Table of Content

21 August 2022, Volume 43 Issue 4

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Strengthening research on the cerebral venous system improves the diagnosis and treatment of neurological diseases——anatomy, physiology, and clinical overview

Zhou Yifan, Jiang Huimin, Wei Huimin, Gu Yuhang, Hu Wenbo, Liu Lu, Zhou Chen, Ji Xunming

2022, 43(4):  505-520.  doi:10.3969/j.issn.1006-7795.2022.04.001

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The brain is the most metabolically active organ in the human body, and it requires abundant blood supply to maintain complex functional activities. The blood supply of the human brain is divided into the arterial system and the venous system. The cerebral venous system holds 70%-80% of the intracranial blood volume,which plays an important role in ensuring blood perfusion and removing metabolic waste, maintaining the integrity of the blood-brain barrier, regulating intracranial pressure, immune monitoring, and even regulating the meningeal lymphatic function. As a new research field, cerebral venous system has attracted more and more attentions to its pathophysiological role in maintaining cerebral homeostasis and various acute/chronic central nervous system diseases. This review summarizes the anatomical drainage and structural characteristics of cerebral vein system, physiological functions of cerebral vein and its pathological role in central nervous system diseases, aiming to provide references for comprehensively scientific understanding of cerebral vein function and various central nervous system diseases.

Deafness Disease: Basic Research to Clinical Diagnosis and Treatment

Role of mitochondrial deacetylated protein SIRT3 on the cochlea of noise-induced hidden hearing loss

Yang Zijing, Zhao Chunli, Liang Wenqi, Chen Zhongrui, Liu Ke, Gong Shusheng

2022, 43(4):  521-526.  doi:10.3969/j.issn.1006-7795.2022.04.002

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Objective To investigate the role of mitochondrial deacetylation protein sirtuin-3 (SIRT3) in noise-induced hidden hearing loss (NIHHL). Methods Injected SIRT3 inhibitor [3-(1H-1,2,3-triazol-4-yl) pyridine, 3-TYP] and untreated C57BL/6J mice were exposed to 100 dB white noise for 2 hours and hearing examination was performed within 24 h or fourteen days after noise exposure (NE). The changes of ribbon synapses (RS) of inner hair cells (IHCs) were observed by immunofluorescence staining. Via the frozen section, 4-hydroxynonenal (4HNE) staining was used to observe the accumulation of reactive oxygen species (ROS) in the cochlea. Results Compared with the control group, the NE group and 3-TYP group showed a temporary threshold shift, ROS accumulation and loss of ribbon synapses after NE. Compared with the NE group, the threshold of mice in 3-TYP group did not return to normal level 2 weeks after NE. We also found an obvious loss of ribbon synapses and the accumulation of ROS. Conclusion NE causes oxidative stress in the inner ear, and SIRT3 may protect auditory system function by resisting oxidative stress.

Comparison of transfection effects of different serotypes of adeno-associated virus into inner hair cells of mouse cochlea by canalostomy

Liu Shan, Guo Rui, Song Xinyu, Yu Qianru, Chen Zhongrui, Liang Wenqi, Teng Qi, Gong Shusheng, Liu Ke

2022, 43(4):  527-534.  doi:10.3969/j.issn.1006-7795.2022.04.003

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Objective To investigate the efficiency and safety of adeno-associated virus (AAV) of different serotypes transfected into inner ear cells of adult mice through posterior semicircular canal pathway. Methods Twenty C57BL/6J mice aged 6-8 weeks were randomly divided into five groups: AAV8 virus injection group, AAV9 virus injection group, AAVie virus injection group and Anc80L65 virus injection group. They were injected through the latter half regulatory path, and each mouse was injected with 2 μL of virus solution.In the normal control group, each mouse was injected with 2 μL normal saline, and the left ear was used as the operating ear. Auditory brainstem response (ABR) was examined one day before operation and two weeks after operation in each group, and then samples were taken for immunofluorescence staining to observe the distribution of virus in corti. Results AAV8 group: at 2 weeks after operation, 34.6%±1.8% inner hair cells were transfected at the apical and middle turn of cochlea, and 39%±5.9% inner hair cells at the middle and basal turn of cochlea expressed green fluorescent protein (GFP). AAV9 group: 92.5%±1.1% inner hair cells were transfected at the apical and middle turn of cochlea and 94.6%±1.0% inner hair cells expressed GFP at the middle and basal turn of cochlea 2 weeks after operation.AAVie group: 96.7%±1.5% inner hair cells were transfected at the apical and middle turn of the cochlea and 97.7%±0.8% inner hair cells at the middle and basal turn of the cochlea expressed GFP at 2 weeks after operation.Anc80L65 group: at 2 weeks after operation,62.5%±3.3% inner hair cells were transfected at the apical and middle turn of the cochlea, and 63.1%±6.1% inner hair cells at the middle and basal turn of the cochlea expressed GFP.No GFP expression was found in the normal control group. Conclusion Injecting AAVie and AAV9 virus solution through semicircular canal can efficiently transfect into cochlear inner hair cells. This result has certain reference significance for inner ear gene therapy of deafness.

