Table of Content

21 June 2021, Volume 42 Issue 3

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Basic and Clinical Research in Neurology Field

Progression in autoimmune encephalitis after herpes simplex virus infection

Chi Bowen, Wang Jiawei

2021, 42(3):  341-346.  doi:10.3969/j.issn.1006-7795.2021.03.001

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Autoimmune encephalitis caused by herpes simplex virus encephalitis has received increasing attention, the pathogenesis of which may be related to the immune response caused by the release of antigens after the herpes simplex virus infecting neurons. This secondary autoimmune encephalitis has various clinical manifestations, which are easily confused with recurrent herpes simplex virus encephalitis. The delayed treatment may lead to severe neurological deficits and poor prognosis. The detection of autoimmune encephalitis related antibodies in cerebrospinal fluid and serum is helpful for diagnosis. Immunotherapy is effective for autoimmune encephalitis secondary to herpes simplex virus encephalitis. This article reviews the development history, pathogenesis, clinical manifestations, auxiliary examinations, diagnosis, and treatment procedures of autoimmune encephalitis after herpes simplex virus infection.

Effect and mechanism of blood glucose fluctuation on cognitive function in type 2 diabetic rats

Li Zhi, Zhang Jun, Dai Yuexuan, Qin Mingyang, Liang Furu

2021, 42(3):  347-353.  doi:10.3969/j.issn.1006-7795.2021.03.002

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Objective To investigate the effect of blood glucose fluctuation on cognitive function in type 2 diabetic rats and its correlation with oxidative stress in hippocampus. Methods Type 2 diabetes mellitus (T2DM) was established by high sugar and high fat diet combined with intraperitoneal injection of streptozotocin (STZ). The rats were randomly divided into sustained hyperglycemia group (SHG group) (n=12) and intermittent hyperglycemia group (IG group) (n=12). In the IG group, the blood glucose fluctuation model was established by changing the diet habit and life rhythm of rats. The normal blood glucose control group(C group) (n=10) was established. After 6 weeks, the blood glucose levels in each group were measured at 9 points in time within a day, and the mean blood glucose (MBG), standard deviation of daily average blood glucose (SDBG), the largest amplitude of glycemic excursions (LAGE) and mean amplitude of glycemic excursions (MAGE) were obtained. Morris water maze was used to detect the spatial learning and memory ability of the rats in each group at the 10th week. The contents of malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in the hippocampus were measured at the 11th week. The correlation between oxidative stress and cognitive function was analyzed. Results 1) After 6 weeks of blood glucose fluctuation, MBG, SDBG, LAGE and MAGE in the IG group and SHG group were significantly higher than those in the C group(P<0.05). SDBG, LAGE and MAGE in the IG group were higher than those in the SHG group, while MBG was lower than that of SHG group (P<0.05). 2) With regard to the learning and memory ability of rats, the escape latency of diabetic rats (IG group and SHG group) on the 4th day was longer than that in the C group (P<0.05). The number of crossing platform on the 5th day, the activity distance ratio and time ratio of passing through the target quadrant (the quadrant where the platform is in the positioning navigation experiment) were lower than that in the C group (P<0.05). Compared with the SHG group, the times of crossing platform, the activity distance ratio and time ratio of passing through the target quadrant in the IG group on the 5th day were shorter (P<0.05). 3) Detection of oxidative stress index: compared with the C group, the content of MDA in the IG group and SHG group increased, while the content of SOD and GSH-Px decreased (P<0.05). Compared with the SHG group, the content of MDA in the IG group increased, while the content of SOD and GSH-Px decreased (P<0.05). 4) The analysis correlation between oxidative stress index and learning and memory ability showed that MDA was negatively correlated with activity distance ratio, activity time ratio and times of crossing platform (P<0.01), while GSH-Px and SOD were positively correlated with activity distance ratio, activity time ratio and times of crossing platform (P<0.01). Conclusion 1) High glucose and high-fat diet combined with low-dose STZ (30 mg/kg) could successfully establish the model of T2DM, and the blood glucose fluctuation model of T2DM could be successfully established by changing diet habits and biological rhythm. 2) Blood glucose fluctuation is more likely to affect the cognitive function of T2DM rats than continuous hyperglycemia. 3) The fluctuation of blood glucose may aggravate the oxidative stress injury in hippocampus.

