observation group were smoother than those of the control group. There were significant differences in interaction between groups and time points with respect to HR and MAP between the two groups (P<0.05). There was a significant difference in interaction between groups and time points with respect to HR (P<0.05), while there was no significant difference in interaction between groups and time points with respect to MAP (P>0.05). The ICP of the two groups showed an increasing trend over time, while CPP showed a fluctuating trend. There was a significant difference in interaction between the two groups (P<0.05), while there was no significant difference in the interaction between time points, or between groups and time points (P>0.05). 
    Conclusion The EGDS regimen can more effectively improve the cerebral oxygen metabolism, ICP, and CPP of SCH patients, and can also more accurately maintain the patient′s hemodynamics in a shallow sedation state. 

    Changes in serum miR-497 and miR-5787 levels to predict the severity of pulmonary infections in severe stroke patients and their correlation with inflammatory response
    HAN Xue-jiao1, CHEN Yue-jing1, SHI Li-min1, LIU Jie2
    2024, 45(9):  1018-1024.  doi:10.3969/j.issn.1007-3205.2024.09.006
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    Objective To explore the prediction of the severity of pulmonary infections in severe stroke patients by changes in serum levels of miR-497 and miR-5787 and their correlation with inflammatory response. 
    Methods A retrospective study was conducted on 202 patients with severe stroke treated in  the Third Hospital of Xingtai City. The patients were classified into three groups based on the occurrence and severity of pulmonary infection: non-infection group, mild to moderate infection group, and severe infection group. Serum levels of miR-497 and miR-5787 were evaluated in patients from these groups, and inflammatory factors were collected. The correlation between serum miR-497 and miR-5787 levels and inflammatory factors was analyzed using the Pearson method. Univariate and multivariate Logistic regression analyses were performed to identify the risk factors associated with different severities of pulmonary infection. Additionally, the predictive value of serum miR-497 and miR-5787 for different severities of pulmonary infection was assessed using receiver operating characteristic (ROC) curves. 
    Results The serum C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) levels in the non-infection group were lower than those in the mild to moderate infection group and severe infection group, which were lower in the mild to moderate infection group than in the severe infection group (P<0.05). The serum miR-497 and miR-5787 levels in the non-infection group were lower than those in the mild to moderate infection group and severe infection group, which were lower in the mild to moderate infection group than in the severe infection group. Serum miR-497 was positively correlated with serum CRP, IL-6, and TNF-α (r=0.756, 0.595, 0.718, P<0.001), and serum miR-5787 was positively correlated with serum CRP, IL-6, and TNF-α (r=0.929, 0.827, 0.878, P<0.001). Logistic regression analysis showed that miR-497 (OR=1.824, 95%CI: 1.473-2.258) and miR-5787 (OR=2.034, 95%CI: 1.234-3.353) were influencing factors for pulmonary infection in patients with severe stroke (P<0.05). The ROC results showed that the critical value for miR-497 diagnosis was 3.55, with a corresponding sensitivity of 69.77%, specificity of 71.07%, and the area under the ROC curve (AUC) of 0.801 (95%CI: 0.750-0.852). The critical value for miR-5787 diagnosis was 10.27, with a corresponding sensitivity of 74.42%, specificity of 69.81%, and AUC of 0.760 (95%CI: 0.707-0.812). The sensitivity of regression analysis was 86.05%, specificity was 83.02%, and AUC was 0.869 (95%CI: 0.831-0.907). 
    Conclusion Serum levels of miR-497 and miR-5787 are found to be significantly upregulated in patients with severe stroke, which have a positive correlation with the severity of pulmonary infection. They can be used to predict pulmonary infection in severe stroke patients and are worthy of further clinical research and promotion. 

    Analysis of prognosis and risk factors in elderly patients with posterior circulation ischemia
    CUI Xiu-ying1, YANG Min2, BAI Hai-bo3, ZHANG Mu-yuan4, ZHANG Ran1
    2024, 45(9):  1025-1029.  doi:10.3969/j.issn.1007-3205.2024.09.007
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    Objective To explore the prognosis and risk factor of elderly patients with posterior circulation ischemia (PCI). 
