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    Basic research
    Effect of maternal high-fat diet on placental phenotype in mice
    XU Yidan, ZHANG Qianren, LU Xingyu, DONG Yan
    2023, 43 (4):  397-405. 
    doi: 10.3969/j.issn.1674-8115.2023.04.001

    Abstract ( 188 )   HTML ( 380 )   PDF (4365KB) ( 222 )  

    Objective ·To analyze the effects of maternal high-fat diet on placental phenotype, and investigate the role of placental microenvironment in the intergenerational transmission. Methods ·The 3-week-old C57BL/6J female mice were fed with either the high-fat diet (HFD group) or the control diet (CD group) for 5 weeks before mating and throughout gestation. Placentas and fetal liver tissues were collected from maternal mice after 20 d of gestation. The effects of maternal HFD on the placental inflammation and placental structure were investigated by hematoxylin-eosin staining (H-E staining), immunohistochemistry, Western blotting and RT-PCR. The lipid deposition levels in fetal livers were also detected. Body weight changes, fasting blood glucose and glucose tolerance levels of the 3-week-old weaned mice were also detected. Results ·The body weight of female mice in the HFD group increased significantly, and the liver triacylglycerol (TAG) and total cholesterol (TC) levels were higher than those in the CD group (all P<0.05). Compared to the CD group, the liver cells of fetus in the HFD group showed steatosis, lipid vacuoles of different sizes, and the content of TAG in the fetal livers in the HFD group increased, but the difference was not statistically significant (P>0.05). Compared to the CD group, the body weight, fasting blood glucose level and the area under the glucose tolerance curve of the 3-week-old weaned mice of the HFD group were increased significantly (all P<0.05). The immunohistochemical results showed that the levels of interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) in the placenta in the HFD group were significantly increased (both P<0.05), and the level of IL-1β did not change significantly. In addition, H-E staining of placentas showed that the area proportion of the labyrinth zone (the maternal-fetal exchange area) in the HFD group decreased significantly, which was statistically significant by ImageJ software (P<0.05). The intervascular membrane thickened, and the maternal blood sinuses were narrow. RT-PCR results showed the expressions of placental tight-junction-related protein Zo-1 (zonula occludens 1) and claudin were increased (both P<0.05). Conclusion ·Maternal high-fat diet may result in placental inflammation and abnormal structure, which may be related to glucose and lipid metabolism disorder in offspring.

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    Ameliorative effects on osteoporosis of small extracellular vesicles derived from bone marrow mesenchymal stem cells
    LI Xuran, TAO Shicong, GUO Shangchun
    2023, 43 (4):  406-416. 
    doi: 10.3969/j.issn.1674-8115.2023.04.002

    Abstract ( 196 )   HTML ( 377 )   PDF (7654KB) ( 180 )  

    Objective ·To investigate the effects of small extracellular vesicles (sEVs) derived from human bone marrow mesenchymal stem cells (BMSCs) on the regulation of osteoclast differentiation and macrophage polarization in mice, and mouse model of osteoporosis. Methods ·BMSCs were cultured and sEVs were isolated through differential centrifugation. The isolated sEVs were identified by transmission electron microscopy (TEM) and nanoparticle tracking analysis (NTA). RAW264.7 cells were cultured and stimulated with macrophage colony-stimulating factor (M-CSF) and receptor activator of nuclear factor-κB ligand (RANKL) to differentiate the cells into osteoclasts. Tartrate-resistant acid phosphatase (TRAP) staining and phalloidin staining were performed to assess the effect of sEVs on osteoclast formation. The expression levels of osteoclast marker genes, i.e., cAMP-response element binding protein (CREB), cathepsin K (CTSK), and Jun proto-oncogene (c-Jun) were examined by real-time quantitative PCR. To polarize RAW264.7 cells to M1 phenotype, they were cultured with lipopolysaccharides; to polarize them to M2 phenotype, they were cultured with interleukin-4 (IL-4) and IL-13. Flow cytometry was performed to detect the effect of sEVs on macrophage polarization. Micro-computed tomography (micro-CT) and TRAP staining were performed to investigate the effect of sEVs on the bone tissues of lumbar vertebrae in osteoporosis mouse models. Results ·TEM and NTA demonstrated that the isolated sEVs had a typical globular structure with a diameter ranging from 30?150 nm. TRAP staining and phalloidin staining showed that BMSC-derived sEVs inhibited the fusion of RAW264.7 cells to form osteoblasts. PCR revealed that sEVs could decrease the expression of CREB, CTSK, and c-Jun (all P<0.05). Flow cytometry analysis indicated that BMSC-derived sEVs inhibited RAW264.7 macrophages polarization to M1 phenotype and induced RAW264.7 macrophages polarization to M2 phenotype. Micro-CT indicated that the number of trabeculae and the bone volume fraction of lumbar vertebrae were significantly higher in the sEV-intervened group than those in the control group (both P<0.05). TRAP staining revealed a reduction of osteoclast number in the lumbar vertebrae after intervention with sEVs. Conclusion ·The sEVs from human BMSCs can delay bone loss in osteoporosis mice, which may be related to its effects of inhibiting osteoclast differentiation and promoting the polarization of M2 type macrophages.

