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Novel coronavirus article
Study on nursing emergency management strategy of general hospitals in non-epidemic areas under the outbreak of coronavirus disease 2019
WANG Lin1, 2, JIANG Li-ping2, 3, YANG Yan2, 4, LIN Wei-dong1, 2, ZHANG Ya-qing2, 5
2020, 40 (08):  1005-1008.  doi: 10.3969/j.issn.1674-8115.2020.08.001
Abstract ( 23 )   PDF (6684KB) ( 11 )  
Objective · To understand the implementation of the emergency management plan of nursing in the general hospitals in non-epidemic areas under the outbreak of coronavirus disease 2019 and propose strategies. Methods · Nine experts were interviewed by the method of focus group interviews method and the data were collected and analyzed by the method of Colaizzi data analysis method. Results · The important themes of nursing emergency management included the deployment and training of human resources, the development and implementation of material management system, and ward visiting system, the training and reserve of specialist nurses,as well as the psychological assistance and humanistic care. Conclusion · The emergency management of nursing in the general hospitals in non-epidemic areas is a systematic project. Nursing managers should further complete the construction of team and system for nursing emergency management, and improve the emergency nursing abilities and the mental health of nurses.
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Experience of healthcare-acquired infection control against coronavirus disease 2019 by integrated medical team in Wuhan
SHI Da-ke, HU Wei-guo, YANG Zhi-tao, LIN Jing-sheng, WANG Xiao-ning, GUO Ying, QIAN Wen-jing, CAI Ming, XIANG Xiao-gang, LIANG Xiao-hong, ZHAI Rong-cheng, ZHANG Yi-bo, NI Yu-Xing
2020, 40 (08):  1009-1012.  doi: 10.3969/j.issn.1674-8115.2020.08.002
Abstract ( 18 )   PDF (7009KB) ( 22 )  
Objective · To sum up the experience of healthcare-acquired infection control against coronavirus disease 2019 (COVID-19) in Wuhan by a medical team from Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, so as to provide reference for the contain strategy of sudden infectious diseases in China. Methods · The whole process of prevention and control of HAI was implemented through methods such as management organization construction, institutional establishment and implementation, personnel training, occupational exposure planning, and introduction of high-tech methods. Results · There were a total of 136 members in the medical team, including 30 doctors, 100 nurses, and 6 administrative staffs. None of them were infected with COVID-19, achieving zero infection among medical staff. Conclusion · Although the task of assisting Wuhan was tight in time, and materials and heavy, under the leadership of the team leader and the cooperation of all the staff, all measures were implemented, the training covered all the staff, and high-tech means were introduced to optimize the control strategy, achieving the goals of zero infections among medical staffs and zero cross infections among patients.
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Investigation of the discomforts of the medical staff in COVID-19 isolation room
XU Li1, 2, LIU Tong1, 2, XI Hui-qin1, 2, JI Meng-ting1, 2, QIAN Ping1
2020, 40 (08):  1013-1017.  doi: 10.3969/j.issn.1674-8115.2020.08.003
Abstract ( 21 )   PDF (6236KB) ( 10 )  
Objective · To investigate the occurrence of medical staff leaving the COVID-19 isolation room due to discomforts and to provide reference for clinical prevention and treatment. Methods · Stratified sampling method was used to investigate the occurrence of medical staff from Shanghai medical team leaving isolation room earlier due to discomforts, as well as the main symptoms and signs of theirs. Logistic regression was used for risk factor analysis. Results · Among the 227 medical staff working in Leishenshan Hospital in Wuhan, Hubei Province, who were assisted by Shanghai, 69 (30.4%) staff left earlier due to discomforts while working in the isolation room. Two of them had syncope, and sixty-seven of them had symptoms and signs related to presyncope. Symptoms of presyncope include headache, nausea, sweating, dyspnea, and palpitations, etc. Univariate analysis revealed statistically significant differences in occupation (P=0.002), gender (P=0.006), and standing time (P=0.002). Logistic regression analysis showed that occupation (P=0.000), standing time (P=0.025), and hunger (P=0.029) were statistically significant. Conclusion · Different occupation, gender and standing time have different effects on the situation of medical staff leaving the isolation room due to discomforts. Occupation, standing time and feeling of hunger are the influencial factors for medical staff leaving the isolation room earlier.
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Innovative research team achievement
Study of Fusobacterium nucleatum-related bacterial biofilm promoting M2 polarization of macrophages and chemoresistance in colon cancer
LU Shi-yuan1, HONG Jie1, CHEN Ying-xuan1, CHEN Jin-xian2, ZHONG Ming2, FANG Jing-yuan1
2020, 40 (08):  1018-1029.  doi: 10.3969/j.issn.1674-8115.2020.08.004
Abstract ( 16 )   PDF (11620KB) ( 13 )  
Objective · To investigate whether and how Fusobacterium nucleatum-related bacterial biofilm modulates the infiltration of tumor-associated macrophages into tumor microenvironment and the response to chemotherapy in colon cancer patients. Methods · Both biofilm-based F.n-culture medium (BF-CM) and planktonic F.n-culture medium, (P-CM) Fusobacterium nucleatum was cultured ,and the culture-medium was collected to co-culture with CRC cell lines and macrophages. Quantified real time PCR( qRT-PCR) was used to measure genes related to chemoresistance, CCK8 assay was conducted to measure proliferation inhibition rate of chemicals to cancer cells, qRT-PCR was used to measure the expression of genes related to macrophage polarization. Fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) were conducted to evaluate existence of bacterial biofilm and infiltration of macrophages in tumor tissues of colon cancer. Results · Expression of chemoresistance-related genes(e.g. MDR1/Abcb1a/Abcb1b) were higher in BF-CM treated CRC cells than those in P-CM treated cells. CRC cell inhibition level via LOHP/5-FU were reduced with F.n culture medium(metabolites) co-culture, and much lower in BF-CM group. Expression of M2-polarization markers were also higher after BF-CM treated macrophages than P-CM. Biofilm positivity was higher in recurrent(confirmed by PET-CT, CT, or colonoscopy) colon cancer patients with post-resection adjuvant chemotherapy, than that in non-recurrent ones; correlated with infiltration rate of M2 macrophages. Conclusion · Fusobacterium nucleatum-related bacterial biofilm can induce M2-polarization of intratumor macrophages and could promote chemoresistance to chemicals in CRC cells, which may contribute to prognosis of colon cancer patients.
