Table of Content

21 December 2021, Volume 42 Issue 6

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Basic and Clinical Research in Critical Care Medicine

The feasibility of positive end-expiratory pressure selection based on prolonged expiration in the model of acute respiratory distress syndrome

Wang Yumei, Wang Yan, Zhou Yimin, Xu Shanshan, Yang Yanlin, Zhang Linlin, Zhou Jianxin

2021, 42(6):  903-908.  doi:10.3969/j.issn.1006-7795.2021.06.001

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Objective To explore the feasibility of positive end-expiratory pressure (PEEP) selection based on prolonged expiration combined with ventilator monitoring in the model of acute respiratory distress syndrome (ARDS). Methods ARDS model was established by alveolar instillation of hydrochloric acid. Decremental PEEP trial was performed by prolonged expiration maneuver. A prolonged expiration (6-9 seconds) maneuver was performed while abruptly decreasing PEEP from a high to a low level for one breath (from 20 cmH₂O to 0 cmH₂O in decremental steps of 5 cmH₂O). Because inspiratory tidal volume (VT) was unchanged, the difference in expiratory VT values between the expired VT displayed immediately after decreasing PEEP and the breath before changing PEEP was referred to as the total change in lung volume from high to low PEEP. Meanwhile, the predicted change in lung volume was estimated by the product of respiratory system compliance at low PEEP and the change in pressure. The difference of total change of lung volume and predicted value was taken as an estimate of derecruited volume or recruitment volume (Vrec). The PEEP with the largest Vrec may be the appropriate PEEP interval. This PEEP was verified by electrical impedance tomography (EIT) based on the overdistension and collapse. Optimal PEEP level was set based on the appropriate PEEP interval, hemodynamics, and other indicators. Results The PEEP interval with the largest Vrec by prolonged expiration was 5-10 cmH₂O. According to EIT, the optimal PEEP level was also in the interval of 5-10 cmH₂O with appropriate overdistension and collapse. When PEEP was in 15-20 cmH₂O, intravenous norepinephrine was used to maintain mean arterial pressure (MAP) above 65 mmHg, and driving pressure was large to cause the ventilator-associated lung injury. It was unreasonable for physiological PEEP when PEEP was under 5 cmH₂O. Conclusion It is feasible to select PEEP using prolonged expiration combined with ventilator monitoring. The PEEP with the largest Vrec assessed by prolonged expiration may be the appropriate PEEP interval. Then, the optimal PEEP level may be further confirmed with hemodynamics and other parameters.

Risk factors of cerebral infarction after cardiac surgery

Hu Wenli, Hou Dengbang, Wang Liangshan, Jia Ming, Lai Yongqiang, Hou Xiaotong, Wang Hong

2021, 42(6):  909-914.  doi:10.3969/j.issn.1006-7795.2021.06.002

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Objective To investigate the risk factors of in-hospital cerebral infarction with carotid artery ultrasound parameters for postcardiotomy patients. Methods The data of 491 adult patients who underwent cardiac surgery in Beijing Anzhen Hospital, Capital Medical University from January 2020 to December 2020 were retrospectively analyzed. The patients were divided into cerebral infarction and control group. The risk factors were analyzed via univariate and multivariate Logistic regression. Results The total incidence of in-hospital cerebral infarction in postcardiotomy patients was 1.8%, and the survival rate of patients complicated with cerebral infarction was 77.8%. The higher European system for cardiac operative risk evaluation (EuroSCORE) II level (OR=1.585, 95%CI: 1.043-2.409), bilateral cervical and vertebral artery plaques (OR=14.513, 95%CI: 2.538-82.978), extracorporeal membrane oxygenation (ECMO) support (OR=112.518, 95%CI: 8.967-1 411.907), and new postoperative atrial fibrillation (OR=20.800, 95%CI: 3.639-118.902) were independent risk factors for cerebral infarction after cardiac surgery. Conclusion Besides higher EuroSCORE II, ECMO support and new-oneset postoperative atrial fibrillation, the carotid ultrasound-based bilateral carotid artery and vertebral artery plaques is risk factor for cerebral infarction after cardiac surgery. It is necessary to carry out a preoperative carotid artery ultrasound screening and strict intraoperative and postoperative management for the patients at risk.

The important role of simplified acute physiological score-3 in early corticosteroid treatment for patients with acute respiratory distress syndrome

Liu Hui, Xiao Jianguo, Hu Xin, Wang Li, Zhou Feihu

2021, 42(6):  915-922.  doi:10.3969/j.issn.1006-7795.2021.06.003

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Objective To investigate the role of Simplified Acute Physiological Score-3 (SAPS-3) in spotting who was likely to benefit from early corticosteroid treatment in patients with acute respiratory distress syndrome (ARDS). Methods Electronic intensive care unit collaborative research database (eICU-CRD) was used to extract data about moderate or severe ARDS patients. After the cut-off value of SAPS-3 was identified, accordingly, the enrolled patients were divided into two groups. Propensity score matching analysis (PSMA) was used to remove confounding factors before comparing the effect of early corticosteroid treatment in ARDS patients. Results There were 3 234 ARDS patients with early corticosteroid treatment and 1 122 ARDS patients without this treatment. After propensity score matching analysis (PSMA), the data showed that ARDS patients with SAPS-3>70 had a shorter duration of mechanical ventilation after early corticosteroid treatment [(5.2±5.6) d vs (6.5±5.9) d, P<0.001), compared with the patients with SAPS-3≤70. There was no difference in mortality whether early corticosteroid treatment was applied or not. Conclusion The ARDS patients with SAPS-3>70 were likely to benefit from early corticosteroid treatment.

Meta-analysis of risk factors for bloodstream infections in intensive care unit

Qi Zhili, Lin Jin, Dong Lei, Liu Jingfeng, Duan Meili

2021, 42(6):  923-930.  doi:10.3969/j.issn.1006-7795.2021.06.004

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Objective To investigate the risk factors of bloodstream infections (BSI) in intensive care unit (ICU). Methods We screened the studies in English databases (Cochrane Library, PubMed, Embase, Web of Science) and Chinese databases (CBM, CNKI, Wanfang, Weipu) from each starting year to April 2021.Two investigators independently reviewed the articles and extracted the information according to the established inclusion and exclusion criteria, and cross-checked. Data analysis was performed by the software RevMan5, and the heterogeneity among the study and risk of bias were also evaluated. Results Among the initial identified 13 691 articles, 11 studies were brought into study. Our results showed that risk factors of BSI are parenteral nutrition (OR=5.07,95%CI:2.89-9.10), respiratory failure(OR=3.03,95%CI:1.90-4.83), sepsis(OR=2.13,95%CI:1.50-3.01), central venous catheterization(OR=3.57,95%CI:2.16-5.90), immunosuppression(OR=3.52,95%CI:1.72-7.20),mechanical ventilation(OR=5.28,95%CI:2.05-13.62), cardiovascular events(OR=3.07,95%CI:1.68-5.62), and previous antibiotic exposure(OR=2.46,95%CI:1.14-5.33). Conclusion The risk factors of BSI in the ICU included parenteral nutrition, respiratory failure, sepsis, central venous catheterization, immunosuppression, mechanical ventilation, cardiovascular events, and previous antibiotic exposure.

