Journal of Capital Medical University

Progress in diagnosis and treatment of critical COVID-19

Liu Jingyuan, Guo Hebing, Li Ang

2020, 41(3): 321-327. doi:10.3969/j.issn.1006-7795.2020.03.001

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COVID-2019 has been widely spread around the world and has become the most severe current global public health event. The treatment of critical COVID-19 is the key to reduce the fatality rate and is also a severe clinical challenge for us. We discussed the etiology, epidemiological characteristics, pathological changes, pathogenesis, clinical characteristics and clinical treatment program of COVID-19, to provide reference for the diagnosis and treatment of critical COVID-19.

Some thoughts on diagnosis and treatment of the COVID-19

Liu Jingyuan, Guo Hebing, Li Ang

2020, 41(3): 328-335. doi:10.3969/j.issn.1006-7795.2020.03.002

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As a newly emerged and highly infectious respiratory disease, the COVID-19 is spreading around the world. This disease has infected millions of people and many of them die in the end. It is a serious threat to the safety of human life and property.We provide references for diagnosis and treatment of the COVID-19 by summarizing the characteristics and evolutions of the disease in clinical treatment.

Comparison of throat swab and sputum specimens for viral nucleic acid detection in 31 cases of 2019-nCoV infection

Guo Jingjing, Fang Qian, Liu Yanan, Qu Pei, Ma Xueying, Wang Shuang, Fang Wei, Zhou Ru, Zhang Xiang, Tang Yunxia, Yang Siyuan, Yu Fengting, Wang Yajie

2020, 41(3): 336-339. doi:10.3969/j.issn.1006-7795.2020.03.003

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Objective To comparatively analyze the detection efficiency of viral nucleic acid in throat swab and sputum sample of 2019-novel coronavirus(2019-nCoV) cases. Methods Ribonucleoprotein (RNP) gene in human epithelial cells, viral ORF1ab genes and N genes were tested and compared with real-time PCR in throat swabs and sputum specimens from 31 confirmed cases of 2019-nCoV. Results In the throat swabs and sputum samples of 31 cases, the RNP gene of human epithelial cells showed obvious and typical amplification signal curves. In the detection of viral ORF1ab gene and N gene, the amplification signal of sputum samples was stronger than that of throat swab, and the cycle threshold (Ct) value of amplification curve was lower than that of throat swab, especially in case 9 and 16 were single gene positive, the pharyngeal swabs of the 9th and 16th patients were single gene positive, and the 17th patient was double gene positive, and the rest of the 28 patients were negative. Sputum specimens collected at the same time showed that all the 18 patients were single gene positive and 13 were double gene positive. Conclusion In the viral nucleic acid testing of 2019-nCoV laboratory detection, the virus content in sputum specimens was higher than that in throat swab specimens, and the detection efficiency was higher than that in throat swab specimens.

Value of CT findings in predicting transformation of clinical types of COVID-19

Lyu Zhibin, Guan Chunshuang, Yan Shuo, Chen Qiyi, Li Jingjing, Zhang Yujun, Chen Budong, Xie Ruming

2020, 41(3): 340-344. doi:10.3969/j.issn.1006-7795.2020.03.004

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Objective To explore the value of artificial intelligence (AI) in computed tomography (CT) prediction for outcome of 2019 Coronavirus disease (COVID-19). Methods The initial and first follow-up CT imaging of 62 cases with common COVID-19 pneumonia diagnosed in Beijing Ditan Hospital, Capital Medical University from January 25 to February 17, 2020 were retrospectively analyzed. Ratio of male:female was 31:31. Based on the fact whether patients' conditions had deteriorated into severe type, all the cases were stratified into common type group (51 cases) and deteriorated type group (11cases). Differences of quantitative CT findings by AI in two groups of patients were analyzed. Results Based on initial CT, the percentage of volume of inflammatory lesions to volume of lungs in deteriorated group was 3.3% (1.6%, 7.2%), higher than that of common group. Sensitivity and specificity of diagnose for deteriorated cases reached the best diagnostic value by setting cut-off value as 2.0%. The sensitivity was 72.7%, specificity was 66.7%, and area under a receiver operating characteristic (ROC) curve was 0.744. On first follow-up CT, significant difference was observed on the change of lesion volume. Compared to common type group, percentage of lesion volume in lungs increased significantly to 10.0% (8.9%, 18.1%). The sensitivity (90.9%) and specificity (78.4%) of diagnose for deteriorated cases reached the best diagnostic value by setting cut-off value of increased percentage of lesions in lungs as 2.65%. Area under ROC was 0.896. Changes on percentage of ground glass opacity and consolidation in lesions were significantly different between the groups (P<0.05). Conclusions AI has a profound value in CT prediction for outcome of COVID-2019. It can help in early warning for severe and critical type of patients. The percentage of volume of lesions in lungs and rapidly increase may predict outcome of COVID-19.