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Original article (Basic research)
Role of long noncoding RNA AC073046.25 in regulation of systemic lupus erythematosus susceptibility gene TET3 expression
XU Ning, ZHOU Tian, HOU Guo-jun, SHEN Nan, TANG Yuan-jia
2020, 40 (08):  1030-1035.  doi: 10.3969/j.issn.1674-8115.2020.08.005
Abstract ( 9 )   PDF (8226KB) ( 12 )  
Objective · To investigate the regulatory effect of long noncoding RNA (lncRNA) AC073046.25 on the expression of Tet methylcytosine dioxygenase 3 (TET3) in monocytes, and analyze the feasibility of AC073046.25 as a biomarker for the diagnosis of systemic lupus erythematosus (SLE). Methods · The cell specificity and function of AC073046.25 were predicted by epigenetic modification and cytoplasm/nuclear location experiment. In U-937 cells, antisense oligonucleotide (ASO) was used to knock down AC073046.25. The effect of ASO knockdown on TET3 expression was analyzed by quantitative real-time PCR. Monocytes from healthy volunteers (n=32) and SLE patients (n=46) were collected. The correlation between AC073046.25 and TET3 expression was analyzed by Pearson coefficient. Healthy volunteers were included in the healthy control group, and the SLE patients were divided into SLE-inactive group and SLE-active group according to the systemic lupus erythematosus disease activity index (SLEDAI). The differences of AC073046.25 and TET3 expression in healthy control group and different disease activity groups were compared by unpaired bilateral student's t test. Results · The epigenetic modification and cytoplasm/nuclear location experiment showed that AC073046.25 may be involved in the regulation of TET3 expression in monocytes. In U-937 cells, after ASO knocked down AC073046.25, TET3 expression level decreased (both P=0.002 in ASO groups). Correlation analysis showed that AC073046.25 expression was positively correlated with TET3 expression in primary monocytes (r=0.650, P=0.000). Unpaired bilateral student's t test showed that the expression level of AC073046.25 in the SLE-active group was lower than that in the healthy control group (P=0.002) and the SLE-inactive group (P=0.000). Conclusion · In monocytes, AC073046.25 can regulate the expression of TET3, and its expression is significantly decreased in monocytes derived from disease active SLE patients, which implicating that AC073046.25 can be thought as a biomarker for SLE disease activity diagnosis.
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Single-stranded adeno-associated virus serotype 9 mediated gene expression in astrocyte via intravenous delivery
WANG Xiao-dan1, YANG Zhao1, SHEN Fan-xia1, 2
2020, 40 (08):  1036-1040.  doi: 10.3969/j.issn.1674-8115.2020.08.006
Abstract ( 12 )   PDF (6750KB) ( 11 )  
Objective · To investigate the expression of LacZ gene mediated by intravenous injection of the single-stranded adeno-associated virus serotype 9 (ssAAV9) containing hypoxia-responsive element (HRE) promoter in the cerebral ischemic area, and further identify the types of brain cells that can be transfected by the vector. Methods · A mouse model of permanent left distal middle cerebral artery occlusion (dMCAO) was established. The expression of hypoxia-inducible factor-1 (HIF-1) in cerebral ischemic area was detected at 1 and 5 days after ischemia. The ssAAV vector containing HRE-regulated LacZ gene was packaged into the capsid of AAV9 virus (AAV9-H9LacZ), and AAV9-H9LacZ was injected into mice through jugular vein 1 h after the establishment of dMCAO model. Five days after injection of AAV9-H9LacZ, X-gal staining was used to detect the expression of β-galactosidase (β-gal) encoded by the LacZ gene in the ischemic area and liver tissue. Immunofluorescence double staining was used to detect the expression of β-gal in astrocyte, neurons and vascular endothelial cells. Results · The expression of HIF-1 was increased 1 and 5 days after ischemia. β-gal was mainly expressed in ischemic penumbra of mice injected with AAV9-H9LacZ. There was no positive expression of β-gal in the liver tissue of mice. β-gal was mainly co-expressed with glial fibrillary acidic protein as an astrocyte-specific marker, and a little of β-gal was co-expressed with neuron-specific nuclear protein. Conclusion · After cerebral ischemia, intravenous injection of AAV9-H9LacZ can effectively mediate gene expression in astrocyte in the cerebral ischemia area. HRE can effectively control the expression of the LacZ gene in cerebral ischemia.
