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    21 December 2020, Volume 41 Issue 6
    Basic and Clinical Research on Plastic Surgery
    Adipose derived stem cells ameliorate experimental lymphedema
    Zhou Chenxiao, Su Wanchun, Li Na, Liang Shuntao, Zhang Guoying, Ma Gang, Li Peilin, Cui Lei
    2020, 41(6):  869-875.  doi:10.3969/j.issn.1006-7795.2020.06.001
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    Objective To explore the feasibility of locally injected adipose derived stem cells (ADSCs) in treating lymphedema via reduction of CD4+T cells. Methods ADSCs isolated from subcutaneous adipose tissue of C57BL/6J mice were cultured in vitro to passage 3 to 5. Tail lymphedema was created on C57BL/6J mice by disconnecting both superficial and deep lymphatic vessels. Mice in total of 50 that received surgery were randomly assigned to two groups immediately after surgery. Animals in group 1 were injected subcutaneously with 15μL of PBS as control. Mice in group 2 were injected with 5×105 nADSCs suspended in 15 μL of PBS. At every week after ADSCs injection, tail volumes of mouse tails were calculated. Tails were harvested at 3 weeks after injection. Subcutaneous adipose thickness, degree of fibrosis, lymphatic morphology and lymphatic reflux, were detected by Whole mount-BODIPY staining, Masson trichrome staining, immunofluorescence, and FITC-Dextran respectively. Results Transfer of ADSCs demonstrated an amelioration of lymphedema, which corresponded to a decrease in tail volume and nearly 40% decrease in adipose tissue thickness, as compared with controls. Using Masson trichrome staining, we found a 20% reduced collagen deposition after ADSCs transfer. Furthermore, the dramatic expansive lymphatic vessels were reduced by about 60% in area, while the total numbers were not changed. Transport function of lymphatic vessels was improved as evidenced by an increase in the amount of dye passing through the surgical incision within a limited time. Conclusion Local application of ADSCs alleviates lymphedema.
    Clinical observation of autologous platelet rich fibrin in the treatment of refractory wounds
    Liu Jing, Wu Shunxiang, Han Yanfu, Xu Guang, Cui lei
    2020, 41(6):  876-881.  doi:10.3969/j.issn.1006-7795.2020.06.002
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    Objective To observe the clinical efficacy of autologous platelet rich fibrin (PRF) in the treatment of chronic refractory wounds. Methods Totally 33 patients with chronic refractory wounds from March 2014 to March 2016were selected. After debridement, 33 patients were treated with PRF once a week. Taking wound healing as the index, the clinical efficacy was summarized. Results All 33 cases were treated with PRF 3 to 7 times, 21 cases of which were cured, 8 cases improved, and 4 cases ineffective. All patients were followed up for 3 to 6 months. No recurrence after wound healing. Conclusion The curative effect of autologous PRF in the treatment of refractory wound was explicit and definite. It could shorten the treatment course and reduce the cost, and no adverse reactions occurred during treatment. Therefore, it is a new simple and effective wound therapy technology.
    Ten-year experience in facial bone contouring plasty
    Wang Jiguang, Li Peilin
    2020, 41(6):  882-886.  doi:10.3969/j.issn.1006-7795.2020.06.003
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    Objective To review ten-year experiences in facial bone contouring plasty by our craniofacial team. Methods During ten-year clinical practice, we have performed 750 cases of mandibular contouring surgery, 141 cases of reduction malarplasty with type I or type L osteotomy combined with temple-facial soft tissue lifting, and 117 cases of different type genioplasty. Results All 1 008 individuals underwent surgery of facial bone contouring plasty have got prominent improvement in facial bone contour. As for complications, 3 cases with temporary injury to temporal branch of facial nerve were found in reduction malarplasty, 1 case with massive haemorrhage in mandibular contouring surgery, and 2 cases with infections in mandibular contouring surgery, and 2 cases with mental nerve damages. All complications were recovered after effective treatment. Conclusion Facial bone contouring plasty with reasonable surgery procedures and skillful technical operation may significantly improve patients facial bone contour appearance.
    Clinical application of modified inverted L-shape epicanthus correction combined with double eyelid plasty
    Yin Hongyu, Wang Chuan, Peng Qili, Cui Lei
    2020, 41(6):  887-890.  doi:10.3969/j.issn.1006-7795.2020.06.004
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    Objective To explore the clinical effect of the correction of epicanthus by the modified inverted L-shape epicanthoplastycombined with double eyelid surgery. Methods From January 2018 to January 2020, a total of 716 eyes of 358 patients had undergone the inverted L-shape epicanthoplasty and double eyelid plasty.The inverted “L” short arm was continuous with double eyelid incision, and the long arm was hidden in the lower eyelid margin. All the patients were followed up in 6 month after the operation using the PROM (Patient Reported Outcome Measures) to evaluate the outcomes. Results Totally 347 patients were satisfied with operation result. The contours of the eyelid fissure were smooth and natural, while the surgery scare was hidden naturally. 15 eyes in 11 patients had the poor morphology after operation of epicanthoplasty and double eyelid plasty, all of which were repaired with the second operation, and the satisfaction rate is 97%. Conclusion The inverted L-shape epicanthoplasty combined with double eyelid plasty we explored was an effective and practical method.
