Table of Content

21 October 2022, Volume 43 Issue 5

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Expert Comment

Current status and clinical research of brain-heart comorbid vascular diseases in China

Zhao Jizong

2022, 43(5):  671-673.  doi:10.3969/j.issn.1006-7795.2022.05.001

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Cerebrovascular diseases and cardiovascular diseases are important issues that threaten the health of people, and the incidence and comorbidity of both are increasing. This article will discuss the current status and related clinical research of brain-heart comorbid vascular diseases from the aspects of risk factors, diagnosis and treatment methods, problems and development.

Clinical and Basic Research in Nephrology

Effect of shared peripheral circulation on renal injury in diabetic kidney disease mice

Huang Qi, Zhou Yilun, Sun Xuefeng

2022, 43(5):  674-679.  doi:10.3969/j.issn.1006-7795.2022.05.002

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Objective To investigate the effects of the shared peripheral circulation on diabetic kidney disease (DKD).Methods Parabiotic surgery was performed between the 8-week-old male C57BL/6J mice and the DKD male mice of the same strain, the DKD mice was induced by streptozocin (STZ) injection and divided into three groups based on the stage of DKD: 12 weeks after STZ injection, 20 weeks after STZ injection, and 28 weeks after STZ injection. The animals were sacrificial 8 weeks after parabiotic surgery,and the blood, urine and kidney tissue samples of mice in each group were collected. Results A total of 24 pairs of parabiosis mice were obtained, 8 pairs in DKD 12 weeks, 8 pairs in DKD 20 weeks and 8 pairs in DKD 28 weeks. DKD mice in the same stage without peripheral circulation were set as the positive control group, and wild mice of the same age as the negative control group.The levels of blood glucose, insulin, triglyceride and total cholesterol in DKD with shared peripheral circulation group were significantly lower than those in the positive control group throughout all stage of DKD. In the DKD 20 weeks, the level of albumin-to-creatinine ratio in the group receiving shared peripheral circulation was significantly lower than that in the positive control group, with superiority was more significant in the DKD 28 weeks. In addition, in the DKD 28 weeks, the degree of renal injury and the expression of fibrosis marker protein in the positive control group were significantly higher than those in DKD mice receiving shared peripheral circulation. Conclusion Shared peripheral circulation could reduce blood glucose level, enhance insulin sensitivity and regulate lipid metabolism in DKD mice, and then alleviate renal tissue damage, improve renal fibrosis and protect renal function.

Efficacy and influence factors of low-dose rituximab therapy in idiopathic membranous nephropathy

Xu Xiaoyi, Wang Guoqin, Cheng Hong, Zhao Zhirui, Dong Hongrui, Sun Lijun

2022, 43(5):  680-686.  doi:10.3969/j.issn.1006-7795.2022.05.003

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Objective To investigate the therapeutic effect of low-dose rituximab (RTX) in idiopathic membranous nephropathy (IMN)and its influence factors.Methods Data of 35 patients with idiopathic membranous nephropathy diagnosed by renal biopsy in Beijing Anzhen Hospital Capital Medical University and treated with low-dose RTX January 1, 2019 to July 31, 2021 with follow-up were collected retrospectively to explore the clinical efficacy of low-dose rituximab therapy. Results A total of 35 patients were enrolled in this study, of which 10 cases (28.6%) were treated with RTX as initial treatment. The single dose of RTX in all patients was 0.2-1.0 g, and the cumulative dose was 1.0 (0.6, 1.3) g. The median follow-up time was 6 (4.0, 12.0) months. ① After RTX treatment, the urine protein decreased, and the serum albumin increased. The treatment remission rate was 51.4% and the complete remission rate was 20.0%.According to sex, age, and serum anti-idiopathic membranous nephropathy(PLA2R)-antibody before treatment, patients with non RTX immunosuppressive treatment were randomly matched 1∶1 as the control group. There was no difference in remission rate between two groups after treatment. The range of increase of serum albumin and creatinine in RTX group was lower than that in control group (P<0.05). ② Compared to the previous immunosuppressive treatment group, the level of serum albumin before treatment and dose of RTX achieving B cell <5 μL were lower (all P<0.05)in the initial group, and the proportion of pathological changes of renal ischemia was higher (P < 0.05). There was no significant difference in the remission rate between the two groups. ③ Compared with the non remission group, the serum creatinine level before treatment was lower in the remission group (P < 0.05). Multivariate Cox regression analysis showed that RTX as initial treatment was an independent influencing factor of treatment remission (HR=3.025, 95% CI: 1.024-8.932). Conclusion RTX had satisfactory curative effect on IMN, whether it was used as the initial treatment or as the follow up treatment when the previous treatment effect is poor. The initial use of RTX in IMN is more conducive to disease remission.