Characteristic and correlationship of behavioral and psychological symptoms in patients with mild and moderate Alzheimer's disease

Zhan Minmin, Ma Huixuan, Kang Xuechun, Lu Xinliang, Gong Shuting, Zou Qi, Lv Jihui, Zhou Aihong, Jia Jianping, Wei Cuibai

2021, 42(3):  354-359.  doi:10.3969/j.issn.1006-7795.2021.03.003

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Objective To investigate the characteristics and correlation between mental and behavioral symptoms in patients with mild and moderate Alzheimer's disease (AD). Methods According to the score of Clinical Dementia Rating Scale (CDR), 38 AD patients were divided into mild AD (n=23) and moderate AD (n=15) groups. Their mental and behavioral symptoms were assessed with Neuropsychiatric Inventory Scale (NPI). SPSS statistics 22.0 was used to analyze the characteristics and differences of NPI and its subitems between mild and moderate AD patients. The correlation rules for mental and behavioral symptoms in mild and moderate AD groups were analyzed using R software. Results Among all AD patients, the proportion of any mental and behavioral symptoms was 81.58%. The proportion was 78.26% in mild AD group, and 86.67% in moderate AD group. There was no statistical difference between the groups. In the comparison of the incidence of each subitem, there was only significant difference in the incidence of apathy between the groups (60.00% vs 26.09%, P=0.049). Comparing the severity of mental and behavioral symptoms, the NPI total score in moderate AD group was higher than that in mild AD group (10.60±8.92 vs 4.87±4.97, P=0.015). Further compaction demonstrated that the scores of apathy and aberrant motor behavior in moderate AD patients were higher than those in mild AD patients (apathy: 2.78±2.32 vs 1.04±2.18, P=0.025; aberrant motor behavior: 1.80±2.39 vs 0.30±1.26, P=0.016). Association rule analysis showed that there was a strong correlation between depression, hallucinations, delusions and apathy in mild AD patients (lift>3), and a strong correlation between night-time behavior, appetite, irritability and apathy in patients with moderate AD (lift>3). Conclusion There were differences in the incidence, severity and correlation of mental and behavioral symptoms between the mild AD patients and moderate AD patients.

Clinical features and difficulties in diagnosis of multiple sclerosis in China

Liu Xiran, Xu Yan, Wang Weizhi, Wang Lihua, Zhang Meini, Li Chunyang, Dong Huiqing, Li Guozhong, Liu Hongbo, Fu Jin, Jin Tao, Guan Yangtai, Tan Guojun, Guo Li, Zhang Xinghu

2021, 42(3):  360-366.  doi:10.3969/j.issn.1006-7795.2021.03.004

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Objective To summarize the clinical features and diagnostic difficulties of multiple sclerosis(MS) in China. Methods Totally 557 patients with MS were retrospectively studied, and the data including analyzed demographic characteristics, clinical characteristics, Kurtzke Expanded Disability Status Scale (EDSS) score, diagnosis type, diagnosis time were collected and analyzed. Results Among the 557 patients, the ratio of female to male was 2.09∶1. The average age of onset was (34.9±11.2) years. The mean duration of disease was (66.8±61.5) months. Relapsing-remitting multiple sclerosis (RRMS) was the main subtype (69.3%). The most common clinical manifestation was motor symptoms (62.1%). Median EDSS score was 2.5. The recurrence frequency was one episode per year in 23.9% patients and one episode in 2 to 4 years in 21.9% patients. 83.9% patients visited the doctor immediately after the onset of the disease, and the average time (0.28±1.11) years. 55.1% patients were diagnosed at their first visit, and the average time being diagnosed was (0.91±2.36) years. Compared with RRMS, the duration, sensory symptoms, sphincter dysfunction and EDSS of progressive MS were significantly increased. Conclusion The clinical characteristics of MS in Chinese population are partly similar to those of Caucasians, such as the age of onset, gender ratio, the composition and proportion of symptoms. Meanwhile, MS in Chinese population showed its own characteristics, such as a lower RRMS proportion and a milder disease severity. The time to diagnosis is still slightly longer than that in some western countries. It is necessary to reduce the time to diagnosis by raising the awareness of the general population and primary care doctors about MS.

Efficacy of music therapy combined with bright light therapy on sleep disorders in patients with Alzheimer's disease

Hu Yueqing, Lyu Jihui, Wang Qiang, Ma Zongjuan, Li Wenjie, Mu Haiyan, Li Mo, Gao Wenchao, Jia Dongmei