Clinical research of glucocorticoid treatment in severe cases of COVID-19

Li Xingang, Xu Yanli, Wang Lin, Zhou Yang, Yang Li, Tan Dawei, Chen Zhihai, Song Rui

2020, 41(3): 345-349. doi:10.3969/j.issn.1006-7795.2020.03.005

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Objective To evaluate the effect of glucocorticoid (GC) on severe cases of COVID-19. Methods There were 6 severe cases of diagnosed COVID-19 patients enrolled in Beijing Ditan Hospital during January 20th and February 20th in 2020.According to treatments,these patients were divided into two groups:GC group and control group. Results Compared with control group, the recovery of temperature[(2.7±1.2) d vs (6.3±0.6) d, P<0.05],oxygenation index (more than 300 mmHg,1 mmHg=0.133 kPa)[(4.6±2.1) d vs (10.6±3.1) d, P<0.05], pulmonary inflammation[(4.3±1.5) d vs (7.6±1.2) d, P<0.05] and the clinical symptoms improvement[(2.3±0.5) d vs (7.3±0.6) d, P<0.05] were earlier in GC group, and the time of oxygen inhalation was shortened[(12.1±0.8) d vs (21.7±5.7) d, P<0.05]. Conclusion Earlier use of glucocorticoid with small doses could alleviate clinical symptoms, improve their clinical courses, and promote the absorbance of infiltration in their lungs manifested in chest computed tomography(CT)for the severe cases of COVID-19.

Expression and significance of Slit guidance ligand 3 in upper tract urothelial carcinoma

Wu Xikang, Wang Yue, He Huiying

2020, 41(3): 354-359. doi:10.3969/j.issn.1006-7795.2020.03.007

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Objective To observe the expression of Slit guidance ligand 3(Slit3) in upper tract urothelial carcinoma (UTUC) and its relationship with the clinicopathological features and prognosis of UTUC patients. Methods The expression of Slit3 in UTUC was detected by immunohistochemical method, and the association of Slit3 expression with the clinicopathological features of UTUC (including age, sex, histological grade, stage and extensive necrosis, etc.) and prognosis were analyzed. Results For UTUC patients, the Slit3 expression decreased with the increased histological grade and tumor stage (P=0.014, P=0.006). Slit3 was also associated with the bladder recurrence (P=0.011). In univariate survival analysis, the lower Slit3 expression was associated with the shorter disease-free survival and cancer-specific survival in UTUC patients (P=0.006, P=0.015), but it was not statistically significant in multivariate analysis (P=0.213, P=0.332). Conclusion Slit3 is likely to be involved in the progression of UTUC. The lower expression of Slit3 is associated with the higher tumor grade, stage and bladder recurrence rate, however, Slit3 is not an independent prognostic factor for UTUC patients.

Value about artificial intelligence-assisted liquid-based thin-layer cytology for cytology cervical cancer screening

Li Xue, Shi Zhongyue, Yang Zhiming, Pang Wenbo, Jin Mulan

2020, 41(3): 360-363. doi:10.3969/j.issn.1006-7795.2020.03.008

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Objective To explore the value of artificial intelligence-assistance for cytology cervical cancer screening in liquid-based cytology. Method Totally 1000 liquid-based cytology cervical cell smears archived in Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University were selected. Multiple groups of comparative experiment were designed through artificial intelligence-assisted screening system developed by iDeepWise Company and professional pathologists manual diagnosis. The dysplasia classified into atypical squamous cells of undetermined significance (ASC-US) or higher grade was regarded as the positive criteria for cervical precancerous lesions based on the positive grading criteria of TBS 2014. The differences in the results of screening methods were analyzed, and the sensitivity and specificity were calculated. Results The results of artificial intelligence-assisted screening and manual diagnosis by professional pathologists were basically consistent with the previously archived results. The sensitivity, specificity, and accuracy of artificial intelligence-assisted screening were 100.00%,90.68% and 97.80%, respectively. Conclusion The artificial intelligence-assisted screening combined with the pathologist's reading skills could effectively reduce the incidence of missed diagnosis, with high sensitivity and specificity. It also could greatly reduce the workload of pathologists.

Diagnosis, clinical and pathological analysis of pituitary adenomas based on the new World Health Organization classification

Gao Wei, Zhao Lihong, Wang Wei, Wang Leiming, Xu Susu, Wei Lifeng, Teng Lianghong

2020, 41(3): 364-371. doi:10.3969/j.issn.1006-7795.2020.03.009

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Objective To analyze the diagnosis, clinical and pathological characteristic and to investigate the value of the new World Health Organization(WHO) classification of pituitary adenomas. Method The clinical features of 134 cases diagnosed as pituitary adenomas were retrospectively reviewed. The characteristic of morphology and the result of immunohistochemical expression were analyzed. Results The study population was composed of 134 patients (74 male and 60 female) and the median age was 51. Totally 24.6% of all pituitary adenomas were functional or hormone-secreting, while the remaining 75.4% were non-functional present with symptoms related to local mass effects. The imaging showed 7 cases with microadenomas, 120 cases with macroadenomas and 7 cases with giant adenomas. According to the 2017 WHO classification of pituitary adenomas, there were 68 (50.7%) gonadotroph adenomas, 25(18.7%) corticotroph adenomas, 17 (12.7%) somatotroph adenomas, 11 (8.2%) lactotroph adenomas, 4 (3.1%) silent Pit-1 positive pituitary adenomas, 3 (2.2%) plurihormonal adenomas, 3(2.2%) double adenmoas, 2 (1.5%) null cell adenomas, and 1 (0.7%) thyrotroph adenomas. This classification also recognizes some subtypes of pituitary adenomas as high-risk pituitary adenomas, which include 2 sparsely granulated somatotroph adenoma, 6 lactotroph adenoma in men, 2 silent corticotroph adenoma, and 3 newly introduced plurihormonal Pit-1-positive adenoma. Conclusion According to the different transcription factor, the new classification of pituitary adenomas was of important effect and significance to the clinical diagnosis and treatment.

