Journal of Shanghai Jiao Tong University (Medical Science)

PTEN-regulated alternative splicing of FoxM1 affects tumor cell migration

WANG Xiaoling, GE Mengkai, SHEN Shaoming

2023, 43 (11): 1339-1347.
doi: 10.3969/j.issn.1674-8115.2023.11.001

Abstract ( 149 )

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Objective ·To study the effect of phosphatase and tensin homolog on chromosome 10 (PTEN) on alternative splicing of forkhead box M1 (FoxM1), and its impact on tumor cell migration. Methods ·PTEN was knocked down by short hairpin RNA (shRNA) in human embryonic kidney 293T cells, human prostate cancer DU145 cells, human colorectal adenocarcinoma RKO cells, and human colon cancer SW480 and SW620 cells. Specific primers were designed for FoxM1 and its subtypes FoxM1B and FoxM1C, and the mRNA expression levels of FoxM1B and FoxM1C were detected by quantitative real-time PCR (qRT-PCR). FoxM1B and FoxM1C were overexpressed in DU145 cells, and their effects on tumor cell migration were tested by Transwell assay and wound healing assay. Immunofluorescence and dual luciferase reporter gene assay were used to explore the potential mechanism of differential regulation of tumor cell migration by FoxM1B and FoxM1C. Results ·① PTEN was knocked down in 293T, DU145, RKO, SW480, and SW620 cell lines. qRT-PCR results showed that compared with the control cells, the mRNA expression level of FoxM1B significantly increased in PTEN knockdown cells, while the mRNA expression level of FoxM1C decreased or remained unchanged. Knockdown of PTEN did not affect the transcription level of FoxM1, but caused the variable splicing of FoxM1 and promoted the generation of FoxM1B. ② Compared with the control cells, the number of DU145 cells migrating to the below chamber increased in the FoxM1B overexpression group (P=0.024), while the number of migrating DU145 cells in the FoxM1C overexpression group was lower (P=0.000). The healing ability of DU145 cells was significantly enhanced in the FoxM1B overexpression group (P=0.001), while the healing ability of DU145 cells was weakened in the FoxM1C overexpression group (P=0.021). Overall, FoxM1B and FoxM1C had opposite effects on tumor cell migration. FoxM1B promoted tumor cell migration, while FoxM1C inhibited tumor cell migration. ③ Neither FoxM1B nor FoxM1C overexpression could induce β-catenin to enter the nucleus. Dual luciferase reporter gene assay showed no difference in the transcriptional activity of FoxM1B and FoxM1C. The difference between FoxM1B and FoxM1C in the regulation of tumor metastasis was also not mediated by β-catenin translocation. Conclusion ·Knockdown of PTEN regulates the alternative splicing of FoxM1, leading to increasing expression of transcript FoxM1B, which plays a positive role in tumor cell migration.

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Association between stroke and physical activities in Shanghai Community Elderly Cohort

WANG Yayu, JIANG Huiru, YE Mengyue, LI Ping, YUAN Ancai, ZHANG Wei, PU Jun

2023, 43 (11): 1348-1358.
doi: 10.3969/j.issn.1674-8115.2023.11.002

Abstract ( 129 )

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Objective ·To compare the physical activities of stroke population and non-stroke population based on the baseline survey of the elderly population cohort in Shanghai communities, and explore the participation in different types of physical activities of stroke population. Methods ·The subjects were screened from Shanghai Community Elderly Cohort constructed from February to August, 2019 according to the admission criteria. The subjects were divided into non-stroke group and stroke group according to whether they had reported a history of stroke by themselves, and the two groups were matched 2 to 1 by controlling age and sex with propensity score matching. The baseline characteristics of the two groups were collected, and the physical activities related to sports, transportation and housework in the last week were investigated with the International Physical Activity Questionnaire (IPAQ). Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality of the subjects. Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to evaluate anxiety and depression of the subjects, respectively. The above characteristics were compared between the stroke group and non-stroke group, and the participation of different types of physical activities were compared between the two groups by multivariate Logistic regression model. Results ·Among the 17 948 people included, there were 993 (5.5%) in the stroke group and 16 955 (94.5%) in the non-stroke group. After propensity score matching, there were 1 984 people (66.7%) in the non-stroke group and 992 people (33.3%) in the stroke group. There were significant differences in education level, pre-retirement occupation, waist circumference, body mass index, sleep status, anxiety symptoms, depression symptoms and disease history between the two groups (all P<0.05). In terms of physical activities, the female stroke group had shorter daily moderate exercises time, fewer riding and walking days in one week, and shorter daily riding time, compared with the non-stroke people, with statistical significance (all P<0.05). Compared with the non-stroke people, the weekly housework days and daily housework time in the male and female stroke groups were lower than those in the non-stroke group, while the daily sedentary time was longer, with statistical significance (all P=0.000). In terms of physical activity level, the proportions of men and women in the stroke group who reached medium or high level were lower than those in the non-stroke group, and the differences were statistically significant (all P=0.000). After adjusting for gender, age, occupation, anxiety symptoms, history of hyperlipidemia, history of atrial fibrillation, history of chronic gastritis and history of hip fracture by multivariate Logistic regression model, the level of vigorous exercise participation in the stroke group was lower, the proportions of no housework in the last week and sedentary time greater than 180 min per day were higher, and the proportion at medium and high activity levels was lower (all P<0.05). Conclusion ·The frequency and duration of housework participation and the physical activity level of elderly people with a history of stroke in Shanghai communities are at a lower level than those without stroke, and they also have a longer sedentary time.

