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25 October 2022, Volume 38 Issue 20
Review
Research progresses of breast cancer vaccines for breast cancer
SHI Fujun
2022, 38(20):  2505-2509.  doi:10.3969/j.issn.1006⁃5725.2022.20.001
Abstract ( 251 )  
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At present,chemotherapy,targeted therapy and endocrine therapy have constituted the corner⁃stone of non⁃surgical treatment of breast cancer. From the clinical treatment status,the overall cure rate of breast cancer has been significantly improved. However,there is still a lack of adequate treatment for patients with advanced metastatic breast cancer. The advent of cancer vaccine therapy promises to solve this clinical dilemma. Breast cancer vaccine is a new treatment,which can be roughly divided into two categories:preventive vaccine and thera⁃peutic vaccine. Vaccine therapy introduces tumor⁃associated antigens,which can induce the activation of the body′s immune system to precisely kill cancer cells. It may also reduce the risk of cancer recurrence because of the body′s long immune memory. However,the clinical research results of universal breast cancer vaccine have not shown significant therapeutic effect. Therefore,in order to improve the therapeutic effect of patients with advanced meta⁃static breast cancer,it is necessary to consider trying to combine universal breast cancer vaccine with existing chemotherapy,radiotherapy,targeted therapy and other means,or try to develop individualized neoantigen vaccine to benefit patients.This article aims to review the development prospect of breast cancer vaccine and provide refer⁃ence for the development of breast cancer vaccine with better therapeutic or preventive effect.

Clinical Advances

Advances in clinical applications and research of bio⁃3D printing in volumetric muscle loss

PAN Xinyao, LI Ting, WU Yaobin, LI Yanbing, HUANG Wenhua.
2022, 38(20):  2510-2517.  doi:10.3969/j.issn.1006⁃5725.2022.20.002
Abstract ( 275 )  
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Skeletal muscle plays a critical role in human locomotor system. Volumetric muscle lossVMLoften exceeds the ability of skeletal muscle to recover from its own regenerationresulting in skeletal muscle dys⁃ function. Currentlythe clinical therapies are unable to fully restore damaged skeletal muscle tissue and functionthereforeskeleton muscle tissue engineeringSMTEoffers a viable treatment option for severe myopathic injuries such as VML. This paper outlines the current status of research on skeletal muscle tissue engineering applying 3D bioprinting technology to treat skeletal muscle injuriesreviews commonly used 3D bioprinting technologies and biomaterials/inks and summarizes recent advances in the application of 3D bioprinted scaffolds in SMTE. In additionvascularization and nerve regeneration are crucial for skeletal muscle repair. We further explore the strate⁃gies for vascularization and nerve connection and the research progress of skeletal muscle bioprintingand finally discuss the future development and challenges in this fieldin order to provide a reference for clinical treatments of skeletal muscle injury.

Basic Research

Specific myocardial IL ⁃ 8 knockout improves cardiac function and inflammatory response in mice with chronic heart failure via inhibiting STAT3 activation

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EN Ge, CHEN Shaojie, LIU Yang, LIN Xiangcan.
2022, 38(20):  2518-2523.  doi:10.3969/j.issn.1006⁃5725.2022.20.003
Abstract ( 216 )  
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Objective To study the effect of specific myocardial interleukin⁃8IL⁃8knockout on cardiac function and inflammatory response in mice with chronic heart failureCHFvia inhibiting signal transducer and activator of transcription 3STAT3. Methods Wild typeWTmale mice were divided into WT control group and WT model group. Myocardial specific IL⁃8 knockoutKOmale mice were divided into KO control group and KO model group. The CHF model was established by abdominal aortic coarctation. Four weeks after modelingechocardiography and the levels of N⁃terminal proBNP were used to evaluate heart functionthe levels of interleukin⁃ 1βIL⁃1 β),interferon⁃ γIFN⁃ γ),tumor necrosis factor⁃αTNF⁃αand the expression levels of IL⁃8 and p⁃STAT3 were detected. Results Pathological changes of CHF were found in the myocardium of WT model groupthe cardiac function was weaker than that of WT model groupthe levels of IL⁃1βIFN⁃γTNF⁃α and the protein expression levels of IL⁃8p⁃STAT3 in myocardium were higher than those in the control groupP < 0.05. After specific IL ⁃ 8 knockout and CHF modeledthe pathological changes of CHF in myocardium of KO model group were significantly reducedIL⁃8 was not expressed in myocardiumthe cardiac function was better than that of WT model groupthe levels IL⁃1βIFN⁃γTNF⁃α and the protein expression levels of p⁃STAT3 were lower than those in WT model groupP < 0.05. Conclusion Myocardial specific IL ⁃8 knockout significantly improved cardiac function and myocardial inflammatory response in CHF micethe inhibition of STAT3 phosphorylation activation was a possible molecular mechanism.

miR ⁃let ⁃7c improves sperm quality mediating differentiation of spermatogonial stem cell in mice