Analysis of total calories balance and in-hospital mortality in criticallyill patients during acute phase

Gao Ming, Zhou Yingli, Zhu Yan, Qin Junping, Huang Huibin, Ren Yu, Tan Li, Zhou Hua, Xu Yuan

2021, 42(6):  931-935.  doi:10.3969/j.issn.1006-7795.2021.06.005

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Objective To analyze the correlation of energy delivery and in-hospital mortality in acute phase of critical illness in intensive care unit (ICU). Methods The patients who were admitted to general ICU, Beijing Tsinghua Changgung Hospital for more than 7 days from April 2019 to April 2021 were enrolled.The clinical and nutritional data on the first 7 days were retrospectively collected. Multivariate Logistic regression was used to analyze the risk factors of in-hospital mortality. Results A total of 61 patients were recruited, and 18 of them died during hospitalization. The results of multivariate logistic regression showed thatNutrition Risk Screening(NRS) 2002 score (P=0.018), days of continuous renal replacement therapy (CRRT) (P=0.013) and total calories risk (TCB) in the first 3d (P=0.044) were the risk factors of in-hospital mortality. The risk of in-hospital mortality increased by 120% per each 500 kcal (1 kcal=4.186 kJ) of total calories balance during the first 3 days of ICU. For the patients with high nutritional risk (NRS 2002≥5), TCB in the first-3d (P=0.042) and days of CRRT (P=0.019) were also the high risk factors of in-hospital mortality. While they were no predictive values in the patients with lower nutrition risk (NRS 2002<5). Conclusion NRS 2002 score, days of CRRT and TCB in the first-3d were the risk factors of in-hospital mortality for critically ill patients in ICU, particularly for the high nutritional risk one.

Screening for multidrug resistant organisms in patients admitted to the 10 community hospitals

Qian Fang, Jiang Li, Liu Yongdong, Huang Jing, Ren Yanming, Liu Yudong, Li Emei, Yuan Jing, Pei Shuang, Zhao Yan, Sun Wenxiu, Yu Liyan, Zhang Xiaoping, Zhang Xinmei, Wang Nan

2021, 42(6):  936-942.  doi:10.3969/j.issn.1006-7795.2021.06.006

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Objective To investigate the patient screening for multidrug-resistant organisms (MDROs) on admission to the 10 community hospitals in Beijing. Methods The patients admitted to the 10 community hospitals in Xicheng district were enrolled in the study from June 11, 2015 to September 30, 2016. The patients were divided into hospital group and community group according to the place before admission. Nasal swabs and anal swabs were collected within 48 hours after admission. Chromogenic culture medium technology was used to identify methicillin resistant staphylococcus aureus (MRSA), extended-spectrum β-lactamases (ESBL)-producing Enterobacteriaceae, and vancomycin resistant enterococcus (VRE). The positive percentage and distribution of the MDROs were compared between the groups. We also try to find risk factors for the positive MDROs. Results A total of 644 patients were enrolled in the study, among which 220 of the 304 patients in the hospital group showed positive screening at least one site, significantly higher than that of the 340 patients in community group (72.4% vs 51.5%, P<0.001). The positive percentage of nasal swab in hospital group was higher than that in the community group (11.8% vs 3.2%, P<0.001). The MRSA was the most found MDROs. The positive percentage of anal swab was higher than that of nasal swab in both groups. The patients with positive anal swab screening for 2 or more MDROs were significantly higher in the hospital group than that in the community group (18.9% vs 12.8%, P=0.046), especially with Escherichia coli (ECO) and Klebsiella-Enterobacter-Serratia-Citrobacter (KESC). Cerebrovascular disease, hypertension,surgery or interventional procedure, antibiotic exposure within 4 weeks prior to admission, and systemic inflammatory response syndrome (SIRS) on admission were risk factors for positive MDROs screening. Conclusion The positive MDROs screening were found in more than half of the patients admitted to the 10 community hospitals, especially, in patients transferred from tertiary hospital nearby. We should pay sufficient attention to these patients.

Clinical study of double filtration plasmapheresis in the treatment of hyperlipidemia pancreatitis

Liu Li, Wang Guan, Zhao Xinyu, Liu Jingyuan, Ji Yu, Liu Yong, Han Wei, Weng Yibing, Li Ang

2021, 42(6):  943-949.  doi:10.3969/j.issn.1006-7795.2021.06.007

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Objective To verify the clinical significance of double filtration plasmapheresis (DFPP) in the treatment of hypertriglyceridemia acute pancreatitis (HTG-AP). Methods A retrospective case-control research methods was used to collect HTG-AP patients who were admitted to the Department of Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University for the first time. The DFPP group included 45 HTG-AP patients admitted in from September 2017 to March 2021 and treated with DFPP to reduce triglyceride (TG). The insulin group collected 24 HTG-AP patients admitted in from September 2015 to August 2017, who were treated with insulin and glucose infusion to control TG. Both groups were given standard treatments such as fasting, gastric acid and pancreatic enzyme secretion suppression, and nutritional support. The demographic characteristics, biochemical blood indicators, inflammatory markers, incidence of adverse events, length of stay in intensive care unit (ICU) and hospital stay of the two groups of cases were collected. Results There was no significant difference between the two groups in terms of gender, age, and severity of HTG-AP (P>0.05). The DFPP group was significantly better than the insulin group in reducing the time required for TG, staying time in ICU, and length of hospital stay in the insulin group (P＜0.05). The time required for TG to drop below 3.71 mmol/L in the test group was significantly less than that in the insulin group (6.7±3.3) h and (44.1±11.6) h, respectively (P<0.01). The 72-hour relief rate of clinical symptoms such as abdominal pain and bloating in the test group was significantly higher than that in the insulin group (P<0.05). With regard to the speed and amplitude of decline, the peripheral blood leukocytes, C-reactive protein, interleukin 6, interleukin 8, tumor necrosis factor-alpha and other inflammatory indicators in the DFPP group are significantly better than that in the insulin group (P<0.01). During the treatment, the vital signs of the patients in both groups were stable and well-tolerated, and there were no adverse events such as allergic reactions and bleeding, suggesting the treatment safety was good. Conclusion The results showed that the DFPP is the fastest and most effective treatment for reducing TG, and its efficacy in severe HTG-AP depends on its early implementation. For large medical institutions with mature operating technology, we believe that it should be beneficial to use DFPP method to treat severe HPG-AP as early as possible with a view to blocking the possible malignant process of HPG-AP as soon as possible.