Analysis of imaging and hearing results in children with enlarged vestibular aqueduct

Yang Yali, Huang Lihui, Cheng Xiaohua, Liu sha

2022, 43(4):  535-539.  doi:10.3969/j.issn.1006-7795.2022.04.004

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Objective To explore the differences in the pass rate of neonatal hearing screening and degree of hearing loss between the ears with simple enlarged vestibular aqueduct (EVA) and EVA accompanied by other inner ear malformations. Methods The objects of this study were children diagnosed with enlarged vestibular aqueduct by computed tomography in Children's Hearing Diagnosis Center, Beijing Tongren Hospital,Capital Medical University and accepted newborn hearing screening (NHS) from January 2009 to December 2019. There are a total of 182 ears of 92 cases. The results of their NHS, clinical hearing tests and imaging of ear were collected, and the children were grouped according to image performance. The ears in group A with EVA alone, group B with EVA and Mondini deformity (vestibular pool enlarged may be included simultaneously)(IP-Ⅱ), and group C with EVA and enlarged vestibular pool or semicircular canal malformation without Mondini malformation. The difference in the pass rate of NHS between different groups was analyzed with chi-square test. Kruskal Wallis rank sum test was used to compare the degree of hearing loss between different groups. Results The age of 92 patients is between 1.5-65.0 months, 47 males (51.1%) and 45 females (48.9%). There were 73 ears in group A(40.11%, 73/182),48 ears in group B(26.37%, 48/182), and 61 ears in group C(33.52%, 61/182). Group B and group C account for 59.89% in total. The pass rate of NHS showed no significant difference between A, B, and C groups (χ²=1.122,P=0.571), and between B and A+C groups (χ²=0.401,P=0.526).The difference of the degree of hearing loss between different group showed no statistical significance(P>0.05). Conclusion Most children (about 60%)enrolled in this study had EVA accompanied by other inner ear malformation. The pass rate of newborn hearing screening and the degree of hearing loss showed no significant difference between the groups. Whether vestibular aqueduct enlargement is accompanied by other inner ear malformations could lead to delayed hearing loss.

Analysis of the efficacy of endolymphatic sac decompression combined with triple semicircular canal plugging for vertigo in refractory Meniere's disease

Feng Rong, Liu Yun, Wang Guopeng, Gong Shusheng

2022, 43(4):  540-545.  doi:10.3969/j.issn.1006-7795.2022.04.005

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Objective To investigate the efficacy of endolymphatic sac decompression combined with triple semicircular canal plugging for the treatment of vertigo symptoms in refractory Meniere's disease and the postoperative effects on balance function and quality of life. Methods Twenty-six patients with refractory Meniere's disease were enrolled to undergo endolymphatic sac decompression combined with triple semicircular canal plugging. The pre-and post-operative vertigo control, balance, hearing, Dizziness Handicap Inventory(DHI),Tinnitus Handicap Inventory(THI) and tinnitus pain level of patients were analyzed. Results The vertigo improved significantly in 26 patients after surgery, and the rate of complete control of vertigo was 88.46%, with an effective rate of 100%. The postoperative sensation of balance instability was improved in an average of (5.08±4.52) months, and all of them had no risk of falling. The incidence of postoperative nystagmus was 69.23%, and the symptoms disappeared in about (5.00±2.67) days. The Burg score and visual analogue scale score revealed that the patients' balance gradually recovered as the postoperative time was prolonged. The DHI score indicated that the patients' quality of life gradually improved as the postoperative time was prolonged and stabilized at 6 months after surgery. In addition, the mean hearing threshold was slightly higher in 26 patients at 6 months postoperatively compared with that preoperatively, but not statistically significant. THI scores and tinnitus pain level were decreased at 6 months postoperatively. Conclusion This study showed good control of vertigo with endolymphatic sac decompression combined with triple semicircular canal plugging, significant improvement in postoperative quality of life, and some effect on subjective balance, which returned to normal after about 5 months.

