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    25 November 2024, Volume 45 Issue 11
    Analysis of the expression significance of CA125, miR-145, miR-141-3p and MCP-1 in EM patients and their relationship with pregnancy outcomes
    YANG Hong-jie, KANG Xiao-bei, DU Xiu-fang, FU Chang-na, YANG Tao, LIN Kai-qing
    2024, 45(11):  1259-1265.  doi:10.3969/j.issn.1007-3205.2024.11.004
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    Objective To explore the expression significance of carcinoembryonic antigen 125 (CA125), microRNA-145 (miR-145), microRNA-141-3p (miR-141-3p), and monocyte chemoattractant protein-1 (MCP-1) in patients with endometriosis (EM) and their relationship with pregnancy outcomes. 
    Methods A total of 117 EM patients were selected as the EM group, and 80 healthy women who underwent physical examinations during the same period were selected as the control group. The serum levels of CA125, miR-145, miR-141-3p, and MCP-1 were compared between the two groups. The serum levels of CA125, miR-145, miR-141-3p, and MCP-1 in EM patients with different r-AFS stages were compared. Spearman′s test was used to analyze the correlation between serum CA125, miR-145, miR-141-3p, MCP-1, and r-AFS stages in EM patients. EM patients were followed up for 2 years after laparoscopic surgery to analyze pregnancy outcomes. Clinical data were compared between the good pregnancy outcome group and the poor pregnancy outcome group. Logistic regression models were used to analyze the risk factors and protective factors for poor pregnancy outcomes in EM. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of serum CA125, miR-145, miR-141-3p, and MCP-1 for poor pregnancy outcomes in EM. 
    Results Compared with the control group, the serum levels of CA125, MCP-1, and miR-145 in the EM group were significantly increased (P<0.05), while the serum levels of miR-141-3p were significantly decreased (P<0.05). Compared with those before surgery, the serum levels of CA125, MCP-1, and miR-145 in EM patients were significantly reduced at 48 h after surgery (P<0.05), while the serum levels of miR-141-3p were significantly increased (P<0.05). Compared with stages Ⅰ-Ⅱ, preoperative serum levels of CA125, MCP-1, and miR-145 were significantly increased (P<0.05) in stage Ⅲ-Ⅳ patients, while miR-141-3p levels were significantly decreased (P<0.05). Spearman′s test showed that preoperative serum CA125, MCP-1 and miR-145 were positively correlated with r-AFS staging (r=0.640, 0.581, 0.637, P<0.001), while serum miR-141-3p was negatively correlated with r-AFS staging (r=-0.605, P<0.001). All 117 EM patients were followed up for 2 years after surgery. During the follow-up period, 5 patients were to fllow-up and 112 patients were followed up. Fifty-four patients had poor pregnancy outcomes, with an incidence rate of 48.21%. Compared with the good pregnancy outcome group, the proportion of r-AFS staging in stages Ⅲ-Ⅳ, preoperative CA125, preoperative MCP-1, and preoperative miR-145 in the poor pregnancy outcome group was significantly increased (P<0.05), while the proportion of preoperative anti Mullerian hormone, miR-141-3p, and simple ovarian type was significantly decreased (P<0.05). The results of the logistic regression model showed that high r-AFS stage, preoperative CA125, preoperative MCP-1, and preoperative miR-145 were risk factors for poor pregnancy outcomes in EM patients (OR=1.746, 2.367, 2.760, 1.997, P<0.05), while preoperative anti Mullerian hormone and miR-141-3p were protective factors for poor pregnancy outcomes in EM patients (OR=0.802, 0.640, P<0.05). ROC curve was drawn, and it was found that the area under the ROC curve (AUC), sensitivity, and specificity of serum CA125, miR-145, miR-141-3p, and MCP-1 in combination for the prediction of adverse pregnancy outcomes in EM were 0.883, 83.32%, and 84.52%, respectively, which were significantly better than single detection (P<0.05). 
    Conclusion Serum CA125, MCP-1, and miR-145 are highly expressed in EM patients, while miR-141-3p is lowly expressed. This expression level is closely related to the staging of EM and pregnancy outcome. Combined detection of these four indicators can help predict adverse pregnancy outcomes in EM. 