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    Establishment of a mouse embryonic stem cell line carrying a reporter of mT-F2A-EGFP based on CRISPR/Cas9n technology
    WANG Jingyi, WANG Qiong
    2023, 43 (4):  417-427. 
    doi: 10.3969/j.issn.1674-8115.2023.04.003

    Abstract ( 132 )   HTML ( 361 )   PDF (4013KB) ( 156 )  

    Objective ·To establish a T-box transcription factor Brachyury(T gene) fluorescence reporter cell line, in which foot-and-mouth disease virus 2A (F2A) and enhanced green fluorescent protein (EGFP) were knocked in at the end of mouse T gene (mT-F2A-EGFP) in mouse embryonic stem cells (mESCs) by CRISPR/Cas9n (clustered regularly interspaced short palindromic repeats/CRISPR-associated protein 9 nickase)-mediated homologous-directed repair (HDR) technology. Methods ·First of all, the specific single guide RNA (sgRNA) plasmid targeting the sequence near the stop codon of the mouse T gene and the plasmid donor containing F2A-EGFP were constructed. These two plasmids were co-delivered into mESCs E14Tg2a (E14) by electroporation. In this way, the desired fluorescent marker EGFP with self-cleaving peptide F2A were introduced into the end of T gene via HDR. Then, the monoclonal cells, obtained after drug selection and verified by sequencing, were induced for differentiation as embryonic bodies (EB), of which the fluorescence signals of mT-F2A-EGFP were monitored by fluorescence microscope and flow cytometry. These reporter clones were also selected before and after differentiation by real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR), which detected the transcription levels of marker genes determing pluripotency, mesendoderm differentiation or ectoderm differentiation. In addition, the cell cycle and growth curve of these clones were detected. Meanwhile, alkaline phosphatase (AP) staining was used to detect the stem cell characteristics of these candidate clones. Finally, the clone T1 carrying mT-F2A-EGFP was selected for EB differentiation. Flow cytometry was used to sort out EGFP expression cells (EGFP) and non-EGFP expressing cells (EGFP) from the EBs comprising multiple lineage cells upon differentiation, of which cell lineage markers were checked by RT-qPCR. Results ·EGFP was correctly inserted after the T gene in E14, whose fluorescence intensity reflected the expression level of endogenous T without observed side effects. When the fluorescence reporter clone T1 was differentiated, the EGFP+ cells sorted by flow cytometry mainly expressed mesendoderm marker genes. Conclusion ·The establishment of mESC line carrying mT-F2A-EGFP can realize rapid monitoring of the degree of T regulation, and track mesendoderm cells expressing T marker, EGFP in real time during differentiation.

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    Preparation and target protease identification of a cyanobacterial serine protease inhibitor, arthropin
    XU Jiawei, ZHOU Aiwu, YANG Yufeng
    2023, 43 (4):  428-436. 
    doi: 10.3969/j.issn.1674-8115.2023.04.004

    Abstract ( 113 )   HTML ( 36 )   PDF (3094KB) ( 123 )  

