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15 July 2018, Volume 46 Issue 7 Previous Issue    Next Issue

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The protective effects of dulaglutide on AD-like neurodegenerative changes CHEN Yan-lin, GUO Ai, PENG Peng, ZHOU Mei, GU Zhong-ya, LIU Xiao-han, ZHANG Meng-zhe, DENG Yan-qiu 2018, 46 (7):  673-677.  doi: 10.11958/20180368 Abstract ( 1032 )   PDF (763KB) ( 4091 )   Objective To investigate the protective effects of dulaglutide on Alzheimer’s disease (AD) - like neurodegenerative changes and its mechanism thereof. Methods Dulaglutide，a new drug for diabetes, was applied to observe and explore AD-like neurodegenerative changes induced by PI3K inhibitor wortmannin in SH-SY5Y cells. MTT assay was used to observe the cell vitality induced by dulaglutide, wortmannin and glucagon-like peptide (GLP-1) 1 receptor antagonist ex9-39. Western blot assay was used to detect the levels of phosphorylated Tau, neurofilaments (NFs) and the proteins of PI3K/GSK-3β signaling pathway. Results Dulaglutide improved the impaired vitality, increased the levels of phosphorylated PI3K and GSK-3β and decreased phosphorylation levels of tau and NFs induced by wortmannin in SHSY5Y cells. Ex9-39 antagonized the effects of Dulaglutide. Conclusion Dulaglutide protects SH-SY5Y cells from ADlike neurodegenerative changes through improving PI3K /GSK-3β insulin signaling pathway. Related Articles | Metrics

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The correlation between liver fibrosis inflammatory infiltration and postoperative cholangitis after Kasai operation for children with biliary atresia XIONG Xi-qian, ZHAN Jiang-hua, HU Xiao-li, QI Mei-jiao 2018, 46 (7):  692-695.  doi: 10.11958/20180078 Abstract ( 846 )   PDF (631KB) ( 3888 )   Objective To analyze the relationship between the degree of hepatic fibrosis, the inflammatory cell infiltration and the postoperative cholangitis after Kasai operation in children with biliary atresia (BA). Methods A total of 92 children diagnosed as BA in our hospital from January 2015 to December 2016 were selected in this study. Patients were divided into hepatic fibrosis grade Ⅰgroup (n=8), hepatic fibrosis grade Ⅱ group (n=31), hepatic fibrosis grade Ⅲ group (n= 35) and hepatic fibrosis grade Ⅳ group (n=18), according to Japan’s Ohkuma’s hepatic fibrosis grading criteria. Combined with Kasai age, the relationship between hepatic fibrosis and surgical age was analyzed. Samples of liver tissues were evaluated by hematoxylin / eosin (HE) and Masson staining. The expressions of specific inflammatory cell marker antibody LCA, CD4, CD8 and CD68 in liver were observed by IHC staining. Combined with the postoperative follow-up data of Kasai, the relationship between the degree of inflammatory infiltration of liver tissue, the degree of hepatic fibrosis and the postoperative cholangitis of Kasai in BA children was analyzed. Results Routine pathological staining showed that lymphocytes infiltrated mainly in liver tissue. The expression levels of LCA and CD4 were higher in groupⅠand group Ⅳ compared with those of group Ⅱ and group Ⅲ . There was no significant difference in the CD8 expression between four groups. All 92 children with BA were followed up. It was found that cholangitis occurred in 50 cases, early cholangitis occurred in 38 cases, and frequent cholangitis occurred in 23 cases. The incidence of cholangitis, early cholangitis, and frequent cholangitis after Kasai surgery was statistically significant in BA patients with different grades of hepatic fibrosis (P＜0.05). The incidence of cholangitis was higher in the group Ⅰ and group Ⅳ than that in group Ⅱ and group Ⅲ .Conclusion The occurrence of cholangitis after Kasai operation in children with BA is correlated with the hepatic fibrosis and liver inflammatory cells, especially T lymphocyte subgroups. Related Articles | Metrics

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Observation on patency of radial artery bridge in patients after coronary artery transplantation GAO Wen-qing, LI Tong, HU Xiao-min, WU Peng, LANG Yu-heng, ZHENG Wei-feng, ZHAO Yue, MA Qun-xing, NING Meng 2018, 46 (7):  696-699.  doi: 10.11958/20180454 Abstract ( 906 )   PDF (377KB) ( 3493 )   Objective To explore the patency of bridge vessels in patients after coronary artery transplantation, and to provide reference for the selection of clinical bridge vessels. Methods Data of 32 patients underwent coronary angiography after coronary artery bypass grafting were selected and analyzed retrospectively. The overall usage and patency of the great saphenous vein graft (SVG), the left internal mammary artery (LIMA) and the radial artery (RA) were analyzed. The patency of the near future (5 years), the medium term (5-10 years) and long term (>10 years) were compared between the three kinds of bridging vascular vessels. The RA occlusion was analyzed. Results The total number of bridge vessels used in 32 patients was 85, only 1 case used right internal mammary artery (RIMA), the others used SVG, LIMA and RA, in which 48, 23 and 13 branches were used respectively. The patency rates of SVG, LIMA and RA were 25% (12/48), 73.91% (17/23) and 69.23(9/13) respectively. The recent and medium-term patency rates of all bridge vessels showed a decreasing trend, in which the recent patency rate of SVG was significantly higher than that in LIMA, the intermediate patency rates of LIMA and SVG were higher than that of RA, and the long-term patency rate of RA was significantly higher than that of LIMA and SVG. There was severe stenosis (＞90%) or occlusion in the proximal segment of anastomosis in the 9 radial arteries unobstructed. Conclusion The utilization rate of RA is still low, and the overall patency rate of RA is superior to the SVG. RA can be used as the second optimal bridge vessel. The patient selection and RA evaluation should be done before applying RA.The proximal stenosis degree of target vessel significantly affects the long-term patency of RA. Related Articles | Metrics

