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15 October 2020, Volume 48 Issue 10 Previous Issue    Next Issue

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Analysis of the effect of lumbar disc herniation treated by spinal endoscope in ambulatory surgery mode during the prevalence of COVID-19 ZHANG Chun-hong, DU Li-long, ZHANG Kai-hui, XU Bao-shan△ 2020, 48 (10):  913-916.  doi: 10.11958/20201764 Abstract ( 1397 )   PDF (393KB) ( 4280 )   Abstract: Objective　To compare the clinical efficacy between lumbar disc herniation treated by spinal endoscope in ambulatory surgery mode and general hospitalization mode during the prevalence of the COVID-19. Methods　The 100 patients with lumbar disc herniation treated by percutaneous endoscopic lumbar discectomy (PELD) with ambulatory surgery mode or general hospitalization mode were analyzed retrospectively. The operation time, blood loss, hospitalization time and hospitalization cost were compared between the two groups. Visual analogue scale (VAS), Oswestry disability index (ODI) and modified MacNab criteria were performed before surgery and 1 month after surgery in the two groups of patients. Results　All the patients completed PELD surgery successfully. The hospitalization time and hospitalization cost were significantly lower in the ambulatory surgery mode than those of the general hospitalization mode (P＜0.05). The VAS and ODI scores were significantly improved after operation compared with those before operation in the two groups (P＜0.05). There were no significant differences in the VAS and ODI scores before and after the operation between the two groups of patients. The excellent and good rates of modified MacNab in the ambulatory surgery mode and general hospitalization mode were 91.7% and 92.0% respectively, and there was no significant difference between them (P＞0.05). Conclusion　During the prevalence of the COVID-19, PELD in ambulatory surgery mode is safe, feasible and effective. It can reduce the hospitalization time and hospitalization cost, which is worthy of popularization and application. Related Articles | Metrics

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Analysis of risk factors for subsequent infection in patients with COVID-19 HAN Jing, SHI Li-xia, XIE Yi, HUANG Shu-ping, LI Jian-guo, LIU Ling-mei, SHAO Shi-feng, △ 2020, 48 (10):  916-919.  doi: 10.11958/20201043 Abstract ( 1371 )   PDF (389KB) ( 4494 )   Abstract: Objective　To explore the risk factors of subsequent bacterial infection in patients with novel coronavirus disease 2019 (COVID-19). Methods　The clinical data of 136 patients with COVID-19 admitted to Tianjin Haihe Hospital were retrospectively analyzed. According to the results of clinical diagnosis, the patients were divided into two groups: subsequent infection group (44 cases) and non-subsequent infection group (92 cases). The clinical characteristics, treatment and disease outcome of the two groups were compared. The risk factors of subsequent infection were analyzed by Logistic regression. Results　The results of univariate analysis showed that patient age and comorbidity were significantly higher in subsequent infection group than those of non-subsequent infection group (P＜0.01). The proportion of OI＜400 mmHg, hyperthermia (body temperature > 39 ℃), severe cases, acute respiratory distress syndrome (ARDS), hypoproteinemia and cardiac insufficiency were also significantly higher in subsequent infection group than those in non-subsequent infection group (P＜0.05). In the treatment, the proportion of mechanical ventilation, invasive operation, hormone treatment and hospitalization time were significantly higher in the subsequent infection group than those in the non-subsequent infection group (P＜0.05). Logistic regression analysis showed that comorbidity (OR=4.613, 95%CI: 1.756-12.118), hormone therapy (OR=2.403, 95%CI: 1.012-6.422), admission OI＜400 mmHg (OR = 6.534, 95%CI: 2.064-20.691), hypoproteinemia (OR=12.949, 95%CI: 3.284-51.067) were independent risk factors for subsequent bacterial infection. Conclusion　The subsequent infection of COVID-19 patients is closely related to OI＜400 mmHg, hypoproteinemia, hormone therapy and comorbidity. Early clinical intervention can prevent subsequent infection in patients and help improve prognosis. Related Articles | Metrics

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The potential mechanism of coronavirus disease 2019 and the treatment effect of mesenchymal stem cells ZHAO Ya-ping, MA Hui, CAO Jie△ 2020, 48 (10):  920-924.  doi: 10.11958/20201541 Abstract ( 1322 )   PDF (400KB) ( 4638 )   Abstract: The coronavirus disease 2019 (COVID-19) is highly infectious, and the mortality of severe patients with the novel coronavirus pneumonia is high. Its pathogenesis is still unclear, and there is a lack of specific treatment method. The cytokine storm and imbalance of immune response may be the pathophysiological basis of acute respiratory distress syndrome (ARDS), multiple organ failure (MOF) and even death for the novel coronavirus pneumonia. Mesenchymal stem cells (MSC) has shown initial efficacy and clinical prospect in the treatment of severe patients by the immune regulation, tissue repair and anti-fibrosis properties. This article reviews the potential pathogenic mechanism of the COVID-19, the possible mechanism and application of MSC in the treatment of the COVID-19, which will provide reference for clinical treatment. Related Articles | Metrics