    Objective ·To prepare a high-purity cyanobacterial serine protease inhibitor, screen its target proteases, and detect its inhibitory activity. Methods ·A novel serine protease inhibitor from Arthrospira platensis was identified in the Expanded Human Oral Microbiome Database (eHOMD) by amino acid sequence alignment and named as arthropin. The fusion expression vector pSUMO3-arthropin was constructed and transferred into Escherichia coli (E. coli) BL21(DE3) system for fusion protein expression. The recombinant arthropin was purified by a four-step chromatographic purification approach of nickel affinity chromatography, enzymatic digestion, reverse nickel affinity chromatography, and anion exchange chromatography. In addition, the recombinant arthropin was co-incubated with 14 serine proteases such as activated factor Ⅸ (FⅨa), FⅩa, FⅪa, activated protein C (APC) and kallikrein 1 (KLK1), respectively, and then analyzed by SDS-PAGE. The inhibitory rate of arthropin on KLK1 was assayed with kinetic methods. The crystallization conditions of the recombinant arthropin were screened preliminarily, and the suitable crystals were picked for X-ray diffraction to collect the data. Finally, a sub-stable structure model of arthropin was predicted with AlphaFlod Colab. Results ·SDS-PAGE showed that the fused arthropin was successfully expressed in the E. coli BL21(DE3) system, and following purification, the high-purity recombinant arthropin, the relative molecular mass of which was similar to the theoretical value (45 800), was obtained. The co-incubation analysis of recombinant arthropin with 14 serine proteases revealed that arthropin was able to form stable covalent complexes with 9 proteases, including FⅩa, APC, FⅨa, FⅪa, trypsin, cathepsin G, KLK1, KLK7 and thrombin. Arthropin inhibited KLK1 with a second-order association rate constant of 1.7×103 L/(mol·s). Moreover, the recombinant arthropin crystalised under the condition of 25% PEG MME 550, 0.1 mol/L MES (pH 6.5) and 0.01 mol/L ZnCl2 , and the crystals preliminarily diffracted to a resolution of 10 ? (1 ?=1×10-10 m). The analysis of the structure predicted by AlphaFlod Colab revealed that arthropin had the classical structural features of the inhibitory serpin. Conclusion ·Arthropin, a serpin from Arthrospira platensis, was successfully obtained with high purity and a broad-spectrum of serine protease inhibition, but at a low inhibitory rate.

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    Clinical research
    A modified clinically relevant post-operative pancreatic fistula risk evaluation model based on ultrasound shear wave elastography: a prospective study
    TIAN Xiaofan, DONG Yi, LOU Wenhui, ZHANG Qi, QIU Yijie, ZUO Dan, WANG Wenping
    2023, 43 (4):  437-444. 
    doi: 10.3969/j.issn.1674-8115.2023.04.005

    Abstract ( 116 )   HTML ( 39 )   PDF (2304KB) ( 113 )  

    Objective ·To modify previous clinically relevant post-operative pancreatic fistula (CR-POPF) risk evaluation models with quantitative evaluation of pancreatic tissue stiffness by ultrasound shear wave elastography (SWE). Methods ·In this prospective study, the patients who were diagnosed as having pancreatic tumors and scheduled to undergo pancreatectomy at Zhongshan Hospital, Fudan University were initially enrolled, whose clinical information was collected. Virtual touch tissue imaging and quantification technology (VTIQ) assessment was applied to the patients within one week before the surgery to measure the shear wave velocity (SWV) of pancreatic lesions and the normal parenchyma of pancreatic body in the superficial layer of the portal vein. During the surgery, the surgeons qualitatively evaluated the stiffness of pancreases via direct palpation and divided them into soft pancreases and medium-hard pancreases. During the 3-week follow-up period after pancreatectomy, CR-POPF was diagnosed according to 2016 International Study Group of Pancreatic Fistula (ISGPF) standard. Peri-operative risk factors of CR-POPF were analyzed by univariate and multivariate Logistic regression to build the prediction model. Evaluation and comparison of diagnostic efficacy and clinical benefits among different models were then performed via receiver operating characteristic (ROC) curve and decision curve analysis (DCA). Results ·From September 2021 to March 2022, 100 patients were enrolled in this study, including 33 patients (33.0%) who received pancreaticoduodenectomy (PD) and 67 patients (67.0%) who received distal pancreatectomy. CR-POPF was diagnosed in 35 patients (35.0%) during the 3-week post-pancreatectomy follow-up. Multivariate Logistic regression analysis revealed that the SWV value of the body part of pancreatic parenchyma in the superficial layer of the portal vein [lgOR=-2.934 (95%CI -4.387?-1.479), P=0.000] and the presence of a non-dilated main pancreatic duct (≤3 mm) [lgOR=0.805 (95%CI 0.274?1.335), P=0.003] were independent risk factors that significantly correlated with the occurrence of CR-POPF after pancreatectomy. The modified model based on the SWE parameter achieved the area under the ROC curve of 0.842, with the sensitivity, the specificity, the positive predictive value, the negative predictive value and the likelihood ratio of 85.7%, 64.6%, 70.5%, 81.8% and 2.422 in predicting CR-POPF. DCA revealed a better clinical benefit of the modified model compared to the previous prediction models [fistula risk score (FRS) and alternative fistula risk score (a-FRS)]. Conclusion ·The modified model based on the SWE parameter and identified clinical risk factors can make non-invasive, quantitative and objective evaluation of CR-POPF risk before pancreatectomy, and provide sufficient diagnostic efficacy and clinical benefits.

