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    Strengthening and optimization of immunization strategy for COVID-19 vaccines
    Xiao-ya LÜ, Lei SONG, Zhao MA, Shu-guang WANG, Hao MA, Yi-ming SHAO, Zhi-yin WU
    2021, 41 (12):  1545-1550. 
    doi: 10.3969/j.issn.1674-8115.2021.12.001

    Abstract ( 2 )   HTML ( 0 )   PDF (1404KB) ( 0 )  

    At the beginning of the founding of New China, the government implemented a series of health policies and measures to quickly improve the people's health. The development of vaccine and the construction of public health facilities work together to provide important support for the implementation of the ??prevention first'' policy, and have played an important role in preventing the spread of various infectious diseases. Since the outbreak of COVID-19, China has rapidly deployed five technical routes to accelerate vaccine research and development. Combining vaccination with public health emergency measures, Chinese government stopped the spread of COVID-19 scientifically and effectively. Due to the rebounded global epidemic, the pressure of ??external defense input, internal defense rebound'' keeps increasing. How to adjust the strategies for epidemic prevention and control has become an important issue. This article reviews the vaccine research and development, vaccine administration, dynamic adjustment of immunization strategies, booster immunization, immunization for the elderly, and the immunization plan. With predicting the trend of global epidemic and analyzing China's COVID-19 vaccination strategy, it provides new thoughts for the next strategic adjustment of China's COVID-19 vaccination as well as the epidemic prevention and control.

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    Comparative study of Medical Technology development in China and abroad
    Dong-liang LI, Wei-wei ZHANG, Su-ping WANG, Yu-chen LAI, Ye-xuan TAO
    2021, 41 (12):  1551-1556. 
    doi: 10.3969/j.issn.1674-8115.2021.12.002

    Abstract ( 4 )   HTML ( 0 )   PDF (850KB) ( 1 )  
    Objective

    ·To compare and analyze the current situation of Medical Technology development in domestic and foreign famous medical schools.

    Methods

    ·By searching U.S. News & World Report Best Global Universities Rankings, Academic Rankings of World Universities (ARWU), and the websites of domestic and foreign medical schools and Ministry of Education of China, and interviewing the experts, this study summarized the differences of Medical Technology discipline in China and aboard in three aspects, i.e. major setting, enrollment conditions and academic degree granting, and disciplinary strength.

    Results

    ·In the U.S. News discipline rankings for undergraduate education, “Radiology, Nuclear Medicine & Medical Imaging” was the only subject in the field of Medical Technology. As for the discipline rankings for graduate education, the subject category of “Medicine” included “Radiology”, and the subject category of “Health” contained several subjects related with Medical Technology, including “Audiology” “Rehabilitation Counseling” “Speech-Language Pathology” “Occupational Therapy” and “Physical Therapy”. In the ARWU, “Medical Technology” discipline contained “Medical Laboratory Technology”“Neuroimaging” and “Radiology, Nuclear Medicine & Medical Imaging”. At the stage of undergraduate education in China, Medical Technology-related majors included 13 majors in the category of “Medical Technology” and 3 majors in the category of “Clinical Medicine”. At the stage of graduate education in China, Medical Technology-related majors included 11 majors in the category of “Medicine” and 2 majors in the category of “Natural Science”. Taking Rehabilitation-related majors as examples of enrollment condition and academic degree granting, there were many master's and doctoral programs abroad, and the enrollment conditions were flexible. However, the Rehabilitation-related majors in China concentrated on the undergraduate education; the graduate education enrollment required relevant professional background. In the ARWU, the top five universities in “Medical Technology” in Chinese mainland ranked 76?200 globally. The indicators of publications in the journals of Q1 range and in the top journals as well as the honours of prominent prizes were relatively low.

    Conclusion

    ·There is still a gap in the international rankings of Medical Technology discipline between domestic universities and the top universities abroad. The construction of world's first-class discipline of Medical Technology in China will be boosted by optimizing the major setting, adjusting the professional education system and academic degree granting, and strengthening the scientific research.

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    Innovative research team achievement column
    Role of SIRT3 SUMOylation deficiency in the proliferation and chemotherapeutic sensitivity of breast cancer cells MCF7
    Yan-yun HAO, Si-hui YÜ, Jing LU, Xiang GU, Fan ZHANG, Jin-ke CHENG, Tian-shi WANG
    2021, 41 (12):  1557-1563. 
    doi: 10.3969/j.issn.1674-8115.2021.12.003

    Abstract ( 2 )   HTML ( 0 )   PDF (2214KB) ( 0 )  
    Objective

    ·To investigate the effects of deSUMOylation of sirtuin 3 (SIRT3) on the proliferation and chemotherapeutic drug resistance in breast cancer cells.

    Methods

    ·In order to construct the MFC7-SIRT3KO cell line, the CRISPR-Cas9 plasmid pX330-sgRNA targeting SIRT3 gene was designed. Then, this cell line was infected with SIRT3 K288R (sumoylation modification site mutant), SIRT3 WT (wild type) or Vector retrovirus to establish the SIRT3 SUMOylation site mutation and control cell lines. Cell counting and microscopic observation were used to determine the changes in tumor cell number and morphology under the same incubation condition. To detect the chemotherapeutic drug resistance of SIRT3 K288R and the control cells, these cells were treated with different concentrations of adriamycin (ADM) for 24 h, 48 h and 72 h.

    Results

    ·The MFC7-SIRT3KO cell line was constructed successfully, and then SIRT3 K288R, SIRT3 WT and Vector cell lines were established. The cell growth curves showed that the growth rate of SIRT3 K288R cells was significantly slower than those of SIRT3 WT and Vector cells under the same incubation condition (P=0.000). This phenotype was also observed under the microscope. The diameter of non-adherent breast cancer cell clumps of SIRT3 K288R cells was smaller than those of the control cells. ADM resistance experiment showed that the activity of SIRT3 K288R cells was significantly higher than those of Vector and SIRT3 WT cells treated with different concentrations of ADM (1.25 μg/mL, 2.5 μg/mL, 5 μg/mL and 10 μg/mL) for 24 h, 48 h and 72 h (P<0.05), and the half maximal inhibitory concentration (IC50) of ADM in the SIRT3 K288R cells was higher than those in the control cells.