    Study on the correlation of the expression of serum SHBG and TXNIP with insulin resistance, and glucose and lipid metabolism in gestational diabetes mellitus
    HUANG Lei, ZHAO Bei
    2024, 45(11):  1266-1270.  doi:10.3969/j.issn.1007-3205.2024.11.005
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    Objective To explore the correlation of the expression of serum sex hormone-binding globulin (SHBG) and thioredoxin interacting protein (TXNIP) with insulin resistance, and glucose and lipid metabolism in gestational diabetes mellitus (GDM). 
    Methods In total, 112 GDM patients admitted to the Northwest Women's and Children's Hospital between January 2021 and January 2023 were selected as the research subjects, and another 112 pregnant women without GDM undergoing pregnancy examination in our hospital during the same period were selected as the control group. The levels of fasting blood glucose (FBG), 2-hour postprandial glucose (2 hPG), insulin resistance index (IRI), triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), serum SHBG and TXNIP were compared between the two groups. The correlation of the expression of serum SHBG and TXNIP with FBG, 2 hPG, glycated hemoglobin, TG, TC, LDL-C, fasting insulin and IRI was analyzedas well as the evaluation value of serum SHBG and TXNIP in the pathogenesis of GDM. 
    Results The FBG, 2 hPG, glycated hemoglobin, TG, TC, LDL-C, fasting insulin and IRI in the research group were higher than those in the control group (P<0.05). The SHBG of the research group was lower than that of the control group, while TXNIP was higher than that of the control group (P<0.05). Serum SHBG was negatively correlated with FBG, 2 hPG, glycated hemoglobin, TG, TC, LDL-C, fasting insulin and IRI (P<05). Serum TXNIP was positively correlated with FBG, 2 hPG, glycated hemoglobin, TG, TC, LDL-C, fasting insulin and IRI (P<05). IRI, glycated hemoglobin and serum TXNIP were identified as risk factors for the development of GDM (P<05), while serum SHBG was protective factor for GDM (P<05). The area under the curve (AUC) of serum SHBG and TXNIP alone and in combination in the assessment of development of GDM was 0.771, 0.751, and 0.844, respectively. 
    Conclusion FBG, 2 h PG, glycated hemoglobin, TG, TC, LDL-C, fasting insulin and IRI are negatively correlated with serum SHBG and positively correlated with serum TXNIP. 

    The protective effect of induction of anesthesia with esketamine on postoperative cognitive function in patients undergoing laparoscopic total hysterectomy
    WEI Meng, ZHANG Yang, WANG Yuan-lin
    2024, 45(11):  1278-1282.  doi:10.3969/j.issn.1007-3205.2024.11.007
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    Objective To explore the protective effect of induction of anesthesia with esketamine on postoperative cognitive function in patients undergoing laparoscopic total hysterectomy (LTH). 
    Methods A total of 80 patients undergoing LTH admitted to Department of Gynecology of the First Hospital of Huai′an Affiliated to Nanjing Medical University were randomly divided into group A and group B. Group A consisted of 40 patients who received anesthesia induction with ciprofol and sufentanil, while group B consisted of 40 patients who received anesthesia induction with ciprofol and esketamine. The vital signs [mean arterial pressure(MAP), heart rate(HR)], cognitive function [mini-mental state examination (MMSE)] scores, depressive state [self-rating depression scale (SDS)] scores, sleep quality [Pittsburgh Sleep Quality Index (PSQI)] scores, and adverse reactions (nausea, vomiting, respiratory suppression, delayed awakening, shivering, restlessness) of the two groups were compared. 
    Results The average MAP and HR of the two groups after tracheal intubation, at 1 min and 30 min after skin incision were lower than those before anesthesia induction, while MAP and HR of group B were higher than those of group A at the same time period; there were significant differences in interaction between groups, time points and time points between groups (P<0.05). The MMSE scores of the two groups at 1 d and 3 d after operation were lower than those before operation,which were higher in group B than in group A at the same time period; there were significance differences in interaction between groups, time points and time points between groups (P<0.05). SDS scores of the two groups at 1 d and 3 d after operation were higher than those before operation, which were lower in group B than in group A at the same time period; there were differences in interaction between groups, time points and time points between groups (P<0.05). PSQI scores of the two groups at 1 d and 3 d after operation were higher than those before operation, which were lowerin group B than in group A at the same time period; there were significance differences in interaction between groups, time points and time points between groups (P<0.05).The incidence of adverse reactions in group B was lower than that in group A (P<0.05). 
    Conclusion The application of ciprofol combined with esketamine anesthesia induction in LTH has a good effect, which can stabilize the patient′s intraoperative vital signs, reduce the impact on their cognitive function, psychological state, and sleep quality, and has fewer adverse reactions. Therefore, it is worthy of promotion. 

