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15 June 2021, Volume 49 Issue 6 Previous Issue    Next Issue

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Recommendations on the clinical significance grading of genetic variation in clinical gene testing Medical Genetics Branch of Tianjin Medical Association, Genetic Counseling Branch of Tianjin Medical Association 2021, 49 (6):  561-569.  doi: 10.11958/20210386 Abstract ( 2646 )   PDF (657KB) ( 4127 )   Presently, clinical genetic testing reports for genetic patients mainly describe the pathogenicity of gene variations and their clinical implications. When writing reports, laboratory staff often focus on the nature of variation itself. However, clinicians have to face the referred cases, so their focus is mainly on the clinical situation of cases. This situation often causes clinicians to misunderstand test reports. The paper proposes a five-tier categorization system of the sequence variation findings based on their clinical significance. That is, the genetic test report should not only classify the pathogenicity of gene variants, but also include the classification of clinical significance. This protocol recommended that the clinical significance of gene mutation be divided into five levels: variants with strong clinical significance, variants with potential clinical significance, variants of unknown clinical significance, unexpected secondary findings and variants with no important clinical significance. This protocol emphasizes the importance of accuracy and comprehensiveness of clinical phenotypes and the importance of laboratory-clinical communication. The standardization of phenotype description is advocated. These recommendations will promote the mutual understanding for the clinicians and laboratory staff, and will be helpful for the interpretation of the testing reports and genetic counseling. Related Articles | Metrics

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In vivo and in vitro study on the therapeutic effects of aloe polysaccharides on osteoarthritis in rats #br# ZHU Bi-kang, SHU Ke-gang, XU Wei-hua, QU Yang-yang, PANG Cong, LUO Shi-xing 2021, 49 (6):  570-576.  doi: 10.11958/20203584 Abstract ( 639 )   PDF (1278KB) ( 3488 )   Objective To explore the therapeutic effects of aloe polysaccharides (APS) on osteoarthritis (OA) in rats through in vitro and in vivo experiments. Methods The articular chondrocytes of SD suckling mice were isolated in vitro and cultured to 2 generations. The concentration of APS in the experimental group was screened by CCK-8. The chondrocyte proliferation and matrix degradation were assessed by detecting DNA content and proteoglycan (GAG) secretion. The realtime fluorescent quantitative PCR was used to detect osteoarthritis-related gene expression, and enzyme-linked immunosorbent assay (ELISA) method was used to detect inflammatory factor levels. Hematoxylin -Eosin (HE) staining, Safranin O and immunofluorescence staining were used to observe the anti-inflammatory and cartilage protection effects of APS. Its effects on osteoarthritis were further explored in SD rat model. Results The APS concentrations of 5 g/L, 10 g/L and 20 g/L were selected by CCK-8 as the low, medium and high dose experimental groups. It was found that DNA contents were significantly higher in each experimental group than those of the model group (P＜0.05). The detection showed that of GAG secretion was significantly higher in the high-dose experimental group than that of the model group (P＜0.05). PCR results showed that the expression levels of aggrecan (ACAN) and type Ⅱ collagen (COL2A1) were significantly up-regulated in the high-dose experimental group compared with those of the model group (P＜0.05), while tumor necrosis factor (TNF)- α, interleukin (IL)-6, the expression of matrix metalloproteinase (MMP)-3 and MMP-13 were significantly down-regulated (P＜0.05). The secretion levels of TNF-α and IL-6 were significantly lower in the high-dose experimental group than those of the model group (P＜0.05). HE and Safranin O staining also showed that the cell morphology was better in the APS experimental group than that of the model group. The immunofluorescence assay showed that the expression level of MMP- 13 was significantly lower in the high-dose experimental group than that of the model group (P＜0.05). In vivo articular cartilage tissue Safranin O staining and the International Osteoarthritis Research Society (OARSI) cartilage damage score also showed that the cartilage damage was significantly lower in the experimental group than that in the model group (P＜ 0.05). Conclusion APS has certain anti-inflammatory and cartilage protective effects on OA. Related Articles | Metrics

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miR-132 inhibits proliferation and migration of nasopharyngeal carcinoma cells by targeting KLF7 ZHANG Ke, JIANG Lan△, SENG Dong-jie, ZHU Qing-wen 2021, 49 (6):  577-582.  doi: 10.11958/20210313 Abstract ( 696 )   PDF (1233KB) ( 3755 )   Objective To investigate the effects of miR-132 on the proliferation and migration of nasopharyngeal carcinoma (NPC) cells by negatively targeting the expression of Kruppel-like factor 7 (KLF7). Methods NPC CNE-2Z cells were divided into blank group, NC group, miR-132 mimics group, KLF7-OE group and miR-132 mimics + KLF7-OE group. The expressions of miR-132 in NPC tissues and cells and normal nasopharyngeal tissues and cells were detected by fluorescence quantitative PCR (qPCR). The expression level of KLF7 protein was detected by Western blot assay. The targeting relationship between KLF7 and miR-132 was predicted and verified by TargetScan website and dual luciferase detection. CCK-8 test and Transwell test were used to detect the proliferation, migration and invasion of CNE-2Z cells. The tumor formation test in nude mice and immunohistochemistry were used to detect the growth of CNE-2Z cells in vivo and the blood vessels in tumor. Results The expression level of miR-132 was decreased in nasopharyngeal carcinoma tissue than that in normal nasopharyngeal tissue, and the expression of KLF7 protein was increased. The expression level of miR-132 was decreased in nasopharyngeal carcinoma CNE-2Z cells than that in normal nasopharyngeal epithelial cells NP69, and the expression of KLF7 protein was increased (P＜0.05). TargetScan prediction and dual luciferase detection showed that KLF7 was the target gene of miR-132. Compared with those in the blank group and NC group, the expression of KLF7 protein, cell proliferation activity at 36, 48 and 60 h, numbers of migration and invasion, tumor volume and microvessel density (MVD) in CNE-2Z cells were significantly decreased in miR-132 mimics group (P＜0.05), while the results were oppositive in KLF7- OE group (P＜0.05). Compared with those in miR-132 mimics group, the expression level of KLF7 protein, cell proliferation activity at 36, 48 and 60 h, numbers of migration and invasion, tumor volume and MVD were significantly increased in miR-132 mimics + KLF7-OE group (P＜0.05). Conclusion miR-132 can affect the proliferation, migration and invasion of NPC cells by negatively regulating the expression of KLF7. Related Articles | Metrics

