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10 May 2023, Volume 39 Issue 9
Clinical Advances

Advances in the diagnosis and treatment of secondary cardiac lymphoma

YANG Yuanyuan, SHI Mingxia.
2023, 39(9):  1067-1071.  doi:10.3969/j.issn.1006⁃5725.2023.09.001
Abstract ( 184 )  
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Cardiac lymphoma is a rare form of extranodal lymphoma with an extremely poor prognosis. Sec⁃ ondary cardiac lymphoma(SCL)is more common than primary cardiac lymphoma and is usually found in patients with disseminated lymphoma or advanced lymphoma. Patients with SCL often experience non ⁃ specific symptoms, which lead to a delay in diagnosis and treatment,and in some cases,SCL cannot be detected until a postmortem. There are no systematic guidelines for the diagnosis and treatment of SCL. The value of early diagnosis and therapy in enhancing survival rates cannot be underestimated. This article outlines the most recent developments in the diag⁃ nosis and treatment of SCL.

Basic Research

Tspan1 antagonizes oxaliplatin⁃induced apoptosis in colorectal cancer cells by inducing cellular autophagy

LI Xiaoping, ZHOU Hongjian, GAO Fangfang, LI Wei.
2023, 39(9):  1072-1078.  doi:10.3969/j.issn.1006⁃5725.2023.09.002
Abstract ( 206 )  
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Objective To investigate the effect of tetraspanin 1(Tspan1)overexpression on oxaliplatin (OXA)⁃induced apoptosis in human colorectal cancer cell line HCT116 and to analyze its possible mechanism of action. Methods HCT116 cells were transfected with Tspan1 overexpression plasmid and its negative control vec⁃ tor plasmid. The expression levels of Tspan1 mRNA and protein were detected by qRT⁃PCR and Western blot. The transfected HCT116 cells were treated with 14.15 μg/mL OXA or combined with 5 mmol/L autophagy inhibitor 3⁃ MA. MTT assay was used to detect cell proliferation. Flow cytometry was used to detect cell apoptosis. The expres⁃ sion of LC⁃3B protein was detected by immunofluorescence. The expression levels of autophagy⁃related proteins LC⁃ 3,Beclin1 and P62 were detected by Western blot. Results Overexpression of Tspan1 significantly up⁃regulated Tspan1 mRNA and protein expression levels in HCT116 cells,reduced the sensitivity of HCT116 cells to OXA,in⁃ hibited OXA⁃induced apoptosis of HCT116 cells,and enhanced the fluorescence intensity of LC3B protein,up⁃reg⁃ ulated the protein expression level of Beclin1 and the ratio of LC⁃3II/LC⁃3I,down⁃regulated the protein expression level of p62,and antagonized the induction of apoptosis by OXA. However,combined treatment with 3⁃MA re⁃ versed the inhibitory effect of Tspan1 overexpression on OXA ⁃induced apoptosis of HCT116 cells,and increased the sensitivity of cells to OXA. Conclusion Overexpression of Tspan1 antagonizes OXA ⁃ induced apoptosis in HCT116 cells by a mechanism that may be mediated through the induction of cellular autophagy.

Screening of gene differential expression of NSUN2 in ovarian cancer cells based on transcriptome sequenc⁃ ing technology

HE Wanshan , HONG Xiaoshan, CHEN Guanqiao, CHEN Bin, WEN Bin, LIN Yu, WEI Zhifu, LUO Xiping
2023, 39(9):  1079-1085.  doi:10.3969/j.issn.1006⁃5725.2023.09.003
Abstract ( 197 )  
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Objective To investigate the effect of gene expression by NSUN2 in ovarian cancer cell line A2780 by RNA ⁃seq technology,and to provide a theoretical basis for clarifying the role of NSUN2 in the occur⁃ rence and progression of ovarian cancer. Methods Expression of NSUN2 in A2780 cells was knocked down by lentivirus⁃mediated RNA interference technique. The cells transfected with empty vector were used as control,and the interfering cell lines were screened for differentially expressed genes by high⁃throughput sequencing using RNA⁃ seq technology. KEGG Pathway,GO analysis and GSEA enrichment analysis were used to explore the related sig⁃ naling pathways and biological processes of NSUN2⁃regulated differential genes. Results Compared with the con⁃ trol cells,there were 1 642 differentially expressed genes in the A2780 cell line with NSUN2 knockdown,includ⁃ ing 1 020 up⁃regulated genes and 622 down⁃regulated genes. Through GO analysis,KEGG Pathway and GSEA en⁃ richment analysis,it was found that differentially expressed genes were mainly enriched in hedgehog signaling path⁃ way and P53 signaling pathway,and were involved in viral transcription,translation initiation and regulation. Three key genes related to the P53 signaling pathway(ZMAT3,EI24 and CCND2)were screened out through fur⁃ ther analysis of the genes related to the p53 signaling pathway. The expression results were verified by RT ⁃qPCR and the sequencing results were consistent. Conclusion There are significant differences in gene expression pro⁃ files between A2780 sh⁃NSUN2 group and A2780 sh⁃NC group,and the differential genes are mainly concentrated in P53 signaling pathway. In ovarian cancer,NSUN2 may regulate the occurrence and development of ovarian can⁃ cer by regulating the expression of P53 signaling pathway related factors.