    Conclusion

    ·The SIRT3 SUMOylation deficiency inhibits the proliferation of breast cancer cells MCF7, while increases the drug resistance to ADM.

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    Effects of work stress, psychological resilience and perceived social support on compassion fatigue of nurses in assisted reproduction departments
    Yu-lian HU, Ya-qing ZHANG
    2021, 41 (12):  1565-1571. 
    doi: 10.3969/j.issn.1674-8115.2021.12.004

    Abstract ( 3 )   HTML ( 0 )   PDF (2407KB) ( 0 )  
    Objective

    ·To understand the current status of work stress, psychological resilience, perceived social support, and compassion fatigue among assisted reproduction department nurses in China, and explore their quantitative relationship model on this basis.

    Methods

    ·Using a convenience sampling method, 511 assisted reproduction department nurses from 32 tertiary hospitals in 17 provinces and cities in the eastern, central and western economic regions of China were surveyed from September to December 2020 with using a general information questionnaire, the Nurses' Work Stressor Scale, the Mental Toughness Scale, the Appreciative Social Support Scale and the Compassion Fatigue Scale. Through basic statistics and structural equation modeling, we constructed a quantitative relationship model among work stress, psychological resilience, perceived social support, and compassion fatigue, and analyzed the relationships among these variables and their effects on compassion fatigue among assisted reproduction department nurses in China.

    Results

    ·The mean item scores of the dimensions of compassion fatigue among nurses in our assisted reproduction departments were compassion satisfaction (3.68±0.63), job burnout (2.39±0.52), and secondary traumatic stress (2.46±0.56), all of which were at moderate levels; there was a correlation between work stress, psychological resilience, perceived social support, and compassion fatigue among nurses in assisted reproduction departments (all P=0.000).The results of structural equation modeling showed that job stress had a direct negative effect on compassion satisfaction (β=-0.34, P=0.000), a direct positive effect on compassion fatigue symptoms (β=0.25, P=0.000); psychological resilience had a direct positive effect on compassion satisfaction (β=0.53, P=0.000), and a direct negative effect on compassion fatigue symptoms (β=-0.29, P=0.000); psychological resilience mediated the effect between job stress and compassion fatigue symptoms and between job stress and compassion satisfaction, and appreciating the role of social support in compassion fatigue symptoms and compassion satisfaction was not significant.

    Conclusion

    ·Compassion fatigue of nurses in our assisted reproduction departments is affected by a variety of factors, among which the role of psychological resilience is significant in improving compassion satisfaction. It is recommended to start from enhancing the psychological resilience of nurses, take effective measures to improve the psychological resilience of nurses, reduce the incidence of compassion fatigue of nurses, and thus improve the quality of care.

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    Cross-cultural adaptation,reliability and validity testing of the Chinese version of Brain Metastases Symptom Checklist
    Xian QIU, Wei-yi ZHU, Peng ZHAO, Si-jian PAN, Bo-min SUN, Bei-wen WU
    2021, 41 (12):  1573-1578. 
    doi: 10.3969/j.issn.1674-8115.2021.12.005

    Abstract ( 1 )   HTML ( 0 )   PDF (2057KB) ( 0 )  
    Objective

    ·To translate the English version of Brain Metastases Symptom Checklist (BMSC) into Chinese version and test its reliability and validity.

    Methods

    ·The translation and adaption of BMSC for the Chinese population were generated by Brislin translation and back-translation model. From January 2017 to June 2019, a sample of 239 brain metastases patients matched with the inclusion criteria were selected via convenience sampling from the Center for Functional Neurosurgery, Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine and Gamma Knife Center, Shandong Provincial Hospital affiliated to Shandong First Medical University. The Cronbach's α coefficient was used to evaluate the internal consistency, and the intra-class correlation coefficient (ICC) was used to determine the retest reliability. The item-related content validity index (ICV) and the scale-level average content validity index (S-CVI/Ave) were applied to assess the content validity of the Chinese version of BMSC. The effective size (ES) was calculated to evaluate the responsiveness of the Chinese version of BMSC, and the minimal clinical important difference (MCID) of the Chinese version of BMSC was evaluated by using anchor-based approach and distribution-based approach respectively.

    Results

    ·The Cronbach's α coefficient of the Chinese version of BMSC was 0.85, and the ICC reflecting retest reliability was 0.72. The I-CVI was 0.8?1.0, and the S-CVI/Ave was 0.97. The scores of the Chinese version of BMSC before and after gamma knife treatment showed significant differences (P<0.05), and the ES of the Chinese version of BMSC was 0.01?0.35. The MCID value of BMSC score obtained by anchor-based method was 0.07?1.28, and the value obtained by distribution-based method was 0.01?0.60.

    Conclusion

    ·The Chinese version of BMSC has good validity and reliability.

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    Characteristics and influencing factors of postoperative delirium among elderly patients in intensive care unit
    Zhi-shan WU, Run HUANG, Li-ping LIANG, Yu-ting ZHU, Qiao-mu ZHENG, Li-ping JIANG
    2021, 41 (12):  1580-1586. 
    doi: 10.3969/j.issn.1674-8115.2021.12.006

    Abstract ( 1 )   HTML ( 0 )   PDF (2255KB) ( 0 )  
    Objective

    ·To investigate the characteristics and influencing factors of postoperative delirium among elderly patients admitted to intensive care unit (ICU).

    Methods

    ·The convenience sampling method was used to select cardiothoracic surgical ICU patients after operation in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from May to September 2020. Delirium was assessed using the Confusion Assessment Method-ICU (CAM-ICU) and the assessment was performed until ICU discharge or for a maximum of 7 d, whichever occurred first. Patients′ demographics and clinical data were collected. The influencing factors were analyzed by univariate analysis and multivariate Logistic regression.