Effect of inhaled acetylcysteine alveolar lavage therapy on patients with severe pneumonia

Niu Xia, Chen Xiumei, Zheng Yanhui

2021, 42(6):  950-955.  doi:10.3969/j.issn.1006-7795.2021.06.008

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Objective To observe the therapeutic effect of inhaled acetylcysteine in the bronchoalveolar lavage treatment for the patients with severe pneumonia. Methods Sixty patients with severe pneumonia were randomly divided into the treatment and control groups according to the principle of baseline feature matching. All patients were given basic treatment such as mechanical ventilation, anti-infection, expectorant, and tracheoscopic bronchoalveolar lavage. The lavage fluid in the treatment group was inhaled acetylcysteine,and normal saline in the control group. The white blood cell (WBC), C-reactive protein (CRP), procalcitonin (PCT), oxygenation index (OI), respiratory mechanical indexes such as airway resistance (Raw), platform pressure (Pplat), positive end-expiratory pressure (PEEP), and dynamic lung compliance(Cdyn) were detected for the two groups before and after treatment. Moreover, treatment effective rate, mechanical ventilation time, and intensive care unit (ICU) retention time were compared with each other between the two groups. Results Before treatment: there were no significant differences in WBC, CRP, PCT, OI and respiratory mechanics indexes between the two groups (P>0.05). After treatment, WBC, CRP, PCT, RAW, PPLAT and PEEP in the treatment group were significantly decreased compared with that in the control group (P<0.05).OI, Cdyn and effective rate in the treatment group were higher than those in the control group (P<0.05).The mechanical ventilation time and ICU retention time in the treatment group were shorter than that in the control group (P<0.05), and the differences were statistically significant. Conclusion The bronchoalveolar lavage with inhaled acetylcysteine may benefit inflammatory absorption and improve prognosis in patients with severe pneumonia.

Recognition and management of neurological complications during extra corporeal membrane oxygenation

Miao Mingyue, Zhang Linlin, Zhou Jianxin

2021, 42(6):  956-960.  doi:10.3969/j.issn.1006-7795.2021.06.009

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Extra corporeal membrane oxygenation(ECMO) is an extracorporeal life support for life-threatening cardiopulmonary failure. Although many patients survive due to its introduction, significant neurological complications like seizures, ischemic strokes, intracranial hemorrhage, ischemic hypoxic encephalopathy, and brain death occur during ECMO and lead to serious adverse outcomes, with high frequency and associated mortality of neurological complications. Although the incidence is reported ranging from 13% to 27%, the prevalence of ECMO-related neurological complications is still unclear. Neurological complications in patients during ECMO associated with lots of risk factors, while the treatments mainly depend on internal medicine. In recent years, non-invasive monitoring is brought into focus, such as electroencephalography (EEG) monitoring and so on.The mortality of patients with ECMO-related neurological complications is much higher than those patients without.The systematic neurological monitoring and early intervention may improve the outcomes.

Basic Research and Clinical Investigation of Prostatic Disease

The effects and mechanism of phenylethyl isothiocyanate on cell proliferation and apoptosis in BPH-1 cells

Liu Zhibin, Jin Song, Niu Yinong

2021, 42(6):  961-966.  doi:10.3969/j.issn.1006-7795.2021.06.010

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Objective To investigate the effects of phenethyl isothiocyanate (PEITC) on human benign prostatic epithelial cells(BPH-1). Methods Exposure of BPH-1 cells to PEITC at different concentrations (6, 12, and 24 μmol/L) for 6, 12, 24, or 36 hours. The suppression of cell proliferation was assessed with CCK-8 assay. The cell apoptosis was evaluated with Annexin V/PI staining by fluorescent flow-cytometric assay. The Western blotting analysis was applied to examine the expression of X-linked inhibitor-of-apoptosis protein (XIAP) and Atg5-12. The expression of XIAP mRNA was detected with RT-PCR. Results 1)Upon the treatment of PEITC at 6, 12, and 24 μmol/L, the cell relative viability was 71.22%, 48.90%, and 13.57%, respectively, for 6 hours; 52.57%, 42.37%, and 10.11%, respectively, for 12 hours; 36.73%, 25.88%, and 8.39% for 24 hours, respectively, and 33.57%, 25.83%, and 13.06%, respectively, for 36 hours. PEITC suppressed the proliferation of BPH-1 cells in a concentration-dependent way, compared with the control group (P<0.05). 2)The total percentages of apoptotic cells was 19.5%, 30.4%, and 40.1% in BPH-1 cells upon the treatment of PEITC at 6, 12, and 24 μmol/L for 24 hours, respectively. PEITC promoted cell apoptosis at concentrations of 12 μmol/L and 24 μmol/L, compared with the control group (P<0.05). 3)The relative expression of XIAP mRNA and XIAP was suppressed in a concentration-dependent way (6, 12, and 24 μmol/L) upon the treatment of PEITC for 24 hours. The expression of Atg 5-12 protein was also inhibited in a concentration-dependent way (6, 12, and 24 μmol/L) upon the treatment of PEITC for 24 hours. Conclusions PEITC suppressed the proliferation of benign prostatic epithelial cells and induced cell apoptosis by inhibiting the expression of XIAP mRNA and XIAP in a concentration-dependent way, which was probably associated with the suppressed autophagy pathway in BPH-1 cells.

The outcome of cytoreductive radical prostatectomy for prostate cancer patients with bone metastasis

Jiang Mingxin, Su Yao, Xiong Tianyu, Ye Xiaobo, Jin Song, Xing Nianzeng, Jin Mulan, Yang Mingfu, Niu Yinong

2021, 42(6):  967-972.  doi:10.3969/j.issn.1006-7795.2021.06.011

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Objective To evaluate the clinical efficacy of cytoreductive radical prostatectomy in prostate cancer patients with bone metastasis. Methods A total of 34 prostate cancer patients with bone metastasis were included in this study,who underwent cytoreductive radical prostatectomy in the Department of Urology, Beijing Chaoyang Hospital, Capital Medical University from February 2012 to June 2021. Overall survival(OS) and biochemical progression-free survival (BPFS) were evaluated using descriptive statistical analyses, the Kaplan-Meier method, and univariate and multivariate analyses. Results The median follow-up time was 29.0 months, the 2-year OS was 85.9%, the median biochemical progression-free time was 75.0 months, and the 2-year BPFS was 63.9%.9 patients suffered Clavien-DindoⅠ-Ⅱ level complications within 1 month after surgery,and the patients’ urination function was basically recovered at 3 months after surgery. There were statistically significant differences in mean BPFS between the number of bone metastasis ≥5 and <5 group (28.1 months vs 63.2 months, P=0.012),and the positive and negative margins group(34.8 months vs 70.3 months, P=0.029). Multivariate analysis showed that positive/negative surgical margins was significantly associated with BPFS(P=0.026). Conclusion Prostate cancer with bone metastasis is not an absolute operational contraindication. The cytoreductive radical prostatectomy is safe and feasible for the patients after screening and preparation, with acceptable operation duration, bleeding volume and postoperative complications. The serum prostate specific antigen can be effectively controlled via combination treatment with endocrine therapy and other treatments after surgery, which is expected to improve disease progression and prolong the length of survival.