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Causal relationship between atrial fibrillation and cognitive impairment: a Mendelian randomization study

GAO Xiong, ZHANG Qiuxia, YANG Miaomiao, LUO Wei, WANG Yuegang, XIU Jiancheng

2023, 43 (11): 1359-1365.
doi: 10.3969/j.issn.1674-8115.2023.11.003

Abstract ( 183 )

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Objective ·To investigate the causal relationship between atrial fibrillation (AF) and cognitive impairment. Methods ·A two-sample Mendelian randomization (TSMR) analysis was used to assess the potential causality of AF on cognitive dysfunction. Single nucleotide polymorphisms (SNPs) strongly associated with AF were extracted as instrumental variables by using a dataset of a large-scale genome-wide association study (GWAS) on AF. The associations of SNPs with Alzheimer′s disease dementia, Parkinson′s disease dementia, vascular dementia, Lewy body dementia, frontotemporal dementia, undefined dementia, and overall cognitive function assessment were extracted separately from publicly available GWAS data on cognitive dysfunction. The inverse variance-weighted (IVW) method was used for the main analysis, and sensitivity analyses were conducted by using Cochran′s Q test, MR-Egger regression, and leave-one-out method. To verify the robustness of the results, replicate analyses and meta-analyses were performed by using different GWAS data. Results ·In the initial analysis, 101 SNPs were extracted as instrumental variables from a meta-analysis of a genome-wide association study involving up to 1 030 836 individuals. The IVW analysis showed no evidence for causal associations between AF and dementia [dementia (OR=1.032; 95%CI 0.973?1.094; P=0.290), Parkinson′s disease dementia (OR=1.004; 95%CI 0.780?1.291; P=0.977), vascular dementia (OR=1.123; 95%CI 0.969?1.301; P=0.125), or unspecified dementia (OR=1.013; 95%CI 0.910?1.129; P=0.807)]. In the replication analysis, 27 SNPs were extracted as instrumental variables from the FinnGen AF GWAS data, and the IVW analysis were consistent with the initial analysis [cognitive function (OR=0.999; 95%CI 0.982?1.016; P=0.874), Alzheimer′s disease dementia (OR=0.977; 95%CI 0.943?1.012; P=0.193), Lewy body dementia (OR=1.014; 95%CI 0.898?1.145; P=0.826), or frontotemporal dementia (OR=0.996; 95%CI 0.745?1.333; P=0.980)]. Both Mendelian randomization analyses and meta-analyses showed no evidence of an association between genetically predicted AF and different types of dementia or overall cognitive function assessment. MR-Egger regression suggested no horizontal pleiotropy and leave-one-out analysis showed stable results after individually removing each SNP. Conclusion ·No evidence of a causal relationship between AF and cognitive impairment was found. The associations observed in observational studies can be partially attributed to confounding factors such as shared biology or co-morbidities.