Clinical characteristics and surgical outcome of 10 cases of superior semicircular canal dehiscence syndrome treated via transmastoid approach

Wang Guopeng, He Kaixuan, Xie Jing, Liu Yuhe, Gong Shusheng

2022, 43(4):  546-551.  doi:10.3969/j.issn.1006-7795.2022.04.006

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Objective To investigate clinical characteristics of patients with superior semicircular canal dehiscence syndrome (SSCDS), and to analyze the surgical outcome of the transmastoid approach. Methods From May 2015 to September 2021, the clinical data of SSCDS patients who underwent surgical treatments in Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed, and postoperative follow-ups were conducted. Surgical methods included the repair of the superior semicircular canal dehiscence and the occlusion of superior semicircular canal via transmastoid approach. According to the improvement of patients' symptoms after operation, the postoperative effect was divided into three types (cured, improved and invalid). Results There were 10 patients in the study, including 5 males and 5 females. Nine cases had unilateral SSCDS, and the remaining one had bilateral SSCDS. Common symptoms were bone-conduction hyperacusis, vascular pulsatile tinnitus, vertigo induced by loud sounds, and vertigo caused by pressure changes in middle ear or intracranial cavity. All were unilateral operations. Four patients underwent the repair of the superior semicircular canal dehiscence via transmastoid approach, and the remaining six patients underwent the occlusion of superior semicircular canal via transmastoid approach. One patient was lost to follow-up after surgery. Among nine patients who were followed up for 4-73 months, five patients recovered, three patients got improved, and one patient was invalid. The potential reason for the failure of the operation was that the patient's middle cranial fossa was low, and it was difficult to expose the gap between the dura and the arcuate eminence during the surgery of repair of the superior semicircular canal dehiscence, which resulted in inadequate repair. All patients had no serious postoperative complications such as cerebrospinal fluid leakage or intracranial infection. Conclusion Transmastoid approach for repair of the superior semicircular canal dehiscence and transmastoid approach for the occlusion of superior semicircular canal are both safe and effective for SSCDS. The surgery of the occlusion of superior semicircular canal is more accessible, especially for patients with low middle cranial fossa.

Integrated Diagnosis and Treatment of Lung Cancer

Postoperative pathological analysis of elderly pulmonary ground-glass opacity

Su Lei, Zhang Yi, Gao Yan, Wei Bing, Li Yuanbo, Wang Tengteng, Qian Kun, Wang Leiming

2022, 43(4):  552-557.  doi:10.3969/j.issn.1006-7795.2022.04.007

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Objective Analyze the imaging manifestations and pathological results of elderly patients with pulmonary ground-glass opacity (GGO). Methods The imaging findings and postoperative pathological findings of 281 GGO patients aged over 60 years who underwent surgical treatment in our hospital from January 2017 to December 2019 were retrospectively studied. Results The mean maximum diameter of GGO was (13.3±7.5)mm. There were 97 cases (34.5%) of GGO type I, 119 cases (42.3%) of GGO type Ⅱ, 51 cases (18.1%) of GGO type Ⅲ and 14 cases (5.0%) of GGO type IV. The mean observation time was (13.5±23.3) months. In the postoperative pathological report, there were 30 cases (10.7%) of benign lesions, 75 cases (26.7%) of preinvasive lesions, 65 cases (23.1%) of minimally invasive adenocarcinoma(MIA), and 111 cases (39.5%) of invasive adenocarcinoma(IA). The correlation analysis of GGO imaging features and postoperative pathological results showed that there was a significant correlation between GGO classification based on GGO imaging features and postoperative pathological results (r=0.365, P<0.01). GGO classification was possibly correlated with pathological subtypes of lung cancer (P<0.05, r=0.276), and significantly correlated with STAS (P<0.05, r=0.175) and pleural infiltration (P<0.01, r=0.236). Conclusion The GGO imaging classification in elderly patients is more closely related to postoperative tumor properties and tumor invasive degree.

Diagnostic value of computed tomography guided percutaneous transthoracic needle biopsy (PTNB) for ground-glass nodule

Qian Kun, Zhao Xin, Tan Xiaogang, Tian Xiaoru, Liu Xingsheng, Zhang Yi

2022, 43(4):  558-563.  doi:10.3969/j.issn.1006-7795.2022.04.008

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Objective To investigate the diagnostic value of computed tomography(CT) guided percutaneous transthoracic needle biopsy (PTNB) for ground-glass nodule (GGN). Methods The clinicopathological data of 217 patients with GGN who underwent CT guided PTNB from January 2014 to January 2019 were retrospectively analyzed. The cases with malignant puncture were judged to be positive. The patients with benign puncture were clinically diagnosed in combination with the follow-up results, and the puncture pathology was compared with the final clinical diagnosis. The accuracy, sensitivity, negative predictive value, and complication rate of puncture biopsy in each group were statistically analyzed. Results The overall accuracy of 217 patients was 93.5% (203/217), the sensitivity was 92.2% (165/179), and the negative predictive value was 73.1% (38/52). The overall incidence of complications was 35.5%, mainly hemoptysis and pneumothorax. Conclusion CT guided PTNB GGN had high accuracy and sensitivity. It is necessary to be vigilant against false negative results and properly deal with complications.