WANG Ming, SA Rula, WANG Chaoqi, YAN Zhen.
2022, 38(20):  2524-2530.  doi:10.3969/j.issn.1006⁃5725.2022.20.004
Abstract ( 231 )  
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Objective To observe the effect of miR⁃let⁃7c inhibitor on spermatogonial stem cellsSSCsby transfecting it on the differentiation of SSCs and sperm quality in mice. Methods SSCs were isolated from testes of neonate mice3~6 days old),and their purities were performed by flow cytometry with ID4 and Thy1 markers. Cultured cells were transfected with miR⁃let⁃7c inhibitor. Evaluation of the proliferationGFRa1PLZFand ID4and differentiationC⁃Kitmarkers of SSCs were accomplished by immunocytochemistry and western blot 48h after transfection. In vivo experiments60 mg/kg·dintraperitoneal injection of cyclophosphamide was used to prepare a mouse model of oligoasthenospermiaand SSCs transfected with miR⁃let⁃7c inhibitor were injected into the epidid⁃ ymis to observe the changes of spermatogenic cells and interstitial cells and analyze sperm concentrationvitality and morphology. Results The expression of differentiation markers of SSCs after transfection in the miR⁃let⁃7c inhibitor group was significantly increasedthe protein of GFRa1PLZFand ID4 was decreasedand the sperm concentrationsperm motility and regular morphological rate of oligoasthenospermia mice were significantly in⁃ creased. Conclusion miR⁃let⁃7c inhibitor promotes the differentiation of spermatogonial stem cells and improves sperm quality in mice.

Trimethylamine oxide promotes polarization of M1 macrophages and exacerbates ventricular remodeling after myocardial infarction

LI Zehua, ZENG Yuhong, FENG Liyun, QUE Dongdong, YAN Jing.
2022, 38(20):  2531-2544.  doi:10.3969/j.issn.1006⁃5725.2022.20.005
Abstract ( 234 )  
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Objective This study was to investigate the effects of trimethylamine N⁃oxide(TMAO)on cardiac function and macrophage polarization in mice with myocardial infarction(MI). Methods Male C57BL/6 mice were randomly divided into the Sham,MI,and MI+TMAO groups. For the MI model,mice were subjected to permanent left anterior descending ligation. After the surgery,mice in the MI+TMAO group were fed high choline diet,while those in the Sham and MI groups were fed chow diet. Twenty⁃one days later,serum TMAO levels and the levels of CK⁃MB and cTnT were detected. The infarct size of myocardial tissue was detected by Masson staining,and the expression of apoptotic cells was detected by TUNEL staining. Echocardiography,WGA staining and NT ⁃ proBNP were used to analyze the degree of cardiac function and hypertrophy. Immunofluorescence staining was used to detect the expression of Cx43. Furthermore,the expressions of serum inflammatory factors(IL⁃6,TNF⁃α)were detected by Elisa. RT⁃qPCR was used to detect M1 macrophage markers(IL⁃6,TNF⁃α and INOS)and M2 macrophage markers (CD206,IL⁃10 and TGF⁃ β)in myocardial tissues,respectively. Results (1)High choline diet significantly increased plasma TMAO levels in MI mice,and TMAO promoted infarction size and myocardial enzymes as well as apoptosis in MI mice.(2)TMAO limited cardiac function and promoted ventricular hypertrophy in MI mice.(3)The results of Cx43 immunofluorescence staining indicated that TMAO significantly reduced the connection integrity between cardiomyocytes.(4)The mRNA levels of M1 macrophage markers in MI + TMAO group were significantly higher than those in MI group. On the contrary,the mRNA levels of M2 macrophage markers CD206,IL⁃10 and TGF ⁃β were significantly reduced in MI + TMAO group compared with MI group. Conclusion TMAO aggravated myocardial tissue injury and ventricular remodeling in MI mice by promoting M1⁃type macrophage polarization.

HOPX suppress the proliferation of gastric cancer cells via regulating Wnt/β ⁃ catenin signal pathway 

LING Li, ZHANG Jing, ZHANG Zongmin, LINGHU Xitao, WANG Yuying.
2022, 38(20):  2538-2544.  doi:10.3969/j.issn.1006⁃5725.2022.20.006
Abstract ( 254 )  
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Objective To investigate the expression of HOPX in gastric cancer and the ability to regulate the proliferation of gastric cancer cells and its mechanism. Methods HOPX expression in gastric cancer cells and tissues were detected by Real⁃Time PCR and Western Blot. CCK⁃8colony formationEdU and flow cytometry assays were performed to investigate the tumor suppressor gene functions of HOPX in the growth and proliferation capability of gastric cancer cells. In additionTOP flash and FOP flash plasmids were transfected into gastric cancer cellsand the effect of HOPX on the transcriptional activity of β ⁃catenin/TCF/LEF was detected by luciferase reporter assay. Furthermorethe effect of HOPX on the expression of GSK⁃3βp⁃GSK⁃3β and β⁃catenin in gastric cancer cells was detected by Western blot. In order to explore the mechanism of gastric cancer cell proliferation mediated by HOPXwe further detected the expression level of β⁃catenin protein in gastric cancer nucleus and the expres⁃ sion of downstream target gene CyclinD1. Results Real time ⁃PCR and Western blot showed that the expression levels of mRNA and protein of HOPX in gastric cancer were significantly decreasedand the overexpression of HOPX significantly inhibited the proliferation and G1⁃S phase cell⁃cycle transition of gastric cancer cells. Western blot results show that overexpression of HOPX can promote the degradation of β⁃catenin by inhibiting the phosphor⁃ ylation level of GSK3βthus inhibit the entry of β⁃catenin into the nucleusand then down⁃regulate the expression of downstream target gene CyclinD1so as to inhibit the proliferation of gastric cancer cells. Conclusion This study found that overexpression of HOPX inhibits the proliferation of gastric cancer cells by inhibiting Wnt/β⁃catenin signaling pathway. 