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Effects of Hedyotis diffusa-sculellaria barbata components on biological behavior of adenocarcinoma of colon Lovo cells BAO Sa-ru-la, AN Gui-feng, SA Ru-la, SU-BU De-ge-ri-le 2020, 48 (10):  925-930.  doi: 10.11958/20200633 Abstract ( 824 )   PDF (840KB) ( 5031 )   Abstract: Objective To investigate the effect and mechanism of Hedyotis diffusa-sculellaria barbata components on the proliferation, invasion, migration and apoptosis of adenocarcinoma of colon Lovo cells. Methods The Hedyotis diffusa and scutellaria barbata were decocted for three times according to the quality of 1∶1 to obtain the water extract. Then, a proper amount of extract was taken and degreased with petroleum ether, and then extracted with ethyl acetate for many times to obtain the components of Hedyotis diffusa and scutellaria barbata and calculated the yield. The experimental cells were divided into control group (normal cultured Lovo cells), Hedyotis diffusa-sculellaria barbata component low dose group (10 mg/L), medium dose group (30 mg/L), and high dose group (50 mg/L). The proliferation inhibition rates were detected by thiazole blue colorimetric (MTT) assay. The invasion ability and migration ability were checked by Transwell and cell scratch test. Flow cytometry was used to detect cell cycle distribution, and TUNEL was used to check apoptosis rate. The expression of Grb2-associated binding protein 1 (Gab1)/Vascular endothelial growth factor receptor 2 (VEGFR-2)/Phosphatidylinositol 3-kinase (PI3K)/Kthreonine kinase (Akt) signaling pathway protein, apoptotic protein Bcl-2 and Bax and metalloproteinase-9 (MMP-9) were detected by Western blot assay. Results Four compounds, p-hydroxyacetophenone, scutellarin, luteolin and apigenin, were found in the pair of Hedyotis diffusa and Scutellaria barbata. The yield was 0.61% after ethyl acetate extraction. Compared with the control group, the cell proliferation inhibition rate, apoptosis index (AI) value, the proportion of G1 phase of tumor cells increased in the low, middle and high dose groups, the number of cell penetrating membrane and the rate of scratch closure decreased significantly (P＜0.05). The expressions of Gab1, VEGFR-2, PI3K, Akt, MMP-9 and Bcl-2 proteins decreased, the expression of Bax increased with a dose-dependent manner (P＜0.05). Conclusion Hedyotis diffusa-sculellaria barbata components can inhibit the proliferation of adenocarcinoma of colon Lovo cells in G1 phase, reduce the migration and invasion and induce the apoptosis. The mechanism might be related to the inhibition of Gab1/VEGFR-2/PI3K/Akt signaling pathway. Related Articles | Metrics

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The effect of high uric acid on the activity of cardiomyocytes and its related mechanism LIU Di-dan, GAO Kai, XIE Yang, LI Zhi△ 2020, 48 (10):  931-936.  doi: 10.11958/20201203 Abstract ( 713 )   PDF (978KB) ( 4743 )   Abstract: Objective　To investigate the effect of high uric acid on cardiomyocyte activity in vitro and its related mechanism. Methods　H9C2 cells were divided into the control group (Con), the high uric acid group (HUA), the antioxidant group (NAC), the ERK inhibitor group (PD98059), the P38 inhibitor group (SB203580), the high uric acid + antioxidant group (NAC+HUA), the high uric acid + ERK inhibitor group (PD98059+HUA), the high uric acid + P38 inhibitor group (SB203580+HUA) and the high uric acid + antioxidant + ERK inhibitor group (NAC+PD98059+HUA). MTT method was used to detect the vitality of cardiomyocytes. Immunofluorescence staining and flow cytometry were used to detect the reactive oxygen species (ROS). Western blot assay was used to detect the protein expression levels of extracellular signal regulating kinase (ERK) and phosphorylated P38. Results　After treatment with high uric acid (0.15 g/L), the activity of cardiomyocytes decreased significantly. Compared with the Con group, the oxidative pressure increased significantly in the HUA group, while compared with the HUA group, the oxidative pressure decreased in the NAC+HUA group (P＜0.05). Compared with Con group, the activity level of cardiomyocytes decreased significantly in the HUA group, while compared with the HUA group, the activity levels of cardiomyocytes increased significantly in the NAC+HUA group, PD98059+HUA group and SB203580+HUA group (P＜0.05). Compared with the Con group, phosphorylation levels of ERK and P38 were increased significantly in HUA group. Compared with the HUA group, the phosphorylation levels of P38 of SB203580 group were decreased significantly, while the phosphorylation levels of ERK and P38 were decreased significantly in NAC+HUA group, PD98059+HUA group and NAC+PD98059+HUA group (P＜0.05). Conclusion　High uric acid inhibits myocardial cell activity by activating ERK/P38 signaling pathway through oxidative stress in vitro. Related Articles | Metrics

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Irbesartan alleviates steatosis in LO2 cells by promoting autophagy via PPAR- γ mediated AMPK/mTOR pathway ZHONG Juan, LEI Ren-guo, ZHONG Qing-rong, QIN Ya-qin, LI Hong-mian△ 2020, 48 (10):  936-941.  doi: 10.11958/20193626 Abstract ( 1624 )   PDF (906KB) ( 4446 )   Abstract: Objective　To investigate the effect of irbesartan on steatosis in LO2 cells by regulating PPAR-γ-mediated AMPK/mTOR signaling pathway and autophagy. Methods　The cell model was established by lipid mixture (LM). LO2 model cells were divided into model group, irbesartan group and irbesartan + PPAR-γ antagonist group. The normal cells were served as the normal group. After 24 hours of intervention, the triacylglycerol (TG) and total cholesterol (TC) levels in cells were measured using enzyme-linked immunosorbent assay (ELISA) kits, and cultured cells were stained with oil red O solution to assess the lipid content. The expression levels of PPAR-γ and AMPK/mTOR signaling pathway molecules in cells were detected by Western blot assay, and the changes of autophagy marker protein LC3B were observed by confocal microscopy and Western blot assay. The changes of autophagy marker protein LC3B were observed by laser confocal technique. Results　The concentration of irbesartan in 10μmol/L and below had no obvious toxic effect on the growth of LO2 cells, but 20 μmol/L irbesartan had a significant inhibitory effect on cell viability. Compared with the normal group, the intracellular TG and TC levels as well as lipid deposition were significantly increased in model group, the expressions of PPAR-γ, P-AMPK and LC3B proteins were decreased, and the level of phosphorylated mTOR was increased (P＜0.05). Compared with the model group, the intracellular TG and TC levels as well as lipid deposition were significantly decreased in irbesartan group. Moreover, it was found that irbesartan strongly increased the expressions of PPAR-γ, p-AMPK and LC3B, and reduced the level of phosphorylated mTOR in LM-induced LO2 cells (P＜0.05). However, these effects were reversed by irbesartan and PPAR-γ inhibitor treatment. It was found that irbesartan strongly increased the expressions of PPAR-γ, p-AMPK and LC3B, and reduced the level of phosphorylated mTOR in LM-induced LO2 cells (P＜0.05). Conclusion　Irbesartan alleviates lipid deposition and hepatic steatosis by activating PPAR-γ mediated AMPK/mTOR signaling pathway, thereby inducing hepatocyte autophagy. Related Articles | Metrics