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    Current status of neurodevelopmental outcomes and its influencing factors of early-to-moderate preterm infants at corrected age of 18 months
    SHEN Li, HUANG Hengye, YU Guangjun
    2023, 43 (4):  445-452. 
    doi: 10.3969/j.issn.1674-8115.2023.04.006

    Abstract ( 121 )   HTML ( 38 )   PDF (1671KB) ( 61 )  

    Objective ·To analyze the neurodevelopmental outcomes and risk factors of early-to-moderate preterm infants with gestational age≤34 weeks at corrected age of 18 months. Methods ·The early-to-moderate preterm infants hospitalized in Neonatal Intensive Care Unit of Shanghai Children's Hospital from January 2013 to April 2020, and regularly followed up after discharge were included in this study. Demographic and clinically relevant data of preterm infants and their parents were collected. The infants were divided into the neurodevelopmental retardation group and the normal neurodevelopment group according to their Gesell Development Schedule (GDS) scores at corrected age of 18 months. The demographic characteristics of preterm infants, birth status, demographic characteristics of parents and prenatal examinations between the two groups were compared, and stepwise Logistic regression was used to explore the factors influencing neurodevelopmental outcomes in preterm infants. Results ·A total of 929 preterm infants were included in the study, including 527 boys (56.7%) and 402 girls (43.3%), with a mean gestational age of (31.06±2.23) weeks and 138 (14.9%) extremely preterm infants. A total of 147 infants (15.8%) had neurodevelopmental retardation of early-to-moderate preterm infants at corrected age of 18 months, with abnormalities of 7.4%, 9.7%, 17.9%, 14.2% and 13.7% in gross motor, fine motor, language, adaptive behavior and personal-social behavior, respectively. A comparison of the clinical characteristics between the neurodevelopmental retardation group and the normal neurodevelopment group revealed statistically significant differences in terms of gender, whether the baby was an extremely preterm infant, birth weight, mode of delivery, and occurrence of intrauterine distress (all P<0.05). Stepwise Logistic regression analysis showed that boys (OR=1.60, 95%CI 1.05?2.44, P=0.028), cesarean section (OR=1.67, 95%CI 1.08?2.60, P=0.022), extremely preterm infants (OR=2.20, 95%CI 1.34?3.62, P=0.002) and intrauterine distress (OR=5.03, 95%CI 2.11?11.99, P=0.000) were the risk factors for neurodevelopmental retardation. Conclusion ·Boys, extremely preterm infants, cesarean section and intrauterine distress may increase the neurodevelopmental retardation risk of early-to-moderate preterm infants and improving follow-up management of these preterm infants should be focused on and enhanced.

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    Factors influencing the amount of blood loss in pediatric patients during craniosynostosis surgery
    JIANG Jing, BIAN Yong, ZHENG Jijian, HUANG Yue
    2023, 43 (4):  453-458. 
    doi: 10.3969/j.issn.1674-8115.2023.04.007

    Abstract ( 98 )   HTML ( 38 )   PDF (1544KB) ( 46 )  