Research of Baoshentongluo formula-medicated serum on regulating mitophagy and reducing oxidative damage of podocytes induced by high glucose

Wang Mengdi, Guo Yifan, Pang Yanyu, Liu Yufei, Zhao Wenjing

2022, 43(5):  687-693.  doi:10.3969/j.issn.1006-7795.2022.05.004

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Objective To observe the effect of Baoshentongluo formula-medicated serum on oxidative damage of podocytes cultured with high glucose, and explore its underlying mechanism. Methods The podocytes in vitro were used as the research object, and stimulated with high concentration of glucose. CCK-8 method was used to determine optimal model and drug concentration, and then the podocytes were divided into the normal control group, high glucose group and Baoshentongluo formula group. Cytoskeleton of podocytes was stained with phalloidin.The expression levels of podocyte-specific protein nephrin and autophagy-related proteins autophagy-related protein 5(ATG5), ATG7 and microtubule-associated protein 1 light chain 3(LC3) was detected with Western blotting.Flow cytometry was used to detect the level of reactive oxygen species (ROS) and mitochondrial membrane potential of podocytes. Colocalization of LC3B and mitochondria were examined with immunofluorescence to observe the generation of mitochondrial autophagy vesicles in podocytes of each group. Results The podocyte viability was significantly decreased with 30 mmol/L high glucose intervention for 48 h (P<0.05), and Baoshentongluo formula-medicated serum could significantly increase the viability of high glucose-induced podocyte (P<0.01).Compared with normal control group, the podocytes of high glucose group were demonstrated with folded skeleton into a polygon and destroyed stress fiber bundles with increased ROS production (P<0.01), reduced expression of nephrin, ATG5, ATG7 and LC3Ⅱ/LC3Ⅰ ratio (P<0.05), decreased co-labeling of LC3B with mitochondria, lowerer mitochondrial membrane potential (P<0.01). Compared with high glucose group, the podocytes of Baoshentongluo formula group showed improved podocyte structure,decreased production of ROS (P＜0.01), elevated expression of nephrin, ATG5, ATG7 and LC3Ⅱ/LC3Ⅰ ratio (P＜0.05) ,increased co-labeling of LC3B with mitochondria, higher mitochondrial membrane potential (P＜0.01). Conclusion Baoshentongluo formula-medicated serum can alleviate oxidative damage to podocytes induced by high glucose and the mechanism may be related to improvement of mitophagy.

Analysis of risk factors associated with bleeding events after ultrasound-guided percutaneous native renal biopsies

Zhao Weihao, Zhang Yani, Li Ke, Yao Tian, Jing Lanmei, Huo Yujia, Ma Xiaoqin, Wang Xin, Liu Jing, Ma Xiaotao, Fu Rongguo, Tian Lifang

2022, 43(5):  694-699.  doi:10.3969/j.issn.1006-7795.2022.05.005

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Objective To identify the risk factors associated with bleeding events after ultrasound-guided percutaneous native renal biopsies. Methods Research subjects were 1 026 admitted patients who underwent renal biopsy in the second affiliated Hospital of Xi'an Jiaotong University from January 2019 to December 2021. We compared means of clinical indicators between bleeding patients (343 cases) and non-bleeding (683 cases) patients. Correlations were analyzed between bleeding size and each clinical indicator in all patients or bleeding patients. We selected the influence factors associated with bleeding events by Logistic regression. Results There were 343 (33.4%) cases with bleeding which were detected by ultrasound, including 5 cases (0.49%) with major bleeding which received therapy. The bleeding rate in women after renal biopsy was significantly higher than that in men (37.8% vs 29.4%, P<0.05). Among all the basic information and clinical indicators, body mass index, hemoglobin, red blood cells, platelets, urine specific gravity, urine protein, triglyceride, total cholesterol, prothrombin activity, thrombin time in bleeding group were all significantly lower than non-bleeding group. Oppositely, prothrombin time, international normalized ratio in bleeding group were all significantly higher than non-bleeding group. By further analyzing the data of the bleeding group, we found that the size of the hematoma was significantly positively correlated with fasting blood glucose and activated partial thromboplastin time. Through multivariate Logistic regression analysis, platelet counts were identified as high risk factors for bleeding events (OR=0.996, P<0.05). Conclusion Lower platelets counts are the high risk factors associated with bleeding events after ultrasound-guided percutaneous native renal biopsies.