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An experimental study on the inhibition of eATP-P2X7R-NLRP3 signaling pathway by carbenoxolone to alleviate fibrosis in chronic pancreatitis ZHANG Gui-xian, WANG Man-xue, LIU Da-wei, LIU Hong-bin△, NIE Wei, SHI Chuan 2020, 48 (10):  942-946.  doi: 10.11958/20201592 Abstract ( 936 )   PDF (1088KB) ( 4451 )   Abstract: Objective　To investigate the effects of extracellular ATP (eATP) -P2X7R -NLRP3 axis on the inflammation and fibrogenesis of chronic pancreatitis (CP), and the therapeutic effect of ATP inhibitor carbenoxolone (CBX) on CP. Methods　C57BL/6 mice (male, 6-week-old) were randomly divided into 5 groups: normal group, model group, CBX low, medium and high-dose groups (25, 50 and 100 mg/kg, respectively). After the mouse models of CP were established, the three CBX groups were intraperitoneally injected with corresponding doses of drugs. The mice were killed by cervical dislocation 24 h after the last drug injection. Pancreatic histopathological changes were evaluated by HE staining. eATP levels were measured by the luminescence ATP detection assay. The protein expressions of P2X7R, NLRP3 and Caspase-1 were measured by immunofluorescence staining, and the expressions of P2X7R, NLRP3, Caspase-1 and Pannexin-1 (PAN-1) mRNA were detected by real-time fluorescent polymerase chain reaction (qPCR). Results　Under light microscope, the normal group showed tightly distributed cells in murine pancreas without fibrosis and inflammatory cell infiltration. Compared with the normal group, the intercellular space of the pancreatic tissue, atrophy of the pancreatic acinus, hyperplasia of the collagen fibers and infiltration of a large number of inflammatory cells among fibers were elevated in model group with an increased histopathological score (P＜0.01). Compared with the model group, the content of collagen and the degree of inflammatory cell infiltration were reduced with a decreased histopathological scores in CBX groups. The eATP level was significantly higher in model group than that of the normal group (P＜0.01). After 2 weeks of treatment, the levels of eATP in murine pancreatic tissue were lower in CBX medium and high-dose groups than that of model group. Compared with the normal group, the protein expressions of P2X7R, NLRP3 and Caspase-1 were significantly increased in the model group (P＜0.01). Compared with the model group, these 3 protein expressions were down-regulated in CBX treatment groups, in which a significant effect was found in the CBX medium and high-dose groups (P＜0.05). Results of qPCR showed that the expression of PAN-1 mRNA was significantly up-regulated in model group compared with that of normal group. Compared with the model group, the levels of PAN-1 mRNA were reduced in CBX medium and high-dose groups (P＜0.01). Conclusion　In the course of CP, the eATP level is significantly increased, and then activates the P2X7R, which can accelerate the NLRP3 inflammasome assembly and aggravates pancreatic fibrosis. CBX can down-regulate the expressions of P2X7R, NLRP3 and Caspase-1, alleviate the injury and fibrosis of pancreatitis and consequently play a therapeutic role. Related Articles | Metrics

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The role of iron deposition on white matter demyelination in delayed encephalopathy after acute carbon monoxide poisoning GAO Ye, HAN Qin, LEI Rui-qi, JIANG Li, FU Meng, YAN Xiang, LI Jing-lun△ 2020, 48 (10):  947-951.  doi: 10.11958/20201480 Abstract ( 962 )   PDF (901KB) ( 3826 )   Abstract: Objective　To investigate the role of iron deposition on white matter demyelination in rats with delayed encephalopathy after acute carbon monoxide (CO) poisoning (DEACMP). Methods　SD rats screened by water maze experiment were divided into air control group (AC group), CO poisoning group (CO group) and deferriamine (DFO) + CO poisoning group (DC group). Each group was further divided into 5 subgroups including day 1, 3, 7, 14 and 21 groups. The DEACMP model was prepared by intraperitoneal injection of CO gas in rats of CO group and DC group. Rats in DC group were intraperitoneally injected with 100 mg/kg of deferriamine 1 h before modeling, and injected once a day after modeling. Rats in AC and CO groups were intraperitoneally injected with the same amount of normal saline. Morris water maze and HE staining were used to observe the changes of the behavior and pathological neurons of rats before and after exposure. Prussian blue staining was used to detect the expression of iron. The expression of ferritin (Fn) and basic myelin protein (MBP) were detected by Western blot assay. The expression of 2', 3' -cyclic nucleotide phosphodiesterase (CNPase) was detected by immunohistochemical staining and the expression of MBP was detected by immunofluorescence staining. Results　After 14 days of exposure, the escape latencies were longer in CO and DC groups than those in AC group, and the escape latency was shorter in DC group than that in CO group. The times of crossing the platform were significantly lower in CO group than those in AC and DC groups (P＜0.05). The cell degeneration and necrosis were found in CO group at 14 days after infection. The cell degeneration and necrosis in the DC group were between AC and CO groups (P＜0.05). The expression of iron reached the peak on 14 days in CO group (P＜0.05). Compared with CO group, the expressions of iron and Fn decreased in DC group, and the expression of MBP increased after 3 days of exposure in DC group, and the expressions of CNPase increased at 14 and 21 days (P＜0.05). The myelin arrangement was denser in DC group than that in CO group, and the expression of MBP was increased. Conclusion　After acute CO poisoning, excessive deposition of iron may lead to progressive demyelination of the white matter in rats by reducing the expressions of CNPase and MBP, and damaging oligodendrocytes (OLs), resulting in delayed cognitive dysfunction. Related Articles | Metrics

