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    Expert forum
    Progress and controversy in comprehensive treatment of hilar cholangiocarcinoma
    Wei CHEN, Yingbin LIU
    2022, 42 (1):  1-8. 
    doi: 10.3969/j.issn.1674-8115.2022.01.001

    Abstract ( 112 )   HTML ( 91 )   PDF (1076KB) ( 365 )  

    Hilar cholangiocarcinoma is a tumor with a poor prognosis, which is difficult to diagnosis in the early stage and has caused lots of controversies in clinical treatment. At present, surgical resection provides the main possibility for cure. Precise evaluation and adequate preparation before surgery and safe, effective, standardized resection are the key methods to successful treatment. Comprehensive treatment based on chemotherapy improves the survival of patients. In the future, guided by concepts of oncology, comprehensive treatment of multiple modes, containing surgery, chemotherapy, targeted therapy, immune therapy and biological therapy, is the development trend of hilar cholangiocarcinoma treatment.

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    Influences of oral administration of probiotics on postoperative infection and liver function recovery in patients with partial hepatectomy
    Yi WU, Fang FANG, Hao HUANG, Ying CHEN
    2022, 42 (1):  9-15. 
    doi: 10.3969/j.issn.1674-8115.2022.01.002

    Abstract ( 93 )   HTML ( 21 )   PDF (942KB) ( 303 )  
    Objective

    ·To investigate the influences of oral administration of probiotics on postoperative infection and liver function recovery in patients with partial hepatectomy.

    Methods

    ·A total of 165 patients undergoing partial hepatectomy in Shanghai General Hospital, Shanghai Jiao Tong University, were involved in this prospective randomized control study. In accordance with the random number table, patients were divided into mechanical bowel preparation group (MBP group, n=55), non-bowel preparation group (NBP group, n=55) and probiotics bowel preparation group (PBP group, n=55). Patients' general information, postoperative fever, the first time of flatus and defecation, and infectious indexes and liver function indexes on the 1st,3rd and 5th day after operation were collected and compared among the groups.

    Results

    ·There was no significant difference in the basic data among the 3 groups (all P>0.05). On the 5th day after operation, the white blood count of the PBP group was significantly lower than that of the MBP group (P=0.012) and NBP group (P=0.029). The level of glutamic-pyruvic transaminase of the PBP group was significantly lower than that of the MBP group and NBP group on the 3rd day (P=0.040, P=0.036) and the 5th day (P=0.002, P=0.019) after operation.

    Conclusion

    ·Oral probiotics intestinal preparation is helpful to reduce infection after partial hepatectomy and accelerate the recovery of liver function.

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    Application of modified Nutrition Risk in the Critically Ill score to critically ill elderly patients
    Xuemei LU, Lan CHEN
    2022, 42 (1):  16-20. 
    doi: 10.3969/j.issn.1674-8115.2022.01.003

    Abstract ( 106 )   HTML ( 18 )   PDF (859KB) ( 306 )  
    Objective

    ·To validate the role of the modified Nutrition Risk in the Critically Ill (mNUTRIC) score in the assessment of nutritional risk and clinical prognosis in critically ill elderly patients.

    Methods

    ·A prospective observational study was carried out. The mNUTRIC score was employed to assess the nutritional risk of elderly patients who were admitted into the intensive care unit (ICU) of Shanghai General Hospital, Shanghai Jiao Tong University between October 2020 and February 2021. Patients were divided into high nutritional risk group and low nutritional risk group based on the mNUTRIC score results. The observational end-points were transferred, discharged or death. Different nutrition risk patients' nutritional support were analyzed, including nutritional support methods, the time period before nutritional support, and energy supply conditions. The length of ICU stay, days with mechanical ventilation, and 28-day mortality of different nutrition risk patients were compared.

    Results

    ·Among critically ill elderly patients, 51.8% were at high nutritional risk. The energy compliance rate of the low nutritional risk group was 73.3%, and that of the high nutritional risk group was 58.8%. It took 5.00 (1.00, 8.00) d for the low nutritional risk group and 9.00 (3.00, 12.50) d for the high nutritional risk group to reach the energy standard. There was no statistical difference in the nutritional support methods, the time period before nutritional support, and energy supply conditions between the two groups. The mechanical ventilation time of the high nutritional risk group was 5.00 (1.50, 12.50) d, longer than that of the low nutritional risk group (P=0.018). The 28-day mortality rate of the high nutritional risk group was 47.7%, higher than that of the low nutritional risk group (P=0.001). There was no statistical difference in ICU stay between the two groups.

    Conclusion

    ·mNUTRIC score can be used to evaluate nutritional risk and predict the clinical prognosis of critically ill elderly patients. It is suggested that stratified clinical nutrition management should be carried out for the critically ill elderly patients with different nutritional risks. Critically ill elderly patients can benefit from personalized nutritional support programs, and the clinical prognosis of patients may be improved.

