前 言 本文件按照GB/T 1.1-2020《标准化工作导则第1部分:标准化文件的结构和起草规则》的规定起草. 请注意本文件的某些内容可能涉及专利.本文件的发布机构不承担识别专利的责任. 本文件由中华预防医学会提出并归口. 本文件起草单位:中国疾病预防控制中心病毒病预防控制所、国家儿童医学中心(北京)/首都医科大学附属北京儿童医院、首都儿科研究所、温州医科大学附属育英儿童医院、国家儿童健康与疾病临床医学研究中心/重庆医科大学附属儿童医院、中国医学科学院病原生物学研究所、长春市儿童医院、河南省疾病预防控制中心、甘肃省疾病预防控制中心、深圳市儿童医院、中日友好医院.
Objective To observe the BleeMACS score and GRACE score during dual antiplatelet therapy(DAPT)in patients with ST-elevation myocardial infarction(STEMI),and to investigate their values to the prediction of bleeding during one-year DAPT after percutaneous coronary intervention(PCI)in patients with STEMI.Methods Totally 404 STEMI patients underwent PCI followed by DAPT in Henan Provincial People's Hospital from March 2018 to June 2019,and were divided into bleeding group(n=18)and non-bleeding group(n=386)according to the occurrence of bleeding within one-year DAPT.The age,body mass index,smoking history,previous medical history,Killip classification,prehospital cardiac arrest,diseased vessel,out-of-hospital medication,postadmission laboratory examination,BleeMACS score and GRACE score were compared between two groups.ROC curve,category-free net reclassification improvement(NRI),integrated discrimination improvement(IDI)and decision curve analysis(DCA)were used to evaluate the efficiencies of BleeMACS score and GRACE score on predicting bleeding during one-year DAPT after PCI in STEMI patients.Results Among 404 STEMI patients,18 patients(4.46％)developed bleeding during one-year DAPT after PCI.The patients were older in bleeding group[73.80(64.44,77.79)years]than in non-bleeding group[61.50(50.91,68.63)years](P＜0.05).The level of serum creatinine,BleeMACS score and GRACE score were higher in bleeding group[88.00(66.00,103.00)μmol/L,21.00(15.00,27.00),161.00(135.00,187.00)]than those in non-bleeding group[67.00(56.00,79.00)μmol/L,9.00(7.00,18.00),139.00(120.00,160.00)](P＜0.05),and the body mass index was lower in bleeding group[23.48(22.89,24.61)kg/m2]than that in non-bleeding group[24.49(23.60,25.85)kg/m2](Z=-2.212,P=0.027).The AUCs of BleeMACS score and GRACE score for predicting bleeding during one-year DAPT after PCI were 0.749(95％CI:0.633-0.866,P＜0.001)and 0.685(95％CI:0.555-0.814,P＜0.001),with the sensitivities of 72.2％and 66.7％,and the specificities of 81.3％and 74.6％,respectively.The AUCs of two scores showed no significant differences(Z=0.065,P=0.435).Compared with GRACE score,NRI of BleeMACS score was 0.155(Z=0.640,P=0.519),and IDI was 0.015(Z=0.760,P=0.450).The DCA showed that BleeMACS score added more benefit than GRACE score in the threshold probability intervals of 1.8％to 4％and 5％to 12％.Conclusion Both BleeMACS score and GRACE score can be used to predict bleeding during DAPT after PCI in STEMI patients,and BleeMACS score achieves more clinical benefit.