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Effects of heme oxygenase -1 on MUC5AC and IL-25 in asthmatic mice ZHAN Qian, DU Li-jun, DAI Xi, YUAN Jing, LIU Ben, WANG Rong-li△ 2020, 48 (10):  952-956.  doi: 10.11958/20201497 Abstract ( 916 )   PDF (1054KB) ( 4717 )   Abstract: Objective　To explore the regulatory effect and mechanism of heme oxygenase-1 on airway inflammation in asthmatic mice. Methods　Twenty-eight healthy BALB/C female mice were randomly divided into four groups: asthma group, fludostame group, hemin group and control group. Asthma group, fludostame group and hemin group were sensitized by intraperitoneal injection of 20 μg ova + 500 μg Al (OH) 3 + 0.2 mL PBS at the day 1, 14, and ovalbumin was also given by aerosol inhalation, once a day from the day 25 to 28 to build the model of asthma mice by stimulating airway hyper responsiveness. The control group was replaced by the same amount of normal saline, and hemin group was injected intraperitoneally 75 μmol/kg of hemin at the day 1, 2 before sensitization, the 12, 13, 23, 24 and 27 after sensitization. Fludostame group was given fludostame (200 mg/kg) by gavage at the day 25, 26 and 27 before sensitization. 24 hours after sensitization. Samples of blood and lung tissue were collected. The morphological changes of lung tissues were observed by HE staining. The expression of MUC5AC in lung tissue was detected by immunohistochemistry. The levels of MUC5AC in lung tissue and IL-25 in serum were detected by enzyme-linked immunosorbent assay (ELISA). The correlation between MUC5AC and IL-25 was analyzed. Results　A large number of inflammatory cell infiltration, tracheal mucosal thickening and submucosal edema were observed in the lung tissue of asthmatic mice. A small amount of inflammatory cell infiltration and exudation were observed in hemin group and fudosteine group, and the pathological changes were less severe than those in asthma group. Compared with control group, the expression levels of MUC5AC and IL-25 were significantly increased in asthma group, hemin group and fudosten group (P＜0.05). Compared with asthma group, MUC5AC and IL-25 expression levels were significantly decreased in hemin group and fudosteine group (P＜0.05), and the reduction was more significant in the hemin group than in the fudosteine group. The expression levels of MUC5AC and IL-25 were positively correlated (r=0.932, P＜0.01). Conclusion　HO-1 can down regulate the expression levels of MUC5AC and IL-25 in asthmatic mice, reduce airway inflammation and mucus hypersecretion. Related Articles | Metrics

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The improving effect of volatile oil of rhizoma atractylodis on ulcerative colitis in rats LIU Xiao-lan, ZHANG Yong-zhong, ZHANG Jun-ling, NIE Xiao-bo, JIA Lin, LIU Hui-li△ 2020, 48 (10):  956-960.  doi: 10.11958/20200699 Abstract ( 1048 )   PDF (642KB) ( 5442 )   Abstract: Objective To study the effect of volatile oil of rhizoma atractylodis (VRA) on the improvement of ulcerative colitis (UC) in rats. Methods The rat model of UC was established with 5% 2,4,6-trinitrobenzenesulfonic acid enema. The model rats were randomly divided into model group, positive control group (gavage mesalamine 0.36 g/kg), low dose, medial dose and high dose groups (gavage VRA 1, 2 ,4 g/kg respectively), with 10 rats in each group. Another 10 rats were set in the control group (gavage equal volume distilled water). Rats in each group were given the drug (or distilled water) once a day for 10 days. The changes of body weights before modeling, before and after administration were recorded in each group. After the last administration, colon tissues of rats were taken, and pathological changes were observed by HE staining. The levels of interleukin 6 (IL-6) and tumor necrosis factor-α (TNF-α) in colon tissue were determined by enzyme linked immunosorbent assay (ELISA). Belin1 and P62 mRNA expressions were detected by real-time PCR. LC3 protein expressions were detected by Western blot assay. Results Compared with the control group, the model group showed the decreased body mass, shedding of colonic mucosal epithelial cells, distortion or atrophy of crypt, and infiltration of inflammatory cells. The levels of IL-6 and TNF-α in colon tissues were increased, and the mRNA levels of P62 and Beclin 1 were increased (P＜0.05). There were no significant differences in the levels of LC3Ⅱ/Ⅰprotein expressions between control group and model group (P＞0.05). Compared with the model group, rats in the medial dose group, high dose group and the positive control group increased in body weight after administration. The levels of IL-6 and TNF-α were significantly decreased. Beclin 1 and P62 mRNA expressions were significantly up-regulated. The mRNA levels of Beclin 1 and P62 were significantly increased in the high dose group and positive control group than those of model group (P＜0.05). There were no significant differences in the changes of each index between low dose group and model group (P＞0.05). Conclusion VRA can improve the pathological damage of the colon tissue in UC model rats, reduce the levels of lL-6 and TNF-α in colon tissue, which may be related to the up-regulation of Beclin 1, P62 mRNA and LC3 Ⅱ/Ⅰ relative protein expression. Related Articles | Metrics

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Predictive value of clinical anatomical composite grading system for short-term outcome of coronary artery bypass grafting BAI Yun-peng, LIU Xian-kun, , GUO Zhi-gang△, CHEN Qing-liang, JIANG Nan, WANG Lian-qun, WANG Qiang 2020, 48 (10):  961-965.  doi: 10.11958/20201932 Abstract ( 595 )   PDF (405KB) ( 3843 )   Abstract: Objective　To establish a clinical anatomic composite grading system and to evaluate the combined effects of the European Heart Surgery Risk Scoring System (EuroSCORE) Ⅱ and SYNTAX scoring system in predicting the prognosis of patients undergoing coronary artery bypass grafting (CABG). Methods　The perioperative data of CABG patients in Tianjin chest hospital from July 2017 to December 2018 were retrospectively analyzed. EuroSCOREⅡ and SYNTAX were used to stratify the cardiovascular risk of patients. According to the classification of the two systems, they were arranged and redistributed to construct the clinical anatomy composite grading system. The discrimination and calibration of the system were evaluated compared by EuroSCOREⅡ and SYNTAX. Results　The actual hospital mortality for 301 patients was 1.54% (20/1 301). According to the comparison of baseline data after grading by scoring system, there were significant differences between EuroSCORE Ⅱ groups except unstable angina pectoris and SYNTAX. There were significant differences in age, unstable angina pectoris and 30-day death between SYNTAX groups. There were significant differences in other variables except unstable angina pectoris, NYHA and peripheral arterial disease between composite grading system groups. The results of H-L goodness of fit test showed that EuroSCORE Ⅱ, SYNTAX and composite grading system had good fitting degree. ROC curve analysis showed that the accuracy of composite classification system was the best,(AUC=0.862). AUC of EuroSCORE Ⅱ and SYNTAX were 0.849 and 0.732 (P＜0.01). This indicates that the composite grading system can significantly improve the predictive ability of 30-day mortality after operation. Compared with EuroSCORE Ⅱ, NRI of composite grading system was 14.05% (Z=7.205, P＜0.01), compared with SYNTAX, NRI=37.85% (Z=4.240, P＜0.01). Conclusion　The composite classification system of EuroSCORE Ⅱ and SYNTAX can improve the ability of single type scoring system to predict the short-term mortality of CABG. Related Articles | Metrics

