Table of Content

21 February 2023, Volume 44 Issue 1

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Clinical Epidemiology and Clinical Trials

The relationship between serum CX3CL1 level and cognitive dysfunction in patients with white matter hyperintensity

Li Qiong, Zhao Jianhua, Liu Hao, Wang Fan, Li Qing, Chen Xiyan, Cai Ruiyan, Wu Qingwu, Zhang Jian, Ji Sibei, Lu Chengbiao, Li Shaomin

2023, 44(1):  6-12.  doi:10.3969/j.issn.1006-7795.2023.01.002

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Objective To explore the correlation between serum chemokine C-X3-C-motif ligand 1 (CX3CL1), also know as fractalkine (Fkn). levels and cognitive dysfunction in patients with white matter hyperintensity (WMH). Methods A total of 152 patients with cerebral small vessel disease (CSVD) enrolled in the First Affiliated Hospital of Xinxiang Medical University from March 2020 to August 2022 were collected. The general clinical data of patients, the routine sequence of cranial magnetic resonance imaging (MRI), biochemical indicators, serum CX3CL1 level, and Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) cognitive scores were collected, and the correlation between serum CX3CL1 levels and white matter hyperintensity and cognitive function was analyzed. Results A total of 152 participants were enrolled and divided into the group with normal cognitive function and the group of cognitive dysfunction according to the MMSE results, with the mean age of (59.60±8.84) years and (62.91±7.99)years, respectively. The correlation analysis results showed that CX3CL1 level and apparent space were negatively correlated with executive function, attention, and orientation.Regression analysis showed that CX3CL1 levels and white matter high-signal were risk factors for cognitive dysfunction. Receiver operating characteristic (ROC) curve analysis suggested that CX3CL1 levels may have potential predictive value for cognitive impairment. Conclusion Serum CX3CL1 levels and white matter hyperintensity are associated with cognitive function, and elevated serum CX3CL1 levels are risk factors for the development of cognitive dysfunction.

Relationship between carboxylesterase 1 and carboxylesterase 2 gene expression levels and body mass index, and gene polymorphism analysis

Zhang Jianxiong, Li Dandan, Hu Mengmeng, Cheng Xuewei, Dong Ruihua

2023, 44(1):  13-19.  doi:10.3969/j.issn.1006-7795.2023.01.003

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Objective To explore the role of carboxylesterase 1(CES1) and carboxylesterase 2 (CES2) in metabolism by detecting gene polymorphisms and gene expression levels ofCES1 and CES2 in healthy volunteers. Methods The DNA was extracted from peripheral blood lymphocytes of 48 volunteers with written consent, and total genomic DNA was sequenced using a target sequencing strategy. The total RNA was extracted to determine gene expression levels. The multiple linear regression was used to analyze the relationship between CES1 and CES2 gene expression and sex, age and body mass index (BMI). Results The expression level of CES1 and CES2 was 141.8 (72.7, 237.8) and 74.4 (30.8, 133.6), respectively. The multiple linear regression analyses indicated that BMI (β = －28.83, P=0.048) had a significant effect on the expression level of CES2. Age, sex, or BMI were not associated with the expression level of CES1. The sequence variants were identified, and 10 of a total of 20 sequence variants of CES1 caused a change in the CES1 amino acid sequence and two of a total of six sequence variants of CES2 caused a change in the CES2 amino acid sequence. Conclusion In this study, we found that the expression level of CES2 was correlated with BMI, while the expression level of CES1 was not significantly correlated with BMI. The results of gene prediction suggested that the genetic variation of CES1 might affect its functional expression.

Effect and associated factors of mental health education on the elderly in endowment institutions in Beijing

Qi Han, Jia Pengju, Wang Chunyan, Hu Weiming, Fu Chenguang, Xia Chenni, Jiang Tao, Wu Manqin, Wang Xuehao, Zhang Changchun, Yan Fang

2023, 44(1):  27-34.  doi:10.3969/j.issn.1006-7795.2023.01.005

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Objective To evaluate the effect and associated factors of mental health education on elderly people who lived in endowment institutions in Beijing. Methods A self-controlled community experimental design was adopted, and the elderly who met the inclusion and exclusion criteria were selected through a two-stage selection process. The mental health educations were carried out by professionally psychological service staff for a half year. The demographic data were collected, and the depression symptoms, anxiety symptoms, insomnia symptoms, and cognitive disorders were assessed with scales before and after the interventions. The response rates, changes of the total scores and the associated factors of the effect were analyzed. Results Totally, 620 elderly people from 30 endowment institutions were included in the analysis. The average age was (77.92±9.79) years old, and 50.5% were men. The total scores of the depression, insomnia, anxiety and cognitive impairment scales were significantly decreased after the interventions (P <0.05). The multivariate Logistic regressions showed that gender, age group, personal monthly income, education level and chronic diseases were significantly associated with the effect of the mental health educations (P<0.05). Conclusion The mental health educations could effectively improve the mental health status of the elderly in the endowment institutions in Beijing. According to the characteristics of the elderly, personalized mental health educations should be adopted to further improve the mental health status and quality of life in the future.