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    Relationship between preoperative glycosylated hemoglobin and postoperative delirium in patients following off-pump coronary artery bypass grafting
    Ye HE, Fang FANG
    2022, 42 (1):  21-27. 
    doi: 10.3969/j.issn.1674-8115.2022.01.004

    Abstract ( 89 )   HTML ( 18 )   PDF (1071KB) ( 297 )  
    Objective

    ·To investigate the relationship between postoperative delirium and preoperative HbA1c in patients with off-pump coronary artery bypass grafting (OPCAB), so as to provide reference for further intervention.

    Methods

    ·A prospective study was used to collect 364 surgical patients admitted to the Department of Cardiac Surgery in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. The data were collected through the general information questionnaire and the simple mental status assessment scale, and the Confusion Assessment Method of Intensive Care Unit, and Chinese Version of 3-minute Diagnostic Confusion Assessment Method were used to assess postoperative delirium. Univariate analysis was used to screen out the risk factors for delirium with P<0.05, and then a multi-factor Logistic regression analysis was used. The generalized additive model was used to observe the dynamic changes of HbA1c and the incidence of postoperative delirium, and the receiver operating characteristic (ROC) curve was drawn to clarify the boundary value.

    Results

    ·The influencing factors of postoperative delirium in OPCAB patients were age, alcohol use, peripheral vascular disease, NYHA function classification, LVEF, albumin, HbA1c, intraoperative blood transfusion, acid-base imbalance, and electrolyte imbalance. The generalized additive model and multivariate Logistic regression analysis showed that the higher the preoperative HbA1c, the higher the incidence of postoperative delirium in OPCAB patients.Through ROC curve analysis, it was determined that when the HbA1c>6.45%, the risk of delirium after OPCAB increased accordingly.

    Conclusion

    ·For patients undergoing OPCAB surgery, HbA1c is an independent risk factor for postoperative delirium. With the increase of HbA1c, the incidence of delirium gradually increases, suggesting that the preoperative HbA1c of OPCAB patients should be maintained at a normal level.

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    Development of knowledge-attitude-practice questionnaire for mechanical prophylaxis of deep venous thrombosis and its reliability and validity testing
    Chunhong HAN, Jie WANG, Yang HONG, Yahui TONG
    2022, 42 (1):  28-35. 
    doi: 10.3969/j.issn.1674-8115.2022.01.005

    Abstract ( 82 )   HTML ( 16 )   PDF (950KB) ( 291 )  
    Objective

    ·To develop a knowledge-attitude-practice questionnaire for mechanical prophylaxis of deep venous thrombosis for orthopedic nurses in China, and analyze its reliability and validity.

    Methods

    ·On the basis of literature review, combined with the characteristics of orthopedic diseases and orthopedic nurses, a preliminary questionnaire for mechanical prophylaxis of deep venous thrombosis was prepared. In January 2020, two rounds of expert letter consultation were conducted to demonstrate and modify the items in the first draft and form the test version of the questionnaire for mechanical prophylaxis of deep vein thrombosis.In March 2020, tests were conducted among 620 orthopedic nurses from 36 medical units in 13 cities in Jiangsu Province. Item analysis was carried out with critical ratio method and homogeneity test. Reliability analysis was carried out from internal consistency reliability, split-half reliability and retest reliability. Validity was analyzed from content validity and structure validity.

    Results

    ·The first draft of the questionnaire contained 37 items; after the first round of expert consultation, 4 items were revised and 7 items were added; after the second round of expert consultation, a test version of the questionnaire containing 44 items was formed. A total of 620 questionnaires were distributed. The effective recovery rate of the questionnaire was 96.77%. The critical ratio method showed that the item decision values t, which reflected the t-test results of independent samples of high and low groups, ranged from 5.89 to 20.31, and the difference was statistically significant (all P<0.05). The homogeneity test showed that Pearson correlation coefficient r, which reflected the correlation between the score of each item and the total score of the scale, ranged from 0.49 to 0.79, and the difference was statistically significant (all P<0.05). Therefore, 44 items were retained after item analysis. The Cronbach's α coefficient reflecting the internal consistency of the total questionnaire was 0.893, the Spearman-Brown coefficient reflecting the half-fold reliability was 0.794, and the intraclass correlation coefficient reflecting the retest reliability was 0.909. The scale-level content validity index reflecting content validity was 0.926 and the item-level content validity index was 0.833?1. Kaiser-Meyer-Olkin measure of sampling adequacy and Bartlett's sphericity test chi-square value which reflected the structure validity were 0.883 and 12 560.176 (df=666, P<0.05) respectively. These values indicated that the questionnaire was suitable for exploratory factor analysis. In addition, 7 items were deleted according to the absolute value of factor load. Finally, 37 items remained. Seven common factors with eigenvalue greater than 1 were extracted. The 7 common factors were named the act of mechanical prophylaxis, risk perception of mechanical prophylaxis, indications of mechanical prophylaxis, contraindications of mechanical prophylaxis, conceptual cognition of mechanical prophylaxis, mechanical preventive response and health education cognition of mechanical prophylaxis, respectively. The cumulative variance contribution rate was 61.992%.