Effect of rat cardiac fibroblasts on H9c2 cardiomyocytes intercellular communication after hypothermia hypoxia/reoxygenation

TONG Rui , GAO Hong, AN Li, YI Jing, CAO Ying, MENG Fuxue, WU Xueyan, MA Yanyan.
2023, 39(9):  1086-1091.  doi:10.3969/j.issn.1006⁃5725.2023.09.004
Abstract ( 158 )  
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Objective To observe the effect on myocardial H9c2 cells gap junction intercellular communi⁃ cation(GJIC)by rat cardiac fibroblasts(RCFs)after hypothermia hypoxia/reoxygen(H/R)and to explore the pos⁃ sible mechanisms. Methods After co⁃cultured of RCFs cells with H9c2 cells in a 2:1 number ratio by Transwell, cells was randomly divided into 6 groups. The T+AngⅡ group and H/R⁃T+AngⅡ group were added 1.5nM AngⅡ, and the T+ARB group and H/R⁃T+ARB group were added 1nM valsartan. The T group,T+AngⅡ group and T+ ARB group were cultured normally,and the H/R⁃T group,H/R⁃T+AngⅡ and H/R⁃T+ARB group were treated with H/R. The AngⅡ concentration in the culture medium;the expression and phosphorylation of Cx43 and ERK1/2; and GJIC of H9c2 cells were detected. Results Compared with the T group,the expression and phosphorylation of ERK1/2 and Cx43 were decreased(P < 0.05)and GJIC was diminished(P < 0.05)in H9c2 cells in the H/R⁃T and T+Ang II group; he expression and phosphorylation of ERK1/2 and Cx43 were increased(P < 0.05)and GJIC was enhanced(P < 0.05)in H9c2 cells in the T+ARB group. Compared with H/R ⁃T group,he expression and phosphorylation of ERK1/2 and Cx43 were decreased(P < 0.05)and GJIC was diminished(P < 0.05)in H9c2 cells in H/R ⁃T+Ang II group; and the expression and phosphorylation of ERK1/2 and Cx43 were increased(P < 0.05)and GJIC was diminished(P < 0.05)in H9c2 cells in H/R ⁃T+ARB group. Conclusion After H/R,in⁃ creased AngⅡ secretion by RCFs may downregulate Cx43 expression by inhibiting the MAPK/ERK pathway in H9c2 cells,resulting in diminished GJIC between H9c2 cells.

Remimazolam alleviates LPS ⁃ induced acute lung injury by regulating macrophage polarization 

WANG Jing , GAO Yuru, CAI Qianwei, ZHUA Weiwei, HUANG Xiao, SUN Dakang, WANG Xiaozhi, WANG Tao.
2023, 39(9):  1092-1097.  doi:10.3969/j.issn.1006⁃5725.2023.09.005
Abstract ( 260 )  
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Objective To investigate the effect and molecular mechanism of remimazolam on LPS⁃induced acute lung injury. Methods C57BL/6 mice were divided into normal control group,acute lung injury group,remimazolam pretreatment group and remimazolam control group,After 12 hours,the mice were sacrificed for BALF,serum and lung tissue collection. Lung injury was evaluated by HE,W/D ratio and total protein concentra⁃ tion in BALF. ELISA was used to detected the contents of TNF⁃α,IL⁃6,IL⁃1β,IL⁃10. The M1 macrophage marker iNOS + and the M2 macrophage marker CD206 + in F4/80 + macrophages were detected by flow cytometry and the mRNA and protein expressions of TNF ⁃ α,iNOS,CD206 and Arg1 were detected by real ⁃time quantitative PCR and Western blotting. Results Twelve hours after intratracheal injection of LPSA,the lung injury score,W/D ra⁃ tio and total protein concentration in BALF were significantly higher,the TNF⁃α,IL⁃6,IL⁃1β in BALF and serum was significantly increased,iNOS + macrophage was significantly increased,the mRNA and protein expressions of TNF⁃α and iNOS were significantly increased,as compared with the control group. After activated by remimazol⁃ am,the lung injury score,W/D ratio and total protein concentration in BALF were significantly decreased,the TNF⁃α,IL⁃6,IL⁃1β in BALF and serum was significantly decreased,IL⁃10 was significantly increased,iNOS + macrophage was significantly decreased,CD206 + macrophage was significantly increased,the mRNA and protein expressions of TNF⁃α and iNOS were significantly decreased,the mRNA and protein expressions of CD206 and Arg⁃ 1 were significantly increased,as compared with the LPS group. Conclusion Remimazolam alleviates LPS ⁃in⁃ duced acute lung injury by inhibiting macrophage polarization to M1 phenotype and promoting the macrophage po-larization to M2 phenotype.

Molecular mechanism of CARM1 regulating ferroptosis in malignant biology of lung cancer cells

LU Tian⁃ long, YANG Qiying, YANG Shiwen, SONG Xiaolong.
2023, 39(9):  1098-1104.  doi:10.3969/j.issn.1006⁃5725.2023.09.006
Abstract ( 170 )  
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Objective To explore the molecular mechanism of arginine methyltransferase 1(CARM1)reg⁃ ulating ferroptosis in malignant biology of lung cancer cells. Methods The expression of CARM1 in normal human bronchial epithelial cells(HBE4)and lung cancer lines(A549,H1299,H1640,HCC827)was detected by west⁃ ern blot. CARM1 sequence or Vector and shRNA sequence against CARM1(shCARM1)and Notch homologue 2 (shNotch2)or negative control shRNA(shNC)were transfected into lung cancer cells. Cell proliferation,migration and invasion were measured by CCK ⁃8 test and Transwell test respectively. RIP ⁃PCR and MeRIP ⁃qPCR analysis were used to explore the mechanism of CARM1. Erastin,a classical ferroptosis inducer,was used to treat lung can⁃ cer cells to determine whether CARM1 could affect the sensitivity of cells to ferroptosis. Results Compared with human normal airway epithelial cell HBE4,CARM1 was significantly over⁃expressed in lung cancer lines(A549, H1299,H1640,HCC827)(P < 0.05). Compared with Vector group,the proliferation,migration and invasion ability of A549 cells in CARM1 group was significantly increased(P < 0.001),while that of HCC827 cells in shCARM1 group was significantly lower than that in shNC group(P < 0.001). MeRIP⁃qPCR analysis showed that m6A abundance of Notch2 mRNA increased significantly when CARM1 was overexpressed(P < 0.05). RIP analy⁃ sis showed that CARM1 overexpression significantly promoted the binding between CARM1 and Notch2 mRNA (P < 0.05). Notch2 knockdown weakened the proliferation,invasion and migration of A549 cells up⁃regulated by CARM1(P < 0.001). Conclusion CARM1 is significantly elevated in lung cancer,and plays its carcinogenic role by activating Notch2. In addition,CARM1 can make lung cancer cells insensitive to ferroptosis by stabilizing Notch2.