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Correlation analysis between sleep quality and carotid atherosclerosis in low and moderate risk individuals for cardiovascular and cerebrovascular diseases

ZHAO Qian, WANG Ying, HAMULATI Xieyire, TUERXUN Gulijiehere, LI Xiaomei, YANG Yining

2023, 43 (11): 1366-1373.
doi: 10.3969/j.issn.1674-8115.2023.11.004

Abstract ( 123 )

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Objective ·To explore the relationship between sleep quality and carotid atherosclerosis in the population with low or moderate risk of cardiovascular and cerebrovascular diseases. Methods ·Based on the population-based cohort study of chronic diseases in Xinjiang, the researchers selected residents aged 35－75 from two fixed communities in Urumqi and Korla, in Northern and Southern Xinjiang, respectively, using a two-stage random cluster sampling method from July 2019 to September 2021. In the population without a history of coronary heart disease and cerebrovascular events, the prediction model for atherosclerotic cardiovascular disease (ASCVD) risk in China (China-PAR) was used to evaluate the risk of cardiovascular and cerebrovascular diseases. Low and moderate risk population of cardiovascular and cerebrovascular diseases were included. Participants completed physical examinations, questionnaires [including the Risk Factors Assessment Scale of Cardiovascular and Cerebrovascular Diseases in Xinjiang, Pittsburgh Sleep Quality Index (PSQI), International Physical Activity Questionnaire (IPAQ), and Food Frequency Questionnaire], cardiovascular and metabolic biochemical examinations, and carotid color doppler. Carotid intima-media thickness (CIMT) and plaque formation were used to determine the carotid atherosclerosis of the study subjects. Multivariate Logistic regression model and restricted cubic spline (RCS) were used to analyze the relationship between sleep quality and carotid intima-media thickening/plaque formation in the population with low and moderate risk of cardiovascular and cerebrovascular diseases. Results ·A total of 1 528 subjects were included in the study, the mean age was (49.4±8.2) years, and 685 (44.8%) were male. In the included population, there were 581 (38.0%) subjects with carotid intima-media thickening and 305 (20.0%) subjects with carotid plaque formation. Among them, intima-media thickening and plaque formation both occurred in 154 (10.1%) people. Therefore, the prevalence of carotid atherosclerosis was 47.9% (732 subjects). Compared with the group without carotid artery thickening, the group with carotid intima-media thickening/plaque formation had higher levels of general cardiovascular and cerebrovascular risk factors, including age, male ratio, blood lipid levels and obesity, and higher PSQI sleep score [(7.06±2.13) vs (7.43±2.51), P=0.001]. The proportion of patients with poor sleep quality was higher (6.5% vs 12.1%, P=0.001). Multivariate Logistic regression analysis showed that poor sleep quality was an independent risk factor for carotid atherosclerosis [adjusted OR (aOR)=1.22, 95%CI 1.004－1.492, P=0.040]. RCS analysis suggested that PSQI and the risk of carotid atherosclerosis showed a positive linear correlation, that is, the worse quality of sleep, the higher risk of carotid atherosclerosis. Conclusion ·Although the traditional metabolic risk factors are at a low risk level, the prevalence of carotid atherosclerosis is high and poor sleep quality is an independent risk factor for carotid atherosclerosis in the low and moderate risk population of cardiovascular and cerebrovascular diseases.

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Construction of an mRNA vaccine encoding hemagglutinin of influenza A H1N1 virus and investigation on booster immunization strategy

SHEN Haiqian, YU Kangying, CHEN Yingying, JI Ping, WANG Ying

2023, 43 (11): 1374-1383.
doi: 10.3969/j.issn.1674-8115.2023.11.005

Abstract ( 139 )