    Results

    ·A total of 343 patients were included for this study and 103 developed postoperative delirium, with an incidence of 30.03%. All the delirium occurred within 7.5?130.0 h after operation, with a mean of (47.4±29.7) h and a median of 35.5(23.0, 61.0) h. On the whole, delirium uniformly distributed throughout the day. Only the delirium that occurred within 24 h after surgery showed a central tendency with the high-incidence time at 11:53 am while the others did not. Delirium duration lasted 6.5?131.0 h, with a mean of (32.4±28.1) h and a median of 20.5(14.0, 45.0) h. Comparison of the characteristics of patients in the delirium group and non-delirium group showed that there were statistical differences in gender, history of diabetes, heart function classification, American Society of Anesthesiologists (ASA) classification, operation duration, intraoperative blood loss, intraoperative cardiopulmonary bypass, intraoperative hypotension, postoperative mechanical ventilation and postoperative oxygenation index. Multivariate Logistic regression analysis showed that ASA classification, intraoperative hypotension and cardiopulmonary bypass had significant influence on postoperative delirium (all P<0.05).

    Conclusion

    ·The incidence of postoperative delirium is high among elderly patients who are admitted in ICU after operation. Higher ASA classification, intraoperative hypotension and cardiopulmonary bypass are influencing factors of delirium. To reduce delirium occurrence and shorten its duration, medical staff should understand the characteristics and influencing factors of postoperative delirium, evaluate delirium and implement preventive interventions.

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    Analysis of the interdependence between chronic kidney disease child-parent transition readiness and the quality of life of both parties
    Si-si ZHOU, Ge-yan GONG, Jia-li MA, Wen-ying GAO, Ying ZHANG
    2021, 41 (12):  1588-1595. 
    doi: 10.3969/j.issn.1674-8115.2021.12.007

    Abstract ( 4 )   HTML ( 0 )   PDF (3041KB) ( 0 )  
    Objective

    ·To investigate the interdependence between chronic kidney disease children's transition readiness assessment of children and their parents and the quality of life of both parties by using an Actor-Partner Interdependence Model.

    Methods

    ·A convenience sample of 177 pairs of children with CKD aged 12?18 years who were hospitalized in the Nephrology Department of Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine and Children′s Hospital of Shanghai, Shanghai Jiao Tong University from October 2018 to April 2021, and their parents were selected for the general information questionnaire and self-care and transition readiness and quality of life questionnaire, and a model was constructed by using AMOS 24.0 to analyze the correlations.

    Results

    ·The assessment of transition readiness of 177 children with CKD and their parents was unsatisfactory, with item average score of 3.39±0.62 for the children and 3.31±0.63 for the parents; the item average score of quality of life for the children and parents were 75.35±15.28 and 70.27±18.56, respectively. Multiple stratified regression analysis showed that the number of school days missed within six months was a negative predictor of the child′s quality of life; duration of illness, only child or not in a family, and mother unemployment were negative predictors of the parent′s quality of life, while doctor-patient communication between the child and the parent was a positive predictor for both parties. The results of the actor-partner interdependence model showed interdependence between child and parent assessment of the child′s transition readiness and quality of life of both parties, with an actor effect between parent transition readiness and parent quality of life (B=27.76, P=0.000) and a partner effect for both child and parent (child: B=-14.91, P=0.007; parent: B=14.35, P=0.000), and in the subdimensional analysis, there were actor-partner effects of varying degrees.

    Conclusion

    ·There is a reciprocal relationship between child′s transition readiness by the child with CKD and his or her parents and the quality of life of both parties, and health care providers need to focus on parent-child interaction during the child-parent transition and include both the child and parents in the development of a targeted transition readiness plan to improve the quality of life of both parties.

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    Experience of sexuality after breast reconstruction in breast cancer survivors: a qualitative study
    Lu GAN, Yu-fei JIN, Qing REN, Xiao-jing DONG, Nan ZHANG
    2021, 41 (12):  1597-1601. 
    doi: 10.3969/j.issn.1674-8115.2021.12.008

    Abstract ( 2 )   HTML ( 0 )   PDF (2058KB) ( 0 )  
    Objective

    ·To study the recognization and attitudes regarding sex of the breast cancer patients who underwent breast reconstruction, and their experience of altered sexual status and their coping styles.

    Methods

    ·The breast cancer patients who underwent breast reconstruction surgery in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, were selected as the study population through purposive sampling. The general information questionnaire was used to collect the basic information of the patients. A semi-structured in-depth interview on the experience of sexual status change and coping style after breast reconstruction surgery was conducted by using phenomenological research method. The data were analyzed according to seven steps of Colaizzi′s method.

    Results

    ·A total of 12 respondents with a median age of 40 (28?51) years were included, all of whom underwent deep inferior epigastric perforator flap with an median postoperative duration of 17.5 months. Their sexual life and emotional experience could be summarized into 3 themes. ① The patients′ perceptions of changes in sexual life after breast reconstruction surgery: all the respondents had a good understanding of the importance of sex; most of the respondents could resume sexual life after completing adjuvant treatment for breast cancer; the altered body image and the impaired skin sensation resulting from breast reconstruction surgery affected the patients sexual experience. ② The patients response to the changes in sexual life after breast reconstruction: there was less communication about sex between the patients and their spouses; the patients actively initiated compensatory mechanisms to mitigate adverse sexual experience. ③ The patients′ need for support in resuming sexual life after surgery: the patients had a high demand for sexual health, but there was little communication between the doctors and the patients on sexual issues; the patients expected to receive professional information support through appropriate access.

    Conclusion

    ·After breast reconstruction, the patients are relatively positive about sexual life and emotional experience, but lack of communication with their spouses and medical staff about sexual problems. Health care providers should effectively communicate, assess the patients sexual problems, and provide timely interventions in clinical work to improve their quality of life.

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    Basic research
    Changes of m6A methylation in renal tissue during cisplatin-induced acute injury
    Jian-xiao SHEN, Wan-peng WANG, Xing-hua SHAO, Jing-kui WU, Shu LI, Xia-jing CHE, Zhao-hui NI
    2021, 41 (12):  1603-1611. 
    doi: 10.3969/j.issn.1674-8115.2021.12.009

    Abstract ( 1 )   HTML ( 0 )   PDF (5401KB) ( 0 )  
    Objective

    ·To investigate the role of N6-methyladenosine (m6A) methylation modification in the process of cisplatin-induced acute injury in mice.