Clinical Research

Association between microRNA⁃206 gene polymorphisms and Alzheimer′s disease

LI Junyan, YU Mengq⁃ ing, YANG Linlin, CAI Yuying, LI You, YANG Yu.
2022, 38(20):  2545-2548.  doi:10.3969/j.issn.1006⁃5725.2022.20.007
Abstract ( 233 )  
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Objective To analyze the relationship of microRNA⁃206 gene polymorphisms and Alzheimer′s diseaseAD. Methods The SNP rs16882131 in the microRNA⁃206 was genotyped in 100 AD patients and 100 healthy controls using the SNaPshot technique. Quantitative real⁃time PCR was employed to evaluate the levels of microRNA ⁃206 expression in the peripheral blood of the two groupsand the association of the SNP rs16882131 with microRNA ⁃206 expression was further analyzed. Results There were significant differences in the genotype and allele frequencies of the SNP rs16882131 between the AD patients and controlsgenotype CC vs. CT vs. TTP = 0.027TT + CT vs. CCP = 0.034OR = 1.831allele T vs. CP = 0.005OR = 1.860. The microRNA⁃ 206 expression in the peripheral blood of the AD patients was significantly higher than that in the healthy controls P < 0.05. Additionallythe microRNA ⁃206 expression in the healthy controls who were TT + CT genotypes of the SNP rs16882131 was significantly higher compared with the CC genotypesP < 0.05. Conclusion The SNP rs16882131 in the microRNA⁃206 is associated with the susceptibility to the ADand the T allele may contribute to risk roles in the AD.

Impact of intravenous anesthesia vs. inhalation anesthesia on perioperative T cells subsets in patients with colorectal cancer

LI Fuyu, FENG Jianguo, WANG Xiaobin, BAI Yiping.
2022, 38(20):  2549-2555.  doi:10.3969/j.issn.1006⁃5725.2022.20.008
Abstract ( 171 )  
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Objective To compare the impact of intravenous anesthesia versus inhalation anesthesia on T cell subsets and CD8+ T cell surface signaling molecules in patients with colorectal cancer. Methods Sixty⁃four patients with colorectal cancer undergoing elective radical resection were randomly divided into Sev groupn = 32and Pro groupn = 32. The Sev group was treated with inhalation of sevofluraneand the Pro group received intra⁃ venous infusion of propofol. Peripheral blood samples were collected before anesthesiaT1),2 hours after anesthesia T2),3 days after operationT3and 7 days after operationT4. CD4+ TCD8+ TCD28+ CD8+ TPD⁃1+ CD8+ TCD45RO+ CD62LCD8+ T and CD45RO+ CD62L+ CD8+ T were detected and analyzed. Results CD4+ T/CD8+ T at T2 was lower than that at T1 in both groups. CD4+ TCD4+ T/CD8+ T in the Sev group were lower than thatin the Pro Group at T2 and T3PD⁃1+ CD8+ T was higher than that in the Pro Group at T2and CD28+ CD8+ T was lower than that in the Pro Group at T2P < 0.05. CD45RO+ CD62LCD8+ T and CD45RO+ CD62L+ CD8+ T in the Sev group were lower than those in the Pro group at T3 and T4P < 0.05. Conclusion General anesthesia may cause immunosuppression in colorectal cancer patients and the intravenous anesthesia of propofol causes less immunosuppression. Moreover intravenous anesthesia of propofolhas less inhibitory effect on memory T cellsas compared to inhalation anesthesia of sevoflurane. 

Role of CDKN2A/B gene polymorphism in the formation of intracranial aneurysm

ZHANG Litong, LI Ran, XU Hongqi, LIANG Honglei.
2022, 38(20):  2556-2560.  doi:10.3969/j.issn.1006⁃5725.2022.20.009
Abstract ( 173 )  
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Objective Intracranial aneurysm is a complex disease induced by the interplay of genes and environmental factorscommonly leading to fatality and disability. The purpose of this study was to explore the corre⁃ lation between CDKN2A/B gene polymorphism and intracranial aneurysm formation. Methods Eighty⁃two patients with clipped aneurysm and one hundred and fourteen patients with non ⁃intracranial aneurysm were enrolled. SNP genotyping was used to analyze the single nucleotide polymorphismsSNPrelated to CDKN2A/B. RT ⁃ PCR and Western Blot were used to detect gene translation and expression in aneurysm walls and immunofluorescence was used to compare the volumes of protein expression of the genes. Results The p15INK4b/p16INK4a protein that CDKN2A/B gene expressed was detected in the aneurysm wallsand the frequency of allele T at rs10757272 was higher than that in the control groupP = 0.029OR1.65895%CI1.051 ~ 2.614. The p16INK4a and p15INK4b mRNAs at rs10757272 locus were transcribed at a low level in the T/T genotype aneurysmal wall tissuesP < 0.001 and 0.014respectively),and the p15INK4b was expressed in T/T genotype at a low levelP = 0.027. Howeverthere was no significant difference in the expression level of p16INK4aP = 0.089in spite of presenting a similar trend of low expression. The immunofluorescent staining of aneurysm wall tissues showed the identical results. Conclusion The mutation of SNP at rs10757272 participates in the formation of intracranial aneurysms by interven⁃ ing the expression of CDKN2A/B and thereby affecting the plasticity of the aneurysm wall tissue cells.