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Analysis of serum metabonomics in renovascular hypertensive rats based on GC-TOF/MS CHEN Hui-xia, YAN Yu-han, YU Hui, WANG Zhan-li, HU Hai 2021, 49 (6):  583-587.  doi: 10.11958/20200326 Abstract ( 503 )   PDF (843KB) ( 3524 )   Objective To analyze changes of serum metabolites in two-kidney-one-clip (2K1C) renal hypertension rats and sham-operated rats based on the gas chromatography-time-of-flight mass spectrometry (GC-TOF/MS) technology. Methods Twenty healthy male SD rats were randomly divided into sham operation group and 2K1C model group with 10 rats in each group. The changes of body mass and tail artery systolic pressure before modeling and four weeks after modeling were compared between the two groups of rats. GC-TOF/MS was used to detect the expression level of serum metabolites, and orthogonal partial least squares discriminant analysis (OPLS-DA) was used to screen out the differential metabolites. The screened differential metabolites were analyzed by Cluster analysis and KEGG pathway analysis. Results A total of 7 rats were successfully modeled after 4 weeks in the 2K1C model group. Compared with the Sham group, a total of 14 differentially expressed metabolites were screened in the 2K1C model group, including up-regulated arachidonic acid, hippuric acid, heptadecanoic acid, indolelactate, xylose, cis-gondoic acid, fumaric acid, cytidine-monophosphate, lactamide, 2-hydroxy-3-isopropylbutanedioic acid and biuret, and down-regulated tyrosine, cholic acid and stigmasterol. These differential metabolites were closely related to energy metabolism, amino acid metabolism, lipid metabolism and primary bile acid biosynthesis. Conclusion The changes of serum metabolites in 2K1C hypertensive rats are involved in various pathways such as energy metabolism, which in turn affects the pathophysiological process of renal hypertension. Related Articles | Metrics

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Effects of emodin on oxidative stress damage and miR-34a/SIRT1 axis in rat model of streptococcus pneumoniae pneumonia ZHANG Xiao-hong, WANG Hong-min, LI Yang, HU Chao-yang, LI Feng-zhi, CHANG Rui, HUANG Han, JIN Li 2021, 49 (6):  588-592.  doi: 10.11958/20203007 Abstract ( 612 )   PDF (556KB) ( 3860 )   Objective To investigate the effects of emodin on oxidative stress injury and microRNA-34a/silent information regulator factor 2 related enzyme 1 (miR-34a/SIRT1) axis in streptococcus pneumoniae pneumonia rat model. Methods According to random number table, sixty rats were divided into sham operation group, model group, low-dose (20 mg/kg) emodin group, middle-dose (40 mg/kg) emodin group and high-dose (80 mg/kg) emodin group, with 12 rats in each group. The model of pneumonia was established by intratracheal instillation of streptococcus pneumoniae. At 24 h after successful modeling, the emodin intervention group was intraperitoneally injected with emodin solution once a day for 7 days. HE staining was used to detect the pathological changes of lung tissue. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and glutathione peroxidase (GSH-Px). UV-VIS spectrophotometer was used to detect the levels of superoxide dismutase (SOD) and malondialdehyde (MDA). The levels of miR-34a and SIRT1 mRNA in lung tissue were detected by qPCR. The expression of SIRT1 protein was detected by Western blot assay. Results In the sham operation group, the lung tissue was normal without obvious pathological changes. In the model group, it was found that the alveoli collapsed and a large number of inflammatory cells infiltrated. In the low, middle and high dose emodin groups, the inflammatory lesions of lung tissue were alleviated. Compared with those in the sham operation group, the levels of TNF-α, IL-6, MDA and miR-34a were significantly higher in the model group (P <0.05), and the levels of SOD, GSH-Px and SIRT1 mRNA and protein in lung tissue were significantly lower (P < 0.05). Compared with those in the model group, the levels of TNF- α, IL-6, MDA and miR-34a were significantly lower in the middle and high-dose emodin groups (P < 0.05), and the levels of SOD, GSH-Px and SIRT1 mRNA and protein in lung tissue were significantly higher (P < 0.05), in which the high-dose emodin group showed the most obvious changes. Conclusion Emodin can reduce inflammatory reaction and oxidative stress injury in rat model of streptococcus pneumoniae pneumonia, which may be related to the regulation of miR-34a/SIRT1 axis. Related Articles | Metrics