The effects of different pathological types and histological features on bleeding events after ultrasound-guided percutaneous native renal biopsies

Ma Xiaotao, Zhang Yani, Cui Chenkai, Guo Zhao, Guo Meng, Shi Yue, Wu Yao, Zhao Li, Liu Jing, Zhao Weihao, Fu Rongguo, Tian Lifang

2022, 43(5):  700-706.  doi:10.3969/j.issn.1006-7795.2022.05.006

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Objective To evaluate the effects of different pathological types and histological features on bleeding events after ultrasound-guided percutaneous native renal biopsies. Methods Research subjects were 1 026 admitted patients who underwent renal biopsy in the second affiliated Hospital of Xi'an Jiaotong University from January 2019 to December 2021. We compared bleeding ratio among different pathological type groups. We calculated the medullocortical ratio, number of arcuate artery, glomerulosclerosis and interstitial fibrosis on stained sections of renal biopsy tissues. Correlations were analyzed between bleeding area size and each histological features. Finally we compared each histological feature among different pathological type groups. Results There were 343 (33.4%) cases with bleeding which were detected by ultrasound, including 5 cases (0.49%) with major bleeding which received therapy. The four pathological types with high bleeding rate were as follows: renal damage of Sjogren's syndrome (100%), acute/subacute renal tubular injury (66.7%), sclerosing nephritis (50.0%), and membranous/ endocapillary proliferative nephritis (50.0%). The three pathological types with low bleeding rate were as follows: minimal change nephropathy (25.3%), membranous/atypical membranous nephropathy (26.3%) and diabetic nephropathy (27.9%). Both medullocortical ratio(P=0.032) and number of arcuate artery (P=0.037) positively correlated with bleeding area size, while glomerulosclerosis and interstitial fibrosis were not significantly correlated with bleeding area size. These histological features did not differ between different pathological type groups. There were statistical differences in some clinical data of the common pathological types. Conclusion The bleeding rates were significantly different among pathological types. The medullocortical ratio and number of arcuate artery on renal biopsy tissue can affect on bleeding events after ultrasound-guided percutaneous native renal biopsies.

Clinical and pathological risk factors for renal prognosis in patients with biopsy-proven diabetic nephropathy classified as chronic kidney disease stage 4

Yu Tianyu, Jiang Shimin, Gao Hongmei, Zou Guming, Li Wenge

2022, 43(5):  707-712.  doi:10.3969/j.issn.1006-7795.2022.05.007

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Objective To investigate the pathological types, clinical manifestations and prognosis of patients with pathologically diagnosed diabetic nephropathy (DN) classified as chronic kidney disease (CKD) stage 4. Methods The clinical data of pure DN patients with biopsy-proven diagnosis with CKD stage 4, were selected from the Department of Nephrology of China-Japan Friendship Hospital during January 2002 to March 2021.The primary endpoint was set to the composite of progression to end stage renal disease (ESRD) or death. Patients were divided into the stable and progressive groups according to the occurrence of endpoint events. Univariate analysis and Cox regression were used to analyze the relationship between clinical manifestations, pathological types and prognosis of patients. Results A total of 53 patients were included in the study, including 19 cases of type Ⅱb, 32 cases of type Ⅲ, and 2 cases of type Ⅳ. The median follow-up was 24 (2.0,46.5) months, and the median renal survival was 17.3 (8.7,25.8) months. The primary end point event occurred in33 patients and 5 of them died. Median renal survival was 16.5 (9.6,23.5) months in the non-continued angiotensin-converting enzyme inhibitors (ACEI)/angiotensin Ⅱ receptor blockers (ARB) group (n=32) and 20.7 (8.8,25.8)months in the continued ACEI/ARB group (n=21).The multivariate Cox regression analysis showed thatnone of triglyceride, control of blood glucose and pathological class were independent prognostic factors for renal survival(P＞0.05). Conclusion There was no significant relationship between pathological type and DN renal survival time. The continued use of ACEI/ARB drugs could not effectively delay the progression of advanced CKD in DN. There was no significant correlation between different pathological classification and prognosis of DN during CKD stage 4. ACEI/ARB therapy has a prolonged but no significant benefit for renal survival. Patients with DN should be diagnosed and treated early.