    Methods A total of 120 patients with PCI in Chengde Central Hospital were selected and grouped according to the prognosis at 3 months after treatment. The differences in clinical data, fasting peripheral blood glucose (FBG), and hemoglobin A1C(HbA1c) between patients with poor prognosis and those with good prognosis were analyzed.  
    Results There were 39 patients with poor prognosis, and the incidence of poor prognosis was 32.50%. The age of patients with poor prognosis and the highest National Institutes of Health Stroke Scale (NIHSS) score during admission were (68.93±4.02) years and (19.30±2.50) points, respectively, which were significantly higher than those with good prognosis (P<0.05). The FBG, HbA1c, lipoprotein-associated phospholipase a2 (Lp-PLA2), high-sensitivity C-reactive protein (hs CRP) and platelet activating factor (PAF) in poor prognosis group were (7.28±0.92) mmol/L, (7.02±0.86)%, (330.50±65.53) μg/L, (20.22±6.43) ng/L and (248.23±44.18) ng/L, respectively, which were significantly higher than those in good prognosis group (P<0.05). Logistic regression analysis showed that age, the highest NIHSS score during hospitalization, FBG, Lp-PLA2, and PAF were the prognostic factors of patients (P<0.05). The area under the receiver operating characteristic predicted by this equation for poor prognosis was 0.884 (95%CI: 0.821-0.948), (P<0.05), and the sensitivity and specificity were 84.60% and 81.50%, respectively. 
    Conclusion The proportion of poor prognosis in elderly patients with PCI is high, and the prognosis is affected by the age of patients, the highest NIHSS score during hospitalization, FBG, Lp-PLA2, and PAF. Meanwhile, the model constructed by this method has high predictive value for the poor prognosis of patients. 

    Pathogenic bacteria and Logistic regression analysis of risk factors in 165 patients with MDRO infection in patients with diabetic foot
    WU Dan, ZHANG Yang-fan, XIE Jia-liang, SUN Xue, LI Yang-qing, WANG Xian-wei
    2024, 45(9):  1041-1046.  doi:10.3969/j.issn.1007-3205.2024.09.010
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    Objective To analyze the pathogenic bacteria and risk factors of multi-drug resistant bacteria (MDRO) infection in 165 patients with diabetic foot. 
    Methods Clinical of 165 patients with diabetic foot who were admitted to the Department of Endocrinology of People′s Hospital of Shijiazhuang City were retrospectively analyzed. They were divided into the infection group (n=49) and the non-infection group (n=116) according to presence of MDRO infection. The incidence of MDRO infection and the detection of pathogenic bacteria in patients with diabetic foot were calculated, and multivariate Logistic regression was used to analyze the risk factors for MDRO infection in patients with diabetic foot. 
    Results The incidence of MDRO infection in 165 patients with diabetic foot was 29.70%. A total of 132 infectious pathogens were cultured from 165 patients with diabetic foot, including 85 Gram-negative bacteria, accounting for 64.39% and 47 Gram-positive bacteria, accounting for 35.61%. A total of 88 strains of MDRO infection were detected, and the detection rate of MDRO infection was 66.67%. Among them, the main pathogenic bacteria of MDRO infection were Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa, accounting for 22.73%, 18.18% and 14.77%, respectively. Multivariate Logistic regression analysis showed that the combination with osteomyelitis, combination with macroangiopathy, use of third-generation cephalosporins, use of ≥3 antimicrobial agents, presence of neuroischemic injury, duration of antimicrobial treatment ≥5 d, and Wanger grades 3-5 were all the independent risk factors for MDRO infection in patients with diabetic foot (OR=3.171, 2.992, 2.678, 2.740, 2.445, 3.785, 2.514, P<0.05). 
    Conclusion The incidence rate of MDRO infection in patients with diabetic foot is high. The pathogenic bacteria of MDRO infection include Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa, which are mainly related to presence of combined osteomyelitis, combined macroangiopathy, use of the third-generation cephalosporins, the types of antibacterial drugs used, neuroischemic injury detected, the antibacterial drug treatment course adopted, and Wanger grade. 