Implementation and related influencing factors of the clinical pathway of acute exacerbation of chronic obstructive pulmonary disease

Wang Yingquan, Feng Lin, Zuo Yingting, Tong Zhaohui, Liang Lirong

2023, 44(1):  35-41.  doi:10.3969/j.issn.1006-7795.2023.01.006

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Objective To investigate the effect and implementation of clinical pathway(CP) for hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in a tertiary general hospital, analyze the existing problems and propose corresponding suggestions. Methods Patients with primary diagnose of AECOPD were selected from January 1^st, 2016 to December 31^st, 2021 through the hospital's integrated big data platform. The clinical baseline characteristics, clinical outcomes, and hospitalization costs were compared with each other between those entered CP of AECOPD and those not, and the factors affecting the enter of CP were analyzed with multivariate Logistic regression. Similar analyses were done between those completed CP and those not completed CP implementation. Results A total of 1 817 hospitalized patients with AECOPD were included. Among these cases, 20.7% (377 of 1 817) of them entered CP of AECOPD, and the proportion changed significantly during the study period. Further, 66.0% (249 of 377) of those entered CP of AECOPD completed the CP, and the proportion did not change significantly during the study period. Age and Charlson Comorbidity Index (CCI) ≥ 2 were the independent influencing factors of not entering CP, and comorbidities of respiratory failure, moderate to severe renal disease were the independent influencing factors of not completing CP. Neither entering CP nor completing CP has significant correlation with patients' in-hospital mortality and length of stay. However, the patients who completed the CP had less medical costs than whose who didn't. Conclusion In real world, the proportion of AECOPD patients who entered CP and the proportion of those completed CP in a tertiary general hospital are both relatively low, especially among the elderly and those with severe chronic comorbidities. The entry and exit criteria of the clinical pathway for these patients should be detailed to improve the implementation of the AECOPD clinical pathway.

Cardiovascular risk of isolated systolic or diastolic hypertension in subjects with abnormal glucose metabolism

Zuo Yingting, Wu Shouling, Chen Shuohua, Tian Xue, Xu Qin, Zhang Yijun, Zhang Xiaoli, Wang Anxin

2023, 44(1):  42-48.  doi:10.3969/j.issn.1006-7795.2023.01.007

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Objective To explore whether cardiovascular risk differ among the subgroups of abnormal glucose metabolism adults with isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH) or systolic and diastolic hypertension(SDH). Methods This study included 24 605 participants from Kailuan Study during 2006 and 2007, without taking antihypertensive medication and free of a history of cardiovascular disease (CVD). The baseline blood pressure (BP) was measured. The participants were categorized as having normal BP [systolic BP(SBP)<120 mmHg(1 mmHg=0.133 kPa)/diastolic BP (DBP)<80 mmHg], elevated BP (SBP 120－129 mmHg/DBP<80 mmHg), stage 1 IDH (SBP<130 mmHg/DBP 80－89 mmHg), stage 1 ISH (SBP 130－139 mmHg/DBP<80 mm Hg); stage 1 SDH (SBP 130－139 mmHg/DBP 80－89 mmHg), stage 2 IDH (SBP<140 mmHg/DBP≥90 mm Hg), stage 2 ISH (SBP≥140 mmHg/DBP<90 mm Hg), and stage 2 SDH (SBP≥140 mmHg/DBP≥90 mmHg). The outcome was the first occurrence of CVD from baseline to the end of follow-up (December 31, 2019). Multivariable-adjusted Cox proportional hazards models were performed to evaluate the associations. Results During a median follow-up of 12.9 (interquartile range: 12.5－13.1) years, we observed 2,406 incident CVD events. With normal BP as the reference, multivariable-adjusted hazard ratios for CVD events were 1.31 (95%CI 0.96－1.79) for stage 1 ISH, 1.15 (95%CI 0.96－1.37) for stage 1 IDH, and 1.30 (95%CI 1.07－1.57) for stage 1 SDH. Furthermore, stage 2 ISH, stage 2 IDH and stage 2 SDH all had a higher risk of CVD than the normal BP. The risk of CVD in stage 2 SDH was 2.24 times higher than normal BP (95% CI 1.91－2.61). Conclusions Categorizing abnormal glucose metabolism adults with stage 1 hypertension further into stage 1 ISH, IDH, and SDH may improve risk stratification for identifying high-risk individuals.