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Potential roles of small metabolites in the differential diagnosis between lung cancer and pneumonia
ZOU Chen1, 2, XU Run-hao1, 3, ZHANG Hong2, MA Zhan2, CHEN Li2, ZHANG Jie3, LI Min3, ZHANG Shu-lin1
2020, 40 (08):  1041-1047.  doi: 10.3969/j.issn.1674-8115.2020.08.007
Abstract ( 16 )   PDF (9818KB) ( 9 )  
Objective · To study on the changes of serum small metabolites in patients with lung cancer and pneumonia, assess the performance of these metabolites on differential diagnosis between lung cancer and pneumonia, and establish diagnostic model. Methods · Liquid chromatography tandem mass spectrometry(LC-MS/MS) was applied to test the serum metabolites, including 13 amino acids and 15 bile acids, of 95 patients with lung cancer, 69 patients with pneumonia and 90 healthy people. T test and Mann-Whitney U test were used to analyze the differences among the three groups. Binary logistic regression was applied to screen valuable indexes and establish diagnostic model. The receiver operating characteristic curve (ROC) was used to compare the differential diagnostic value of single index and diagnostic model. Results · Compared with the control group, 3 kinds of amino acids and 7 kinds of bile acids were decreased significantly, while 1 kind of amino acid and 2 kinds of bile acids were increased significantly in pneumonia patients. 6 kinds of amino acids and 2 kinds of bile acids were decreased significantly, while 2 kinds of amino acids and 4 kinds of bile acids were increased significantly in lung cancer patients. Deoxycholic acid was the most valuable metabolite in differential diagnosis. Citrulline, phenylalanine and deoxycholic acid were screened to establish differential diagnostic model of lung cancer and pneumonia. The area under curve (AUC) of the model was 0.829, and the Cut-Off value was 0.55,while the sensitivity was 76.8%, the specificity was 79.7%, and the coincidence rate was 78.3%. Conclusion · This study revealed that some small metabolites in serum of the patients with pneumonia and lung cancer have changed significantly. The diagnostic model composed of some metabolites has the potential value to assist differential diagnosis of lung cancer and pneumonia.
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Screening of differential proteins from follicular fluid of patients with polycystic ovarian syndrome employing protein chip array
JIANG Yi-hong, LIAO Yu, YUE Jiang, HUANG Rong, LIU Wei
2020, 40 (08):  1048-1054.  doi: 10.3969/j.issn.1674-8115.2020.08.008
Abstract ( 11 )   PDF (8463KB) ( 16 )  
Objective · To identify the differential proteins from follicular fluid of patients with polycystic ovarian syndrome (PCOS) employing protein chip array, and provide a theoretical basis for further study of PCOS. Methods · AAH-BLG-507 array was used to test the follicular fluid of 6 PCOS patients with normal body mass index (BMI) and 6 non-PCOS controls with age and BMI-matched. The differential proteins were identified and bioinformatics analysis was carried out by functional annotation analysis, KEGG pathway analysis and protein-protein interaction network analysis. Results · Compared with non-PCOS controls, 25 up-regulated proteins and 49 down-regulated proteins were identified from follicular fluid of patients with PCOS. The classification of differential proteins based on molecular function revealed that they were mainly involved in cytokine activity and chemokine activity. KEGG pathway analysis was performed and pathways associated with cytokine-cytokine receptor interaction and chemokine signaling pathway were significantly enriched. The core proteins filtered by protein-protein interaction network analysis were mainly chemokines and their receptors. Conclusion · Protein chip array can be used to establish the differential expressed protein profile from follicular fluid of patients with PCOS. The cytokine-cytokine receptor interaction and chemokine signaling pathway may be involved in the pathogenesis of PCOS.
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Study on the difference of orthodontic tooth movement rate and pressure side bone remodeling between obese and obesity-resistant rats
LUO Hong1, 2, WU Hong-yan1, 3, TAN Xi1, 3, DAI Hong-wei1, 2, 3, HUANG Lan1, 2, 3
2020, 40 (08):  1055-1062.  doi: 10.3969/j.issn.1674-8115.2020.08.009
Abstract ( 9 )   PDF (8852KB) ( 12 )  
Objective · To investigate on the difference of the orthodontic tooth movement rate and pressure side bone remodeling between diet-induced obese rats and diet-resistant rats. Methods · Forty male Sprague-Dawley rats were randomly divided into two groups, including the normal diet (ND) group and high-fat diet (HFD) group. And then the HFD group was subdivided into diet-induced obese (DIO) group (n=10) and diet-resistant (DR) group (n=10). Orthodontic applications were placed between the left upper first molar and incisors in rats respectively. After orthodontic treatment for 14 d, the rats were executed and their maxillae were harvested bilaterally. The number of osteoclasts in 3 groups were observed by tartrate-resistant acid phosphatase (TRAP) staining. The expression of osteocalcin in 3 groups was observed by immunohistochemical staining. The tooth movement distance and trabecular bone parameters on the pressure side were measured by Micro-CT. Results · The rate of orthodontic tooth movement was significantly lower in the DR group than that in the DIO and ND groups (P=0.000, P=0.005). After orthodontic treatment for 14 d, the bone mineral density, percentage trabecular bone volume/total volume, trabecular number and trabecular thickness in the DR group were significantly higher than those in the DIO group (P=0.001, P=0.000, P=0.005, P=0.000). The number of osteoclasts in the DR group was significantly lower than that in the ND group and DIO group (P=0.005, P=0.001). The expression of osteocalcin was higher in the DIO group than that in the ND group (P=0.047). Conclusion · High-fat diet-induced obesity or obesity-resistance may affect bone remodeling process during orthodontic treatment by promoting or inhibiting osteoclastogenesis, thereby affecting the rate of tooth movement.