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Objective ·To construct an mRNA vaccine encoding hemagglutinin (HA) of influenza A H1N1 virus, and explore the protective effects of different booster vaccination strategies. Methods ·Firefly luciferase (Fluc) was used as the reporter gene to construct Fluc mRNA vaccine enveloped in lipid nanoparticles (LNP). The in vivo expression of Fluc mRNA-LNP after intramuscular injection was determined by live imaging assay in mice. Furthermore, M15-HA mRNA-LNP derived from H1N1 subtype (A/Michigan/45/2015) was constructed. Mice were immunized with 20, 10, 5, or 1 μg doses of M15-HA mRNA-LNP twice (with an interval of 3 weeks) through intramuscular injection. Serum antibody titers were measured by enzyme-linked immunosorbent assay (ELISA) at 2 weeks and 4 weeks after the second immunization, and functional antibody levels were detected by hemagglutination inhibition test. The third booster vaccination was performed 40 d after the second immunization in 1 μg dose group with 1 μg M15-HA mRNA-LNP or 10 μg HA subunit vaccine. The levels of specific antibody and functional antibody were detected by ELISA and hemagglutination inhibition test, respectively 2 weeks and 4 weeks later. Results ·Live imaging assay showed that luciferase activity could be detected in mice 1 d after injection of Fluc mRNA-LNP. At 2 weeks and 4 weeks after the second immunization of M15-HA mRNA-LNP, HA-specific antibodies were significantly higher than those before the immunization in all vaccination groups at different doses (P=0.000). The hemagglutination inhibition test showed that the levels of functional antibodies in the 20 μg dose and 10 μg dose groups were significantly higher than those in the PBS control group (P<0.05). After 1 μg dose group mice were immunized with HA protein or M15-HA mRNA-LNP, higher levels of HA-specific antibody and functional antibody were induced and maintained for a long time. There was no significant difference between the two different booster immunization strategies. Conclusion ·M15-HA mRNA-LNP vaccine is constructed with immunogenicity and antibody neutralization activity. Low-dose mRNA priming vaccination followed by both homologous mRNA vaccine and heterologous protein subunit vaccine booster vaccination can induce stronger immune recall responses.

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Quantitative analysis of the developmental potential of cells and tissues based on evolutionary conservation of genes and regulatory regions

WANG Zhiming, TONG Ran, YANG Chen, JIAO Huiyuan, WANG Yihao, LI Linying, WANG Yexin, ZHANG Feng, LI Lingjie

2023, 43 (11): 1384-1395.
doi: 10.3969/j.issn.1674-8115.2023.11.006

Abstract ( 112 )

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Objective ·To study the relationship between evolution and the developmental process from the perspective of DNA sequence conservation, and explore their inherent principles. Methods ·First, conservation rate (CR) was established by analyzing the conservation of amino acid sequences of coding genes in 100 species to quantify the evolutionary conservation of genes. The relationship between CR and developmental potential was verified by using the feature genes involved in embryonic stem cells pathways. Secondly, cell type-specific genes and their characteristics in conservation were studied by analyzing the RNA sequencing (RNA-seq) data of the three early germ layers (ectoderm, mesoderm and endoderm) and their corresponding mature organs (brain, heart, liver, etc). Then, chromatin immunoprecipitation sequencing (ChIP-seq) data of enhancer histone H3 acetylated at lysine 27 (H3K27ac) from early germ layers and mature organs were collected to search for enhancer sites and identify super enhancers in various cells and tissues by using the ROSE procedure. Functional enrichment and signaling pathway analysis of genes was used to examine the identity correlation between SEs-regulated genes and the corresponding cell characteristics, to clarify whether the SEs identified in this study were consistent with the characteristics reported in previous studies. Finally, PhastCons program was used to calculate the DNA conservation score (CS) of non-coding regulatory regions to study their relationship with developmental potential. Results ·In the coding region of DNA, CR was successfully established to quantify the conservation of genes. The gene expression data of early germ layers and mature organs showed that the genes with higher conservation rate were more relevant to the stemness and early developmental process, and the differences between the tissues from early and late development could be distinguished by using CR. In the non-coding regions of DNA, it was found that the conservation of regulatory regions was also correlated with development. The CS of the SE sequences in the early developmental germ layers was significantly higher than that of the SE sequences in the corresponding mature organs. However, cell-specific typical enhancers (TEs) did not show such a trend. Conclusion ·During the developmental process, CR of genes expressed in the coding region decreases, and CS of super-enhancer DNA in the non-coding region decreases.

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Changes in drug resistance of Acinetobacter baumannii during the change of meropenem concentration in the environment and its mechanism

ZHAO Fumao, PENG Mei, PENG Xiaolu, SHU Weiwei, PENG Li

2023, 43 (11): 1396-1407.
doi: 10.3969/j.issn.1674-8115.2023.11.007

Abstract ( 132 )