Clinical Research

Microecological study of airway bacterial community in patients with silicosis in different disease stages

JING Ru , MENG Fanli, LI Xudong.
2023, 39(9):  1105-1110.  doi:10.3969/j.issn.1006⁃5725.2023.09.007
Abstract ( 191 )  
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Objective To investigate the composition in bacterial microbial composition in silicosis pa⁃ tients with different stages. Methods 13 healthy subjects,29 patients with occupational silicosis,including 6 pa⁃ tients with silicosis I,15 patients with silicosis Ⅱ and 8 patients with silicosis Ⅲ. The sputum of four groups of subjects was collected,16S rDNA sequencing technology was used to detect bacterial microorganisms in the spu⁃ tum samples,and the relative abundance of bacterial microorganisms and the difference of microbial diversity in⁃ dex(alpha diversity index,beta diversity index)were analyzed;the subject working characteristic curve(ROC) was drawn to assess whether bacterial microorganisms have the potential of biomarkers. Results The relative abun⁃ dance of Neisseria,Moraxella,Staphylococcus,Corynebacterium,Dolosigranulum and Treponema in sputum sam⁃ ples of subjects(P values < 0.05). The results of the LEfSe analysis showed that,the increased species in the sili⁃ cosis I group include Pseudomonadales,Neisseriaceae,Moraxellaceae,and Neisseria. The additional species in⁃ cluded in the silicosis Ⅱ group were Staphyloccaceae Bacillaceae,Bacillus,Staphylococcus,and Staphylococ⁃ cus_aureus. The ROC analysis showed that the area using Neisseria relative abundance of silicosis Ⅰ and silicosis Ⅱ was 0.87(95% confidence 0.71~0.99),sensitivity = 100.0%,specificity = 73.3%,Youden index = 0.73, P = 0.01. Conclusion Neisseria may be related to the disease process in patients with silicosisis and have the po⁃ tential as a biomarker for distinguishing the silicosis stage.

Comparison of quadratus lumborum block at the lateral supra⁃arcuate ligament and subcostal transversus abdominis plane block on postoperative pain and recovery quality after open partial hepatectomy 
MAO Ye, ZHAO Wei, HAO Mengxiao, XING Rui, YAN Ming.
2023, 39(9):  1111-1117.  doi:10.3969/j.issn.1006⁃5725.2023.09.008
Abstract ( 254 )  
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Objective To compare the effect of quadratus lumborum block at the lateral supra⁃arcuate liga⁃ ment and subcostal transversus abdominis plane block on postoperative painand recovery quality in patients under⁃ going open partial hepatectomy. Methods Sixty patients undergoing open partial hepatectomy were enrolled and randomly allocated into two groups:a quadratus lumborum block at the lateral supra⁃arcuate ligament group(group Q,n = 30)and a subcostal transversus abdominis plane block group(group T,n = 30). The cumulative total mor⁃ phine equivalent consumption and numerical rating scale(NRS)scores over the 48 hours postoperative period were recorded. Other outcomes including quality of recovery⁃15(QoR⁃15)scores,Athens insomnia scale(AIS)scores, time to first patient ⁃controlled intravenous analgesia(PCIA),invalid bolus times in PCIA,the rescue analgesia rate and adverse events were also recorded. Results Compared with group T,the cumulative total morphine equiv⁃ alent consumption in postoperative 48 hours and the NRS pain scores in 24 hours after surgery were decreased sig⁃ nificantly in group Q(P < 0.05). The rescue analgesia rate and invalid bolus times in PCIA were significantly low⁃ er in group Q than in group T(P < 0.05). Time to first PCIA request were prolonged significantly in group Q than in group T(P < 0.05). There was a significant increase in QoR⁃15 scores and a significant decrease in AIS scores among patients in group Q compared with those in group T(P < 0.05). No significant difference in adverse events was observed between the two groups(P > 0.05). Conclusion Compared with subcostal transversus abdominis plane block,ultrasound⁃guided quadratus lumborum block at the lateral supra⁃arcuate ligament could provide bet⁃ ter postoperative analgesia,reduce perioperative opioid consumption and promote the early recovery quality for pa⁃ tients undergoing open partial hepatectomy.