    Application of mandibular angle arc osteotomy guider in arc osteotomy of the introversion mandibular angle
    Yin Hongyu, Wang Chuan, Cui Lei, Zhang Zhiyong, Tang Xiaojun, Li Binghang, Feng Shi
    2020, 41(6):  891-895.  doi:10.3969/j.issn.1006-7795.2020.06.005
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    Objective To explore the efficacy and safety of the mandibular angle arc osteotomy guider in osteotomy of the introversion mandible via the intraoral approach. Methods From August 2015 to August 2017, 21 patients with prominent introversion mandible angle underwent arc osteotomy by guider. Results During follow-up from 6 months to 2 years,there were 2 patients without obvious improvements.Other patients were satisfied with the improvement of the lower facial contour. No complications occurred, including postoperative infection, facial artery rupture, mandible fracture, and inferior alveolar nerve injure. Conclusion A mandibular angle arc osteotomy guider can control osteotomy lines safely and effectively, reduce the incidence of severe surgical complications and increase patients' satisfaction.
    The complex landscape of dermal white adipose tissue on skin physiology and pathology
    Li Peilin, Cui lei
    2020, 41(6):  896-900.  doi:10.3969/j.issn.1006-7795.2020.06.006
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    The dermal white adipose tissue(dWAT)is defined as adipose tissue underlying the reticular dermis,which could modulates skin homeostasis. The studies on the mechanism have revealed that dermal adipose tissue played an essential role in maintenance of hair cycles, healing of cutaneous wounds, and antibacterial ability of innate immune and skin aging. These studies update and deepen our understanding of the complicated interaction between dWAT and skin. It opened a novel avenue to find new targets in the treatment of skin diseases and the intervention of skin aging. This paper reviewed the recent research on dWAT.
    Basic Research
    Analysis of the distribution characteristics of Chinese medicine syndromes and syndrome elements in COVID-19
    Chen Jianming, Chen Tengfei, Lian Bo, Chen Yishan, Xu Xiaolong, Liu Qingquan
    2020, 41(6):  901-907.  doi:10.3969/j.issn.1006-7795.2020.06.007
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    Objective To investigate the distribution characteristics of Chinese syndromes and syndrome elements in COVID-19. Methods The modern traditional Chinese medicine (TCM) literature about COVID-19 in China knowledge network (CNKI), Wanfang database, Weipu database and Medline database from January to April 2020 was retrieved. Referring to TCM Diagnostics, TCM Syndrome Differential Diagnostics, TCM Clinical Diagnosis and Treatment Terminology-S Syndrome Part, TCM Digital Syndrome Differentiation Machine developed by Zhu Wenfeng in 1 978 and related research results of “973 Project”. The resolution method of syndromes and syndromes elements was used to standardize and split the types of nonstandard and compound syndromes, and to extract the syndrome elements of disease location and disease type. The statistical analysis was performed with descriptive statistical method (frequency/rate). Results Ten TCM syndromes literature were included to study. Compared with the latest version of the diagnostic criteria (7th edition), only 56.14% of the syndromes types reported in these literatures was involved in the nine syndromes types proposed in the criteria. A total of 58 types of syndromes were reported in the literature (with a total frequency 1 587). After standardization, 43 types of syndromes were referred to with a total frequency 1 732. The common syndrome types with frequency over 5% were Yidu-Bifei, Shire-Yufei, Hanshi-Yufei, Feipi-Qixu, Shixie-Yufei, and Qiyin-Liangxu. The cumulative frequency of these six syndromes was 989, accounting for 57.10% of the total syndromes. For 15 kinds of syndrome elements of disease location after literature standardization, the frequency of occurrence was 1 777 times, with Fei, Pi, Wei, Weifen, Qifen, and Shen(Xin,Nao) as the common syndrome elements of disease location (frequency>2%), accounting for 95.94% of the total disease location syndrome elements. A total of 20 types of syndrome elements which appeared 2 567 times with occurrence frequency >2% were Shi(Waixie), Bi(Fei, Xinshen, Naoqiao), Qixu, Du(Yi, Re, Han), Shire, Yu, Re(Waixie, Feng), Shi(Neisheng), and Yinxu, accounting for 81.65% of the total disease type syndrome elements. Conclusions The complexity of the etiology and pathogenesis of COVID-19 led to the diversity of syndrome differentiation system. Whatever the syndrome type is, we should pay attention to the importance of “Feipi-Qixu” in the development of disease.