    Conclusion

    ·The questionnaire in this study shows good reliability and validity. It can be used as an investigation tool to study the current attitude, knowledge and behavior of mechanical prophylaxis of orthopedic nurses.

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    Basic research
    Enhancement of BMP4 inhibitor DMH1 on the efficiency of BiSF in human iPSC-induced differentiation into neurons
    Yanna LIU, Zhaorui REN, Jingbin YAN
    2022, 42 (1):  36-43. 
    doi: 10.3969/j.issn.1674-8115.2022.01.006

    Abstract ( 153 )   HTML ( 30 )   PDF (4932KB) ( 71 )  
    Objective

    ·To obtain an efficient way of promoting induced human pluripotent stem cells (hiPSCs) to differentiate into neurons by improving existing methods BiSF.

    Methods

    ·Induction was initiated when hiPSCs reached 75% fusion, and BMP4 inhibitor (4-[6-[4-(1-methylethoxy)phenyl]pyrazolo[1,5-a]pyrimidin-3-yl]quinoline,DMH1) was added based on this induction method. The growth state was observed under microscope, and the expression of neural stem cell (NSC)-specific genes was quantitatively detected by quantitative real-time PCR (qRT-PCR) and immunofluorescence analysis. The proliferation level of the induced cells was determined by cell counting kit-8 (CCK-8). Then the NSC-like cells were further induced into neurons, and the ability of differentiation was detected by qRT-PCR and immunofluorescence.

    Results

    ·Microscopically, it was found that more spindle cells appeared around the cell mass of BiSF+DMH1 group on day 9, and a small amount of spindle cells appeared in the BiSF group with irregular gray cell clusters. CCK-8 growth curve showed that the cells derived from method BiSF+DMH1 were with a significantly higher proliferation on the next day (P=0.000). The cells derived from method BiSF+DMH1 achieved higher expression of nestin and PAX6 (P=0.019, P=0.011). The number of neurons with positive neuron-specific marker βⅢ-tubulin in the BiSF+ DMH1 group was significantly higher than that in BiSF group (P=0.003). The results of qRT-PCR showed that the relative expression of MAP2 in the BiSF+DMH1 group was significantly higher than that in the BiSF group (P=0.006).

    Conclusion

    ·The synergistic effect of DMH1 can significantly improve the efficiency of hiPSCs to differentiate into neurons.

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    Role of autosis of fibroblasts in hypertrophic scar regression
    Jian ZHANG, Fei SONG, Xiqiao WANG
    2022, 42 (1):  44-50. 
    doi: 10.3969/j.issn.1674-8115.2022.01.007

    Abstract ( 166 )   HTML ( 26 )   PDF (4892KB) ( 55 )  
    Objective

    ·To investigate whether autosis occurred in fibroblasts during hypertrophic scar regression.

    Methods

    ·The scar tissues of 16 burn patients were collected from June 2018 to June 2019 in the Burn Department of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. They were divided into two groups: hyperplasia group (control group, 8 cases) and regression group (experimental group, 8 cases). Autophagy was observed by transmission electron microscopy. Fibroblasts of the two groups were cultured in vitro to establish a hypoxia model. The fibroblasts were collected at 12, 24 and 48 h respectively, and autophagy was observed by transmission electron microscopy. Live/dead cells were detected by using Calcein /PI fluorescent dye kit. The autophagy and apoptosis were observed by immunofluorescence. The numbers of apoptosis and autophagic death were detected by flow cytometry. Then the expression of hypoxia inducible factor1 (HIF-1), beclin-1, microtuble-associated protein light chain 3 (LC3), caspase-3 and caspase-9 were assayed at the protein level. Student's t test was used for quantitative data between the two groups, and One-way ANOVA test was used for quantitative data among multiple groups.

    Results

    ·The electron microscopy showed that autophagosome existed in hyperplasia scar, and autosis occured in the regressive scar. In vitro study by electron microscopy was consistent with in vivo tissue observation. The dead cells had a marked increase at 24 hours, and further increased at 48 hours. Among them, the cell death type was mainly autosis, and a small amount of apoptosis. High expression of LC3 was responsible for this.

    Conclusion

    ·In addition to apoptosis, autosis may be the major cell death during hypertrophic scar regression, and LC3 plays an important role.