External validation of the international IgA nephropathy prediction tool in a modern Chinese cohort

Guo Kanglin, Cheng Yichun, Ge Shuwang, Xu Gang

2022, 43(5):  713-719.  doi:10.3969/j.issn.1006-7795.2022.05.008

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Objective To externally validate the international IgA nephropathy prediction tool in a modern Chinese cohort, so as to provide more evidence for clinical application. Methods This study included IgA nephropathy patients diagnosed by kidney puncture in Tongji Hospital Affiliated to Huazhong University of Science and Technology from January 2012 to December 2016. The predicted risk of each patient was calculated according to the international IgA nephropathy prediction tool, with the 50% decline of estimated glomerular filtration rate (eGFR) or end-stage renal failure as the endpoint. This study evaluated the performance of two models (Model 1: without racial factor; Model 2: with racial factor) in the international IgA nephropathy prediction tools in discrimination, calibration, reclassification and clinical utility. Results The median follow-up time in the modern Chinese cohort in this study was 4 years, and 48(10%) subjects reached the endpoint. The C indices of the two models were 0.86, and the survival curves were well separated, showing excellent discrimination ability. The performance of the two models in calibration is basically the same, both slightly underestimate the risk of 5 years. The reclassification indicates that there is no significant difference between the two models in predicting 5-year risks. The decision curves analysis showed that the two models were clinically practical in predicting five-year risks, and there was no significant difference between two models. Conclusion The international IgA nephropathy prediction tools showed significant discrimination, acceptable calibration and satisfactory clinical utility, and there is no significant difference between the two models.

Progress on the injury and repair mechanism of renal tubular epithelial cells in the transition of acute kidney injury to chronic kidney disease

Chen Xiaomei, Ma Yuanyuan, Nie Jing, Zhu Fengxin

2022, 43(5):  720-727.  doi:10.3969/j.issn.1006-7795.2022.05.009

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Acute kidney injury (AKI) is a clinical syndrome caused by various factors and characterized by renal function declines sharply in a short period of time. AKI, an independent risk factor of chronic kidney disease (CKD) and end-stage renal disease, is associated with high levels of morbidity and mortality. Currently, the treatments for AKI and the prevention of the transition of AKI to CKD are very limited. Therefore, it is essential to explore the mechanism of AKI to CKD. Renal tubular epithelial cells (RTECs) are the major cells of the kidney and are vulnerable to various biological stresses, such as ischemia, hypoxia and toxins.RTECs are also key inflammatory and fibrogenic cells that drive the progression from acute to chronic kidney disease. In view of the central role of RTECs, this review will focus on the maladaptive repair mechanisms of RTECs in the transition of AKI to CKD, providing novel targets and new strategies for effective treatment.

Protective Assist / Support Ventilation

Accuracy of automatic measurement of airway occlusion pressure by ventilator: bench and clinical study

Zhang Linlin, Tian Ye, Miao Mingyue, Duan Yuqing, Tian Ying, Zhou Jianxin

2022, 43(5):  728-733.  doi:10.3969/j.issn.1006-7795.2022.05.010

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Objective To investigate the agreement of the airway occlusion pressure (P0.1) measured automatically by the ventilator with the standard measurement method, and the influence of different types of trigger on the automatic measurement. Methods Ventilator with automatic measurement of P0.1 using the unoccluded fitting method was selected. Bench and clinical studies were conducted in a lung simulator and mechanically ventilated patients. A total of 48 conditions were adjusted to simulate different statuses of respiratory effort and mechanics. The tested ventilator was used to deliver the pressure support ventilation to the simulator. The clinical study included 15 adult patients undergoing pressure support ventilation. In both bench and clinical studies, the pressure and flow trigger were used as random crossover. After collecting the P0.1 automatically monitored by the ventilator, the standard end-expiratory airway occlusion was performed to measure the P0.1 as the standard reference value. The Bland-Altman test was used to analyze the agreement between the ventilator monitoring value and the standard reference value, and the bias (ventilator monitoring value-standard reference value) and 95% limit of agreement were calculated. Bias in P0.1 measurement of the two triggering methods was compared. Results In the simulated lung validation, the bias (95% limit of agreement) in P0.1 measurement during pressure and flow trigger was 0.04 (－0.63-0.70) and －0.54 ( －1.44－0.36) cmH₂O, respectively, which was statistically significant (P<0.001). Similar results were obtained in clinical studies, with the bias (95% limit of agreement) at pressure and flow triggering of －0.11 (－0.73-0.52) and －0.54 (－1.50-0.59) cmH₂O, respectively, which was also statistically significant. Conclusion During pressure trigger, an excellent agreement was found in P0.1 measured by the ventilator the standard method. However, the ventilator measurement significantly underestimates P0.1 during flow trigger. It is recommended to switch to pressure trigger during automatic monitoring of P0.1 by ventilator.