Analysis of clinical characteristics and risk factors of arrhythmia after thoracoscopic pneumonectomy in elderly patients with lung cancer

Zhang Jingtao, Wang Xinran, Han Binru, Qiang Ying, Liu Xueqi, Zhang Yi

2022, 43(4):  564-569.  doi:10.3969/j.issn.1006-7795.2022.04.009

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Objective To investigate the risk factors of arrhythmia in elderly lung cancer patients age≥60 years after thoracoscopic pneumonectomy under general anesthesia. Methods Retrospective analysis was performed on the data of 100 elderly lung cancer patients admitted to Xuanwu Hospital, Capital Medical University from October 2021 to December 2021. Patients diagnosed with concurrent arrhythmia were selected as the observation group (arrhythmia group), and patients diagnosed with non-arrhythmia were selected as the control group (non-arrhythmia group). Univariate and multivariate Logistic regression were used to analyze risk factors. Results The total incidence of arrhythmia in hospitalized patients after thoracoscopic lung cancer resection was 19%. Age, surgical methods, complications and hypertension were independent risk factors for arrhythmia in patients with lung cancer surgery. Conclusion For elderly lung cancer patients, the possibility of postoperative arrhythmia could be inferred by the age, past history of hypertension, postoperative constipation, surgical methods, albumin abnormalities, and then targeted treatment, in order to achieve early diagnosis and prevention of postoperative arrhythmia.

Clinical application of electromagnetic navigation bronchoscopy in the diagnosis and treatment of peripheral lung lesions

Tan Xiaogang, Zhang Yi

2022, 43(4):  570-575.  doi:10.3969/j.issn.1006-7795.2022.04.010

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As low-dose computed tomography(CT) is applied more and more in high-risk populations for lung cancer screening, the detectable rate of peripheral pulmonary lesions (PPLs) also increases. Electromagnetic navigation bronchoscopy (ENB) is a tool that can diagnose, locate and treat PPLs. Because of its higher safety and reliability, the application of ENB may change the methods of diagnosis and treatment for lung diseases in the future so as to alleviate and even cure lung cancer, and path a way for the treatment of lung cancer.

Medical Informatics:Application and Development

Computable clinical evidence synthesis:a literature review

Bai Yongmei, Du Jian

2022, 43(4):  576-583.  doi:10.3969/j.issn.1006-7795.2022.04.011

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The rapid growth of medical publications and the increasing medical data have brought unprecedented difficulties for rapid clinical evidence synthesis. In recent years, how to keep up with the development of massive medical evidence and convert it into clinical practice has become an urgent problem to be solved. At present, the method of making full use of structured medical database and directly using structured data to promote the synthesis of medical evidence has become a major trend in clinical evidence synthesis. By converting human-readable medical evidence in PDF and HTML formats into machine-readable format, we can construct a graph of medical knowledge to help domestic doctors to quickly understand the medical research progress and carry out evidence synthesis to support evidence-based clinical decision-making. We introduced the current research status of computable evidence synthesis for system review and clinical trials and clarified the implementation framework and future development direction of computable evidence synthesis through case analysis.

A systematic approach to constructing DAG from knowledge graph

Bai Yongmei, Sun Huage, Du Jian

2022, 43(4):  584-591.  doi:10.3969/j.issn.1006-7795.2022.04.012

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Causal inference is the primary goal of observational research based on big data, as opposed to correlation analysis. Causal graph often visualize complex causal relationships by integrating large amount of priori knowledge through directed acyclic graph(DAG). The directed acyclic graph has become an important tool for developing causal inference strategies. However, the construction of causal graph for specific research questions currently relies heavily on expert knowledge and local experience. Medical knowledge extraction from existing publications is the basis for the systematic construction of DAG. In this paper, we will systematically introduce the structured medical knowledge system platform developed based on the SemMedDB database of the National Institutes of Health. This study attempts to provide a new strategy for systematically constructing DAG by defining causal graphs from an interdisciplinary perspective as complex networks between the concepts involved in a research problem (head and tail concepts) and all their third-party variables. There are two main approaches for the current systematic construction of causal graphs: (1) Prune the knowledge graph into causal graph; (2) Combine the evidence claims based on population-interventions/exposure-comparisons-outcomes (PI/ECO) framework into causal graphs.