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The expression of serum miR-122 and miR-155 in liver injury induced by valproate in mouse offspring CUI Li-hua, LI Yang, BAI Jing, MA Xiao-yan, WANG Meng, MA Jing-yi, SONG Jia-hui, FENG Fu-min 2021, 49 (6):  593-597.  doi: 10.11958/20202948 Abstract ( 672 )   PDF (797KB) ( 3813 )   Objective To explore the dynamic expressions of serum miR-122 and miR-155 during the liver injury induced by valproate (VPA) in young mice and their relationship with liver injury. Methods Kunming mice aged 4 weeks were randomly divided into control groups (n=30) and experimental groups (n=56) according to random number table method. Seven experimental groups were given VPA 375 mg·kg-1·d-1 for 1 day, 3 days, 5 days, 7 days, 14 days, 21 days and 28 days consecutively. While five control groups were given 1 mL normal saline daily for 1 day, 7 days, 14 days, 21 days and 28 days. The serum samples and liver tissues of each group were collected. The pathological changes of liver tissue were observed by HE staining. The activity of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in serum were detected by automatic biochemical analyzer. The serum expression levels of miR-122 and miR-155 were detected by real-time quantitative polymerase chain reaction (qPCR). Results The histopathological results showed that liver cells had different degrees of vacuolar degeneration in the experimental groups. A small number of inflammatory cells were observed in the cytoplasm of hepatocytes on the day 3, 5, 7, a large number of hepatocytes were denatured and necrotic on day 21 and regenerated on day 28. It showed a trend of decreasing-increasing on ALT and AST. The expression level of miR-122 was down-regulated in the experimental group after administration, decreased to the lowest level on day 7 (decreased by 81%), and then up-regulated. However, the expression trend of miR-155 was opposite to that of miR-122, reached the peak on day 7, which was 2.88 times that of the control group. MiR-122 was positively correlated with ALT and AST (rs= 0.965 and 0.900, respectively, P＜0.05), while miR-155 was negatively correlated with AST (rs=-0.811, P＜0.05). Conclusion MiR-122 and miR-155 are involved in the occurrence of VPA drug-induced liver injury and are expected to become the early warning indicators. Related Articles | Metrics

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The effect of atorvastatin calcium on pulmonary vascular remodeling in chronic obstructive pulmonary disease rats #br# HE Yong-hong, QIANG Li, WANG Song-ping 2021, 49 (6):  598-602.  doi: 10.11958/202013011 Abstract ( 700 )   PDF (857KB) ( 3682 )   Objective To investigate the regulatory mechanism of atorvastatin on pulmonary vascular remodeling and expression of histone deacetylation enzyme-2 (HDAC2) in chronic obstructive pulmonary disease (COPD) rats. Methods Eighteen female SD rats were randomly divided into control group, COPD group and atorvastatin calcium group, with 6 rats in each group. The COPD model was established by passive smoking and intratracheal injection of lipopolysaccharide. From the second day, atorvastatin group was intragastrically administered with atorvastatin 10 mg/(kg·d) half an hour prior to smoking, control group and COPD group were given equal amount of normal saline at the same time. The experiment lasted six weeks. The general condition of the rats was observed during the experiment, and the body weight was weighed every two weeks. After six weeks, Hematoxylin-eosinstaining and Victoria Blue + Van Gibson VG were used to observe lung tissue pathological changes, and the degree of pulmonary vascular remodeling was evaluated. HDAC2 was determined with ELISA. The protein expression of HDAC2 was measured by Western blot assay and HDAC2 mRNA was detected by qPCR. Results At the 2nd, 4th and 6th week, compared with the control group, the body weights were decreased in COPD group (P＜0.05). Compared with COPD group, the weights of rats were increased in the atorvastain group (P＜0.05). Compared with control group, the degree of pulmonary vascular inflammation and pulmonary vascular remodeling increased in COPD group, and the vascular wall area/total vascular area (WA% ), vascular wall thickness/vascular outer diameter length (WT% ), lung inflammation score increased significantly, with the serum and lung tissue expressions of HDAC2 decreased. The level of VEGF in the lung tissue increased (P＜0.05). Compared with COPD group, the lung tissue showed less inflammatory cells in the atorvastatin group, and vascular pathological changes were significantly relieved. The WT% , WA% and lung inflammation score decreased significantly, with the expression of HDAC2 in the serum and lung tissue increased, and the level of VEGF in the lung tissue decreased (P＜0.05). Conclusion Atorvastatin calcium can reduce the degree of pulmonary vascular remodeling in COPD rats by increasing the expression and level of HDAC2. Related Articles | Metrics