Efficacy of local oxygen therapy combined with rb ⁃ bFGF and negative pressure drainage technology in chronic refractory wounds

BAI Ziye, WANG Huaigu, ZHANG Li, ZHU Kun, CUI Lei, HAN Na, WANG Shuo.
2022, 38(20):  2561-2567.  doi:10.3969/j.issn.1006⁃5725.2022.20.010
Abstract ( 261 )  
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Objective To analyze the effect of local oxygen therapy combined with recombinant bovine basic fibroblast growth factor(rb ⁃ bFGF)and negative pressure drainage(VSD)on chronic refractory wounds. Methods From October 2020 to October 2021,40 patients with chronic refractory wounds who were admitted to the Department of Plastic and Burn Surgery,The First Affiliated Hospital of Bengbu Medical College,were selected and randomly divided into control group and experimental group. The control group was treated with debridement and then with closed negative pressure drainage(VSD)combined with normal saline,while the experimental group was treated with local oxygen therapy combined with rb⁃bFGF lavage on the basis of the control group. The hospital⁃ ization time and cost,clinical efficacy,and NRS pain score were compared between the two groups,and the wound tissues were collected before operation,7 days after the operation to observe the histopathological changes (the number of inflammatory cells in the wound),and immunohistochemical staining of VEGF and HIF⁃1α expres⁃ sion. Results Compared with the control group,the experimental group had significantly shorter hospitalization time,lower hospitalization expenses,and less pain,and the differences were statistically significant(P < 0.05). Compared with that in the control group,the number of inflammatory cells in the wound tissue of the experimental group was significantly reduced,showing statistical significance(P < 0.05). The immunohistochemical staining of VEGF and HIF⁃1α in the wound tissue in the experimental group showed that the expression of VEGF was signifi⁃ cantly increased,but that of HIF⁃1α was decreased,and the differences were statistically significant(P < 0.05). Conclusion The therapeutic effect of local oxygen therapy combined with rb⁃bFGF and VSD is significantly betterthan that of VSD combined with saline irrigation. Local oxygen therapy combined with rb⁃bFGF and VSD can signif⁃ icantly reduce HIF⁃1α,increase the expression of VEGF,and improve the microcirculation of the wound and the healing of the wound. It also helps to shorten hospital stay,and reduce the economic burden of the patients. 

Analysis of risk factors of concurrent ICU acquired weakness in elderly patients with sepsis undergoing me⁃ chanical ventilation and the early predictive value of mNUTRIC score 

LI Yunting, LI Fen, XING Bo.
2022, 38(20):  2568-2573.  doi:10.3969/j.issn.1006⁃5725.2022.20.011
Abstract ( 218 )  
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Objective To analyze the risk factors of concurrent intensive care unit acquired weakness ICUAWin elderly patients with sepsis undergoing mechanical ventilationMV),and to explore the early predic⁃ tive value of modified Nutrition Risk in the Critically illmNUTRICscore for ICUAW. Methods 320 elderly patients with sepsis undergoing MV admitted to the ICU of our Hospital were enrolled and assigned to the ICUAW groupn = 98and the non⁃ICUAW groupn = 222according to whether ICUAW occurred. The general datasmNUTRIC score and laboratory index at ICU admission were collected and compared.The incidence of ICUAW in different mNUTRIC score evaluation groups was compared. Multivariate logistic regression analysis and receiver operating characteristicROCcurve were used to explore the relationship between mNUTRIC score and concurrent ICUAW in elderly patients with sepsis undergoing MV. Results The agebody mass indexcharlson comorbidity Index scoresequential organ failure assessment scoreacute physiology and chronic health evaluation system Ⅱ scoremNUTRIC scorethe proportion of septic shockthe duration of MV and serum lactate level in ICUAW group were significantly higher or longer than those in the non ⁃ ICUAW groupwhile the serum albumin level in ICUAW group was significantly lower than that in the non⁃ICUAW groupP < 0.05. The percent of patients with ICUAW in different mNUTRIC scores with 0 ~ 4 points and 5 ~ 9 points were 6.28%66.67%respectivelyand the difference was statistically significantχ2 = 132.141P < 0.001. Multivariate logistic regression analysis showedthat concurrent septic shockOR = 2.23895%CI1.099 ~ 4.555P = 0.026),long duration of MVOR = 1.13195%CI1.019 ~ 1.254P = 0.020and elevated value of mNUTRIC scoreOR = 2.50895%CI1.968 ~ 3.196P < 0.001were independent risk factors for concurrent ICUAW in elderly patients with sepsis undergoing MV. The ROC curve analysis showed that the area under the ROC curvesensitivity and specificity of mNUTRIC score in predicting concurrent ICUAW in elderly patients with sepsis undergoing MV were 0.87095%CI0.828 ~ 0.905), 87.76% and 80.63%respectively. Conclusion mNUTRIC score at ICU admission has a high clinical value in predicting concurrent ICUAW in elderly patients with sepsis undergoing MV.