    Correlation between peripheral blood CCN1 and early renal injury in patients with type 2 diabetes mellitus
    LI Kun1, ZHAO Wei-li2, ZHANG Pei2, XU Yun-qiang1
    2024, 45(9):  1047-1052.  doi:10.3969/j.issn.1007-3205.2024.09.011
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    Objective To explore the correlation between peripheral blood cysteine-rich protein 61 (CCN1) and early renal injury in patients with type 2 diabetes mellitus (T2DM). 
    Methods A retrospective study was conducted on 321 patients with T2DM in the Second Hospital of Shijiazhuang City. Using the urinary albumin excretion rate (UAER) as the gold standard, the patients were divided into three groups: early renal injury group (n=78, 20 μg/min≤UAER≤200 μg/min), diabetic nephropathy (DN) group (n=28, UAER>200 μg/min) and normal group (n=215, UAER<20 μg/min). The expression of CCN1 in peripheral blood of the three groups was compared. Pearson method was used to determine the correlation between UAER and CCN1 in peripheral blood, and receiver operating characteristic (ROC) curve was used to evaluate the predictive value of CCN1 in peripheral blood for early renal injury and DN in T2DM patients. Univariate analysis was used to analyze baseline data and multivariate logistic regression analysis was used to determine the influencing factors of early renal injury or DN. 
    Results The levels of CCN1 and UAER in DN group were higher than those in early renal injury group and normal group, and the levels of CCN1 and UAER in the early renal injury group were also higher than those in the normal group (P<0.05). There was a positive correlation between peripheral blood CCN1 and UAER, and the difference was statistically significant (r=0.916, P<0.001). Using peripheral blood CCN1 as the test variable, the ROC curve was plotted with early renal injury as the state scalar, sensitivity as the Y-axis, and "1-specificity" as the X-axis. The ROC results showed that the critical value for CCN1 diagnosis was 1.59 μg/L, with a corresponding sensitivity of 85.85%, specificity of 73.02%, and AUC of 0.871 (95%CI: 0.831-0.903). Peripheral blood CCN1 was used as the test variable, with the occurrence of DN as the state scalar, sensitivity as the Y axis, and "1-specificity" as the X axis to draw the ROC curve. The ROC results showed that the critical value for CCN1 diagnosis was 3.41 μg/L, with a corresponding sensitivity of 71.43%, specificity of 73.72%, and AUC of 0.761 (95%CI: 0.707-0.813). There were significant differences in the course of disease, hypertension, hyperlipidemia, systolic blood pressure(SBP), fasting plasma glucose(FPG), HbA1c, uric acid (UA), total cholesterol (TC), triglyceride (TG) and low-density lipoprotein (LDL)among the DN group, the early renal injury group and the normal group (P<0.05). Logistic regression analysis showed that the course of disease (OR=1.740, 95%CI: 1.180-2.565), SBP (OR=1.943, 95%CI: 1.267-2.978), hyperlipidemia (OR=1.654, 95%CI: 1.310-2.088), FPG (OR=2.776, 95%CI: 1.260-6.116), UA (OR=2.228, 95%CI: 1.174-4.229) and CCN1 (OR=3.744, 95%CI: 1.709-8.200) were the influencing factors of early renal injury in T2DM patients (P<0.05). Logistic regression analysis showed that the course of disease (OR=1.752, 95%CI: 1.177-2.609), SBP (OR=1.818, 95%CI: 1.034-3.198), hyperlipidemia (OR=1.680, 95%CI: 1.320-2.138), FPG (OR=2.389, 95%CI: 1.519-3.758), UA (OR=1.260, 95%CI: 1.038-1.530) and CCN1 (OR=3.815, 95%CI: 1.636-8.897) were the influencing factors of DN (P<0.05). 
    Conclusion Peripheral blood CCN1 demonstrates a positive correlation with urinary albumin excretion rate, thereby serving as a risk factor for the onset of early-stage renal injury and DN. It can be used to predict the occurrence of early renal injury or DN, which is worthy of further clinical research and promotion. 

    Expression of ADAMTS13 in peripheral blood of patients with proliferative type 2 diabetic retinopathy and its value in evaluating the effect of atorvastatin intervention
    JIANG Li-hua1, XI Wei1, CAI Xin2
    2024, 45(9):  1053-1057.  doi:10.3969/j.issn.1007-3205.2024.09.012
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    Objective To investigate the expression of von Willebrand factor cleaving protease (ADAMTS13) in peripheral blood of patients with proliferative type 2 diabetic retinopathy and its value in evaluating the effect of atorvastatin intervention. 