Clinical application value of embryo densification during frozen ⁃ thawed embryo transfer cycle 
JIA Junlong, CHENG Yaoping, WANG Ling, YU Yan, SUN Yang, LÜ Aixia, MA Xiaoyan.
2023, 39(9):  1118-1122.  doi:10.3969/j.issn.1006⁃5725.2023.09.009
Abstract ( 167 )  
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Objective To study the influence of densification degree and quantity of D4 embryos on clinical pregnancy outcome in the freezing and thawing embryo transfer cycle,and to make clear the effect of densification embryo on live birth rate. Methods Younger patients(< 40 years old)having frozen ⁃thawed embryo transfer were selected. According to the densification degree of transferred embryos,the transfer cycles were divided into group A (containing two more partially densified embryos or densified embryos);group B(containing one partially densified or densified embryo group);group C(without partially densified or densified embryos). The implantation rate and clinical outcome were analyzed,and the final pregnancy outcome of densified embryos was studied. Results (1)Age and body mass index in group C were significantly lower than those in group A. Infertility duration,basic FSH,basic LH,and basic E2 were not significantly different among the three groups by using nonparametric test. There was no statistical difference among the three groups in the endometrial preparation protocols. The endometrial thickness of group C was significantly higher than that of group A.(2)The average number of high ⁃quality embryos transferred in group A,B and C decreased successively,and the difference was statistically significant. The loss rate of early pregnancy was significantly different among the three groups,which was increased in group B but decreased in group A. The live birth rate was significantly different among the three groups,and the difference between group A and group B and C was significant. Conclusion Transferring two more partially densified embryos can significantly increase live birth rate,but not increase multiple pregnancy rate and cesarean section rate. However,transferring one more partially densified embryo could not improve the clinical pregnancy rate,multiple pregnancy rate and live birth rate. 
Clinical efficacy of transanal opening of intersphincteric space approach combined with loose seton in the treatment of complex anal fistula 
YUAN Hexue , PAN Chunlai, LIU Zongjian, ZHANG Yong, LUO Fang, ZHU Na.
2023, 39(9):  1123-1126.  doi:10.3969/j.issn.1006⁃5725.2023.09.010
Abstract ( 200 )  
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Objective This article mainly discusses the clinical effect of transcter approach combined with loose seton in the treatment of complex anal fistula. Methods Selecting 80 patients with complex anal fistula admitted to our hospital from May,2020 to July 2022,Randomly divided into treatment group and control group.40 cases in the treatment group(N = 40)and 40 cases in the control group(N = 40). The patients in the treatment group used intersphincter approach combined with relaxtion thread drawing. The patients in the control group were circumcised by cutting and drainage to compare the operation time,hospitalization time and wound heal⁃ ing time between the two groups. VAS,functional recovery(anal canal rectal pressure measurement and Wexner in⁃ continence score). Results Clinical curative effect was achieved in both groups. There were no significant differ⁃ ences in cure rate,preoperative anal function(anorectal pressure measurement,Wexner incontinence score)and VAS score on the 7th day after surgery between the two groups(P > 0.05). There were significant differences in length of hospital stay,wound healing,operation time and VAS scores 1,3 and 5 days after surgery(P < 0.05). There were significant differences in anorectal pressure measurement(anal resting pressure and anal retraction pressure)and Wexner incontinence score more than 3 months after surgery between the two groups(P < 0.05). Conclusion The treatment of complex anal fistula through intersphincter approach combined with loose seton has obvious advantages in functional protection(anorectal pressure measurement,Wexner score),wound healing and postoperative pain compared with traditional cutting and drainage. It has been proved that the treatment of compli⁃ cated anal fistulas by intersphincter approach combined with relaxation and hanging line is safe and effective for the protection of anal function and worthy of popularization and application. 
Application of laparoscopic guided regional nerve block of bilateral uterosacral ligaments in gynecological endoscopic myomectomy
WANG Haijin, WANG Kegong, GONG Ting, LIU Ying, ZHANG Zhen, LUO Huiyu.
2023, 39(9):  1127-1131.  doi:10.3969/j.issn.1006⁃5725.2023.09.011
Abstract ( 268 )  
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Objective To investigate the effect of laparoscopic guided regional nerve block of bilateral uterosacral ligaments on postoperative analgesia and early rehabilitation of patients undergoing laparoscopic myo⁃ mectomy. Methods 70 patients scheduled for elective laparoscopic myomectomy under general anesthesia were randomly divided into two groups with 35 patients in each group. The observation group performed after general an⁃ esthesia combined with nerve block in bilateral uterosacral ligament region,andthe control group performed after general anesthesia. The amount of anesthetic used during the operation,the VAS pain score at different time points after the operation,the recovery time of intestinal function after the operation,the time of immobility,and the 15 quality of recovery(QoR ⁃ 15)scores 24 hours after the operation were recorded. The total amount of analgesics used,the recovery rate of analgesia and the occurrence of related adverse reactions were recorded. Results Com⁃ pared with control group,the intraoperative consumption of remifentanil was significantly reduced(P < 0.05),and the VAS pain score of 2 hours after operation in the observation group was lower(P < 0.05). The QoR⁃15 score at 24 hours after the operation were significantly increased(P < 0.05),and the analgesic dosage,analgesic salvage rate,and the incidence of nausea and vomiting were significantly reduced in the observation group within 24 hours after surgery(P < 0.05). Conclusion Laparoscopic guided regional nerve block of bilateral uterosacral ligaments can reduce the perioperative opioid dosage of patients with laparoscopic myomectomy,reduce postoperative pain,re⁃ duce postoperative complications,and improve the quality of postoperative recovery. 