Objective To observe the expression of adenosine triphosphate(ATP)in CD4+T lymphocytes in septic patients,and to investigate its value to the prediction of prognosis of septic patients.Methods Fifty-five septic patients in Lingnan Hospital,the Third Affiliated Hospital of Sun Yat-sen University from October 2021 to August 2022 were divided into sepsis group(n=29)and septic shock group(n=26)according to the severity of the disease.The clinical data such as blood lactate,total bilirubin and sequential organ failure assessment(SOFA)score were recorded in two groups.Within 24 h after diagnosis,the percentages of CD4+and CD8+T lymphocyte as well as CD4+and CD8+T lymphocyte subsets in peripheral blood were detected by flow cytometry in two groups.The ATP levels in CD4+and CD8+T lymphocytes were detected by chemiluminescence assay.The 28-day mortality was compared between two groups.ROC curves were plotted to evaluate the efficiency of ATP in CD4+T lymphocytes on predicting poor prognosis of septic patients.ATP in CD4+T lymphocytes was ≤133.60 μg/L(optimal cut-off value)in 14 patients with septic shock,among whom 8 patients(4 survived,4 died)were detected the ATP level in CD4+T lymphocytes in peripheral blood at one week after diagnosis.The ATP levels in CD4+T lymphocytes were compared in 24 h after diagnosis and in one week after diagnosis between the survived and died septic shock patients.Results The blood lactate level,total bilirubin,creatinine and SOFA score were higher in septic shock group[2.08(1.43,4.26)mmol/L,26.56(11.93,101.14)μmol/L,207.50(98.75,257.75)μmol/L,11.00(8.00,14.75)]than those in sepsis group[1.50(1.09,1.88)mmol/L,16.00(8.20,23.48)μmol/L,103.00(78.00,164.00)μmol/L,7.00(4.00,11.00)](P＜0.05),the ATP level in CD4+T lymphocytes and platelet count were lower in septic shock group[99.68(45.95,357.29)μg/L,63.50(28.50,102.75)× 109/L]than those in sepsis group[236.90(137.20,414.70)μg/L,170.00(121.00,212.00)× 109/L](Z=-2.158,P=0.031;Z=-3.642,P＜0.001),the patients were younger in septic shock group[(53.46±14.35)years]than in sepsis group[(64.07± 16.33)years](t=2.545,P=0.014),and the percentages of CD4+T lymphocytes,CD8+T lymphocytes and CD4+and CD8+T lymphocyte subsets as well as ATP level in CD8+T lymphocytes showed no significant differences between two groups(P＞0.05).When the optimal cut-off value of ATP level in CD4+T lymphocytes was 133.60 μg/L,the AUC for predicting poor prognosis of septic patients was 0.689(95％CI:0.543-0.802,P=0.029),with a sensitivity of 77.14％,and a specificity of 65.10％.The mortality rate was higher in septic shock group(57.69％)than that in septic group(20.69％)(x2=7.952,P=0.005).The ATP level in CD4+T lymphocytes was higher in one week after diagnosis[275.84(164.01,378.89)μg/L]than that in 24 h after diagnosis[42.24(33.00,75.18)μg/L]in the survived septic shock patients(Z=3.896,P=0.030),and showed no significant difference in one week after diagnosis[52.08(15.06,87.57)μg/L]and in 24 h after diagnosis[36.70(15.98,106.84)μg/L]in the died septic shock patients(Z=0.050,P=0.963).Conclusions The ATP level in CD4+T lymphocytes can be used to evaluate the cellular immune function of septic patients.The more severe the disease,the lower the ATP level.The patients with persistently low ATP level have a poor prognosis.The ATP level in CD4+lymphocytes has a predictive value for poor prognosis of septic patients.
Acute and chronic hepatitis and their complications caused by hepatitis B virus infection pose a serious threat to human health.Autophagy and hepatitis B virus are closely correlated and influence each other.Hepatitis B virus uses autophagy related mechanisms to promote its replication in cells and enhance infectivity and destructiveness.Autophagy can effectively suppress and clear hepatitis B virus by the immune system.In this process,multiple autophagy targets are involved,and may become a breakthrough in the development of hepatitis B new drugs and in the treatment hepatitis B.This paper reviews the research progress of the role of autophagy in hepatitis B virus replication and clearance.