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Objective ·To explore the mechanism of changes in resistance to meropenem (MEM), a carbapenem drug, in Acinetobacter baumannii (A. baumannii) cultured in different antibiotic concentrations. Methods ·Through changing the MEM concentration and other culture conditions of the standard sensitive strain of A. baumannii ATCC19606 and the clinical drug-resistant strain AB.2014, the derived strains with different levels of MEM-resistance were induced. The growth curves of all the stains were detected. DNA and RNA of them were extracted. PCR was used to analyze the expression of carbapenemase genes, including IMI, KPC, GES-1, IMP, VIM, NDM-1, OXA23, OXA24, OXA51, and OXA58. Real-time fluorescent quantitative PCR (RT-qPCR) was used to analyze the expression levels of the carbapenemase gene (OXA51), efflux pump genes (adeB, adeG, and adeJ), pore protein genes (carO, omp33-36, and oprC)and the penicillin-binding protein gene (ponA)in the A. baumannii strains with different resistance to MEM, of which the differential gene enrichment was also detected by whole genome sequencing and bioinformatics tools. Results ·The 11 derived strains of ATCC19606 and AB.2014 with different levels of resistance to MEM were obtained, of which the minimum inhibitory concentrations (MIC) were 1?128 μg/mL. The growth rates and peak values of ATCC19606 and its derivatives decreased with the increase of drug resistance, but AB.2014 and its derivatives did not show this trend. ATCC19606 and its derived strains expressed 3 carbapenemase genes, i.e., OXA51, VIM and IMP, while AB.2014 and most of its derived strains expressed 4 carbapenemase genes, i.e., OXA23, OXA51, VIM and IMP, with only one sensitized derivative of AB.2014 losing OXA23 gene. RT-qPCR results showed that only in ATCC19606 and its drug-resistant derivatives, the expression level of oprC gene decreased with the increase of drug resistance, and the expression levels of most drug-resistant genes were consistent with the changes of drug resistance levels of the strains. Bioinformatics analysis indicated that the differential genes among different ATCC19606 strains were mainly enriched in the siderophore uptake transmembrane transporter activity, cell outer membrane, bacterial secretion system and quorum sensing, while those among AB.2014 strains were mainly enriched in cell outer membrane, cellular response to chemical stimulus, atrazine degradation and RNA polymerase. Conclusion ·The environmental pressure from carbapenems will cause the change of drug resistance of A. baumannii with the involvement of the genes of carbapenemases, efflux pumps, pore proteins and penicillin-binding proteins. The loss of carbapenemase gene OXA23 may lead to the desensitization of drug-resistant A. baumannii strains to carbapenems.

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Latent profile analysis of multiple symptom distress in children and adolescents with cancer and its effect on their physical activity

LIU Yanyan, YANG Tiantian, SHEN Nanping, HE Mengxue, ZHANG Hongyan

2023, 43 (11): 1408-1416.
doi: 10.3969/j.issn.1674-8115.2023.11.008

Abstract ( 94 )

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Objective ·To describe the level of multiple symptom distress and physical activity in children and adolescents with cancer, analyze symptom distress profiles, and explicit the relationship between latent profiles and physical activity. Methods ·From November 2021 to March 2023, the convenient sample method was used to recruit children and adolescents with cancer aged 10－18 years old, who had been treated for more than 1 month in the Departments of Hematology/Oncology, Shanghai Children′s Medical Center and Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine. The questionnaires, including General Information Questionnaire, Memorial Symptom Assessment Scale 10-18 (MSAS 10-18) and Modified Chinese Version of Children′s Leisure Time Activities Study Survey (CLASS-C), were used. Latent profile analysis was used to identify whether the level of multiple symptom distress in children and adolescents with cancer was population heterogeneity and its explicit characteristics. Whether there were differences in physical activity levels among different profiles of symptom distress was also analyzed. Results ·A total of 165 valid questionnaires were collected, with an effective response rate of 91.7%. The symptom distress scores of the top five occurrence rates of symptoms in children and adolescents with cancer were lack of energy with a median of 1 (1, 2) point, nausea 1 (1, 2) point, lack of appetite 2 (2, 3) points, sweat 1 (1, 2) point, and pain 1 (1, 2) point. The physical activity level of the patients was mainly light, with a median of 2 530.00 (1 577.50, 3 721.00) min/week, and moderate to vigorous physical activity was relatively lower [70.00 (10.00, 197.50) min/week]. The patients with cancer could be divided into two latent profiles: "high fatigue-high nausea-high hair loss-high sleepy" and "high fatigue-low nausea-low vomiting-low sleepy", which were named as high symptom distress (n=47, 30.6%) and low symptom distress (n=118, 69.4%) separately. Multivariate Logistic regression analysis showed that patients with acute lymphoblastic leukemia were more likely to be classified as high symptom distress group, and outpatients in the latest hospital visit were more likely to classified as low symptom distress group (both P<0.05). In addition, patients with high symptom distress had a higher level of light physical activity (P<0.05), and had a lower level of moderate to vigorous physical activity, but the difference was not statistically significant. Conclusion ·There is population heterogeneity in the multiple symptom distress in children and adolescents with cancer. Disease type (acute leukemia) and the way of the latest hospital visit (through outpatient department) are the predictors of symptoms profiles of patients with cancer. Patients who experience high symptom distress have higher level of light physical activity, and perhaps lower level of moderate to vigorous physical activity.