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    Screening potential hub genes associated with myocardial ischemia-reperfusion injury in mice based on GEO database and bioinformatics analysis
    Jianru WANG, Guangcao PENG, Mingjun ZHU
    2022, 42 (1):  51-62. 
    doi: 10.3969/j.issn.1674-8115.2022.01.008

    Abstract ( 169 )   HTML ( 24 )   PDF (8936KB) ( 173 )  
    Objective

    ·To screen the potential hub genes associated with myocardial ischemia-reperfusion injury (MIRI) in mice by bioinformatics analysis based on gene expression omnibus (GEO) database.

    Methods

    ·The mouse MIRI data sets GSE61592, GSE83472 and GSE160516 were obtained from GEO database. The differentially expressed genes (DEGs) in each data set were screened by limma package, and then robust DEGs were screened by robust sorting integration (RRA) method. The protein-protein interaction (PPI) network of robust DEGs was constructed, and the submodules and hub genes in the PPI network were screened. The clusterProfiler package was used to analyze the robust DEGs, the most important submodule genes and hub genes by gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG). Eighteen male C57BL/6 J mice aged 6?8 weeks were randomly divided into sham group and MIRI group, 9 mice each group. The MIRI model was constructed by left anterior descending coronary artery ligation for 30 min ischemia and 24 h reperfusion, and the mRNA expression of hub genes was detected by reverse transcription-quantitative polymerase chain reaction (RT-qPCR).

    Results

    ·RRA method identified 294 robust DEGs in three data sets. In PPI network, a total of 14 sub-modules were screened, of which module 1 was the most important and 17 hub genes were found. GO and KEGG analysis showed that the robust DEGs, module 1 genes, and the hub genes were mainly involved in regulating the migration of inflammatory cells, the activity of chemokines and cytokines and their receptors, Toll-like receptors and other biological function and signaling pathways. RT-qPCR results showed that compared with the sham group, the expressions of chemokine (C-C motif) ligand 4 (Ccl4), Ccl6, Ccl7, chemokine (C-X-C motif) receptor 4 (Cxcr4), chemokine (C-C motif) receptor 2 (Ccr2), signal-regulatory protein β1 (Sirpb1), low affinity immunoglobulin gamma Fc region receptor Ⅱb (Fcgr2b), leukocyte surface antigen CD53 (Cd53), arachidonate 5-lipoxygenase activating protein (Alox5ap), myeloid differentiation primary response gene 88 (Myd88), macrophage scavenger receptor 1 (Msr1), matrix metallopeptidase 14 (Mmp14), triggering receptor expressed on myeloid cells 2 (Trem2) and leupaxin (Lpxn) were up-regulated in the myocardium of the MIRI group, but there was no difference inlow affinity immunoglobulin gamma Fc region receptor Ⅲ (Fcgr3), complement C1q subcomponent subunit B (C1qb) and a disintegrin and metalloproteinase domain-containing protein 8 (Adam8). By reviewing the literatures, Trem2, Lpxn, Cd53, Alox5ap, Sirpb1 and Fcgr2b were not reported to participate in MIRI.

    Conclusion

    ·This study has unearthed 6 potential hub genes for MIRI in mice, and the results can provide new ideas and entry points for further exploring the molecular mechanism and therapeutic targets of MIRI.

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    Clinical research
    Molecular genetic diagnosis of 9 cases with 46,XY complete gonadal dysgenesis
    Haicheng WANG, Yu LIU, Hui YE, Lin NI, Ying CAO, Yunlong SUN, Bing XIAO, Caixia MA, Lifang TANG
    2022, 42 (1):  63-69. 
    doi: 10.3969/j.issn.1674-8115.2022.01.009

    Abstract ( 96 )   HTML ( 17 )   PDF (1628KB) ( 36 )  
    Objective

    ·To identify the genetic causes of 9 patients with 46,XY complete gonadal dysgenesis (CGD) .

    Methods

    ·The genetic variations of 9 patients with 46,XY CGD were analyzed by combining SRY mutation screening, next generation sequencing (NGS) and chromosome microarray (CMA).