Objective To analyze the clinical data of the patients with multiple glomus tumors,and to discuss their clinical and imaging features.Methods Nine patients with multiple glomus tumors received resection after ultrasound,X-ray and MRI scan examination in Henan Provincial People's Hospital from January 2018 to June 2023.The clinical data were collected as the age of onset,age of diagnosis,previous diagnosis and treatment duration,symptoms and signs as well as the tumor location and number.The clinical and imaging features were analyzed.Results The onset age ranged from 7 to 48 years old,and the age of diagnosis ranged from 13 to 54 years old.Their misdiagnosis and mistreatment lasted for 1 to 38 years.The patients were misdiagnosed with growing pains,muscle strain,myofasciitis,tenosynovitis,vasculitis,or venous malformation.The glomus tumors were located in hand in 1 case,thigh in 1 case,and calf and/or foot in 7 cases.The clinical manifestations included intermittent episodes of severe pain,pressure pain and cold sensitivity in 9 cases,local soft tissue swelling in 8,and thinning of the affected limb in 7.There were totally 118 glomus tumors in 9 patients,including 35 of subcutaneous,15 of muscular,and 68 of interosseous.The long diameter was 2.4 to 45.0 mm.The ultrasound featurespresented as hypoechoic masses with clear boundaries,regular morphology,and abundant blood flow signals and local edema in surrounding tissues,scattering in subcutaneous,muscular,and interosseous tissues.X-ray showed no abnormal skeletal changes in lesion area.The MRI appearance showed multiple low signal areas on T1 weighted images,multiple uneven moderate-high signal mass shadows on T2 weighted images,and significant high signal liquid shadows around.Conclusions Multiple glomus tumors clinically present as intermittent episodes of severe pain,pressure pain,cold sensitivity and local soft tissue swelling,which can be considered as the clinical tetralogy of multiple glomus tumors.The ultrasound features include multiple hypoechoic mass with clear boundary,regular morphology,abundant blood flow signal mass inside,and local surrounding tissue edema.MRI images are featured by multiple masses with low T1 signals and high T2 signals,as well as local edema imaging in surrounding tissues.
Objective To observe the change of Nsun2 expression in renal tissues of patients with diabetic nephropathy(DN)and to explore its relationship with clinicopathological features.Methods From December 2020 to December 2022 in Henan Provincial People's Hospital,25 patients with DN(DN group,including 10 cases of DN stage Ⅰ to Ⅱ and 15 cases of DN stage Ⅱ to Ⅳ),and 20 patients with renal cancer(renal cancer group)were enrolled.The renal biopsy tissues of DN group and normal adjacent renal tissues of renal cancer group were taken and performed PAS staining to observe the pathological manifestations of the renal tissues of DN patients at different pathological stages and renal cancer group.The expression of Nsun2 in renal tissues was detected by immunohistochemical method.The body mass index,hypertension history and baseline laboratory indexes[hemoglobin,albumin,blood creatinine,urea,urinary microalbumin/creatinine ratio(UACR),estimated glomerular filtration rate(eGFR),C-reactive protein,prothrombin time,fibrinogen]were compared between two groups.The correlation between Nsun2 expression and laboratory indexes in renal tissues of DN group was analyzed by Pearson and Spearman correlation methods.Results The serum creatinine,urea,fibrinogen and UACR were higher in DN group[81.00(66.00,137.50)pmol/L,6.59(5.50,9.04)mmol/L,(46.70±12.30)mg/L,2 803.00(1 185.60,4 948.00)mg/g]than those in renal cancer group[70.00(58.25,77.75)pmol/L,5.86(4.29,6.30)mmol/L,(30.00±15.20)mg/L,19.89(10.92,29.31)mg/g](P＜0.05),the eGFR and C-reactive protein level were lower in DN group[83.31(47.50,95.54)mL/(min·1.73 m2),0.61(0.00,2.16)mg/L]than those in renal cancer group[97.36(82.99,108.06)mL/(min·1.73 m2),23.32(8.45,62.08)mg/L](Z=-2.238,P=0.025;Z=-4.496,P＜0.001),and there were no significant differences in the body mass index,hypertension rate,prothrombin time,and levels of hemoglobin and albumin between two groups(P＞0.05).Glomerular hypertrophy,basement membrane thickening,mesangial cell proliferation,mesangial matrix increase,and partial capillary loop compression and occlusion were observed in the renal tissues of DN stageⅠ-Ⅱ.Nodular glomerulosclerosis or K-W nodule was showed in the renal tissues of DN stage Ⅲ.Glomerular fibrosis and atrophy,renal tubule fibrosis,and interstitial infiltration of a large number of inflammatory cells were observed in the renal tissues of DN stage Ⅳ.DN patients were found extensive fusion of glomerular foot process,diffuse thickening of basement membrane,and no deposition of electron dense matter.The expression of Nsun2 was strongly positive in renal tubular epithelium and glomerular cells in normal adjacent renal tissues of renal cancer group.Nsun2 positive expression was lower in the renal tissues of DN stage Ⅲ-Ⅳ and DN stage Ⅰ-Ⅱ than that in the normal adjacent renal tissues of renal cancer group,and was lower in the renal tissues of DN stage Ⅲ-Ⅳ than that in the renal tissues of DN stage Ⅰ-Ⅱ.The expression of Nsun2 was lower in the renal tissues of DN group(3.36±1.78)than that in the normal adjacent renal tissues of renal cancer group(8.35±2.48)(t=7.865,P＜0.001),and was lower in the renal tissues of DN stage Ⅲ-Ⅳ(2.60±1.40)than that in the renal tissue of DN stage Ⅰ-Ⅱ(4.50±1.71)(t=2.911,P=0.010).The expression of Nsun2 in the renal tissues of DN patients was positively correlated with eGFR(r=0.553,P=0.004),and negatively correlated with blood creatinine and UACR(r=-0,556,P=0,004;r=-0,448,P=0,025).Conclusions The expression of Nsun2 reduces in the renal tissues of DN patients,and gets lower when the pathological stage of DN becomes higher and the renal function becomes worse.