Detection of patient-ventilator asynchrony based on semi-supervised convolutional neural network

Zhou Yimin, Ning Zexing, Luo Xuying, He Xuan, Yang Yanlin, Chen Guangqiang, Li Ruirui, Zhou Jianxin

2022, 43(5):  734-739.  doi:10.3969/j.issn.1006-7795.2022.05.011

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Objective To construct a patient-ventilator asynchrony (PVA) detection model based on semi-supervised convolutional neural networks (semi-CNN)and evaluate its diagnostic efficiency in pressure support ventilation (PSV) mode.Methods The mechanical ventilation data of 85 brain injury patients with PSV mode were analyzed retrospectively. Tracing of flow, and airway pressure combined with esophageal pressure data were used to identify manually the presence of PVA visually. Patient's future breathing observations were predicted by the Transformer-based time series prediction module. The output of the Transformer module was used as the input parameter of the semi-CNN to detect the occurrence of PVA. The accuracy, sensitivity, and specificity of the semi-CNN model and agreement between the semi-CNN model and human experts were validated in the test set. Results The initial training set included 513 normal breaths and 69 PVA breaths. After 500 epochs, the model converges.The test set included 48 normal breaths and 24 PVA breaths. In the test set, the accuracy,the sensitivity, and the specificity of the Transformer + semi-CNN model in identifying PVA are 0.92(0.83－0.97), 0.79(0.58 - 0.93), and 0.98(0.89 －1.00), respectively.There is substantial agreement between the semi-CNN and the human experts in identifying PVA (Kappa=0.80, 95%CI:0.65-0.95, P<0.01). Conclusion This study provided a PVA detecting method based on a semi-CNN algorithm with high accuracy and specificity. The proposed method showed a substantial agreement with human experts in identifying PVA and could be applied in real-time monitoring of PVA clinically.

Concept and progresses of diaphragm protective ventilation

Cheng Wei, Long Yun

2022, 43(5):  740-746.  doi:10.3969/j.issn.1006-7795.2022.05.012

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It has been over 50 years since the proposal of acute respiratory distress syndrome. From the initial mechanical ventilation treatment to the recognition of ventilator-related lung injury, lung protective ventilation strategy has become a consensus clinically. As the strategy limits the mechanical pressure exerted on the lungs by the ventilator or the patient's own breathing efforts, the incidence of weaning difficulties is increasing, and the role of diaphragm dysfunction is becoming more and more obvious. Diaphragm protective ventilation strategy should be applied. Optimizing mechanical ventilation parameters and diaphragmatic load and reducing ventilator asynchronization, can reduce or avoid diaphragmatic injury. However, lung protection should still be the primary consideration of mechanical ventilation. Through the best way to reduce the complications of mechanical ventilation and optimize the patient's respiratory efforts, the protection of lung and diaphragm should be achieved simultaneously. This article reviews the concept and progress of diaphragmatic protective ventilation.

Basic Research

Functional change of hERG1a mutation H70R on hERG1a homomeric current and hERG1a/1b heteromeric currents

Feng Li, Yang Jiaxue, Li Xin, Jia Changqi, Jiang Chenxi

2022, 43(5):  747-753.  doi:10.3969/j.issn.1006-7795.2022.05.013

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Objective To investigate the electrophysiological effects of hERG1a specific N terminal mutation (H70R) on current (I_Kr) carried by co-expressed hERG1a/1b channels. Methods H70R was introduced in pcDNA3.1 (hERG1a) by site-directed mutagenesis, and transient transfection was applied to express hERG in HEK293 cell. Whole cell patch clamp analysis of the HEK293 cell with expressing wild type and mutant channel was used to investigate the molecular and electrophysiological mechanism. Results H70R showed I_Kr current decrease in both homologues and heterologous hERG channel, the effect on hERG1a/1b channels was more significant than that of hERG1a expressed alone. H70R caused steady-state activation curve to shift to the left and decreased V_1/2 in both homomeric and heteromeric hERG channel. Different from early report, H70R showed no effect on I_Kr deactivation; however, hERG1a/1b channels showed significantly accelerated deactivation. Conclusions hERG1a (H70R) caused a decreased current in both homomeric and heteromeric hERG channel, but a more significant suppression on heteromeric hERG. It suggested that we should pay more attention to the co-expressed I_hERG1a/1b channels in the clinical study of hERG-related channel mutations.