    Comparison of the application of percutaneous electrical stimulation for preemptive analgesia and intravenous infusion of lidocaine combined with dexmedetomidine before anesthesia induction in laparoscopic hysterectomy
    HUI Yu-jia, CHEN LI-ping, JIA Mi-mi, ZHANG Jin, XU Meng
    2024, 45(11):  1283-1288.  doi:10.3969/j.issn.1007-3205.2024.11.008
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    Objective To explore the comparison of the effects of percutaneous electrical stimulation for preemptive analgesia and intravenous infusion of lidocaine combined with dexmedetomidine before anesthesia induction in laparoscopic hysterectomy. 
    Methods A total of 140 patients who underwent laparoscopic hysterectomy in Northwest Women and Children′s Hospital were selected, and the patients were divided into Group A (n=70) and Group B (n=70) by a random number table method. Both groups underwent laparoscopic hysterectomy, Group A received percutaneous electrical stimulation for preemptive analgesia, while Group B received intravenous infusion of lidocaine combined with dexmedetomidine before anesthesia induction. The differences including duration of operation, intraoperative blood loss, and adverse reactions between the two groups were observed. In the meantime, the differences in heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2), bispectral index (BIS), stress inflammatory factors, and visual analogue scale (VAS) pain score between the two groups at different time points were observed. 
    Results The awakening time and extubation time of Group A were significantly faster than those of Group B (P<0.04). HR, MAP, and BIS values of Group A and Group B showed a decrease followed by an increase, with significant differences in time points (P<0.05). However, there was no significant difference in the interaction between groups or time points between groups (P>0.05). There was no significant difference in postoperative cortisol (Cor), norepinephrine (NE), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) between the two groups (P>0.05). There was no significant difference in VAS pain scores between the two groups at 2, 6, 12, and 24 h after surgery (P>0.05). The incidence rates of malignant vomiting, postoperative cognitive impairment, and bradycardia in Group A were significantly lower than those in Group B (P<0.05). 
    Conclusion Percutaneous electrical stimulation for preemptive analgesia and intravenous infusion of lidocaine combined with dexmedetomidine before anesthesia induction has good application value in laparoscopic hysterectomy. Among them, percutaneous electrical stimulation for preemptive analgesia has faster postoperative recovery and lower incidence of adverse reactions. 

    Effects of dexmedetomidine combined with ropivacaine for erector spinae plane blockon analgesic efficacy, inflammatory stress and cognitive function in patients undergoing thoracoscopic lung cancer surgery
    GONG Hai-peng, WANG Fei
    2024, 45(11):  1289-1294.  doi:10.3969/j.issn.1007-3205.2024.11.009
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    Objective To investigate the effects of dexmedetomidine combined with ropivacaine for erector spinae plane block (ESPB) on analgesic efficacy, inflammatory stress and cognitive function in patients undergoing thoracoscopic lung cancer surgery. 
    Methods A total of 104 patients who underwent thoracoscopic lung cancer surgery in Pizhou People's Hospital, Jiangsu Province, were selected and divided into research group (n=52) and control group (n=52) by random number table method. The control group received ESPB combined with general anesthesia. On the basis of the control group, the research group was supplemented with dexmedetomidine combined with ropivacaine. The analgesic efficacy, inflammatory response, oxidative stress response, cognitive function and anesthesia-related adverse reactions were compared between the two groups. 
    Results The visual analogue scale (VAS) score of both groups decreased gradually after surgery, and there were significant differences in interaction between groups, time points and time points between groups (P<0.05). After surgery, the serum levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in both groups first increased and then decreased, and there were significant differences in interactions between groups, time points, and time points between groups (P<0.05). After surgery, the serum superoxide dismutase (SOD) level of the two groups increased gradually, and there were significant differences in interactions between groups, time points, and time points between groups (P<0.05). The level of serum malondialdehyde (MDA) in the two groups decreased gradually after surgery, and there were significant differences in interactions between groups, time points, and time points between groups (P<0.05). After surgery, the scores of mini-mental state examination (MMSE) in both groups gradually decreased, and there were significant differences in interactions between groups, time points, and time points between groups (P<0.05). There was no difference in the total incidence of anesthesia-related adverse reactions between the two groups (P>0.05). 
    Conclusion Dexmedetomidine combined with ropivacaine for ESPB is effective for analgesia in patients undergoing thoracoscopic lung cancer surgery, which can reduce the inflammatory response and oxidative stress response, and improve cognitive function, with good safety. 