Application research hotspot of traditional Chinese medicine informatics

Gao Man, Li Haiyan

2022, 43(4):  592-599.  doi:10.3969/j.issn.1006-7795.2022.04.013

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This paper summarized the popular applications of traditional Chinese medicine(TCM) informatics research to provide useful references for researchers, which include TCM clinical data mining and utilization, TCM intelligent diagnosis and treatment equipment research, Chinese medicine information research, discipline knowledge service based on TCM ancient and modern literature information, and TCM evaluation research based on big data.

Continuous risk prediction of acute kidney injury in elderly critically-ill patients based on electronic medical records

Wu Jinming, Sun Haixia, Wang Jiayang, Qian Qing

2022, 43(4):  600-609.  doi:10.3969/j.issn.1006-7795.2022.04.014

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Objective To explore the feasibility of early continuous risk prediction of acute renal injury in severe elderly patients (≥60 years old) and promote the application of machine learning in clinical decision support. Methods The data were collected from the Medical Information Mart for Intensive Care (MIMIC)-Ⅲ database. Logistic regression (LR), support vector machine (SVM), random forest (RF), and light gradient boosting machine (LightGBM) were applied to predict the risk of acute kidney injury (AKI). The prediction results were evaluated based on area under curve (AUC), accuracy, and recall. Results A total of 11 261 intensive care unit (ICU) records were included. When the data of every six hours was used for continuous prediction, AUCs yielded with LightGBM were 0.845－0.925, and those with RF, SVM, and LR were all less than 0.73. As for using the data of the first 6 hours, LightGBM reached AUC 0.845. Compared current data with the cumulative data of ICU, LightGBM yielded higher AUC, accuracy, and recall, whilst it was opposite in RF, SVM, and LR. Conclusion LightGBM completed AKI continuous prediction task with acceptable performance. It is practical to use the data of the first 6 hours on ICU admission for AKI early prediction, which achieve prediction effect of 24－hour accumulated data. In addition, different models have different data applicability. LightGBM performed better based on current data while the other three models favored cumulative data.

Interpretable machine learning methods applied in disease risk prediction: a case study of sepsis mortality risk predication

Yang Fengchun, Zheng Si, Li Jiao

2022, 43(4):  610-617.  doi:10.3969/j.issn.1006-7795.2022.04.015

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Objective To investigate the application of interpretable machine learning methods in disease risk prediction. Methods In this study, we used sepsis mortality risk prediction as a case. A total of 19 903 electronic medical records (EMRs) of intensive care unit (ICU) patients with Sepsis-3 who met the criteria were collected from Medical Information Mart for Intensive Care (MIMIC)-Ⅳ, a public EMR database. Then, the predictive models of sepsis death were constructed using the models with inherent interpretation, decision tree, Logistic regression, and complex model random forest, XGBoost and LightGBM models. The machine learning models were interpreted using global interpretable methods (feature importance, partial dependency plot, individual conditional expectation plot, global surrogate model) and local interpretable methods (local interpretable model-agnostic explanations, Shapley value). These methods were used to explore the risk factors affecting the prognosis of sepsis patients. Results The models with low interpretability [area under curve (AUC) values of LightGBM, random forest, and XGBoost models are 0.913, 0.892 and 0.872, respectively], performed with higher predictive ability than models with intrinsic explanatory ability (AUC values of Logistic regression model and decision tree model are 0.779 and 0.791, respectively). Both the global and local interpretable methods were used to explain the decision process of machine learning model. Conclusion The global interpretable methods were able to explain the responsive trend of models in the whole feature space, while the local interpretable methods were able to explain how decisions were made in particular cases.

Reasons and countermeasures for retraction articles in the field of neuroscience in China from 2010 to 2021

Zhang Jianjun

2022, 43(4):  618-621.  doi:10.3969/j.issn.1006-7795.2022.04.016

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Objective To analyze the reasons for the retraction articles in the field of neuroscience in China, and to put forward countermeasures. Methods Using the query service of “The Retraction Watch Database” to search the retraction situation in the field of neuroscience in China (including Hong Kong, Macao and Taiwan) in recent 11 years from August 2010 to May 2021, and then to classify and analyze the reasons for retraction. Results In recent 11 years, 313 retraction records in the field of neuroscience in China were retrieved, and 65.2% of the papers were retracted because of academic misconduct. Conclusion In the field of neuroscience, we should further strengthen the supervision of scientific research papers and scientific integrity.