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Role of histone acetylation in the pathogenesis of IgA nephropathy
DAI Qin1, WANG Wei-ming2
2020, 40 (08):  1063-1068.  doi: 10.3969/j.issn.1674-8115.2020.08.010
Abstract ( 7 )   PDF (7294KB) ( 9 )  
Objective · To study the role of abnormal histone acetylation modification in the pathogenesis of IgA nephropathy (IgAN), and explore the pathogenesis of IgAN from the perspective of epigenetics. Methods · 30 patients with primary IgAN and 19 healthy controls were included. Of the 19 controls, 16 cases were used to collect blood samples and 3 cases were used to collect normal renal tissues. Peripheral venous blood was collected to extract mononuclear cells (PBMC) for detection. The levels of histone H3 and H4 acetylation in PBMC of IgAN group and healthy control group were detected by ELISA. Real-time PCR was used to detect the mRNA expressions of P300、CREBBP、HDAC1-3、HDAC7、HDAC8、C1GALT1 and ST6GALNAC2. The acetylation levels of histone H3 and H4 in promoter regions of C1GALT1 and ST6GALNAC2 were detected by chromatin immune-precipitation (CHIP). The protein expression of HDAC1 and H3Ac was detected by immunofluorescence. T-test was used for statistical analysis. Results · Compared with the healthy control group, the acetylation levels of H3 and H4 in IgAN group were significantly higher than those in healthy control group (P=0.035, P=0.012);the mRNA expressions of P300, CREBBP, HDAC1, HDAC8 and ST6GALNAC2 were significantly increased in IgAN group (P=0.002, P=0.001, P=0.001, P=0.045 P=0.012); the mRNA expressions of HDAC2 and C1GALT1 were decreased significantly (P=0.035, P=0.008); the acetylation degree of H3 and H4 in C1GALT1 promoter region was significantly decreased (P=0.043, P=0.005), the degree of H3 and H4 acetylation in the promoter region of ST6GALNAC2 gene was increased significantly in IgAN group (P=0.038, P=0.021);immune fluorescent results of renal tissue indicated that the HDAC1 protein expression was increased obviously, and H3Ac protein expression was significantly reduced in the renal tissue of IgAN patiegts. Conclusion · Abnormal acetylation modification exists in IgAN patients. Histone acetylation modification may participate in the pathogenesis of IgAN by regulating the expression of glycosylase gene.
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Expressions and effects of serum miR-23a-3p and miR-27a-3p in mice with ulcerative colitis
CHEN Wei, HAN Zheng, ZOU Yan-li, HUANG Sha-sha, TIAN Xia
2020, 40 (08):  1069-1074.  doi: 10.3969/j.issn.1674-8115.2020.08.011
Abstract ( 7 )   PDF (7786KB) ( 8 )  
Objective · To explore the expression levels of miR-23a-3p and miR-27a-3p in the sera of mice with ulcerative colitis (UC) and their potential action mechanisms. Methods · Twenty C57BL/6 mice were randomly divided into the control group and the model group with 10 mice in each group. The model group mice were induced orally by water with 5% dextran sulfate sodium (DSS) for 7 d. During the induction period, the general condition, fecal morphology and occult blood status of the mice were observed. After 7 d, the whole blood and colon tissues of mice were collected, and the colon lengths and wet weights were measured. The expressions of miR-23a-3p and miR-27a-3p in the sera were detected by qRT-PCR. The expressions of peroxisome proliferator-activated receptor γ, coactivator-1α (PPARGC1A), PH domain leucine-rich repeat protein phosphatase 2 (PHLPP2), B-cell lymphoma-2 (BCL-2), BCL-2 associated X protein (BAX), cytochrome c (CYT-C) and cleaved cysteine-containing aspartate-specific protease (cleaved-caspase-3) were detected by Western blotting. Results · After DSS induction, the model group mice showed mental depression, weight loss, diarrhea, and bloody stool, whose colon lengths were shortened and colon wet weights decreased. The UC model was constructed successfully. In the model group, the expressions of miR-23a-3p and miR-27a-3p in the sera decreased significantly (P<0.05), and the expressions of PPARGC1A, PHLPP2, BAX, CYT-C and cleaved-caspase-3 in the colon tissues increased significantly (P<0.05), but BCL-2 decreased (P<0.05). Conclusion · The expressions of miR-23a-3p and miR-27a-3p are low in the sera of UC mice, which may be involved in the occurrence and development of UC by up regulating the expressions of PPARGC1A and PHLPP2 in the colons and triggering mitochondrial pathway to induce apoptosis.
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Original article (Clinical research)
Effects of typical or atypical antipsychotics on cognitive symptoms of the patients with schizophrenia
ZHOU Shao-yu1, FENG Zhen-xiao1, YAO Xiao-ping2, WANG Wan1, ZHAO Jing3#, YI Zheng-hui4#
2020, 40 (08):  1075-1080.  doi: 10.3969/j.issn.1674-8115.2020.08.012
Abstract ( 13 )   PDF (7536KB) ( 14 )  
Objective · To compare the effects of long-term use of typical and atypical antipsychotics on cognitive symptoms of the patients with schizophrenia. Methods · One hundred and two long-term inpatients with schizophrenia in Shanghai Jinshan Mental Health Center were included. According to the types of antipsychotics, the inpatients were divided into typical antipsychotics treatment group (typical group) or atypical antipsychotics treatment group (atypical group) with 51 cases each. Mental symptoms were evaluated by Positive and Negative Symptom Scale (PANSS), and cognitive symptoms were evaluated by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Results · Ninety-nine patients completed the investigation (49 cases in typical group and 50 cases in atypical group). PANSS score: the negative symptom score in the atypical group was lower than that in the typical group, and the difference was statistically significant (P=0.049). RBANS score: The total score of RBANS and the scores of immediate memory, language, attention and delayed memory in the atypical group were significantly higher than those in the typical group (all P<0.05). Conclusion · Compared with the patients who take typical antipsychotics, the patients with schizophrenia who take atypical antipsychotics for a long time have better cognitive symptom scores.