Clinical study of NOSES in elderly women with right hemicolectomy in the backgroud of enhanced recov⁃ ery after surgery

LIN Jiawei, XU Sheng, HUANG Shunrong, PANG Liming, QIN Huabo, DONG Chencheng, ZHOU Bingchuan, ZHANG Qiuhuan, YUAN Enquan.
2022, 38(20):  2574-2579.  doi:10.3969/j.issn.1006⁃5725.2022.20.012
Abstract ( 209 )  
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Objective To investigate the clinical value of total laparoscopic right hemicolectomy with natural orifice specimen extractionNOSEusing transvaginal specimen extraction in elderly female patients with right colon cancer in the mode of enhanced recovery after surgeryERAS. Methods A retrospective analysis was con⁃ ducted using the clinical data of 68 female patients aged more than 70 years with right colon cancer who were admit⁃ ted to our hospital from September 2017 to September 2020. There were 30 patients in the NOSES group who under⁃ went total laparoscopic right hemicolectomy with transvaginal specimen extraction and 38 patients in the TLC group who underwent traditional laparoscopic right hemicolectomy. The intraoperative conditionpostoperative recoverywhite blood cell count and serum albumin level were compared between the two groups. The enrolled patients were followed up till March 2022. Results The NOSES group had a longer operation timelower white blood cell count on the first day after surgerylower pain scores on the first and third days after surgeryhigher serum albumin lev⁃ els on the firstthird and fifth days after surgeryshorter first anal exhaust time after surgery and shorter average postoperative length of hospital stay than the TLC groupwith the differences being statistically significantall P < 0.05. Howeverintraoperative bleedingpostoperative complication ratepostoperative 3⁃year distant metastasis rate and overall survival rate showed no significant differences between the two groupsall P > 0.05. Conclusion Total laparoscopic right hemicolectomy with transvaginal specimen extraction is a safe therapeutic choice for elderly female patients and can reduce postoperative painpostoperative gastrointestinal function recovery time and length of hospital stay. It has immense significance in the clinical practice of enhanced recovery after surgery. 

Drugs and Clinic Practice

Effects of different doses of dexmedetomidine on inflammatory responseimmune function and brain func⁃ tion in patients with sepsis associated encephalopathy

XU Meng, WANG Ziwen, XIE Xu, ZHANG Linna.
2022, 38(20):  2580-2584.  doi:10.3969/j.issn.1006⁃5725.2022.20.013
Abstract ( 200 )  
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Objective The aim of this study was to investigate the effects of different doses of dexmedeto⁃ midine on inflammatory response,immune function and brain function in patients with sepsis⁃associated encepha⁃ lopathy(SAE). Methods A total of 60 patients with SAE were enrolled and randomly divided into L,M,and H groups according to the different dose of dexmedetomidine. The above three groups were given dexmedetomidine 0.2,0.4 and 0.6 μg/(kg·h)respectively. Inflammatory factors(TNF⁃α and IL⁃6),immune function(CD4+ ,CD8+ and CD4+ /CD8+ )and brain function(SjvO2,Da⁃jvO2,CERO2 and S100β)before administration(T0),and 12 h (T1 ),24 h(T2 ),72 h(T3 )after treatment were recorded and compared. Incidence of adverse reactions,length of stay in the ICU and mortality were also recorded. Results Inflammatory response and immune function:the inflamma⁃ tory response and immune function of group H were significantly improved when comparing with group L at T1; Group H were better than the other two groups at T2 and T3 in inflammatory response and immune function;Group H > group M > group L in reducing inflammation and improving immune suppression at T3(P < 0.05). Brain function:the cerebral oxygen index of group H was significantly better than that in group L and M at T2 and T3,and the S100β at T3 was significantly lower than the other two groups(P < 0.05). There was no significant difference in the incidence of bradycardia,hypotension,length of ICU stay and mortality among the three groups(P > 0.05). Conclusion Dexmedetomidine could reduce inflammation and immunosuppression ,improve cerebral oxygen metabolism and brain function with 0.6 μg/(kg·h)treatment. It did not increase the incidence of adverse reactions and its effects would be more and more significant with the increase of dexmedetomidine dose.

Correlation between HBV pgRNA expression level andresponsiveness to nucleoside analog therapy in pa⁃ tients with chronic hepatitis B