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The predictive value of TG/HDL-C and TyG index for hyperuricemia in T2DM patients YANG Xi, LIU Yi-ying, WAN Qin 2021, 49 (6):  603-608.  doi: 10.11958/20203608 Abstract ( 1498 )   PDF (497KB) ( 3836 )   Objective To investigate the predictive value of triacylglycerol high-density lipoprotein cholesterol ratio (TG/HDL-C) and triacylglycerol glucose product index (TyG) on the development of hyperuricemia (HUA) in patients with type 2 diabetes mellitus (T2DM). Methods A total of 668 patients diagnosed with T2DM were selected and were divided into HUA group (n=183) and non-hyperuricemia (NUA) group (n=485) according to their serum uric acid levels. The basic information, physical examination and other data of patients were collected. The laboratory-related indicators were tested. Multivariate Logistic regression was used to explore the relationship of TG/HDL-C (quartiles Q1 to Q4 groups) and TyG index (quartiles q1 to q4 groups) with the development of HUA in patients with T2DM, and the effect of both with serum uric acid on diabetic complications. The subject working characteristic (ROC) curve was used to assess the predictive value of the TG/HDL-C and TyG index for HUA in T2DM patients. Results Multivariate Logistic regression analysis showed that after uncontrolled and controlled for age, sex, systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass, body mass index (BMI), waist circumference (WC) and hip circumference, the risk of HUA was higher in quartiles 3 and 4 groups of the TG/HDL-C and TyG index than that in quartile 1 group (P < 0.05), and there was no significant difference between quartile 2 group and quartile 1 group (P＞0.05). After further control of triacylglycerol (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), history of hypertension, history of smoking, and history of alcohol consumption, the risk of HUA was still higher in quartiles 3 and 4 groups of TG/HDL-C than that in quartile 1 group (P < 0.05), while TyG index was not associated with the risk of HUA at this time (P＞0.05). TG/HDL-C, TyG index and serum uric acid were three risk factors for diabetic albuminuria, and TG/HDL-C was a protective factor for diabetic peripheral neuropathy (P＜0.05), while all three were not associated with diabetic retinopathy (P＞0.05). The area under the ROC curve showed that TG/HDL-C and TyG index were both predictive for HUA, and the AUC of TG/HDL-C was 0.651, the AUC of TyG index was 0.617. Conclusion TG/HDL-C and TyG index are risk factors for the occurrence of HUA in T2DM, and both have some predictive value for HUA. TG/HDL-C, TyG index and serum uric acid are closely related to diabetic complications and should be closely monitored clinically. Related Articles | Metrics

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Analysis of related factors of intraventricular hemorrhage in very low birth weight premature infants  ZHAO Ying, TIAN Xiu-ying, ZHANG Wan-xian 2021, 49 (6):  608-612.  doi: 10.11958/20203214 Abstract ( 500 )   PDF (399KB) ( 3647 )   Objective To analyze the related factors of intraventricular hemorrhage (IVH) in very low birth weight premature infants and to improve the survival rate and quality of life. Methods A retrospective analysis of 421 very low birth weight premature infants admitted to the neonatal intensive care unit of Tianjin Central Hospital of Gynecology and Obstetrics from July 2017 to July 2019 was conducted, including their gestational age, gender, delivery mode, birth weight, head ultrasound result, maternal pregnancy complications (maternal pregnancy with hypertension, thyroid dysfunction, gestational diabetes mellitus, premature rupture of membranes, chorioamnionitis and the antenatal use of glucocorticoids) and perinatal conditions (whether Apgar score 5 minutes after birth was ≤ 7, and whether there was sepsis, hemorrhagic disease, patent ductus arteriosus or invasive mechanical when the ultrasound examination was conducted within 72 hours after birth). On this basis, we analyzed the related factors of intraventricular hemorrhage and its severity. Results Compared with the non-IVH group, the proportion of infants with gestational age ≤28 weeks, birth weight≤1 000 g, 5 min Apgar score after birth ≤7, history of septicemia and history of invasive mechanical ventilation were significantly higher in the IVH group, the proportion of maternal pregnancy with hypertension was significantly lower (all P<0.05). Binary Logistic regression analysis showed that 5 min Apgar score after birth≤7 (OR=2.273, 95%CI: 1.163-4.442) and vaginal delivery (OR= 2.727, 95%CI: 1.522-4.885) were the independent risk factors for intraventricular hemorrhage. Compared with the nonsevere IVH group, the proportion of infants with gestational age ≤28 weeks, birth weight≤1 000 g, 5 min Apgar score after birth ≤7, history of septicemia were higher in the severe IVH group, while the proportion of antenatal use of glucocorticoids was lower (all P＜0.05). Conclusion The effective resuscitation and appropriate delivery mode can effectively reduce the incidence of intraventricular hemorrhage in very low birth weight premature infants, and the antenatal use of glucocorticoids can reduce the occurrence of severe intraventricular hemorrhage. Related Articles | Metrics

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Correlation between serum albumin level and cognitive impairment after acute ischemic stroke #br# MEN Hui, JIN Xiang-lan, ZHAO Shi-jiao, WANG Ying, LI Shi-xin, ZHOU Jing 2021, 49 (6):  613-616.  doi: 10.11958/20210275 Abstract ( 524 )   PDF (391KB) ( 3817 )   Objective To investigate the correlation between serum albumin level and cognitive function in patients with acute ischemic stroke (AIS) and to provide a basis for the early identification of cognitive impairment after stroke. Methods A total of 103 AIS patients were selected and divided into cognitive impairment group (MMSE≤26, n=48) and the group without cognitive impairment (MMSE>26, n=55) by Mini-Mental State Examination (MMSE). The differences in demographic characteristics, serum biochemical parameters and imaging characteristics at admission were compared between the 2 groups. The multivariate logistic regression was used to analyze the influencing factors of cognitive dysfunction in AIS patients, and Spearman correlation was used to analyze the correlation between albumin levels and MMSE scores in patients. Results Compared with the group without cognitive impairment, patients in the cognitive impairment group were older, had a lower education level and had an increased proportion of low albumin (≤ 40 g/L) level (52.08% vs. 18.18%). Multivariate logistic regression analysis showed that the low albumin was one of risk factors for cognitive impairment in AIS patients (OR=3.379, 95%CI: 1.227-9.302, P＜0.05). There was a positive correlation between MMSE score and the serum albumin level (rs=0.426, P＜0.01). Conclusion The low albumin level is one of risk factors for cognitive decline in patients with AIS. The early cognitive assessment is helpful for early recognition of cognitive impairment after stroke. Related Articles | Metrics