Clinical analysis of Helicobacter pylori infection in outpatients with digestive system diseases

Dong Fang, Chen Dong, Shang Jianfeng, Fang Wei, Teng Fei, Zhang Ruiqi

2020, 41(3): 372-375. doi:10.3969/j.issn.1006-7795.2020.03.010

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Objective To analyze the current situation, distribution characteristics and molecular typing composition of Helicobacter pylori (Hp) infection in patients with digestive system diseases in Beijing Anzhen Hospital, Capital Medical University using Taqman probe molecular assays, so as to provide theoretical basis for prevention and treatment of Hp infection and clinical medication. Methods 10839 patients who underwent gastroscopy from April 2018 to September 2019 were selected for Hp molecular detection, molecular typing and infection degree classification. The detection rate and molecular typing composition of Hp in different months, different quarters, different genders and different ages were analyzed. Results Among the 10839 subjects, the positive rate of Hp was 33.76%, and the positive rate of males was higher than that of females (P<0.05). The positive rate of Hp was the highest in summer. It increased at first and then decreased with the increase of age. The positive rate of Hp reached the peak in the age group of 40 years old. There were significant differences in the detection rate of Hp among different seasons and different age groups (P<0.05). In the two molecular types of Hp, the detection rate of type Ⅰ in males was higher than that in females (P<0.05). Conclusion The positive rate of Hp in male is higher than that in female, the detection rate of Hp is related to season and age, and the detection rate of Hp in type Ⅰ is higher than that in type Ⅱ.

Research progress on BRAF gene abnormality in glioma

Sun Mengxue, Wang Leiming, Teng Lianghong

2020, 41(3): 380-384. doi:10.3969/j.issn.1006-7795.2020.03.012

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The serine threonine kinase v-RAF murine sarcoma viral oncogene homologue B1 (BRAF) is a member of the growth signal transduction protein kinase RAF gene family, which regulates mitogen-activated protein kinase/extracellular signal-related kinase pathways and plays an important role in cell division, differentiation and development. BRAF alteration mostly includes BRAF gene mutation and fusion. In recent years, alterations in BRAF are detected in a variety of glioma types. As a unique molecular genetic feature, BRAF alterations provide an important basis for the diagnosis, prognosis and treatment of glioma. This article reviewed the abnormal forms, mechanism and detection of BRAF gene, as well as the role of BRAF alteration in the diagnosis and treatment of glioma.

Effects of cornel iridoid glycoside on mitochondria damage in rats with cerebral ischemia reperfusion injury

Wang Mingyang, Sun Zhengyu, Zhang Li, Li Yali, Li Lin, Zhang Lan

2020, 41(3): 385-390. doi:10.3969/j.issn.1006-7795.2020.03.013

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Objective To investigate the effects of cornel iridoid glycoside (CIG) on the mitochondria damage induced by cerebral ischemia reperfusion injury in middle cerebral artery occlusion (MCAO) rats. Methods Male SD rats were subjected to MCAO surgery and the right artery was occluded for 2 h followed by reperfusion. All rats were randomly divided into 5 groups (n=6):sham group, model group, CIG 60mg/kg group, CIG 120 mg/kg group, and extract of Ginkgo biloba (EGB) group. Drugs were intragastrically administered at 6th hour after reperfusion, once a day for 7 days. Modified Neurological Severity Scores (mNSS) was carried out to evaluate the neurological functioning in MCAO rats. The mitochondrial ultrastructure in injured cortex of MCAO rats was detected by transmission electron microscopy. The expression of mitochondrial function related proteins NIX, Beclin1, DRP1, OPA1, and PGC-1α were evaluated using Western blotting. Results The MCAO rats scored significantly higher in mNSS, and mitochondrial ultrastructure was damaged in injured cortex. Furthermore, the expression of NIX, Beclin1, DRP1, OPA1, and PGC-1α were also remarkably downregulated in the injured cortex of MCAO rats. While treatment with CIG declined the mNSS scores, ameliorated the mitochondrial injury, and significantly increased the expression of NIX, Beclin1, DRP1, OPA1, and PGC-1α in the injured cortex of MCAO rats. Conclusion CIG treatment could increase the mitochondrial biogenesis, fission and fusion process, and activate the mitophagy, hence ameliorate the mitochondrial injury, promote the recovery of neurological function after MCAO injury in rats. Our research showed that CIG may be a candidate drug for cerebral stroke therapy.

Changes of synapse-related proteins in the brain of 7-month-old and 16-month-old APP/PS1/tau transgenic mice and the effects of cornel iridoid glycoside on the AD model