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Distribution characteristics of vaginal flora and pregnancy outcomes in cervical incompetence patients

LI Xue, XIAO Yi, ZHANG Hong

2023, 43 (11): 1417-1422.
doi: 10.3969/j.issn.1674-8115.2023.11.009

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Objective ·To investigate the distribution characteristics of vaginal flora in patients with cervical incompetence (CIC), and the effect of cervical cerclage on pregnancy outcome in patients with CIC with abnormal vaginal flora. Methods ·A total of 1 261 pregnant women participated in the study. According to the diagnosis, they were divided into cervical incompetence group (CIC group) and normal pregnancy group (NP group). The CIC group patients randomly received cervical cerclage (CIC-C group) or expectation therapy (CIC-E group). Vaginal secretion samples of the patients in the groups were collected and analyzed in the laboratory. Meanwhile, through the results of vaginal flora, the CIC-C group and CIC-E group were further divided into normal vaginal flora groups (CIC-C-N group and CIC-E-N group) and abnormal vaginal flora groups (CIC-C-A group and CIC-E-A group). All groups were processed accordingly and analyzed on pregnancy outcomes. T-test and Chi-squared test were used for comparison between the groups, and One-way ANOVA was used for comparison among the three groups. Statistical significance was accepted at a value of P<0.05. Results ·Among 1 261 vaginal secretion specimens, the positive rate of pathogenic bacteria was 22.0% (277/1 261). The pathogen detection rates in the CIC group and NP group were 32.9% (229/696) and 8.5% (48/565). Twenty-three types of vaginal flora were detected in the CIC group, and 9 were detected in the NP group. The proportions of women who had term birth were 75.94% in the CIC-C group, 70.03% in the CIC-E group, and 87.79% in the NP group (P=0.000). Compared with the CIC-C-A group, the CIC-E-A group had a lower term delivery rate (61.84% vs 77.78%, P=0.011) and a higher incidence of pregnancy complications (22.37% vs 9.15%, P=0.006). Conclusion ·There are differences in the distribution and diversity of vaginal flora between CIC patients and normal pregnant women. Cervical cerclage can improve pregnancy outcomes in CIC patients with abnormal vaginal flora.

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Analysis of influencing factors of adaptation level in patients with permanent enterostomy

TAI Rui, FANG Fang, MAO Jingjue, ZHOU Xia

2023, 43 (11): 1423-1429.
doi: 10.3969/j.issn.1674-8115.2023.11.010

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Objective ·To investigate the level of stoma adaptation in patients with permanent enterostomy and its influencing factors. Methods ·In this cross-sectional study, 260 patients with permanent enterostomy from North Campus in Hongkou and South Campus in Songjiang of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine were recruited by convenience sampling approach from January to December, 2022. The level and the influencing factors of stoma adaptation were investigated by general information questionnaire, Chinese version of Ostomy Adjustment Inventory-20 (OAI-20), Hospital Anxiety and Depression Scale, Stoma Self-Efficacy Scale, Body Image Scale, and The Revised Dyadic Adjustment Scale. Statistical description used mean and standard deviation, frequency and percentage. T test, ANOVA, Spearman correlation and multiple linear regression analyses were preformed to explore the influencing factors of the level of stoma adaptation. Results ·The mean score of OAI-20 was (42.28±11.47). One-way ANOVA results showed the effects of registered residence (P=0.001), monthly income (P=0.000) and the ostomy-related complications (P=0.000) on the OAI-20 score were statistically significant. Spearman correlation analysis results showed that the OAI-20 score was positively correlated with stoma self-efficacy and marital adjustment score (r=0.713, P=0.000; r=0.645, P=0.000), but negatively correlated with anxiety and depression and body image score (r=-0.391, P=0.000; r=-0.523, P=0.000). Four of the eleven variables, ostomy-related complications, anxiety, self-efficacy of ostomy caring and marital satisfaction, were selected by the multiple linear stepwise regression analysis, and could explain 59.8% of total variance (P=0.000). Conclusion ·Most patients with permanent enterostomy have a low level of adaptation. Ostomy-related complications, anxiety, self-efficacy of ostomy caring and marital satisfaction are the main influencing factors of the level of stoma adaptation.