    Methods A total of 118 patients with proliferative diabetic retinopathy (PDR) in Haian People′s Hospital were selected as the PDR group, and all the patients had type 2 diabetes mellitus (T2DM). All of them were tested for the activity of plasma ADAMTS13. All PDR patients were divided into control group and observation group according to the random number table method, with 59 patients in each group. The control group was given conventional hypoglycemic therapy, while the observation group was given atorvastatin on the basis of basic hypoglycemic therapy. The blood glucose, blood lipid and plasma ADAMTS13 and pigment epithelium-derived factor (PEDF) activities of PDR patients were detected at 3 months after continuous administration. 
    Results The plasma ADAMTS13 activity in the PDR group was significantly lower than clinical normal value. After treatment, the blood glucose levels and glycated hemoglobin levels in both groups were lower than those before treatment (P<0.05), while the glycated hemoglobin levels in the observation group were lower than those in the control group (P<0.05). After treatment, the levels of TG, TC, and LDL-C in both groups were lower than those before treatment, and lower in the observation group than in the control group (P<0.05). After treatment, the plasma ADAMTS13 activity increased and plasma PEDF activity decreased in both groups. The plasma ADAMTS13 and PEDF activities in the observation group were higher than those in the control group (P<0.05). Pearson correlation analysis results showed that ADAMTS13 was negatively correlated with PEDF, blood glucose, glycated hemoglobin, TG, TC, and LDL-C (r=-0.451, -0.573, -0.612, -0.548, -0.650, -0.504, P<0.001), while baseline ADAMTS13 was positively correlated with the degree of improvement after treatment (r=0.572, P<0.001). 
    Conclusion Plasma ADAMTS13 expression in patients with T2DM and PDR is down-regulated. Atorvastatin can effectively control blood glucose and blood lipids in patients with T2DM and PDR, and promote the expression of ADAMTS13 in patients with PDR. ADAMTS13 expression can reflect the therapeutic effect of atorvastatin. 

    The effect of preventive ileostomy with a median specimen extraction incision on gastrointestinal function, inflammation level, and anastomotic leakage in patients undergoing laparoscopic radical resection of rectal cancer
    YAO Hao-jie, WANG Jia-chun, YU Feng
    2024, 45(9):  1063-1067.  doi:10.3969/j.issn.1007-3205.2024.09.014
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    Objective To investigate the effect of preventive ileostomy with a median specimen extraction incision on gastrointestinal function, inflammation level, and anastomotic leakage in patients undergoing laparoscopic radical resection of rectal cancer. 
    Methods A total of 160 patients who underwent laparoscopic radical resection of rectal cancer at the 904th Hospital of the Joint Logistics Support Force of the Chinese People′s Liberation Army were selected and divided into a research group (median specimen extraction for preventive ileostomy, n=88) and a control group (traditional incision for preventive ileostomy, n=72) based on the method of ileostomy. The gastrointestinal function and inflammation levels, the healing and occurrence of anastomotic fistula of the two groups, as well as the occurrence of related complications,were compared. 
    Results The first postoperative exhaust time, bowel sound recovery time, and gastrointestinal function recovery time of the research group were shorter than those of the control group (P<0.05).At 3 d after treatment, serum hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) levels of the two groups all increased, which, however, were lower in the research group than in the control group (P<0.05). The incidence of anastomotic fistula in the experimental group was lower than that in the control group after treatment, and the healing time of anastomotic fistula was shorter than that in the control group (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). 
    Conclusion Preventive ileostomy with a median specimen extraction incision in the treatment of patients undergoing laparoscopic radical resection of rectal cancer has shorter recovery time of gastrointestinal function, lower inflammation level, and shorter healing time of anastomotic fistula, suggesting good application effect in clinical practice. 