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The significance of HA, ColⅣ, LN and PⅢNP-P in the evaluation of connective tissue disease with interstitial lung disease LIU Xiao-min, SUN Hui-ying, WANG Yong-fu, LU Fu-ai 2021, 49 (6):  617-621.  doi: 10.11958/20210036 Abstract ( 749 )   PDF (438KB) ( 3668 )   ObjectiveTo explore the significance of the serum changes of hyaluronic acid (HA), Ⅳ type collagen, (Col Ⅳ), laminin (LN) and type Ⅲ before pre-collagen n-terminal peptide (PⅢNP-P) in connective tissue diseases-interstitial lung disease (CTD-ILD). MethodsA total of 157 patients diagnosed as connective tissue disease were selected, including 87 patients with the lung high-resolution CT (HRCT) diagnosed with ILD (CTD-ILD group) and 70 patients without combined ILD (CTD-non-ILD group). The clinical data and serum test results were collected in 2 groups of patients. The pulmonary function test, blood gas analysis and lung HRCT, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), HA, Col Ⅳ, LN, PⅢNP-P and other indicators were also collected. The clinical significance of HA, Col Ⅳ, LN and PⅢNP-P in CTD-ILD was analyzed. Results The serum levels of HA and Col Ⅳ were significantly increased in CTD-ILD group compared with those of the CTD-non ILD group (P＜0.05). There were no significant differences in serum ESR, CRP, PⅢNP-P and LN between the 2 groups of patients. The serum level of HA was positively correlated with ESR, CRP, alveolar inflammation score and clinical-radio-physiological score in CTD-ILD group (rs= 0.230, 0.254, 0.497 and 0.267, P＜0.05), and negatively correlated with arterial oxygen partial pressure [p（O2）] (rs=-0.318, P＜0.01). The serum level of Col Ⅳ was positively correlated with alveolar inflammation score in CTD-ILD group (rs=0.212, P＜0.05), and negatively correlated with p(O2) (rs=-0.327, P＜0.01). ConclusionThe serum levels of HA and Col Ⅳ are closely related to the degree of lung inflammation of CTD - ILD, suggesting its predictive value for CTD-ILD. HA is closely associated with the condition of CTD-ILD activity, which can be used as an indicator to reflect the disease activity of CTD-ILD. Related Articles | Metrics

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Study on the analgesic effect and safety of dexmedetomidine combined with hydromorphone for patient-controlled intravenous analgesia (PCIA) after gynecological open surgery in plateau area RAO Yang, SONG Li-na, LYU Yong-gang, YANG Jing, HUANG Qu-sang-zhu-man, BAI Jie, WANG Li, LI Yi-ze 2021, 49 (6):  621-624.  doi: 10.11958/20210505 Abstract ( 565 )   PDF (410KB) ( 3762 )   Objective To explore the analgesic effect and side effects of dexmedetomidine combined with hydromorphone for patient-controlled intravenous analgesia (PCIA) after gynecological open surgery in plateau area. Methods According to the random number table method, 160 patients in plateau area who received PCIA after gynecological open surgery under general anesthesia were divided into 4 groups: dexmedetomidine 2 μg/kg + sufentanil 1 μg/kg group (DS group), dexmedetomidine 2 μg/kg + hydromorphone 0.03 mg/kg group (DH1 group), dexmedetomidine 2 μg/kg + hydromorphone 0.05 mg/kg group (DH2 group) and dexmedetomidine 2 μg/kg + hydromorphone 0.1 mg/kg group (DH3 group). The visual analogue scale (VAS), the number of self-controlled analgesia and the number of supplementary analgesia in 48 hours were compared to evaluate the analgesic effect between the four groups. The incidence of adverse reactions such as vomiting was also compared between the four groups. Results There were no significant differences in VAS scores of resting pain, motor pain and the frequency of self-control analgesia at each time point between DS group, DH2 group and DH3 group. The VAS scores of resting pain, motor pain and the frequency of self-control analgesia at each time point were significantly higher in DH1 group than those in other groups (P＜0.05). Only the patients in DH1 group needed additional analgesia. The incidence of vomiting was significantly higher in DH3 group than that in other groups (P＜0.05). Conclusion Dexmedetomidine 2 μg/kg combined with hydromorphone 0.05 mg/kg has a significant effect on PCIA after gynecological open surgery in plateau area and has a low incidence of adverse reactions, so it is recommended as the best dose of PCIA after gynecological open surgery in plateau area. Related Articles | Metrics