    Results

    ·SRY mutations were identified in 4 of nine 46,XY CGD probands, including 2 patients with novel SRY gene pathogenic/likely pathogenic mutations, namely SRY deletion and c.208T>C (p.Trp70Arg) missense variation, and 2 patients with reported SRY pathogenic mutation, namely c.169C>T(p.Gln57X) and c.264dup(p.Glu89fs*15). One patient was identified with a heterozygous mutation in MAP3K1 gene c.1016G>A (p.Arg339Gln) by NGS, which was likely pathogenic mutation. In addition, CMA analysis and NGS found no pathogenic copy number variations (CNVs) in other 2 sporadic patients. Whole exome sequencing (WES) was performed on the younger of two sisters, whose parents were consanguineous marriage, filtered homozygous variants in the homozygous regions, no specific deleterious variants or likely variants associated with sexual development were found. CNVs analysis found an approximate 14 kb homozygous deletion in intron 2 of DMRT1 gene in both sister cases (Chr9: 866, 388-880, 086, hg19), and PCR sequencing with amplified spanned the junction revealed that healthy parents were heterozygous deletion carriers. Then PhastCons software was used to analyze the conserved fragments of the deletion intron sequences and two conserved non-coding elements (CNEs) were found.

    Conclusion

    ·SRY mutation was the frequent cause accounted for 46,XY CGD, and 2 novel pathogenic mutations in SRY gene were found. The 14 kb homozygous deletion in intron 2 of DMRT1 might be candidate pathogenic mutation for the sister patients. Stepwise analysis of genetic causes of 46,XY CGD patients might help to fully learn about the molecular changes in these patients.

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    Comparative analysis of 30 cases of metaplastic carcinoma of the breast
    Cui CHEN, Ye JIN, Lin WANG, Hongli LI, Caifeng WAN, Lixin JIANG
    2022, 42 (1):  70-76. 
    doi: 10.3969/j.issn.1674-8115.2022.01.010

    Abstract ( 108 )   HTML ( 17 )   PDF (2397KB) ( 44 )  
    Objective

    ·To comparatively analyze features of metaplastic carcinoma of the breast (MBC) images and immunological characteristics.

    Methods

    ·The data of 30 patients with MBC treated in Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2008 to January 2021 were analyzed retrospectively, and the imaging findings and immunohistochemical results of tumors were analyzed and compared.

    Results

    ·A total of 31 lesions were found in 30 cases of MBC, including 18 squamous cell carcinomas, 3 mixed metaplastic carcinomas, 7 mesenchymal differentiated carcinomas, 1 myoepithelial carcinoma, and 2 spindle cell carcinomas. All patients were female, aged from 33 to 89 years old, with an average age of (61.8±14.2) years. The maximum size of the tumors was 101.0 mm while the minimal was 6.6 mm, with the medium size 25.5 mm and the average size (33.1±18.5) mm. A total of 29 patients underwent ultrasound examination before operation, with a total of 30 lesions. Among them, 23 lesions were irregular-shaped (76.7%), 19 lesions were hypoechoic (63.3%), 11 lesions were mixed echogenicity (36.7%), 14 lesions were found with unclear boundary (46.7%), and 7 lesions were accompanied by small internal calcifications (23.3%). Five cases of axillary lymph nodes were found, in which 3 cases were confirmed by pathology as lymph node metastasis (10.3%). Eight patients were examined by computed radiography (CR), showing lobulated, lumpy or asymmetrical shape, with unclear boundary, and some of them were found with coarse, heterogeneous or fine sand-like calcification. Magnetic resonance imaging (MRI) showed low signal intensity on T1 weighted imaging (T1WI) and T2WI in 6 patients. After enhancement, uneven signal, obscure border, and lobulated shape were shown. The MRI images of 3 patients showed that there was the possibility of surrounding tissue invasion and axillary lymph node metastasis respectively, but ultrasound examination did not show that. Except the invasion of pectoralis major, which was confirmed by pathology, the other 2 cases were all false positive. Four cases accepted CR, MRI and ultrasound, 2 cases of small calcification were missed by MRI and 1 case of axillary lymph node was missed by ultrasound. Sixteen lesions were triple-negative (51.6%), estrogen receptor (ER)/progesterone receptor (PR) expression rate was 32.2% and the over-expression rate of human epidermal growth factor receptor 2 (HER2) was 25.8%.

    Conclusion

    ·Ultrasound, MRI and CR can complement each other and improve the accuracy of diagnosing the malignant degree of MBC.

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    Effect of psychomotor therapy on negative symptoms and cognitive function of patients with stable schizophrenia
    Ruping LU, Hui GAO, Linna JIANG, Xiaoya CHEN, Hong PENG, Hui SHEN, Qing FAN
    2022, 42 (1):  77-81. 
    doi: 10.3969/j.issn.1674-8115.2022.01.011

    Abstract ( 101 )   HTML ( 17 )   PDF (832KB) ( 51 )  
    Objective

    ·To explore the effect of psychomotor therapy on negative symptoms and cognitive function of patients with stable schizophrenia.

    Methods

    ·A random number table was used to divide 64 stable schizophrenia patients from Shanghai No.1 Civil Mental Health Center into a study group and a control group. The control group was given routine treatment, nursing and daily rehabilitation, and the study group increased psychomotor therapy on this basis. Both groups were intervened for 10 weeks, and the patients in the two groups were evaluated by the Positive and Negative Symptom Scale (PANSS), Mini Mental State Examination (MMSE), and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) before and after the intervention.