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Study on genotype of thalassemia with abnormal -α3.7 deletion band
GU Yan-ying1, WU Bei-ying1, LIN Lin1, CAI Gang1#, GU Ming-min2#
2020, 40 (08):  1081-1085.  doi: 10.3969/j.issn.1674-8115.2020.08.013
Abstract ( 10 )   PDF (6685KB) ( 11 )  
Objective · To investigate the rare variant types of abnormal -α3.7 deletion band samples detected by commercial kits commonly used in thalassemia, and analyze their blood type phenotype, so as to provide reference for clinical consultation. Methods · Peripheral blood samples of 4 238 patients from June 2016 to September 2019 in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were collected for routine blood analysis. DNA was extracted from whole blood, and the common mutation genes of thalassemia were detected by gap-polymerase chain reaction (Gap-PCR) and reverse dot blot (RDB). Gap-PCR and Sanger sequencing were used to detect rare mutations of α-thalassemia. Results · A total of 109 cases of -α3.7 deletion band were detected by routine genetic testing for thalassemia, among which 15 cases had abnormal -α3.7 deletion band. Gap-PCR and Sanger sequencing showed that 14 cases were confirmed to contain Hong Kong αα (HKαα) gene and 1 case was NG_000006.1:g.34569_38382 del 3 812 bp rare deletion. The misdiagnosis rate of abnormal -α3.7 deletion bands by routine Gap-PCR test for thalassemia was 13.76%. Conclusion · Patients with abnormal -α3.7 deletion bands should be detected for further confirmation by testing rare type of α-thalassemia, which will help provide more accurate genetic diagnosis results and genetic counseling.
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Balloon dilatation combined with pneumatic and ultrasound lithotripsy in the treatment of unilateral renal stones by percutaneous nephrolithotomy
TANG Hai-xiao, SHI Bo-wen, DAI Ze-hao, HUANG Yun-teng
2020, 40 (08):  1086-1090.  doi: 10.3969/j.issn.1674-8115.2020.08.014
Abstract ( 15 )   PDF (6960KB) ( 18 )  
Objective · To investigate the application effect of balloon dilatation and percutaneous nephrolithotomy (PCNL) combined with pneumatic and ultrasound lithotripsy on the clinical treatment of unilateral kidney stones. Methods · Ninety-four patients with unilateral kidney stones who accepted PCNL in the Department of Urology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from June 2017 to July 2019, were retrospectively analyzed and divided into group A and group B. Among them, 68 patients (group A) were subjected to balloon dilatation combined with pneumatic and ultrasound lithotripsy, while 26 patients (group B) underwent fascia dilatation combined with holmium laser lithotripsy. The clinical effects of two kinds of lithotripsy on the treatment of unilateral kidney stones were compared. Results · The operation time was shorter in group A than that in group B [(107.82±10.87) min vs (115.41±10.68) min, P=0.003]. The increase rate of postoperative white blood cell (WBC) was lower in group A than that in group B (4.41% vs 23.08%, P=0.018). The fever (≥ 38.5 ℃) rate was lower in group A than that in group B (4.41% vs 23.08%, P=0.018). There were no significant differences in hemoglobin reduction, WBC count, hospital stay, stone-free rate, blood transfusion rate and perforation rate of collection system between the two groups (all P>0.05). Conclusion · Balloon dilatation combined with pneumatic and ultrasound lithotripsy in treatment of unilateral renal stones by PCNL can shorten the operation time, and reduce the increase rate of postoperative WBC and fever rate, which is worthy of being promoted in the clinical treatment of patients with unilateral kidney stones.
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Application of optical coherence tomography angiography to evaluation of clinical effect of anti-vascular endothelial growth factor agents on wet age-related macular degeneration
ZHANG Qiong1, LIN Zhong-jing1, ZHANG Shi-sheng2, HU Qi-wei1, SHEN Xi1, XU Jian-min1
2020, 40 (08):  1091-1097.  doi: 10.3969/j.issn.1674-8115.2020.08.015
Abstract ( 6 )   PDF (8600KB) ( 13 )  
Objective · To apply optical coherence tomography angiography (OCTA) to evaluate the clinical effects of intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents on wet age-related macular degeneration (AMD). Methods · The 31 eyes of 31 wet AMD patients in the Department of Ophthalmology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from April 2018 to December 2018 were included. These patients received monthly intravitreal injection of anti-VEGF agents for three consecutive months. The best-corrected visual acuity (BCVA) before and 1, 2 and 3 months after first injection was compared. The macular fovea thickness and choroidal neovascularization (CNV) area at different time points before and after treatment were detected by OCTA and compared. Results · The baseline BCVA (logarithm of the minimum angle of resolution) of the included patients was 0.93±0.43, and the BCVA was significantly improved after treatment (P<0.05). The results of OCTA showed that before treatment the inner limiting membrane-retinal pigment epithealium thickness and inner limiting membrane-retinal pigment epithelial fit thickness were (329.03±110.73) μm and (468.84±209.50) μm, respectively, and they both decreased significantly after treatment (P<0.05). The CNV area before treatment was (4.78±3.24) mm2, and it decreased gradually with time after treatment (P<0.05). Conclusion · Intravitreal injection of anti-VEGF agents can reduce macular edema and inhibit CNV in the wet AMD patients. OCTA can be used to evaluate the efficacy of intravitreal injection of anti-VEGF agents in the treatment of wet AMD.