The effect of modified apical dissection and periurethral structure preservation in the immediate continence recovery after laparoscopic radical prostatectomy

Wang Mingshuai, Xiong Tianyu, Jiang Mingxin, Qian Xiaosong, Wang Sihao, Cui Yun, Niu Yinong

2021, 42(6):  973-977.  doi:10.3969/j.issn.1006-7795.2021.06.012

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Objective To explore the effect of modified apical dissection and periurethral structure preservation in the immediate continence recovery after laparoscopic radical prostatectomy. Methods The patients who were diagnosed with prostate cancer in the Department of Urology of Beijing Chaoyang Hospital from September 2020 to December 2020 were selected as the study subjects. Among them, total 10 patients underwent laparoscopic radical prostatectomy with modified apical dissection and periurethral structure preservation by the same surgical team. The perioperative and follow-up data were collected for analyzing the perioperative complication and immediate continence rate. Results The mean age was 68±9, the median Eastern Cooperative Oncology Group (ECOG) score was 1, the median maximum prostate specific antigen (PSA) was 15.05(7.05,31.00)ng/mL. There were 8 cases for cT2, 1 case for cT3, and 1 case for cT4. The mean operative time was (123±26) min and the mean established blood loss was (63±28) mL. The median day of catheter removal was 5 (5, 7) days and 9 patients obtained complete urinary continence at the day of catheter removal. One case suffered Clavien I complication postoperatively. Totally 2 cases were diagnosed as pT2a, 5 cases as pT2c, 1 case as pT3b and 2 case as pT4. Gleason score of 2 cases was 3+3, 5 cases 4+3, and 3 cases 4+5/5+4. Four patients had positive apical surgical margin. Conclusion The primary study indicated that the technique of modified apical dissection and periurethral structure preservation could improve the immediate continence rate after laparoscopic radical prostatectomy without compromising complication. However, the apical positive surgical margin was higher. The technique requires further development, and high-quality clinical study was required to confirm the efficacy.

Efficacy of abiraterone acetate combined with prednisone in the treatment of castration-resistant prostate cancer

Ye Xiaobo, Xiong Tianyu, Cui Yun, Wang Mingshuai, Yang Hui, An Zhuoling, Niu Yinong

2021, 42(6):  978-985.  doi:10.3969/j.issn.1006-7795.2021.06.013

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Objective To analyze the efficacy and safety of abiraterone acetate (AA) combined with prednisone (P) in patients with castration-resistant prostate cancer (CRPC). Methods Retrospective analysis was performed on 46 CRPC patients who were treated with AA+P from July 2018 to April 2021 in the Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, and finally 37 patients were included in the study. To analyze the basic data of 37 patients, the prostate specific antigen (PSA) response rate was calculated according to the PSA Working Group 2 (PSAWG2) standard, and the patient’s imaging outcome during treatment was evaluated according to response evaluation criteria in solid tumors(RECIST) standard. The difference in PSA response rate was compared with each other group for AA+P treatment with/without docetaxel chemotherapy. Results The median follow-up time was 9.7 months after 37 CRPC patients received AA+P treatment. At the beginning of receiving AA+P, 5 patients had PSA flare, and the median time for their PSA rising to peak followed by a drop below the baseline level was 3.0(2.0,4.5) months. The overall PSA response rate of 37 patients was 59.5%, of which 13 patients had PSA recurrence after reaching remission, with a median recurrence time of 7.0 months. According to RECIST criteria, of 37 CRPC patients, 7 patients had imaging progression, and 5 patients had definite imaging remission. Six patients who relapsed after reaching PSA remission were treated with dexamethasone as an alternative of prednisone. Among them, 2 patients had PSA response, with the PSA response rate 33.3%. For the patients with or without docetaxel chemotherapy, the PSA response rate was 20.0% (1/5), and 65.6% (21/32),respectively. There was no statistically significant difference in response rate (P=0.076). In addition, the response rate of PSA of patients with PSA flare was significantly lower than that without this phenomenon (20.0% vs 65.6%, P=0.070). Abiraterone acetate was generally well tolerated and had fewer adverse drug reactions. Conclusion In CRPC patients, oral abiraterone acetate combined with prednisone had a definite effect and high safety. For patients who were unwilling to choose or could not tolerate chemotherapy, there is a higher PSA response rate. PSA flare was not uncommon during AA treatment, and the proportion of these patients who achieved PSA response was relatively low. The median time to recurrence after PSA response was 7.0 months, and some patients with PSA progression could regain PSA response by replacing prednisone with dexamethasone.

Basic Research

Electroacupuncture selectively regulates the expression of c-Fos in the dorsal striatum of Parkinsonian mice

Su Wenting, Yu Jianan, Jia Jun, Wang Xiaomin

2021, 42(6):  986-992.  doi:10.3969/j.issn.1006-7795.2021.06.014

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Objective To observe the selective regulation of electroacupuncture (EA) on the expression of proto oncogene protein (c-Fos) in the striatum of Parkinsonian mice, so as to explore the potential mechanism of EA in the treatment of Parkinson's disease (PD). Methods PD model mice with right side injury by 6-hydroxydopamine (6-OHDA) were made. The mice were divided into Sham, Sham+EA, Model and Model + EA groups. The “Zusanli” and “Sanyinjiao” acupoints on both sides of the lower limbs of mice were used as the stimulation sites. 100 Hz EA was applied for 30 minutes, and the c-Fos protein expression in the dorsal and ventral striatum and cingulate cortex were detected by immunohistochemistry later. Results Compared with the Sham group, the expression of c-Fos in the right dorsal side of the Model mice was significantly lower (P<0.001), and EA stimulation increased the expression of c-Fos in the right dorsal and ventral side of the Model group (P<0.05). In the cingulate cortex, there was no significant difference in the expression of c-Fos among these groups, and EA had no obvious regulatory effect. Conclusion EA can specifically activate the activity of neurons in the dorsal striatum on the injured side of parkinsonian mice.

Joint effects of soy lecithin and soy isoflavone on improving learning and memory impairment and cerebrovascular function in rats