    Establishment of a nomogram prediction model for predicting the risk of Hp infection ingastric stump after gastric cancer surgery by combining Treg/Th17 cytokines
    AN Yuan-yuan, LIU Si-fang
    2024, 45(9):  1068-1073.  doi:10.3969/j.issn.1007-3205.2024.09.015
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    Objective To analyze the influencing factors of Helicobacter pylori (Hp) infection in gastric stump after gastric cancer surgery by combining regulatory T cells (Treg) and T helper cells (Th17), and to construct a nomogram prediction model of Hp infection in gastric stump after gastric cancer surgery. 
    Methods The clinical data of 80 patients with gastric cancer treated in the First Central Hospital of Baoding City were included. All patients underwent gastrectomy, and were divided into infection group (n=18) and non-infection group (n=62) according to presence of Hp infection after gastric cancer surgery. The clinical data of patients were collected and analyzed retrospectively. Logistic regression analysis was used to determine the influencing factors related to Treg and Th17 cytokines in patients with Hp infection after gastric cancer surgery. The nomogram prediction model of Hp infection after gastric cancer surgery was constructed by Treg/Th17 cytokines. The effectiveness of the nomogram prediction model was evaluated from three dimensions: C index, receiveroperating characteristic (ROC) curve and calibration curve. 
    Results Comparing the clinical data of two groups, there was no significant difference in patient age, body mass index (BMI), gender, clinical stage, and location of onset (P>0.05). The level of IL-17 in the infection group was [(4.76±0.88) ng/L], which was higher than that in the non-infection group [(3.78±0.94) ng/L], and the level of IL-21 was 〖JP2〗[(3.71±0.76) pg/L], which was higher than that in the non-infection group [(3.24±0.81) pg/L]. The level of Th17 was [(3.07±0.53)%], which was higher than that in the non-infection group [(2.71±0.64)%], and the level of IL-10 in the infection group was [(8.15±3.39) ng/L], which was lower than that in the non-infection group [(10.47±3.67) ng/L]. The level of Treg was [(2.59±0.61)%], which was lower than that of the non-infection group [(3.09±0.52)%], and the difference was statistically significant (P<0.05). The results of logistic regression analysis showed that IL-17, IL-21, and Th17 were the influencing factors of Hp infection after gastric cancer surgery (OR>1, P<0.05), while IL-10 and Treg were the protective factors of Hp infection after gastric cancer surgery (OR<1, P<0.05). ROC curves were drawn using the determined influencing factors, and the curve results showed that the area under the ROC curve (AUC) values of IL-17, IL-21, Th17, IL-10, and Treg were all greater than 0.60, indicating that the above indicators provided value for predicting Hp infection after gastric cancer surgery. Using the above influencing factors to establish a nomogram risk model, the verification results showed that the C-index value of the calibration curve was 0.904, indicating that the nomogram model had good predictive effectiveness. 
    Conclusion The probability of Hp infection in gastric stump after gastric cancer surgery can be directly predicted by constructing a nomogram prediction model based on Treg/Th17 cytokines for Hp infection in the gastric stump after gastric cancer surgery.

    Study on the value of PLR, NLR and CRP in evaluating peritoneal metastasis of advanced gastric cancer
    ZHU Mei, LYU Jiao, LI Fei, LI Xiao-feng, ZHAO Hong-ying
    2024, 45(9):  1074-1078.  doi:10.3969/j.issn.1007-3205.2024.09.016
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    Objective To investigate the value of platelet to lymphocyte ratio (PLR), neutrophil tolymphocyte ratio (NLR) and C-reactive protein (CRP) in evaluating peritoneal metastasis of advanced gastric cancer. 
    Methods A total of 124 patients with advanced gastric cancer in Xuzhou Cancer Hospital were retrospectively selected and divided into peritoneal metastasis group (n=36) and non-peritoneal metastasis group (n=88) according to the occurrence of peritoneal metastasis. The clinical data, pathological parameters,CRP, PLR, NLR were compared between the two groups, to analyze the influencing factors of peritoneal metastasis of advanced gastric cancer. Logistic regression model was constructed, and receiver operating characteristic (ROC) curve was used to evaluate its predictive value for peritoneal metastasis. 