    Experimental study on the establishment of a rat depression model by intermittent sleep deprivation combined with chronic unpredictable mild stress
    XIAO Wen-yun-deng1, ZHU Jing-xuan2, CHEN Zhi-yu1
    2024, 45(11):  1295-1300.  doi:10.3969/j.issn.1007-3205.2024.11.010
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    Objective To establish a rat model of insomnia caused by depression by using intermittent chronic sleep deprivation combined with chronic unpredictable mild stress (CUMS), and to compare the effect of CUMS with that of traditional CUMS alone, in order to explore a better modelling method for depression. 
    Methods Thirty-six Sprague-Dawley rats aged 6-8 weeks were selected and randomly divided into three groups after 1 week of adaptive feeding: Group A, blank control group; Group B, CUMS group; and Group C, intermittent sleep deprivation + CUMS group, with 12 rats in each group. Each group was treated according to different depression modelling procedures, and the duration of modelling was 15 d. Behavioural tests were performed at the end of the modelling, and the concentrations of 5-hydroxytryptamine (5-HT), dopamine (DA) and norepinephrine (NE) in the hypothalamus of rats were detected by ELISA method. 
    Results The intermittent sleep deprivation + CUMS group had a smaller body weight growth rate than the blank control and CUMS groups at 7 d and 14 d, a smaller sugar water preference rate than the blank control and CUMS groups, a longer immobility time than the blank control and CUMS groups, and a smaller number of traversing frames and standing than the blank control and CUMS groups (P<0.05). In the CUMS group and the intermittent sleep deprivation + CUMS group, the hypothalamic 5-HT concentration of rats was lower than that of the blank control group, the DA concentration of rats in the intermittent sleep deprivation +CUMS group was lower than that of the blank control group, and the NE concentration of rats in the intermittent sleep deprivation+CUMS group was lower than that of the blank control group and the CUMS group (P<0.05). 
    Conclusion The use of 15-d CUMS combined with 20-h sleep deprivation at 1-d intervals can rapidly establish a stable depression model in SD rats, which has a more obvious effect on behavioural performance than CUMS alone, and has a significant advantage in terms of modelling duration. 

    The mechanism of miR-96-5p regulating inflammatory response of mice with type 2 diabetes mellitus-associated pulmonary tuberculosis via the JAK/STAT signaling pathway
    YU Wen-zhao
    2024, 45(11):  1301-1309.  doi:10.3969/j.issn.1007-3205.2024.11.011
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    Objective To investigate the role of miR-96-5p in the regulation of type 2 diabetes mellitus (T2DM)-associated pulmonary tuberculosis (PTB). 
    Methods A T2DM-associated PTB mouse model was constructed. Real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to analyze the expression of miR-96-5p in lung tissue of mice with T2DM-associated PTB. Masson staining and HE staining were used to analyze pulmonary fibrosis and lung injury. The expression of Janus kinase (JAK)/signal transducer and activator of transcription (STAT) signaling pathway-related proteins was detected by immunohistochemistry and Western blot. The levels of free fatty acids (FFA) and triglyceride in serum were analyzed by kits. 
    Results MiR-96-5p was highly expressed in the lung tissue of mice with T2DM-associated PTB. Inhibition of miR-96-5p could reduce fibrosis and lung injury in lung tissue, reduce the levels of interleukin (IL) -6, tumor necrosis factor-α (TNF-α) and IL-1β in lung tissue and serum of mice with T2DM-related PTB, and reduce the levels of FFA and triglyceride in lung tissue of mice with T2DM-related PTB. The expression of p-JAK2 and p-STAT3 was up-regulated in the lung tissue of mice with T2DM-related PTB. JAK/STAT signaling pathway inhibitor (AZD1480) could reverse the promoting effect of miR-96-5p overexpression on pulmonary fibrosis and lung injury in T2DM-related PTB mouse model, and could weaken the promoting effect of miR-96-5p overexpression on the levels of IL-6, TNF-α and IL-1β in lung tissue and serum of mice with T2DM-related PTB, and reduce the levels of FFA and triglyceride in serum. 
    Conclusion miR-96-5p promotes inflammatory responses of mice with T2DM-associated PTB by regulating the JAK/STAT signaling pathway. 