Yang Cuicui, Bao Xunjie, Zhang Li, Li Yali, Li Lin, Zhang Lan

2020, 41(3): 391-396. doi:10.3969/j.issn.1006-7795.2020.03.014

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Objective To explore the changes of memory ability and synapse-related proteins along with their influencing factors in the brain of APP/PS1/tau(3×Tg)transgenic mice of 7 and 16-month old, and to study the effect of cornel iridoid glycoside (CIG) on synapse-associated proteins in the brain of model mice. Methods 3×Tg mice of 7-month-old and 16-month-old were both treated with CIG for 2 months. New object recognition test was used to detect the ability of learning and memory in 3×Tg mice. Western blotting was used to observe the expression of synapsin-1, synaptophysin, synaptotagmin, amyloid precurson protein (APP), recombinant a disintegrin and metalloprotease 10(ADAM10), β-site APP-cleaving enzyme 1 (BACE1), presenilin-1(PS1), insulin degrading enzyme (IDE), and tau phosphorylation at Thr212 and Thr217. Results Compared to control group, 7-month-old 3×Tg mice had no change in the discrimination index, expression of synapsin-1, synaptophysin and synaptotagmin in cortex, while 16-month-old 3×Tg mice showed lower discrimination index and less expression of synapsin-1. After treatment, 16-month-old 3×Tg mice showed higher discrimination index and more expression of synapsin-1. Compared to control group, 7-month-old 3×Tg mice showed a similar level of APP, ADAM10, BACE1, PS1, and IDE in the brain. Conclusion Synapse-associated proteins are differentially expressed in the brains of 3×Tg mice at different ages. CIG has distinct effects on the expression of synapse-related proteins and memory ability in the brains of 3×Tg mice at different ages.

Effects of cornel iridoid glycoside on cognitive function and tau phosphorylation in rats with traumatic brain injury

Ma Denglei, Zhang Xu, Zhang Li, Li Yali, Zhang Lan, Li Lin

2020, 41(3): 397-402. doi:10.3969/j.issn.1006-7795.2020.03.015

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Objective To investigate the effects of cornel iridoid glycoside (CIG) on cognitive impairment and tau hyperphosphorylation induced by traumatic brain injury (TBI) in rats. Methods TBI model was induced with the modified Feeney's method on the right cerebral cortex in male adult rats. Drug administration started at 3 h after TBI surgery and lasted for 28 days. The passive avoidance memory function was measured by step through test. Fluoro Jade B staining was used to detect neurodegeneration in the brain. The expression of tau phosphorylation was determined by Western blotting. Results At the 28th day after TBI surgery, the model group rats showed an increase in the error times in the step through test, the number of degenerated neurons in the hippocampus, and the expression of phosphorylated tau protein in the wound site. Intragastric administration of CIG for 28 days ameliorated the passive avoidance memory impairment, alleviated neurodegenerative lesions in the hippocampus, and decreased the hyperphosphorylation of tau protein at Thr205 and Ser309 sites near the injury site in TBI rats. Conclusion The results suggest that CIG may be beneficial to treating the cognitive impairment induced by brain trauma.

Screening and analysis of O-glycosylation-associated differential expressed genes in colorectal cancer

Yao Jiannan, Gao Tianbo, Duan Ling, Liu Jian, Jiang Yuliang, An Guangyu, Ge Yang

2020, 41(3): 403-410. doi:10.3969/j.issn.1006-7795.2020.03.016

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Objective To identify differentially expressed genes (DEGs) between normal and abnormal O-glycosylated colon cancer cells, which are regarded as directly O-glycosylation-associated genes, and to investigate their underlying mechanisms. Methods The gene expression profiles of LS174T Tn (+) cells stably transfected with Cosmc or control plasmid were subjected to one-color microarray-based gene expression profiles. After RNA hybridization, gene expression profiles were obtained, and differential and integrative analysis was performed on Wegstalt platform by gene set enrichment analysis (GESA). Gene ontology (GO) analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) tumor-related pathways analysis, R software packages, and protein-protein interaction (PPI) networks by STRING were conducted. Results A total of 1474 genes, including 502 up-regulated genes and 972 down-regulated genes, were selected as DEGs. GO analysis demonstrates that both up-regulated and down-regulated DEGs are enriched for numerous biological processes such as extracellular matrix organization and growth factor activity. DEGs are mainly enriched in several tumor-associated pathways such as phosphatidylinositol 3-kinase (PI3K) signaling pathway, transforming growth factor-β (TGF-β) signaling pathway, and Wnt signaling pathway. Conclusion This study is the first work focused on the transcriptional changes caused by O-glycosylation in colon cancer cells, which helps to uncover the molecular characteristics of O-glycosylated colorectal cancer(CRC) cells and may provide new targets for future research and therapy.

Effects of high glucose on store operated calcium entry and related protein expressions in H9C2 and neonatal rat ventricular cardiomyocytes

Shaletanati·Talabieke, Sun Zhipeng, Wang Luqi, You Hongjie, Luo Dali

2020, 41(3): 411-420. doi:10.3969/j.issn.1006-7795.2020.03.017

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Objective To investigate the effects of high glucose on store operated calcium entry (SOCE) and the endogenous stromal interaction molecule 1 (STIM1) expression and its activated structure "puncta" in rat embryonic cardiomyocytes line (H9C2) and neonatal rat ventricular myocytes (NRVMs), which may be involved in the pathogenic mechanism of diabetic cardiomyopathy (DCM). Methods H9C2 and NRVMs cardiomyocytes were divided into two groups:normal glucose group (5.5 mmol/L) and high glucose group (25 mmol/L) treated and cultured for 48 h. The alteration of Ca²⁺ influx mediated by SOCE pathway were observed by laser confocal microscope after treated with thapsigargin (TG, 2 μmol/L) in H9C2 and NRVMs cells. The expression levels of STIM1 and calcium release-activated calcium channel modulator 1 (Orai1) were detected by Western blotting. The aggregated formation of STIM1 puncta in NRVMs was detected by chemical crosslinking and immuno-fluorescence staining. Direct interaction between endogenous STIM1 and Orai1 in NRVMs was observed by co-immunoprecipitation. Results Compared with control group, TG stimulated sarcoplasmic reticulum(SR) Ca²⁺ store depletion and induced more SOCE (P<0.05), and increased STIM1 and Orai1 expressions (P<0.01) in the H9C2 and NRVMs cells cultured with high glucose. While the interaction between endogenous STIM1/Orai1 was not altered between the two groups of cells, the aggregated formation of STIM1 puncta was significantly increased after SR Ca²⁺ store depletion by TG in NRVMs cells cultured with high glucose (P<0.01). Conclusion High glucose could up-regulate the expression levels of STIM1 and Orai1 proteins and promote the formation of STIM1 puncta, leading to an increased SOCE in H9C2 and NRVMs cardiomyocytes, which implicated a potential mechanism involved in diabetic cardiomyopathy.