    Effects of nitric oxide on nerve growth factor and brain derived neurotrophic factor expressions in rats with focal cerebral ischemia/reperfusion injury
    Yang Nan, Ding Mao, Huang Yuyou, Fang Yalan, Shi Wenjuan, Zhao Yongmei
    2020, 41(6):  908-913.  doi:10.3969/j.issn.1006-7795.2020.06.008
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    Objective To investigate the dynamic changes of nerve growth factor (NGF) and brain derived neurotrophic factor (BDNF) during reperfusion time in a rat middle cerebral artery occlusion (MCAO)/reperfusion model and to observe the effects of nitric oxide synthase (NOS) inhibitor Nω-nitro-L-argininic methyl ester (L-NAME) on the expression of NGF and BDNF, in order to explore the deep mechanism of cerebral ischemia/reperfusion injury. Methods A total of 42 male Sprague Dawley rats were divided randomly into 7 groups according to random number table: Sham group, MCAO with 0h reperfusion (MCAO 0 h) group, MCAO with 6h reperfusion (MCAO 6 h) group, MCAO with 12 h reperfusion (MCAO 12 h) group, MCAO with 24 h reperfusion (MCAO 24 h) group, MCAO with 72 h reperfusion (MCAO 72 h) group and MCAO 24 h+L-NAME group. L-NAME was administered at a dose of 1 mg/kg by intraperitoneal injection at 30 minutes before MCAO. N=6 for each group. MCAO operation was performed by using suture method, the rats underwent 90 min of right MCAO, and then were reperfused by withdrawal of the filament. The expression of NGF and BDNF in the ischemic penumbra of frozen sections of the brain tissues were detected by immunofluorescence staining. The colocalization of 3-nitrotyrosine (3-NT), the marker of NO-mediated protein damage, with NGF and BDNF, was detected by immunofluorescence double staining respectively. Results There were no NGF and BDNF positive cells in the penumbra of MCAO 0 h and MCAO 6 h groups, while few of NGF and BDNF positive cells were observed in the penumbra of MCAO 12 h group. Compared with the MCAO 12 h group, the expressions of NGF and BDNF in the ischemic penumbra of MCAO 24 h group increased significantly (P<0.05). However, the expressions of NGF and BDNF in the penumbra of MCAO 72 h group were significantly decreased in contrast with MCAO 24 h group (P<0.05). In the penumbra of brain tissue of MCAO 24 h group, 3-NT was colocalized with NGF and BDNF. There were no 3-NT and NGF double staining cell in the sham group. In the MCAO 24 h group, lots of 3-NT and NGF double staining positive cells were observed in the ischemic penumbra. After treated with L-NAME, the number of 3-NT and NGF double staining positive cells in the penumbra of the ischemia/reperfusion rats were significantly decreased compared with that of MCAO 24 h group (P<0.05). There were no 3-NT and BDNF double staining cells in the sham group. In the ischemic penumbra of MCAO 24 h group rats, amounts of 3-NT and BDNF double staining positive cells were observed. Compared with MCAO 24 h group,the numbers of 3-NT and BDNF double staining positive cells in the penumbra of the ischemia/reperfusion rats were significantly decreased after treatment with L-NAME (P<0.05). Conclusions Cerebral ischemia /reperfusion induced the upregulation of the expression of NGF and BDNF in the penumbra of ischemic rats. The initial upregulated expression appeared at about 12 h after reperfusion, the expression of NGF and BDNF increased with the prolongation of reperfusion time and reached peak at 24 h after reperfusion, followed with a significant decrease at 72 h after reperfusion. L-NAME reduced the production of NO by inhibiting the activity of NOS, leading to the reduction of 3-NT, and then reduce the expression of NGF and BDNF, indicating that NO induces the expression of NGF and BDNF during cerebral ischemia/reperfusion injury.
    Effects and mechanism of Tenuigenin on lipopolysaccharide induced Parkinson's disease model
    Yuan Huili, Gong Xiaoli, Fan Zheng, Liang Zhigang, Wang Xiaomin
    2020, 41(6):  914-922.  doi:10.3969/j.issn.1006-7795.2020.06.009
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    Objective To investigate the effects of Tenuigenin (TEN) on lipopolysaccharide (LPS) -induced rat model of Parkinson's disease (PD). Methods Five experimental groups were set up to analyze the effect and mechanism of TEN on PD rats, with animal behavior tests, detection of inflammatory cytokines in the substantia nigra and plasma, detection of the survival rate of dopamine (DA) neurons and observation of morphological sections of major metabolic organs. Results The treatment with TEN improved motor impairment induced by LPS. Also, TEN significantly ameliorated the degeneration of dopaminergic neurons and inhibited the secretion of proinflammatory cytokines in substantia nigra. Furthermore, TEN had no effect on the major metabolic organs. Conclusion TEN showed neuroprotective effect on PD rats. The mechanism is related to the anti-inflammatory activity of TEN.
    Inhibition effect of platelet-rich plasma on matrix metalloproteinase-13 expression in rabbit osteoarthritis cartilage
    Wang Zhenzhong, Yu Fei, Yang Bo, Ma Lifeng
    2020, 41(6):  923-928.  doi:10.3969/j.issn.1006-7795.2020.06.010
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    Objective To investigate the protective effect of platelet-rich plasm (PRP) to inhibit expression of matrix metalloproteinase-13 (MMP-13) in rabbit knee osteoarthritis. Methods Thirty New Zealand adult clean class rabbits were randomly divided into three groups, the blank control group, osteoarthritic group, and PRP group, ten rabbits in every group. The latter two groups underwent surgery to establish knee osteoarthritis (OA) model with Hulth method, and the control group underwent sham operation. One week after operation, 0.2 mL PRP was extracted from venous blood of ear margin in every group. Only the PRP group received articular injection. All experimental animals were killed at 6th week, and the left knee joints were obtained. Cartilage thickness was measured under a microscope with HE staining, the number of MMP-13 positive cells was counted with immunohistochemical staining, and the expression of MMP-13 was detected with immunofluorescence and Western blotting. Results The control group showed the morphology of articular cartilage close to normal. The cartilage damage was obvious in the arthritis group. In the PRP intervention group, the joint cartilage thickness was preserved, and the MMP-13 positive cells and their expression were significantly inhibited. Conclusion PRP can protect cartilage by reducing the number of MMP-13 chondrocytes and inhibiting the expression of MMP-13.