Analysis of the relationship between non-high-density lipoprotein cholesterol and arterial plaque characteristic in a cohort of ischemic stroke patients

Xu Jianke, Liu Ning, Han Miao, Zhang Hongyang, Han Xinsheng

2023, 44(1):  49-53.  doi:10.3969/j.issn.1006-7795.2023.01.008

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Objective To investigate the relationship between non-high density lipoprotein-cholesterol (non-HDL-C) and artery plaque characterization of stroke. Methods The hospitalized patients diagnosed as atherosclerotic stroke in the neurological department of Kaifeng Central Hospital were recruited as the experimental group (400 cases), who were divided as the stable and unstable plaque groups, according to the stenosis intensity. Another 400 healthy controls were recruited. The serum levels of non-HDL-C of all the patients and control groups were detected. Results The levels of non-HDL-C were significantly different (P<0.05) between the stroke group and the health control. The levels of non-HDL-C in the unstable plaque group were significantly higher than that in the stable control group, and the mean of non-HDL-C was (3.81±0.99)mmol/L and (2.92±0.72)mmol/L,respectively, with significant difference (P<0.05). Spearman correlation ananlysis showed the levels of non-HDL-C was positively correlated with the unstable plaque (r=0.521, P<0.01). Logistic regression analysis showed that non-HDL-C was an important risk factor for carotid artery unstable plaque(OR=3.990,95%CI:2.369－6.720). Conclusion There was correlation between the non-HDL-C and arterial plaque characteristic in ischemic stroke patients, which can be used as the important basis for clinical examination.

Basic and Clinical Research on Cerebrovascular Diseases

Limb remote ischemic perconditioning combined with remote ischemic postconditioning promotes neurogenesis in rat models of ischemic stroke

Qin Linhui, Li Ning, Yang Yu, Yang Yong, Ren Changhong

2023, 44(1):  54-61.  doi:10.3969/j.issn.1006-7795.2023.01.009

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Objective To explore comfirm the effect of limb remote ischemic per-conditioning (PerC) combined with post-conditioning (PostC) on neurogenesis after ischemic stroke, and to explore the effect of PerC combined with PostC on the rate-limiting enzyme of fatty acid β-oxidation (FAO): carnitine palmitoyl transferase 1A (CPT1A). Methods Adult male Sprague Dawley rats were subjected to middle cerebral artery occlusion (MCAO). Limb remote ischemic conditioning was applied 30 min after the MCAO model, followed by repeated short episodes of remote ischemic conditioning 24 h after reperfusion (post-conditioning). The neurogenesis in the subependymal ventricular zone(SVZ) region was analyzed with immunohistochemistry staining, and the expression of CPT1A was analyzed with enzyme linked immunosorbent assay(ELISA). Results PerC+PostC treatment significantly improved neurological function and increased the number of neural stem cells (NSCs) and the number of cells that migrated to the infarct area compared to the MCAO and PerC/PostC groups. Pearson correlation analysis showed that the number of neural stem cells had a negative correlation with neurological function. However, the number of apoptotic NSCs that migrated to the basal ganglia did not differ significantly between groups. Further mechanism studies showed that the treatment with PerC+PostC significantly increased the protein level of CPT1A. Conclusion PerC combined with PostC treatment can improve neurological function by increasing the number of NSCs. FAO of NSCs may be one of its mechanisms to promote the migration of NSCs.

Epigenetic regulation of HDAC2 on TBC protein family members of neutrophils in patients with ischemic stroke

Li Xue, Fan Junfen, Wang Rongliang, Ma Qingfeng, Luo Yumin, Zhao Haiping

2023, 44(1):  62-71.  doi:10.3969/j.issn.1006-7795.2023.01.010

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Objective To study the molecular mechanism that mediating neutrophil degranulation and phagocytosis after acute ischemic stroke(AIS) and the epigenetic regulatory mechanism of histone deacetylase 2 (HDAC2). Methods Three 60－80 years old male patients from the Department of Emergency, Xuanwu Hospital, Capital Medical University who did not receive thrombolysis or endovascular treatment within 6 h after anterior circulation ischemia onset and three healthy gender and age-matched controls were included in this study. The peripheral blood neutrophils was isolated with density gradient centrifugation method, and the transcriptome difference between AIS patients and healthy controls was analyzed with RNA sequencing (RNA-seq). In addition, HDAC2 binding genes in neutrophils were analyzed with chromatin immunoprecipitation high-throughput sequencing (ChIP-seq). Results (1) RNA-seq results indicated that compared with the healthy control group, the transcription level of 13 TBC1D family molecules changed significantly after AIS, among which TBC protein family members TBC1D10A, TBC1D31, and TBC1D5 were significantly down-regulated, and TBC1D10B, TBC1D10C, TBC1D17, TBC1D2, TBC1D22A, TBC1D26, TBC1D29, TBC1D3H, TBC1D8, and TBC1D9B were significantly up-regulated. (2) ChIP-seq analysis indicated that HDAC2 binding genes of TBC1D family in AIS patients were differentially expressed. Methylation analysis of HDAC2 binding promoters showed that these TBC1D family molecules were modified by hypermethylation and moderate methylation, which were regulated by acetylation and methylation modification. Conclusion This study showed that TBC1D family molecules may be potential targets for regulating neutrophil degranulation and phagocytosis after ischemic stroke, and HDAC2 may have extensive binding sites in the genome of this family.