Yu Huiyan, Chi Yafei, Li Hongrui, Wang Xuan, Zhou Xueyang, Xiao Rong, Xi Yuandi

2021, 42(6):  993-999.  doi:10.3969/j.issn.1006-7795.2021.06.015

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Objective To explore the effects of soy lecithin (SL) combined with soy isoflavone (SIF) on cognitive function and cerebrovascular damage in rats with learning and memory impairment, and to explore the best combined dosage in order to provide scientific evidence of the neuroprotective effects of soybean's active substances and their combined supplementary effects. Methods: In this study, SPF-grade adult male Wistar rats were used. Using the L9(34) orthogonal experimental design, control group, β-amyloid(Aβ) group and nine different dose combinations of SIF+SL were obtained. Methods Such as water maze, cerebrovascular HE staining, enzyme-linked immunosorbent assay (ELISA), and enzymatic kits were used. The rat's learning and memory ability, cerebrovascular pathological damage, the level of oxidative damage, and the redox balance system were tested. Results Compared with the control group, the escape latency of the Aβ model group rats was significantly prolonged (P<0.05), and the morphological changes of cerebrovascular tissue were obvious, and there were increased significant changes in malondialdehyde (MDA) and 3-nitrotyrosine (3-NT) in rats (P<0.05), the ratio of glutathione/oxidized glutathione (GSH/GSSG) decreased significantly (P<0.05). On the contrary, compared with the model group in the SL+SIF intervention group, SL+SIF played a protective role for the model group. Based on the above results, the study found that SL(40 mg·kg^-1·d^-1)+SIF(50 mg·kg^-1·d^-1) is the best combined dose to improve the rat's learning and memory impairment, protect the cerebral blood vessels and regulate the redox balance system. Conclusion SL+SIF can significantly improve Aβ-mediated learning and memory impairment in rats, and its neuroprotective effect may be related to the antioxidant activity of the two to antagonize Aβ-mediated cerebrovascular injury, and their neuroprotective effects of SL(40 mg·kg^-1·d^-1)+SIF(50 mg·kg^-1·d^-1) is the best combined dose for rats.

Effects of major facilitator superfamily domain containing 2A on the cell proliferation, apoptosis and invasion of human hepatocellular carcinoma

An Songlin, Ma Ling, Zhao Yue, Li Yan

2021, 42(6):  1000-1006.  doi:10.3969/j.issn.1006-7795.2021.06.016

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Objective To explore the effects of major facilitator superfamily domain containing 2A (MFSD2A) on cell proliferation, apoptosis and invasion of hepatocellular carcinoma. Methods Hepatocellular cancer cell lines HepG2 and SMMC-7721 were transfected with lentivirus vector carried shRNA to knock down MFSD2A expression, meanwhile they were also transfected with lentivirus vector carried full length MFSD2A sequence to overexpress MFSD2A level. The qPCR and Western blotting were applied to evaluate the transfection efficiency. CCK-8 assay was used to investigate the functional effect of MFSD2A on cell proliferation. The cell apoptosis was detected with flow cytometry. The Transwell invasion assay was applied to determine the cell invasion and migration of the transfected cells. Results Upregulation of MFSD2A in hepatocellular cancer cells could significantly suppress the cell proliferation, induce the apoptosis, and decrease the cell invasion. On the contrary, downregulation of MFSD2A led to the opposite effect. Conclusion MFSD2A acted as a novel tumor suppressor gene for hepatocellular carcinoma through cell proliferation inhibition and apoptosis induction.

Effect of filtration on exosome extraction by ultracentrifugation

Li Rong, Chen Jing, Li Chuanyun, Zhou Tong, Chen Huan, Chen Dexi, Qiao Yuebing, Li Weihua

2021, 42(6):  1007-1013.  doi:10.3969/j.issn.1006-7795.2021.06.017

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Objective To clarify the effect of filtration on the quantity and purity of exosomes extracted by ultracentrifugation, and to provide a reference for the current extraction methods of exosomes. Methods Healthy human plasma and lung cancer cell PC-9 / IR cell culture supernatants were collected and divided into unfiltration group (NC) and filtration group (GL), the filtration group was filtered with 0.22 μm filter. Exosomes were extracted by ultracentrifugation. The number and size of nanoparticles (exosomes) before and after filtration were detected by nanoparticle tracking analysis (NTA). The number and percentage of CD9⁺ exosomes (CD9⁺Exo) and CD63⁺ exosomes (CD63⁺Exo) before and after filtration were detected by Aminis imaging flow cytometry. Results The results of NTA showed that compared with the NC group, the number of exosomes decreased by 4.7 times after plasma filtration, and the number of exosomes decreased by 2.5 times after filtration of the culture supernatant. The results of flow cytometry showed that the number of CD9⁺Exo and CD63⁺Exo in plasma decreased by 5 and 2.6 times respectively after filtration, and the number of CD9⁺Exo and CD63⁺Exo in culture supernatant decreased by 3 and 2.3 times respectively after filtration. The difference was statistically significant (P<0.05). But the percentage of CD9⁺Exo and CD63⁺Exo did not significantly increase after filtered both in plasma and supernatant (P>0.05). Conclusion Filtration decrease the number of exosomes, but not improve the purity of exosomes.

Clinical Research

Application of periareolar incision combined with mastoscopic axillary lymph node dissection in breast conserving surgery for early breast cancer

Wei Changsheng, Luo Chengyu, Zhang Shuqi

2021, 42(6):  1014-1020.  doi:10.3969/j.issn.1006-7795.2021.06.018

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Objective To investigate the efficacy and cosmetic results of periareolar incision combined with mastoscopic axillary lymph node dissection (MALND)in breast conserving surgery (BCS)for early breast cancer. Methods From January 2016 to January 2019, 98 patients with early breast cancer received breast conserving surgery, of whom 46 cases (periareolar incision group) received periareolar incision and MALND,52 cases (tumor surface incision group)received tumor surface incision and conventional axillary lymph node dissection(CALND)in the same period.The surgical observation indicators such as the operative time,bleeding,drainage tube time,hospital stay were compared between the two groups.The cosmetic results of breast were evaluated according to the appearance of breast more than 6 months after operation. Results There was no significant difference in tumor size, tumor location, distance between tumor and nipple-areola complex(NAC), lymph node metastasis, pathological type, clinical stage and molecular type between the two groups(P>0.05). The operation time was shorter in the tumor surface incision group (P<0.05). There was no significant difference in bleeding, drainage tube time,hospital stay between the two groups (P>0.05). The scores of texture and elasticity, symmetry, degree of breast depression, skin color, surgical scar and breast compliance in the periareolar incision group were higher than those in the tumor surface incision group (P<0.05). The excellent and good rate of total score greater than 24 in the periareolar incision group (78.3%, 36/46) was significantly higher than that in the tumor surface incision group (51.9%, 27/52), the difference was significant (P<0.05). Conclusion The BCS effect is the same as that of the tumor surface incision when the tumor is removed through the periareolar incision. Combined with MALND technology, the operation effect of BCS for early breast cancer and the postoperative quality of life of patients are improved, and the best cosmetic results is obtained.