Basic Research

Dysregulated microbial metabolites in brain of mice with type 1 diabetes mellitus-induced cognitive impairment

An Yu, Bian Nannan, Ding Xiaoyu, Chang Xiaona, Liu Jia, Wang Guang

2022, 43(4):  622-629.  doi:10.3969/j.issn.1006-7795.2022.04.017

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Objective To investigate the changes of intestinal microflora metabolites in brain tissue of type 1 diabetes mellitus (T1DM)mice with cognitive impairment. Methods To develop a T1DM model, male C57BL/6 mice aged 6 weeks were given by intraperitoneal injection of STZ at dosage 40 mg/kg of body weight for five consecutive days. The Morris water maze test was used to assess learning and memory ability in mice. An ultra-performance liquid chromatography coupled to tandem mass spectrometry (UPLC-MS/MS) system was applied to identify and quantify microbiota-derived metabolites in brain samples collected from sacrificed mice. Results The gut microbial metabolic profiles in brains of diabetes mellitus (DM) mice differed significantly from controls. Compared with control mice, brain levels of glutamine (Log₂FC=0.262,P=0.002), tartaric acid (Log₂FC=0.847,P=0.017), lactic acid (Log₂FC=0.326,P=0.002) and m-aminobenzoic acid (Log₂FC=1.028,P=0.046) were significantly higher (all Log₂FC>0, P<0.05) while indolelactic acid, 3-hydroxybutyric acid (Log₂FC=-1.466,P=0.049) and other 5 metabolites were significantly lower (all Log₂FC<0, P<0.05) in DM mice. Such metabolic differences encompassed pyrimidine metabolism, D-glutamine and D-glutamate metabolism, pyruvate metabolism, purine metabolism and other metabolic pathways. Conclusion Gut microbiome and its metabolites may play a crucial role in the onset and development of type 1 diabetes-induced cognitive impairment. Targeting the gut microbiome and relevant microbiota-derived metabolites would be effective therapeutic treatments for T1DM-induced cognitive impairment.

Clinical Research

Mean arterial pressure variability and the prognosis in intensive care unit patients: a retrospective analysis of the MIMIC-Ⅲ database

Wang Yumei, Zhang Linlin, Zhou Yimin, Miao Mingyue, Duan Yuqing, Zhou Jianxin

2022, 43(4):  630-634.  doi:10.3969/j.issn.1006-7795.2022.04.018

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Objective To explore the relationship between mean arterial pressure (MAP) variability and the mortality in intensive care unit (ICU) at the critically ill patients. Methods This is a retrospective analysis with 38 852 clinical data of critically ill patients in the Medical Information Mart for Intensive Care (MIMIC)-Ⅲ database. MAP variability was calculated by the coefficient of variation (CV) of MAP within 24 hours after admitted to ICU. According to the MAP variability within 24 hours, the patients were divided into 10 groups with equal frequency. Then, the general linear regression was used to assess the correlation between the MAP variability and the mortality in ICU.Area under the curve (AUC) of receiver operating characteristic (ROC) was applied to determine whether MAP variability can be a prognostic predictor on the in-ICU mortality in critically ill patients. Results There is a significant correlation between the 24-hour MAP variability and the mortality in ICU (R²=0.860, P <0.001). The larger the MAP variability, the higher the mortality in ICU. The AUC of 24-hour MAP variability prediction ICU mortality was 0.610. Conclusion The 24-hour MAP variability has a good correlation with the mortality in ICU at the critically ill patients. The greater the MAP variability, the higher the mortality in ICU. The MAP variability may provide some information for easily and quickly predicted the mortality in ICU of critically ill patients.

A study on the correlation between atopy and symptoms, exacerbation of patients with chronic obstructive pulmonary disease