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Analysis of predictive efficacy of EuroSCORE Ⅱ and SinoSCORE for patients undergoing coronary bypass surgery in single center LI Kai-tao, BAI Yun-peng, GUO Zhi-gang 2018, 46 (7):  700-707.  doi: 10.11958/20171189 Abstract ( 920 )   PDF (465KB) ( 3988 )   Objective To compare the predictive efficacy of EuroSCORE Ⅱ and SinoSCORE in the postoperative mortality of Chinese patients underwent coronary artery bypass grafting (CABG). Methods The clinical data of 4 507 patients with CABG at our department in January 2011 and April 2015 were retrospectively analyzed. Cardiovascular risk stratification was performed on patients using EuroSCORE Ⅱ and SinoSCORE. Patients were divided into Ⅰ, Ⅱ, Ⅲ and Ⅳ groups according to the predicted fatality rates. The mortality rates were predicted in all groups of patients respectively. Predictive effectiveness was analyzed by the analysis of discernment and calibration force. Results The in-hospital mortality rate was 1.35% in all patients, while the mean mortality rate predicted by EuroSCORE Ⅱ was 1.470%±1.215% (95%CI：1.43-1.50), and predicted by SinoSCORE was 2.860% ± 3.454% (95% CI：2.76-2.96). The AUC values of EuroSCORE Ⅱ and SinoSCORE were 0.728 and 0.716. It was found that the calibration degree of EuroSCORE Ⅱ was poor and SinoSCORE was acceptable detected by Hosmer-Lemeshow Test. EuroSCORE Ⅱ underestimated the mortality rates of group Ⅳ, but overestimated mortality rates in other groups of patients. SinoSCORE underestimated mortality rates of patients in group Ⅰ and overestimated mortality rates in other groups of patients. EuroSCORE Ⅱ only achieved good discrimination for patients of group Ⅰ (AUC=0.707), and SinoSCORE achieved good discrimination for patients of group Ⅱ (AUC= 0.754) EuroSCORE Ⅱ overestimated the mortality rate in the isolated CABG group and underestimated mortality rates in patients with other cardiac surgeries. SinoSCORE overestimated mortality rates in group Ⅱ. The AUC values of EuroSCORE Ⅱ and SinoSCORE were 0.694 and 0.687 in isolated CABG group. The AUC values of EuroSCORE Ⅱ and SinoSCORE were 0.772 and 0.669 in CABG combined with other cardiac surgeries. Conclusion EuroSCORE Ⅱ has a good predictive efficacy in the entire group of patients and Ⅰ, Ⅱ and Ⅲ groups, but has a poor performance in group Ⅳ. SinoSCORE overestimates mortality rates in the entire group and Ⅰ, Ⅱ and Ⅲ groups, and it underestimates mortality rates in patients of group Ⅰ. The application and establishment of risk models should focus on different heart diseases and different risk levels, and the modeling method of established risk systems needs to be improved. Related Articles | Metrics

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The preoperative risk factors for new onset atrial fibrillationin after off-pump coronary artery bypass grafting ZHANG Kai, WANG Lian-qun 2018, 46 (7):  708-711.  doi: 10.11958/20180503 Abstract ( 785 )   PDF (320KB) ( 3798 )   Objective To investigate the preoperative risk factors of postoperative atrial fibrillation (POAF) in patients undergoing off-pump coronary artery bypass grafting (CABG). Methods A total of 1 888 patients underwent off-pump CABG in our hospital were divided into new onset atrial fibrillation group (POAF group, n=389) and non AF group (NPOAF group, n=1 499). Univariate analysis was used to compare general clinical data, preoperative biochemical indicators, preoperative echocardiography, coronary artery disease and preoperative medication between two groups. The indicators with statistically significant differences were further analyzed by Logistics regression analysis. Results The incidence of POAF was 20.60% (389 / 1 888). The data of age, chronic obstructive pulmonary disease (COPD) history, myocardial infarction history, preoperative urea nitrogen (BUN) level, left atrial diameter (LAD) and left ventricular end diastolic diameter (LVEDD) were higher in POAF group than those of NPOAF group, and the preoperative HYHA grading was lower in POAF group than that of NPOAF group（P＜0.05). The proportion of preoperative use of beta blockers was significantly lower in POAF group than that of NPOAF group (P＜0.01). Logistic regression analysis showed that increased age and LAD were independent preoperative risk factors for POAF. Preoperative beta blocker application was a protective factor for POAF. Conclusion It suggests that age, LAD and preoperative beta blocker application are related to the occurrence of POAF in patients underwent off-pump CABG. Related Articles | Metrics