    Methods

    ·Four C57BL/6 mice were injected with cisplatin (20 mg/kg) through tail vein (the injury group); Another 4 C57BL/6 mice were injected with the same amount of saline (the control group). The changes of serum creatinine and urea nitrogen levels in the mice and the pathological injury in the renal tissue sections of the mice were evaluated to judge the success of the model. Methylated RNA immunoprecipitation (MeRIP) and RNA sequencing were used to detect the changes of m6A methylation and RNA expression in the kidney tissue of the two groups of mice. Gene ontology and Kyoto Encyclopedia of genes and genomes were used for visualization and comprehensive research. Transcriptome data and epigenetic data were combined to find candidate genes for pathological changes of cisplatin-induced acute injury.

    Results

    ·Cisplatin could induce significant increase in the levels of serum creatinine and urea nitrogen compared with those in the baseline. Light microscope showed extensive tubular vacuolar degeneration, epithelial cell exfoliation and tubular necrosis, suggesting the success of modeling. MeRIP detection showed that a total of 2 277 genes contained 2 981 differentially expressed m6A methylation sites (expression multiple ≥2 and P<0.05) in the kidneys of mice in the injury group and the control group. These genes were mainly concentrated in the metabolic and cell death pathways. The joint analysis of genes expressing differential m6A methylation sites and RNA differential expression genes found 1 002 genes with the same expression trend, such as fibrinogen α chain, solute carrier family 12 member 1 and hepatitis A virus cellular receptor 1.

    Conclusion

    ·Cisplatin can induce the change of methylation level of m6A methylation site on mRNA in renal tissue, and promote the process of acute renal injury.

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    Association study of HRAS proto-oncogene single nucleotide polymorphism with schizophrenia and therapeutic response to atypical antipsychotics
    Rui LI, Duan ZENG, Shen HE, Yi-feng SHEN, Hua-fang LI
    2021, 41 (12):  1613-1617. 
    doi: 10.3969/j.issn.1674-8115.2021.12.010

    Abstract ( 0 )   HTML ( 0 )   PDF (2086KB) ( 0 )  
    Objective

    ·To investigate the relation of HRAS proto-oncogene (HRAS) polymorphism in rs11246176 with schizophrenia and therapeutic response to atypical antipsychotics in the Chinese Han population.

    Methods

    ·A total of 460 schizophrenia patients with acute attack (case group) and 386 healthy controls (control group) were recruited. The patients were treated with atypical antipsychotics and followed up for 26 weeks. Positive and Negative Syndrome Scale (PANSS) were used to evaluate the patients' conditions at the time of enrollment, and 13 weeks and 26 weeks after enrollment respectively. The reduction rates at 26th week were calculated as the standard for drug efficacy (the reduction rate ≥50% was considered effective, and <50% was considered ineffective), and then the patients were divided into the responder group and the non-responder group. The peripheral blood samples were collected to extract DNA. Rs11246176 was genotyped by using TaqMan assays. SHEsis software and SNPstats software were used to compare the frequency distributions of alleles, genotypes, and genotypes under different genetic models between the case group and the control group as well as between the responder group and the non-responder group. In addition, expression quantitative trait loci (eQTL) analysis was used to explore the difference in HRAS expression in the brain among different rs11246176 genotypes.

    Results

    ·There were no significant differences in the distribution of allelic and genotypic frequencies between the case group and the control group (P>0.05). The frequency of A allele in the responder group was higher than that in the non-responder group (P=0.010). The frequency of AA and AG genotypes in the responder group was higher than that in the non-responder group (P=0.040). The reduction rate of PANSS of the patients with AA or AG genotype 26th week was significantly higher than that of the patients with GG genotype (P=0.010). Furthermore, the brain eQTL analysis revealed that in the dorsolateral prefrontal cortex of normal Caucasians and African Americans, the HRAS mRNA expression level of the AA genotype was the highest, followed by the AG genotype and the GG genotype in the order (P=0.000).

    Conclusion

    ·Rs11246176 polymorphism in HRAS gene is not associated with the occurrence of schizophrenia in the Chinese Han population, but may be related to therapeutic response to atypical antipsychotics. A allele carriers may have better response to atypical antipsychotics.

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    Ameliorative effect of atorvastatin on hepatic fibrosis and its mechanism
    Nan WANG, Ye LU, Feng-jie HAO, Jun-qing WANG
    2021, 41 (12):  1619-1626. 
    doi: 10.3969/j.issn.1674-8115.2021.12.011

    Abstract ( 0 )   HTML ( 0 )   PDF (3364KB) ( 0 )  
    Objective

    ·To investigate the role of atorvastatin and its mechanisms in patients and animal models of hepatic fibrosis.

    Methods

    ·The literatures in PubMed were searched for statins for different chronic liver diseases from January 2010 to June 2020. Meta analysis was performed based on the occurrence of liver fibrosis, liver failure and overall patient mortality. Sixteen male C57BL/6 mice were randomly divided into control group, atorvastatin group, CCl4 injection group, and CCl4 injection combined with atorvastatin group with 4 mice in each group. The mice in the CCl4 injection group were administered intraperitoneally twice a week with 20% volume fraction of CCl4 at a dose of 1 mL/kg; the control group was administered intraperitoneally by using the same dose of corn oil; the mice in the atorvastatin group were gavaged once daily with a dose of 15 mg/kg of atorvastatin; the mice in the CCl4 injection combined with atorvastatin group were treated with a combination of CCl4 and atorvastatin. After 4 weeks, the animals were euthanized, and serum glutamic pyruvic transaminase (GPT) and glutamic oxaloacetic transaminase (GOT) were detected; the degree of intrahepatic fibrosis in the mice was detected by Sirius red staining; immunofluorescence staining was used to detect the expression of collagen ⅠA; the mRNA expressions of α-smooth muscle actin (α-SMA), collagen Ⅰ, collagen Ⅲ, interleukin (IL)-1b, IL-6, and transforming growth factor-β (TGF-β) were detected by real-time fluorescence quantitative PCR; the expressions of α-SMA protein and phosphorylated Smad4 (pSmad4) protein were detected by Western blotting.