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Efficacy and safety of oral midazolam in combination with intranasal dexmedetomidine for paediatric magnetic resonance imaging sedation
JI Ying-ying, XUE Bin, HUANG Yue, ZHANG Jian-wei
2020, 40 (08):  1098-1102.  doi: 10.3969/j.issn.1674-8115.2020.08.016
Abstract ( 11 )   PDF (6929KB) ( 15 )  
Objective · To evaluate the efficacy and safety of sedation using oral midazolam in combination with intranasal dexmedetomidine for magnetic resonance imaging (MRI) in paediatric patients. Methods · A total of 186 children aged 3–8 years undergoing MRI in Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, from March 2019 to July 2019, were randomly assigned to two groups, who received either oral 50 mg/kg chloral hydrate combined with 2 μg/kg intranasal dexmedetomidine (chloral hydrate group, n=93) or oral 0.3 mg/kg midazolam combined with 2 μg/kg intranasal dexmedetomidine (midazolam group, n=93). The efficacy and safety of the sedative regimens were evaluated based on the successful sedation rate, sedation onset time, wake-up time, total sedation time and the incidence of clinical side effects. Results · The successful sedation rates were 98.9% and 94.6% in chloral hydrate group and midazolam group, respectively, with no significant difference (P>0.05). The sedation onset time was 20.0 (10.0, 20.0) min in midazolam group, which was longer than that in chloral hydrate group (P=0.000). The wake-up time was 15.0 (3.0, 31.8) min and the total sedation time was 68.0 (58.0, 82.0) min in midazolam group, both of which were significantly shorter than those in chloral hydrate group (P=0.000, P=0.001). The sedation in midazolam group was better accepted by children who did not experience nausea or vomiting. Hypotension and bradycardia were rare and did not require intervention in either group. Conclusion · Oral midazolam combined with intranasal dexmedetomidine is better accepted by the paediatric patients and the wake-up time of it is shorter, which may be used effectively and safely for sedation during paediatric MRI procedures.
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Expressions of FOSB and P16 and their correlation in different molecular subtypes of breast invasive ductal cancer
DAI Xin-zhen, MI Xian-jun, ZHONG Shou-jun, DUAN Li-feng, YANG Wei-hong, LIU Xiang-yu, XU Xiu-mei, CHEN Zhi-qiang
2020, 40 (08):  1103-1107.  doi: 10.3969/j.issn.1674-8115.2020.08.017
Abstract ( 6 )   PDF (6283KB) ( 9 )  
Objective · To detect the expressions of proto-oncogene protein FOSB and cyclin protein P16 in the different molecular subtypes of breast invasive ductal cancer and their correlation. Methods · The tumor tissues of 138 patients diagnosed with breast invasive ductal cancer by postoperative pathological examinations in Zhongshan Bo'ai Hospital from August 2013 to March 2019 were collected with normal breast tissues as control. Immunohistochemical staining was performed for the expressions of FOSB and P16 to investigate their correlation in the breast cancer. Besides, their expressions and their correlations in the different molecular subtypes of breast cancers, i.e. Luminal A, Luminal B [According to the expression of human epidermal growth factor 2 (HER2), it can be divided into HER2- and HER2+.], HER2 positive subtype, and triple-negative breast cancer (TNBC), were also detected. Results · ① The expression level of FOSB in 138 cases of breast invasive ductal cancer tissues was negatively correlated with P16 (r=-0.181, P=0.033). ② The expression of FOSB was significantly higher in Luminal A than those in other subtypes (P=0.028, P=0.033, P=0.001, P=0.010), while the expression of P16 was significantly higher in TBNC than those in other subtypes (P=0.025, P=0.005, P=0.008, P=0.011). ③ The expression level of FOSB in TBNC was negatively correlated with the expression of P16 (r=-0.566, P=0.018). Conclusion · The expressions of FOSB and P16 in the different molecular subtypes of breast invasive ductal cancer are different. The expression level of FOSB significantly increases in Luminal A, and that of P16 significantly increases in TBNC. There is a negative correlation between the expression levels of FOSB and P16 in TBNC.
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Clinical characteristics and genetic analysis of adult late-onset glycogen storage disease type II
ZU Juan*, QIAN Fang-yuan*, WU Di, XIE Xin-xin, REN Qing-guo, ZHANG Zhi-jun
2020, 40 (08):  1108-1112.  doi: 10.3969/j.issn.1674-8115.2020.08.018
Abstract ( 7 )   PDF (6359KB) ( 11 )  
Objective · To investigate the clinical and genetic characteristics of adult late-onset glycogen storage disease type Ⅱ (GSD Ⅱ). Methods · The clinical data, muscular magnetic resonance imaging (MRI) and muscle pathological characteristics of a patient with late-onset GSD Ⅱ were retrospectively analyzed and his family history was investigated. Peripheral blood DNAs of the proband and his father were extracted for genetic testing. Results · The proband presented progressive limb weakness for 7 years and short of breath after activities for 2 years. His parents were inbred, but he was the only one among the 18 members of 5 generations who had clinical phenotype. The blood creatine kinase moderately increased. The muscle MRI of both lower limbs showed that muscles were severely atrophied, and the fat component increased significantly. The pathological findings of muscle biopsy indicated vacuolar degeneration and increased activity of acid phosphatase. Gene sequencing confirmed that the pathogenicity was a homozygous mutation of acid α-glucosidase (GAA) gene c.1634C>T, and his father was a heterozygous mutation of c.1634C>T. Conclusion · Homozygous mutations of GAA gene c.1634C>T may lead to late-onset GSD Ⅱ .