The evaluation of the efficacy and prognosis of conscious sedation in endovascular treatment in acute ischemic stroke

Jiang Fucheng, Huang Jyumei, Feng Yuexian, Zhong Hongliang, Jia Jianwen, Yang Hongchao, Liu He, Liu Yang

2023, 44(1):  72-77.  doi:10.3969/j.issn.1006-7795.2023.01.011

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Objective To analyze the effect and impact on prognosis of conscious sedation (CS) and conversion to general anesthesia (CGA) in endovascular treatment of acute ischemic stroke (AIS). Methods A retrospective analysis was conducted on 117 AIS patients who received endovascular therapy in Beijing Chaoyang Hospital, Capital Medical University from January 2021 to December 2021. The patients were divided into 2 groups according to anesthesia methods: CS (n=97) and CGA (n=20). General data, admission National Institutes of Health Stroke Scale (NIHSS), site of occlusion vessels, time course, the technical efficacy of the endovascular procedure in establishing reperfusion, complications and prognosis were compared between the two groups. The 1∶3 propensity score matching was calculated from the patients' base line data, so that the number of CS group was adjusted to 60 and CGA 20. Results The CS group had a significantly shorter time of puncture to recanalization (P=0.007). There was a statistically significant difference in the location of vascular occlusion between the two groups (P=0.017), and the incidence of vertebral artery occlusion was higher in the CGA group. There was no significant difference indoor to puncture(DPT) and postoperative modified thrombolysis in cerebral infarction(mTICI )between two groups (P>0.05). CS group had a significantly lower prevalence of postoperative malignant edema and hypostatic penumbra(P<0.05), and a significantly higher rate of good prognosis (P=0.019). Conclusion In the endovascular treatment of AIS, CS is simple and effective. Compared with CGA patients, it can achieve faster reperfusion and is associated with a better clinical prognosis.

Correlation between glycemic variability and neurological deterioration in patients with acute ischemic stroke and diabetes mellitus

Li Sen, Guo Xuewen, Zhao Xin, Huang Anqi, Lin Jingge, Li Xingmao, Li Xiu, Du Yifeng, Zhao Yongmei, Bai Jie, Xia Zhangyong

2023, 44(1):  78-84.  doi:10.3969/j.issn.1006-7795.2023.01.012

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Objective To explore the correlation between glycemic variability and neurological impairment in patients with acute ischemic stroke (AIS) complicated with diabetes mellitus. Methods A total of 125 patients with AIS and diabetes mellitus were selected. The general clinical data at baseline were recorded, and the National Institutes of Health Stroke Scale (NIHSS) was scored at admission and discharge respectively, and the modified Rankin Scale (mRS) score was recorded 1 month after discharge to evaluate neurological changes and disability after stroke. According to whether the NIHSS score worsened or not, the patients were divided into a non-deterioration group and a deterioration group, and the baseline data and glycemic variability parameters were compared between the two groups. Logistic regression was used to analyze the possible factors affecting neurological deterioration, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of blood glucose variability indicators for neurological deterioration. Results There was no statistical difference in baseline clinical data between the two groups, but a statistical differences in blood glucose variability parameters with mean amplitude of glycemic excursions(MAGE) and largest amplitude of glycemic excursions(LAGE) (P<0.05). Binary Logistic regression analysis showed that time in range(TIR) (OR=0.937, P<0.001), MAGE (OR =1.360, P=0.024), and LAGE (OR=1.364, P=0.015) were the risk factors for worsening NIHSS score. Ordinal multivariate Logistic regression analysis showed that MEAN (OR=1.208, P=0.033), MAGE (OR=1.206, P=0.040) and admission fasting blood glucose (OR=1.182, P=0.016) were the risk factors affecting the mRS score. The ROC curve showed that the area under the curve (AUC) of TIR for predicting deterioration was 0.781 (95% CI:0.699－0.862, P<0.001), the sensitivity was 82.6%, the specificity was 60.8%, and the best cut-off value was 41.3%. Conclusion The glycemic variability indicators represented by TIR and others are related factors that may indicate the deterioration of neurological function in patients with AIS and diabetes mellitus.

Basic Research

Transcriptome analysis of lipid metabolization-related differential genes mediated by P53 apoptosis-stimulating protein 2 in alcoholic liver disease

Zhang Ying, Liu Chaonan, Shi Honglin, Liu Fang, Chen Dexi, Shi Hongbo

2023, 44(1):  85-92.  doi:10.3969/j.issn.1006-7795.2023.01.013

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Objective We used the Illumina sequencing platform to investigate the effect of p53 apoptosis stimulating protein 2 (ASPP2) on the expression of genes related to lipid metabolism in alcoholic liver disease. Methods The expression of ASPP2 was down-regulated by human hepatocyte HL-7702 cells infected with lentivirus. The two groups of cells (ASPP2-low and control) were cultured in a definite concentration of alcohol for 24 h. Then we used the Illumina sequencing platform to screen the differentially expressed genes. Then, a functional enrichment analysis and network interaction analysis were performed to explore the biological processes involving these genes. Results Total 150 differentially expressed genes were screened out by high-throughput sequencing according to the criteria of P<0.05 and | log₂ (foldchange) |>1, of which 58 were up-regulated and 92 were down-regulated. Among them, there were 8 up-regulated genes and 7 down-regulated genes related to lipid metabolism. Gene ontology (GO) enrichment analysis found four cell components related to lipid metabolism, including high-density lipoprotein particles, plasma lipoprotein particles, lipoprotein particles, and protein-lipid complexes. Conclusion We found 15 different genes related to lipid metabolism in this study. These genes may be involved in ASPP2 mediated lipid accumulation in alcoholic liver disease, which lays a foundation for further study on the regulation mechanism of ASPP2 in lipid metabolism of alcoholic liver disease.