    Application of FMEA combined with PDCA in 1-h antibiotic use in septic shock
    ZHANG Man-li, WANG Guo-ying, HU Yu-ding, CHEN Hui, SONG Xuan, TONG Fei
    2024, 45(11):  1310-1316.  doi:10.3969/j.issn.1007-3205.2024.11.012
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    Objective To investigate the effect of failure model and effect analysis (FMEA) combined with PDCA management tool in 1-h antibiotic use in patients with septic shock. 
    Methods In total, 177 patients with septic shock and 32 medical staff were selected as research subjects in the Second Hospital of Hebei Medical University. The medical staff were grouped according to different time periods, with the same medical staff in each group. A total of 87 patients with septic shock and 32 medical staff from January 2022 to June 2022 were selected as control group. A total of 90 patients with septic shock and 32 medical staff from July 2022 to December 2022 were selected as the observation group. The control group was given conventional management, while the observation group was given FMEA combined with PDCA. The general data, risk priority number (RPN) value, compliance rate of 1-h antibiotic use, 28-day mortality rate and cooperation satisfaction of medical staff were compared between the two groups, and the factors affecting the compliance rate of 1-h antibiotic use were analyzed. 
    Results There was no significant difference in general information and 28-day mortality between the two groups (P>0.05). The compliance rate of 1-h antibioticuse and satisfaction degree of medical cooperation of septic shock patients in the observation group were significantly higher than those in the control group, and the RPN values of the first 5 failure modes were significantly lower than those in the control group, with statistical significance (P<0.05). The results of multivariate analysis showed that the underlying disease (OR=0.585, 95%CI: 0.405-0.845, P<0.05), antibiotic use grade (OR=0.272, 95%CI: 0.134-0.551, P<0.05) and family education level (OR=2.484, 95%CI: 1.100-5.611, P<0.05) were independent risk factors affecting the compliance rate of 1-h antibiotic use. 
    Conclusion FMEA combined with PDCA management tools can standardize the process of 1-h antibiotic use in patients with septic shock, improve the compliance rate of 1-h antibiotic use, and strengthen medical cooperation. 

    Monte Carlo analysis of imaging quality of aspherical intraocular lens
    TIAN Kun, ZHANG Bin, LIU Dan-yan, LIU Xiao-li, REN Tao-ran
    2024, 45(11):  1317-1321.  doi:10.3969/j.issn.1007-3205.2024.11.013
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    Objective The model eyes were implanted with four kinds of intraocular lens (IOL) with different spherical aberration, including spherical IOL, 0 μm aspheric IOL, -0.1 μm aspheric IOL, -0.26 μm aspheric IOL.The 10% better and 10% worse Modulation transfer function (MTF) values of each IOL at 3 mm, 4 mm and 5 mm pupil diameters were compared using Monte Carlo analysis, and the imaging quality and anti-decentration performance were compared. 
    Methods For experimental study, four kinds of IOL with different spherical aberration were inserted into the model eye under the condition of pupil diameter of 3 mm, 4 mm and 5 mm, respectively. In the computer optical simulation system, the Monte Carlo analysis method was used to design four kinds of IOL with random 0-0.5 mm decentration, and 1 000 random simulations were performed respectively. The experimental studies with the 10% better and 10% worse image quality of the four IOL were compared. 
    Results In the case of random decentration, under the 3 mm pupil diameter, the MTF values of -0.1 μm aspherical IOL, -0.26 μm aspherical IOL and 0 μm aspherical IOL were higher than spherical IOL at the best 10%, and the MTF value of -0.1 μm aspherical IOL was higher than -0.26 μm aspherical IOL and spherical IOL at the worst 10%. Under the 4 mm pupil diameter, the MTF values of -0.1 μm aspherical IOL and -0.26 μm aspherical IOL 10% were higher than -0 μm aspherical IOL and spherical IOL at the best 10%, and the MTF values of -0.1 μm aspherical IOL were higher than those of -0.26 μm aspherical IOL and spherical IOL at the worst 10%. Under the 5 mm pupil diameter, the MTF value of -0.1 μm aspherical IOL was higher than 0 μm aspherical IOL and spherical IOL at the best 10%, and the MTF value of -0.1 μm aspherical IOL was higher than that of the other three IOL at the worst 10%. 
    Conclusion -0.1 μm aspherical IOL has good tolerance to decentration and high stability of image quality. 