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Analysis of related factors of tinnitus and cerebrospinal fluid leakage after acoustic neuroma #br# HE Peng, LI Ran, LUO Wen-kai, SHANG Wei, LIU An-long 2021, 49 (6):  625-628.  doi: 10.11958/20202517 Abstract ( 1057 )   PDF (383KB) ( 3567 )   Objective To explore the influencing factors of tinnitus and cerebrospinal fluid leakage in patients with acoustic neuroma after microsurgery. MethodsA total of 127 patients with acoustic neuroma treated in the department of neurosurgery of our hospital from October 2017 to January 2020 were selected as the study objects. Patients were divided into large tumor group (43 cases), medium tumor group (46 cases) and small tumor group (38 cases) according to the long diameter of tumor. The incidence of tinnitus and cerebrospinal fluid leakage was compared between the three groups. The influencing factors of tinnitus and cerebrospinal fluid leakage after acoustic neuroma microsurgery were analyzed. Results Among the 127 patients, 54 (42.52%) cases of tinnitus occurred and 49 (38.58%) cases of cerebrospinal fluid leakage occurred after operation. The incidence of tinnitus was higher in the large tumor group than that in the small tumor group (P＜0.017). The incidence of cerebrospinal fluid leakage was higher in the large tumor group than that in the small and medium tumor group (P＜0.017). Compared with the non tinnitus group, the tinnitus group had a longer course of disease, a higher proportion of preoperative internal auditory canal enlargement, a higher proportion of internal auditory canal posterior wall abrasion, and a longer operation time (P＜0.05). Compared with the group without cerebrospinal fluid leakage, the group with cerebrospinal fluid leakage had older age, longer course of disease, higher proportion of preoperative expansion of internal auditory canal, higher proportion of partial abrasion of posterior wall of internal auditory canal and longer operation time (P＜0.05). Larger tumor size was an independent risk factor for tinnitus after acoustic neuroma operation (P＜0.05), and larger tumor size and longer operation time were independent risk factors for the cerebrospinal fluid leakage after acoustic neuroma operation (P＜0.05). Conclusion The early detection of acoustic neuroma can reduce the risk of tinnitus and cerebrospinal fluid leakage after acoustic neuroma microsurgery. Related Articles | Metrics

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The clinical effect of vital pulp preservation for carious exposed permanent molars unable to complete root canal therapy CHEN Liang, CAI Liang-jing, ZHANG Zhen-fang, MO Fei-fei, TIAN Guang-jie, WANG Zi-hui, WANG Yong-lan, WU Chen-xuan 2021, 49 (6):  629-632.  doi: 10.11958/20202953 Abstract ( 520 )   PDF (550KB) ( 3634 )   Objective To observe the clinical effect of vital pulp therapy in permanent molars with cariously exposed pulp that can not complete root canal therapy. Methods Thirty patients with carious exposed pulp permanent molars who could not compete root canal therapy were treated by partial pulpotomy (12 cases) or pulpotomy (18 cases). The bioceramic material iRoot BP Plus was used to preserve the pulp. The patients were followed up regularly after operation, and the treatment effect was observed by clinical and imaging examination. Results After 12-36 month follow-up, 26 cases showed a good clinical effect, no pain and the root and periapical were normal. Two cases had cold stimulation sensitivity after operation and developed to acute pulpitis. Two cases had buccal sinus. The pulp vitality test showed that the pulp was dead and the teeth were extracted. Conclusion The vital pulp therapy in permanent molar with cariously exposed pulp has good clinical effect. The operation of vital pulp therapy is easier and the treatment time was shorter than that of root canal therapy. Related Articles | Metrics

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EBUS-TDB, endobronchial ultrasound guided tunnel- drilling biopsy #br# FENG Jing, SHI Yu 2021, 49 (6):  633-635.  doi: 10.11958/20210657 Abstract ( 608 )   PDF (468KB) ( 3493 )   Sarcoidosis, tuberculosis, malignant tumor, lymphadenitis and other diseases can cause hilar and mediastinal lymphadenopathy, mainly including sarcoidosis, tuberculosis, tumor and lymphadenitis, but lack of characteristic clinical manifestations and imaging changes, so the diagnosis is more difficult. Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is an interventional pulmonary technology for cytopathological or histopathological diagnosis by puncturing to obtain diseased tissues, which is guided by endobronchial ultrasound (EBUS) to distinguish the extratracheobronchial hilar and mediastinal lesions, blood vessels and lymph nodes. On the basis of EBUS-TBNA, endobronchial ultrasound guided tunnel- drilling biopsy (EBUS-TDB) can improve the sensitivity and specificity of diagnosis further for hilar and mediastinal diseases. Related Articles | Metrics