    Results

    ·Thirty patients in the study group and the control group completed the observation. The repeated-measures analysis of variance (ANOVA) showed that after 10 weeks of intervention, the score of PANSS negative symptom subscale and PANSS total score were lower than those of the control group (all P=0.000), while the scores of MMSE and RBANS were higher than those of the control group (P=0.008, P=0.000). After 10 weeks, the negative symptom subscale score and PANSS total score of the study group were lower than those before the study (all P=0.000), while the MMSE and RBANS scores were higher than those before the study (all P=0.000).

    Conclusion

    ·Psychomotor therapy can improve the negative symptoms and cognitive function of patients with stable schizophrenia.

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    Application of high-throughput drug sensitivity screening system in the treatment of non-small cell lung cancer with malignant pleural effusion
    Yu ZHANG, Xiaoyuan WU, Lihua GUAN, Yiyuan LIU, Xingyue PENG, Haiyan XIE, Wei HU, Keke HAO, Ning XIA, Guojun LU, Zhibo HOU
    2022, 42 (1):  82-89. 
    doi: 10.3969/j.issn.1674-8115.2022.01.012

    Abstract ( 113 )   HTML ( 67 )   PDF (2900KB) ( 38 )  
    Objective

    ·To explore the feasibility of individualized treatment of malignant pleural effusion (MPE) patients with non-small cell lung cancer (NSCLC) guided by in vitro high-throughput drug sensitivity screening system.

    Methods

    ·Thirty NSCLC patients with MPE treated in Nanjing Chest Hospital from January 2019 to May 2020 were included. The tumor cells in MPE were collected and isolated, and primary cells were cultured. The ex vivo drug sensitivity of primary cells was assessed for 30 chemotherapeutical and molecular targeted drugs by using the high-throughput drug sensitivity screening system of automated digital fluorescence imager. The consistency between the drug sensitivity assay results and the clinical efficacy of patients was evaluated.

    Results

    ·The ex vivo drug sensitivity results of primary tumor cells cultured from MPE revealed considerable heterogeneity in drug response. Most of the primary cells were sensitive to Epirubicin, Lobaplatin, Gemcitabine and Irinotecan. Clinical efficacy of 23 patients can be evaluated. For patients with previously untreated, epidermal growth factor receptor (EGFR) mutation-positive advanced NSCLC, the consistency between the efficacy of targeted therapy and the high-throughput drug sensitivity assay results was 44.4% (4/9). For the EGFR negative untreated patients and EGFR mutation-positive advanced NSCLC patients with acquired resistance to targeted treatment, the consistency between the therapeutic effect of chemotherapy and the high-throughput drug sensitivity assay results was 85.7% (12/14).

    Conclusion

    ·The high-throughput drug sensitivity assay based on MPE primary cell culture in NSCLC patients has a high consistency with the clinical efficacy of chemotherapy, which is helpful for decision-making of personalized chemotherapy.

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    Clinical comparison on patients undergoing general anesthesia and tracheal intubation between Jinhoujian and lidocaine aerosol
    Lei WU, Chonglin DU, Yimeng XIA
    2022, 42 (1):  90-94. 
    doi: 10.3969/j.issn.1674-8115.2022.01.013

    Abstract ( 133 )   HTML ( 16 )   PDF (893KB) ( 38 )  
    Objective

    ·To compare the clinical application of Jinhoujian spray and Lishuka aerosol (lidocaine) in tracheal intubation under general anesthesia.

    Methods

    ·A total of 100 patients undergoing elective laparoscopic cholecystectomy with tracheal intubation under general anesthesia were enrolled in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. They were randomly divided into Jinhoujian spray group (research group) and lidocaine aerosol group (control group), with 50 patients each. 1 min after anesthesia induction, the glottis was exposed by UE visual laryngoscope and Jinhoujian spray or lidocaine aerosol was applied to the throat by 2 press respectively. Mean arterial pressure (MAP) and heart rate (HR) were recorded at different time points, including before anesthesia induction (T0) , the time (T1),3 min (T2), 5 min (T3) and 10 min (T4) after intubation of endotracheal tube, the time (T5), 3 min (T6) and 5 min (T7) after extubation of endotracheal tube. MAP and HR were observed at different time points, including before (T0) and immediately after intubation (T1), 3 min (T2), 5 min (T3) and 10 min after intubation (T4), immediately (T5), 3 min (T6) and 5 min after extubation (T7). The emergence agitation and acceptance of tracheal tube were also recorded before and after extubation. The patients were followed up 24 h after the operation to observe pharyngalgia, hoarseness and extubation responses.