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The predictive value of NLR combined with hs-cTnT on atrial fibrillation after off-pump coronary artery bypass grafting WANG Hao-jie, LIANG Bing△, ZHAO Hui, JING Yuan-hu, ZHANG Pei, SHI Gong-ning 2020, 48 (10):  966-969.  doi: 10.11958/20201393 Abstract ( 629 )   PDF (419KB) ( 4511 )   Abstract: Objective　To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) combined with high-sensitivity cardiac troponin T (hs-cTnT) for atrial fibrillation (AF) after off-pump coronary artery bypass grafting (OPCAB). Methods　A total of 108 patients who were received OPCAB treatment in our hospital from January 2017 to June 2019 were selected, and they were divided into AF group (n=32) and non AF group (n=76) according to whether AF occurred after operation. The general data, cardiac function, OPCAB perioperative indexes, NLR and hs-cTnT were collected and compared between the two groups. The risk factors of AF after OPCAB were analyzed by multiple Logistic regression. The predictive values of NLR and hs-cTnT on AF after OPCAB were analyzed by receiver operating characteristic (ROC) curve. Results　The age, NYHA cardiac function grade≥grade Ⅲ, left atrial diameter (LAD), NLR, hs-cTnT and mechanical ventilation time of patients were significantly higher in the AF group than those in the non AF group (P＜0.05). Multiple Logistic regression analysis showed that the elevated LAD (OR=3.032, 95%CI: 1.614-5.696), NLR (OR=2.186, 95%CI: 1.171-4.081) and hs-cTnT (OR=2.284, 95%CI: 1.313-3.973) were independent risk factors of AF after OPCAB (P＜0.05). ROC analysis showed that NLR and hs-cTnT had higher predictive values for AF after OPCAB, and the areas under the curve were 0.781 (95%CI: 0.685-0.877) and 0.764 (95%CI: 0.663-0.866). The cut-off values were 3.52 and 13.08 ng/L respectively. The combined analysis of the two could further improve the predictive values, and the area under the curve was 0.846 (95%CI: 0.767-0.925). Conclusion　The combination of NLR and hs-cTnT has a higher clinical value in predicting AF after OPCAB, which has certain clinical application value. Related Articles | Metrics

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Analysis of follow-up results of Moyamoya disease in children after combined bypass surgery SUN Ning, ZHAO Yan, WEI Zhong-nan, MA Xiao, ZHANG Qing-jiang, CUI Hua-lei, YANG Xin-yu△ 2020, 48 (10):  970-973.  doi: 10.11958/20200443 Abstract ( 766 )   PDF (549KB) ( 4443 )   Abstract: Objective To review the effect of combined bypass surgery for Moyamoya disease in children. Methods Data of 9 children (5 -12-years) with Moyamoya disease treated with superficial temporal artery-middle cerebral artery bypass and encephalo-duro-myo-synangiosis (EDMS) were followed up since 2016, and which were compared with dada of adult patients of the same surgical procedure in the same period. Results In this group of children, there were 8 cases with bilateral cerebral hemisphere disease, 1 case of unilateral cerebral hemisphere disease, 16 cases of ischemic type and 1 case of hemorrhagic type. Seventeen patients completed superficial temporal artery-middle cerebral artery bypass operation (hemorrhagic type was completed on both sides). The short-term contralateral facial twitching occurred in 2 children after surgery. The bone flap loosened in one case 3 months after operation. None of the children showed cerebral ischemia or cerebral hemorrhage during peri-operation and long-term follow-up, and there were no abnormalities in physical development and academic performance compared to children of the same age. There were no significant differences in complications after surgery between child group and adult group. Conclusion Moyamoya disease occurs frequently in children. The combined bypass surgery can provide the safe and effective treatment for children aged 5-12 years, help children return to normal physical growth and development, and prevent stroke. Related Articles | Metrics

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The influence of difficult cholecystectomy on intraoperative and postoperative complications and the establishment of risk prediction model CAO Bao-qiang, LI Min, HU Jin-long, YUAN Zhong-xu, ZHONG Xing-guo, YAO Jia-ming, WANG Run-dong 2020, 48 (10):  974-978.  doi: 10.11958/20193596 Abstract ( 878 )   PDF (461KB) ( 5077 )   Abstract: Objective To analyze the influence of difficult cholecystectomy (DC) on intraoperative and postoperative complications and to explore risk factors of DC, so as to establish a risk prediction model of DC. Methods Data of 201 patients who underwent cholecystectomy from January 1, 2018 to November 10, 2019 were analyzed retrospectively. The highest quartile (P75) of cholecystectomy operation time was used as a cutting point of DC (≥P75) and NLC (＜P75). Logistic regression was used to analyze the influencing factors of DC, and its risk model was constructed for prediction. Results A total of 201 patients were included, 53 were in DC group (including 3 cases of conversion to laparotomy) and 148 were in NLC group (all by laparoscope). The intraoperative blood loss, the frequency of vomiting at the first 24-hour after operation, the rates of conversion to abdominal surgery and drainage tube placement were higher in DC group than those of NLC group (P＜0.01). The time of the first anal exhaust and length of hospital stay were longer in DC group than those of NLC group (P＜0.05). The multivariate Logistic regression analysis showed that body mass index (BMI) ＞ 25 kg/m2, white blood cell (WBC) count ＞ 10×109/L, calculus incarcerated in neck of gallbladder, the relapse of acute cholecystitis in the last 2 months ＞ 4 times, thickness of gallbladder wall ＞ 0.5 cm and maximum diameter of stone ＞ 2 cm were independent risk factors for DC. The prediction efficiency of the Logistic regression equation was 0.879 (χ2=1.457，P＞0.05). Conclusion The difficult cholecystectomy can increase the risk of intraoperative and postoperative complications. The establishment of a risk prediction model has a certain clinical guiding value for difficult cholecystectomy. Related Articles | Metrics