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The clinical analysis of drug induced acute angle-closure glaucoma ZHAO Liang, LIU Ai-hua, GUO Ru-ru, SUN Feng-yuan 2018, 46 (7):  712-715.  doi: 10.11958/20180267 Abstract ( 771 )   PDF (365KB) ( 3646 )   Objective To explore the clinical characteristics, drug types and mechanism of drug induced acute angleclosure glaucoma. Methods Clinical data of 10 patients (13 eyes) with drug induced glaucoma were collected in Tianjin Medical University Eye Hospital from August 2016 to November 2017. The history of primary disease, medication history, clinical features, treatment and prognosis were recorded and analyzed. Results There were 3 males and 7 females in 10 patients, with the average age 61.1 years old (46-81 years old). There were three cases of binocular glaucoma and seven cases of monocular glaucoma. In 10 patients the involved systemic diseases included acute abdominal disease, organophosphate poisoning, postoperative general anesthesia, cerebral infarction, plastic surgery of tongue cancer, respiratory system diseases, trigeminal neuralgia and depression. Among them, 3 cases had glaucoma history, and they were treated with anti-glaucoma surgery or laser iridotomy. The drugs involved in acute angle-closure glaucoma including atropine, alprostadil, albuterol, isopropyl, bromide, carbamazepine, olanzapine, lorazepam, azolam and hydrochlorothiazide. Eight patients accepted the conservative treatment and two accepted glaucoma cataract surgeries. Four patients were relieved after conservative treatment and 1 patient was eventually blinded due to higher intraocular pressure. Two patients underwent surgical treatment, intraocular pressure control was stable, and vision function was restored. Three patients were lost to follow-up. Conclusion Acute angle-closure glaucoma can be induced by the medication treatment for the systemic diseases, which can lead to serious complications. The clinicians should inquire the medical history, and take measures to prevent the onset of glaucoma, in order to save the visual function. Related Articles | Metrics

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The role of pulmonary valve pressure gradient in the evaluation of pulmonary artery systolic pressure in patients with atrial septal defect GUAN Xin, DU Xin, WAN Zheng, YANG Zhen-wen, YANG Meng-yun, WU Tian-feng 2018, 46 (7):  715-719.  doi: 10.11958/20180321 Abstract ( 1237 )   PDF (514KB) ( 3573 )   Objective To investigate the role of pulmonary valve pressure gradient in the estimation of pulmonary artery systolic pressures (PASP) in patients with atrial septal defect (ASD). Methods Sixty eight patients with ASD and hospitalized in Tianjin Medical University General Hospital were included in this study. The tricuspid regurgitation pressure gradient method was used for measuring PASP before interventional occlusion operation. And pulmonary valve pressure gradient was measured through pulmonary valve velocity to calculate corrected values (PASP’), which were compared with those (PASPr) obtained by right cardiac catheterization (RHC) respectively. The patients were divided into group A (defect size≤15 mm) and group B (defect size>15 mm) by the size of defect. The measurements obtained by ultrasound echocardiography (UCG) and RHC were compared between the two groups. Results There were statistically significant differences between PASP [(31.66±6.76) mmHg], PASP’[(26.86±6.66) mmHg] and PASPr [(28.79±6.43) mmHg] in group A (P＜0.05). The PASP was significantly higher than PASPr [(45.29±13.49) mmHg vs. (34.56±9.47) mmHg] (P＜0.05), but there was no significant difference between PASP’[(37.30 ± 12.71) mmHg] and PASPr in group B (P＞0.05). Values of PASPr were positively correlated with PASP (r =0.664, 0.588 respectively, P＜0.01) in group A and group B. The correlation coefficients of PASPr and PASP’were improved in two groups after adjusted with pulmonary valve pressure gradient (respectively r =0.700, 0.645, P＜0.01). Conclusion The adjusted PASP calculated by tricuspid regurgitation pressure gradient method with pulmonary valve pressure gradient can improve the accuracy of echocardiographic estimates of PASP in ASD patients with the defect size>15 mm. Related Articles | Metrics

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A prospective observation and analysis of changes in liver function after primary closure following laparoscopic common bile duct exploration LIU Hao, SHANG Hai-tao, ZHANG Xi-bo, BAO Jian-heng, HAO Cheng-fei, LIU Jun-jian, LI Zhong-lian 2018, 46 (7):  720-723.  doi: 10.11958/20180331 Abstract ( 663 )   PDF (356KB) ( 3480 )   Objective To observe the change of liver function after laparoscopic common bile duct exploration in patients with secondary common bile duct stones, and evaluate its safety. Methods A total of 210 patients with secondary common bile duct stones conforming to operative indications were divided into a suture group (n=110) and T tube drainage group (n=100) with random number table method. The values of serum total bilirubin (TBIL), direct bilirubin (DBIL), total bile acid (TBA), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and transglutaminase (GGT) were detected preoperation and 1 day, 2 days after operation, and compared between groups. Results The levels of TBIL, DBIL, ALT, ALP, GGT and TBA were significantly lower after operation than those before operation in the two groups (P＜0.05). Some patients showed higher levels of TBIL 1 day after operation than that pre-operation in both of the two groups (P＜0.05). The level of jaundice decreased rapidly in the T tube drainage group than that in the primary closure group (P＜0.05). In the primary closure group, the serum level of bilirubin in patients with elevated bilirubin was lower on the third day after operation than that before operation. Conclusion Patients with secondary common bile duct stones conforming to operative indications are suggested primary closure following laparoscopic common bile duct exploration, and changes of liver function after operation are in the safe range. Related Articles | Metrics