Objective To compare the efficacy and safety of contrast-enhanced ultrasound(CEUS)combined with ultrasound-guided radiofrequency ablation(RFA)versus laparoscopic partial nephrectomy(LPN)in the treatment of T1a renal cancer.Methods Totally 137 patients with solitary renal cancer in stage T1aN0M0 were diagnosed and treated in the First Affiliated Hospital of Xinxiang Medical University from August 2017 to June 2021,among whom 33 patients underwent CEUS combined with ultrasound-guided RFA(RFA group)and 104 underwent LPN(LPN group).The age,ECOG score,ASA grade,tumor diameter,tumor type,tumor location,WHO/ISUF grade,RENAL score,operation lasting time,length of postoperative hospital stay,intraoperative blood loss,estimated glomerular filtration rate(eGFR)loss of the affected kidney,eGFR of the affected kidney before and after operation,postoperative complications and tumor clearance rate were compared between two groups.Results The patients were older in RFA group[75(69,78)years]than LPN group[65(59,70)years](Z=7.308,P＜0.001).The ECOG scores,and rates of ASA Ⅱ,central,mid-lower pole and dorsal tumors were higher in RFA group[1(1,1),93.94％,15.15％,90.91％,72.73％]than those in LPN group[0(0,0),13.46％,2.88％,68.27％,41.35％](P＜0.05),and there were no significant differences in the tumor diameter,WHO/ISUF grade and RENAL score between two groups(P＞0.05).The operation lasting time and postoperative hospital stay were shorter in RFA group[(83.76±19.03)min,(3.58±0.61)d]than those in LPN group[(138.41±10.08)min,(6.70±0.55)d](t=-15.318,P＜0.001;t=-27.490,P＜0.001),the intraoperative blood loss and eGFR loss of the affected kidney were less in RFA group[(74.55±13.23)mL,5(-3,6)mL/(min·1.73 m2)]than those in LPN group[(139.92±20.14)mL,6(5,7)mL/(min·1.73 m2)](t=-21.550,P＜0.001;Z=-5.191,P＜0.001),the preoperative and postoperative eGFRs of the affected kidney were lower in RFA group[(38.82±5.32),(36.39±6.06)mL/(min·1.73 m2)]than those in LPN group[(43.88± 4.80),(39,18±5.45)mL/(min·1.73 m2)](t=-5.131,P＜0.001;t=-2.491,P=0.014),the postoperative eGFR of the affected kidney was lower than the preoperative eGFR in LPN group(t=12.036,P＜0.001),and there was no significant difference in eGFR of the affected kidney before and after operation in RFA group(t=2.111,P=0.079).There were no significant differences in the tumor clearance rate and the incidence rates of postoperative fever,nausea/vomiting,hematuria,renal pain and perirenal hematoma between two groups(P＞0.05).Conclusions CEUS combined with ultrasound-guided RFA has a similar tumor clearance rate with LPN in the treatment of T1a renal cancer,which can effectively protect renal function without increasing the incidence of complications.It is particularly suitable for elderly patients with poor basic conditions and central,mid-lower pole and dorsal renal cancer.