    Biological role and mechanism of GPRC5A in the development of laryngeal carcinoma
    JIA Qiao-jing1, YANG Zhi-chao1, LIN Di1, HAN Yong-cheng2, SHAN Chun-guang1, WANG Jian-xing1
    2024, 45(11):  1322-1329.  doi:10.3969/j.issn.1007-3205.2024.11.014
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    Objective To investigate the expression characteristics of G protein-coupled receptor family C, member 5, group A (GPRC5A) in laryngeal carcinoma tissues, and to explore its role and mechanism in the development of laryngeal carcinoma. 
    Methods The expression of GPRC5A in laryngeal carcinoma and para-carcinoma tissues of 32 patients with laryngeal squamous cell carcinoma confirmed in the Second Hospital of Hebei Medical University by pathological examination was detected by immunohistochemistry, and the correlation between its expression characteristics and clinical data was analyzed. Quantitative polymerase chain reaction (qPCR) was used to detect the expression of laryngeal carcinoma tissues and para-carcinoma tissues for validation at the tissue level, and to detect human bronchial epithelial cell BEAS-2B, laryngeal carcinoma cellline TU686 and hypopharyngeal cancer cell Fadu for validation at the cellular level. GPRC5A overexpression plasmid p-GPRC5A was constructed and transfected into TU686 cells. The effects of GPRC5A overexpression on the proliferation, invasion and migration of TU686 cells were detected by Cell counting kit 8 (CCK8)and Transwell methods. Western blot was applied to detect the effect of GPRC5A gene overexpression on the expression of apoptosis-related proteins in cells, and validate the effect of GPRC5A gene overexpression on epidermal growth factor receptor/signal transducer and activator of transcription 3 (EGFR/STAT3) pathway. 

    Results Immunohistochemical results showed that the positive expression rate of GPRC5A in laryngeal carcinoma tissues was significantly lower than that in para-carcinoma tissues (χ2=14.190, P<0.001). The differences in the expression of GPRC5A in laryngeal carcinoma was not significant with respect to different tumor stage, lymph node metastasis and differentiation degree (P>0.05). The expression of GPRC5A mRNA in laryngeal carcinoma group was significantly lower than that in para-carcinoma group (t=3.175, P=0.003). The expression of GPRC5A in TU686 cells and Fadu cells was (0.73±0.08) and (0.78±0.04) times that of BEAS-2B respectively, with a significant difference (F=9.060, P=0.015). The CCK8 results indicated that after 48 h, the OD of the p-GPRC5A group was (0.76±0.03), which was significantly lower than that of the NC group (1.20±0.01) and the control group (1.30±0.08) (F=69.970, P<0.001). Transwell experiment showed that the number of cells migrated in p-GPRC5A group was (138.70±10.97), which was significantly lower than that in control group (251.3±16.9) and NC group (247.7±17.5) (F=5 731.100, P<0.001). The number of cells invaded in p-GPRC5A group was (113.00±10.21), which was significantly lower than that in control group (193.30±10.02) and NC group (190.00±7.90) (F=8 894.100, P<0.001). Western blot results showed that the protein expression of Caspase 3 in p-GPRC5A group was significantly higher than that in control group (F=78.880, P<0.001), and the expression of Bcl-2 protein in p-GPRC5A group was significantly decreased (F=125.820, P<0.001). The expression of EGFR and p-STAT3 in p-GPRC5A group was significantly lower (F=25.573, P=0.001; F=60.614, P<0.001). 
    Conclusion GPRC5A has a low expression level in laryngeal carcinoma tissues and cell lines. Overexpression of GPRC5A can inhibit the proliferation, migration and invasion of laryngeal carcinoma cells, promote cell apoptosis, and inhibit the activation of EGFR/STAT3 pathway. 

    Distribution characteristics of pathogensic bacteria and immune function analysis in children with positive blood cultures
    GUO Wei-wei1, ZHAO Meng-chuan2, YAN Xiao-tong1, LIU Ying-ye1, LIU Teng1, CUI Xiao-wei1
    2024, 45(11):  1330-1335.  doi:10.3969/j.issn.1007-3205.2024.11.015
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    Objective To understand the distribution of pathogenic bacteria and changes in peripheral blood lymphocyte subpopulations in children with positive blood cultures in Hebei Children′s Hospital, and to provide a reference basis for the diagnosis and treatment of patients with bloodstream infections in clinical settings. 
    Methods Nine hundred and seventy-four children with positive blood cultures were collected from Outpatient Department, Emergency Department and Inpatient Department of Hebei Children′s Hospital for bacterial culture and identification. Among them, 468 children were tested for lymphocyte subpopulations, and mixed infections and co-infections were excluded. Finally, 219 children with purely positive blood cultures were finally included as a case group, and 250 children undergoing physical examination were included as a healthy control group. A case-control study was used to analyse the changes in the peripheral blood lymphocyte subpopulations in children with bloodstream infections. 
    Results In 2022, the top five strains isolated from blood cultures were Staphylococcus epidermidis (25.20%), Staphylococcus hominis (11.20%), Staphylococcus aureus (9.00%), Streptococcus pneumoniae (7.00%), and Klebsiella pneumoniae (6.40%). In 2023, the top five positive strains isolated from blood culture were Staphylococcus epidermidis (23.21%), Staphylococcus hominis (17.93%), Klebsiella pneumoniae (11.60%), Staphylococcus aureus (7.59%), and Escherichia coli (6.75%). Changes in peripheral blood lymphocyte subpopulations were consistent between children with Gram-positive bacterial infections and those with positive blood cultures, both of which showed that the percentages of peripheral blood total T cells, helper T cells, suppressor T cells, and double-negative T lymphocytes were significantly lower than those of healthy control group (P<0.001), whereas the percentages of B-lymphocytes and NK cells were significantly higher than those of healthy control group (P<0.001). Percentages of total peripheral blood T cells, suppressor T cells and double-negative T lymphocytes in children with Gram-negative bacterial infections were significantly lower than those in the healthy control group (P<0.001), and the differences in percentages of peripheral blood helper and double-positive T lymphocytes, B lymphocytes and NK cells were not statistically significant when compared with those in the healthy control group (P>0.05). 
    Conclusion Both Gram-positive and Gram-negative bloodstream infections are associated with cellular immune suppression. However, unlike children with Gram-negative bloodstream infections, children with Gram-positive bloodstream infections also have abnormal activation of humoral and intrinsic immune functions. 