Construction of LILRB2 overexpression lentivirus vector and THP-1-LILRB2 stable transformation cell

Bai Ruojing, Lyu Shiyun, Hua Wei, Wu Hao, Dai Lili

2023, 44(1):  93-98.  doi:10.3969/j.issn.1006-7795.2023.01.014

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Objective To construct stable human myeloid leukemia mononuclear cells (THP-1) overexpressing leukocyte immunoglobulin-like receptor subfamily B member 2 (LILRB2) cDNA by viral packaging with a lentiviral vector overexpressing LILRB2 and infecting THP-1 cells using puromycin selection, and to successfully validate the overexpression effects at both mRNA and protein levels, we will provide prerequisites to study the role of LILRB2 in monocytes. Methods The LILRB2 overexpression lentiviral vector was constructed by inserting polymerase chain reaction (PCR) amplified LILRB2 gene fragments into Xba I and BamH I followed by the lentiviral backbone vector pLV-SFFV-MCS-EF1-ZsGreen1-T2A-Puro. After positive clones were screened and identified by sequencing, the multiplicity of infection (MOI) value was determined experimentally before virus infection. Virus was packaged in 293T cells, and the stock obtained after concentration was subjected to virus titer. To confirm the setting of the overexpression (LV-OE-LILRB2) group and control (LV-OE-NC) group, the green fluorescence of virus-infected THP-1 in each group was observed by fluorescence microscope. Puromycin selection of THP-1 cell lines stably expressing LILRB2. The mRNA and protein expression levels of LILRB2 in THP-1 cells were determined by quantitative real-time PCR (qPCR) and Western blotting (WB), respectively. Results The base sequences in the vector were confirmed to be correct by PCR and sequencing to confirm the completion of the LILRB2 overexpression lentiviral vector construction. Virus infection pre experiments were performed to determine the monocyte cell line THP-1 infected for 72 h at MOI=5. Viral titer measurements yielded LV-OE-LILRB2 group titers of 1 × 10⁸ TU / mL, while the titer in the LV-OE-NC group was 3.3 × 10⁸TU/mL. A concentration of 2 μ g / mL puromycin selected stable cell lines subjected to qPCR showed that the mRNA expression level of LILRB2 in the LV-OE-LILRB2 group was significantly upregulated compared with that in the LV-OE-NC group (P<0.001). Moreover, WB assay showed that the protein expression level of LILRB2 in LV-OE-LILRB2 group was significantly increased compared with that in LV-OE-NC group (P <0.05). Conclusion The successful establishment of THP-1 cell lines stably overexpressing LILRB2 was achieved, providing a cell model for studying the mechanism of LILRB2 in monocytes.

Establishment and characterization of immune cells in an orthotopic cell-derived xenograft mouse model of human lung cancer using multi-color flow cytometry

Yang Min, Yan Xiang, Liu Xijuan, An Guo, Ding Huirong, Cai Ying, Ge Huizheng

2023, 44(1):  99-106.  doi:10.3969/j.issn.1006-7795.2023.01.015

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Objective To establish a method to classify T cells, macrophages, and natural killer (NK) cells with detail in tumor microenvironment are needed to address the factors affecting tumor cell progression. Methods The combination of 11-color multiple fluorescence labeling markers for epithelial cells, T cells, macrophages, and NK cells was established to identify blood samples from immunized mice. Luciferase labeling PC-9 cells were further inoculated in the lung of nude mice. More real M1 and M2 macrophages and NK cells of different maturity levels were identified with penal analysis. Results This strategy can maximize the fluorescence effect of various markers and reduce the color cross-talking. Flow cytometry analysis of mouse blood samples allows accurate classification and typing of lymphocytes, macrophages, and NK cells. In orthotopic cell derived xenograft(CDX) samples, tumor cells, various immune cells, and cell subtypes can be distinguished. After the oncolytic virus treatment, the immune cell types were found significantly different. Conclusion In the orthotopic CDX model, the 11-color flow cytometry(FCM) scheme can accurately classify various immune cells in the tumor microenvironment, showing potential in the study of the interaction between different immune cells and tumor cells, and further apply to tumor microenvironment studies.