超声支气管镜引导的经支气管针吸活检是应用超声支气管镜联合专用吸引活检针,在实时支气管腔内超声引导下进行经支气管针吸活检.超声支气管镜前端搭载电子凸阵扫描探头,有灰阶、血流和弹性成像模式,灰阶模式可显示穿刺目标的边界、大小、形态、回声、钙化及液化等特征;血流模式可协助判断血管位置,防止误穿血管;弹性成像模式可引导操作者选择穿刺目标,并初步评估良恶性质.超声支气管镜引导的经支气管针吸活检已成为肺门、纵隔及临近气管/支气管的肺内病变诊断的重要方法,可有效评估肺癌分期.近年来国内超声支气管镜引导的经支气管针吸活检开展逐渐增多,为规范操作,河南省呼吸内镜诊疗质量控制中心组织专家讨论并制定了临床应用共识.
;Objective To investigate the effect and safety of robot-assisted thoracoscopic surgery(RATS)for congenital pulmonary sequestration in infants and young children.Methods Twenty-one infants and young children with congenital pulmonary sequestration were performed RATS in Henan Children's Hospital from November 2022 to April 2023,the intraoperative transfer to open chest,time of mechanical arm establishment,operation time,postoperative complications such as pulmonary infection and pleural effusion,and length of hospital stay were recorded.The patients were followed up for 3 months to 1 year to observe the pulmonary function,and the growth and activity of patients.Chest X-ray and CT examination were done to observe the development of residual lung.Results The anomalous arteries originated from thoracic aorta in 12 cases and subphrenic artery in 9 cases.The lesions were located in the left lower lobe in 12 cases and right lower lobe in 9 cases.There were 15 cases of intralobar type and 6 cases of extralobar type.RATS was successfully completed in all patients,including wedge resection in 2 patients,segmentectomy in 9,and total inferior lobectomy in 4.The patients of extralobar type underwent isolated lobectomy.Intraoperative mechanical arm was established in 10 to 15(11.00±1.25)min,and the operation lasted for 40 to 185(92±27)min.No patient was transfered to open chest during operation.Postoperative pulmonary infection occurred in 2 cases,and pleuraleffusion occurred in 2 cases,all of whom were improved after symptomatic treatment.Postoperative chest X-ray showed greenstick fracture of the fourth rib without dislocation.The length of hospital stay of 21 cases was 7 to 10(8.2±1.5)days.The chest CT examination before discharge showed a good ventilation in residual lung,and there were no obvious effusion and gas accumulation.All these 21 patients were discharged after recovery.The follow-up for 3 months to 1 year showed a normal growth,activity,vital capacity,blood gas analysis and other pulmonary function indexes.Both chest X-ray and CT showed a fine development of residual lung.Conclusion RATS achieves a satisfied result in the treatment of pulmonary sequestration in infants and young children,with small trauma and less postoperative adverse reactions.
Objective To observe the expressions of hypoxia-inducible factor-1α(HIF-1α)and glycolysis-related genes in patients with acute myeloid leukemia(AML),and to explore the influence of HIF-1α on the prognosis of AML patients and its possible mechanism.Methods From July 2015 to July 2018,90 patients with initially diagnosed AML(AML group)and 18 healthy allogeneic hematopoietic stem cell transplantation donors(control group)were detected the mRNA relative expressions of HIF-1α in the bone marrow mononuclear cells and glycolysis-related genes(HK2,PFKM,ALDOA,PGK1,PDK1,LDHA)by real-time fluorescence quantitative PCR in the First Affiliated Hospital of Zhengzhou University and Children's Hospital Affiliated to Zhengzhou University.Spearman correlation analysis was done to evaluate the correlations of the relative expressions of HIF-1α mRNA with the relative expressions of HK2,PFKM,ALDOA,PGK1,PDK1 and LDHA mRNAs in AML patients.AML group received"3+7"regimen to induce chemotherapy,and 45 patients achieved complete remission and 45 patients did not achieve complete remission after one course of chemotherapy.The relative expression of HIF-1α mRNA was compared between those with and without complete remission.Taking the median relative expression of HIF-1α mRNA(2.0403)as the boundary,AML group was divided into 45 patients with HIF-1α mRNA relative expression＜2.040(low-expression group)and 45 patients with HIF-1α mRNA relative expression ≥2.040(high-expression group),and the FAB classification,white blood cell count,platelet count,hemoglobin,bone marrow original cell ratio,prognosis stratification and complete remission rate after one-course chemotherapy were compared between two groups.Univariate