    Results

    ·Finally 9 papers were selected for meta analysis, and the results showed that statins reduced the incidence of liver fibrosis, liver failure and overall mortality in patients with liver disease. In the animal experiments, the weight of mice in both the CCl4 injection group and the CCl4 injection combined with atorvastatin group decreased significantly compared with that in the control group (P=0.000); while the weight of mice in the CCl4 injection combined with atorvastatin group decreased to a lesser extent compared with that in the CCl4 injection group (P=0.040). Compared with the control group, GPT and GOT concentrations were significantly increased in both the CCl4 injection group and CCl4 injection combined with atorvastatin group (P=0.000), while liver enzymes in the CCl4 injection combined with atorvastatin group showed a smaller increase in GPT and GOT compared with that in the CCl4 injection group (P=0.020). Sirius red staining showed excessive deposition of intrahepatic fibers in the CCl4 injection group, and immunostaining suggested high expression of collagen ⅠA in the CCl4 injection group. The results of fluorescence quantitative PCR and Western blotting suggested that α-SMA protein expression increased, and mRNA expressions of α-SMA, collagen Ⅰ, and collagen Ⅲ were upregulated in the CCl4 injection group compared with the control group(P<0.05), whereas the expressions of these markers were downregulated in the CCl4 injection combined with atorvastatin group compared with the CCl4 injection group (P<0.05). The mRNA expressions of IL-1b and IL-6 were slightly upregulated and the expression of TGF-β was significantly upregulated in the CCl4 injection group compared with the control group (P<0.05). In contrast, the mRNA expressions of IL-1b and IL-6 were significantly up-regulated and the expression of TGF-β decreased in the CCl4 injection combined with atorvastatin group compared with the CCl4 injection group (P<0.05). The expression of pSmad4 protein increased in the CCl4 injection group compared with the control group, while the expression of pSmad4 protein was lower in the CCl4 injection combined with atorvastatin group compared with the CCl4 injection group.

    Conclusion

    ·Atorvastatin may attenuate the occurrence and development of liver fibrosis via manipulating TGF-β signaling pathway.

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    Study on changes of hippocampal bile acid receptors in the depression mouse models
    Jing WU, Xue-yi LI, Jing-hong CHEN, Ze-jian WANG
    2021, 41 (12):  1628-1634. 
    doi: 10.3969/j.issn.1674-8115.2021.12.012

    Abstract ( 0 )   HTML ( 0 )   PDF (4032KB) ( 0 )  
    Objective

    ·To explore the changes of bile acid receptors in hippocampi of depression mouse models.

    Methods

    ·Thirty female C57BL/6 mice with the age of 4 weeks were randomly divided into control (CON, n=10) group, chronic unexpected mild stress (CUMS, n=10) group and dexamethasone (DEX, n=10) group. CUMS group mice were treated with different CUMS every day, DEX group mice were administered with DEX (0.2 mg/kg) by oral gavage twice a day, and CON group and CUMS group were given equal volumes of CMC-Na (solvent) by oral gavage every day. The treatments lasted for 5 weeks, and the mice were weighed once a week. After modeling, the forced swimming test, the tail suspension test and the sucrose preference test were applied to detect the depression-like behavior in mice. After the mice being sacrificed, the hippocampus and the other organs were separated and weighed. The expressions of brain-derived neurotrophic factor (BDNF), farnesoid X receptor (FXR) and G protein-coupled bile acid receptor 1 (GPBAR1, also TGR5) in the hippocampus were evaluated by Western blotting. The serum levels of fibroblast growth factor 15 (FGF15) and cholecystokinin (CCK) were detected by ELISA kits. Meanwhile, in the rat glioma cell line (C6) incubated with different concentrations of DEX, the expressions of FXR and TGR5 were detected by Western blotting, and the levels of BDNF and glial cell line-derived neurotrophic factor (GDNF) in the cell culture medium were detected by ELISA kits. The ROS assay kit was used to detect intracellular oxidative stress levels. C6 cells were pretreated with 5 mmol/L N-acetyl-L-cysteine (NAC) for 2 h, and the effects of DEX on bile acid receptors were observed.

    Results

    ·Compared with CON group, both DEX group and CUMS group had decreased sucrose preference, prolonged immobility time in the forced swimming test and the tail suspension test (P<0.05) and greater organ relative mass of gallbladder (P<0.05). The level of serum FGF15 in DEX group was significantly higher than that in CON group, but significantly lower in CUMS group (P<0.05); the level of CCK in CUMS group was significantly higher than that in CON group (P<0.05). Additionally, in the hippocampi of the two different depression models, the protein levels of TGR5 and FXR decreased and increased, respectively (P<0.05). The 200 μmol/L and 400 μmol/L DEX increased the expression of FXR, while significantly inhibited the expression of TGR5 in C6 cells; the levels of GDNF and BDNF (BDNF only in 400 μmol/L group) significantly decreased (P<0.05) in the culture medium. DEX at 200 μmol/L significantly increased the levels of ROS in the C6 cells. The cells pretreated with NAC partially reversed the overexpression of FXR and the low expression of TGR5 induced by DEX.

    Conclusion

    ·The similar changes of bile acid receptors, i.e. decreased TGR5 and increased FXR, are found in the hippocampi of depression mouse models induced by CUMS and DEX, respectively. These changes may be related to the elevated level of oxidative stress.

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    Clinical research
    Relation between body mass index and left ventricular structure and function in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance imaging study
    Ye-zi CHAI, Meng JIANG, Jun PU
    2021, 41 (12):  1636-1641. 
    doi: 10.3969/j.issn.1674-8115.2021.12.013

    Abstract ( 0 )   HTML ( 0 )   PDF (2149KB) ( 0 )  
    Objective

    ·To evaluate the relation between body mass index (BMI) and left ventricular structure and function in patients with hypertrophic cardiomyopathy (HCM) through cardiovascular magnetic resonance (CMR).