Clinical Research

Establishment and validation of 2-year predictive scoring model for patients with liver cirrhosis complicated with superior mesenteric venous thrombosis

Feng Ying, Shi Ke, Wang Xianbo

2023, 44(1):  107-114.  doi:10.3969/j.issn.1006-7795.2023.01.016

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Objective To investigate the influencing factors of long-term prognosis of liver cirrhosis complicated with superior mesenteric venous thrombosis (SMVT). Methods The clinical information of 254 patients with liver cirrhosis complicated with SMVT diagnosed from December 2016 to March 2020 was collected. Taking March 30, 2019 as the time point, the patients were divided into modeling group (170 cases) and validation group (84 cases). The modeling group was divided into survival group (148 cases) and death group (22 cases) according to the outcome of follow-up for 2 years. The influencing factors of prognosis were analyzed by Logistic regression and the model was established. The receiver operating characteristic (ROC)curve,calibration curves, and Hosmer-Lemeshow test were used to validate and evaluate the discrimination and calibration of the model, while the decision curve analysis was used to evaluate its clinical validity. Results Age(HR=4.625,95% CI:1.493－14.322,P=0.008), neutrophils/lymphocyte ratio (NLR) (HR=4.650,95% CI:1.343－16.099,P=0.015) were independent prognostic factors in patients with liver cirrhosis complicated with SMVT. Calculation formula of prediction model is PI=－4.753+1.531×age+1.537×NLR. The area under the curve(AUC) of the predictive scoring model was 0.838(95%CI:0.751－0.925), the sensitivity was 86.4%, the specificity was 62.8%; The AUC of internal validation was 0.806, the sensitivity was 81.8%, and the specificity was 79.4%, Kappa=0.408.The Hosmer-Lemeshow test showed perfect fitting degree (modeling:P=0.494;validation:P=0.128). Decision curve analysis showed a risk threshold of 10% and demonstrated a clinically effective predictive model. Conclusion Age and NLR are independent factors affecting the 2-year prognosis of patients with liver cirrhosis complicated with SMVT. The model established in this study has certain application value in predicting the 2-year prognosis of such patients.

Diagnostic value analysis of endoscopic ultrasound for early colorectal cancer

Li Rongxue, Zhang Qian, Xing Jie, Sun Xiujing, Li Peng, Jiao Yue, Zhang Shutian

2023, 44(1):  126-130.  doi:10.3969/j.issn.1006-7795.2023.01.018

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Objective To investigate the accuracy and influencing factors of endoscopic ultrasound for T-staging of early colorectal cancer. Methods A total of 186 patients (with 200 lesions) with early colorectal cancer who were hospitalized and underwent endoscopic resection at Beijing Friendship Hospital, Capital Medical University from September 2017 to June 2021 were included. The clinical information, pathological diagnosis, colonoscopy and endoscopic ultrasound manifestations were retrieved. The diagnostic efficacy of endoscopic ultrasound was analyzed with reference to pathological staging, and the factors affecting the accuracy of endoscopic ultrasound were analyzed by Logistic regression model. Results The overall accuracy of endoscopic ultrasound in diagnosing the depth of infiltration of early colorectal cancer was 75.0% (150/200), and the accuracy rates for intramucosal and submucosal infiltrating cancers were 85.0% and 35.0%, respectively. Univariate analysis showed that the diagnostic accuracy of endoscopic ultrasound was not related to lesion site, size, or morphology, but related to histologic type and lesion depth (P<0.001). Multivariate analysis showed that histologic type was a risk factor for misjudgment of depth, and the accuracy was significantly lower for moderately/poorly differentiated adenocarcinoma, mucinous adenocarcinoma or signet-ring cell carcinoma (P=0.019). Conclusion Endoscopic ultrasound is useful for determining the depth of infiltration in early colorectal cancer. However, the accuracy is reduced when the tumor has a moderately/poorly differentiated or undifferentiated component.

Clinical characteristics of rash and mucositis induced by Mycoplasma Pneumoniae in children

Jia Yanhong, Guo Fang, Wu Xiaoyuan, Li Wenhui

2023, 44(1):  131-136.  doi:10.3969/j.issn.1006-7795.2023.01.019

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Objective To compare the clinical characteristics, treatment management and prognosis of Mycoplasma pneumoniae (MP) and drug-induced Stevens-Johnson syndrome (SJS) in children. Methods The clinical data of 94 children with SJS and 206 cases with erythema multiforme admitted to our hospital from 2010 to 2021 were retrospectively analyzed, and the control group consisting of MP positive children(n=26) and MP negative children(control group,n=31)with definite drug factors was compared and analyzed. Results In this study, MP positive SJS was more common in older children, and its incidence in children over 72 months was significantly higher than control group. Mucosal involvement was found in all patients, especially periocular mucosa (n=25, 96.2%). The main treatments were macrolide antibiotics (100%), corticosteroid (Cs) (84.6%) and intravenous immunoglobulin (IVIG) (26.9%). All patients with a severity-of-illness score for toxic epidermal necrolysis(SCORTEN) of 2 or above were treated with Cs. The proportion of IVIG was increased with the increase of SCORTEN. Conclusion MP-induced SJS is common in school-age children, with lower hospital stay,lower mortality, and better prognosis. The mucous membranes of the eye and mouth are often involved.