and multivariate Cox regression analyses were done to evaluate the influencing factors of poor prognosis of AML patients.After 1-72 months of follow-up,the survival was recorded in high-and low-expression groups.Kaplan-Meier survival curve was plotted,and the log-rank method was used to compare the event-free survival time and overall survival time between two groups.Results The relative expressions of HIF-1α,HK2,PFKM,ALDOA,PGK1,PDK1 and LDHA mRNAs were higher in AML group[2.040(0.836,4.750),1.743(0.946,3.752),1.200(0.595,2.701),4.212(2.980,6.941),3.254(1.612,5.443),2.160(1.140,5.724),2.621(1.425,6.094)]than those in control group[1.000(0.945,1.074),1.000(0.881,1.095),1.000(0.600,1.238),1.000(0.841,1.256),1.000(0.921,1.220),1.035(0.842,1.200),1.035(0.829,1.209)](P＜0.05).The relative expression of HIF-1α mRNA in AML group was positively correlated with the relative expressions of HK2,PFKM,ALDOA,PGK1,PDK1 and LDHA mRNAs(P＜0.05).The relative expression of HIF-1α mRNA after one-course chemotherapy was lower in patients with complete remission[1.800(0.793,3.075)]than that in patients without complete remission[2.919(0.838,5.812)](Z=2.719,P=0.008).There were no significant differences in the gender ratio,age,FAB classification,white blood cell count,platelet count,hemoglobin,bone marrow original cell ratio,prognosis stratification and rate of complete remission after one-course chemotherapy between high-expression group and low-expression group(P＞0.05).Prognosis stratification(HR=1.840,95％CI:1.245-2.719,P=0.002),complete remission after one-course chemotherapy(HR=2.074,95％CI:1.155-3.725,P=0.015)and relative expression of HIF-1α mRNA(HR=1.863,95％CI.1.063-3.265,P=0.030)were the influencing factors of poor prognosis of AML patients.The median follow-up time was 21 months.The event-free survival time and overall survival time were shorter in high-expression group[(10.67±9.26),(12.78± 11.39)months]than those in low-expression group[(21.60±15.29),(21.22±15.47)months](x2=22.450,P＜0.001;x2=4.720,P=0.030).Conclusions The expression of HIF-1α increases in AML patients.The patients have higher risk of poor prognosis when the expression of HIF-1α is high,the pretreatment prognosis stratification is poor,and the patients achieve no complete remission after one-course chemotherapy.HIF-1α may accelerate AML progression and drug resistance by activating glycolysis.
Objective To analyze the clinical data of 4 patients with paroxysmal sympathetic hyperactivity syndrome(PSH)after cardiopulmonary resuscitation(CPR),and to explore the effect of hyperbaric oxygen therapy on PSH.Methods Four patients with PSH after CPR were treated in Zhengzhou People's Hospital from February 2022 to May 2023.All of them received hyperbaric oxygen therapy at 1.6 standard atmospheric pressure,70 min per time,twice a day,10 days as one course,totally for 3 to 4 courses.The clinical data were recorded including CPR time,time of CPR to PSH,clinical symptoms of PSH,Glasgow coma scale(GCS)score at attack of PSH,and GCS score in 1 month after attack of PSH.The patients were followed up till 1 month after discharge to observe the recovery of PSH and the survival.Results CPR lasted for 20,20,15 and 10 min,and PSH developed by day 2,3,5 and 5 after CPR in 4 patients,respectively.After successful CPR,all 4 patients showed prolonged coma and increased body temperature,heart rate,respiratory rate and blood pressure,3 patients showed an increase in muscle tone,and 2 patients showed great sweating,which occurred intermittently at varied frequency.The PSH-AM scores were 21,24,21 and 19,respectively,and all patients were diagnosed with PSH.After 3 to 4 courses of hyperbaric oxygen therapy,the symptoms of PSH were significantly relieved in all patients,and all patients changed from coma to consciousness by day 24,16,32 and 30 after the attack of PSH,respectively.The GCS scores at attack of PSH were 4,5,4 and 4,respectively,and the GCS scores in 1 month after attack of PSH were 14,14,15 and 13.After 1 month of follow-up,the symptoms of PSH disappeared completely without recurrence and all patients survived.Conclusion Hyperbaric oxygen therapy after CPR is effective for PSH patients,and it can alleviate the symptoms and brain injury and promote the awakening of patients.