    Methods

    ·Twenty-two healthy people (control group) and 92 consecutive patients with HCM (HCM group) who received treatment in the Department of Cardiology of Renji Hospital, Shanghai Jiao Tong University School of Medicine were included from January 2016 to December 2020, and all participants completed CMR examination under the scrutiny of cardiologists and radiologists. Patients with HCM were grouped according to BMI index: the normal BMI subgroup (BMI<24.00 kg/m2), the overweight subgroup (24.00 kg/m2≤BMI<28.00 kg/m2) and the obesity subgroup (BMI≥28.00 kg/m2). The structural and functional indexes of CMR between the HCM group and the control group and among the three HCM subgroups were compared, including left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI) and global longitudinal strain (GLS). The relationship between BMI and GLS was explored by stepwise linear analysis.

    Results

    ·The HCM group had higher LVEF (P=0.001), higher LVMI (P=0.000) and lower GLS (P=0.000) compared with the control group. LVEDV increased (both P=0.000) and GLS decreased (P=0.005, P=0.000) in the overweight and the obesity subgroup compared with the normal BMI subgroup. In the stepwise linear regression, it suggested that BMI in patients with HCM was associated with decreased GLS independently after being adjusted for age (β=-0.431, P=0.000).

    Conclusion

    ·BMI is negatively correlated with the left ventricular structure and function in patients with HCM. Losing weight to keep BMI in normal range may help to improve left ventricular function and clinical prognosis.

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    Assessment of cardiopulmonary exercise capacity in early stage of patients with breast cancer undergoing neoadjuvant chemotherapy and related factors
    Ye-zi CHAI, Jun MA, Wen-long JIANG, Qi-ming LIU, Qi-fan LU, Zheng-yu TAO, Meng JIANG, Jun PU
    2021, 41 (12):  1643-1648. 
    doi: 10.3969/j.issn.1674-8115.2021.12.014

    Abstract ( 0 )   HTML ( 0 )   PDF (2524KB) ( 0 )  
    Objective

    ·To assess the cardiopulmonary exercise capacity in patients with breast cancer after neoadjuvant chemotherapy in the early stage and explore possible factors leading to the reduced functional tolerance in those patients.

    Methods

    ·Fifty-two consecutive patients suffering from breast cancer and receiving neoadjuvant chemotherapy were included and completed cardiopulmonary exercise testing (CPET), laboratory tests, electrocardiograph and echocardiography after 1 cycle of chemotherapy in the Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine from September, 2020 to May, 2021. Fifty-two healthy age-, gender- and body mass index (BMI)-matched volunteers were enrolled and received CPET as the control group. The general conditions, hematological biomarkers, electrocardiogram and echocardiography of the subjects in the two groups were collected and recorded.

    Results

    ·Compared to the control group, the group of patients receiving neoadjuvant chemotherapy had reduced peak VO2 [(18.22±3.48) mL/(min·kg) vs (22.80±3.13) mL/(min·kg), P=0.000], anaerobic threshold [(12.09±2.35) mL/(min·kg) vs (14.93±2.60) mL/(min·kg), P=0.000] and oxygen pulse [(7.67±1.45) mL/beat vs (8.87±1.29) mL/beat), P=0.000]. On multivariable regression analysis, BMI was independently associated with peak VO2 (β=-0.528,P=0.047) of patients in the early stage of neoadjuvant chemotherapy.

    Conclusion

    ·Decreased cardiopulmonary function could be detected in the early stage of neoadjuvant chemotherapy on patients with breast cancer via CPET. High BMI can be an independent predictor of the reduced peak VO2. Maintaining BMI at normal level by losing weight may help to improve patients' cardiopulmonary function and long-term cardiovascular prognosis.

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    Correlation study on personality traits of patients with anorexia nervosa
    Han CHEN, Jing ZHANG, Xiao-ping LI, Hui-qin HAN, Meng-ting WU, Yan CHEN, Qing KANG, Wen-yan XU, Jue CHEN
    2021, 41 (12):  1650-1655. 
    doi: 10.3969/j.issn.1674-8115.2021.12.015

    Abstract ( 0 )   HTML ( 0 )   PDF (2122KB) ( 0 )  
    Objectives

    ·To investigate the personality traits of patients with anorexia nervosa (AN), and compare the differences of personality traits among different subtypes of AN.

    Methods

    ·A total of 164 patients with AN treated in the Clinical Psychosomatic Ward and Psychological Counseling Clinic of Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine from July 2013 to July 2018 were selected and 124 healthy controls (HC) were recruited. According to Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), AN was divided into restricting type AN (AN-R), binge-purging type AN (AN-BP) and atypical AN. In AN group, 76 cases were AN-R, 81 cases were AN-BP, and 7 cases were atypical AN. The severity of pathological psychological symptoms of AN patients was evaluated by Eating Disorder Examination-questionnaire (EDE-Q 6.0), and the personality traits of perfectionism, impulsivity and self-esteem of AN patients were evaluated by Frost Multidimensional Perfectionism Psychological Scale (FMPS), Barratt Impulsiveness Scale 11th Version (BIS-11) and Self-esteem Scale (SES). Independent sample t test and variance analysis were used to compare the differences between AN-R group and AN-BP group and differences between the AN group and HC group, and correlation analysis was used to analyze the correlation between personality traits and AN clinical symptom.

    Results

    ·The total FMPS score of the AN group was significantly higher than that of the HC group (P=0.044), and the total score of SES was significantly lower than that of the HC group (P=0.000). The total score of FMPS, non-adaptive dimension score, BIS-11 total score, attentional impulse score, motor impulse score, and unplanned impulse score in the AN-BP group were significantly higher than those in the AN-R group (all P<0.05). Compared with the AN-R group, AN-BP group had significantly lower organization (adaptive dimension) score and SES total score (all P<0.05). The severity of clinical symptoms of AN (EDE-Q 6.0 total score and subscale scores) was positively correlated with perfectionism (FMPS total score) and impulsivity (BIS-11 total score), and negatively correlated with self-esteem (SES total score) (all P=0.000).

    Conclusion

    ·Patients with AN have perfectionism and low self-esteem. The patients with AN-BP have more perfectionism, high impulsivity and low self-esteem, while the patients with AN-R show low impulsivity.