Correlation of serum uric acid level and metabolic syndrom in elder patients with type 2 diabetes mellitus

Su Zhiyan, Liu Wei, Shi Tingting

2023, 44(1):  137-142.  doi:10.3969/j.issn.1006-7795.2023.01.020

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Objective To investigate the association of serum uric acid (UA) and metabolic syndrom(MS) in elder patients with type 2 diabetes mellitus(T2DM). Methods From January 2018 to December 2020, a total of 612 elder patients with T2DM were enrolled. Among them, there were 439 patients combined with MS group and 173 patients without MS (non-MS group). The general clinical characteristics and serum UA of the two groups were analyzed.Levels of serum UA in different MS group were compared with each other, while the relationship between serum UA and MS was analyzed with Pearson correlation analysis.Risk factors of MS were analyzed by Logistic regression analysis.A model for UA was established with the receiver operating characteristic (ROC) curve to predict MS incidence and to screen the cut-off value. Results The level of serum UA in MS group was significantly higher than that in Non-MS group (P＜0.05). The level of UA was increased with the MS component items increase; The Pearson correlation analysis indicated that serum UA was negatively correlated with high density lipoprotein-cholesterol (HDL-C) (r=－0.233, P=0.000). Logistic regression analysis showed that HDL-C was a protective factor for MS. The ROC curve analysis of serum UA for predicting MS in men yielded a cut-off value of 336.50, and in women yielded a cut-off value of 317.00. Conclusions In elder patients with T2DM, the levels of serum uric acid were associated with metabolic syndrome. The level of serum UA and the risk of developing MS was risen in elderly patients with T2DM.

Relationship between kinesin family proteins 2C and chemoresistance in ovarian cancer

Wang Wenwen, Cai Yu, Jia Shuangshuang, Zhai Jianjun

2023, 44(1):  143-147.  doi:10.3969/j.issn.1006-7795.2023.01.021

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Objective To investigate the relationship between kinesin family proteins 2C (KIF2C) and chemoresistance in ovarian cancer. Methods Totally 151 patients with epithelial ovarian cancer who underwent surgery in Beijing Tongren Hospital, Capital Medical University from January 2010 to December 2020 were selected. Among them, 98 patients were sensitive to platinum chemotherapy and 53 patients were resistant to platinum chemotherapy. The expression of KIF2C in chemosensitive and chemoresistant ovarian cancer was detected by immunohistochemistry. Results The expression of KIF2C was significantly lower in the chemoresistant tissues of ovarian cancer. KIF2C and pathological stage ⅢC are the risk factors of chemotherapy resistance in ovarian cancer. Conclusion KIF2C may become a marker for predicting the chemosensitivity of ovarian cancer patients and a new therapeutic target in resistant ovarian cancer.

Analysis of human papilloma virus genotypes distribution characteristics and risk factors of the recurrence in male patients with condyloma acuminatum

Wang Jianlei, Zhu Tian, Han Yu, Wang Yue, Wen Chunmiao, Wei Jia

2023, 44(1):  148-153.  doi:10.3969/j.issn.1006-7795.2023.01.022

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Objective To describe the genotype distribution characteristics of human papillomavirus (HPV) infection in male patients with condyloma acuminatum (CA). To explore the potential risk factors of the recurrence and provide scientific reference for the prevention and treatment of CA. Methods Total of 167 male CA patients who visited dermatology and venereology department of Civil Aviation General Hospital were selected as the research subjects. HPV genotypes were detected in skin tissue of the patients by DNA chip technology. A patient questionnaire was designed and compiled to collect the sociodemographic characteristics, sexual behavior characteristics, disease characteristics and lifestyle characteristics of the patients. The risk factors for male CA recurrence were analyzed using univariate and multivariate binary Logistic regression analysis in the study. Results Among the 167 male CA patients, the top 5 infection rates of HPV were HPV6 (62.28%), HPV11(39.52%), HPV16(17.37%), HPV42(14.37%) and HPV43(11.38%), respectively. Single infection accounted for 42.51%, mixed infection accounted for 57.49%; Low risk HPV infection accounted for 97.18% of single infection. In the mixed infection, the high - low - risk mixed type accounted for 93.75%. Long course of disease (OR=6.447), high-risk HPV infection (OR=4.868), number of 5 or more lesions (OR=5.780), staying up late (OR=4.149) and smoking (OR=3.671) were independent risk factors for male CA recurrence (P＜0.05). Conclusion HPV infection in male CA patients is mainly low risk HPV 6 and 11, mixed infection is higher than single infection, and the high-low-risk mixed infection is more common. HPV type, course of disease, number of lesions and bad living habits are closely related to the recurrence of male CA, and corresponding prevention and treatment measures should be taken accordingly in clinic.