ZHU Xueli, LIN Zhaokun, WANG Liyun.
2022, 38(20):  2585-2596.  doi:10.3969/j.issn.1006⁃5725.2022.20.014
Abstract ( 218 )  
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Objective To investigate the correlation between the expression level of HBV pgRNA and the responsiveness to nucleoside analogsNAsin patients with chronic hepatitis BCHB. Methods A total of 237 CHB patients diagnosed in the outpatient department of our hospital from January 2020 to June 2021 were selected as the research subjects. All patients met the NAs treatment standard. Before treatmentall patients were tested for HBV pgRNAand the general datalaboratory data and imaging data were collected. NAs ⁃ related drugs were administered for a 24⁃week treatment plan. The treatment response of the patients during the treatment was counted and grouped at the end of the treatment. logistic regression was used to analyze the correlation between treatment response and HBV pgRNAand ROC curve was drawn to analyze the predictive value of HBV pgRNA for treat⁃ ment response. Results As of December 2021the treatment period of all patients had expiredand a total of 207 patients had completed the treatment and follow⁃up plan prescribed in this studywith a completion rate of 87.34%. Patients were divided into complete response groupn = 87),partial response groupn = 79),and poor response groupn = 41. There was no statistically significant difference in general data among the three groupsP > 0.05. There were significant differences in HBV ⁃ DNAHBV pgRNAHBsAgHBeAg and HBeAb among the three groupsP < 0.05. The HBV⁃DNAHBV pgRNAHBsAgand HBeAg in the poor response group were higher than those in the other two groupsbut HBeAb was lowerand the difference was statistically significantP < 0.05. The HBV pgRNA in the partial response group was higher than that in the complete response groupand the differ⁃ ence was statistically significantP < 0.05. There was no significant difference in HBV ⁃DNAHBsAgHBeAg and HBeAb between the partial response group and the complete response groupP > 0.05. HBV ⁃DNAHBVpgRNAHBsAg and HBeAg were independent risk factors for treatment responsewhile HBeAb was an indepen⁃ dent protective factor for treatment responseP < 0.05. The AUC of HBV pgRNA in response to NAs treatment was significantly bigger than that of HBV ⁃DNAHBsAgHBeAgand HBeAbP < 0.05. Conclusion HBV pgRNA is significantly correlated with the response to NAs treatment in CHB patients. 

Efficacy and safety of intravenous hormone in patients with severe AECOPD complicated with type 2 dia⁃ betes mellitus 

PENG Miaoguan, DENG Xuefeng.
2022, 38(20):  2590-2596.  doi:10.3969/j.issn.1006⁃5725.2022.20.015
Abstract ( 207 )  
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Objective To explore the efficacy and safety of intravenous hormone combined with compre⁃ hensive treatment in patients with severe acute exacerbation of chronic obstructive pulmonary disease(AECOPD) complicated with type 2 diabetes mellitus(T2DM). Methods Out of 131 screened patients,a total of 122 patients were included in the study,and 9 patients dropped out due to compliance issues. Patients were randomly divided into two groups,and receiving intravenous glucocorticoid(observation group,n = 67)or oral hormone(control group,n = 55). Outcome measures including therapeutic efficacy,inflammatory factor levels,pulmonary function and glucose levels and adverse events were evaluated. Results The effective rate between two groups was differ⁃ ent,and the observation group(97.0%)was higher than that of the control group(87.3%),the difference was sta⁃ tistically significant(P < 0.05). The length of hospital stay in the observation group was shorter[(11.2 ± 2.0)vs. (14.1 ± 2.2)days],with statistically significant differences(P < 0.001). At discharge,compared with the control group,the levels of inflammatory cytokines in the observation group were significantly decreased[IL⁃1β:(58.32 ± 6.53)vs.(41.34 ± 4.97)pg/mL;IL⁃18:(412.47 ± 44.48)vs.(321.43 ± 34.69)pg/mL;PCT:(0.067 ± 0.006) vs.(0.042 ± 0.012)ng/mL;hs⁃CRP:(10.86 ± 0.77)vs.(7.32 ± 0.89)mg/L],the differences were statisticallysignificant(p values were < 0.001,< 0.001,0.019 and < 0.001,respectively=. The indexes of pulmonary ventila⁃ tion function were improved[FEV1:(1.88 ± 0.67)vs.(2.74 ± 0.51)L;FEV1/FVC(%):PEF(L/S)(2.08 ± 0.37)vs.(2.67 ± 0.47)],the differences were statistically significant(ALL P < 0.001). At 3⁃month follow⁃up, there were no significant differences in glucose metabolism indexes between the two groups,observation group vs. control group:[Fasting blood glucose:(7.89 ± 1.19)vs.(7.97 ± 0.95)mmol/L,P = 0.249;HbA1c(%):(7.13 ± 0.88) vs.(7.02 ± 0.82),P = 0.076]. However,insulin dosage in the observation group(84.42 ± 3.22)U was higher than that in the control group(50.61 ± 2.84)U,and the difference was statistically significant(P < 0.001. No significant difference in the incidence rate of adverse reactions was noted during treatment(P > 0.05). Conclusions Compared with oral hormone,intravenous hormone was more effective in patients with severe AECOPD complicated with T2DM,which improved pulmonary ventilation function,increased blood oxygen level,shortened hospital stay,and avoided worsening blood glucose with the simultaneous use of insulin. 
New technology and new method

Short ⁃ term efficacy of right mini ⁃ thoracotomy vs. partial upper sternotomy in aortic valve replacement