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The diagnostic significance of CT values in upper urinary tract calculi with secondary renal infection ZHANG Jian-ping, WU Xiao-xia△, LIN Rong-kai 2020, 48 (10):  978-981.  doi: 10.11958/20200420 Abstract ( 932 )   PDF (497KB) ( 5196 )   Abstract: Objective　To explore the clinical application value of CT values in upper urinary tract calculi with pyelonephritis and pyonephrosis. Methods　The retrospective analysis was performed on 157 patients with renal infection caused by upper urinary tract calculi admitted to the hospital from March 2015 to January 2020. According to the clinical manifestations and auxiliary examinations, the patients were divided into three groups: simple hydronephrosis group (n=73), acute pyelonephritis group (n=58) and pyonephrosis group (n=26). All patients underwent multi-slice spiral CT plain scanning, and the CT values of renal pelvis hydrops were measured, calculated and compared in the three groups. The receiver operating curve (ROC) was drawn to search the optimal critical CT value as the diagnostic basis for identifying pyelonephritis andpyonephritis. Results　CT values of the simple hydronephrosis group, acute pyelonephritis group and pyonephrosis group increased in turn: (2.85±1.7) HU, (9.21±4.8) HU and (17.69±4.2) HU, respectively. There were significant differences between the three groups (F=175.127, P＜0.05). The area under ROC curves of CT values of renal pelvis hydrops in identifying pyelonephritis and pyonephrosis was 0.897, and the 95%CI was 0.812-0.953. When the CT value of renal pelvis hydrops was 12 HU, the Youden index was the largest (0.768), the sensitivity was 84.48% and the specificity was 92.31%. Conclusion　CT values accurately reflect the disease progression of pelvis infection caused by upper urinary tract calculi, and which has early clinical diagnostic value in identifying pyelonephritis and pyonephrosis. Related Articles | Metrics

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Preliminary study on the prognostic value of platelet count dynamic changes in sepsis ZONG Xiao-long, , HAN Yue, LI Wan-qiu, LI Hao-yu, WEI Dian-jun, LI Zhen-yu, △ 2020, 48 (10):  982-986.  doi: 10.11958/20201530 Abstract ( 694 )   PDF (518KB) ( 3750 )   Abstract: Objective　To explore the prognostic value of platelet count dynamic changes in the 28-day mortality of sepsis. Methods　The consecutive patients with sepsis hospitalized from January 2018 to December 2019 in our hospital were retrospectively studied. Dynamic data of platelet counts (PLT) within 14 days after ICU admission were collected. Progressive thrombocytopenia (PTCP) was identified as PLT decreasing over 20 percent than the baseline (the day 1) on the day 7. The performance of PTCP and sequential organ failure (SOFA) in predicting the 28-day mortality was evaluated via ROC analysis. The Logistic regression model was constructed to investigate the risk factors for the 28-day mortality of sepsis. The survival status of patients with and without PTCP were compared through Kaplan-Meier survival analysis. Results　A total of 148 patients were included in this study, 30 in the non-survival and others in the survival group. The 28-day mortality was 20.3%. In comparison with survival group, the SOFA score, hD-dimer, TCP and PTCP were significantly higher in non-survival group (P＜0.01). Five days after admission, PLT showed a tendency of progressive decline in non-survival group. The numbers of PLT were significantly higher on the day 7, 10, and 14 in survival group than those of non-survival group (P＜0.01). The area under ROC curves for PTCP, SOFA and their combination in predicting the 28-day mortality of sepsis were 0.683, 0.691 and 0.778, respectively. Logistic regression analysis indicated that PTCP was an independent risk factor for the 28-day mortality of sepsis (P＜0.01). Kaplan Meier survival analysis showed that the 28 day survival rate was significantly reduced in patients with PTCP (P＜0.01). Conclusion　PTCP is an independent risk factor for the 28-day mortality of sepsis. PTCP has a certain predictive value for the 28-day mortality of sepsis, and combined with baseline SOFA score can improve predictive efficiency. Related Articles | Metrics

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The association between serum adipocytokines levels and non-ST segment elevation acute coronary syndrome SI Yue-qiao, DING Zhen-jiang, WANG Wen-feng, SHAN Wei-chao, SHI Fei, LIU Tong, SUN Wang-le-xian△ 2020, 48 (10):  987-991.  doi: 10.11958/20200172 Abstract ( 684 )   PDF (444KB) ( 5022 )   Abstract: Objective　To explore the association of serum adipocytokines levels with the severity of non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods　A total of 137 inpatients with non-ST-segment elevation acute myocardial infarction and unstable angina pectoris (NSTE-ACS group) were enrolled in this study. Seventy-nine inpatients underwent coronary angiography (CAG) but without coronary artery stenosis during the same period (Non-CAD group) were also included. Serum levels of adipocytokines pentraxin3 (PTX-3), plasminogen activator inhibitor-1 (PAI-1), galectin-3 (GAL-3), netrin-1 (NTN1), interleukin-37 (IL-37) and adiponectin (ADP) were detected by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) curve was used to analyze the predictive value of pro-inflammatory cytokines and anti-inflammatory cytokines. The relationship between coronary atherosclerosis index (CAI) score and adipocytokines was assessed. The difference of serum adipocytokines levels in patients with the different number of stenotic coronary arteries was also compared. Results　The serum levels of pro-inflammatory adipocytokines PTX-3, PAI-1 and GAL-3 were significantly higher in NSTE-ACS group than those in Non-CAD group, while the serum levels of anti-inflammatory adipocytokines NTN1, IL-37 and ADP were significantly lower in NSTE-ACS group than those in Non-CAD group (all P＜0.01). The PTX-3 (rs=0.594), PAI-1 (rs=0.452), GAL-3 (rs=0.682) were positively correlated with CAI scores. The NTN1 (rs=-0.312), IL-37 (rs=-0.650) and ADP (rs=-0.582) were negatively correlated with CAI scores (all P＜0.05). The AUC of PTX-3, PAI-1, GAL-3, NTN1, IL-37 and ADP to predict NSTE-ACS were 0.913, 0.701, 0.837, 0.776, 0.905 and 0.857, respectively, and the best diagnostic cutoff values were 2.95 μg/L, 724.5 ng/L, 2.66 μg/L, 58.6 ng/L, 103 ng/L and 9.1 μg/L respectively. In the NSTE-ACS group, the serum levels of PTX-3, PAI-1 and GAL-3 were increased with the increased numbers of stenotic coronary arteries, but the NTN1, IL-37 and ADP levels were decreased (all P＜0.01). Conclusion　Serum pro-inflammatory adipocytokines including PTX-3, PAI-1 and GAL-3 are positively correlated with the severity of NSTE-ACS, while the anti-inflammatory adipocytokines, NTN1, IL-37 and ADP are negatively correlated with the severity of NSTE-ACS. All the above adipocytokines can be used as biomarkers for the clinical diagnosis and the severity assessment of NSTE-ACS. Related Articles | Metrics