    Results

    ·There was no significant difference in general features between the two groups. After drug treatment, both groups could prevent the cardiovascular stress response caused by endotracheal intubation and extubation. And there was no statistical significance in MAP, HR and emergence agitation scores. Compared with the control group, the tolerance satisfaction of tracheal catheter (P=0.021) and acceptability (P=0.021) were significantly improved in the research group, and the incidence of pharyngeal pain within 24 h after surgery was significantly reduced (P=0.020).

    Conclusion

    ·The application of Jinhoujian spray can effectively reduce the cardiovascular stress response caused by tracheal intubation under general anesthesia, improve the tolerance of patients undergoing laparoscopic cholecystectomy to tracheal catheter, and reduce the incidence of postoperative pharyngeal pain.

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    Evidence-based medicine
    Meta-analysis of impacts of inhaled nitric oxide on postoperative renal injury and hemorrhage
    Dewei QIAN, Ren ZHOU, Lichun GUAN, Hang ZHANG, Min YU
    2022, 42 (1):  95-100. 
    doi: 10.3969/j.issn.1674-8115.2022.01.014

    Abstract ( 97 )   HTML ( 13 )   PDF (1964KB) ( 152 )  
    Objective

    ·To evaluate the effects of inhaled nitric oxide on renal injury and hemorrhage after surgery.

    Methods

    ·China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), WanFang Data, PubMed, Embase, Web of Science and The Cochrane Library were searched systematically from the establishment of each database to March 26, 2021. “外科手术” and “一氧化氮” were used as Chinese keywords for retrieval. Correspondingly, the “nitric oxide”“surgical procedures, operative”“cardiac surgical procedures”“cardiac surgery” and “transplantation” were used as subject words and free words for searching. The literatures were screened according to the pre-established inclusion and exclusion criteria. Meta-analysis was performed by using RevMan 5.3. The study end points were the incidences of renal injury and hemorrhage.

    Results

    ·Seven literatures were included for analysis, with a total of 689 surgical patients. Of them, 337 received nitric oxide treatment and 352 received placebo treatment. Compared with the control group, patients treated with nitric oxide demonstrated a statistically difference in reducing the incidence of postoperative renal injury (RR= 0.75, 95%CI 0.61?0.92, P=0.005). There was no significant difference in the incidence of hemorrhage (RR=0.79, 95%CI 0.22?2.83, P=0.710) between the two groups.

    Conclusion

    ·Application of nitric oxide after surgery does not increase the risks of renal injury and hemorrhage. In contrast, the use of nitric oxide in cardiopulmonary bypass might protect renal function.

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    Review
    Research progress of interleukin-1 receptor accessory protein in the pathogenesis of neuropsychiatric diseases
    Peipei CHENG, Yasong DU
    2022, 42 (1):  101-106. 
    doi: 10.3969/j.issn.1674-8115.2022.01.015

    Abstract ( 135 )   HTML ( 12 )   PDF (853KB) ( 52 )  

    Interleukin-1 receptor accessory protein (IL1RAP) is one of the important components of interleukin-1 (IL-1) signaling pathway, which can participant in the formation of IL-1/ IL-1RⅠ (interleukin-1 receptor Ⅰ)/IL1RAP complex and recruit adaptor proteins and downstream signal intermediates, further activate protein kinases, and ultimately induce the synthesis of proinflammatory mediators and the occurrence of acute inflammation response. In addition, IL1RAP is also involved in regulating the formation of neural synapses, which is an important molecular link between immune system and nervous system, and may be involved in the pathological process of neuropsychiatric diseases. This paper reviews the latest research results of IL1RAP in neuropsychiatric diseases (such as glioma, Alzheimer's disease, schizophrenia, etc.) in recent years, in order to explore the role and mechanism of IL1RAP in the pathogenesis of these diseases and provide theoretical support for its diagnosis and treatment.

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    Research progress on the role of PD-1/PD-L1 pathway in autoimmune eye diseases
    Chenling YANG, Huifang ZHOU
    2022, 42 (1):  107-112. 
    doi: 10.3969/j.issn.1674-8115.2022.01.016

    Abstract ( 135 )   HTML ( 16 )   PDF (825KB) ( 59 )  

    Autoimmune eye diseases are a kind of inflammatory eye disease caused by autoimmune reaction, mainly including autoimmune uveitis, thyroid-associated ophthalmopathy, Sj?gren's syndrome-related ophthalmoxerosis, neuromyelitis optica spectrum disorder and so on. The pathogenesis of these diseases is complex, involving the ocular surface, intraocular and orbital lesions. Traditional treatment methods mainly include corticosteroids and immune inhibitors, which have low efficiency and many side effects. Therefore, more in-depth research on the pathogenesis of autoimmune eye diseases is needed in order to find therapeutic targets for the etiological treatment. Programmed death 1 (PD-1) has been confirmed to be associated with many autoimmune diseases, and PD-1/programmed death ligand 1 (PD-L1) pathway plays a key role in the regulation of immune responses. Inactivation of the PD-1/PD-L1 pathway may lead to abnormal activation of autoimmune T cells, leading to the occurrence and development of autoimmune diseases. In this review, the immune regulation mechanism of PD-1/PD-L1 pathway that has been discovered at the present stage, as well as its role in autoimmune ophthalmopathy, is systematically summarized, and the potential of targeted treatment of autoimmune eye diseases in the future is prospected.