LIU Junxiang, WANG Yixuan, GUO Chao.
2022, 38(20):  2597-2601.  doi:10.3969/j.issn.1006⁃5725.2022.20.016
Abstract ( 234 )  
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Objective To explore the short⁃term clinical effect of the two approachesright mini⁃thoracot⁃ omyRMTand partial upper sternotomyPUSin aortic valve replacementAVRcomparatively. Methods A total of 240 patients who underwent aortic valve replacement with RMTn = 120and PUSn = 120from August 2017 to June 2021 in Union Hospital were enrolled in the retrospective analysis. The preoperative historygeneral situation of operationpostoperative complications and follow ⁃ up results were compared between the two groups. Results The preoperative baseline characteristics of the two groups were comparableand all valvular surgeries were completed successfully and effectively. The cardiopulmonary bypass timeP = 0.02and aortic cross⁃clamping timeP = 0.03in the RMT group were longer than those in the PUS groupbut the total value of blood transfusion was significantly smallerP = 0.02),the ICU stay and postoperative hospitalization were both significantly shorter P = 0.02P = 0.04),and the rate of postoperative complications was significantly smaller than those in PUS group. The short⁃term follow⁃up showed no significant difference in the survival rate and the rate of major complications between the two groupsP > 0.05. Conclusion Aortic valve replacement through RMT is safe and feasiblewhich can be combined with video⁃assisted thoracoscopy. Compared with PUSRMT has the advantages of less traumarapider recoveryshorter postoperative hospital stay and better cosmetic results. The short⁃term effect of RMT is exactly the same as that of PUSthus it is expected to become a routine choice for some patients undergoing aortic valve replacement in case of no contraindications.

Clinical efficacy of total hip arthroplasty vs hemiarthroplasty through the direct anterior approach for elderly patients with femoral neck fractures

LI Junran, ZHAI Jingxiu, LUO Cheng, WANG Lei, XU Ying, HAN Shuo, LIANG Junsheng, LI Ligeng.
2022, 38(20):  2602-2607.  doi:10.3969/j.issn.1006⁃5725.2022.20.017
Abstract ( 237 )  
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Objective To investigate the clinical effect of total hip arthroplasty(THA)versus hemiarthro⁃ plasty(HA)through the direct anterior approach(DAA)for femoral neck fractures in elderly patients. Methods A total of 86 elderly patients with femoral neck fractures in our hospital from June 2019 to October 2020 were enrolled and assigned to total hip arthroplasty group(n = 41,THA group)and hemiarthroplasty group(n = 45, HA group). The operation duration,intraoperative blood loss,time of first postoperative walking,duration of post⁃ operative hospitalization,central fixation of femoral prosthesis,limb length discrepancy,Harris hip score in 3 months,6 months and 12 months after the operation,and complications were compared between the two groups. Results Compared with the THA group,HA group had shorter operation duration,less intraoperative blood loss and higher ratio of limb length discrepancy shortened than 5mm,and the differences were statistically significant between the two groups(P < 0.05). The Harris score in 12 months after the operation in the THA group were signif⁃ icantly higher than that of the HA group,and the difference was statistically significant(P < 0.05). No significant difference was noted in time of first postoperative walking,duration of postoperative hospitalization,central fixation of femoral prosthesis,the ratio of limb length discrepancy shortened than 10mm,the Harris score in 3 months and 6 months after the operation,and the incidence of complications between the two groups(P > 0.05). Conclusion Both THA and HA via DAA could achieve excellent short⁃term efficacy in the treatment of femoral neck fractures in elderly patients. But the long⁃term outcomes of THA were better than HA,the latter was featured by shorter opera⁃ tion time,less intraoperative blood loss and accurate limb length reconstruction.

Clinical effect of minimally invasive transforaminal lumbar interbody fusion via multifidus ⁃ splitting ap⁃ proach for lumbosacral degenerative diseases

LI Jia, ZHANG Xin, WANG Lei, SHAN Zhongshu, LIU Wei, LI Tao.
2022, 38(20):  2608-2613.  doi:10.3969/j.issn.1006⁃5725.2022.20.018
Abstract ( 185 )  
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Objective To investigate the clinical effect of minimally invasive transforaminal lumbar inter⁃ body fusionTLIFby multifidus ⁃splitting approach in the treatment of lumbosacral degenerative diseases. Methods A total of 127 patients with lumbosacral single ⁃ level degeneration who met the inclusion criteria from February 2017 to February 2021 were selected as the study subjects. According to different surgical approachesthe patients were divided into treatment groupn = 62and control groupn = 65. Patients in the treatment group received TLIF surgery after median incision and splitting of multifidus musclewhile patients in the control group received TLIF surgery after traditional paravertebral muscle dissection. Lumbar Oswestry Disability IndexODIand JOA scoresvisual analogue scaleVASscoresintraoperative blood lossoperation timepostoperative drainagelength of hospital stayand multifidus fat infiltration grade were compared between the two groups before and after treatment and at 1⁃year follow⁃up. Results The amount of intraoperative blood lossoperation timepostoperative drainage volume and length of hospital stay in the treatment group were lower than those in the control groupwith statistical significanceP < 0.05. There were no statistically significant differences in preoperative ODI and JOA scores between 2 groupsP > 0.05),but ODI score in treatment group was lower than control group and JOA score was higher than control group at 3 days and 1 year follow⁃up after surgerywith statistically significant differences P < 0.05. There was no statistically significant difference in preoperative VAS scores between 2 groupsP > 0.05), and VAS scores of 3 days and 1 year after surgery in the treatment group were lower than those in the control group. The difference was statistically significantP < 0.05. One year after surgerythe proportion of higher fat infiltra⁃tion grade of multifidus muscle in the treatment group was significantly lower than that in the control groupand the difference was statistically significantP < 0.05. Conclusion Compared with traditional approachTLIF by splitting the multifidus approach for the treatment of lumbosacral single ⁃segment degenerative disease can signifi⁃ cantly improve the lumbar function of patientsand has the advantages of less bleedingless postoperative painshort operation timeand short hospital stay. It can reduce the adipose formation of multifidus muscle retain its functionand has the advantages of minimally invasive surgeryand promote the rapid perioperative recovery of patients. 