Clinical comparison of posterior cervical single⁃opening spinal canal expansion plasty and anterior cervical decompression internal fixation for cervical hyperextension injury 
TANG Guangman, WANG Laiyi, JIN Ge⁃ nyang.
2023, 39(9):  1132-1137.  doi:10.3969/j.issn.1006⁃5725.2023.09.012
Abstract ( 228 )  
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Objective To compare the efficacy of posterior cervical open door enlarged spinal canal plasty with anterior cervical decompression and internal fixation for cervical hyperextension injury. Methods Fifty⁃seven patients with cervical hyperextension injury admitted to the orthopedic department of the hospital from June 2018 to December 2021 were selected,with 33 patients who underwent posterior cervical single⁃opening spinal canal expan⁃ sion plasty(group A)and 24 patients who underwent anterior cervical decompression and internal fixation(group B). We retrospectively analyzed and compared the surgical and postoperative recovery indexes of the two groups,while discussing the efficacy and safety of different surgical approaches. Results The operative time,surgical bleeding, and hospital stay were less in group A than in group B(P < 0.05);the JOA score and Frankel classification were slightly better in group A than in group B,the fusion segment height and Cobb angle were slightly higher than in group B,and the complication rate was slightly lower than in group B,but none of them were statistically different (P > 0.05). Conclusion In patients with cervical hyperextension injury,either posterior single⁃opening spinal canal enlargement plasty or anterior decompression internal fixation can achieve a better outcome according to the imaging findings,but posterior single ⁃opening has less surgical risk and more complete decompression,which is worth giving priority to. 
Clinical efficacy of paraspinal nerve block combined with transcranial direct current stimulation in postherpetic neuralgia 
ZHANG Yuqing, LIU Qianhan, YANG Sen, LI Xiaoqiang, CHEN Liping, SHEN Wen.
2023, 39(9):  1138-1142.  doi:10.3969/j.issn.1006⁃5725.2023.09.013
Abstract ( 207 )  
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Objective To observe the effect of ultrasound ⁃guided paraspinal nerve block combined with transcranial direct current stimulation(tDCS)on pain and mood in patients with postherpetic neuralgia. Methods From March 2022 to August 2022,72 patients with PHN were randomly divided into two groups:The control group (group A,n = 36)and the observation group(group B,n = 36). Both groups were treated with neural nutrients, analgesics and ultrasound⁃guided paraspinal nerve block. The patients in group B received daily transcranial direct current stimulation,while the patients in group A was treated with sham stimulation. Numerical Rating Scale (NRS)and state⁃trait anxiety inventory(STAI⁃S)were assessed at the time of pre⁃treatment(T0),1 week(T1), 1 month(T2),2 months(T3)and 3 months(T4)after treatment,self⁃rating scale of sleep(SRSS)was assessed at T0,T2,T3 and T4. The therapeutic effects of the two groups were evaluated 3 months after treatment. Results After treatment,the scores of NRS,STAI ⁃ S and SRSS in both groups were significantly lower than those before treatment(P < 0.05),the scores of NRS,STAI ⁃ S and SRSS in group B were significantly lower than those in group A(P < 0.05). Three months after treatment,the curative effect of group B was better,the difference was sta⁃ tistically significant(P < 0.05). Conclusions Ultrasound⁃guided paraspinal nerve block combined with transcrani⁃ al direct current stimulation is more effective than paraspinal nerve block alone in relieving pain,improving mood and sleep quality in patients with postherpetic neuralgia.
Influence of refractory peritoneal dialysis ⁃ associated peritonitis and the prediction of extubation risk 
WANG Min, XING Lingling, ZHANG Chunxia, LU Suyu, WU Xiaolei, XU Longyun, JIANG Zujuan, LI Shao⁃ mei, PEI Huaying.
2023, 39(9):  1143-1147.  doi:10.3969/j.issn.1006⁃5725.2023.09.014
Abstract ( 237 )  
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Objective Analyzed the factors of refractory peritoneal dialysis ⁃ associated peritonitis(rP⁃ DAP),To predict the probability of extubation in rPDAP patients. Methods A retrospective analysis was per⁃ formed on 164 patients who had regular follow ⁃ up in our hospital from January 2016 to December 2021 and had peritoneal dialysis⁃associated peritonitis(PDAP). According to the clinical treatment results,the patients were di⁃ vided into refractory group and refractory group. The clinical data of the two groups were compared,and the influ⁃ encing factors of rPDAP occurrence and prognosis were explored by multivariate Logistic regression analysis. The risk prediction model of rPDAP extubation was established,and the diagnostic value of the predictive factors was analyzed by ROC curve. Results Among the two groups,66 patients were in refractory group and 98 were in re⁃ fractory group. Compared with non⁃refractory group,patients in refractory group had longer dialysis age[42.5(20, 64.5)months vs. 32.5(11.8,50.25)months]and lower serum albumin[(31.21±5.88)g/L vs.(32.99±5.20)g/ L]. Staphylococcus aureus and fungal infections were high(13.6% vs. 3.1% and 6.1% vs. 0).Multivariate Logistic regression analysis showed that serum albumin level was negatively correlated with rPDAP development,but no cor⁃ relation was found with prognosis of patients(P < 0.05). The extubation rate of patients with long dialysis age and multiple PDAP was positively correlated with that of patients with rPDAP(P < 0.05). The area under ROC curve for predicting extubation risk of rPDAP was calculated based on dialysis age and multiple occurrence of PDAP. The diagnostic value of dialysis age was the largest,and the defined value of dialysis age was 54.5 months. Conclu⁃sion Serum albumin is an independent protective factor for rPDAP development. Long dialysis age and multiple occurrence of PDAP are of diagnostic value for extubation risk in rPDAP patients,and extubation risk is higher in rPDAP patients with dialysis age of 54.5 months or above. 