2021, 42(3):  367-372.  doi:10.3969/j.issn.1006-7795.2021.03.005

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Objective To explore the effect of combination therapy with music therapy (MT) and bright light therapy (BLT) on sleep disorders in patients with moderate-severe Alzheimer's disease (AD). Methods A total of 120 patients with moderate or severe AD accompanied with sleep disorders were randomly divided into 4 groups: routine therapy group (control group), MT group, BLT group, and combination therapy group. All patients in the 4 groups received routine treatment. Besides listening to soothing music for 30 minutes before bedtime was supplemented to the MT group, while bright light exposure in the morning for 30 minutes was supplemented to the BLT group; Both MT and BLT were performed in the combination therapy group. The Pittsburgh Sleep Quality Index (PSQI) was evaluated before and after the intervention which lasted for 4 consecutive weeks. Results The baseline characteristics, scores of PSQI and its subscores had no significant difference in the pre-intervention assessment among 4 groups (P>0.05). In the comparison of the difference between pre- and post-intervention, the decrease of the score of sleep medication in the combination therapy group was higher than that in the BLT group, with a statistically significant difference (P<0.05), while in the comparison of the PSQI total score and the scores of other components between the two groups, the difference was not statistically significant (P>0.05). However, the scores of PSQI, sleep quality, sleep latency, sleep efficacy and daytime dysfunction in the combination therapy group and BLT group decreased more significantly than those in the MT group and the control group (P<0.05). The score of PSQI and sleep medication in the MT group decreased significantly compared with the control group, and the differences were both statistically significant (P<0.05). Conclusion The routine treatment supplemented by MT in combination with BLT can effectively improve the overall sleep quality for patients with moderate or severe AD accompanied with sleep disorders, but MT or BLT alone is only effective for certain components of sleep disorders.

Study on the association between white matter connectivity changes and cognitive deficits in vascular cognitive impairment no dementia using diffusion tensor imaging

Qin Qi, Tang Yi, Qu Yida, Zhou Aihong, Ding Jianping, Yin Yunsi, Liu Yong, Jia Jianping

2021, 42(3):  373-384.  doi:10.3969/j.issn.1006-7795.2021.03.006

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Objective To explore the relationship between vascular cognitive impairment, no dementia (VCIND) and white matter microstructural changes to confirm a diagnosis of dementia. VCIND is the most common subtype of mild cognitive dysfunction. Neuroimaging provides the basis for the early diagnosis, severity and efficacy evaluation of VCIND.However, traditional magnetic resonance imaging (MRI) cannot clarify the relationship between structural changes and cognitive impairment. Methods Diffusion tensor imaging (DTI) was carried out to investigate white matter microstructural changes in 246 brain areas in 31 VCIND patients and 22 normal controls. All patients underwent neuropsychological assessments and DTI examination. Voxel-based analyses were performed to extract fractional anisotropy (FA) and mean diffusivity (MD) measures. Correlation analysis and mediation analysis were performed with cognitive dysfunction. Results Compared with the healthy elderly subjects, subcortical VCIND patients presented with abnormal white matter connectivity changes in several key hubs, especially in frontal lobes. The severity of damage significantly correlated with cognitive dysfunction. FA significantly correlated with general cognitive impairment,memory function and executive function. We also found a significant negative correlation between MD and general cognitive function,memory function and executive function. Mediation analyses demonstrated that the disrupted white matter connectivity could explain the cognitive dysfunction. Conclusions The results indicate that the brain white matter connectivity changes of DTI may be a neuroimaging marker for VCIND early diagnosis and cognitive severity measurement.

White matter hyperintensities are related to functional disturbance of upper and lower extremities

Hou Yutong, Yang Shuna, Li Yue, Li Xuanting, Hu Wenli

2021, 42(3):  385-390.  doi:10.3969/j.issn.1006-7795.2021.03.007

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Objective To investigate the relationship between white matter hyperintensity(WMH), a common marker of cerebral small vessel disease, and functional disturbance of upper and lower extremities. Methods Totally 256 participants from Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University who underwent magnetic resonance imaging (MRI)were recruited in this cross-sectional study.According to total Fazekas scores they were divided into low WMH burden group(0-2 points) and medium-high WMH burden group(3-6 points). Gait was assessed by 4 metre walkway, Timed Up and Go(TUG)test, Short Physical Performance Battery(SPPB)test and Tinetti test. Upper extremities function was evaluated with 10-repeat pronation-supination time, 10-repeat finger-tapping time and 10-repeat open and close hands time.Univariate and multivariate line regression were used to detect the correlation between function of upper and lower extremities and WMH. Results The mean age of the participants was (61.6±10.1)years. 172(67.2%)were with low WMH burden, while 84(32.8%)with medium-high WMH burden. The multivariable linear regression analyses were performed after adjustments for gender, age, height, vascular risk factors and coexisting markers of cerebral small vessel disease(cSVD).The stride width(β=1.174,P=0.021)and cadence(β=0.533,P=0.022)were correlated with the severity of the WMH, not step length and velocity (β=-1.550,P=0.228;β=0.062,P=0.429). We also found that the participants had lower Tinetti and SPPB score(β=-1.127,P=0.000;β=-0.844,P=0.000)and needed more time to achieve TUG (β=1.518,P=0.000) in medium-high WMH burden group.There were significant differences in 10-repeat pronation-supination time, 10-repeat finger-tapping time and 10-repeat open and close hands time between medium-high WMH burdenand low WMH burden (β=0.635,P=0.021;β=0.962,P=0.000;β=0.518,P=0.020). Conclusions Our study suggested that gait disturbances and upper extremities disorders were related with medium-high WMH burden. It may be helpful to explore the mechanism ofmovement disorder resulting from WMH.