Characteristics of speciality limited due to hearing disorder among college entrance examination candidates in Beijing from 2009 to 2018

Luo Zhifu, Tao Lixin, Liu Xiangtong, Zhang Jingbo, Guo Xiuhua

2022, 43(5):  754-759.  doi:10.3969/j.issn.1006-7795.2022.05.014

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Objective To investigate the status and trend of specialty limited due to hearing disorder among college entrance examination students in Beijing from 2009 to 2018. Methods Collecting the ten-year college entrance examination data in Beijing. To analysed the population, time and spatial distribution characteristics of the specialty limited due to hearing disorder. Mann-kendall was used to analyze the trend of specialty limited due to hearing disorder. A thermal map was used to describe the spatio-temporal interaction trend of the detection rate among college entrance examination from 2009 to 2018. Results From 2009 to 2018, a total of 717 342 students in Beijing underwent physical examination for college entrance examination, and 428 cases were detected with specialty limited due to hearing disorder, the detection rate was 6.11 per 10 000. The detection rate of specialty limited due to hearing disorder among college entrance examination in Beijing was in an obvious upward trend(χ²=13.270,P=0.000). The detection rate of urban students was 7.32/10 000, higher than 4.06/10 000 in the suburbs(χ²=31.148,P=0.000). The average detection rate in Fengtai District was the highest, with a total number of 40 cases and a detection rate of 10.91/10 000, and the lowest in Pinggu District, with a total number of 4 cases and a detection rate of 1.64/10 000. There was no significant difference between male and female(6.17/10 000 vs 5.78/10 000, χ²=0.445,P=0.505). Conclusion The trend of specialty limited due to hearing disorder detection rate among college entrance examination students in Beijing was increasing. Hearing health should be managed in the whole life cycle, and adolescents should establish the awareness of protection as early as possible.

Clinical Research

Application value of systemic immune-inflammation index in the screening of early colorectal cancer and precancerous lesions

Wang Yun, Li Wenkun, Su Jiayi, Wang Yadan, Wu Jing

2022, 43(5):  760-766.  doi:10.3969/j.issn.1006-7795.2022.05.015

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Objective To explore the application value of different inflammatory markers in the diagnosis of early colorectal cancer and precancerous lesions. Methods We collected the general data, laboratory examination results, colonoscopy results and other clinical medical records of patients with early colorectal cancer and precancerous lesions in the digestive endoscopy center of our unit from February 2008 to January 2019, and analyzed the correlation between inflammatory markers and clinicopathological characteristics of early colorectal cancer and precancerous lesions. Results The univariate analysis showed that smoking history(P =0.006), lesion location(P =0.000), lesion size(P =0.000), lesion number(P =0.004), lesion treatment method(P =0.000), neutrophil count(P =0.000), NLR(P =0.000), SII(P =0.001)are related to the pathological properties of early colorectal cancer and colorectal precancerous lesions. Multivariate Logistic regression analysis showed that history of hyperlipidemia(P =0.009), lesion location(P =0.000), lesion size(P =0.000), lesion number(P =0.024), SII (P =0.004)are independent predictors of the pathological properties of the two groups of patients, and the area under the ROC curve of SII to distinguish the two groups of patients is 0.643 (95% CI: 0.560－0.725; P=0.001). When the SII is 500.27, its sensitivity for diagnosing early colorectal cancer is 54.9%, and its specificity is 70.7%, but the consistency between the diagnostic results and pathological is poor (Kappa < 0.40). Conclusion The use of SII in the screening of early colorectal cancer and precancerous lesions may be helpful for colonoscopist to diagnose the pathological types.

The relationship between the new adipokines visfatin and vaspin expression in patients with type 2 diabetes mellitus and left ventricular hypertrophy

Ma Yixin, Zhang Zhongying, Si Sicong, Luo Hongyu, Zhao Huan, Yang Wei

2022, 43(5):  767-773.  doi:10.3969/j.issn.1006-7795.2022.05.016

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Objective To explore the relationship between the expression of new adipokines in serum such as visfatin and vaspin,and left ventricular hypertrophy (LVH) in patients with type 2 diabetes mellitus (T2DM). We studied the related factors affecting LVH in T2DM.Methods Totally 93 patients with T2DM were enrolled, all patients were tested for biochemical indicators and blood routine indicators, echocardiography was done, the left ventricular myocardial mass index (LVMI) was calculated. According to LVMI, patients were divided into T2DM with LVH group (case group, n=45) versus T2DM without LVH group (control group, n=48), Logistic regression was used to analyze the correlation between visfatin, vaspin and LVH in T2DM patients. Results Compared with the control group, the concentrations of visfatin and vaspin in the case group were increased [(4.57±2.74)ng/mL vs (3.35±2.05)ng/mL,(417.40±230.71)pg/mL vs (328.07±218.99)pg/mL], and the difference was statistically significant (P< 0.05). The results of Logistic multivariate regression analysis showed that visfatin, coronary heart disease, and high density lipoprotein-cholesterol(HDL-C)were independent predictors of T2DM combined with LVH. Further analysis of the factors related to visfatin and glucose and lipid metabolism showed that the level of visfatin was negatively correlated with HDL-C in T2DM population (P<0.05). Conclusion Serum visfatin concentrations were increased with LVMI in T2DM and associated with glycolipid metabolism disorder. Visfatin may be involved in the pathological process of developing LVH in T2DM.It may be a predictive factor for the development of LVH in patients with diabetes.