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Original article (Public health)
Time series analysis and prediction on clinical usage demand of red blood cells
LIU Yun-nan1*, PENG Rong-rong1*, YANG Dong-yan2, ZHAO Ming-feng1, WANG Han-rou1, YANG Xiao-li1
2020, 40 (08):  1113-1119.  doi: 10.3969/j.issn.1674-8115.2020.08.019
Abstract ( 6 )   PDF (7031KB) ( 9 )  
Objective · To establish the clinical usage demand prediction model of red blood cells (RBCs) based on the autoregressive integrated moving average (ARIMA) model, and provide scientific basis for plans of blood collection and blood donor recruitment. Methods · Clinical RBCs outflow data of Chongqing Blood Center from January, 2006 to June, 2016 were collected, and SPSS software was used to establish ARIMA model of ABO blood groups. The clinical usage demand of ABO blood groups of RBCs from July to December, 2016 were predicted by using the established model and the prediction effect was verified by comparing with the actual value. Results · The optimal models of ABO blood groups were established successfully, i.e. blood group A was ARIMA(3,1,0)(1,1,0)12, blood group B was ARIMA(3,1,0)(0,1,1)12, blood group O was ARIMA(3,1,0)(1,0,1)12, and blood group AB was ARIMA(3,1,0)(0,1,1)12. There was no statistical significance of Ljung-Box Q statistics in each model. The residual sequences were white noise with good fitting effects. The dynamic trend of the fitted value and the actual value from January, 2006 to June, 2016 of each ARIMA model was approximately the same, the actual values of clinical usage demand from July to December, 2016 were within the 95%CI of predicted values, and the average relative errors were less than 10%. Conclusion · The ARIMA model has a high prediction accuracy, which can fit the trend of clinical usage demand of RBCs well, and is suitable for short-term prediction of clinical usage demand of ABO blood groups of RBCs.
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Moderating role of peer attachment in the relationship between adolescent knowledge-attitude-practice and psychological resilience
DIAO Hua, RAN Min, YANG Jing-wei, YANG Lian-jian, LI Ting, JIN Feng, PU Yang, WANG Hong
2020, 40 (08):  1120-1125.  doi: 10.3969/j.issn.1674-8115.2020.08.020
Abstract ( 7 )   PDF (7269KB) ( 12 )  
Objective · To explore the relationship between adolescent knowledge-attitude-practice (KAP), peer attachment and psychological resilience, and the moderating role of peer attachment in the relationship between adolescent KAP and psychological resilience. Methods · A stratified cluster sampling method was conducted, involving 5 105 subjects who were investigated by self-designed Adolescent KAP Questionnaire, Inventory of Peer Attachment and Resilience Scale for Chinese Adolescents. Statistical analysis and inference were performed using analysis of variance, t test, Pearson correlation analysis, hierarchical regression analysis and simple slope analysis. Results · The scores of target concentration, emotional control, positive cognition, family support and interpersonal assistance were more than 3 points for adolescents. Adolescent KAP, trust and peer communication had a significant positive predictive effect on target concentration, emotional control, family support and interpersonal assistance (all P<0.05). Peer estrangement was negatively related to all dimensions of psychological resilience (all P<0.05). Communication (B=0.007, SE=0.003, P=0.026) and peer estrangement (B=-0.010, SE=0.003, P=0.000) had the moderating effect on the relationship between adolescent KAP and psychological resilience. Conclusion · Adolescents have relatively better psychological resilience. Adolescents with higher adolescent KAP and greater peer attachment have better psychological resilience. Similarly, peer communication and estrangement can regulate the effect of adolescent KAP on psychological resilience.
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Review
Role of bile acid on maintaining metabolic homeostasis
LI Sen1, JIA Zi-heng1, WEI Xue-rui1, MA Sai1, LU Tian-cheng1, LI Ting-ting2, GU Yan-yun2
2020, 40 (08):  1126-1130.  doi: 10.3969/j.issn.1674-8115.2020.08.021
Abstract ( 10 )   PDF (8992KB) ( 16 )  
Bile acids are the main products of the cholesterol degradation in the liver. They promote the absorption and transportation of the intestinal lipids. Diverse bile acid receptors are widely distributed in human tissues and organs, including farnesoid X receptor (FXR) and Takeda G protein receptor (TGR5). The expression pattern of different bile acid receptors and their different affinities to various bile acids as their ligands determines their pleiotropic downstream effects, including regulating bile acid synthesis and transportation, immune and metabolism homeostasis. In addition, the bile acid pool includes components derived from both host and gut microbiota, which collaboratively contribute to the bile acid signaling activation in different compartments. Therefore, bile acid pool represents an information hub allowing the crosstalk between the host and gut microbiome and hereby modulating host metabolic homeostasis and gut microbiome symbiosis. This article reviews the recent advances in the field of bile acid regulation and the related mechanisms of bile acid signaling pathway to maintain metabolic homeostasis.