    Results The tumor diameter of the abdominal metastasis group was higher than that of the non-abdominal metastasis group, the invasion depth, TNM stage, and PLR, NLR, CRP levels were higher than those of the abdominal metastasis group, and the degree of histological differentiation was lower than that of the non-abdominal metastasis group (P<0.05). After excluding confounding factors such as tumor size, invasion depth, TNM stage and histological differentiation, the Logistic model was established and multivariate analysis was performed. PLR, NLR and CRP were found to be risk factors for peritoneal metastasis in advanced gastric cancer (P<0.05). The risk prediction model was constructed: logit (p) =PLR×1.416+NLR×1.149+CRP×1.088. As for predictive value of the model, when logit (p) > 0.5, the AUC value was 0.755, χ2 was 10.212, the diagnostic sensitivity was 80.95%, and the specificity was 61.64%. 
    Conclusion Peritoneal metastasis of advanced gastric cancer is correlated with the levels of PLR, NLR and CRP and related clinical characteristics. The predictive model based on PLR, NLR, CRP and related clinical factors has high predictive value, and can provide a basis for clinical decision-making. 

    The predictive value of Klotho level in peripheral blood for AVF restenosis after ultrasound-guided PTA
    WU Liang1, QI Ya-nan1, JIAO Wen-cui2, YAN Peng3, WEN Hui-xin1, ZHENG Hui-xiao1
    2024, 45(9):  1079-1084.  doi:10.3969/j.issn.1007-3205.2024.09.017
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    Objective To explore the predictive value of Klotho protein in peripheral blood for arteriovenous fistula (AVF) restenosis in patients with end-stage renal disease (ESRD) after percutaneous transluminal angioplasty (PTA). 
    Methods A total of 240 ESRD patients undergoing PTA  in the Second Affiliated Hospital of Xingtai Medical College were selected as the research subjects. The follow-up deadline was December 2022, and they were divided into stenosis group and non-stenosis group based on occurrence of AVF restenosis. The peripheral blood Klotho levels of two groups were detected and compared, and the correlation between peripheral blood Klotho and AVF restenosis and predictive value of peripheral blood Klotho for AVF restenosis were analyzed.  Clinical data of the two groups were collected for univariate analysis and multiple logistic regression analysis to explore independent risk factors for VAF restenosis. 
    Results The peripheral blood Klotho in the stenosis group was significantly lower than that in the non-stenosis group, with a significant difference (P<0.05). There was a negative correlation between peripheral blood Klotho and AVF restenosis (r=-0.039, P<0.001). The area under the receiver operating characteristic (ROC) of peripheral blood Klotho for predicting AVF restenosis was 0.866 (95%CI: 0.823-0.909), with a cutoff value of 1.35 ng/L. Multiple logistic regression analysis showed that age ≥ 75 years (OR=2.425, 95%CI: 1.054-5.579), glycated hemoglobin ≥ 6.5% (OR=2.570, 95%CI: 1.328-4.975), serum albumin <40 g/L (OR=3.105, 95%CI: 1.040-9.269), calcium phosphorus product >50 mmol/L (OR=3.804, 95%CI: 1.155-12.524), and Klotho protein <1.35 ng/L (OR=2.863, 95%CI: 1.272-6.446) were independent risk factors for postoperative restenosis in ESRD patients undergoing PTA (P<0.05). 
    Conclusion The level of peripheral blood Klotho has a negative correlation with the occurrence of AVF restenosis in ESRD patients after PTA, which has a high predictive value. The decrease in peripheral blood Klotho level, the advanced age, the increase in glycated hemoglobin level, the decrease in serum albumin level, and the increase in calcium phosphorus product are independent risk factors for AVF restenosis. 

    Correlation between the detection of serum IL-17 and Treg cells in peripheral blood and the effectiveness of 308 nm excimer light in the treatment of advanced vitiligo
    DU Xiao-li, ZHANG Wei, ZHANG Jie-na, LIU Xin, WANG Yan, YAN Yue-ying
    2024, 45(9):  1085-1089.  doi:10.3969/j.issn.1007-3205.2024.09.018
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    Objective To explore the correlation between the detection of serum interleukin-17 (IL-17) and T regulatory cells (Treg) in peripheral blood and the effectiveness of 308 nm excimer light in the treatment of advanced vitiligo. 