    Cost-effectiveness analysis of tenofovir in blocking mother-to-child transmission of hepatitis B
    JIAO Fang1, YANG Da-wei1, YUE Xin2, CAO Hui2, JI Ya-liang3, XU Qing-yun4
    2024, 45(11):  1336-1341.  doi:10.3969/j.issn.1007-3205.2024.11.016
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    Objective To evaluate the cost-effectiveness of domestic and imported tenofovir in blocking mother-to-child transmission of hepatitis B virus (HBV). 
    Methods Pregnant patients with high HBV load who were treated and delivered at the Department of Obstetrics and Gynecology in the Second Hospital of Nanjing were enrolled in this study. A retrospective analysis was conducted to analyze clinical efficacy of domestic and imported tenofovir for mother-to-child transmission of HBV. The incremental cost-effectiveness ratio and sensitivity analysis was performed based on cost-effectiveness analysis. 
    Results A total of 179 patients met the inclusion criteria, including 131 patients in the domestic group and 48 patients in the imported group. The positive-to-negative conversion rates of HBV DNA were 45.04% and 52.08% in the domestic group and the imported group respectively, while the rates of blocking mother-to-child transmission of HBV were 98.47% and 100.00% respectively, exhibiting no statistical significance (P>0.05). The total treatment costs of the domestic and imported groups were (20 313.73±11 467.36) yuan and (20 906.19±6 211.43) yuan, respectively, which did not demonstrate statistical significance (P>0.05), either. The drug expense of domestic group was observed to be significantly lower compared with its counterpart [(47.53±8.07) yuan vs. (1 118.62±200.89) yuan, P<0.05]. The incremental cost-effectiveness ratio of the domestic group and the imported group was 700.05, which was lower than the willing payment threshold of our country. This result was validated by sensitivity analysis. 
    Conclusion The efficacy of domestic tenofovir is consistent with its imported counterpart on blocking mother-to-child transmission of hepatitis B, while the former has more pharmacoeconomic advantages. Consequently, it is recommended to select drugs rationally according to the practical requirements of patients in clinical practice.

    Comparative analysis of clinical efficacy of different internal fixation methods in midfoot and forefoot fractures
    LIU Xi-bo, ZHANG Chun-hui, LIU Ji, FAN Bo-yuan, LIANG Feng, SHEN Jiang-tao
    2024, 45(11):  1342-1346.  doi:10.3969/j.issn.1007-3205.2024.11.017
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    Objective To investigate the clinical efficacy of different internal fixation methods for midfoot and forefoot fractures. 
    Methods The clinical data of 33 patients with midfoot and forefoot fractures who underwent internal fixation with absorbable screws in Beijing Luhe Hospital Affiliated to Capital Medical University were retrospectively analyzed and included in the observation group. In addition, 33 patients with midfoot and forefoot fractures who underwent internal fixation with titanium alloy screws in our hospital during the same period were included in the control group. Perioperative indicators of two groups were recorded and compared, and the foot and ankle function in both groups surgery before and at 3 months after surgery were evaluated using Maryland Foot Score (MFS) and American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score. The levels of inflammatory cytokines [procalcitonin (PCT), interleukin-6 (IL-6), C-reactive protein (CRP)] in the two groups were detected, and the incidence of complications between the two groups was observed and compared. 
    Results The duration of operation, length of hospitalization and duration of fracture healing in observation group were significantly shorter than those in control group (t=3.492, 2.607, 7.581, P<0.05). At 3 months after surgery, MFS and AOFAS scores in both groups were higher than those before surgery (P<0.05), and higher in the observation group than in the control group (t=3.034, 3.041, P<0.05). At 3 months after surgery, the levels of PCT, IL-6 and CRP in the two groups were lower than those before surgery (P<0.05), and lower in the observation group than in the control group (t=3.816, 10.315, 10.050, P<0.001). There was no significant diffence in the total incidence of complications between the two groups (χ2=2.747, P=0.099). 
    Conclusion Internal fixation with absorbable screw in the surgical treatment of midfoot and forefoot fracture has a significant effect, which can promote the recovery of fracture and ankle function, reduce the patient′s inflammatory response, and has a high safety. Therefore, it is worthy of clinical application and promotion. 