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The effects of nicorandil on clinical outcome after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction PI Shu-fang, LIU Ying-wu, LI Tong, WANG Yu, LIU Bo-jiang, LI Xin, PENG Wen-jin, WANG Yun-yun, HUANG Lei 2018, 46 (7):  724-728.  doi: 10.11958/20180377 Abstract ( 1184 )   PDF (382KB) ( 3679 )   Objective To evaluate the effects of combined intracoronary and intravenous administration of nicorandil on myocardial microcirculation and short-term prognosis in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI). Methods A total of 100 patients with acute STEMI underwent PPCI were randomly divided into the nicorandil group (patients received intracoronary bolus injection of nicorandil when the target vessel opened and then continuous intravenous infusion within 24 hours, n=50) and the control group (patients received normal saline as control, n=50). The main outcome measures were immediate coronary flow and myocardial perfusion after PPCI, including thrombo-Lysis in myocardial infarction (TIMI) flow grade, corrected TIMI frame count (CTFC), reperfusion arrhythmia, ST-segment resolution, plasma creatine kinase isoenzyme (CK-MB) peak value and time. The secondary indicators were major adverse cardiovascular events (MACE) and left ventricular ejection fraction (LVEF) during hospitalization. Results There were no significant differences in hepatorenal function, heart rate and blood pressure before and after operation in each group (P＞0.05). The incidence of reperfusion arrhythmia, the level of MACE, CTFC, and peak value of CK-MB were all significantly lower in the nicorandil group compared with those of control group (P＜0.05). The proportions of patients with TIMI 3 flow, CK-MB peak time in 14 hours, and the proportion of ST-segment resolution were significantly higher in the nicorandil group than those of the control group (all P＜0.05). There was no significant difference in LVEF during hospitalization between two groups (P＞0.05). Conclusion Intracoronary and intravenous administration of nicorandil can significantly improve revascularization effects, reduce the occurrence of slow flow/no reflow, limit myocardial infarction size, increase myocardial perfusion and improve myocardial microcirculation and the short-term prognosis of acute STEMI patients. Related Articles | Metrics

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Clinical research of operation in the treatment for potentially resectable cancer of pancreatic body-tail LI Hong-xia, SHANG Hai-tao, ZHANG Xi-bo, BAO Jian-heng, HAO Cheng-fei, LIU Jun-jian, LI Zhong-lian 2018, 46 (7):  728-732.  doi: 10.11958/20180332 Abstract ( 751 )   PDF (616KB) ( 3651 )   Objective To discuss the clinical effect and technical method of the surgical treatment for potentially resectable cancer of pancreatic body-tail. Methods Eleven patients with potentially resectable cancer of pancreatic body-tail or adjacent organ metastasis, who underwent wide excision and postoperative chemotherapy in our department were retrospectively analyzed. Results In eleven patients, 10 patients with adjacent organ metastasis were performed involved organs resection, 3 patients were given resection of the celiac axis (CA) and common hepatic artery (CHA) and 2 patients were given total gastrectomy and jejunal interposition pouch reconstruction. One patient had prolonged hospital stay due to incision infection, but no serious complications occurred in other patients. Except for 2 patients, the other patients underwent postoperative chemotherapy of gemcitabine. All of the patients achieved relief through operation. The median survival time was 28 (14, 36) months. One and 3-year survival rates were 90.9% and 36.3%. Conclusion The resection rate of potentially resectable carcinoma of pancreatic body and tail operation is lower, and patients have long been plagued by abdominal pain. The treatment of extensive resection operation and recessive resection and postoperative adjuvant chemotherapy can improve the quality of life and prolong the survival rate of patients Related Articles | Metrics

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Effects of sodium valproate on epilepsy and cognitive function in the treatment of epilepsy in school-age children ZHANG Yang, ZHOU Meng-ling 2018, 46 (7):  733-737.  doi: 10.11958/20180094 Abstract ( 832 )   PDF (405KB) ( 3844 )   Objective To investigate the effects and adverse reactions of sodium valproate (VPA) on cognitive function in school-age children with epilepsy. Methods A total of 60 school-age children with epilepsy and treated with a single dose of VPA were included in this study. The 5 mg/(kg·d) were added to the initial dose of 10 mg/ (kg·d), and gradually increased to maintain therapeutic doses of 20-30 mg/ (kg·d). Patients were given for drug dosage treatment at the first 4 weeks, and drug reduction therapy for 12 weeks. The treatment information was recorded weekly. Wechsler Intelligence Scale was used to analyze the therapeutic effects, adverse reactions and cognitive function before and after treatment. Results The total effective rate was 86.7% (52/60). The block and decoding scores were significantly lower after treatment than those before the treatment. There were no significant differences in verbal IQ (VIQ), and the full-scale IQ (FIQ) before and after treatment. The performance IQ (PIQ) was significantly lower after treatment than that before treatment (P＜0.05). There was a positive correlation between the age of onset, FIQ, VIQ and PIQ in school-age children with epilepsy (P＜ 0.001). The duration of epilepsy and the frequency of epileptic seizures were negatively correlated with FIQ, VIQ and PIQ before and after treatment in school-age children with epilepsy (P＜0.001). The incidence of adverse reactions was 8.33% (5/ 60) during the period of drug dosage treatment (the first 4 weeks). The incidence of adverse reactions was 11.67% (7/60) during maintenance treatment (after 12 weeks). Conclusion The earlier seizure onset, the longer epilepsy duration and the higher frequency of seizures are correlated with the damage degree of cognitive function. VPA has a significant effect on the treatment of generalized tonic clonic seizure in school-age children, which is an ideal drug for clinical treatment of children with epilepsy. Related Articles | Metrics