    Objective ·To analyze and explore the risk factors influencing intraoperative blood loss in pediatric patients during open cranial repair for craniosynostosis. Methods ·The clinical data of pediatric patients diagnosed as having craniosynostosis undergoing open cranial repair from June 2013 to June 2019 in Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine were retrospectively collected, including age, gender, weight, body length, type of craniosynostosis, number of sutures, previous craniofacial surgery, the duration of symptoms, family history, operation duration, operation type, intraoperative blood loss, amount of blood products, amount of fluid transfusion, the use of hemostatic drugs and so on. According to whether intraoperative blood loss exceeded 20% of the total blood volume, all patients were divided into massive bleeding group (≥20%) and non-massive bleeding group (<20%). The clinical data of the two groups were compared and analyzed by univariate analysis and binary Logistic analysis, and the risk factors of intraoperative blood loss were explored. Results ·A total of 239 children were included, including 215 cases in the massive bleeding group and 24 cases in the non-massive bleeding group. Univariate analysis showed that there were differences in age, weight, body length, lowest body temperature during operation, craniosynostosis type and operation type between the two groups. Patients with massive bleeding amounts had lower age, weight, body length, and lowest body temperature than those in the non-massive bleeding group (all P<0.05). There was no difference in other clinical data between the two groups. Binary Logistic regression analysis showed that body weight (B=-0.24, OR=0.79, 95%CI 0.64?0.96, P=0.018) was an independent risk factor for intraoperative massive bleeding in craniosynostosis surgery. Receiver operator characteristic curve (ROC curve) was obtained based on binary Logistic regression model. The area under the curve (AUC) was 0.69 (95%CI 0.57?0.81). Youden index was further calculated to be 0.392, and the corresponding body weight threshold was 10.45 kg. Conclusion ·The lower body weight of children with craniosynostosis are, the higher incidence of massive hemorrhage they have during open cranial repair, especially in children with body weight less than 10.45 kg.

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    Preliminary study of pelvic floor structural changes in early and middle pregnant women with cervical incompetence
    HE Ping, SHAO Feixue, GUO Lili, LI Keting, MAO Xiaoyuan, BAO Yirong, WANG Lei
    2023, 43 (4):  459-465. 
    doi: 10.3969/j.issn.1674-8115.2023.04.008

    Abstract ( 104 )   HTML ( 34 )   PDF (2427KB) ( 63 )  

    Objective ·To explore the changes of pelvic floor structure in the early and middle pregnant women with the history of cervical incompetence (CIC) by ultrasound. Methods ·The pregnant women during early and middle trimesters were collected from Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine from August 2022 to January 2023. All the pregnant women had only one history of premature delivery, abortion or induced labor in the middle trimester, and were divided into CIC group and control group according to whether having the history of CIC in the previous pregnancy. Age, body mass index (BMI), gestational age, the prevalence of funneling of internal urethral orifice and the prevalence of urinary incontinence were compared between the two groups. Two-dimensional, three-dimensional, and four-dimensional pelvic floor ultrasound was used to measure the pelvic floor structures of the women in the states of resting, pelvic floor muscle contraction (PFMC) and Valsalva maneuver (VM). The parameters of pelvic floor structure included bladder neck position, urethral inclination angle, urethral rotation angle, posterior angle of bladder, bladder neck mobility, cervix position, position of ampulla of rectum, area of urogenital hiatus (HA), hiatal transverse diameter, and hiatal anteroposterior diameter. General linear regression model was used to correct the influence of confounders and to analyze the association between the history of CIC and the different indexes of pelvic floor structure. Results ·A total of 76 pregnant women in early and middle trimesters were collected, including 39 women in the CIC group and 37 women in the control group. There was no significant difference in the age between the two groups, while BMI and gestational age in the CIC group were significantly greater than those of the control group, and the differences were significant (both P<0.05). At the states of resting and PFMC, there were no significant differences in structural parameters (all P> 0.05); at the state of VM, HA (P=0.016) and hiatal anteroposterior diameter (P=0.014) increased in the CIC group, while other parameters did not change significantly. It was found that the CIC history was associated with HA (P=0.038) and hiatal anteroposterior diameter (P=0.049) at VM after adjusting gestational age and BMI by the general linear regression model. The incidence rates of funneling of internal urethral orific in the CIC group and the control group were 10.25% and 0, respectively; the incidence rates of stress incontinence were 23.07% and 13.51%, respectively. Neither of the differences were significant (both P>0.05). Conclusion ·In the pregnant women with the history of CIC, HA and hiatal anteroposterior diameter at VM increase, and the morphological change of the levator ani hiatus is more obvious with the increase of the vertical axis.