Correlation between serum calcium and cardiovascular outcome in patients with acute coronary syndrome

Wang Rongrong, Tian Junping

2023, 44(1):  154-160.  doi:10.3969/j.issn.1006-7795.2023.01.023

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Objective To investigate the relationship between serum calcium and cardiovascular prognosis in patients with acute coronary syndrome (ACS). Method A total of 721 ACS patients hospitalized in the Department of Cardiovascular Medicine, Beijing Tiantan Hospital,Capital Medical University from June 2019 to December 2019 were selected, and all patients underwent coronary angiography. The clinical data of the patients were collected and blood samples were drawn to determine biochemical indexes such as serum calcium. All patients were followed up for 1 year. And the occurrence of endpoint events was recorded. The relationship between serum calcium and cardiovascular prognosis in ACS patients was analyzed. Results Among the 721 ACS patients, the mean age was (62.23±10.00) years, 527 (73.1%) were males, and the mean follow-up was (10.92±2.96) months. Among them, 110 patients (15.26%) had an end point event, including 1 case of cardiovascular death, 3 cases of recurrent myocardial infarction, 103 cases of unstable angina, and 3 cases of ischemic stroke. All patients were divided into group Q₁ (<2.20 mmol/L), group Q₂ (2.20－2.26 mmol/L), group Q₃ (2.27－2.31 mmol/L) and group Q₄ (≥2.32 mmol/L).The proportion of patients with acute myocardial infarction in Q1 group was higher than that in Q₃ and Q₄ groups (P <0.05), the GRACE score in Q₁ group was higher than that in Q₂, Q₃ and Q₄ groups (P<0.05), and the incidence of cardiovascular events in Q₁ group was higher than that in Q₄ group (P<0.05). Kaplan-meier analysis showed that patients with the lowest serum calcium level had a worse cardiovascular prognosis (log-rank χ²=9.787, P=0.020). In addition, after adjusting for potential confounders in the multivariate Cox proportional risk model, lower serum calcium level (HR=0.096, 95%CI:0.014－0.646, P=0.016) was independently associated with cardiovascular outcomes. Conclusion Low serum calcium level is an independent risk factor for adverse cardiovascular outcome in patients with ACS. And the decrease of serum calcium level has an important reference value for identifying high-risk ACS patients.

Clinical characteristics and prognostic analysis of multiple myeloma involving central nervous system

Jia Jing, Chen Wenming, Li Yanchen

2023, 44(1):  161-166.  doi:10.3969/j.issn.1006-7795.2023.01.024

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Objective To investigate the clinicopathological features and prognostic survival of multiple myeloma (MM) with central nervous system (CNS) involvement. Methods Among 1 529 MM patients reviewed, totally 18 MM patients with CNS involvement were included in this retrospective study. Both clinical and prognostic characteristics of MM and the involved intracranial site were analyzed. Results CNS involvement occurred in 1.2% of MM patients. The average age was (54.5±11.0) years. The fluorescence in situ hybridization (FISH)detection suggested that 43.8% of patients with CNS MM had high-risk cytogenetic abnormality with mean Ki-67 proliferation index of 50.9%±24.2%. Eight patients (44.4%) were diagnosed with CNS involvement at an initial MM diagnosis and 10 (55.6%) at relapse/progression. The median time from MM diagnosis to CNS MM diagnosis was 23.5(14.3,36.0)months. The median overall survival (OS) from the onset of CNS involvement for the entire group was 18.0(95%CI: 7.3－28.7)months. The univariate analysis indicated that the patients with high-risk cytogenetic abnormality by FISH (7.0 months vs 24.0 months, P=0.007) and those with a Ki-67 proliferation index of ＞50% (13.0 months vs 29.5 months, P=0.042) had shorter OS. Conclusion A CNS imaging screening should be considered at initial diagnosis and relapse/progression of MM. Patients with CNS MM had invasive biological characteristics and the prognosis was generally poor. High-risk cytogenetic abnormality by FISH and a Ki-67 proliferation index of ＞50% were associated with worse OS.

Enhanced recovery after surgery on postoperative function for total knee arthroplasty

Cao Fuyu, Ji Changgao

2023, 44(1):  167-171.  doi:10.3969/j.issn.1006-7795.2023.01.025

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Objective To investigate the effects of enhanced recovery after surgery(ERAS) on postoperative recovery following total knee arthroplasty(TKA) by comparing postoperative functional results. Methods Depending on whether the ERAS regimen was used, a total of 1 881 inpatients who were diagnosed with knee osteoarthritis at Beijing Chaoyang Hospital, Capital Medical University, from January 1, 2010 to December 31, 2021, were divided into an ERAS group and a control group. Basic information, knee range of motion, American Knee Society Score(KSS), the Western Ontario and McMaster Universities(WOMAC) osteoarthritis score were withdrawn before and one month after surgery. Additionally, the satisfaction was recorded one month after surgery. Results After the implementation of ERAS program, the hospitalization duration and hospitalization cost in ERAS group were significantly lower than those in the control group (P<0.01). At one month after surgery, patients in the ERAS group had significantly greater postoperative satisfaction than patients in the control group and significantly better KSS clinical and functional scores and knee range of motion than patients in the control group(P<0.05). At one month following surgery, there was no apparent change in the WOMAC scores between the two groups (P>0.05).Conclusion Better postoperative function and satisfaction can be attained with TKA using the ERAS protocol, while the hospital duration and cost are decreased.