Application of ApoC3 transgenic mice in acute pancreatitis with severe hypertrig-lyceridemia

Liu Xin, Xu Youqing, Cui Chunying, Zhao Zhigang

2020, 41(3): 421-427. doi:10.3969/j.issn.1006-7795.2020.03.018

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Objective To establish acute pancreatitis mouse model with severe hypertriglyceridemia. Methods Wild type and apolipoprotein C3 (ApoC3) transgenic mice were used to induce acute pancreatitis with caerulein. Plasma levels of lipids, amylase activity and pancreatic pathology were detected. The pancreatic pathological changes were also evaluated by administrating antioxidant terbiary-butylhydroquinone (tBHQ). Results ApoC3 transgenic mice demonstrated significantly higher plasma levels of triglyceride, and aggravated pancreatic pathological injury after inducing acute pancreatitis. Amylase activity in ApoC3 transgenic mice increased at 9h and 12h. The treatment of tBHQ did not improve pancreatic pathology in ApoC3 transgenic mice. Conclusions ApoC3 transgenic mice showed increased plasma amylase activity, and significantly aggravated pancreatic pathological injury after inducing acute pancreatitis. These were similar to pathological changes of pancreas in clinical patients with acute pancreatitis in severe hypertriglyceridemia. ApoC3 transgenic mice could be used as a mouse model for studying pathological mechanism of acute pancreatitis in severe hypertriglyceridemia.

Relationship between emotional intelligence,self-esteem and subjective well-being of clinical medicine undergraduates

Li Jie

2020, 41(3): 428-432. doi:10.3969/j.issn.1006-7795.2020.03.019

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Objective To explore the relationship between emotional intelligence, self-esteem and subjective well-being of medicine undergraduates. Method A survey of 568 medicine undergraduates was carried out by using the scale of Subjective Well-being, Self-esteem Scale, and Emotional Intelligence Scale. Result There were significant correlations between each dimension of emotional intelligence, self-esteem and subjective well-being, except that the negative emotional dimension of subjective well-being was not significantly correlated with the overall emotional intelligence, the ability to use emotions and the ability to regulate others' emotions. The dimensions of self-esteem, overall emotional intelligence and self-regulation have a positive prediction for subjective well-being. Conclusion The relationship between subjective well-being, self-esteem and emotional intelligence is unbalanced and complicated in the medicine undergraduates.

Safety and efficacy of catheter ablation for atrial fibrillation patients with history of renal transplantation

Yu Ronghui, Tang Ribo, Wu Jiahui, Wen Songnan, Lin Hui

2020, 41(3): 433-438. doi:10.3969/j.issn.1006-7795.2020.03.020

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Objective To study the prognosis of catheter ablation in atrial fibrillation (AF) patients with history of renal transplantation. Methods Seven AF patients with renal transplantation history who had received radiofrequency ablation due to the poor effect of antiarrhythmic drugs were selected as the case group, and 42 controls were selected according to the 1:6 matching principle (age, gender and type of atrial fibrillation). The recurrence rate, perioperative complications and the incidence of contrast nephropathy were compared and analyzed. Results No periprocedural complications and contrast nephropathy were observed in either group. During a follow-up period of 12 months, the ATa recurrent rate was higher in AF patients with renal transplantation history (Log rank test, P=0.027). Conclusion Catheter ablation for AF can be safely performed in patients with history of renal transplantation. AF patients with renal transplantation history tend to have higher ATa recurrence after the catheter ablation.

Factors affecting long-term prognosis of hilar cholangiocarcinoma after operation

Cao Di, Li Xianliang, Zhang Hui, He Qiang

2020, 41(3): 439-443. doi:10.3969/j.issn.1006-7795.2020.03.021

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Objective To explore the factors which influence long-term prognosis after operation of hilar cholangiocarcinoma. Methods Forty-nine patients of hilar cholangiocarcinoma underwent surgical treatment were analyzed retrospectively from January 2011 to December 2017 in Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital, Capital Medical University. Overall survival rates were evaluated based on follow-up results, and risk factors were analyzed. Results The overall 1-year, 3-year and 5-year survival rates were 87.3%,30.8% and 6.2% respectively. The median survival time was 29 months. Single factor analysis showed that neurological invasion, tumor differentiation and percutaneous transhepatic cholangic drainage (PTCD) may be the risk factors. COX proportional hazard model analysis showed that neurological invasion was an independent risk factors affecting prognosis of patients, as well as that of tumor differentiation (P<0.05). The 1-year, 3-year and 5-year survival rates of patients with and without nerve invasion were 77.2%,7.7%,7.5% and 100%,58.4% and 11.8%, respectively. The 1-year, 3-year and 5-year survival rates of patients with high, medium and low differentiation were 100%,54.1%,13.4%,100%,19.9%,0 and 68.8%,14.1% and 0, respectively. Conclusion The overall prognosis of patients with hilar cholangiocarcinoma is poor, and the low degree of differentiation and associated nerve invasion are independent risk factors.