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    Evidence-based medicine
    Meta analysis of correlation between lipid accumulation product and hypertension in Chinese adults
    MA Zhuoran, YUAN Ancai, JIANG Huiru, CHEN Xiaoyu, ZHANG Wei, PU Jun
    2023, 43 (4):  466-473. 
    doi: 10.3969/j.issn.1674-8115.2023.04.009

    Abstract ( 83 )   HTML ( 38 )   PDF (2312KB) ( 46 )  

    Objective ·To explore the correlation between lipid accumulation product (LAP) and hypertension in Chinese adults. Methods ·By searching the English literature databases including PubMed and Web of Science, and the Chinese literature databases including CNKI and WanFang Data Knowledge Service Platform database, the earliest literature related to LAP and hypertension in Chinese adults that could be retrieved from databases establishment to August 2022. Two researchers independently screened all the retrieved literature according to the inclusion and exclusion criteria, and used the diagnostic research scale developed by Joanna Briggs Institute (JBI) to evaluate the literature quality of the selection, comparability, exposure evaluation and results of the study population. The sample size, gender, sensitivity, specificity and other information were extracted from the included literature. Stata 16.0 software was used for meta-analysis. Results ·A total of 6 articles were included, including five in English and one in Chinese. The JBI bias scores of the included articles ranged from 14 to 17 points, all of which were greater than 70% of the total score, so the biases could be considered small. The total number of samples included was 48 329, including 15 746 patients with hypertension. The results of meta-analysis showed that in the total population, the sensitivity of LAP in predicting hypertension was 0.50 (95%CI 0.35?0.64), and the specificity was 0.78 (95%CI 0.66?0.86); In women, the sensitivity was 0.48 (95%CI 0.32?0.64), and the specificity was 0.77 (95%CI 0.64?0.86); In males, the sensitivity was 0.56 (95%CI 0.39?0.72), and the specificity was 0.64 (95%CI 0.49?0.77). The area under the summary receiver operator characteristic curve (SROC curve) of the total population included was 0.70 (95%CI 0.66?0.74), indicating that there was a certain correlation between LAP and hypertension. Conclusion ·In Chinese adult population, LAP is associated with hypertension to a certain extent.

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    Advances in fluorescence imaging of malignant tumors
    WANG Wenbo, ZHANG Fangrong, SHI Tingwang, CHEN Yunfeng
    2023, 43 (4):  474-479. 
    doi: 10.3969/j.issn.1674-8115.2023.04.010

    Abstract ( 151 )   HTML ( 45 )   PDF (1491KB) ( 92 )  

    Malignant tumors are common diseases that threaten human health. Early diagnosis and complete resection can significantly improve the prognosis of patients with malignant tumors. At present, the imaging techniques used clinically for malignant tumor detection have problems such as poor sensitivity and temporal-spatial resolution, long scanning time, etc., which cannot achieve early diagnosis and meet the requirements of surgical navigation. As a new imaging technology with excellent imaging characteristics, fluorescence imaging can perform real-time imaging of the structure and function of biological tissues and organs. It can realize the accurate detection of malignant tumors by designing fluorescent probes with high sensitivity, high selectivity and specificity. The sensitivity of fluorescence imaging mainly depends on the fluorophore of the probe, and the selectivity and specificity mainly depend on whether the probe adopts an effective targeting strategy. Studies have shown that near infrared fluorophores with emission wavelengths in the near infrared window, especially those in the near infrared Ⅱ window, have excellent optical properties, which can effectively improve the sensitivity of fluorescence imaging of malignant tumors; at the same time, based on the unique structure and metabolic features of malignant tumors, various targeting strategies have been developed to design "always-on" fluorescent probes and "turn-on" fluorescent probes, which significantly improved the selectivity and specificity of fluorescent imaging of malignant tumors. In this paper, the newly developed near infrared fluorophores and the strategies of fluorescent probes targeting malignant tumors are reviewed.