    Statistics and analysis of research paper output of community health institutions in Mainland China—based on Web of Science Core Collection
    Zhu Xiaofang, Ma Lu
    2020, 41(6):  929-934.  doi:10.3969/j.issn.1006-7795.2020.06.011
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    Objective To analyze statistically the current status and research content of the publication of scientific research papers in community medical institutions, and to provide a decision-making basis for strengthening the scientific research and the paper publication by community medical institutions in China. Methods The papers published by community health centers in China during 2009 to 2018 were collected from Web of Science Core Collection. These papers were further analyzed using the bibliometric approach. Results Totally 515 papers were collected. Numbers of publications and citations are increasing annually. Most frequent keywords are obesity, apoptosis, and Alzheimer disease. Three quarters of these papers were supported by the national or province-level funding agencies. Over one fifth of the researches involved international collaborations. Less than 5% of the papers were published with community health center employees as the first author or corresponding author. Conclusions The paper publication by community health research had steadily progressed in 2009-2018. The main focuses of the research were common diseases and chronicle diseases. Although community health centers have taken part in the research, the major force in conducting such researches was still from the university. The scientific researches with international collaboration showed significantly higher influence, however, such researches was occasional and little. The development of research paper publication in different areas were imbalanced.
    Clinical Research
    The relationship between ADIPOR1 rs7539542 and the susceptibility of coronary artery disease and type 2 diabetes in Han population
    Li Xiang, Pu Lianmei, Ruan Yang, Li Hong, Jin Zening
    2020, 41(6):  935-942.  doi:10.3969/j.issn.1006-7795.2020.06.012
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    Objective To analyze whether single nucleotide polymorphisms (SNPs) in non-intronic regions contributed to coronary artery disease (CAD) or type 2 diabetes (T2D) risk. Methods Seven hundred thirty-seven subjects who had undergone coronary arteriography were included in this multi-disease comparative study, with gender-, age-, and body mass index-matched among groups. There were 193 controls, 142 patients with T2D, 203 with CAD, and 199 with T2D and CAD. Three SNPs (rs7539542 G>C and rs10581 C>T at 3′ untranslated regions (UTR), rs7517286 T>C at 5′UTR) were genotyped by direct Sanger sequencing. Results rs7539542 C allele was positively associated with both CAD (OR=1.67-2.34, P=2.87×10-4-0.002) and CAD with T2D (OR=1.52-2.08, P=0.003-0.016). Further analysis of case-case comparative results showed that rs7539542 C allele was associated with an increased risk of CAD in T2D patients (OR=1.58-2.90, P=0.002-0.038). Subgroup analyses of blood pressure level suggested that the above associations could only be found in the non-hypertension subgroup. For gene-environment interactions in the non-hypertension subgroup, rs7539542 CC genotype correlated with triglyceride level and contributed to a higher risk of CAD (OR=5.006, P=0.041) and CAD with T2D (OR=5.381, P=0.04). No significant association was found between rs7517286 or rs10581 variant and CAD or T2D(P>0.05). Conclusion Our results suggest that rs7539542 at 3′UTR of ADIPOR1 is associated with CAD independently, especially in non-hypertension subjects.
    Retrospective analysis of preoperative breast MRI of breast cancer patients with breast conserving surgery
    Yang Yang, Kang Hua, Zhao Jing, Ling Yuwei, Zhao Ye, Wang Yajun, Rong Dongdong
    2020, 41(6):  943-953.  doi:10.3969/j.issn.1006-7795.2020.06.013
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    Objective To investigate the clinical value of breast magnetic resonance imaging (MRI) for breast cancer patients with breast conserving surgery (BCS). Methods The data of 236 patients with breast cancer confirmed by pathology were retrospectively analyzed, which included preoperative breast MRI, ultrasound, mammography and pathological information. Logistics regression analysis was used to analyze the relationship between preoperative imaging characteristics and pathological status of BCS margin after breast conserving surgery with SPSS software (version 22.0, Statacorp). Results The detection rates of breast lesions by MRI and mammography were 100% and 87.44% respectively. Ultrasound and mammography underestimated breast cancer with tumor size >2cm, while MRI overestimated breast cancer with tumor size ≤2 cm (P<0.05). The BCS margin was positive in 31 cases, of which 17 cases were positive in re-excision margin and 14 cases were negative. The success rate of breast conserving was 89.41%.The morphology and adjacent vascular signs of lesions on breast MRI,multiple lesions in ultrasound, pathological tumor size (Pathmd), HER-2 over-expression type(HR-), and HER-2 positive status were correlated with positive surgical margin(P<0.05). Multivariate analysis revealed that the “MASS & present” type, “NME” type, the present of adjacent multiple punctate vessel signs on breast MRI, and HER-2 over-expression type(HR-) were independent risk factor of positive surgical margin, OR(95%CI):39.472(9.835-158.421), P<0.001; 56.722(7.908-406.838), P<0.001; 24.076(4.979-116.413), P<0.001; 23.170(1.823-294.504), P=0.015. The success rate of breast conserving surgery in the low risk group without risk factors was 98.7%, which was significantly higher than that in the high-risk group with any risk factors of MRI (P<0.001). Conclusions MRI examination is one of the important methods for preoperative examination and evaluation of breast cancer. The “MASS & present” type, “NME” type, the present of adjacent multiple punctate vessel signs on breast MRI, and HER-2 over-expression type(HR-) are significantly associated with a positive resection margin in patients with breast cancer. The success rate of breast conserving surgery is high in breast cancer patients without risk factors.