Integrative Treatment for Mental Disorder

Identification and intervention strategies for anxiety with traditional Chinese medicine during COVID-19 pneumonia pandemics

Li Xue, Ning Yanzhe, Jia Hongxiao

2021, 42(3):  399-403.  doi:10.3969/j.issn.1006-7795.2021.03.009

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The corona virus disease 2019 (COVID-19) has been spreading rapidly since its outbreak, which is highly infectious, and the population is generally susceptible. Due to the lack of effective inactivated vaccine and insufficient understanding of disease prevention knowledge, both infected patients and uninfected people have different degrees of tension and anxiety, which has a serious impact on personal life. The combination of traditional Chinese medicine (TCM) and Western medicine could promote treatment of the anxiety induced by the COVID-19 pneumonia. We described the anxiety manifestation and the influence of anxiety on the immune system. According to the theory of TCM emotion, people should alleviate the tension, fear and anxiety caused by the epidemic situation, and we should apply the classical prescription appropriately and reasonably based on the core symptoms . With the guidance of TCM theory, TCM could be an effective way to relieve and alleviate anxiety induced by COVID-19.

A preliminary study on efficacy for Shi-zhen-an-shen granules on cognitive impairments in prodromal schizophrenia

Ning Yanzhe, Zhu Hong, Song Nan, Zheng Sisi, Li Ziyan, Li Jiajia, Ma Rui, Jia Hongxiao

2021, 42(3):  404-407.  doi:10.3969/j.issn.1006-7795.2021.03.010

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Objective To investigate efficacy for Shi-zhen-an-shen (SZAS) granules on cognitive impairments in prodromal schizophrenia. Methods A total of 60 eligible participants were randomly assigned to either the treatment group or the control group in a ratio of 1∶1. The participants in the treatment group received SZAS and the placebo of aripiprazole, the control group received placebo of SZAS and aripiprazole. The treatment course had lasted for 4 weeks. Outcome measurements included Trail Making Test A (TMTA), Hopkins Verbal Learning Test-Revised (HVLT-R), Brief Visuospatial Memory Test Revised (BVMT-R),Continuous Performance Test (CPT), and Stroop Color-Word Test (SCWT). Results There were no significant group effects on all cognitive assessments between the two groups. The time effects on TMTA,HVLT-R,BVMT-R,Stroop-word test,SCWT and CPT showed significant differences between the two groups. The SCWT and CPT showed significant interactive effects. Further analysis indicated significant changes on all cognitive assessments in the treatment group after 4-weeks therapy in comparison with baseline, while only HVLT-R, BVMT-R, SCWT and CPT showed significant changes in the control group after 4-weeks treatment. Conclusion Compared with aripiprazole, the SZAS could improve cognitive impairment more widely. Longer time treatment may support that the SZAS is better than aripiprazole on improving cognitive impairments.

Preliminary study on the characteristics of five-pattern personality in traditional Chinese medicine with bipolar disorder

Li Ziyan, Liu Xinzi, Du Jian, Wang Hao, Yang Qiuli, Jia Hongxiao

2021, 42(3):  408-411.  doi:10.3969/j.issn.1006-7795.2021.03.011

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Objective To explore the distribution characteristics of five-state personality in patients with bipolar disorder (BD). Methods A total of 144 patients with bipolar disorder in the outpatient clinic at Beijing Anding Hospital affiliated to Capital Medical University from January to December 2017 were investigated with the Five-Pattern Personality Inventory, and the distribution of five-state personality characteristics was analyzed. Results The scores of patients with bipolar disorder in the four dimensions of Taiyang, Shaoyang, Yin-yang peace and Shaoyin were significantly lower than that of the national norm, while the scores of those in the Taiyin dimension were significantly higher than that in the national norm(P＜0.05). There was no difference in the distribution of five-state personality characteristics between bipolar type Ⅰ and bipolar type Ⅱ, and between male and female. Conclusion The high score of those in Taiyin dimension is a significant personality characteristic of patients with bipolar disorder, and personality factors may not be a significant factor affecting the classification of BD subtypes and gender differences.