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    Research progress in brain morphological characteristics of obsessive-compulsive disorder
    ZHANG Chen, GUO Qihui, FAN Qing
    2023, 43 (4):  480-486. 
    doi: 10.3969/j.issn.1674-8115.2023.04.011

    Abstract ( 106 )   HTML ( 39 )   PDF (1231KB) ( 89 )  

    Obsessive-compulsive disorder (OCD) is a high disabling psychiatric disease with the clinical symptoms of recurrent intrusive thoughts or repetitive behaviors. The etiology and pathogenesis of OCD have not been fully elucidated. Exploring the brain morphological characteristics of OCD is important for understanding the pathological mechanism of OCD. Besides, as potential biomarkers, brain morphological characteristics have a good application prospect in assisting clinical diagnosis and treatment. In recent years, neuromodulation techniques such as repetitive transcranial magnetic stimulation (rTMS) and deep brain stimulation (DBS) have been widely used in the treatment of OCD. Exploring the abnormal brain morphological characteristics of OCD may provide a basis for the selection of neuromodulation targets. Current studies on the brain morphological characteristics of OCD mainly focus on the cortico-striato-thalamo-cortical (CSTC) circuit, which is closely related to the pathological mechanism of OCD. Limited by the differences in inclusion and exclusion criteria, medication and data analysis methods among these studies, there are many inconsistent results on the brain morphological characteristics of OCD, and how to promote the clinical application needs further exploration. This article reviews the research results of brain morphological characteristics of OCD, discusses the clinical application prospect, and points out the future development direction, in order to promote the progress of etiology and clinical treatment of OCD.

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    Progress in relationship between chronotype and technology addiction and its mechanism
    WU Yujing, GUO Qian, LIU Xiaohua, LI Guanjun
    2023, 43 (4):  487-494. 
    doi: 10.3969/j.issn.1674-8115.2023.04.012

    Abstract ( 170 )   HTML ( 42 )   PDF (1361KB) ( 114 )  

    In the era of digitalization, the Internet has changed people's lifestyle and circadian rhythm, and has also brought the global problem of technology addiction. Many studies have shown that chronotype is significantly related to specific technology addiction (such as Internet, smartphones, video games and social media), which makes chronotype become a new perspective to explore the occurrence, development and maintenance of technology addiction. Individuals can be classified into three chronotypes: morning type (M-type), neither type (N-type) and evening type (E-type). Most studies showed that E-type was the risk factor in the onset and maintenance of problematic technology use. At present, most of the prior research focused on the relationship between chronotype and technology addiction, and there were few studies on the mechanism. Based on this situation, this paper discusses physiological factors (such as reward system), psychological factors (such as depression), individual factors (such as gender, age, personality traits and sleep patterns) and environmental factors (such as parental style), analyzes the relationship with Interaction of Person-Affect-Cognition-Execution (I-PACE) model and life history theory from the perspectives of etiology and evolution, and reviews the relationship between chronotype and technology addiction and its mechanism.

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    Advances in Helicobacter pylori infection involved in gastric cancer metastasis
    XIAO Rong, TAO Shuangfen, CHEN Siyu, ZHENG Leizhen, ZHU Meiling
    2023, 43 (4):  495-499. 
    doi: 10.3969/j.issn.1674-8115.2023.04.013

    Abstract ( 130 )   HTML ( 44 )   PDF (1282KB) ( 69 )  

    Gastric cancer is a common cancer of the gastrointestinal tract, highly occurring in East and Southeast Asian. Roughly more than 50% of the population is exposed to Helicobacter pylori (H. pylori) infection worldwide. H. pylori infection is one of the risk factors for gastric cancer and is strongly associated with the development of gastric cancer. The association between H. pylori infection and metastasis of gastric cancer is still inconclusive but has made some progress. For one thing, H. pylori is colonized in the gastric mucosa. The effect of its key virulence factors, VacA and CagA proteins, keeps H. pylori alive in the stomach for a long time and makes it possible for H. pylori to promote the proliferation, epithelial-mesenchymal transition and metastasis of gastric cancer cells. For another, the tumor microenvironment is the site of interaction between host immune system and tumor. By interfering with the effect of tumor cells and immune cells, enhancing the formation of an acidic and hypoxic environment and altering the differentiation of cells in the tumor microenvironment, H. pylori infection can strengthen immune escape and then facilitate the metastasis of gastric cancer. H. pylori infection has become a global public health problem, and its influence on the evolution of gastric cancer cannot be disregarded. The review addresses the correlation between H. pylori infection and gastric cancer metastasis through both key virulence factors and tumor microenvironment. It will provide reference for clinical and basic research in gastric cancer.