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Application value of 3.0 T MRI in the preoperative staging and assessment of rectal cancer JI Sheng-chao, GENG Cheng-jun, YANG Xiao-liang, YANG Li-yue, ZANG Ke 2018, 46 (7):  737-741.  doi: 10.11958/20171506 Abstract ( 952 )   PDF (592KB) ( 3955 )   Objective To explore the application value of 3.0 T MRI in the preoperative staging and assessment of rectal cancer. Methods Data of 103 patients with rectal cancer diagnosed by biopsy was collected. The T staging, situations of paracolic lymphatic metastasis and fascia involvement, and distance of tumor edge to anal verge were estimated by preoperative MRI. The stage and assessment of preoperative MRI and postoperative pathology were compared. Results MRI showed that there were 5 patients with stage T1-2, 72 patients with stage T3, and 26 patients with stage T4. And pathological diagnosis showed that there were 5 patients with stage T1, 16 patients with stage T2, 60 patients with stage T3, and 22 patients with stage T4. The sensitivity and specificity of stage T1-2, T3, and T4 were 23.8% and 100%, 96.7% and 67.4%, 90.9% and 92.6%, respectively. Results of MRI were broadly consonant with the results of pathology (Kappa=0.748, P＜0.01). MRI showed that there were 74 patients with paracolic lymphatic metastasis. Pathological diagnosis after surgery showed that there were 66 patients with paracolic lymphatic metastasis. The sensitivity and specificity for MRI diagnosis were 92.4% and 64.9%, respectively (Kappa=0.601, P＜0.01). Among the 18 patients received anal resection, the different value of distance of tumor edge to anal verge was less than or equal to 6 mm between MRI and postoperative specimen, with no significant difference (P＞0.05). Totally 65 patients without fascia involvement diagnosed by MRI were consonant with the results of postoperative pathology. Among the 38 patients with fascia involvement diagnosed by MRI, 12 patients were false-positive. The sensitivity and specificity were 100.0% and 84.4%, respectively (Kappa=0.732, P=0.000). Conclusion 3.0 T MRI can provide accurate preoperative staging and evaluation for patients with rectal cancer before the operation, and help in clinical diagnosis and treatment. Related Articles | Metrics

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Effects of clinical features of neonates and mothers on the screening of congenital hypothyroidism MING Dan, ZHENG Rong-xiu 2018, 46 (7):  742-746.  doi: 10.11958/20180205 Abstract ( 762 )   PDF (383KB) ( 4021 )   Objective To investigate the clinical features of neonates and mothers on the screening of congenital hypothyroidism (CH), and to provide a basis for avoiding the missed diagnosis of CH. Methods A total of 206 neonates with positive thyroid stimulating hormone (TSH) screening were collected from January 2016 to November 2017, and 206 neonates with negative TSH were randomly selected over the same period as normal control group according to 1∶1 ratio. The impact of neonatal sex, gestational age, body weight and maternal comorbidity on CH screening and diagnosis was analyzed in the two groups. Results The body weight of neonates with positive TSH screening was lower than that of normal newborn infants (P＜0.05), while there were no significant differences in sex, gestational age, the proportion of preterm, mature and post-term delivery between two groups. Compared with normal TSH screening, the proportion of mother with hypothyroidism and TSH level was significantly higher in screening positive group, but FT3 and FT4 levels were lower (P＜0.05). There were no significant differences in the ratio of gestational diabetes mellitus, anemia, subclinical hypothyroidism and hyperthyroidism, hemoglobin and fasting glucose between the two groups of mothers. Compared with confirmed normal group (n=198), the body weight was lower in confirmed CH group (n=8), and the proportion of mother with hypothyroidism and TSH level was significantly higher in confirmed CH group, FT3 and FT4 levels were lower (P＜0.05). There were no significant differences in sex, gestational age, the ratio of subclinical hypothyroidism and hyperthyroidism between CH group and confirmed normal group. Conclusion Neonatal low body weight and maternal hypothyroidism significantly affect the screening and diagnosis of CH. Special attention should be paid to clinical screening of CH in order to avoid missed diagnosis. Related Articles | Metrics