Investigation of depression and anxiety and their influencing factors among adolescents in Beijing during the coronavirus disease 2019 epidemic

Liu Shanshan, Chen Xu, Li Yaqiong, Yuan Xiaofei, Yu Hongye, Fang Meng

2021, 42(3):  412-417.  doi:10.3969/j.issn.1006-7795.2021.03.012

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Objective To investigate the level of depression and anxiety and their influencing factors among adolescents in Beijing during the coronavirus disease 2019 (COVID-19) epidemic, and to provide valuable quantified data and scientific references for the mental health education and psychological crisis intervention for the adolescents. Methods The online questionnaire survey was carried out to collect the data. The Center for Epidemiological Studies Depression Scale for Children (CES-DC) and the Generalized Anxiety Disorder 7-Item Scale (GAD-7) were utilized to assess the degree of depression and anxiety, respectively. We collected data from students in junior and senior high schools in Beijing during the COVID-19 epidemic and analyzed correlative factors. Results A total of 1 142 students between 11-18 years old from junior and senior high schools were included in this study. There were 465 cases with CES-DC>15 points, accounting for 40.7%, and 275 cases with GAD-7 ≥ 5 points, accounting for 24.1%. Multivariate regression analysis suggested that the female gender (OR=0.754, P=0.034), sleep time <6 h/d (OR=3.977, P＜0.001), lowered learning efficiency (OR=2.699, P<0.001), and physical exercise time <30 min/d (OR=1.712, P<0.001) represented independent factors for depression, whilst the grades in senior high school (OR=0.428, P=0.002), lowered learning efficiency (OR=2.467, P<0.001), and physical exercise time <30 min/d (OR=1.817, P<0.001) represented independent factors for anxiety. Conclusion This study found that proportion of depression and anxiety increased significantly among adolescents in Beijing during the COVID-19 epidemic. It reminds us to pay attention to the mental and psychological health of the teenagers and the related factors that easily cause depression and anxiety. We should carry out psychological crisis intervention for the adolescents as early as possible.

Basic Research

Influence of intermittent PTHrP stimulation on apoptosis and cementogenesis in cementoblasts

Li Shengnan, Li Fan, Guan Xiuchen, Bai Yuxing

2021, 42(3):  418-424.  doi:10.3969/j.issn.1006-7795.2021.03.013

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Objective To investigate the effect of intermittent parathyroid hormone related protein(PTHrP) on apoptosis and the expression of cementum mineralization related proteins and cellular factors in cementoblasts. Methods OCCM-30 cells were stimulated intermittently with PTHrP (1-36) and PTH1R antagonist PTHrP (7-34). The intermittent administration consisted of three cycles, 48 hours/cycle. The cells were divided into control group, PTHrP (1-36) group and PTH1R blocker group. Cell apoptosis was detected by flow cytometry, osteopontin (OPN), collagen (COL-1) and insulin-like growth factor-1 (IGF-1) were detected by real-time PCR and Western blotting. Results Intermittent administration of PTHrP inhibited the apoptosis of cementoblasts and PTH1R antagonist promoted the apoptosis (P<0.05), intermittent PTHrP significantly increased the mRNA and protein expression of OPN, COL-1 and IGF-1 in cementoblasts (P<0.05) compared with control group. PTH1R antagonist inhibited the mRNA and protein expression of OPN, COL-1 and IGF-1 in cementoblasts (P<0.05). Conclusion Our study indicates that intermittent PTHrP could inhibit apoptosis and promote the cementogenesis by interacting with PTH1R in cementoblasts.

The expression of NLE1 in colon cancer and its influence on proliferation and apoptosis of HT29 cells

Liu Kuiliang, Li Nanshan, Wu Jing, Li Wenkun, Li Qian, Wang Yadan

2021, 42(3):  425-430.  doi:10.3969/j.issn.1006-7795.2021.03.014

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Objective s To verify the expression of Notchless homolog 1 (NLE1) in colon adenocarcinoma and evaluate its possible role and mechanism. Methods The expression of NLE1 was evaluated by immunohistochemistry (IHC) staining and quantitative polymerase chain reaction (PCR). Lentivirus transfection was used to explore the influence of NLE1 on proliferation and apoptosis of HT29 and possible mechanism. Results According to IHC, the high expression rate of NLE1 in normal mucosa, colon adenoma and early stage colon cancer was 14.3% (15/105),44.0% (11/25)and 68.6% (72/105),respectively. The expression of NLE1 was significantly higher in cancer compared with adenoma (P<0.05), as well as in adenoma compared with normal mucosa(P<0.001). According to quantitative RT-PCR, NLE1 expression in normal mucosa, colon adenoma and early stage colon cancer was 1.38±0.82,5.04±2.09, 7.57±1.25, respectively. The expression of NLE1 was significantly higher in cancer compared with adenoma (P<0.05), as well as in adenoma compared with normal mucosa(P<0.01). NLE1 silencing significantly inhibited proliferation and colony-forming ability and prmoted apoptosis of HT29 cells(all P<0.05), and increased the expression of Bax and Fas. Conclusions The elevated expression of NLE1 in colon adenoma and adenocarcinoma might promote colorectal carcinogenesis via promoting proliferation of tumor cells.