Observation of the therapeutic effect of hyperbaric oxygen on refractory interstitial cystitis/bladder pain syndrome

Zhang Jing, Wu Liyang, Yang Jing, Zhang Peng

2020, 41(3): 444-448. doi:10.3969/j.issn.1006-7795.2020.03.022

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Objective To investigate the clinical efficacy of hyperbaric oxygen (HBO) in the treatment of refractory interstitial cystitis/bladder pain syndrome (IC/BPS). Methods Three-day voiding diary was recorded before HBO treatment and 1, 3 and 6 months after HBO treatment in patients with IC/BPS, and the O'leary-Sant score, visual analogue scale (VAS), quality of life index (QoL), pelvic pain, urgency and frequency (PUF) score were evaluated. Bladder capacity, "erythema sign" and ulcer were evaluated before and 6 months after treatment.Results Totally 19 patients, compared with those before treatment, the 24-hour urination frequency (11.37±1.98), nighttime urination frequency (1.53±1.17), O'leary-Sant score (15.95±2.80), VAS (31.79±9.53), QoL (2.11±0.74), PUF score (16.16±4.39) and bladder capacity (347.53±75.28) mL of the patients after 6 months of treatment improved significantly (P<0.05, respectively).There were also significant differences in 24-hour urination frequency, O'leary-Sant score, and VAS among different follow-up periods (P_time<0.01). In addition, 7 patients with "erythema sign" turned into negative and 3 patients with ulcers healed.Conclusion HBO is effective in the treatment of refractory IC/BPS.

Application of vessel encoded arterial spin-labeling magnetic resonance imaging in revascularization surgery in patients with Moyamoya disease

Liu Xingju, Li Jiaxi, Yuan Jing, Lyu Zheng, Zhang Yan, Zhang Dong, Zhao Jizong

2020, 41(3): 449-453. doi:10.3969/j.issn.1006-7795.2020.03.023

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Objective To explore the clinical value of vessel encoded arterial spin-labeling (VE-ASL) magnetic resonance in evaluating direct revascularization in patients with moyamoya disease. Methods Fifty-six patients with Moyamoya disease who underwent middle cerebral artery (MCA)-superficial temporal artery (STA) anastomosis in Beijing Tiantan Hospital were retrospectively analyzed. 3.0T VE-ASL was performed preoperatively and within 1 week postoperatively. Preoperative and postoperative perfusion territories of the bilateral internal carotid arteries, bilateral external carotid arteries, and basilar artery were examined, and the revascularization area was examined by labeling the superficial temporal artery-to-middle cerebral artery bypass postoperatively. Computed tomography angiography (CTP) was performed and compared with VET-ASL results. Results Of the 56 patients, mean values of cerebral blood flow (CBF) from VE-ASL in the anastomosis side at preoperative assessment and 7 days postoperative follow-up were (349±55) mL·kg^-1·min^-1 and (558±74) mL·kg^-1·min^-1 (P<0.01),respectively. At 7days after operation, 36(64.2%)patients VE-ASL demonstrated the blood flow from STA, whereas 20(35.7%)patients had no blood flow from STA. Of them, 6 patients restore blood flow from STA at 3 months after operation. Compared with VE-ASL, CBF of 39(69.6%) and 44(78.5%) patients was improved at 7 days and 3 months, respectively, after operation based on CTP scan. There was good intermodality agreement between VE-ASL and CTP in evaluating the CBF changes at 7days or 3 months after revascularization (7 days Kappa=0.718; 3 months,Kappa=0.744). Conclusion VE-ASL is a promising technique in evaluation of patients with Moyamoya disease, which could provide quantitative assessment of the postoperative CBF changes after direct revascularization.

Analysis of radiation dose of radiology intervention for patients with liver cancer

Fang Da, Zhao Qian, Du Ning, Zhao Liying, Ma Liang, Cui Shichang

2020, 41(3): 454-457. doi:10.3969/j.issn.1006-7795.2020.03.024

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Objective To analyze the radiation dose received by patients with liver cancer undergoing radiation interventional therapy. Methods 261 cases of liver cancer were divided into hepatic lobe superselective intervention group and liver segment super-superselective interventional group. The recorded radiation parameters on the instrument were analyzed. Results The fluoroscopy time was (9.67±6.44) min, number of angiography was (4.29±1.68) times, angiography time was (48.3±19.1) s, dose area product (DAP) was (29531±10798) μGym2, effective dose (ED) was (4.43±1.62) mSv, cumulative dose (CD) was (1029.6±526.8) mGy, peak skin dose (PSD) was (864.9±442.5) mGy. The fluoroscopy time, number of angiography, angiography time, DAP, ED, CD and PSD in the liver segment super-superselective group were higher than those in the hepatic lobe superselective group. 117 patients(44.8%) had CD values greater than 1Gy. Conclusion Patients with liver cancer who undergone radiation interventional therapy received a higher dose of radiation. The surgeon should optimize the DSA parameters to reduce the radiation dose the patients received.