Study on pregnancy management mode of pre-pregnancy obese or overweight women and analysis of obesity related placental factors

Zhang Jin, Chi Jingjing, Zhang Rui, Zhang Xiaoyan, Bai Wenpei

2022, 43(5):  774-781.  doi:10.3969/j.issn.1006-7795.2022.05.017

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Objective To explore the pregnancy management mode and placental factor changes of pre-pregnancy obese or overweight women.Methods Totally 149 singleton pregnant women with pre-pregnancy body mass index (BMI)≥25 kg/m² were collected. They were divided into diet guidance group and routine examination group. Pregnant women with normal pre-pregnancy BMI in the same period were taken as control. Then, expression of CTRP6 and tumor necrosis factor-α (TNF-α) in placenta of pregnant women with different pre-pregnancy BMI were detected by immunohistochemistry. Results After dietary guidance, the weight gain during pregnancy, postpartum hemorrhage and dystocia rate of pre-pregnancy obese/overweight women were significantly reduced, but there was no significant difference in neonatal weight, and the cesarean section rate and the incidence of gestational diabetes mellitus(GDM) were still significantly higher than those in the control group. The expression of CTRP6 and TNF-α in placenta of pre-pregnancy obese/overweight women were significantly higher than those of women with pre-pregnancy normal/underweight BMI. The expression of CTRP6 in placenta of pregnant women with GDM was also significantly increased. Conclusion For pre-pregnancy obese and overweight pregnant women, effective dietary control during pregnancy can reduce the weight gain during pregnancy, but it does not reduce the neonatal weight. Therefore, pre-pregnancy weight has a greater impact on maternal and fetal complications. In pre-pregnancy obese women, CTRP6 may be involved in regulating the inflammatory response in adipose tissue, affecting blood glucose metabolism, then affecting their offspring, which should be further studied.

Comparison of the quantitative results of a multiplex quantitative PCR between positive and negative bacterial culture groups of respiratory pathogens

Zhuo Xianxia, Zhao Jiankang, Cao Bin

2022, 43(5):  782-786.  doi:10.3969/j.issn.1006-7795.2022.05.018

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Objective Comparison of the bacterial quantification of culture-positive and culture-negative lower respiratory tract specimens by the multiplex quantitative polymerase chain reaction (MQ-PCR) molecular diagnostic method. Methods Sputum or bronchoalveolar lavage fluid (BALF) was collected from patients with lower respiratory tract infection (LRTI) in the Clinical Microbiology and Infection Laboratory of China-Japan Friendship Hospital from November 2019 to March 2021, and 12 target pathogens were detected by traditional culture and the MQ-PCR methods. The differences in bacterial quantification between culture-positive and culture-negative groups were compared. Results A total of 125 respiratory samples were collected that met the inclusion criteria, of which 101 were positive for the MQ-PCR. Among the 101 positive samples detected by the MQ-PCR, 31 samples were bacterial culture-positive, and 70 samples were negative for culture. In addition, the target pathogens were detected by the MQ-PCR 33 times in the culture-positive group and 144 times in the culture-negative group. The median of the bacterial load in Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae, which were the most detected, were 1.44×10⁸ copies/mL vs 1.22×10⁷ copies/mL,7.10×10⁸ copies/mL vs 4.83×10⁶ copies/mL,and 4.28×10⁷ copies/mL vs 5.77×10⁴ copies/mL in the culture-positive group and culture-negative group, and the P values were all less than 0.05. Conclusion The MQ-PCR can accurately quantify the target pathogens, and the median of the bacterial load in the culture-positive group is higher than that in the culture-negative group.