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    New insights in small airway dysfunction of childhood asthma
    ZHU Siyu, DONG Xiaoyan
    2023, 43 (4):  500-506. 
    doi: 10.3969/j.issn.1674-8115.2023.04.014

    Abstract ( 112 )   HTML ( 39 )   PDF (1292KB) ( 72 )  

    Small airway dysfunction (SAD) widely exists in different stages of childhood asthma, which is based on airway inflammation, airway remodeling and airway hyperresponsiveness. Among them, airway inflammation is the main pathological feature of SAD. It has been recently found that immune cells involved in the progression of the disease, such as type 2 innervate lymphoid cells (ILC2s), macrophages, and granulocyte, played an important role in clinical control and targeted therapy of asthma. At the same time, with continuous improvement of clinical detection technologies such as impulse oscillometry and exhaled nitric oxide detecting, more and more evidence suggests that SAD is associated with the early occurrence and development of pediatric asthma. The development of ultra-fine particle aerosol and monoclonal antibody targeting small airways has provided a new means for the precise control of asthma. Therefore, the function of small airways in chronic respiratory diseases, including asthma, has received extensive attention in recent years. Previous studies have shown that SAD increases the risk of uncontrolled asthma in children, but it is often ignored. This article describes the latest research progress of SAD and childhood asthma from the aspects of pathogenesis, diagnostic evaluation and treatment, so as to provide a new perspective and understanding for long-term asthma management targeting small airways.

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    Serum potassium level in maintenance hemodialysis patients and its effect on outcome
    MEN Ru, ZHU Minxia, ZHANG Weiming
    2023, 43 (4):  507-513. 
    doi: 10.3969/j.issn.1674-8115.2023.04.015

    Abstract ( 122 )   HTML ( 40 )   PDF (1277KB) ( 78 )  

    Maintenance hemodialysis is one of the renal replacement therapy that end-stage renal disease patients mainly rely on. Dyskalemia is one of the most common metabolic complications in patients undergoing maintenance hemodialysis. Both pre-dialysis hyperkalemia and hypokalemia during and after dialysis may contribute to a higher risk of all-cause mortality, cardiovascular mortality in hemodialysis patients. The impact of serum potassium fluctuation has attracted widespread attention in recent years. Due to the intermittent nature of maintenance hemodialysis, patients are prone to frequent fluctuations of serum potassium. Potassium variability may be a better indicator to reflect potassium homeostasis, and large variability of potassiun is recognized as a potential risk factor for poor outcomes. In addition, the rapid fluctuation of serum potassium concentration during hemodialysis may increase the risk of malignant arrhythmia, sudden cardiac death and other poor outcomes. The gradient of serum and dialysate potassium is an important factor that influence the removal of potassium, which is also affected by other dialysate components. Therefore, strengthening the monitoring and management of serum potassium, selecting appropriate dialysate potassium concentration and individualizing dialysate prescription may be beneficial to maintain potassium homeostasis, reduce dyskalemia and improve prognosis. This review briefly expounds the feature of serum potassium level and discusses its effect on outcomes in patients with maintenance hemodialysis, emphasizing the relevance of potassium variation and prognosis in patients with maintenance hemodialysis and the impact of dialysate composition on potassium homeostasis.

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    Case report
    A case of spinocerebellar ataxia type 28 with orthostatic tremor
    WANG Qunfeng, LIU Shihua
    2023, 43 (4):  514-518. 
    doi: 10.3969/j.issn.1674-8115.2023.04.016

    Abstract ( 88 )   HTML ( 37 )   PDF (2006KB) ( 49 )  

    Spinocerebellar ataxia (SCA) is a rare autosomal neurodegenerative disease. SCA28 is a rare subtype, caused by heterozygous mutation of the pathogenic gene AFG3L2. The clinical features usually include slowly progressive gait and limb ataxia, dysarthria, hyperreflexia of the lower limbs, gaze-evoked nystagmus, ptosis, ophthalmoplegia, decreased ankle reflex, Parkinsonism, dystonia and cognitive impairment. In this paper, a case of SCA28 with orthostatic tremor is reported. The gene detection showed that there was a missense mutation of c. 2098G>A in the AFG3L2 gene of the patient. The clinical symptoms and pathogenic gene mutations of 79 cases of SCA28 type in the previous relevant literature are summarized to strengthen the understanding and clinical diagnosis of the disease.

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