Clinical Nursing

Effect of home visit nursing based on interaction model of client health behavior on rehabilitation of com⁃ munity stroke patients

XU Zhirong, MAI Juanjuan, WANG Li, LIU Guolian, BAI Yaru, MA Jiahui, YAO Wenlian.
2022, 38(20):  2614-2619.  doi:10.3969/j.issn.1006⁃5725.2022.20.019
Abstract ( 260 )  
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Objective To explore the effects of home visit nursing based on interaction model of client health behavior on limb balance function,post ⁃ stroke depression and patient satisfaction in community stroke patients. Methods Respectively,thirty⁃one patients from two community health service centers in Yinchuan City were selected by convenient sampling and assigned into control group and intervention group by lottery. The 31 patients in the control group received routine home visit nursing,and those in the intervention group received home visit nursing based on the interaction model of client health behavior.The simplified Fugl ⁃Meyer scale,Hamilton Depression Scale and Customer Satisfaction Scale were used to evaluate the effect of the intervention at three time points of before the intervention,3 and 6 months after the intervention. Results The simplified Fugl⁃Meyer score of the intervention group was significantly higher than that of the control group at each time point after the interven⁃ tion(P < 0.05). The ANOVA of repeated measuring showed that the simplified Fugl⁃Meyer score of the two groups was statistically significant across the different time points,between the different groups and on time⁃group interac⁃ tion effects(P < 0.05). After 6⁃month intervention,the HAMD score of the intervention group was significantly lower than that of the control group,and the patient satisfaction score was significantly higher than that of the con⁃ trol group(P < 0.05). Conclusion Home visit nursing based on the interaction model of client health behavior can effectively reduce the degree of post ⁃stroke depression in community stroke patients,improve their limb bal⁃ ance function,and enhance patient satisfaction.

Reviews

Role of secretory immunoglobulin A in chronic airway diseasesA review of recent studies

HE Guiqiang, ZHAO Shunshun, LANG Yanzhu, WANG Xiaojing, OUYANG Yao.
2022, 38(20):  2620-2623.  doi:10.3969/j.issn.1006⁃5725.2022.20.020
Abstract ( 239 )  
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Chronic obstructive pulmonary diseaseasthma and cystic fibrosis are distinct respiratory diseases that share features such as the obstruction of small airways and acute exacerbations.Secretory immunoglobulin A sIgAacts as a first⁃line mucosal protective barrier against inhaled particles and pathogens. sIgA mediates immune rejection and promotes clearance of pathogens from the airway surface by inhibiting adhesion of pathogens to the epithelium. sIgA is the main component of local mucosal immunity. The specific immune mechanism of sIgA in chronic airway diseases is still unclear. This article reviews the role of sIgA in chronic airway diseases.

The role and mechanism of microglia⁃mediated synaptic pruning in chronic cerebral ischemia

TANG Shiyi, LAI Meijing, QIU Meiqian, ZHAN Lixuan.
2022, 38(20):  2624-2629.  doi:10.3969/j.issn.1006⁃5725.2022.20.021
Abstract ( 280 )  
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Chronic cerebral ischemiaalso known as chronic cerebral hypoperfusionis a major cause of various central nervous system diseases with main manifestations of white matter injury and cognitive decline. Per⁃ sistent cerebral hypoperfusion has been shown to induce abnormal activation of microgliaresulting in impairment of myelin regeneration and excessive loss of synapses. During brain developmentmicroglia can associate with multiple molecular mechanismssuch ascomplement 3/complement 1q/complement receptor 3C3/C1q/CR3or the C⁃X3⁃C motif chemokine ligand 1/C⁃X3⁃C motif chemokine receptor 1CX3CL1/ CX3CR1signaling pathway to engulf the redundantsynapses and mediate synaptic elimination. Howeveramong a variety of central nervous system diseases including chronic cerebral ischemiathe abnormalities of the above molecular mechanisms often lead to the altered microglial phagocytosiswhich ultimately results inaccumulation or loss of synapses and cogni⁃ tive dysfunction. This paper reviews the researches intothe roles and mechanisms of microglia ⁃ mediated synaptic elimination after chronic cerebral ischemia so as to look for a potential target for treating cognitive declines induced by chronic cerebral ischemia. 

Research Progress of Mesenchymal Stem cells in the treatment of severe burn ⁃ induced Hepatic injury

LIN Hui, PANG Rongqing.
2022, 38(20):  2630-2634.  doi:10.3969/j.issn.1006⁃5725.2022.20.022
Abstract ( 232 )  
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Burn is a post⁃traumatic inflammatory disease. Multiple organ failure is the main cause of death after burn. Excessive systemic and local inflammation directly leads to terminal organ injury. Liver is the largest metabolic and detoxification organ of the human bodyand it is easy to be attacked by endotoxin. The deterioration of liver function will lead to increased morbidity and mortality of burn patients. Thereforethe repair of hepatic injury after severe burn is of great significance. Although progress has been made in the clinical management of burnsthere are still limitations in the treatment of severe burns. In recent yearsMesenchymal stem cellsMSCshave shown great promise in tissue repair. In this reviewwe will focus on the role of MSCs in severe burn⁃induced hepatic injury.