Expression and clinical significance of serum ficolin⁃3 and PTX3 in patients with rheumatoid arthritis com⁃ plicated with pulmonary interstitial lesions 
GAO Dongmei, ZHANG Yanchun, XU Wenjing, LI Huixin, WANG Li, TONG Shengquan.
2023, 39(9):  1148-1152.  doi:10.3969/j.issn.1006⁃5725.2023.09.015
Abstract ( 217 )  
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Objective To investigate the expression of serum ficolin⁃3 and pentraxin 3(PTX3)in patients with rheumatoid arthritis combined with lung interstitial disease(RA ⁃ ILD). Methods From December 2020 to December 2021,65 rheumatoid arthritis(RA)patients in our hospital were enrolled as RA group;70 RA⁃ILD pa⁃ tients as RA⁃ILD group,and 80 healthy subjects as control group. Enzyme⁃linked immunosorbent assay(ELISA) was used to detect the expression level of serum ficolin⁃3 and PTX3;Pearson method was used to analyze the corre⁃ lation of ficolin⁃3 and PTX3 and their correlation with DAS28,ESR,RF,CRP and pulmonary function⁃related in⁃ dexes;ROC curve was drawn to analyze the diagnostic value of ficolin⁃3 and PTX3 in RA⁃ILD. Results The val⁃ ue of DAS28,ESR,RF and CRP in RA ⁃ ILD group was significantly higher than those in RA group and control group,and significant higher value was observed in RA group when compared with the control group(P < 0.05). The value of FVC,VC and DLCO in RA⁃ILD group was significantly lower than that in RA group and the control group,and significant lower value was found in the RA group when compared with the control group(P < 0.05). The expression level of serum ficolin⁃3 in RA⁃ILD group was significantly lower than that in RA group and control group,and the expression level in RA group was significantly lower than that in the control group. The expression level of serum PTX3 in RA⁃ILD group was the highest,followed by RA group and the control group(P < 0.05). Correlation analysis showed that the expression level of ficolin⁃3 in serum of patients in RA⁃ILD group was negative⁃ly correlated with PTX3(P < 0.05);ficolin⁃3 was negatively correlated with the value of DAS28,ESR,RF and CRP,and positively with the value of FVC,VC and DLCO(P < 0.05);PTX3 was positively correlated with the value of DAS28,ESR,RF and CRP,and negatively with the value of FVC,VC and DLCO(P < 0.05). The AUC of the combined diagnosis for RA⁃ILD with ficolin⁃3 and PTX3 was higher than that of ficolin⁃3 or PTX3 alone(Z = 6.787,P = 0.009;Z = 15.492,P < 0.001). Conclusion The expression level of ficolin ⁃3 in serum of patients with RA⁃ILD is significantly decreased,and the expression level of PTX3 is significantly increased. The combina⁃ tion of the two has certain diagnostic value for RA⁃ILD.
Clinical efficacy of IRE ablation combined with PD ⁃1 inhibitor and chemotherapy in treatment of locally advanced pancreatic cancer
ZHANG Tong, LI Xiaoyong, CHEN Yanjun, CHEN Shengyang, HU Shuiquan, CHENG Bingbing, TONG Hao, SONG Lishan.​
2023, 39(9):  1153-1158.  doi:10.3969/j.issn.1006⁃5725.2023.09.016
Abstract ( 161 )  
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Objective To evaluate the clinical safety and efficacy of IRE ablation combined with PD⁃1 in⁃ hibitors and chemotherapy in the treatment of locally advanced pancreatic cancer(LAPC). Methods The clini⁃ cal data of 26 patients with LAPC who were hospitalized in the Fifth Affiliated Hospital of Zhengzhou University from May 2019 to December 2020 were collected and divided into 11 patients treated with IRE combined with PD⁃1 inhibitor and chemotherapy group as study group and 15 patients treated with IRE combined with chemotherapy as control group according to postoperative treatment. The chemotherapy regimens for all the patients were mFOLFIRI⁃ NOX. The two groups were compared in terms of postoperative complications,adverse reactions during adjuvant therapy,CA19⁃9 and FACT⁃G scores at different time points before and after surgery,disease control 6 months af⁃ ter surgery,median overall survival(OS)and median progression⁃free survival(PFS)during follow⁃up. Results No complications of Clavien⁃Dindo of grade ⅡI or above occurred in both groups within one month after surgery, and there was no statistical significance in the incidence of other complications between them(P>0.05). No ad⁃ verse reactions of grade 3 or above occurred between the two groups during the postoperative adjuvant therapy,and there was no statistical significance in the incidence of other adverse reactions between them(P>0.05). The level of CA19⁃9 in the two groups showed an overall decreasing trend 1 and 4 months after surgery,and the difference was statistically significant compared with that before surgery(P<0.05). The level of CA19⁃9 in the two groups be⁃tween 1 and 4 months after surgery was statistically significantly decreased compared with that before surgery(P< 0.05). The FACT⁃G scores of the two groups showed an overall increasing trend 1 month and 4 months after sur⁃ gery,with statistical significance compared with that before surgery(P<0.05). There were no significant differenc⁃ es in disease remission rate(RR)and disease control rate(DCR)between the two groups 6 months after surgery (P>0.05). The median OS and PFS of the study group were significantly higher than those of the control group(24 months vs 18 months;14 months vs10 months)(P<0.05). Conclusion IRE combined with PD⁃1 inhibitor and chemotherapy is safe in the treatment of LAPC. It can prolong the survival time and improve the quality of life of pa⁃ tients. 
Predictive value of serum thyroglobulin and TSH for recurrence of differentiated thyroid cancer after total thyroidectomy without remnant ablation 
YU Jiangtao , WANG Shijie, ZHANG Gaofei, DUAN Xinxin, HUO Qingfeng, ZHENG Shouhua, LIU Peiyu. ​
2023, 39(9):  1159-1163.  doi:10.3969/j.issn.1006⁃5725.2023.09.017
Abstract ( 198 )  