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Effect of asymmetric dimethylarginine on development of atherosclerosis in patients with chronic kidney disease
CHEN Sheng-nan, SHEN Yan
2020, 40 (08):  1131-1136.  doi: 10.3969/j.issn.1674-8115.2020.08.022
Abstract ( 4 )   PDF (9960KB) ( 10 )  
Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide synthase inhibitor and is associated with the incidence of atherosclerosis (AS). ADMA is increased in patients with chronic kidney disease (CKD), which is a predictor of early endothelial dysfunction in CKD and a serologic marker of AS. ADMA can directly lead to or indirectly promote AS, and the concentration of ADMA in vivo is relatively stable, not being easily influenced by other factors. So the prediction value of ADMA for AS and its adverse events in CKD patients is extremely high. ADMA can not only be used for early detection of AS but also be used for reflecting the effectiveness of early intervention and patients' response to treatment by monitoring its dynamic changes, helping in understanding the progress and predicting the prognosis of the disease. This paper reviews the causes of the increase of ADMA and its role in promoting the development of AS in CKD patients.
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Immunotherapy for lung cancer: immunosuppressive cells and intrapulmonary immunity
HE Chun-ming, YIN Hang, ZHENG Jia-jie, TANG Jian, FU Yu-jie, ZHAO Xiao-jing
2020, 40 (08):  1137-1142.  doi: 10.3969/j.issn.1674-8115.2020.08.023
Abstract ( 22 )   PDF (8469KB) ( 25 )  
Immunotherapy is one of the most rapidly developed tumor treatment strategies. Immune checkpoint inhibitors (ICIs) enhance the anti-tumor immune response by inhibiting the inhibitory effect of tumor cells on T cells. At present, antibodies against cytotoxic T-lymphocyte associated protein 4 (CTLA-4), programmed death-1 (PD-1) and programmed death ligand-1 (PD-L1) have been approved for clinical therapies. However, those treatments are only effective in the minority of patients. This may be related to the deeper immunosuppression mediated by myeloid-derived suppressor cells (MDSCs) and regulatory cells (Tregs). The microenvironment of the lung affects tumor immunity with its unique physiological function, which can quickly resist pathogens to maintain immune balance in the lung, but also can promote tumor progression. In this paper, the effects of immunosuppressive cells in the treatment of ICIs and the role of them in the lung immune environment are analyzed to explore the strategies to improve the effect of immunotherapy in patients with lung cancer.
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New direction in diagnosis and assessment of personality disorders
HU Jia, QIU Jian-yin
2020, 40 (08):  1143-1147.  doi: 10.3969/j.issn.1674-8115.2020.08.024
Abstract ( 16 )   PDF (7852KB) ( 23 )  
The diagnosis of personality disorders was formally presented in the first edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-1). DSM-3 proposed a systematic framework for understanding personality disorders, and mentioned the multi-axis diagnosis strategy and category diagnosis criteria. The following editions of DSM still mentioned the strategy and criteria. DSM-5, published in 2013, mentioned the alternative model for personality disorders (AMPD), which indicated a new direction in the diagnosis and assessment of personality disorders. AMPD had a dimensional assessment of the severity of personality pathology (criterion A), and a dimensional assessment of features of personality pathology (criterion B). The criterion A was influenced by the concepts of psychodynamics, like the distinction and integration of self and object in the Kernberg model of personality organization. Level of Personality Functioning Scale (LPFS) and Personality Inventory for DSM-5 were developed to assess personality disorders mentioned in AMPD. The reliability and validity of the tools were demonstrated. Structured Interview of Personality Organization, an assessment tool based on Kernberg model of personality organization, was proved to have significant correlation with LPFS.
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Research progress on related risk factors of premature coronary artery heart disease
XU Hui, LIU Fang
2020, 40 (08):  1148-1151.  doi: 10.3969/j.issn.1674-8115.2020.08.025
Abstract ( 8 )   PDF (7164KB) ( 23 )  
Coronary artery heart disease (CHD) is a common clinical disease with high morbidity and mortality. In recent years, with the improvement of people's living standards and the changes of lifestyle, the age of CHD tends to be younger. Based on the present research situation at home and abroad, this paper explores the hereditary factors, clinical risk factors, inflammatory indexes and new inflammatory markers related to the diagnosis and treatment of premature CHD (PCHD). And the particularity of PCHD in women is analyzed. It is pointed out that PHD is dominated by hereditary factors, with multiple risk factors participating together including psychological factors, and closely related to inflammatory indicators. The emergence of new inflammatory markers provides certain value for the prediction, diagnosis and treatment of PCHD.
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Research progress in diagnosis and treatment of eosinophilic gastroenteritis
BAI Ya-ya, YAO Wei-yan
2020, 40 (08):  1152-1156.  doi: 10.3969/j.issn.1674-8115.2020.08.026
Abstract ( 8 )   PDF (8285KB) ( 18 )  
Eosinophilic gastroenteritis (EGE) is a rare chronic disease of digestive system, characterized by the eosinophil in?ltration of the gastrointestinal tract and the thickening of the gastrointestinal wall. At present, the etiology and pathogenesis of EGE are still unclear. Accompanied with eosinophilia and elevation of serum immunoglobulin E, the clinical manifestations of EGE are dependent on the location of lesions and the extent or depth of eosinophil in?ltration in the gastrointestinal tract. The thickening or edema of the gastrointestinal wall, nodular-like changes, intestinal stenosis and ascites can be regarded as common radiological findings of EGE, while erythema, hyperemia or edema, erosion and ulcer of mucosal are the endoscopic features of EGE. Tissue biopsy is helpful for the diagnosis of EGE. However, with unspecific clinical manifestations, laboratory tests, radiological and endoscopic findings and unidentified cut-off count of pathological diagnostic criteria, EGE is very difficult to be diagnosed. Therefore, this paper mainly reviews the research progress in the diagnosis and treatment of EGE, attempting to improve the clinicians' understanding of EGE.
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