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The quantitative evaluation of left atrial volume and function by four-dimensional echocardiography in patients with different grades of liver cirrhosis DAI Min, WANG Yun-le, PENG Li-juan, DANG Shi-peng, QIAN Da-jun, MA Fang-shan 2021, 49 (6):  636-641.  doi: 10.11958/20203448 Abstract ( 627 )   PDF (687KB) ( 3586 )   Objective To evaluate the strain and volume of left atrium (LA) by four-dimensional left atrium quantification (4D LAQ) in patients with different grades of liver cirrhosis. MethodsSixty patients with liver cirrhosis were enrolled and divided into Child-Pugh A group (n=26), Child-Pugh B group (n=19) and Child-Pugh C group (n=15) according to Child-Pugh grading. The control group consisted of 60 healthy subjects. The left atrial maximum volume (LAVmax), left atrial minimum volume (LAVmin) and left atrial pre-systolic volume (LAVpreA) were measured by 4D LAQ. The left atrial ejection volume (LAEV) and left atrial ejection fraction (LAEF) were calculated. The LA longitudinal and circumferential strain during the left ventricular systole, the early diastole and late diastole (LASr, LAScd, LASct, LASr_c, LAScd_c 和 LASct_c) were measured by 4D LAQ. The traditional echocardiography parameters, LA dimension (LAD), left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) were also analyzed. Results Compared with control group, LAVmax, LAVmin, LAVpreA and LAEV were all significantly increased in varying groups of liver cirrhosis (P＜0.01). The absolute values of LASr, LASct, LASr_c and LASct_c were higher in Child-Pugh A group than those in control group (P＜0.01). There were no significant differences in the absolute values of LAScd and LAScd_c between Child-Pugh A group and the control group. In Child-Pugh B and C groups, the absolute values of LASr, LASct, LASr_c and LASct_c were lower than those in Child-Pugh A group (P＜0.05), and the absolute values of LAScd and LAScd_c were reduced in Child-Pugh B and C groups compared with those in control group (P＜0.05). Correlation analysis showed that LAVmax, LAVmin and LAVpreA were positively correlated with Child-Pugh scores (r=0.383, 0.325 and 0.302, P＜0.05), and the absolute values of LASr, LAScd, LASct, LASr_c, LAScd_c and LASct_c were negatively correlated with ChildPugh scores (r=-0.387, -0.463, -0.623, -0.365, -0.456 and -0.467, P＜0.01). Conclusion 4D LAQ can sensitively evaluate the changes of morphology and function of left atrium in patients with cirrhosis at different stages, providing reliable evidence for the early diagnosis, treatment intervention and efficacy evaluation in patients with cirrhotic cardiomyopathy. Related Articles | Metrics

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Prediction model construction and preliminary application of postoperative delirium in elderly hip fracture patients #br# ZHANG Ming-mei, ZHU Xing-bo, HUANG Li-xin 2021, 49 (6):  641-645.  doi: 10.11958/20201943 Abstract ( 539 )   PDF (529KB) ( 3614 )   Objective To establish an effective predictive model for assessing the risk of postoperative delirium (POD) in elderly patients with hip orthopedics and verify its feasibility. Methods A total of 205 elderly patients undergoing hip surgery in the department of orthopedics were selected. The data of patient age, gender, comorbidities, dystrophia, debilitation, preoperative albumin, intraoperative blood transfusion, surgical method, operative duration, the American Society of Anesthesiologists (ASA) grade, anesthesia method and postoperative C-reactive protein (CRP) were collected. Multivariate Logistic regression was used to screen the influencing factors of POD, and a risk prediction model was established. The histogram was drawn. Receiver operating characteristic (ROC) curve was used to analyze the prediction effect of the model. In addition, 80 elderly patients who underwent hip surgery were selected to preliminarily verify the effectiveness of the prediction model. Results A total of 73 cases occurred POD in 205 elderly patients with hip surgery, and the incidence rate was 35.61%. Univariate and multivariate Logistic regression analysis showed that age, duration of operation, complicated cardiovascular and cerebrovascular diseases, anesthesia method, frailty and ASA grade were influencing factors of POD. The AUC under ROC curve was 0.915 (95%CI: 0.869-0.950), sensitivity was 78.49% and specificity was 85.97%. In the preliminary validation cohort, 21 cases (80 patients) developed POD, and the model predicted 24 cases. The sensitivity and specificity were 90.48% and 91.53%, respectively. ConclusionThe prediction model established in this study is suitable for the risk assessment of perioperative evaluation of elderly hip fracture patients, which provides reference for clinical medical staff to identify high-risk population and provides targeted preventive intervention. Related Articles | Metrics

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Construction and verification of a nomogram prediction model for the risk of restless legs syndrome during dialysis LI Fang, DENG Yue-yi, ZHU Rong, ZHOU Wen-qin, WANG Wei-qiong 2021, 49 (6):  646-650.  doi: 10.11958/20210001 Abstract ( 507 )   PDF (657KB) ( 3655 )   Objective To construct a nomogram prediction model of the risk of dialysis complicated with restless legs syndrome (RLS) and conduct external verification. Methods A total of 524 dialysis patients were collected as the modeling group, and a nomogram prediction model of the risk of RLS complicated by dialysis was constructed. In addition, 101 dialysis patients were collected as the verification group for external verification of the model. Both groups were divided into concurrent group and non-concurrent group according to whether concurrent RLS. Results The complication rate of RLS in dialysis patients was 11.64% in the modeling group. Compared with the uncomplicated group, the proportion of diabetes history, cerebral infarction history, dialysis age and parathyroid hormone (PTH) levels were higher in the complicated group (P＜0.05), and hemoglobin (Hb) and serum iron were lower (P＜0.05). Multivariate Logistic regression analysis showed that diabetes history, cerebral infarction history, dialysis age≥48 months, PTH ≥500 ng/L and Hb＜100 g/L were independent risk factors for dialysis complicated by RLS in the modeling group. Based on this, the risk nomogram prediction model of dialysis concurrent RLS was verified by Bootstrap internal verification. The H-L test showed that χ2=7.541 (P=0.563). The calibration curve fited well. The area under the ROC curve (AUC) and the C-index both were 0.842 (95%CI: 0.787 - 0.896). The external verification results showed that the predicted probability of the calibration curve was in good agreement with the actual probability, and the AUC was 0.854 (95%CI: 0.738 - 0.969). Conclusion The constructed risk nomogram prediction model of dialysis concurrent RLS has good calibration and discrimination. Related Articles | Metrics