Impact of rural order-oriented free medical students' professional commitment on professional maturity:mediating role of emotional intelligence

Li Jie, Hao Jingjing, Hao Hongjun, Liu Yang

2021, 42(3):  431-435.  doi:10.3969/j.issn.1006-7795.2021.03.015

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Objective To explore the impact mechanism of rural order-oriented free medical students' professional commitments on professional maturity, and provide a theoretical basis for improving the professional maturity of rural-oriented medical students. Methods By the Undergraduate Professional Commitment Scale, Emotion Scale and Undergraduate Professional Maturity Scale, 370 targeted medical students were investigated. Results There was a significant positive correlation between the two variables of rural order-oriented free medical students' professional commitment, emotional intelligence, and career maturity (P<0.05). Emotional intelligence started between the rural order-oriented free medical students' professional commitment and professional maturity part of the mediation. Conclusion Improving and fulfilling the professional commitment of rural order-oriented medical students, focusing on the cultivation and education of their emotional intelligence, are conducive to improving the professional maturity of rural order-oriented medical students.

Experimental study on establishment of polycystic ovary syndrome rat model with insulin resistance by letrozole combined with high-sugar and high-fat diet

Wang Jingshang, Yin Xiaodan, He Junqin, Wu Ying, Zhang Ying, Li Xianrui

2021, 42(3):  436-442.  doi:10.3969/j.issn.1006-7795.2021.03.016

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Objective To establish a rat model of polycystic ovary syndrome with insulin resistance (PCOS-IR) by using letrozole combined with high-fat and high-sugar diet. Methods After one week of adjustable feeding, twenty 6-week-old female SD rats were randomly divided into 2 groups:10 rats as control group, the other 10 as model group. Rats in control group were fed with ordinary diet, while model group with high-sugar and high-fat diet for 28 days. From the 8th day, the rats in model group received 0.4 mL letrozole (1 mg/kg) daily for 21 consecutive days and fed with high-sugar and high-fat diet, while rats in control received 0.4 mL 1% carboxymethyl cellulose solution daily and fed with standard diet. The vaginal smear was examined every morning to observe the vaginal exfoliated cell changes from the 15th day to the end of experiment. After lavage, fasting blood glucose (FBG) was measured from caudal vein. The levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone (T) and fasting insulin (FINS) were measured and the LH/FSH ratio, insulin sensitivity index (ISI) and insulin resistance index (HOMA-IR) were calculated. The changes of body weight and ovarian histological phenotypes were observed. Results Compared with the control group,the body weight, the levels of FBG, FINS, T, LH, HOMA-IR, and LH/FSH ratio all increased significantly in model group, while the FSH and ISI levels in the model group decreased significantly,the difference were all statistically significant (P<0.01). The vaginal smear showed that the estrus cycle disappeared in the model group. The local ovarian tissue morphology was normal in the control group, while the model group expressed typically polycystic changes. Conclusion Letrozole combined with high-sugar and high-fat diet can successfully induce PCOS-IR rat model with typical polycystic changes, insulin resistance and endocrine abnormality.

Determination of limonene in volatile oil from citrus peel by gas chromatography

Shao Jianqun, Li Qingyuan, Li Fenghua, Shi Chen, Wang Yuji, Zhang Feng

2021, 42(3):  443-446.  doi:10.3969/j.issn.1006-7795.2021.03.017

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Objective To establish a method for the content determination of limonene in volatile oil from citrus peels. Methods The volatile oil was extracted by steam distillation and the content of limonene was determined by gas chromatography. Gas chromatography conditions were as follows: the capillary column was HP-5(30 m×0.32 mm×0.25 μm)with hydrogen flame ionization detector (FID), and the temperature of inlet and detector were 250 ℃. The temperature program of colum oven started at 70 ℃, holding for 16 minutes, then increased to 250 ℃ at a rate of 30 ℃·min^-1, kept for 1 min. The carrier gas was nitrogen with flow rate of 1 mL·min^-1. Split ration was 100∶1, and injection volume was 1 μL. Results Limonene was linear in the range of 0-17.6 mg·mL^-1(r²=0.999 0). The average recovery was 103.4%(n=9), and relative standard deviation (RSD) was 2.10%(n=9). Conclusion The experiment method has good repeatability, high sensitivity and accuracy, which can be used to determine the content of limonene and control quality in volatile oil from citrus peel.