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Establishment of poor effect model and external validation of oral propranolol in the treatment of infantile hemangioma LIU Zhi-jia, , JIA Jin-fu, FENG Wei, WANG Hao-jie, , ZHANG Shu-jian, LIU Zhi-jie, ZHAN Jiang-hua△ 2020, 48 (10):  992-996.  doi: 10.11958/20201006 Abstract ( 774 )   PDF (494KB) ( 3716 )   Abstract: Objective To establish and validate the model for predicting the efficacy of oral propranolol for infantile hemangiomas (IHs). Methods The children who received oral propranolol for IHs in Tianjin Children's Hospital and Xinjiang Urumqi Children's Hospital were collected from June 2011 to December 2018 as the model group. Univariate and multivariate Logistic regression analysis were used to screen out the factors affecting the therapeutic effect of propranolol and establish the poor-effect prediction model. A total of 113 IHs cases treated with oral propranolol in two hospitals from January to October 2019 were collected as the validation group (83 cases with good effect and 30 cases with poor effect). The receiver operating characteristics (ROC) curve was used to verify the discriminant validity of the poor-effect prediction model. Results A total of 585 children were used as the model group and were divided into good effect group (n=371) and poor effect group (n=214) according to the efficacy. In the modeling group, gestational age less than 37 weeks, the birth weight less than 2 500 g, the sizes of the lesions (the lesion size was 5-10 cm, >10 cm relative to <5 cm), and the age of medication more than 3 months were independent risk factors for poor effect of oral propranolol for IHs. The poor-effect prediction model was established as P=ex/(1+ex), ‘e’ is the natural logarithm, X=-1.082+0.680×(gestational age) + 0.665×(birth weight)－0.920×(medicine age)+0.375×(lesion size 5-10 cm) or (+1.327×lesion> 10 cm). The detection of the fit degree indicated that the fit degree of the prediction model was good (P=0.766), and the area under the ROC curve of the prediction model was 0.779 (95%CI: 0.740-0.818). The area under the ROC curve of external validation for the prediction model was 0.772 (95%CI: 0.639-0.784), which can better distinguish the children with poor effect. Conclusion The accuracy of the model in predicting the probability of oral propranolol for IHs with poor effect as a difference is high, which is helpful to improve the ability of early identification and screening of children with poor effect. Related Articles | Metrics

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Effects of 2.5 mg and 5 mg dexamethasone on ropivacaine brachial plexus nerve block HU Guang-jun, LI Li, SONG Xiao-yang, LI Bi-xi, GAN Guo-sheng 2020, 48 (10):  997-1000.  doi: 10.11958/20200507 Abstract ( 671 )   PDF (378KB) ( 3585 )   Abstract: Objective To evaluate effects of 2.5 mg and 5 mg of dexamethasone combined with ropivacaine for ultrasound-guided brachial plexus nerve block. Methods A total of 90 patients undergoing humerus surgery were enrolled in this study from May 2018 to July 2019, and patients were randomly divided into three groups, namely group D2.5, D5 and C , respectively. Patients received ultrasound-guided supraclavicular nerve block with dexamethasone 2.5 mg (group D2.5), 5 mg (group D5) or just saline combined with 150 mg ropivacaine (group C). The onset time of sensory and motor block and the time of the first analgesic administration after surgery (sensory block time) and the duration of motor block were recorded. Dosages of parecoxib sodium and oxycodone hydrochloride prescribed 48 hours after surgery together with rest and dynamic numeric rating scale (NRS) at 12, 24 and 48 hours after surgery were recorded. Results There were no significant differences in the onset time of sensory and motor block between the three groups. In group D2.5 and group D5, the time of first analgesic administration and the duration of motor block were significantly longer than those of group C (all P＜0.01). The dosages of parecoxib sodium in group D2.5 and oxycodone hydrochloride in group D5 within 48 hours after surgery were lower than those of group C (all P＜0.05). At 12 h after surgery, the rest and dynamic NRS were significantly lower in the group D2.5 and group D5 than those in the group C (P＜0.01). Postoperative blood glucose levels were significantly higher in group D2.5 and group D5 than those of group C (all P＜0.01). The blood glucose levels after operation were significantly higher than those before operation in group D2.5 and group D5 (P＜0.01). Conclusion Dexamethasone 2.5 mg or 5 mg are equivalent in enhancing brachial plexus block of single-shot supraclavicular brachial plexus block with ropivacaine and the time of the first analgesic administration after surgery. Related Articles | Metrics

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The effect of helicobacter pylori infection on peripheral arterial stiffness and 10-year cardiovascular risk in patients with diabetes mellitus GU Jian-wei, LI Yun, GU Xiao-qin, YANG Yun-feng, LIU Mi, WU Bi-hua, LIU Ju-hua, △ 2020, 48 (10):  1001-1005.  doi: 10.11958/20201028 Abstract ( 850 )   PDF (395KB) ( 4742 )   Abstract: Objective　To investigate the effect of helicobacter pylori (Hp) infection on peripheral arterial stiffness and 10-year cardiovascular risk in patients with diabetes mellitus (DM). Methods　DM patients who were tested for Hp infection in physical examination center of our hospital from January 2015 to December 2019 were enrolled in this study. Patients were divided into DMHp+ group and DMHp- group according to the Hp results. The hypertension, hyperlipidemia and smoking history were collected, and blood pressure, body mass index (BMI), cholesterol (TC), high-density lipoprotein (HDL-C), low density lipoprotein (LDL-C)，fasting blood glucose (FBG) and glycated hemoglobin (HbA1c) were also collected in the two groups. The peripheral arterial stiffness was measured by brachial to ankle pulse wave velocity (baPWV). The Framingham risk score (FRS) and Chinese ICVD 10-year risk assessment model were used to assess the 10-year cardiovascular risk and stratification. Results　(1) A total of 6 767 patients were included in the study, including 2 789 patients in the DMHp+ group and 3 978 patients in the DMHp- group. Data of age, percentage of male population, blood pressure, FBG and HbA1c were significantly higher in DMHp+ group compared with those of DMHp- group (P＜0.05). The BMI and HDL-C level was significantly lower in DMHp+ group compared with that of DMHp- group (P＜0.05). (2) The right, left and mean baPWV were significantly higher in DMHp+ group compared with those of DMHp- group（P＜0.01). The percentage of patients with severe peripheral arterial stiffness was higher in DMHp+ group than that of DMHp- group. The percentage of patients with normal, mild and moderate peripheral arterial stiffness was lower in DMHp + group than that of DMHp- group. (3) FRS and ICVD scores were significantly higher in DMHp+ group than those of the DMHp-group (P＜0.05). In the 10-year cardiovascular event assessment model, the percentage population of the high-risk (FRS and ICVD scores) was higher in DMHp+ group than that of DMHp- group (P＜0.01). Conclusion　Hp infection can accelerate pathologic progress of peripheral arterial stiffness and enhance 10-year cardiovascular disease risk in patients with DM. Related Articles | Metrics