Clinical characteristics and risk factors of acute pulmonary embolism after operation for malignant head and neck tumors

Zhang Zhili, Guo Caixia

2022, 43(5):  787-791.  doi:10.3969/j.issn.1006-7795.2022.05.019

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Objective To explore the risk factors of postoperative pulmonary embolism in patients with head and neck malignancies, so as to provide clinical reference for the prevention of head and neck malignancies complicated with acute pulmonary embolism (APE). Methods With the case-control study method of 1∶3 ratio design, the clinical data of 14 patients with pulmonary embolism after head and neck cancer surgery in Beijing Tongren Hospital from January 2019 to October 2020 and 42 patients with head and neck cancer matched by disease, age and gender were collected, including age, gender, body mass index, smoking history, combined with basic diseases. The independent risk factors of head and neck malignant tumor complicated with pulmonary embolism were analyzed with conditional Logistic regression. Results There was no systematic difference in smoking history, body mass index, diabetes mellitus, coronary heart disease, cerebral infarction, blood sugar, estimated glomerular filtration rate, blood lipid, uric acid, blood potassium, preoperative application of low molecular weight heparin, perioperative blood pressure, perioperative volume and postoperative Caprini score in two groups (P> 0.05), but in combination with hypertension, the difference in operation time was statistically significant (P < 0.05). Further conditional Logistic regression analysis showed that hypertension and prolonged operation time were independent risk factors of pulmonary embolism in patients with head and neck tumors. Conclusion The head and neck malignant tumor complicated with hypertension and long operation time increased the risk of embolism. Improving these risk factors could reduce the occurrence of such complications. It should be the key prevention and treatment object of pulmonary embolism.

The clinical effect of “Chinese way” in the treatment of massive rotator cuff injury under arthroscopy

Zhang Bo, Lin Yuan, Ren Shixiang, Chen Tong, Yu Yang, Jia jialin

2022, 43(5):  792-798.  doi:10.3969/j.issn.1006-7795.2022.05.020

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Objective To evaluate the effect of “Chinese way” in the treatment of massive rotator cuff injury under arthroscopy and its therapeutic effect. Methods A retrospective analysis was performed on the clinical data of patients with unilateral massive rotator cuff injury treated by “Chinese way” method in Beijing Chaoyang Hospital from January 2019 to September 2021. A total of 42 patients met the inclusion criteria, including 23 males and 19 females, aged 45－76 years, with an average age of (57.2±6.3) years. During the operation, the long head of biceps tendon was transposed to the footprint area and fixed with an internal row anchor tail suture. The remaining rotator cuff fracture was repaired with a double-row anchor bridge technique. The range of motion, pain and function scores of the shoulder joint were statistically analyzed before surgery, 6 months, 1 year and 2 years after surgery, and the basic operation situation, postoperative complications and imaging results of the patients were recorded. Results All 42 patients in this group were successfully operated, and no serious complications occurred during or after operation. All patients were followed up for 6－24 months, with an average of (13.2±4.2) months. Anova of single factor repeated measurement showed that there were statistically significant differences in the range of motion, pain and functional score between the six months after surgery and the last follow-up (P< 0.01). X-ray examination indicated that there was no obvious progress in shoulder degeneration. Magnetic resonance imaging (MRI) examination revealed retears of reconstructed rotator cuff tissue in 6 patients, with an incidence of 14.3% (6/42). Conclusions The “Chinese way” method for repairing massive rotator cuff injury can reduce pain symptoms, improve range of motion and restore joint function, with lower rate of complications and structural failure, which is worth promoting in clinical practice.

Nobel Prize

Tracing the evolutionary history of humans——Introduction of the Nobel Prize in Physiology or Medicine 2022

Dong Lingyue, Wang Yutong

2022, 43(5):  804-806.  doi:10.3969/j.issn.1006-7795.2022.05.022

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On October 3,2022,Beijing time,the Karolinska Institute of Sweden in Stockholm announced that the 2022 Nobel Prize in Physiology or Medicine was awarded to Swedish evolutionary geneticist Svante Pääbo in recognition of his outstanding contribution for “his discoveries concerning the genomes of extinct hominins and human evolution”. Here, we will provide the introduction of Svante Pääbo as well as his scientific contributions and significance.

Click chemistry and bioorthogonal chemistry: modular construction of the micro world——Introduction of the Nobel Prize in Chemistry 2022

Jiang Bingyin, Zhang Jiyi, Zhang Xiaoyi, Wang Yuji, Zhao Ming

2022, 43(5):  807-812.  doi:10.3969/j.issn.1006-7795.2022.05.023

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On October 5, 2022, the Royal Swedish Academy of Sciences announced that the Nobel Prize in Chemistry 2022 was awarded to American chemist Carolyn R. Bertozzi, Danish chemist Morten Meldal, and the American chemist K. Barry Sharpless, in recognition of their outstanding contributions in the invention and development of click chemistry and bioorthogonal chemistry.