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Relationship between plasma lipoprotein associated phospholipase A2 and coronary in-stent restenosis after percutaneous coronary intervention ZHU Shen-shen, WU Zhao-ke, HU Yan-min 2018, 46 (7):  746-750.  doi: 10.11958/20180140 Abstract ( 800 )   PDF (426KB) ( 3612 )   Objective To investigate the relationship between plasma lipoprotein associated phospholipase A2 (LpPLA2) level and in-stent restenosis (ISR) after percutaneous coronary intervention (PCI). Methods A total of 208 patients treated with PCI and examined with a follow-up coronary angiograph (CAG) were included in this study. The patients were divided into 2 groups based on the results of ISR condition: ISR group (n=29) and NISR group (n=179). The plasma levels of Lp-PLA2 were detected before first-PCI operation and follow-up CAG in two groups. The general clinical data, biochemical parameters, coronary coronariography, interventional features and plasma levels of Lp-PLA2 were compared between the two groups. Logistic regression analysis was used to analyze the independent risk factor for ISR. Receiver operating characteristic curve was used to evaluate the predictive ability of the plasma level of Lp-PLA2 to the occurrence of ISR. Results (1) In ISR group, patients with the history of type 2 diabetes, levels of low density lipoprotein cholesterol (LDL-C) and levels of glycosylated hemoglobin (HbA1c) were significantly higher than those in NISR group, while serum levels of total bilirubin (T- BIL) decreased, the length of the stent was longer, and stent diameter was smaller (P＜0.05). (2) In ISR group, the Lp-PLA2 level and ΔLp-PLA2 level were higher before first-PCI operation than those in NISR group (P＜0.05). (3) Logistic regression analysis showed that T-BIL, stent diameter and ΔLp-PLA2 were the independent risk factors for ISR (P＜0.05). (4) The receiver operating characteristic curve (ROC) area of ΔLp-PLA2 for predicting post-PCI ISR occurrence was 0.862, the optimal cut off value of ΔLp-PLA2 was 20.68 μg/L, the sensitivity was 79%, and the specificity was 83%. Conclusion The increased level of Lp-PLA2 after PCI is correlated with ISR, and the regular monitoring the level of Lp-PLA2 has some significance in forecasting ISR. Related Articles | Metrics

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Diagnosis and treatment of 3 cases of typical nonfunctional pancreas neuroendocrine tumor NIU Lian-jie, ZHANG Ya-min 2018, 46 (7):  755-757.  doi: 10.11958/20180015 Abstract ( 907 )   PDF (524KB) ( 3628 )   Non-functional pancreatic neuroendocrine tumors (NF-PNETs) are rare in clinic. In this paper, three cases of typical NF-PNETs patients with pathological diagnosis in Tianjin First Central Hospital from July 2012 to February 2017 were analyzed retrospectively. The clinical manifestations, pathological and immunohistochemical features, diagnosis and treatment and prognosis of NF-PNETs were discussed. Related Articles | Metrics

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Chronic subdural hematoma complicated with hepatic encephalopathy: a case report WEI Ying-sheng, JIA Ying, AN Shuo, TIAN Ye, SUN Jian, JIANG Rong-cai 2018, 46 (7):  758-760.  doi: 10.11958/20171523 Abstract ( 828 )   PDF (544KB) ( 3518 )   This article report a case of patient with chronic subdural hematoma. After receiving a surgery, the patient presented mental symptoms such as abnormal behaviors and personality changes. The patient was diagnosed as hepatic encephalopathy and secondary epilepsy according to his medical history, laboratory tests, head CT / MRI and electroencephalogram. The secondary epilepsy was diagnosed by convulsion. After receiving corresponding therapy, these symptom disappeared. Related Articles | Metrics

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Case report of one child with idiopathic hypereosinophilic syndrome and literature review WANG Jing-yao, ZHAO Yu 2018, 46 (7):  760-764.  doi: 10.11958/20171352 Abstract ( 728 )   PDF (1058KB) ( 3866 )   Idiopathic hypereosinophilic syndrome (IHES) is a very rare disorder in children, characterized by increased eosinophils in bone marrow, peripheral blood and tissue, resulting in multiple organ damage. We report a case of an 8-yearold girl with IHES, whose initial complaints were diarrhea and abdominal distension. Image examinations indicated that the digestive tract, lung and urinary bladder were all affected. Routine blood test showed that the eosinophilia was 20.64×109/L. Bone marrow smear showed that the mature eosinophilic granulocytes increased to 32%. The FIL1P1/PDGFRA, FGFR1 and IGH gene detection, parasites and antibody tests were all negative. The diagnosis of IHES was considered. The eosinophil decreased significantly and symptoms relieved after steroid treatment, though with recurrences, steroids were still sensitive. Then we reviewed the relevant literature and cases of children with IHES in China. Related Articles | Metrics

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Clinical research progress of proprotein convertase subtilisin/kexin type 9 inhibitors CUI Li, LI Guang-ping 2018, 46 (7):  765-770.  doi: 10.11958/20171266 Abstract ( 1496 )   PDF (389KB) ( 4339 )   Proprotein convertase subtilisin / kexin type 9 (PCSK9) inhibitors can reduce the low density lipoprotein cholesterol (LDL-C) level in circulatory system by blocking PCSK9-low density lipoprotein receptor (LDLR) pathway to mediate the degradation of LDLR. At present, PCSK9 inhibitors have become the focus of cardiovascular lipid-lowering therapy. A variety of PCSK9 inhibitors have entered the clinical trial stage. This paper mainly reviews the molecular structure and mechanism of PCSK9, the classification of PCSK9 inhibitors, and recent clinical study of the monoclonal antibodies of PCSK9 inhibitors in order to evaluate the effectiveness and long-term safety of cardiovascular risk reduction. Related Articles | Metrics