Objective To observe the contrast-enhanced ultrasound(CEUS)features of gastroesophageal reflux(GR)in children with chronic cough,and to explore the value of CEUS to the diagnosis of GR in children with chronic cough.Methods From March 2022 to March 2023,82 children with chronic cough received gastric CEUS in the Second Affiliated Hospital of Xi'an Jiaotong University,and were divided into 49 children with pathological GR(observation group)and 33 children without pathological GR(control group).The frequency and total duration of GR within 5 min at the lower esophageal sphincter and abdominal esophagus were recorded in both groups.The His angle,length of abdominal esophagus,and diameters of abdominal esophagus at rest and during GR were measured.The absolute value of esophageal dilation was calculated.Pearson correlation analysis was used to assess the correlations of total duration and frequency of GR within 5 min with the absolute value of esophageal dilation.ROC curves were plotted to evaluate the efficacies of His angle and length of abdominal esophagus on diagnosing GR in children with chronic cough.Results In 82 children,pathological GR developed in 49 cases(59.76％),among whom 35 children experienced GR once within 5 min,12 experienced GR twice,and 2 experienced GR three times.The total duration of GR within 5 min was 3 to 5 s in 27 children,6 to 8 s in 17,and＞8 s in 5.The absolute value of esophageal dilation was(6.83±2.20)mm.The His angle was greater in observation group[(62.69±7.04)°]than that in control group[(53.45±6.79)°](t=-6.058,P＜0.001),the length of the abdominal esophagus was shorter in observation group[(1.97±0.28)cm]than that in control group[(2.16±0.39)cm](t=2.381,P=0.022),and there was no significant difference in the diameter of abdominal esophagus at rest between observation group[(7.16±1.22)mm]and control group[(7.14±1.06)mm](t=-0.072,P=0.943).In observation group,the total duration and frequency of GR within 5 min were positively correlated with the absolute value of esophageal dilation(r=0.468,P=0.002;r=0.333,P=0.027).When the optimal cut-off values of His angle and abdominal esophagus length were 55° and 1.95 cm,the AUCs for diagnosing GR in children with chronic cough were 0.828(95％CI:0.741-0.915,P＜0.001)and 0.633(95％CI:0.513-0.752,P=0.035),the sensitivities were 91.1％and 53.3％,and the specificities were 63.2％and 80.5％,respectively.Conclusions GR would increase the His angle and reduce the length of abdominal esophagus in children with chronic cough.The absolute value of esophageal dilation can reflect the degree of GR.The His angle has a high diagnostic value.
Objective To observe the changes of serum carbohydrate antigen 19-9(CA19-9),carcinoembryonic antigen(CEA)and heat shock protein 90a(HSP90a)levels in patients with cholangiocarcinoma,and to investigate their diagnostic values.Methods In the First Affiliated Hospital of University of Science and Technology of China from January 2020 to April 2023,85 patients with cholangiocarcinoma(cholangiocarcinoma group)and 69 patients with cholangiolithiasis(cholangiolithiasis group)were compared the hepatic function,and serum levels of CA19-9,CEA and HSP90a.Multivariate logistic regression analysis was used to assess the influencing factors of cholangiocarcinoma.ROC curves were plotted to evaluate the efficiencies of serum CA19-9,CEA and HSP90a alone and in combination on the diagnosis of cholangiocarcinoma.Results The levels of alkaline phosphatase,CA19-9,CEA and HSP90s were higher in cholangiocarcinoma group[189.00(103.00,323.50)u/mL,336.85(12.59,1 200.00)u/mL,3.62(2.15,10.20)μg/L,91.14(48.50,168.00)μg/L]than those in cholangiolithiasis group[138.00(98.50,201.00)u/mL,13.32(5.99,62.30)u/mL,2.04(1.49,3.17)μg/L,48.00(34.69,69.00)μg/L](P＜0.05),and there were no significant differences in the levels of glutamic-pyruvic transaminase,glutamic-oxaloacetic transaminase,gamma-glutamyl transpeptidase,total bilirubin,direct bilirubin and