Risk factors of lower extremity deep vein thrombosis before operation in elderly patients with hip fracture

Yue Rui, Li Xiaoyu, Yang Minghui, Liu Xiaoyan, Fan Bin, Zhang Ping

2020, 41(3): 458-463. doi:10.3969/j.issn.1006-7795.2020.03.025

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Objective To study the risk factors of deep venous thrombosis (DVT) of lower extremity in elderly patients with hip fracture. Methods A retrospective study was conducted on 687 elderly patients over 80 years with hip fracture admitted to the Orthopaedic Trauma ward for the elderly of Beijing Jishuitan Hospital from March 2018 to February 2019. Lower extremity DVT was initially screened by doppler ultrasound, and patients with suspected or positive lower extremity DVT were diagnosed by venography. Univariate and multivariate stepwise Logistic regression analysis was performed to explore the independent risk factors of DVT in lower extremities before surgery. Results The incidence of preoperative lower limb DVT was 12.4% (85/687). Independent predictors of preoperative DVT identified by multivariate stepwise Logistic regression analyses were time from injury to admission, activated partial thromboplastin time (APTT) and intertrochanteric fracture (P<0.05). Conclusion The incidence of DVT in lower extremity is high in elderly patients with hip fracture. Patients with intertrochanteric fractures, delayed admission after fracture, and shortened APTT have an increased incidence of preoperative lower limb DVT. We should take preventive measures for patients with these risk factors to reduce the incidence of preoperative DVT.

Comparison of acute and chronic non-sheathed radial artery injury between the first and repeat transradial intervention by optical coherence tomography

Niu Dan, Hua Qi, Liu Zijing, Li Zixuan, Song Jiahui, Yan Rui, Wang Guozhong, Zhang Libin, Guo Jincheng

2020, 41(3): 464-469. doi:10.3969/j.issn.1006-7795.2020.03.026

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Objective To evaluate the acute and chronic effects of transradial intervention (TRI) on the non-sheathed radial artery (NSRA) by optical coherence tomography (OCT). Methods A total of 162 patients who underwent both OCT-guided TRI and NSRA OCT examination between February 2016 and September 2017 were enrolled. The patients were divided into the first TRI group (n=131) and the repeat TRI group (n=31). The incidence rate of acute injury including intimal tear, dissection, perforation, thrombus and spasm as well as the chronic injury indexes, including intimal area, percentage of lumen narrowing (%LN), intima-media ratio (IMR) and intimal thickness index (ITI), were compared between the two groups. Results The incidence of acute injury in NSRA was 31.5% in the repeat TRI group, significantly higher than that in the first TRI group (48.4% vs 27.5%, P=0.032). There was no significant difference in the incidence of intimal tear (6.5% vs 5.3%, P=1.000), dissection (9.7% vs 1.5%, P=0.075), perforation (3.2% vs 1.5%, P=1.000), thrombus (12.9% vs 6.9%, P=0.457), and spasm (29.0% vs 16.0%, P=0.094) between the two groups. Intimal area (0.59 mm² vs 0.46 mm², P=0.011), IMR (0.40 vs 0.28, P=0.001) and ITI (0.27 vs 0.22, P=0.012) of the patients in the repeat TRI group were significantly greater than those in the first TRI group, while%LN showed no difference (31.70% vs 30.81%, P=0.244). Multivariate Logistic regression analysis revealed that repeat TRI was an independent risk factor for acute NSRA injury (OR=2.772, 95%CI: 1.053-7.301, P=0.039). Conclusions The incidence of acute injury after TRI in NSRA was 31.5%. Compared with the first TRI group, the repeat TRI group has significantly higher incidence of acute injury and intimal hyperplasia. Repeat TRI is an independent risk factor for acute NSRA injury.

Primary investigation on clinical effect of carbazochrome sodium sulfonate and sodium chloride injection on neurogenic pulmonary edema in severe cerebrovascular disease patients

Lu Xiaojiong, Chen Feng, Wang Ying, Ma Jianxin, Zhao Sumin

2020, 41(3): 470-474. doi:10.3969/j.issn.1006-7795.2020.03.027

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Objective To observe the clinical effect of carbazochrome sodium sulfonate and sodium chloride injection on neurogenic pulmonary edema (NPE) in severe cerebrovascular disease patients. Methods Totally 40 patients of severe cerebrovascular disease complicated with NPE, in accordance with the random number table, were randomly divided into two groups and numbered according to the order of hospitalization. The treatment group was given carbazochrome sodium sulfonate injection and standard therapy. The control group was only given standard therapy. The clinical efficacy, hemodynamic index and inflammatory index before and after treatment (2^nd, 4^th and 8^th day) in the two groups were compared. Results The offline period, duration of antibiotics, duration of intensive care unit (ICU) stay, mortality and incidence of multiple organ dysfunction syndrome (MODS) of the treatment group were significantly lower than those of the control group (P<0.05). The extravascular lung water index (EVLWI) after treatment (4^th and 8^th day) of the treatment group were significantly lower than those of the control group (P<0.05). The pulmonary vascular permeability index (PVPI) after treatment (8^th day) of the treatment group were significantly lower than those of the control group (P<0.05). There was no significant difference in C-reactive protein (CRP), white blood cell (WBC) and neutrophil percent (NEUT%) before treatment between the two groups (P>0.05). CRP, WBC and NEUT% after treatment (2^nd, 4^th and 8^th day) of the treatment group were significantly lower than those of the control group (P<0.05). Conclusion The application of carbazochrome sodium sulfonate in the patients with severe cerebrovascular disease complicated with NPE is effective, which provides a new therapeutic strategy.