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    Impulsive trait of patients with different subtypes of anorexia nervosa and its association with 5-hydroxytryptamine transporter gene-linked polymorphic region polymorphism
    Li MEI, Jing ZHANG, Qing KANG, Cheng LIAN, Su-fang PENG, Shun-ying YU, Jue CHEN
    2021, 41 (12):  1656-1660. 
    doi: 10.3969/j.issn.1674-8115.2021.12.016

    Abstract ( 0 )   HTML ( 0 )   PDF (865KB) ( 0 )  
    Objective

    ·To explore the impulsive trait of patients with different subtypes of anorexia nervosa (AN) and its relationship with 5-hydroxytryptamine transporter gene-linked polymorphic region (5-HTTLPR) polymorphism.

    Methods

    ·The patients with AN treated in the Clinical Psychosomatic Ward and Psychological Counseling Clinic of Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine from July 2013 to July 2018 were selected, including 76 patients with restricting type (AN-R group) and 81 patients with binge/pursing type (AN-BP group). The general situations, clinical characteristics and impulsive traits of the two groups were analyzed by General Situation Questionnaire, Eating Disorder Examination Questionnaire 6.0 (EDE-Q 6.0) and Barratt Impulsivity Scale 11th Version (BIS-11), respectively. Quantitative real-time PCR was used to detect the 5-HTTLPR polymorphism of the two groups, and genotyping was performed.

    Results

    ·Compared with AN-R group, the total score of EDE-Q 6.0 and its four subscales, the total score of BIS-11 and its three dimensions in AN-BP group were increased (all P<0.05). However, there was no significant difference in the distribution of 5-HTTLPR genotype and allele frequencies between the two groups. At the same time, there was no significant difference in the total score of BIS-11 and its three dimensions among AN patients with three 5-HTTLPR genotypes (S/S, S/L, L/L).

    Conclusion

    ·AN-BP patients have more obviously impulsive traits than AN-R patients, but there is no correlation between two disease subtypes or impulsive traits and 5-HTTLPT polymorphism.

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    Application of Montreal Cognitive Assessment Scale to the elderly in Chinese community
    An-qi XIA, Jun LI, Ling YUE, Bo HONG, Feng YAN, Ning SU, Shi-fu XIAO, Yuan-yuan LIU, Tao WANG
    2021, 41 (12):  1662-1667. 
    doi: 10.3969/j.issn.1674-8115.2021.12.017

    Abstract ( 0 )   HTML ( 0 )   PDF (2168KB) ( 0 )  
    Objective

    ·To update the cut-off value of the normal elderly (NE) and mild cognitive impairment (MCI) elderly in urban areas of China according to the Montreal Cognitive Assessment (MoCA) scores and analyze the sections of MoCA.

    Methods

    ·A cross-sectional study was conducted to investigate the elderly over 60 years old in ten cities of China. Mini-Mental State Examination (MMSE) and MoCA (Beijing version) were used to assess cognitive function. Data was statistically analyzed by SPSS 19.0.

    Results

    ·There were 2 367 NE, 553 MCI patients, 1 319 males and 1 601 females, with an average age of (70.6±7.5) years and an average length of education of (8.7±5.2) years. There were significant difference in age and length of education between MCI and NE groups (t=12.3, P=0.000; t=-13.5, P=0.000). Female was more likely to have MCI (χ2=13.5, P=0.000). By analyzing the score of MoCA of the NE, it was found that the MoCA score of males, high education level and low age group were higher. Rhinoceros and camel in naming, church and face in delayed memory, alternating connection test and pointer position in clock drawing were more difficult. The sections' scores of MoCA showed that the subjects performed better in the orientation and attention tests, while the scores of visuospatial functions, delayed recalling, sentence repetition and abstract ability were lower. The best cut-off value of MoCA was 20 (sensitivity = 63.7%, specificity = 75.7%). The area under the curve was 0.76.

    Conclusion

    ·MoCA (Beijing version) has a good distinction between NE and MCI, and 20 can be used as a cut-off value in MCI subjects screening in urban areas of China. MoCA score is influenced by age, gender and education level. Based on difficulty analysis, some words that evaluate memory could be replaced (replacing “face” with “hand” and replacing “church” with “factory”).

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    Evidence-based medicine
    Practice for multidisciplinary diagnosis and treatment of dermatofibrosarcoma protuberans: expert consensus of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine (2020 edition)
    2021, 41 (12):  1669-1675. 
    doi: 10.3969/j.issn.1674-8115.2021.12.018

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    Dermatofibrosarcoma protuberans (DFSP) is a low- to intermediate-grade malignant soft tissue sarcoma occurring in the skin and subcutaneous tissues. The high misdiagnosis rate often delays the best treatment opportunity, and the wrong treatment method leads to the high recurrence rate of surgery. Traditional extended resection requires 3?5 cm expansion around the tumor, and the huge tissue defect increases the difficulty of surgery, which is also hard to be accepted. In Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, under the support of the multi-disciplinary treatment group, cutaneous spindle cell neoplasms multi-disciplinary team of accurate diagnosis and treatment normatively conducted treatment of DFSP comprehensive diagnosis and treatment. Modified Mohs micrographic surgery was used to remove the tumor while preserving as much normal tissue as possible. Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine expert consensus of diagnosis and treatment of specification of DFSP multidisciplinary specification was formed.

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    Public health
    Health-related quality of life and its influencing factors among patients with gastroesophageal reflux disease
    Zi-yun GAO, Yu-qing YAN, Tian-ying TONG, Li-jun NING, Jie HONG, Zhen-hua WANG
    2021, 41 (12):  1677-1682. 
    doi: 10.3969/j.issn.1674-8115.2021.12.019

    Abstract ( 2 )   HTML ( 1 )   PDF (1953KB) ( 1 )  
    Objective

    ·To evaluate the health-related quality of life (HRQoL) of patients with gastroesophageal reflux disease (GERD), and to explore the related factors.