    Methods In total, 106 patients with advanced vitiligo admitted to Heze Municipal Hospital were selected, and treated with 308 nm excimer light. At 6 months after treatment, they were divided into ineffective group (n=28) and effective group (n=78) according to the therapeutic effect. The levels of serum IL-17 and peripheral blood Treg cells were compared between the two groups. Factors affecting the effectiveness of 308 nm excimer light in the treatment of advanced vitiligo were analyzed. The receiver operating characteristic (ROC) curve was used to analyze the value of serum IL-17 and peripheral blood Treg cell levels in predicting the ineffectiveness of 308 nm excimer light in the treatment of advanced vitiligo. 
    Results There was no significant difference between the ineffective group and effective group with respect to gender, age, course of disease, skin lesion area, location of skin lesion, family history, drinking history, onset season, sun exposure, tumor necrosis factor α, interleukin-6, interleukin-23, transforming growth factor β, and immunoglobulin G level (P>0.05). The constituent ratio of patients with autoimmune diseases and receiving hormone therapy, and serum IL-17 level in ineffective group were higher than those in effective group (P<0.05), while the level of Treg cells in peripheral blood of patients in ineffective group was lower than that in effective group (P<0.05). Multivariate logistic regression analysis showed that combined autoimmune diseases, IL-17 and Treg cell levels were independent risk factors that affected the ineffectiveness of 308 nm excimer light in the treatment of advanced vitiligo (P<0.05). ROC analysis showed that the optimal cutoff points for predicting the ineffectiveness of 308 nm excimer light therapy in advanced vitiligo were 20.04 ng/L and 3.92%, respectively, The sensitivity was 82.14% and 85.71% respectively, and the specificity was 80.77% and 75.64% respectively. The area under the ROC curve (AUC) was 0.889 and 0.829 respectively, and the combined specificity and AUC were 97.44% and 0.940, respectively. 
    Conclusion The detection of serum IL-17 and peripheral blood Treg cells are both related to the effectiveness of 308 nm excimer light in the treatment of advanced vitiligo. The clinical detection of serum IL-17 and peripheral blood Treg cells can be used as sensitive indicators to predict the effectiveness of 308 nm excimer light in the treatment of advanced vitiligo, and the combined prediction value of the two is higher. 

    Study of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for rapid detection of pathogenic bacteria isolated from sterile body fluids
    WANG Jie1, JIA Qian2, LI Jing1, YANG Chao-ju1, TIE Yan-qing1
    2024, 45(9):  1090-1096.  doi:10.3969/j.issn.1007-3205.2024.09.019
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    Objective To explore the clinical application value of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for rapid detection of pathogenic bacteria isolated from sterile body fluids after positive reporting of enrichment. 
    Methods Four hundred and twelve specimens of sterile body fluids with positive broth culture were collected from Hebei General Hospital. The positive specimens were microscopically examined by smear Gram staining, and inoculated with solid medium for culture. The bacterial membrane grew at 35 ℃ for 4-6 h, and the single colony grew at 35 ℃ for 18-24 h. The VITEK MS was applied to identify the bacterial membrane and the colony respectively, and the results of the mass spectrometry identification of the colony were used as the reference standard to analyze the identification rate of the mass spectrometry identification of the bacterial membrane.  
    Results A total of 412 pathogenic strains were identified by VITEK MS (colony), including 212 Gram-positive cocci (51.45%), 172 Gram-negative bacilli (41.75%) and 28 fungal strains (6.80%). Compared with the VITEK MS (colony) identification results, the overall identification compliance rate was 91.50% (377/412) for VITEK MS (membrane), 89.15% (189/212) for Gram-positive cocci and 94.19% (162/172) for Gram-negative bacilli, all with significant differences (χ2=36.553, 24.319, 10.299, P<0.05). For fungal identification, identification compliance rate was 92.86% (26/28) by VITEK MS (membrane), with no significant difference (χ2=2.074, P=0.150). 
    Conclusion The application of MALDI-TOF MS for 4-6 h identification of sterile body fluid specimens after positive reporting can further shorten the identification time of pathogenic bacteria, provide rapid and accurate identification results, and provide an early basis for the diagnosis and treatment of invasive infectious diseases in clinical practice.