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Effect and complications of different surgical methods in treatment of laryngeal carcinoma

JIANG Yongquan, DAI Li, CHEN Tianhong, WANG Jingshuo, ZHANG Yi, LI Jiping

2023, 43 (11): 1430-1435.
doi: 10.3969/j.issn.1674-8115.2023.11.011

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Objective ·To compare the effects and complications of carbon dioxide laser laryngectomy and open partial laryngectomy in the treatment of laryngeal carcinoma. Methods ·Clinical data of 101 patients with stage Ⅰ-Ⅲ laryngeal squamous cell carcinoma admitted to Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2013 to January 2018 were selected and divided into open surgery group and minimally invasive group according to different surgical methods. The open surgery group received open partial laryngectomy (57 cases), and the minimally invasive group received carbon dioxide laser laryngectomy (44 cases). Follow-up visits were made by telephone and outpatient visits, and the operation time, postoperative laryngeal mucosa edema time, length of stay, 5-year survival rate, complication rate and recurrence rate of the two groups were compared in the different clinical stages (stage Ⅰ, stage Ⅱ, and stage Ⅲ) and tumor locations (glottic type and non-glottic type). Results ·The operation time, postoperative laryngeal mucosa edema time and length of stay of the minimally invasive group were shorter than those of the open surgery group (P<0.05). Comparison of the 5-year survival rates of patients with the same clinical stage and glottic type between the two groups showed no statistically significant difference (both P>0.05); while comparison of the 5-year survival rates of patients with non-glottic type between the two groups (62.5% in the open surgery group vs 0 in the minimally invasive group) showed a statistically significant difference (P<0.05). In the minimally invasive group, there were 3 cases of complications, including 1 case of fever and 2 cases of lung infection; in the open surgery group, there were 14 cases of complications, including 5 cases of fever, 7 cases of lung infection and 2 cases of pharyngeal fistula. The complication rate of patients in the minimally invasive group (6.82%, 3/44) was lower than that in the open surgery group (24.60%, 14/57), and the difference was statistically significant (P<0.05); the complication rate of patients with stage Ⅱ and glottic type in the minimally invasive group was significantly lower than that in the open surgery group (P<0.05). Comparing the recurrence rate of patients in the two groups (10.53% in the open surgery group vs 2.27% in the minimally invasive group), the difference was not statistically significant (P>0.05). Conclusion ·Compared with open partial laryngectomy, carbon dioxide laser laryngectomy has faster postoperative recovery and lower complication rate in the treatment of early and middle laryngeal malignant tumors, so it is worth promoting.

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Current status of development of Chinese versions of insomnia-related scales

LUO Xin, YUAN Chengmei

2023, 43 (11): 1436-1444.
doi: 10.3969/j.issn.1674-8115.2023.11.012

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Insomnia disorder is the most common sleep-wake disorder, and long-term insomnia has a serious negative impact on the physical and mental health of individuals. It is crucial for researchers and clinicians to select appropriate measurement tools as evaluative indicators for insomnia. There are some commonly used insomnia assessment scales in the world, including Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), etc. These scales are widely used to assess insomnia symptoms and sleep quality, providing researchers and clinicians with reliable quantitative tools. In addition to conventional insomnia assessment scales, some scales evaluate sleep cognition, sleep hygiene, and sleep conditions of different groups of people. Domestic scholars are actively developing sleep assessment tools suitable for the Chinese population, which also include sleep assessment for special groups. In addition, some sleep assessment with traditional Chinese medicine characteristics have also been developed to meet the needs of integrated traditional Chinese and Western medicine treatment. During the process of scale development, researchers should clarify the purpose of scale, select appropriate psychometric methods, and emphasize the reliability and validity of the scale. Furthermore, it is important to develop scales that can differentiate subtypes of insomnia and enhance the diversity of insomnia-related measures. This article summarizes the current situation of development of Chinese versions of insomnia-related scales, and provides evaluation and future prospects for existing scales.