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    Research progress of botulinum toxin A in treatment of neurogenic bladder
    Lin ZHANG, Zhong CHEN
    2022, 42 (1):  113-118. 
    doi: 10.3969/j.issn.1674-8115.2022.01.017

    Abstract ( 128 )   HTML ( 12 )   PDF (811KB) ( 40 )  

    In recent years, intradetrusor injection of botulinum toxin A (BTX-A) has achieved satisfactory therapeutic effects on the treatment of neurogenic bladder, improving the bladder function and reducing the lower urinary tract symptoms while improving patients' quality of life. In addition, this therapy has advantages including minimal invasiveness, mild side effects, and allowing repeated injections. At present, there is no international consensus on the injection plan for BTX-A. Therefore, based on the recent clinical research results, this paper reviews the mechanism of action, types, usage, therapeutic effects, influencing factors, as well as adverse reactions and contraindications of BTX-A, in an attempt to provide evidence for its clinical application.

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    Research progress in influencing factors of early rehabilitation among patients in ICU environment
    Fu YANG, Fang FANG, Lan CHEN, Qiuli WANG
    2022, 42 (1):  119-123. 
    doi: 10.3969/j.issn.1674-8115.2022.01.018

    Abstract ( 138 )   HTML ( 13 )   PDF (948KB) ( 85 )  

    Bed rest and long-term immobilization are common phenomena among patients in intensive care unit (ICU), which can increase the risk of ICU-acquired weakness and other complications. Early rehabilitation is helpful to improve the physical function of ICU patients, reduce the occurrence of delirium and other psychological problems, and improve their quality of life, which is of great significance to promote their early return to family or society. This paper reviews the current situation and influencing factors of early rehabilitation in ICU environment.

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    Application progress of machine learning in the study of facial features of patients with depression
    Xin LI, Qing FAN
    2022, 42 (1):  124-129. 
    doi: 10.3969/j.issn.1674-8115.2022.01.019

    Abstract ( 171 )   HTML ( 14 )   PDF (832KB) ( 109 )  

    Major depressive disorder (MDD) is a mental illness that severely affects the quality of life, accompanied by changes in facial expressions and other behaviors. The current diagnosis for MDD mainly relies on self-reports and observations from doctors, which has subjective errors. There is a lack of objective and effective automated MDD detection methods. Facial expressions are important nonverbal behaviors, and the researchers have begun to use facial features to assist in identifying and diagnosing depression. As the core of artificial intelligence, machine learning has outstanding advantages in image feature extraction and classification. Taking IEEE Xplore database as the data source, this article sorts out the researches on the facial features of MDD patients based on machine learning from 2016 to 2021, and prospects the future research directions, to provide reference for clinical intelligent diagnosis and tracking of MDD in the future.

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    Research progress of Gd-EOB-DTPA-enhanced magnetic resonance imaging in the evaluation of biological behavior of hepatocellular carcinoma
    Yihuan WANG, Ruokun LI, Huanhuan CHONG, Fuhua YAN
    2022, 42 (1):  130-134. 
    doi: 10.3969/j.issn.1674-8115.2022.01.020

    Abstract ( 95 )   HTML ( 13 )   PDF (785KB) ( 52 )  

    Hepatocellular carcinoma is the most common primary malignant tumor of liver tumors and ranked as the third leading cause of cancer death. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) is a new hepatocyte-specific contrast agent commonly used at present. Its sensitivity and specificity for the diagnosis of small hepatocellular carcinoma can both be over 90%. Early diagnosis of hepatocellular carcinoma can benefit patients clinically, but as hepatocellular carcinoma is a highly heterogeneous tumor, the tumor biological behavior is also a key factor affecting the prognosis. Gd-EOB-DTPA-enhanced magnetic resonance imaging (EOB-MRI) can provide relevant information about identification of molecular typing, evaluation of immune microenvironment, and prediction of microvascular invasion and postoperative recurrence in hepatocellular carcinoma. This article reviews the research progress of EOB-MRI in the evaluation of biological behavior of hepatocellular carcinoma to provide reference for the diagnosis and treatment of hepatocellular carcinoma.

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