Zhou Yuyan, Chen Xiaoting, Wang Wanying, Li Jing, li Deshuai, Bu Xiaoning

2022, 43(4):  635-640.  doi:10.3969/j.issn.1006-7795.2022.04.019

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Objective To investigate the correlation between atopy and respiratory symptoms, acute exacerbation of patients with chronic obstructive pulmonary disease (COPD). Methods There were 178 patients with stable chronic obstructive pulmonary disease from Beijing Chaoyang Hospital, Capital Medical University from January 2018 to June 2019 were collected. According to the positive serum inhalation allergen screening test, the patients were divided into atopic group (27 cases) and non-atopic group (151 cases). The demographic data, clinical symptoms and laboratory examinations of patients were collected and followed up for 12 months. The acute exacerbation of chronic obstructive pulmonary disease (AECOPD) was recorded. Results After propensity score matching,the symptoms of wheezing in the atopic group(n=27) were higher than those in the non-atopic group(n=77) (77.78% vs 55.84%). The difference was statistically significant (P=0.044). The total serum immunoglobulin(IgE) level in the atopic group was significantly higher than that in the non-atopic group, and the value of forced expiratory volume in first second(FEV1 )was also significantly higher than that in the non-atopic group (P<0.001,P=0.019). Following up for 12 months, the frequency of frequent severe acute exacerbations in the atopic group was significantly higher than that in the non-atopic group (29.63% vs 10.39%), and the difference was statistically significant (P=0.038). Conclusions Atopy can lead to the increase of wheezing symptoms, severe and frequent acute exacerbations in patients with COPD.

Effect of body fat percentage on muscle strength and physical performance in the elders with type 2 diabetes mellitus

Xiu Shuangling, Fu Junling, Mu Zhijing, Sun Lina, Zhao Lei

2022, 43(4):  641-646.  doi:10.3969/j.issn.1006-7795.2022.04.020

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Objective To explore the association between body fat percentage and muscle strength and physical performance in old people with type 2 diabetes mellitus (T2DM). Methods A total of 127 old people aged more than 60 years who were admitted in the Department of Endocrinology, Xuanwu Hospital, Capital Medical University were included in the study. Levels of glycosylated hemoglobin A1c (HbA1c), 25-hydroxyvitamin D₃, [25(OH)D₃],fasting insulin (FINS), serum C-reactive protein (CRP) and interleukin-6 (IL-6) were measured. Body fat percentage and appendicular skeletal muscle mass (ASM) were assessed by dual energy X-ray absorptiometry (DEXA). Muscle strength was assessed using hand-grip strength (HS) and chair stands test. Gait speed (GS) and the Short Physical Performance Battery (SPPB) were used to evaluate physical performance. Multiple linear regression analysis was used to evaluate the association between fat percentage and muscle strength, physical performance. Results Female participants had higher body fat percentage than male subjects (35.18%±6.32% vs 28.75%±4.48%, P＜0.001). Body fat percentage were negatively correlated with ASM, appendicular skeletal muscle mass index (ASMI),hand-grip strength,gait speed,SPPB score, while it was positively correlated with serum levels of CRP, HOMA-IR and chair stands time (P＜0.01). After adjusting age, sex, ASM, HbA1c and high waist circumference, body fat percentage was inversely associated with hand-grip strength and gait speed (β=-33.68,P=0.003; β=-1.316,P=0.002, respectively),while it was positively associated with increased chair stands time (β=31.60,P=0.011). Conclusion Body fat percentage were associated with lower muscle strength and poor physical performance in old people with T2DM.

Comparison of the clinical efficacy of Topping-off surgery and posterior interbody fusion in the treatment of degenerative lumbar disease

Wang Wei, Pan Fumin, Kong Chao, Sun Xiangyao, Hou Xiaofei, Lu Shibao

2022, 43(4):  647-652.  doi:10.3969/j.issn.1006-7795.2022.04.021

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Objective To compare the clinical efficacy of Topping-off surgery with posterior interbody fusion (PIF) in treating degenerative lumbar disease (DLD). Methods Patients who underwent surgery for DLD in Xuanwu Hospital, Capital Medical University from December 2015 to December 2017 were retrospectively reviewed and 40 patients undergoing Topping-off surgery were included. Sixty patients with matched demographic characteristics but undergoing posterior interbody fusion (PIF) surgery were included. All patients were graded for low back pain and lumbar function before and 2 years after surgery. The range of motion (ROM) of L2/3, L3/4, and L2-4 segments were measured with the dynamic lumbar X-rays, and the severity of disc degeneration in L2/3 was assessed with the modified Pfirrmann system. Results The surgical duration in the Topping-off group was significantly shorter than that in the PIF group (P<0.05). The intraoperative blood loss in the Topping-off group was non-significantly less than that in the PIF group (P>0.05). In the Topping-off group, the ROM of the L3/4 segment at two years after surgery was lower than that before surgery (P<0.05), but the ROM of the L2/3 segment was not significantly changed (P>0.05). In the PIF group, the ROM of the L2/3 segment increased significantly at two years after surgery compared with that before surgery (P<0.05). At two years after surgery, no significant difference was detected in the ROM of the L2-4 segment between the two groups (P>0.05), but the modified Pfirrmann score of the L2/3 segment in the PIF group was higher than that in the Topping-off group (P<0.05). Conclusion Both Topping-off surgery and PIF can significantly improve the prognosis of DLD, but Topping-off surgery can prevent or delay the occurrence of adjacent segment degeneration, which is of great significance to the selection of clinical diagnosis and treatment strategies.