Clinical Research

Methylation analysis of multiple genes in blood DNA of patients with Alzheimer's disease, mild cognitive impairment and subjective cognitive decline

Hao Shuwen, Chen Ying, Ding Hui, Zhao Chunsong, Liang Kuo, Xue Jinhua, Cai Yanning

2021, 42(3):  447-452.  doi:10.3969/j.issn.1006-7795.2021.03.018

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Objective To examine DNA methylation levels in the promoters of multiple genes in patients with Alzheimer's disease (AD),amnestic mild cognitive impairment(aMCI), subjective cognitive decline(SCD)and normal controls(NC) and to examine whether DNA methylation in these genes could serve as a diagnostic biomarker for SCD. Methods Using bisulfite pyrosequencing to examine DNA methylation levels in thefatty acid amide hydrolase(FAAH), arachidonate 5-lipoxygenase(ALOX5), CBFA2/RUNX1 partner transcriptional co-repressor 3(CBFA2T3) and basic helix-loop-helix family member e23(BHLHE23)promoters in peripheral blood leukocytes of patients with AD (n=31), aMCI (n=41), SCD (n=57) and normal controls (n=57). Results The DNA methylation levels of FAAH, ALOX5, CBFA2T3 and BHLHE23 genes were not statistically different in the peripheral blood of patients with AD, aMCI or SCD, compared with normal controls(P>0.05). According to the stratified analysis of gender and apolipoprotein E(APOE) genotype, there was no statistically significant difference in the DNA methylation levels in the peripheral blood among the groups (P>0.05). Conclusion The DNA methylation levels of the four genes weren't associated with AD, aMCI or SCD.

Relationship between uric acid and sarcopenia in middle-aged and aged men with type 2 diabetes mellitus

Mi Yingxin, Wang Xin, Zhang Kai, Li Keyue, Sun Lina, Xiu Shuangling

2021, 42(3):  453-458.  doi:10.3969/j.issn.1006-7795.2021.03.019

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Objective To explore the relationship between uric acid (UA) and sarcopenia in middle-aged and aged men with type 2 diabetes (T2DM). Methods All 275 men with T2DM aged over 55 years were selected from the Department of Endocrinology of Xuanwu Hospital. The uric acid (UA), 25 hydroxyvitamin D₃ (25OHD₃), hemoglobin A1c (HbA1c) were measured. The appendicular skeletal muscle mass (ASM), grip strength and gait speed were assessed. In addition, appendicular skeletal muscle mass index (ASMI) was calculated. The association between uric acid and sarcopenia was assessed. Results The prevalence of sarcopenia in men aged over 55 years with T2DM was 32.73%, the level of uric acid in participants of the sarcopenia group was significantly lower than that in non-sarcopenia group [(307.5±76.57) mmol/L vs (342.02±89.02) mmol/L, P=0.002)]. Pearson correlation analysis showed that UA was significantly positively correlated with ASMI (r=0.201, P=0.006), and UA was not significantly correlated with grip strength and gait speed (P>0.05). Multivariate logistic regression analysis showed uric acid was an independent protective factor for sarcopenia in middle-aged and aged men with T2DM (OR=0.89,95%CI:0.79-0.97,P=0.043). Conclusion Uric acid plays a protective role in sarcopenia in middle-aged and aged men with T2DM.

Effects of different doses of dexmedetomidine on postoperative agitation in children receiving craniotomy

Ma Jiajia, Yue Hongli, Wang Dexiang, Jin Xu, Han Ruquan

2021, 42(3):  459-463.  doi:10.3969/j.issn.1006-7795.2021.03.020

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Objective To investigate the effect of different doses of dexmedetomidine (DEX) on postoperative agitation in children receiving craniotomy. Methods Total 120 children aged 3-14 years old receiving elective craniotomy were enrolled and divided into four groups according to the dosage of dexmedetomidine: low-dose group(0.4 μg·kg^-1·h^-1), medium dose group(0.6 μg·kg^-1·h^-1), high-dose group(0.8 μg·kg^-1·h^-1) and normal saline control group, with 30 cases in each group. Primary outcome indexes were based on the incidence of agitation after the craniotomy. Secondary outcomes indexes were based on recovery time and the incidence of choking. Results The incidences of agitation in the middle dose group and the high dose group were significantly lower (17%, 11% vs 64%, P<0.01). The incidences of choking during extubation were reduced in a dose-dependent manner (P<0.01). The recovery time after drug withdrawal was significantly longer in the high-dose group (P<0.01). Conclusion Infusion of dexmedetomidine at the concentration of 0.6 μg·kg^-1·h^-1 at the end of operation significantly reduces the incidence of agitation and choking after craniotomy in children, and the degree of sedation was more appropriate.