Effects of ketogenic diet on menstruation and fertility in overweight/obese women with polycystic ovary syndrome

Li Jian, Bai Wenpei, Jiang Bo, Bai Liran, Wu Fengyun

2021, 42(6):  1021-1025.  doi:10.3969/j.issn.1006-7795.2021.06.019

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Objective To evaluated the effect of ketogenic diet on fertility in overweight/obese women with polycystic ovary syndrome. Methods Overweight/obese patients with polycystic ovary syndrome who visited the gynecological clinic from January 2019 to January 2020 were given ketogenic diet intervention for 12 weeks and followed up for 1 year. The differences of weight, menstrual cycle and pregnancy before and after the intervention were compared. Results A total of 52 patients were included. The median age was 29 years (23-39 years). The median time for diagnosis of polycystic ovary syndrome was 5 years (1-8 years). After ketogenic diet intervention, body weight decreased significantly (75.40±9.74 vs 65.48±8.30 kg, P＜0.001), menstrual cycle shortened significantly [(74.71±45.36) d vs (31.44±4.48) d, P＜0.001], and menstrual disorder rate decreased from 71.15% to 21.15%. There were 29 infertile patients who had fertility requirements before ketogenic diet, and 15 patients were pregnant after intervention, including 1 case of embryo suspension, and the other 14 cases were pregnant to full term. The pregnancy rate was 51.72% and the live birth rate was 48.28%. The average time of pregnancy was 2.4 months from the end of intervention (0.5-10.0 months). The average gestational age of delivery was (39.00±1.13) weeks. The mode of delivery: vaginal delivery accounted for 85.71%, cesarean section 21.43%, neonatal birth weight averaged (3.26±0.48) kg, only 2 cases had gestational diabetes during pregnancy, and 1 cases had gestational hypertension. Conclusion Ketogenic diet can reduce weight, shorten menstrual cycle, improve infertility and reduce pregnancy complications in overweight/obese women with polycystic ovary syndrome.

Rationality verification and evaluate of the 2018 International Federation of Gynecology and Obstetrics staging system for stage ⅠB cervical cancer

Liu Yang, Wu Yumei, He Yue, Fan Bei, Wang Yan, Zhao Hui, Wang Ming

2021, 42(6):  1026-1032.  doi:10.3969/j.issn.1006-7795.2021.06.020

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Objective The paper aimed to verify and evaluate the stage ⅠB of the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) cervical cancer staging schema from the aspects of clinical characteristics and prognosis, etc. Methods This is a retrospective observational study examining 427 patients from January 1, 2010 to December 31, 2014 with cervical cancer of stage ⅠB1-ⅠB3 classified using the 2018 FIGO staging schema. The clinical characteristic including age, tumor characteristics (Including pathological type, histological grade, deep stromal invasion and infiltration of lymphatic vascular space), treatment (postoperative adjuvant radiotherapy and chemotherapy) and 5-year survival rate were estimated for each group by statistical methods such as group comparison and multi factor analysis. Results Stage ⅠB1 tumors were more likely to be squamous cell and well-moderate grade, whereas the adenocarcinoma, adenosquamous cell and poorly grade were more common in stage ⅠB2-ⅠB3 neoplasms (both P<0.001). The rates of deep stromal invasion and lymph-vascular space invasion (LVSI) in stage ⅠB2 and ⅠB3 tumors were significantly higher than stage ⅠB1 (P<0.001, P<0.05). The probability of postoperative radiotherapy and chemotherapy in stage ⅠB2 and ⅠB3 cohorts were significantly higher than that with stage ⅠB1 (P<0.001).The 5-year overall survival rate in stage ⅠB1, ⅠB2 and ⅠB3 diseases significantly different and decreased in turn, which were 97.9%, 93.4% and 81.5% respectively.The survival curve showed that the curves of each group were well separated, and the difference was statistically significant (P<0.001). Conclusion The FIGO 2018 staging schema revised the new system to ⅠB1(≤2 cm),ⅠB2(＞2 cm~≤4 cm)and ⅠB3(＞4 cm), with invasive carcinoma 2 cm in greatest dimension is regarded as a cut off value,which provides better stratification of the disease and prognostic evaluation for patients of stage ⅠB, and has a good clinical guiding significance.

Suicide risk factors of emergency psychiatric patients

Ji Xiao, Pan Yizhu, Zhu Hui, Li Jingyuan, Li Xiaoqiang, Yin Li, Chen Yuan

2021, 42(6):  1033-1040.  doi:10.3969/j.issn.1006-7795.2021.06.021

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Objective To evaluate the clinical, psychological, sociological and biological risk factors of suicide in psychiatric emergency patients. Methods Cross-sectional analysis was conducted on the psychiatric emergency patients from 2015 to 2017 in Beijing Anding Hospital affiliated to Capital Medical University. Suicidal thoughts and behaviors (STB) were assessed using the suicidal risk factor assessment form. The score ≤10 and > 10 points indicate the presence and absence of STB, respectively. A multivariate Logistic regression analysis was applied to determines the risk factors for STB. Results A total of 12 345 patients were enrolled, including 6 885 (56%) female patients. The average age is 36 (27-50) years old. The average scores of Brief Psychiatric Rating Scale (BPRS) total scores, Hamilton Anxiety Scale (HAMA) total scores, Hamilton Depression Scale (HAMD) total scores and Yung Manic Rating Scale (YMRS) total scores were 32 (27-39) points, 7 (3-13) points, 10 (6-15) points and 7 (4-18) points. According to the suicide risk assessment form, 3 436 patients (27.83%) were at risk of STB. Multi-factor analysis showed that the residence, gender, marital status, co-residents, years of education, occupational status, relationship with parents and siblings, incentive, premorbid personality, clarified diagnosis, physical illness, BPRS score,HAMA score, HAMD score, YRMS score, medical treatment time, and the number of psychiatric hospitalizations is independent risk factors for STB. Conclusion The risk of suicide in psychiatric emergency patients was higher, mainly in the young and middle-aged, especially in the mental illness patients who were male, unmarried, unemployed, with poor social and family support. STB was affected by physiological, psychological and social factors in this population.

Clinical analysis of umbilical cord blood transplantation in the treatment of refractory and recurrent acute leukemia

Zhu Ping, Yu Huan, Fu Limei, Liao Xin, Xiong Mujun, Lei Aming, Zhu Pingan, Liang Xinquan

2021, 42(6):  1041-1045.  doi:10.3969/j.issn.1006-7795.2021.06.022

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Objective To analyze the clinical effect of umbilical cord blood transplantation(UCBT)in the treatment of relapsed/refractory acute leukemia(R/R-AL). Methods A retrospective analysis was performed on 22 patients who received UCBT from January 2016 to December 2020 The First People’s Hospital of Chenzhou, including 18 patients with refractory recurrent relapsed/refractory acute myelocytic leukemia (R/R-AML), 4 patients with acute refractory/relapse acute lymphocytic leukemia(R/R-ALL). Results In the study, the rate of +42 d neutrophils implantation was 100% (22/22), the rate of megakaryocyte implantation on +100 days was 90.5%(19/21). The cumulative incidence of Ⅲ-Ⅳ acute graft versus host disease (aGVHD) at + 100 days was 36.4% (8/22), the cumulative incidence of chronic graft versus host disease (cGVHD) for 3 years was 21.1% (4/19), and the cumulative incidence of severe cGVHD at 3 years was 10.5% (2/19). The 3-year cumulative recurrence rate was 3.2%; the 3-year overall survival (OS) was 71.4%; the 3-year disease-free survival (DFS) was 70.9%. Conclusion R/R-AL patients treated with UCBT had low rate of severe cGVHD, low recurrence rate, and higher OS and DFS.