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Advances in the role of circular RNA in schizophrenia

FU Lirong, ZHANG Chen

2023, 43 (11): 1445-1449.
doi: 10.3969/j.issn.1674-8115.2023.11.013

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Schizophrenia is a complex and severe mental disorder, the precise cause of which remains unknown. Circular RNA (circRNA), a type of non-coding RNA with a loop-like structure, is abundant in eukaryotic cell transcriptomes. Recent advancements in molecular genetics have allowed researchers to gain a better understanding of circRNA′s expression profile and biological functions. These molecules play critical roles in various biological processes, including regulation of gene expression, synaptic plasticity, and cognitive flexibility. Due to its high concentration in the mammalian brain, circRNA is involved in neurodevelopment and the maintenance of neural function. Changes in circRNA levels, both within and outside of cells, have been linked to numerous neuro-psychiatric disorders, including schizophrenia. As such, circRNA has a crucial and distinctive function in neuro-psychiatric disorders. Given its characteristics, biological functions, and regulatory roles in diseases, researchers are exploring the abnormal expression of circRNA in schizophrenia and its connection to the onset and progression of the disease. Among them, exosomal circRNA, due to its high stability, disease specificity, and abundant content, is poised to become a potential biological marker for diagnosing schizophrenia. This article provides an extensive overview of the recent circRNA and schizophrenia research, discussing the possibility of using exosomal circRNA as a diagnostic biomarker and therapeutic target for schizophrenia.

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Advances in stem cell therapy for sensory nerve injury

CHEN Huidong, ZHANG Yunlong, ZHANG Zhijian, HUA Qingquan

2023, 43 (11): 1450-1456.
doi: 10.3969/j.issn.1674-8115.2023.11.014

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Sensory nerves belong to the afferent nerve part of the peripheral nervous system. Their role is to accept the stimuli inside and outside the body and transmit them to the center nerve system to form sensations or reflexes. Sensory nerve damage can be caused by trauma, tumor invasion, surgical injury, etc. Sensory nerve injury may cause decline or loss of some sensory organs function in patients. Damage of important sensory nerves such as optic nerves and auditory nerves can bring profound troubles to patients' lives. So far, the main clinical method to repair sensory nerves is autologous nerve transplantation. However, its application is limited by various factors, and the recovery effect of nerve function is often limited. Stem cells have the potential of multi-directional differentiation, which can differentiate into Schwann cells, and then secrete neurotrophic factors to promote axonal growth and myelin regeneration. Schwann cells directionally proliferate and form Büngner zones which guide nerve regeneration. Stem cells can also differentiate into neurons and construct nerve defect repair materials, which is an ideal choice for nerve repair. At present, the tissue engineering technology based on stem cells, combined with several key biotechnology, such as the use of biopolymerized or artificial surface micro-patterning nerve conduit to bridge nerve defects, and the use of microspheres to achieve the controlled release of extracellular matrix proteins and neurotrophic factors, is being widely studied and has achieved certain research results. This article reviews the research progress of stem cells in the repair of several major sensory nerves, such as optic nerves, olfactory nerves, cochlear nerves and sensory nerve fibers of sciatic nerve, expecting to provide a new perspective for neural repair of stem cells, broaden the preclinical research in nerve repair, and provide reference for follow-up clinical application.

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Research progress in diagnosis and differential diagnosis of severe fever with thrombocytopenia syndrome and hemorrhagic fever with renal syndrome

YAN Wenyue, LI Qiang

2023, 43 (11): 1457-1462.
doi: 10.3969/j.issn.1674-8115.2023.11.015

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Severe fever with thrombocytopenia syndrome (SFTS) and hemorrhagic fever with renal syndrome (HFRS) are infectious diseases. The epidemic of these two diseases can seriously affect human life and health, and is also a public health problem currently facing in the world. Due to the uneven level of medical development around the world, many doctors have insufficient understanding of these two diseases, which is likely to lead to missed diagnosis or misdiagnosis, and the patients are not treated correctly, which leads to aggravation of the disease and affects their prognosis. Clinically, the diagnosis of SFTS and HFRS mainly depends on the results of pathogenic examination and serological examination, but many medical institutions have not carried out these two examinations. Therefore, if epidemiological and clinical characteristics can be used to diagnose and differentiate these two diseases, it will help guide clinical practice. This paper reviews the research progress in the diagnosis and differential diagnosis of SFTS and HFRS at home and abroad in recent years.

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