    Analysis of the perioperative clinical efficacy of piggyback and classical non-bypass liver transplantation
    Zhang Juxia, Wu Anshi
    2020, 41(6):  954-959.  doi:10.3969/j.issn.1006-7795.2020.06.014
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    Objective The clinical data of piggyback liver transplantation and classical non-bypass liver transplantation were analyzed retrospectively to compare the efficacy of the two methods on perioperative complications and case fatality rate of liver transplantation patients. Methods Liver transplantation patients from three clinical medical centers between June 2005 and June 2013 were divided into two groups: piggyback liver transplantation group and classical non-bypass liver transplantation group. T test, rank sum test and chi square test were used to compare the differences of observation indexes between the two groups, and repeated measurement analysis of variance was used to explore the difference of creatinine concentration between the two groups during perioperative period. Binary Logistics regression were used to analyze the risk factors of postoperative case fatality rate. Results A total of 1 411 patients were recruied, including piggyback liver transplantation group (n=445) and classical non-bypass liver transplantation group (n=966). Totally 54 patients died at discharge, with a case fatality rate of 3.83%. The analysis of variance of repeated measurement showed that there was no significant difference in the change trend of creatinine concentration between the two groups during the perioperative period, but there was a significant change in creatinine concentration at different time points. The results of binary Logistics regression analysis showed that there was no significant difference inthe states of dischargebetween the two operations (OR=0.679, P=0.231), the opposite result appeared in the subgroup analysis in the center 3 (OR=0.213, P=0.004). Further analysis of the data of the center 3 by binary Logistics regression analysis showed that postoperative hemofiltration, pulmonary infection and renal failure were all risk factors of postoperative death. Conclusions The creatinine concentration after operation in both groups was significantly higher than that before operation. Postoperative hemofiltration, pulmonary infection and renal failure were independent risk factors for perioperative death of liver transplantation.
    Anti-platelet strategies in patients with percutaneous coronary intervention based on CYP2C19 gene polymorphism and platelet function
    Li Xing, Lu Zijin, Wang Xiaodong, Wang Wei
    2020, 41(6):  960-964.  doi:10.3969/j.issn.1006-7795.2020.06.015
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    Objective To investigate the role of CYP2C19 gene polymorphism and platelet function detection in the anti-platelet strategies in the clinical prognosis of patients after percutaneous coronary intervention. Methods From October 2017 to February 2018, a total of 200 with coronary heart disease undergoing percutaneous coronary intervention (PCI) were included, 190 of which were successfully followed up. According to genotype, the patients were divided into normal metabolism of clopidogrel (ultrafast and fast metabolism) and abnormal metabolism (intermediate and slow metabolism). According to the platelet aggregation rate, patients were divided into the normal clopidogrel reaction (NCR) type (maximum platelet aggregation rate<46) and the resistance type, i.e., low clopidogrel (LCR) type (maximum platelet aggregation rate≥46). Group A included normal metabolism of clopidogrel and NCR type, Group B included abnormal metabolism or abnormal clopidogrel resistance type. Group C included both abnormal types. The groups A and B were treated with aspirin and clopidogrel,while the group C were treated with aspirin and ticagrelor. Follow up the major adverse cardiovascular events and bleeding events within 12 months. Results The general clinical data (gender, age, smoking, drinking, hypertension, diabetes, hyperlipidemia), clinical medication [angiotensin converting enzyme inhibitor(ACEI) and angiotension receptor blocker(ARB), beta blockers, calcium-channel antagonist(CCB), proton pump inhibitor (PPI), nitrate medications], biochemical criterion (creatinine, uric acid, transaminase), and PCI surgery (multivessel lesions, stents of number, diameter, length) showed no statistical difference (P>0.05). The incidence of major adverse cardiac events (MACEs) and the target vessels re-revascularization had significant difference in three groups(P<0.05). The incidence of target vessels re-revascularization in group C was decreased, with a statistically significant difference compared with group B (0 vs 11%).There were no statistically significant differences in cardiogenic death, nonfatal myocardial infarction, and recurrent angina pectoris (P>0.05). No MACEs were observed in all the groups. The incidence of dyspnea in group C was higher than that in group A and group B, without statistical significance. Conclusions Aspirin combined with ticagrelon antiplatelet therapy could reduce the incidence of adverse cardiovascular events, without increasing the incidence of bleeding events, and improve the prognosis of clopidogrel hyporeactive patients screened by CYP2C19 genotype combined with platelet function detection.