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Objective To investigate the predictive value of serum thyroglobulin(Tg)and thyroid⁃stimu⁃ lating hormone(TSH)for recurrence in intermediate and low ⁃ risk differentiated thyroid cancer(DTC)after total thyroidectomy(TT)without remnant ablation(RA). Methods This retrospective study engaged 121 patients with intermediate and low ⁃ risk differentiated thyroid cancer who received TT in Zhengzhou People 􀆳s Hospital be⁃ tween January 2014 and July 2019,with 105 patients in non⁃recurrence group(M0)and 7 patients in recurrence group(M1). The t test,Mann⁃Whitney U test,test,and Fisher􀆳s exact test were performed to evaluate the differ⁃ ences in basic clinicopathological features among the 2 groups,and the logistic regression analysis was done to evaluate the independent influence on the recurrence of DTC patients. Spearman correlation analysis was done to ex⁃ plore the relationship between Tg and TSH. The receiver operating characteristic(ROC)curve was analyzed to evaluate the predictive value of Tg and Tg/TSH for the DTC recurrence. Results Significant differences in the se⁃ rum Tg,capsule invasion and recurrence risk were observed between the two groups(P<0.05),while no signifi⁃ cant differences were seen in gender,age,tumor size,lymph node metastasis,and TSH between them(P>0.05). Tg was found to be an independent factor for the DTC recurrence. The areas under the ROC curve of Tg for predict⁃ ing the DTC recurrence were 0.838. The cut ⁃ off value was 1.355 μg/L,and the sensitivity and specificity were 85.7% and 82.9%,respectively. Spearman correlation analysis showed that Tg was positively correlated with TSH. When Tg was ≥1.355 μg/L,the number of patients reached 18 and 16 in the M0 group and the M1 group,respec⁃ tively. There was a significant difference in Tg/TSH between the two groups(P < 0.05). The areas under the ROC curve of Tg/TSH for predicting DTC recurrence was 0.778,the cut ⁃ off value was 1.128,and the sensitivity and specificity were 66.67% and 100.0%,respectively. Conclusion The combined detection of serum Tg and TSH can be used for postoperative follow⁃up of intermediate and low⁃risk DTC patients after TT without RA,and it is of value for predicting DTC recurrence. 
Drugs and Clinic Practice
Effect of exenatide combined with polyene phosphatidyl choline on serum HMGB1 and APN levels in pa⁃ tients with alcoholic fatty liver disease 
WANG Lei , GUI Yaoyao, KOU Li.
2023, 39(9):  1164-1168.  doi:10.3969/j.issn.1006⁃5725.2023.09.018
Abstract ( 162 )  
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Objective To analyze the effect of exenatide combined with polyene phosphatidyl choline on alcoholic fatty liver disease and their effect on serum high mobility group protein B1(HMGB1)and adiponectin (APN)levels. Methods A total of 108 patients with alcoholic fatty liver disease admitted to our hospital from January 2020 to January 2022 were divided into observation group and control group by random number table meth⁃ od,with 54 cases in each group. The control group was treated with polyene phosphatidyl choline,and the observa⁃ tion group was treated with exenatide on the basis of control group. The therapeutic effect and serum levels of HMGB1 and APN in 2 groups were observed and compared between the two groups. Results After 3 months of treatment,the clinical symptoms of both groups were significantly improved and the clinical symptoms disappeared faster. The total clinical effective rate of the observation group was significantly higher than that of the control group (96.30% vs. 83.33%,P<0.05). There were no significant differences in the serum ALT,AST,TC,TG and TBil between the two groups before treatment(all P>0.05). After treatment,the all indexes of the two groups were sig⁃ nificantly decreased,and those of the observation group were lower than of the control group(P<0.01). There was no significant difference in the serum HMGB1 and APN levels between the two groups before treatment. After treat⁃ ment,the serum HMGB1 level in the two groups was significantly decreased(P<0.001),and the serum HMGB1 level in the observation group was lower than that in the control group(P<0.05). After treatment,the serum APN levels of both groups were significantly increased(P<0.001),and the level of observation group was significantly higher than of the control group(P<0.05). There was no significant difference in the adverse reactions between the two groups(P>0.05). Conclusion Exenatide combined with polyene phosphatidyl choline can improve the thera⁃ peutic effect of alcoholic fatty liver disease,reduce serum HMGB1 level and increase serum APN level safely. 
Medical Examination and Clinical Diagnosis
The value of 3.0T CMR quantitative technique for diagnosing the efficacy of acute viral myocarditis and as⁃ sessing short⁃term prognosis 
LI Nan, KANG Zhilei.
2023, 39(9):  1169-1173.  doi:10.3969/j.issn.1006⁃5725.2023.09.019
Abstract ( 201 )  
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Objective To investigate the value of quantitative 3.0T cardiac magnetic resonance(CMR) techniques for diagnosing the efficacy of acute viral myocarditis(AVM)and assessing short⁃term prognosis. Meth⁃ ods 115 patients with suspected AVM from January 2019 to August 2021 in our hospital were selected and divid⁃ ed into AVM and non ⁃AVM groups with reference to clinical diagnosis,to evaluate the diagnostic value of 3.0T CMR quantitative parameters[T2 ratio,early intensification imaging(EGE)ratio,delayed intensification imaging (LGE)volume,and LGE as a percentage of left ventricular mass]for AVM,and patients with AVM were Patients with AVM were followed up for 3 months,prognosis was counted,3.0T CMR quantitative parameters were com⁃ pared in patients with different prognosis,and the relationship between each parameter and prognosis was analyzed. Results Clinical diagnosis showed that 81 patients with confirmed AVM and 34 patients with non⁃AVM;T2 ra⁃ tio,EGE ratio,LGE volume,and LGE as a percentage of LV mass were higher in the AVM group than in the non⁃ AVM group(P < 0.05);the AUC of T2 ratio,EGE ratio,LGE volume,and LGE as a percentage of LV mass for the combined diagnosis of AVM was 0.908(95% CI:0.840 to 0.954)was significantly greater than the single diag⁃ nosis of each parameter(all P < 0.05). Using the most truncated value obtained from the ROC curve as the bound⁃ ary,divided into positive and negative,the risk of AVM occurrence was 8.815 times,2.938 times,2.183 times, and 4.337 times higher in patients with positive T2 ratio,EGE ratio,LGE volume,and LGE as a percentage of LV mass than in patients with negative;at 3⁃month follow ⁃up,the AVM group had a good prognosis in 67 cases,a poor prognosis in 14 cases,and a poor prognosis in T2 ratio,EGE ratio,LGE volume,and percentage of LGE to LV mass were higher than those of patients with good prognosis(P < 0.05);T2 ratio,EGE ratio,LGE volume, and percentage of LGE to LV mass were negatively correlated with short⁃term prognosis of AVM(P < 0.05).Conclusion The 3.0T CMR quantitative technique can be used as a reliable imaging modality for clinical diagno⁃ sis of AVM and also for short⁃term prognostic assessment,which can provide effective objective information for clin⁃ ical diagnosis and treatment. 