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The awareness status and influencing factors of risk factors of acute myocardial infarction in residents over 35 years old in Tianjin #br# HAN Peng, MA Jing, ZHANG Nan, XIAO Jian-yong, WANG Jing-xian, WANG Yuan, XU Shi-bo, GAO Jing, LIU Yin 2021, 49 (6):  651-655.  doi: 10.11958/20210097 Abstract ( 589 )   PDF (422KB) ( 3647 )   Objective To investigate the awareness of the risk factors of acute myocardial infarction (AMI) in community residents over 35 years old in Tianjin and provide a basis for formulating targeted health education. Methods Multi-stage stratified random sampling was used to select 4 122 community residents over 35 years old in Tianjin, and selfdesigned questionnaires were used to investigate the awareness of AMI risk factors. Multivariate Logistic regression analysis was used to analyze factors that may affect the good knowledge of AMI risk factors. Results The average number of AMI risk factors that community residents could correctly identify was (5.1±2.9). 10.9% (451 cases) of the respondents could identify all the 10 risk factors, while 2.6% (107 cases) of the respondents could not identify any AMI risk factors. The three most-known risk factors for AMI were hypertension (70.0%), family history of premature coronary heart disease (62.2%) and hyperlipidemia (58.3%). Per capita monthly income ≥ 8 000 yuan (OR=1.533, 95%CI: 1.110-2.118), having medical insurance (OR=3.106, 95%CI: 1.941-4.969), hypertension (OR=1.338, 95%CI: 1.160-1.543), regular annual physical examination (OR=1.447，95%CI: 1.256-1.668), immediate family members with history of cardiovascular disease (OR=1.580, 95%CI: 1.378-1.811) and university and above education (OR=1.322, 95%CI: 1.139-1.535) showed a relatively high level of cognition of risk factors for AMI. Conclusion Residents over 35 years old in Tianjin havea moderate level of cognition for AMI risk factors, and they still lack sufficient knowledge. There is an urgent need for effective targeted education strategies to improve community residents’awareness of risk factors for AMI, especially low-income, low-level education and diabetes persons, so as to achieve the early intervention of controllable risk factors and reduce the incidence of AMI. Related Articles | Metrics

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Research progress on the role of NLRP3 inflammasome in myocardial ischemia-reperfusion injury #br# LI Dan, GAO Shan 2021, 49 (6):  656-662.  doi: 10.11958/20203050 Abstract ( 792 )   PDF (657KB) ( 3876 )   Inflammasome is a multi-protein complex, which is a crucial constituent of innate immunity. NLRP3 inflammasome is the most extensively studied one. NLRP3 is composed of NLRP3, apoptosis associated spot like protein (ASC) and pro-cysteine aspartate specific protease (caspase) - 1. When cells are stimulated, NLRP3 is activated and can recruit pro-caspase-1 through the binding protein ASC to form NLRP3 inflammasome. Under the action of NLRP3 inflammasome, pro-caspase-1 is activated to caspase-1, which eventually leads to the maturation and secretion of IL-1 β and IL-18, causing a series of inflammatory reactions. The NLRP3 inflammasome plays an important role in atherosclerosis, type 2 diabetes, cancer and other diseases. There has been increasing evidence that NLRP3 inflammasome also plays an important role in heart diseases, including myocardial ischemia/reperfusion injury (MI/RI). This article briefly introduces the basic structure and function of NLRP3 inflammasome and reviews the research progress of the role of NLRP3 inflammasome in the pathophysiology of MI/RI. Related Articles | Metrics

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Research progress of lncRNA regulating the differentiation of mesenchymal stem cells into osteoblasts #br# ZHANG Rui-xin, DONG Yu-di, XIAO Jian-hui 2021, 49 (6):  662-667.  doi: 10.11958/20203229 Abstract ( 578 )   PDF (412KB) ( 3630 )   Mesenchymal stem cells (MSCs) are pluripotent stromal cells, which have been proved to have abilities to differentiate into osteoblasts and adipocytes, and play an important role in bone regeneration and repair. Recent studies showed that long non-coding RNA (lncRNA) was differentially expressed in the process of osteogenic differentiation of MSCs, and affected the process of osteogenic differentiation of MSCs in many ways. It also played an important role in regulating the balance of bone metabolism. This paper reviewed the latest research progress of lncRNA in the regulation of osteogenic differentiation of MSCs and provided a new idea for further research on the mechanisms of lncRNA regulating the osteogenic differentiation and bone formation of MSCs. Related Articles | Metrics

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The effect of intestinal microecology regulation during pregnancy on offspring #br# ZHAO Yi-lin, YU Qin, ZHOU Juan, YAN Hua 2021, 49 (6):  668-672.  doi: 10.11958/20203418 Abstract ( 523 )   PDF (405KB) ( 3747 )   The regulation of intestinal microecology during pregnancy is affected by multiple factors, which are closely related to maternal nutrition, metabolism and immunity, and are related to a variety of pregnancy metabolic complications, which has a profound impact on the establishment of the offspring intestinal flora and long-term health. This article will review and analyze the changes in the intestinal microbiota during pregnancy, the establishment of the intestinal flora of the offspring and the impact of the changes in the intestinal flora of the common metabolic diseases of pregnancy on the offspring. By improving the intestinal structure and preventing the poor metabolic state during pregnancy, the purpose of preventing health risks of offspring will be achieved. Related Articles | Metrics