Clinical analysis of cesarean delivery with cesarean myomectomy in pregnant women with different types of uterine myomas

Lu Chang, Hu Jiangtao, Li Jinjiao, Jiang Haili

2022, 43(4):  653-657.  doi:10.3969/j.issn.1006-7795.2022.04.022

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Objective To explore the clinical outcomes of cesarean myomectomy (CM) in pregnant women with different types of uterine myomas. Methods A retrospective cohort study of 246 singleton pregnancies with different types of uterine myomas underwent cesarean section and CM was performed. There were subserosal myomas (SM) group (135 cases) and intramural myomas (IM) group (111 cases) according to the different types of uterine myomas. The clinical characteristics and delivery outcomes were analyzed. Results ① In IM group, the maternal age,the proportion of myomas(≥5 cm)and the proportion of multiple myomas were significantly higher than those in SM group (37 years vs 34 years, χ²=-3.640, P=0.000; 50.5% vs 25.9%, χ² =15.719, P=0.000; 55.0% vs 23.0%, χ² =26.630, P=0.000). ② In IM group, the operation time and the proportion of using additional oxytocin were higher than those in SM group significantly (50 min vs 45 min, Z=-3.349, P=0.001; 49.5% vs 29.6%, χ² =10.197, P=0.001). In IM group, blood loss ≥500 mL and the blood loss increased significantly than that in SM group (47.7% vs 33.3%, χ² =5.281, P=0.022; 530 mL vs 400 mL, Z=-3.247, P=0.001). Conclusion The proportion of using additional oxytocin and blood loss increased in CM in singleton pregnant women with intramural myomas,but the risk of severe postpartum hemorrhage (PPH) did not increase.

Clinical application of transvaginal endoscopic surgery in intrauterine lesions in women of childbearing age with asexual life

Li Yunfei, Huang Xiaowu, Xia Enlan

2022, 43(4):  658-663.  doi:10.3969/j.issn.1006-7795.2022.04.023

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Objective To explore the clinical diagnosis, treatment and surgical skills of transvaginal endoscopic surgery for intrauterine lesions in reproductive age patients with asexual life. Methods Totally 152 patients, who were under childbearing age with asexual life and treated in Fuxing Hospital Affiliated to Capital Medical University from January 2017 to January 2021, were analyzed retrospectively. They underwent hysteroscopy and/or surgery and histopathology. Results Transvaginal hysteroscopy was successfully performed in all 152 patients. Benign intrauterine or cervical lesions were successfully removed. Endoscopic endometrial biopsy was sufficiently performed. There were no complications such as cervical laceration, uterine perforation and transurethral resection of prostate (TURP). There were 16 cases (10.5%) of iatrogenic abrasion or laceration of hymen. Conclusion Transvaginal endoscopic hysteroscopy can be used to timely and accurately diagnose and treat intrauterine lesions and effectively protect their reproductive potential on the premise of effective protection of hymen.

Review

Formulation and preliminary application of on-site supervision and inspection scoring standards for mutual recognition of medical ethics review in Beijing

Yue Xiaolin, Li Xiaoling, Wang Meixia,Bai Hua, Zhang Zhuoran, Wang Xiangping

2022, 43(4):  664-668.  doi:10.3969/j.issn.1006-7795.2022.04.024

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Objective In order to test the implementation effect of the mutual recognition of ethics, the Beijing Municipal Health Commission decided to conduct on-site supervision and inspection of the 25 medical institutions in the alliance that have the qualifications for the main review. To this end, the alliance has formulated the scoring standards for the on-site supervision and inspection of mutual recognition of ethical review to ensure the objectivity and consistency of the inspection. Methods The scoring standard is mainly formulated with reference to the Working Rules of Beijing Medical Ethics Review Mutual Recognition Alliance and the preliminary basic research of 25 medical institutions. Results The scoring standard consists of 3 first-level indicators, 10 second-level indicators and 13 third-level indicators. The three first-level indicators are system construction (30 points), implementation of mutual recognition (25 points) and review efficiency (45 points). Conclusion The scoring standard is an important tool for promoting mutual recognition of medical ethics review in Beijing. Although individual indicators have limitations in their use at the current stage, in general, they can be used to comprehensively examine the implementation and effect of mutual recognition of ethical review, and have certain operability.