Clinical observation of the significance of peripheral blood eosinophilia in pulmonary sarcoidosis

Sheng Haiyan, Liu Xiaofang, Jin Jianmin, Xu Jie, Liu Yong

2020, 41(3): 475-481. doi:10.3969/j.issn.1006-7795.2020.03.028

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Objective To investigate the clinical significance of peripheral blood eosinophilia in patients with pulmonary sarcoidosis. Methods The clinical data of patients with treatment-naïve pulmonary sarcoidosis admitted to Beijing Tongren Hospital from January 2004 to January 2018 were selected as study subjects. According to the percentage and number of eosinophils in peripheral blood, the patients were divided into two groups:peripheral blood eosinophilia group (PBE group) and non-peripheral blood eosinophilia group (non-PBE group). There were 21 cases in PBE group and 24 cases in non-PBE group. The general data were compared and analyzed, which include clinical manifestations, extrapulmonary involved organs, laboratory results, lung function, bronchoalveolar lavage fluid(BALF) cell count classification, chest imaging features of the two groups. The therapeutic regimen and prognosis of the disease were followed up. Results The percentage of patients with nodular pattern and patchy consolidation in PBE group was higher than that in non-PBE group (80.95% vs 50%, 57.14% vs 25.0%; P<0.05). There were 14 patients in PBE group and 17 patients in non-PBE group were treated with systemic glucocorticoid,respectively. After one week of glucocorticoid treatment, the value of eosinophils in peripheral blood of the two groups was significantly lower than that before treatment (P<0.05). 16 patients in PBE group and 23 patients in non-PBE group completed follow-up,with a median follow-up time was 23.5 months and 21 months, respectively. Compared with non-PBE group, PBE patients were more prone to relapse (31.25% vs 4.35%, P<0.05). The peripheral blood eosinophil levels in the recurrent patients were significantly higher than that after one week of glucocorticoid treatment in PBE group. Conclusion Pulmonary active lesions of sarcoidosis are more common in patients with peripheral blood eosinophilia,as well as the recurrence rate of the disease is higher. It is necessary to closely monitor the condition of this kind of patients during therapy and follow-up.

Factors associated with the prevalence of pulmonary hypertension in patients with sleep overlap syndrome

Fan Zhengyang, Xie Jiang, Li Fei, Wang Jingting, Patiguli·Yisilamu, Sun Dance

2020, 41(3): 482-487. doi:10.3969/j.issn.1006-7795.2020.03.029

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Objective To elucidate the independent correlative factors for polysomnography and spirometry related to pulmonary hypertension (PH) among patients with sleep overlap syndrome (OS). Methods Totally 128 subjects were recruited in the Department of Respiratory and Critical Medicine, Beijing Anzhen Hospital, Capital Medical University from January 2019 to January 2020. Spirometry and full-night sleep test were carried out to identify chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA). OSA was identified if an apnea-hypopnea index(AHI) was higher than 5 events/hour. OS was diagnosed when patients met both criteria of COPD and OSA. Independent correlative factors for the prevalence of PH were surveyed by multiple stepwise Logistic regression with age, sex and body mass index adjusted for. Results Compared with subjects with isolated OSA and COPD, the patients with OS had lower nadir nocturnal saturation (82% and 90% vs 79%, P<0.001) and average nocturnal saturation (93% and 95% vs 92%, P<0.001), but higher percentage of total sleep time with saturation <90% (6% and 0% vs 11%, P<0.001). The PH prevalence in the patients with forced expiratory volume <80% predicted value in the first second (FEV₁) was 2.78 times higher than that in the patients with FEV₁ ≥ 80% predicted value (OR 2.78, 95%CI 1.05-7.38, P=0.040). The PH prevalence was higher in the patients with AHI ≥ 15 events/h than those with AHI <15 events/h (OR 3.46, 95%CI 1.02-11.71, P=0.046). After adjusting for confounding variables, the PH prevalence was 3.57 higher in the patients with FEV₁<80% predicted value than those with FEV₁ ≥ 80% predicted value (OR 3.57, 95%CI 1.20-10.62, P=0.022). Conclusion Pulmonary ventilatory defect is independently associated with the prevalence of PH. Further studies are needed to investigate whether effective interventions may alleviate PH prevalence and thus improve long term prognosis in the patients with OS.

The effect of cluster intervention on enteral nutrition in patients with acute pancreatitis

Liu Yue

2020, 41(3): 488-491. doi:10.3969/j.issn.1006-7795.2020.03.030

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Objective To explore the clinical value of cluster intervention in patients with acute pancreatitis with enteral nutrition. Method Totally 82 cases of severe acute pancreatitis in our hospital from January 2018 to December 2019 were randomly divided into observation group and control group, 41 cases in each group. The patients in the control group were given traditional nutritional support according to the doctor's instructions,while those in the observation group received cluster intervention, naso intestinal tube, enteral nutrition treatment. The contents were as follows:build enteral nutrition management group, strengthen the training and assessment of the strategy of enteral nutrition infusion cluster of group members, improve the enteral nutrition intervention measures and implement continuous quality management. Result The incidence of complications of enteral nutrition (7.32%) and hospitalization time (21.04±5.23) days in observation group were lower than 26.83% and (25.22±6.56) days in the control group, respectively (P<0.05). The albumin of the observation group was higher than that of the control group[(38.69±2.46) g/L vs (33.16±3.07) g/L, P<0.05]. Conclusion The patients with acute pancreatitis were given intensive intervention and enteral nutrition support. It can effectively reduce the incidence of complications related to enteral nutrition, improve the nutritional status of patients, and shorten the hospitalization time.

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