    Application of DWI combined with CTA in preoperative evaluation of meningioma
    DU Hong-bing, XU Bin, GUO Zhi-wei
    2024, 45(11):  1347-1352.  doi:10.3969/j.issn.1007-3205.2024.11.018
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    Objective To explore the application value of diffusion weighted imaging (DWI) combined with computed tomography angiography (CTA) in preoperative evaluation of meningiomas. 
    Methods A total of 127 patients with meningioma who underwent surgical treatment at Nanchong Hospital of Beijing Anzhen Hospital, Capital Medical University, (Nanchong Central Hospital) were selected as the research subjects. All patients underwent preoperative DWI and CTA, and tumor imaging features and related parameters were recorded. After surgery, pathological examination of the tumor tissue was performed, and based on the examination results the tumor was divided into low-grade and high-grade meningiomas. The imaging features, apparent diffusion coefficient (ADC) and mean cycle threshold (CT) value of DWI and CTA in patients with different grades of meningioma were compared, and the receiver operating characteristic (ROC) curve was used to analyze the application value of DWI parameter ADC and CTA parameter mean CT value in preoperative evaluation of meningioma. 
    Results The results of postoperative histopathological examination showed that there were 97 patients with low-grade meningioma (WHO grade I) in 127 patients, accounting for 76.38%, and 7 patients with high-grade meningiomas (WHO grade Ⅱ-Ⅲ), accounting for 5.51%. DWI and CTA imaging features of meningiomas in different diseases were significantly different. The ADC value of tumor tissue in low-grade meningioma patients [(0.80±0.08)×10-3mm2/s] was higher than that in high-grade meningioma patients [(0.70±0.05)×10-3mm2/s], and the average CT value in low-grade meningioma patients [(57.81±5.34) Hu] was lower than that in high-grade meningioma patients [(63.12±10.30) Hu], with a significant difference (P<0.05). The area under the ROC curve of DWI parameter ADC and CTA parameter mean CT value alone and in combination in preoperative evaluation of meningioma grade was 0.855, 0.702 and 0.864, respectively, which had certain evaluation value. 
    Conclusion The combination of DWI and CTA has good application value in preoperative evaluation of meningiomas, which is beneficial for improving the accuracy of differentiation between low-grade and high-grade meningiomas. 

    Analysis of changes in Chinese Medical staff′s perceptions of doctor-patient relationships and influencing factors
    LUO Xi, LIN Liang-quan, ZHANG Qian-kun, ZHANG Xin-qing
    2024, 45(11):  1353-1358.  doi:10.3969/j.issn.1007-3205.2024.11.019
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    Objective To understand the current state and changing trends in Chinese medical staff′s perceptions of doctor-patient relationships before and after the COVID-19 pandemic, and to analyze the influencing factors. 
    Methods Based on Medical Staff′s Employment Surveys in 2018 and 2023, descriptive statistical analysis, univariate analysis and binary logistic regression were used to analyze medical staff′s perception of doctor-patient relationship and influencing factors. 
    Results 11 771 (90.4% response rate) and 8 386 (91.1% response rate) valid questionnaires were collected in 2018 and 2023, respectively. In 2023, 58.5% of medical staff claimed that doctor-patient relationships were tense or very tense, with a decrease by 22% compared with that in 2018 (Z=34.885, P<0.01). Age, hospital type, department, average daily working hours, frequency of verbal abuse, level of hospital cultural development, and media coverage orientation significantly influenced medical staff′s perceptions of doctor-patient relationships (P<0.05). 
    Conclusion Changes in the medical service model and the medical practice environment in the post-epidemic era have contributed to the improvement of doctor-patient relationship. The perceived level of the doctor-patient relationship among medical staff with different characteristics should gain differential attention and maintenance, and emphasis should be placed on strengthening the construction of the hospital culture to enhance the patients′ experience of medical care.