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Screening and analysis of PAH gene mutations in children with phenylketonuria Tangshan city LU Cheng-fei, GUO Zhi-yi△, LU Bi-jia, LI Xiao-qian, LIU Jia-wei 2020, 48 (10):  1006-1009.  doi: 10.11958/20200984 Abstract ( 1313 )   PDF (773KB) ( 3618 )   Abstract: Objective　To analyze the screening results and mutations of phenylalanine hydroxylase (PAH) gene in children with phenylketonuria (PKU) in Tangshan. Methods　From January 2015 to December 2018, 303 777 newborns in Tangshan were selected to detect the content of phenylalanine (PA) in the heel blood by ninhydrin fluorescence method. The polymerase chain reaction (PCR) and gene sequencing methods were used to detect the PAH gene in PKU children. Results　A total of 609 suspected positive cases were found in the preliminary screening of 303 777 newborns. Among them, 411 cases were recalled for re-examination. The recall rate was 67.49%, 42 newborns were diagnosed, and the incidence rate was 13.8/100 000. The PAH gene sequencing in 42 PKU patients showed that 62 mutations were detected on 84 chromosomes, and the detection rate was 73.81%. Twelve mutations were detected, including 8 missense mutations, 2 nonsense mutations, 1 deletion mutation, and 1 splice mutation. The PAH gene mutations of patients were distributed in exons 2, 3, 6, 7, and 9, with the most exon 7 (35, 56.45%), followed by the third exon (14, 22.58%). The most common mutant genes were Exon7-R243Q (18, 29.03%), Exon3-R111X (10, 16.13%) and Exon7-R261Q (10, 16.13%). One child with typical PKU was found in the screening. Two heterozygous mutations were simultaneously found in the exon region: c.208-210delTCT (deletion mutation) and c.964G>A (guanine>adenine). Conclusion　The incidence of neonatal PKU is slightly higher in Tangshan than that in the whole country. The PAH gene mutations are mainly missense mutations. Exon 7 is the high-frequency mutation site of PAH gene in children in Tangshan. Related Articles | Metrics

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Progress in the effect of flavonoids on drug resistance in ovarian cancer LIN Shi-xin, GAO Jun△ 2020, 48 (10):  1010-1014.  doi: 10.11958/20200130 Abstract ( 772 )   PDF (393KB) ( 3768 )   Abstract:Ovarian cancer is the most lethal gynaecological cancer. And chemotherapy resistance is one of the main reasons for its poor prognosis. Recently, some natural products have been reported to overcome drug resistance, including flavonoids that are abundant in plants, foods, and are also one of the active ingredients in many traditional Chinese herbal medicines. Because of their characteristics of broad biological activity, high efficiency, low toxicity, good prevention and cure effects on various types of tumors, flavonoids have received extensive attention. Here, we summarize the research and discuss the underlying mechanisms, concluding that these flavonoids do not function as specific regulators of target proteins, but rather as multi-functional agents that negatively regulate the key factors contributing to drug resistance of ovarian cancer. Related Articles | Metrics

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Research progress of signaling pathways related to exosomes regulating cellular autophagy HU Ming-zhi, YANG Guo-an, SUN Xiao-lin△ 2020, 48 (10):  1015-1020.  doi: 10.11958/20200124 Abstract ( 839 )   PDF (409KB) ( 5056 )   Abstract: Exosomes are bilayer lipid membrane vesicles formed by the fusion and release of encapsulated polycystic body and cell membrane into the extracellular environment. Exosomes are rich in proteins, RNA and lipids, which can mediate intercellular communication and participate in various physiological and pathological processes. Autophagy is a process, in which cells encapsulate organelles, proteins and RNA that need to be degraded in the double-layer membrane vesicles to form autophagosomes, and combine with lysosomes to form autophagosomes and degrade contents. In recent years, many studies have revealed the molecular mechanism of the interaction between exosomes and autophagy, and found that the mTOR signaling pathway, toll-like receptor signaling pathway and STAT3/Bcl-2 signaling pathway are all important related pathways for exosomes to regulate autophagy and participate in the process of exosomes to regulate autophagy. In this paper, the mechanism of exosome regulating autophagy and its research progress are reviewed, which will provide new inspiration and help for future research on the application of exosome regulating autophagy in more diseases. Related Articles | Metrics

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Advances in the treatment of prostate cancer by chimeric antigen receptor modified T cells YOU Xiang-yun, , XIANG Zhen-dong, YI Cheng, ZHANG Man, YU Jun-feng△ 2020, 48 (10):  1020-1024.  doi: 10.11958/20200611 Abstract ( 678 )   PDF (377KB) ( 5212 )   Abstract：The research of chimeric antigen receptor modification T cells (CAR-T) is a hotspot in immunotherapy in recent years, which has achieved remarkable clinical efficacy in the treatment of hematological diseases. At present, CAR-T has also made great progress in the treatment of prostate cancer (PCa). CAR-T therapy targeting prostate-specific membrane antigen (PSMA) and prostate-stem cell antigen (PSCA) has made rapid progresses, which can significantly inhibit tumor cell growth and delay disease progression in a certain extent. This article reviewed the recent clinical research progress of prostate cancer associated antigen (TAA) in the treatment of prostate cancer with CAR-T, and briefly discussed the challenges of CAR-T in the treatment of prostate cancer for better clinical application. Related Articles | Metrics