    Methods

    ·EuroQol 5-Dimensions Instrument with 5-Level Scale (EQ-5D-5L) questionnaire was conducted on 108 GERD patients who visited the Gastroenterology Clinic of Renji Hospital, Shanghai Jiao Tong University School of Medicine from May to December 2019. GERD-Q questionnaire was used to assess their clinical symptoms. Other data including sociodemographic characteristics, disease-related information and medical costs were collected at the same time. Fisher's exact test was used to compare the amount and proportion of patients who had health problems in each dimension. The univariate Tobit model was used to select the influencing factors that were correlated with the EQ-5D-5L utility. Multivariate regression analysis such as the ordinary least squares (OLS) and Logistic regression model were employed to explore the factors affecting HRQoL of GERD patients.

    Results

    ·In the 108 patients, the average EQ-5D-5L utility score was 0.855 with a standard deviation (SD) of 0.162. In the subgroups of body mass index (BMI) (P=0.000), gender (P=0.000), endoscopy grade (P=0.000), GERD-Q score (P=0.049), medication and medical expenditures (P=0.000), the difference of proportion of patients who reported they had health problem were statistically significant. In OLS model, GERD-Q score greater than/equal to 8 and the higher medical expenditure had a negative impact on HRQoL (P<0.05), while use of antacids had a positive effect (P<0.05). Logistic regression analysis indicated that disease duration (OR=1.222, P=0.050) and use of antacids (OR=10.808, P=0.044) had positive relationship with HRQoL.

    Conclusion

    ·GERD could decrease the HRQoL of patients, and it requires the support and attention of medical decision-makers.

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    Review
    Research progress in the association between maternal prenatal polyunsaturated fatty acids and maternal and infant health
    Rui MA, Shu-jin CHEN, Feng-xiu OUYANG
    2021, 41 (12):  1684-1690. 
    doi: 10.3969/j.issn.1674-8115.2021.12.020

    Abstract ( 0 )   HTML ( 0 )   PDF (2289KB) ( 0 )  

    The nutritional status during pregnancy is closely related to the pregnancy outcome of the mother and the health of the offspring. Long chain polyunsaturated fatty acids (PUFAs) mainly include docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), arachidonic acid (AA), α-linolenic acid (ALA) and linoleic acid (LA). DHA, EPA and AA in human body are mainly from diet or synthesized from essential fatty acids ALA and LA. As the important components of cholesterol esters, phospholipids and fat in human body, PUFAs play complex biological functions through a variety of ways. For instance, PUFAs can participate in the composition of cell membrane, work as the second messenger precursors to transmit signals, and transform into hormones and PUFAs derivatives. Lack of PUFAs (EPA and DHA) during pregnancy may be related to the increased risk of preeclampsia, preterm delivery and postpartum depression, and affect the long-term cardiovascular health of children, but these correlations are still controversial. The increased intake of n-3 PUFAs (EPA and DHA) during pregnancy might be associated with the reduced risk of wheezing and asthma, while the increased intake of n-6 PUFAs (AA) might be associated with the increased risk of asthma and allergic rhinitis. For premature infants with insufficient DHA, timely supplementation of DHA could promote neurodevelopment. At present, there is a lack of normal reference range of PUFAs for pregnant women and newborns as the sensitive population. Thus, it is necessary to further study and establish the normal reference range of PUFAs in order to reasonably guide the nutrition of PUFAs during pregnancy.

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    Research progress of endoscope-assisted transnasal orbital decompression
    Rou SUN, Hui-fang ZHOU
    2021, 41 (12):  1692-1697. 
    doi: 10.3969/j.issn.1674-8115.2021.12.021

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    Endoscopic orbital decompression has become a mature surgical method because of the development of endoscope. The surgery through transnasal approach makes use of the natural sinus to avoid surgical scar and the endoscope visualizes the surgical area to reduce the risk. Many studies have demonstrated that transnasal endoscopic orbital decompression can reduce the proptosis and cause no severe complications. Using endoscope to apply transnasal orbital decompression has many operation schemes, which may have influence on the result of surgery and the occurrence of complications. This review is to introduce the application of endoscope to orbital decompression and its effectiveness and safety.

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    Progress of cardiac magnetic resonance in assessment of left ventricular mechanical dyssynchrony
    Jian-xun DONG, Lai WEI, Jie HE, Ling-cong KONG, Heng GE, Jun PU
    2021, 41 (12):  1698-1702. 
    doi: 10.3969/j.issn.1674-8115.2021.12.022

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    Left ventricular mechanical dyssynchrony (LVMD) is one of the manifestations of abnormal left ventricular motion. And the measured indexes related to LVMD are the indexes derived from left ventricular strain, which can predict the response to cardiac resynchronization therapy and the prognosis of the patients with acute myocardial infarction. The premise of LVMD diagnosis is to measure segmental strains of left ventricle accurately. As an emerging cardiac imaging technology, cardiac magnetic resonance (CMR) can accurately measure the strain of each left ventricle segment, which makes it valuable in both clinic and scientific research. In this article, the mechanism of LVMD, the measurement by CMR and its clinical application to heart diseases are reviewed.

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    Case report
    A case report of recurrent and metastatic tongue squamous cell carcinoma treated with salvage surgery combined with chemoradiotherapy and sequential immune checkpoint inhibitor
    Ji-ping DING, Xiao-guang LI, Zhong-long LIU, Gang DENG, Yuan YAO, Yue HE
    2021, 41 (12):  1704-1708. 
    doi: 10.3969/j.issn.1674-8115.2021.12.023

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    A 55-year-old male patient was admitted to hospital with recurrence of left tongue cancer 5 years after surgery. The patient with poor physical fitness and extensive lesions received salvage surgery for recurrent tongue cancer. Only 1 month after operation, bilateral cervical lymph node metastasis occurred. Cervical lymph node dissection was performed sequentially with radiotherapy and chemotherapy. One month after the end of radiotherapy, the metastatic foci in both lungs further increased. After 4 cycles of chemotherapy combined with immune checkpoint inhibitor, all the metastases disappeared. After 9 cycles of immune checkpoint inhibitor maintenance, the drug was stopped due to the occurrence of immune myocarditis, and the efficacy evaluation achieved complete remission.

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