    Application of functional near-infrared spectroscopy in the treatment of mild cognitive impairment after stroke with repeated transcranial magnetic stimulation
    Zhang Yingbin, Mo Linhong, Nie Yiqiu, Liu Aixian
    2020, 41(6):  965-969.  doi:10.3969/j.issn.1006-7795.2020.06.016
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    Objective To explore the effects of high-frequency repeated transcranial magnetic stimulation (rTMS) on mild cognitive impairment and oxyhemoglobin concentration levels of prefrontal lobe in stroke patients. Methods Sixty patients with mild cognitive impairment after stroke were randomly divided into the rTMS group (n=30) and the control group (n=30). Both groups received 8 weeks of routine rehabilitation training,while the rTMS group received additionally 15 Hz rTMS during the treatment. Two groups of patients were assessed with the Mini-mental State Examination(MMSE) and the Montreal Montreal Cognitive Assessment (MoCA) before treatment (T0),4 weeks (T1) and 8 weeks (T2) after treatment. The patients were also examined with functional near-infrared spectroscopy (fNIRS). Results After 8 weeks of treatment(T2),MMSE,MoCA score, and the concentration of oxyhemoglobin in the rTMS group were significantly higher than those in the control group (P<0.01),and the peak time of oxyhemoglobin concentration in the rTMS group was significantly shorter than that in the control group (P<0.01). MMSE,MoCA score, and oxyhemoglobin concentration in the rTMS group after 8 weeks (T2) were significantly higher than that before treatment(T0)(P<0.001). There was a positive correlation between MMSE,MoCA score, and oxyhemoglobin concentration (P<0.001). Conclusion High-frequency rTMS improved mild cognitive impairment after stroke and increased the concentration of oxyhemoglobin in frontal lobe.
    A questionnaire survey on the mentality and behavior of patients with type 2 diabetes duringCOVID-19 pandemic period
    Yin Xingqi, Yu Caiguo, Ke Jing, Zhao Dong, Yu Ke
    2020, 41(6):  970-977.  doi:10.3969/j.issn.1006-7795.2020.06.017
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    Objective To investigate the behavior changes and psychological fluctuation of patients with type 2 diabetes during theCOVID-19 pandemic period pandemic period, and to provide basis for better glucose management, psychological, behavioral guidance. Methods Totally 576 type 2 diabetic patients were subjected from the National Metabolic Management Center(MMC)in Beijing Luhe Hospital, based on the in-house questionnaires, Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder assessment (GAD-7) for the cross sectional analysis. The incidence of anxiety and depression was compared with that of type 2 diabetic patients who were not under MMC management during the same period. Results During 2019-nCoV pandemic period, 68.4% of the patients' fingertip glucose level was controlled well in the past two weeks, with fasting blood glucose at 4.4-7.0 mmol/L and 2-hour postprandial blood glucose below 10 mmol/L. 69.1% of type 2 diabetic patients had less physical exercise than before. The prevalence of anxiety and depression of the type 2 diabetic patients under the MMC management was 27.1% and 23.6%, respectively, lower than those without MMC management during the same period. Patients who lived alone(OR=0.393,95%CI:0.160-0.965), and who had one or more comorbidities (OR=15.544, 95%CI:9.632-25.084)were at high risk of anxiety(All P<0.05). Those who were younger(OR=0.541, 95%CI: 0.389-0.751), lived alone(OR=0.398, 95%CI:0.167-0.948), had one or more comorbidities (OR=7.409, 95%CI:4.962-11.065),and had poor blood glucose control (OR=0.659, 95%CI:0.506-0.859) were at higher risk of depression(All P<0.05). Conclusions During the epidemic period, the incidence of anxiety and depression in type 2 diabetic patients under MMC management was lower than that of patients not under MMC management, and blood glucose of the former was basically well controlled. The patients had a good knowledge of the 2019-nCoV. The cognition and behavior pattern of most patients managed by MMC were positive.
    Influencing factors of coronary artery calcification in patients with early coronary atherosclerosis
    Tan Jing, Li Jing, Zhang Yinghua, Zuo Xuebing
    2020, 41(6):  978-981.  doi:10.3969/j.issn.1006-7795.2020.06.018
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    Objective To analyze the influencing factors of coronary artery calcification (CAC) in patients with early coronary atherosclerosis. Methods A total of 127 consecutive patients (69 males and 58 females, and mean age 59 years) with suspected coronary artery disease confirmed early coronary atherosclerosis (coronary stenosis<30%) with coronary computed tomographic angiography and coronary angiography were enrolled between June 2013 and June 2015. Clinical data were recorded, and ankle brachial index (ABI) and flow mediated dilatation were measured. The patients were divided into CAC group (CAC score>0) and non-CAC group (CAC score=0). Results In the univariant analyses, compared with the non-CAC group, CAC group patients were associated with older age and a higher proportion of hypertension(both P<0.05). ABI in non-CAC group was significant higher than that in CAC group (P<0.05). Logistic regression analysis revealed that age and ABI significantly and independently correlated with the occurrence of CAC. Conclusion Age and ABI were strongly associated with the CAC in early coronary atherosclerosis patients.
    Clinical value of hysterosalpingography with sheath
    Liu Mingming, Liang Yuting
    2020, 41(6):  982-985.  doi:10.3969/j.issn.1006-7795.2020.06.019
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    Objective To evaluate the diagnosis value about hysterosalpingography (HSG) with sheath in women in fertility. Methods The HSG data of patients from May 2018 to October 2018 were retrospectively analyzed. The operation time, contrast agent usage, adverse reaction rate and fallopian tube displaying rate were compared. Results There was no statistical difference between the two groups in the displaying rate of the fallopian tube and contrast agent usage(P>0.05). The operation time of HSG with sheath was shorter than that of traditional HSG, and the incidence of adverse reactions in HSG with sheath was lower than that in the traditional HSG group(P<0.05). Conclusion The HSG with sheath could clearly show the uterine cavity and fallopian tube. It is time-saving and easy to operate. It is more suitable, especially for female patients with no history of spontaneous delivery.