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Advances in the treatment of extraglandular damage of Sjogren’s syndrome LI Ben, XUE Luan 2018, 46 (7):  770-775.  doi: 10.11958/20180272 Abstract ( 901 )   PDF (407KB) ( 3575 )   Primary Sjogren’s syndrome (pSS) is a chronic systemic autoimmune disease mainly involving exocrine glands. Besides the involvement of salivary glands and lacrimal glands, it can also involve multiple external organs of glands, resulting in multiple system damage. At present, there is no effective systemic treatment for Sjogren’s syndrome at home and abroad. Most of the treatment for lesions outside glands are learned from the treatment for rheumatoid arthritis, systemic lupus erythematosus, or glucocorticoids or immunosuppressants based on clinical experience. Although biological agents have broad prospects in the treatment of Sjogren’s syndrome, there are still many disputes. This article will focus on the progress of the treatment for Sjogren’s syndrome of external organs of glands, and hope that it can be helpful to the clinical treatment of Sjogren syndrome. Related Articles | Metrics

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The research progress of mitoKATP in diabetes with cerebral ischemic injury SHI Ning-hua, HAN Jiang-quan, DENG Cai-hong, HE jing 2018, 46 (7):  776-789.  doi: 10.11958/20180055 Abstract ( 718 )   PDF (377KB) ( 3700 )   Diabetes is an important independent risk factor for cerebrovascular diseases. A large number of clinical and experimental studies have confirmed that diabetes can aggravate cerebral ischemic injury, but the mechanism is not yet clear. Mitochondrial ATP-sensitive potassium channel (mitoKATP) is an important ion channel located in the mitochondrial inner membrane, playing very important roles in many physiological and pathological processes. In recent years, studies have showed that mitoKATP has a protective effect on cerebral ischemic neuronal injury, but its protective mechanism is abolished in diabetes. The relationship between mitoKATP and diabetes with cerebral ischemic injury has attracted more and more attention. In this article, the role of brain mitoKATP in diabetes with cerebral ischemic injury was reviewed. Related Articles | Metrics

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Advances in minimally invasive drainage implants in glaucoma surgery SU Long, TANG Xin 2018, 46 (7):  780-784.  doi: 10.11958/20180236 Abstract ( 701 )   PDF (373KB) ( 3509 )   Glaucoma surgery is divided into two major categories: reducing the formation of aqueous humor and increasing the flow of aqueous humor. The former one is represented by the laser ablation of the ciliary processes, and the latter one is represented by trabeculectomy. From traditional glaucoma filtering surgery to newer glaucoma procedures, which target different aqueous outflow pathways, the use of glaucoma drainage implants has improved the safety profile of glaucoma surgery and decreased the complications during the operation and post operation, also the surgical techniques have been getting easier than ever. This article systematically reviews the clinical progress of new glaucoma drainage implants including the implants targeting the trabecular network and schlemm’s canal (iStent, Hydrus Micro-stent)，the implants targeting the superachoridial space (CyPass Micro-Stent, iStent Supra) and the implants targeting the subconjunctival space (XEN gel stent，InnFocus MicroShunt). Related Articles | Metrics

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Application of ultrasound guided brachial plexus combined with deep cervical plexus nerve block in shoulder arthroscopic surgery XIE Shu-hua, DING Ling, WEI Ying, GENG Li-cheng, WANG Guo-lin 2018, 46 (7):  751-754.  doi: 10.11958/20171233 Abstract ( 968 )   PDF (369KB) ( 4469 )   Objective To evaluate the effect of ultrasound guided brachial plexus combined with deep cervical plexus nerve block in shoulder arthroscopic surgery. Methods A total of 60 cases under shoulder arthroscopic surgery were randomly divided into two groups: general anesthesia group (GA) and nerve block group (NA), with 30 cases in each group. Patients of group GA were given general anesthesia, and patients of group NA were given ultrasound guided brachial plexus block with deep cervical plexus nerve block. Data of the haemodynamics of patients, the time for the first feeding of water after operation, ambulation postoperation, the total cost of anesthesia, the average hospitalization days, the satisfaction of anesthesia in patients and surgeons, the pain scores (VAS) at 2, 4, 8, 12 h postoperation, the proportion of patients that needed additional analgesic drugs and the adverse events in 12 h postoperation were all recorded. Results There were no significant differences in gender, age, body mass index (BMI), operation time, intraoperative systolic pressure, diastolic pressure and mean arterial pressure, the minimum heart rate, the satisfaction of anesthesia in patients and surgeons, the proportion of postoperative 12 h VAS score ≤ 3 and the need for additional analgesic drugs between two groups of patients (P＞0.05). In group NA, the intraoperative systolic pressure, diastolic pressure and mean arterial pressure and the maximum heart rate were lower than those in group GA. The time of the first feeding water, and ambulation post operation were shorter in group NA than those of group GA. The incidence of adverse reactions was significantly lower in group NA than that in group GA. The total anesthesia cost and the average hospitalization days were significantly lower in group NA than those of group GA. The proportion of postoperative VAS score ≤ 3 at 2, 4 and 8 h was higher in group NA than that of group GA. The proportion of patients needed additional analgesic drugs was significantly lower in group NA than that of GA group (P < 0.05). Conclusion Ultrasound-guided brachial plexus combined with deep cervical plexus nerve block is a reliable choice for shoulder arthroscopic surgery, which can promote the rapid rehabilitation of patients. Related Articles | Metrics