Analysis of brain function and heart rate variability in insomnia patients with anxiety

Zhang Zhen, Wang Donghui, Sun Na, Wang Yueqing, Han Luyao, Xie Yingzhen, He Yumei

2021, 42(3):  464-469.  doi:10.3969/j.issn.1006-7795.2021.03.021

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Objective Research the brain function and the heart rate variability of insomnia patients with anxiety, analyzing their autonomic neural function and the features on brain using, which is anticipated to improve the vagal function and reduce the consumption of brain energy, and thus, slower the heart rate, relieve anxiety and insomnia symptoms, as well as to improve the clinical efficacy. Methods Take 443 patients with insomnia as a sample who were admitted to Dongzhimen Hospital of Beijing University of Chinese Medicine from October 2016 to August 2018, record their general information, Pittsburgh Sleep Quality Index (PSQI) scores, heart rate rariability (HRV) index and brain function. Divide the patients to 2 groups according to PSQI scores,of which ＜7 are 43 patients as non-anxiety group, while those ≥14 are 269 cases with anxiety, from which randomly select 43 of 269 by the ratio of 1∶1 age stratification. The selected 43 non-anxiety patients is regarded as the case group, while the 43 anxiety as the control. A comparison between the two groups proceeds. Results The anxiety group has more women(P<0.05); gets worse in the sleep quality(P<0.05); in personality, has more cases of those who are overburdened, overstrung and scrupulous(P<0.05), brain load, brain fatigue and attention-awaken increased (P<0.05), among HAV index, total power (TP) reduces, low frequency power (LF) and LF/high frequency power (HF) rises (P<0.05). Conclusion Patients with anxiety have worse situation of insomnia; the anxieties' HRV decreases accompanied by an increase in sympathetic activity; the continuous use of brain result in fatigue and tension of brain and an increasing brain energy consumption as well.

Comparison between ultrasound guided transperineal and transrectal prostate biopsy in the diagnosis of prostate cancer

Liu Sai, Wang Mingshuai, Cao Wen, Xie Dawei, Niu Yinong, Song Liming, Zhang Xiaodong, Wang Jianwen

2021, 42(3):  470-474.  doi:10.3969/j.issn.1006-7795.2021.03.022

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Objective To compare the diagnostic efficacy and safety of transperineal prostate biopsy (TPPB) and transrectal prostate biopsy (TRPB) in prostate cancer. Methods From January 2018 to January 2020, 237 patients received prostate biopsy under local anaesthesia in Beijing Chaoyang Hosipital, Capital Medical University, including TRPB applied to 185 patients between January 2018 and June 2019 and TPPB to 52 cases between July 2019 and January 2020. Results The perioperative information was analyzed and compared. There was no statistically significant differences between the two groups in preoperative parameters, including age [(68.2±9.2) years vs (69.7±8.1) years, P=0.331], body mass index (BMI) [(24.7±3.3) kg/m² vs (24.7±3.1) kg/m², P=0.924], Charlson comorbidity index (CCI) (2.7±1.7 vs 2.8±1.1, P=0.744), prostate volume [(59.5±32.0) cm³ vs (65.9±28.7) cm³, P=0.512)], and International Prostate Symptom Score (IPSS) (10.3±4.7 vs 10.2±5.0, P=0.960). No significant differences was found between the two groups in preoperative laboratory results (P>0.05).Fifty-two patients of TPPB and 185 patients of TRPB was successfully implemented, with 33and 145 cases of complications in Grade 1 of Clavien-Dindo in postoperative 7 days. There were no statistically significant differences between the two groups in cores, positive cores, pathology positive, Gleason Score, clinically significant prostate cancer (CsPCa), hematuria, lower urinary tract symptoms (LUTs), hematospermia or other Clavien-Dindo1 complications. The TPPB group acquired more operative time (P<0.001), less bleeding at puncture points (P=0.003), fewer fever (P=0.047), and more cases of Visual Analogue Scale/Score(VAS)≥4(P=0.005) with statistical significance. Conclusion Compared with TRPB, TPPB possesses similar diagnostic efficacy under local anaesthesia or general anesthesia if needed, with decreased bleeding at puncture points and the rate of fever.

Review

Development and progress of cancer nutrition therapy

Yu Kaiying, Wang Xiaolin, Shi Hanping

2021, 42(3):  499-502.  doi:10.3969/j.issn.1006-7795.2021.03.028

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Malignant tumor is the main health problem/concern and the one of the leading causes of death in human being, and it seriously threatens people's physical and mental health, economic development, social stability, and national security. Malnutrition is the most common complication in the patients with cancer and an independent risk factor for death in the patient with cancer, leading to not only adverse clinical outcomes (shortened survival time and reduced quality of life), but also a significant socio-economic burden. Therefore, treating malnutrition in the cancer patients is of great significance. Compared with daily diet, food for special medical purpose has some special advantages. Numerous studies have proved that oral nutritional supplement is the most convenient and cheapest nutritional treatment methods, which can promote disease rehabilitation, shorten the length of hospital stay and save medical costs. It is necessary to deepen the understanding of the importance of cancer nutrition, advance the practice of the first-line treatment in clinical work, and develop China's food for special medical purpose, especially cancer special medical food, which will greatly improve the overall level of cancer treatment in China and significantly save medical costs.