Clinical analysis and experience summary of large vulvar ulcers in women

Gao Guangcheng, Sun Xin, Xu Ying, Zhuo Fenglin

2021, 42(6):  1046-1052.  doi:10.3969/j.issn.1006-7795.2021.06.023

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Objective To explore the clinical manifestations and differential diagnosis of large vulvar ulcers. Methods By analyzing the clinical data of 3 patients with large vulvar ulcer and literature reports, the types and clinical manifestations of large vulvar ulcers were listed for diagnosis and differential diagnosis. Results Three cases of large vulvar ulcer were diagnosed as Behcet’s disease, fixed drug rash and acute vulvar ulcer, respectively, based on clinical manifestations and laboratory examinations. They were cured after treatments. Conclusion Acute vulvar ulcer, Behcet’s syndrome, fixed drug rash, extramammary Paget’s disease, chemical burn and radiation ulcer should be considered in the cases of large vulvar ulcers. Especially the diagnosis and differential diagnosis of Behcet’s disease and acute vulvar ulcer are more critical. Behcet’s disease can be diagnosed when patients have oral ulcer and vulvar ulcer.

Cluster analysis of risk factors of central lymph node metastasis in papillary thyroid microcarcinoma

Wang Yajun, Kang Hua, Zhao Jing, Hai Tao, Zhang Xiaoli, Cai Wei

2021, 42(6):  1053-1059.  doi:10.3969/j.issn.1006-7795.2021.06.024

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Objective To investigate the risk factors of central lymph node metastasis in papillary thyroid microcarcinoma (PTMC) by cluster analysis. Methods Totally 481 patients diagnosed with PTMC from January 2015 to June 2019 were enrolled in this study. The clinical features including gender, age, tumor diameter, number of tumors, tumor capsule involvement, cervical lymph node metastasis and comorbid with benign thyroid diseases were analyzed by cluster analysis with SPSS software. Furthermore, validation of cluster analysis was made in order to determine the impact factors of central lymph node metastasis. Results In this study, 481 PTMC patients were involved, including 125 males and 356 females, with the average age of (44.87±12.14) years. 207 PTMC patients were with central lymph node metastasis, and the metastasis rate was about 43.0%. Cluster analysis divided PTMC patients into three clinical categories. In cluster group 1, all patients had no tumor involvement of thyroid capsule, most of them were single tumor, the diameter of tumor was smaller than that of the other two groups, and the rate of lymph node metastasis was the lowest (32.54%). In cluster group 2, the diameter of the tumor was large, the capsule was involved and the lymph node metastasis rate was 38.61%. In cluster group 3, thyroid capsule involvement and multiple tumors was found in all patients (100%), and the lymph node metastasis rate was 57.14%. The results of cluster analysis were further confirmed by univariate correlation analysis and multivariate Logistic regression analysis. Tumor size, number of tumors and thyroid capsule involvement were the impact factors of central lymph node metastasis in PTMC, and thyroid capsule involvement and multiple tumors were the more important factors. Conclusion Central lymph node metastasis is common in PTMC. Tumor size, number of tumors, and thyroid capsule involvement are the impact factors of central lymph node metastasis. Capsule involvement and multiple tumors are more important in the evaluateon of central lymph node metastasis.

Clinical and pathological analysis of postmenopausal women with abnormal uterine bleeding

Li Yunfei, Xia Enlan, Huang Xiaowu

2021, 42(6):  1060-1064.  doi:10.3969/j.issn.1006-7795.2021.06.026

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Objective To explore the best clinical diagnosis and treatment method of abnormal uterine bleeding after menopause. Methods Sixty two postmenopausal women with abnormal uterine bleeding were analyzed retrospectively,who underwent transvaginal ultrasound, hysteroscopy and / or surgery and histopathology from January 31, 2019 to January 31, 2020. Results In the 62 women diagnosed by hysteroscopy, there were normal endometrium (including atrophic endometrium and proliferative endometrium) in 13 cases, with endometrial thickness less than 10 mm. There were 41 cases of benign uterine lesions, and in the endometrial thickness of <5 mm,5-10 mm and >10 mm, the incidence rate was similar. Endometrial atypical hyperplasia and endometrial carcinoma were 8 cases. With the increase of endometrial thickness, the incidence rate increased gradually. The coincidence rate between hysteroscopic diagnosis and postoperative pathological examination was 91.9%. Conclusion For the women with abnormal uterine bleeding after menopause, hysteroscopy and direct vision biopsy are recommended to make early diagnosis and treatment for intrauterine lesions.

To explore the clinical study of flexi-bar in the treatment of chronic nonspecific low back pain

Ren Wei, Li Gufeng, Li Suhua, Li Zuoxiang, Xie Ying

2021, 42(6):  1065-1069.  doi:10.3969/j.issn.1006-7795.2021.06.027

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Objective To explore the clinical efficacy of flexi-bar in the treatment of chronic non-specific low back pain, and to formulate simpler and more effective exercise prescriptions for guiding clinical and family training. Methods From January 2019 to December 2019, 60 patients with chronic non-specific low back pain who came to our hospital were selected and randomly divided into two groups according to the random number table. The control group used conventional lumbar stability training, and the experimental group was combined on this basis flexi-bar training. Both groups will receive 4 weeks of exercise intervention, three times a week, 40 minutes each time, including 5 minutes of warm-up and 5 minutes of relaxation. The experimental group performed flexi-bar exercises for 15 minutes during the training process, in standing, double bridge, abdominal crunching and four-point support positions. The flexi-bar vibration was maintained for 30 s and rested for 30 s. Each exercise was performed 3 times. Before and after training, the two groups were applied with the Numerical Rating Scale (NRS), Oswestry disability index(ODI), and pressure biofeedback unit (PBU) to evaluate pain, lumbar spine function and transversus abdominis activation ability. Results Before treatment, there was no significant difference in NRS score, ODI score, and transversus abdominis activation pressure between the two groups of patients (P>0.05). After 4 weeks of treatment, the NRS, ODI score and transversus abdominis activation pressure of the two groups were not statistically significant. The values were significantly improved compared with before treatment (P<0.01), and the NRS, ODI scores and pressure values of the experimental group were significantly different from those of the control group (P<0.05). Conclusion The application of flexi-bar in the treatment of chronic non-specific low back pain can significantly improve the function of the patient's lumbar spine and relieve the symptoms of low back pain. It is a safe and effective treatment.