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The expression of lncRNA UCA1 and its role on the proliferation and invasion in hepatic cancer and HepG2 cells WANG Hai-bo, LI Zhong-lian 2018, 46 (7):  678-682.  doi: 10.11958/20180024 Abstract ( 524 )   PDF (480KB) ( 3815 )   Objective To investigate the effects of long non-coding RNA urothelial carcinoma-associated 1 (lncRNA UCA1) silencing on cell proliferation and invasion of human hepatic cancer HepG2 cells, and its mechanism thereof. Methods The expression of lncRNA UCA1 was analyzed by real-time PCR in 20 tumor tissue and 20 adjacent non-tumor tissue samples of hepatic cancer. HepG2 cells was cultured in vitro, and lncRNA UCA1 specific short hairpin RNA (shRNA1 and shRNA2) was transfected. CCK-8 assay, Transwell assay and Wound-healing assay were used to detect the effect of lncRNA UCA1 silencing on cell proliferation, invasion and migration of HepG2 cells. The effect of lncRNA UCA1 silencing on protein and mRNA expression of Cyclin D1, vascular endothelial growth factor (VEGF), matrix metalloproteinase (MMP)- 9, focal adhesion kinase (FAK) and Integrin β3 on lncRNA UCA1 silencing was measured by real-time PCR and Western blot assay. Results The expression of LncRNA UCA1 was higher in hepatic cancer tissues. The silencing of lncRNA UCA1 significantly inhibited the growth of HepG2 cells, and the abilities of cell invasion and migration were downregulated. Western blot assay and real-time PCR showed that expressions of Cyclin D1, VEGF, MMP-9, FAK and Integrin β3 were significantly inhibited. Conclusion The results suggest that the abnormal expression of lncRNA UCA1 is associated with the development of human hepatic cancer. The silencing of lncRNA UCA1 could suppress the cell proliferation, invasion and migration of hepatic carcinoma cells Related Articles | Metrics

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Experimental study on osteogenic differentiation of adipose-derived mesenchymal stem cells induced by hydroxyapatite CHENG Sheng-cheng, LIU Yi, Jing Ya-qing, JU Ming-yan, LI Guang 2018, 46 (7):  687-691.  doi: 10.11958/20180604 Abstract ( 972 )   PDF (803KB) ( 3294 )   Objective To investigate the effect of hydroxyapatite (HA) on the osteogenic differentiation potency of adipose-derived mesenchymal stem cells (ADSCs). Methods ADSCs were isolated and purified from C57BL/6 mice. Toxic effects of hydroxyapatite on ADSCs were detected by cell proliferation assay. Alkaline phosphatase (ALP) assay was used to detect the effects of different concentrations of HA on osteogenic differentiation of ADSCs. Relative mRNA expression levels of osteogenic genes (BGLAP, ALP, COL1A1, OPN and Runx2) were measured by RT-PCR. Results The low concentration of HA (≤20 mg/L) showed less effect on proliferation of ADSCs. With the increase of HA concentration, the cell proliferation decreased. The co-culture of 20 mg/L HA with ADSCs significantly increased the ALP activity, and promoted the expression of osteoblast-related genes (P＜0.01). Conclusion Hydroxyapatite have the ability to induce the osteogenic differentiation of ADSCs, which provide a theoretical basis for combinating HA and ADSCs into a new bone engineering scaffold. Related Articles | Metrics

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Mild hypothermia facilitates the long-term survival and maturation of hippocampal newborn neurons after traumatic brain injury in rats WANG Jing, XU Chao, LI Xiao-hong, TU Yue, CHEN Chong, MA Tie-zhu, WANG Li-na, ZHU Xu, REN Ji-bin, XU Zi-ning, YANG Hui-yun, ZHANG Sai 2018, 46 (7):  678-682.  doi: 10.11958/20180175 Abstract ( 507 )   PDF (1032KB) ( 2946 )   Objective To investigate the effect of mild hypothermia (MHT) in long-term survival and maturation of newborn neurons in the dentate gyrus (DG) of hippocampus after traumatic brain injury (TBI) in rats. Methods Fifty-nine adult Sprague-Dawley (SD) rats were randomly divided into the sham-injured group (n=15), TBI group (n=22) and TBI+ MHT group (n=22). The TBI rat model was established with hydraulic impact brain damage instrument, and the pressure was set at 2.0 atm (1 atm=101.325 kPa). The rats in TBI +MHT group were received MHT after injury, and the rectal target temperature was 33.5 ℃ maintaining 4 h, and then raised the temperature slowly within 1.5 h to 37 ℃. The Morris water maze, modified neurological severity scores (mNSS) and immunofluorescence staining were used at the corresponding time points to observe functional recovery of nervous system and long-term survival and maturation of newborn neurons in hippocampus. Results Morris water maze tests showed that the escape latency was significantly decreased, and the number of platform crossings and the time stayed in the target quadrant were increased at 4 weeks after injury in TBI+MHT group compared with those of TBI group (P＜0.05). Compared with TBI group, mNSS was significantly decreased at 1, 2 and 4 weeks after injury in TBI+MHT group (P＜0.01). Compared with sham group，BrdU-positive cells and BrdU/NeuN doublelabeled cells in rat hippocampal DG were significantly increased at 1, 4 and 8 weeks after injury in TBI group and TBI+MHT group (P＜0.05), and which were increased more obviously in TBI + MHT group than those of TBI group (P＜0.05). Furthermore, the BrdU/NeuN double-labeled cells were further increased at 4 weeks and 8 weeks after injury in TBI+MHT group, and which were decreased in TBI group compared with 1 week after injury (P＜0.05). Conclusion MHT could facilitate not only long-term survival but also maturation of newborn neurons after TBI, and promote the functional recovery of nervous system. Related Articles | Metrics