    Surgical efficacy of combined procedures for involutional lower eyelid entropion
    Yuan Wei, Zhang Jian, Zhang Xuxiang
    2020, 41(6):  986-990.  doi:10.3969/j.issn.1006-7795.2020.06.020
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    Objective To observe the surgical efficacy of combined procedures for involutional lower eyelid entropion. Methods Sixty-five eyes of 52 cases of lower eyelid involutional entropion underwent the combined procedures:skin muscle excision with orbicularis strip advancement and inferior retractor tightening. During the surgery, a lower eyelid incision was created along the marking line, the orbital septum was opened, and part of the fat pad was dissected. Then the disinserted retractor was reattached to the inferior edge of the tarsal plate, a 5mm strip of the pretarsal orbicularis oculi muscle was isolated, and the lateral end of this strip was incised and pulled temporally and sutured to the periosteum of the lateral orbital wall. The follow-up time was 12 to 16 months.The effect after operation was observed. Results After the operation, 61 eyes among the included 65 eyes were corrected, and the overall recovery rate was 93.85%. Two cases of recurrence underwent lateral tarsal strip procedure combined with skin muscle excision and obtained good results. Lower eyelid ectropion after the surgery occurred in 1 case, which was treated with lateral tarsal strip and retractor plication procedure. Conclusion The combined procedures are effective for the treatment of involutional entropion witha lower recurring rate and a more long-lasting effect on maintaining lower eyelid stability.
    Epidemiological characteristics of diarrheagenic Escherichia coli among diarrhea outpatients in Shunyi district of Beijing, 2013-2018
    Feng Ran, Zhen Guoxin, Li Ying, Zhang Shuang, Ji Guoqiang, Gao Peng, Ma Hongmei
    2020, 41(6):  991-996.  doi:10.3969/j.issn.1006-7795.2020.06.021
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    Objective To understand the epidemiological characteristics of diarrheagenic Escherichia coli (DEC) among diarrhea outpatients in sentinel hospitals in Shunyi District of Beijing, and to provide evidences for the prevention and treatment control of diarrhea. Methods C1inical and epidemiological data regarding from diarrhea patients from 2 sentinel surveillance hospitals from 2013 to 2018 were collected,with fecal specimens sampled and tested for DEC. The descriptive epidemiological statistical analysis was performed with SPSS 25.0 and Excel 2010. Results Among all the 2 068 diarrhea cases,182 cases(8.80%)appeared DEC positive,which included the PCR subtypes enterotoxigenic E.coli (ETEC)(111 cases,5.37%), enteropathogenic E.coli (EPEC)(45 cases,2.18%), and enteroaggregative E.coli (EAEC)(27 cases,1.31%).Epidemiological characteristics regarding the heterogeneities of DEC showed no difference in regions,gender and age groups (P>0.05). The positive rate of DEC showed an obvious seasonal distribution,which reached the peaks in summer for all the subtypes,especially, the ETEC(χ2=76.591,P<0.001)and EAEC(χ2=10.204,P<0.05). The positive rates of EPEC (χ2=12.243,P<0.001) and EAEC (χ2=7.947,P<0.01) in local people were higher. The detection rate of EAEC showed significant difference in different ages (χ2=17.171,P<0.05). Fever, nausea, abdominal pain and dehydration had no effect on the detection rate of DEC, but the detection rate of DEC in patients with vomiting, mainly in ETEC (χ2=15.073,P<0.001), was high (χ2=7.099,P<0.01). There was significant difference in the detection rate of EAEC between febrile group and non febrile group(χ2=4.951,P<0.05). Conclusion ETEC, EPEC and EAEC were the predominant bacterial types of DEC in Shunyi. The seasonal characteristics of DEC was obvious,and thus the prevention and control of diarrhea caused by DEC should be strengthened in summer.
    Clinical characteristics and chest computed tomographic findings: analysis of 66 novel coronavirus pneumonia cases
    Yao Chunyong, Li Yangfan, Jia Yuanju
    2020, 41(6):  997-1001.  doi:10.3969/j.issn.1006-7795.2020.06.022
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    Objective To analyze the early stage characteristics COVID-19 in Yicheng area in terms of computed tomographic (CT) imaging and clinical features. Methods The data of 66 patients with COVID-19 diagnosed in Yicheng People's Hospital from January 16 to February 9, 2020 were analyzed retrospectively. All patients underwent laboratory examination and chest CT examination at the first visit. The basic information of patients, laboratory examination results, and chest CT image characteristics of patients in the early stage of onset were analyzed and summarized. Results Totally 66 COVID-19 patients were 21-71 years. Based on the degree of illness on admission, they were divided into mild type (n=4), common type (n=51), severe type (n=6), and critical type (n=5). The main symptoms were fever, cough, and fatigue. Laboratory examination showed that lymphocyte percentage decreased, C-reactive protein increased, erythrocyte sedimentation rate (ESR) increased, eosinophils (EOS) decreased, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) increased, blood urea nitrogen (BUN) and creatinine (CREA) decreased, and albumin (ALB) decreased. Brain natriuretic peptide (BNP), fibrin (FIB), and D-Dimer (D-D) increased significantly in severe and critical patients. The chest CT results showed no obvious abnormality in the chest CT imaging examination of mild patients. 15 cases (29.41%) had single lesion and 36 cases (70.59%) had multiple lesions in common type cases. 1 case (16.67%) had single lesion and 5 cases (83.33%) had multiple lesions in severe cases. The main manifestations of chest CT images of common type, severe type and critical type patients were patchy high-density shadow and ground glass shadow. Conclusion The laboratory indexes of COVID-19 patients in Yicheng area had obvious changes. In the early stage of the disease, the main CT manifestations were patchy high-density shadow and ground glass shadow. The location of the lesions was double lung, subpleural and lung field zone. This result has a strong reference value for the early diagnosis and treatment of viral infection.