An analysis on three-dimensional gait of patients with adult spinal deformity

Bai Sen, Qi Shuyan

2021, 42(6):  1070-1075.  doi:10.3969/j.issn.1006-7795.2021.06.028

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Objective The walking characteristics of patients with adult spinal deformity(ASD) at pre-operation were analyzed with the three-dimensional gait analysis systemso as to further understand the pathophysiological changes of the lower limb function among patients with ASD, which probably gives physicians guidelines for diagnosis and treatment. Methods Totally 51 ASD patients were included as the observation group, and 51 healthy elderly patients were recruited as the control group according to the general situation (gender, age, body mass index, and basic diseases) of the observation group.Healthy Related Questionnaire of Life (HRQOL) was recorded for all subjects, including Visual Analogue Score (VAS), Oswestry Disability Index (ODI), and Short Form-36 (SF-36).Kinematic parameters were recorded by gait analysis system.At least 10 gait cycles were recorded after marker placed at specific positions of pelvis and lower limbs. Volunteers walked at individual comfortable pace within the set route.SPSS 23.0 software was used to analyze the parameters. Results Compared with the control group, lower limb step length, stride length and stride frequency of ASD patients decreased significantly, and gradually slowed down during walking.The range of flexion and extension of hip and knee joints was significantly reduced in ASD patients.There were statistically significant differences between groups (P<0.05). VAS and ODI were negatively correlated with step length, stride length, step frequency, knee flexion and hip flexion and extension (P<0.05). There was a positive correlation between Physical Component Summary (PCS) in SF-36 and the above indexes (P<0.05). Conclusions Comparing with healthy volunteers, those patients with ASD walked with much slower step frequency, and shorter step length, stride length, knee range of motion, and hip range of motion. There was significant correlation among kinematics data and HRQOL.

Clinical value of torasemide combined with 50% glucose rapid diuretic ultrasonography in the diagnosis of renal microcalculi in pilot service

Kang Li, Li Shuo, Xiong Ying, Guo Ruijun

2021, 42(6):  1076-1080.  doi:10.3969/j.issn.1006-7795.2021.06.029

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Objective To investigate the clinical value of tolasemide combined with 50% glucose rapid diuretic ultrasound test in the diagnosis of renal microcalculi in flight crew. Methods A total of 189 flight crew in service suspected of renal microcalculi and renal calcification by conventional ultrasonography were examined by tolasemide combined with 50% glucose rapid diuretic ultrasonography. Comparing the results of flexible ureteroscopy as the gold standard, to evaluate the accuracy of diuretic ultrasonography in renal microcalculus. Results Among 189 pilots, 160 cases of renal microcalculi were diagnosed by conventional ultrasound (176 calculi), 10 cases of calcification (20 calcification foci), 19 cases of undefinable diagnosis (19 strong echo points). 155 cases of renal microcalculi (307 calculi) and 34 cases of calcification (45 calcification foci) were diagnosed after diuretic ultrasonography. All the patients diagnosed with renal microcalculi underwent medical lithotripsy or laser lithotripsy. Half a year later, 90 calculi in 20 cases disappeared, and the remaining 169 flight crew were admitted to the hospital for flexible ureteroscopic surgery. 210 calculi in 139 cases and 52 calcification foci in 30 cases were found. There was a statistical difference between conventional ultrasound and post-diuretic ultrasound examination in the diagnosis of renal microcalculi (P＜0.001); there was a statistical difference between conventional ultrasound and flexible ureteroscopy in the diagnosis of renal microcalculi (P=0.026), the sensitivity and specificity of conventional ultrasonography in the diagnosis of renal microcalculi were 58.7% and 75.0%. There was no statistically significant difference between post-diuretic ultrasound examination and flexible ureteroscope examination of renal microcalculi (P=0.874), the sensitivity and specificity of post-diuretic ultrasound in the diagnosis of renal microcalculi were 97.7% and 86.5%. Conclusion Torasemide combined with 50% glucose rapid post-diuretic ultrasound can significantly improve the diagnostic efficiency of renal microcalculi, and it can be used as the preferred method for early diagnosis and treatment of renal microcalculi in flight service.

Correlation of Rock1 level with endothelial function and carotid intima-media thickness in elderly patients with unstable angina pectoris

Fang Ye, Zou Lin, Li Xiao, Lin Jing, He Wei

2021, 42(6):  1081-1085.  doi:10.3969/j.issn.1006-7795.2021.06.030

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Objective To study the relationship between the level of Rho-associated protein kinase 1 (ROCK1) in peripheral blood and vascular endothelial function and carotid intima-media thickness (IMT) in elderly patients with unstable angina pectoris (UA). Methods From June 2018 to June 2020, the elderly patients with suspected coronary heart disease in our hospital were selected and divided into UA group (with positive coronary angiography and diagnosis of UA) 74 cases and control group (with negative coronary angiography and no UA) 52 cases. Total cholesterol (TC), triglyceride (TG),high density lipoprotein-cholesterol(HDL-C), low density lipoprotein-cholesterol (LDL-C), uric acid, glycosylated hemoglobin (HbA1c) and other indicators were measured and compared in each group; Rock1 level in peripheral blood was detected by enzyme labeling method; flow mediated dilation(FMD) and IMT were measured and compared between the two groups. Pearson correlation was used to analyze the correlation between ROCK1 and parameters, and multiple linear regression was used to investigate the multiple factors. Results Except for smoking and HbA1c(P<0.05), there were no significant difference in gender, age, body mass index (BMI), diabetes, hypertension and blood lipid between the two groups (P>0.05). The level of FMD in UA group was lower than that in control group, while the level of IMT and ROCK1 in UA group was higher than that in control group (P<0.05). Multiple linear regression analysis showed that FMD (X4) and IMT (X5) were included in the regression equation, and ROCK1 (Y)=0.512X5-0.462X4+2.106. Conclusion There is a certain correlation between ROCK1 and endothelial function and IMT in elderly patients with UA.

Review

Discussion on positioning of university journal of natural sciences under the background of new era——a case study of Journal of Capital Medical University

Chen Ruifang, Zhang Junmin, Zhang Tieming

2021, 42(6):  1086-1091.  doi:10.3969/j.issn.1006-7795.2021.06.032

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In recent years, the state has paid more and more attention to domestic scientific and technological journals. As an important part of science and technology journals, university journal of natural sciences serves the national science and technology innovation strategy, disciplinary construction and talent cultivation in colleges and universities, and shoulder important social responsibilities. University journal of natural sciences cover a wide range of disciplines. To meet the needs of a variety of disciplines, university journals of natural sciences are all inclusive, and there are some problems in positioning. Based on the analysis of the positioning of university journal of natural sciences, this paper discusses the positioning of university journal of natural sciences, introduces the exploration and practice of the Journal of Capital Medical University, and puts forward suggestions for the high-quality development of university journal of natural sciences to better serve the national innovation leading strategy and the construction of a powerful scientific and technological country and serve the disciplinary construction and talent cultivation of colleges and universities.

How the editors of sci-tech journals prevent academic dishonesty when receiving manuscripts——a case study of Journal of Capital Medical University

Sun Chaoyuan, Sun Lina, Chen Ruifang, Mu Meng, Zhang Junmin

2021, 42(6):  1092-1094.  doi:10.3969/j.issn.1006-7795.2021.06.033

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Academic dishonesty is a global phenomenon at universities. Academic dishonesty considerably affect the quality of sci-tech journals. It is important to prevent upfront and eliminate the misconduct at the early stage in the publication process. Editors should take measures to preclude academic dishonesty when the manuscripts are submitted to editorial boards. It is not enough to rely only on plagiarism detection softwares. Meanwhile, the editors should manually inspect the related information during the process of submission to recognize the manuscripts involving academic dishonesty.