Modernization of Traditional Chinese Medicine
Study on efficacy of modified Wuqinxi on gait and balance dysfunction in elderly stroke patients and on brain mechanism based on fMRI 
ZHANG Fenglin, SHU Hongyan, REN Leilei, YAN Chuan, LIU Junwei, MIU Guangxian, CHEN Xianbing.
2023, 39(9):  1174-1178.  doi:10.3969/j.issn.1006⁃5725.2023.09.020
Abstract ( 159 )  
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Objective To study the efficacy of modified Wuqinxi on gait and balance dysfunction in elder⁃ ly stroke patients and the brain mechanism based on fMRI. Methods The 60 stroke patients treated in our hospi⁃ tal from September 2021 to January 2023 were selected as the study subjects,and were randomly divided into 28 control groups and 32 experimental groups. The control group used conventional rehabilitation treatment,and the experimental group improved Wuqinxi by video practice based on the control group. The fMRI scan of two brain acti⁃ vation area was used to evaluate the cerebral hemodynamic index,immune function index and gait parameters,and the Berg Scale Assessment(berg balance scale,BBS). Results After treatment,the average cerebral artery blood flow rate(Vm),the average blood flow rate(Qm),immunoglobulin G(lmmunoglobin G,IgG),and Immu⁃ noglobulin A(lmmunoglobin)in the experimental group compared with the control group. A,IgA),immunoglobu⁃ lin M(lmmunoglobin M,IgM)levels increase,vascular resistance index(RI)level decline,statistical difference (P < 0.05),the BBS score increase,statistical difference(P < 0.05),the step frequency,stride speed increase, gait cycle decline,statistical difference(P < 0.05);the stride frequency,stride amplitude and stride speed of the experimental group decreased,with the statistical difference(P < 0.05);the range of brain activation areas and brain function in the experimental group were greater than those in the control group. Conclusion The modified Wuqinxi treatment of elderly stroke patients can improve their immune ability,balance ability and gait. 
Reviews
Application progress of orthopedic robotic assistance in cervical surgery 
SUN Wenxi , YANG Yifan# , LIN Rui, ZHAO Shuai, LIU Bingxin, WANG Hongshen, LI Yongjin, CHEN Bolai.
2023, 39(9):  1179-1184.  doi:10.3969/j.issn.1006⁃5725.2023.09.021
Abstract ( 236 )  
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Compared with other surgical fields,surgical robotics is relatively new to spine surgery. With the development of cervical spine surgery techniques,minimally invasive techniques are being increasingly adopted for their advantages of less trauma and faster recovery,but at the same time bring more exposure to radiation. The orthopaedic surgical robot allows for intraoperative navigation and assisted nail placement,reducing operator expo⁃ sure to radiation and improving nail placement accuracy and safety. In recent years,the acceptance of orthopaedic surgical robots has increased and their clinical use has grown. This article reviews the progress of orthopaedic surgi⁃ cal robots in cervical spine surgery,analyses existing research on orthopaedic surgical robotic ⁃ assisted cervical spine surgery,summarises the application and efficacy of robotic technology,and discusses the future direction of development. 
Diagnostic and prognostic value of cfDNA concentration and integrity in cancer 
YING Chao, DING Hui, CAI Yanning.
2023, 39(9):  1185-1189.  doi:10.3969/j.issn.1006⁃5725.2023.09.022
Abstract ( 193 )  
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Cancer is a major public health problem worldwide,and effective early intervention and effica⁃ cy surveillance can reduce the risk of oncology and death in patients. In most cancers,circulating cell ⁃free DNA (cfDNA)concentration and its integrity may be an effective indicator for early diagnosis,progressive patient identi⁃ fication,and prognostic monitoring. The purpose of this paper is to review the efficacy of cfDNA concentration and its integrity in the diagnosis and treatment of different cancers,and to compare it with the current tumor markers commonly used in clinical practice to explore the value and prospect of this index in clinical practice. 
Targeted PI3K signaling pathway inhibitors in treatment of pancreatic cancer 
CHEN Siyu, WANG Xian⁃ wang.
2023, 39(9):  1190-1194.  doi:10.3969/j.issn.1006⁃5725.2023.09.023
Abstract ( 266 )  
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The incidence of pancreatic cancer(PC),as a highly invasive malignant tumor,is increasing both at home and abroad annually. For patients with no indication of surgical treatment,targeted therapy has obvi⁃ ous advantages. The biological behaviors of tumor cells such as proliferation,apoptosis and angiogenesis are regu⁃ lated by the phosphatidylinositol 3 kinase(PI3K)signaling pathway,and the use of PI3K inhibitors can improve the prognosis of patients. Inhibitors of the PI3K signaling pathway include those targeting a single component and dual or multiple inhibitors. At present,PI3K⁃targeted inhibitors have achieved good results in clinical trials of lym⁃ phoid hematopoietic tumors and other solid tumors,but there are few studies on pancreatic cancer. For this reason, we briefly review the research progress of PI3K pathway,summarizing the new advances of inhibitors targeting PI3K signaling pathway in the treatment of pancreatic cancer.