    Nobel Prize
    Genetic engineering technology makes viruses no more mystery—Introduction of The Nobel Prize in Physiology or Medicine 2020
    Wu Yanhua, Wang Peigang, An Jing
    2020, 41(6):  1010-1013.  doi:10.3969/j.issn.1006-7795.2020.06.025
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    On October 5th, 2020, the Nobel Assembly at Karolinska Institute awarded The Nobel Prize in Physiology or Medicine 2020 jointly to three scientists, Harvey J. Alter, Michael Houghton, and Charles M. Rice, for their discovery of hepatitis C virus.
    gene editing technology: gene scissors—a tool for rewriting the code of life—introduction of The Nobel Prize in Chemistry 2020
    Gu Siyu, Yang Xiaomei, He Junqi
    2020, 41(6):  1014-1018.  doi:10.3969/j.issn.1006-7795.2020.06.026
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    The Nobel Prize in Chemistry 2020 was awarded jointly to Dr. Emmanuelle Charpentier and Dr. Jennifer A. Doudna, in recognition of their contribution to “the development of a method for genome editing”. In this review article, we have described the structures and mechanisms of CRISPR/Cas9, the discovery and development of CRISPR/Cas9 system, and the prospects and challenges about CRISPR/Cas9 system.
    Review
    Immunonutrition improves the prognosis of patients with cancer
    Wang Xin, Zhang Junxuan, Gao Jian, Shi Hanping
    2020, 41(6):  1019-1024.  doi:10.3969/j.issn.1006-7795.2020.06.027
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    At present, nutritional support is no longer an adjuvant treatment for cancer, but a first-line treatment that can improve the prognosis of patients and prolong their lifespan. Many studies believe that nutrients not only provide patients with the essential energy, but some nutritional preparations can inhibit tumor cells and prevent carcinogenesis by regulating immunity. However, the mechanism is not entirely clear. This review closely followed the theme of “tumor immunity” and list some examples of successful nutritional treatments, such as diet patterns, amino acids, omega-3 polyunsaturated fatty acids, trace elements, vitamins, dietary fiber, and probiotics, etc. This review also analyzed that nutrients affect the growth, differentiation, autophagy, apoptosis of tumors by regulating the body's immunity. The term “immune nutrition” allows us to consider the concept of a dietary immune index for better designing and optimizing the combination and efficacy of dietary immune modulators, and thus to provide a new direction to explore the new dietary components and mechanisms of immune regulation.
    TrendMD—an article-push service for increasing the international influence of Chinese journals
    Zhang Jianjun, Zhuang Ying, Zhang Junmin
    2020, 41(6):  1025-1028.  doi:10.3969/j.issn.1006-7795.2020.06.028
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    Based on the introduction and application of TrendMD, an article-push service, in our journal, it was validated that this article-push service has a positive effect on the international influence of Chinese journal papers. We suggested that China's periodical publishing industry should expand the lines of thinking, learn from the service concept of TrendMD, and develop our own paper-push service technology, to increase the international influence of China's periodicals.
    Primary exploration of the WeChat official account operation of the Journal of Capital Medical University
    Chen Ruifang, Zhang Junmin, Mu Meng, Sun Chaoyuan
    2020, 41(6):  1029-1032.  doi:10.3969/j.issn.1006-7795.2020.06.029
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    As a high-traffic portal, the WeChat official account is beneficial to the influence and the brand of university journals. Therefore, we registered and ran a WeChat official account for the Journal of Capital Medical University. During the outbreak of COVID-19 in 2020,the WeChat official account provided a professional point-to-point platform and the popularity of WeChat guaranteed an increased number of user and the amount of reading. In this work, we analyzed the operation of WeChat official account and put forward some suggestion and strategy to expand the influence of university journals, and deliver knowledge more effectively with the WeChat official account.
    Strategy analysis of response of medical science and technology periodicals journals to public health emergencies——a case study of Journal of Capital Medical University
    Mu Meng, Zhang Junmin, Chen Ruifang, Sun Chaoyuan
    2020, 41(6):  1033-1036.  doi:10.3969/j.issn.1006-7795.2020.06.030
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    Due to outbreak of COVID-19 in 2020, people's health was seriously endangered and their routine work and life were affected. The coping results were analyzed and summarized based on the work of Journal of Capital Medical University during the epidemic period. The strategies were discussed that medical science and technology periodicals used to deal with such public health emergencies, actively take the academic and social responsibilities of the journal, and quickly release the latest both basic and clinical research results.