indirect bilirubin between two groups(P＞0.05).Serum CA19-9(OR=7.867,95％CI:3.673-16.849,P＜0.001),CEA(OR=7.728,95％CI:2.814-21.227,P＜0.001)and HSP90a(OR=7.654,95％CI:3.454-16.961,P＜0.001)were the influencing factors of the diagnosis of cholangiocarcinoma.When the optimal cut-off values of serum CA19-9,CEA and HSP90a were 100.95 u/mL,5.10 μg/L and 88.00 μg/L,the AUCs for the diagnosis of cholangiocarcinoma were 0.729(95％CI:0.649-0.809,P＜0.001),0.725(95％CI:0.647-0.804,P＜0.001)and 0.726(95％CI:0.646-0.806,P＜0.001),the sensitivities were 62.4％,37.6％and 56.5％,and the specificities were 82.6％,92.8％and 87.0％,respectively.The AUCs of CA19-9+CEA,CA19-9+HSP90a,CEA+HSP90a,and CA19-9+CEA+HSP90a were 0.814(95％CI:0.748-0.881,P＜0.001),0.814(95％CI:0.746-0.882,P＜0.001),0.825(95％CI:0.760-0.891,P＜0.001)and 0.870(95％CI:0.815-0.926,P＜0.001),the sensitivities were 73.0％,80.0％,71.8％and 87.1％,and the specificities were 76.8％,75.4％,81.2％and 71.0％,respectively.The AUC of CA19-9+CEA+HSP90a was greater than that of CA19-9,CEA,HSP90a,CA19-9+CEA,CA19-9+HSP90a,and CEA+HSP90a(P＜0.05).Conclusion The serum levels of CA19-9,CEA and HSP90a are elevated in patients with cholangiocarcinoma,and the combined detection of them three has the highest diagnostic value.
S100A,as an important member of the S100 calcium-binding protein family,is widely involved in cell proliferation,apoptosis,inflammatory responses,and occurrence and development of various digestive malignancies.The pathogenesis of digestive malignancies is not fully illustrated,and they lack efficient and sensitive diagnostic markers and effective therapeutic targets.They are prone to develop recurrence and metastasis and has a high mortality.S100A and its isoforms are closely involved in the occurrence,development and prognosis of digestive malignancies.This paper reviews the research progress of S100A protein family in digestive malignancies.
Objective To analyze the risk factors of non-proliferative diabetic retinopathy(NPDR)and to investigate the correlation between NPDR and old cerebral infarction.Methods From January 2020 to May 2023,the physical examination in Henan Provincial People's Hospital found 34 patients with NPDR(NPDR group),and 72 subjects with no history of diabetes mellitus or NPDR(no-NPDR group).The body mass index,proportions of old cerebral infarction,cerebral atherosclerosis,cerebral white matter demyelination,cerebral atrophy,aortic/coronary artery calcification,carotid artery plaques,positive urinary protein,systolic blood pressure,white blood cell count,fasting plasma glucose,and glycosylated hemoglobin were compared between two groups.Univariate and multivariate logistic regression analyses were done to assess the influencing factors of NPDR.Results The proportions of old cerebral infarction,cerebral atherosclerosis,aortic/coronary artery calcification,carotid artery plaque and positive urinary protein,systolic blood pressure,white blood cell count,fasting plasma glucose and glycosylated hemoglobin were higher in NPDR group[32.35％,55.88％,73.53％,88.24％,23.53％,141.82(127.75,159.25)mmHg,(6.41±1.69)× 109/L,8.86(6.93,10.38)mmol/L,8.28(7.30,9.03)％]than those in no-NPDR[11.11％,29.17％,44.44％,56.94％,4.17％,134.13(121.25,142.00)mmHg,(5.72±1.47)× 109/L,5.62(4.79,6.06)mmol/L,5.88(5.30,6.08)％](P＜0.05),and there were no significant differences in the body mass index,proportions of cerebral white matter demyelination and cerebral atrophy,diastolic blood pressure,erythrocyte count,platelet count,and levels of hemoglobin,blood creatinine,blood uric acid,blood homocysteine,total cholesterol,triacylglycerol,low-density lipoprotein cholesterol and high-density lipoprotein cholesterol between two groups(P＞0.05).Old cerebral infarction(OR=7.698,95％CI:1.047-56.599,P=0.045),urinary protein(OR=12.926,95％CI:1.068-156.517,P=0.044)and glycosylated hemoglobin(OR=3.020,95％CI:1.340-6.809,P=0.008)were the independent influencing factors of NPDR.Conclusion Patients with NPDR have a higher incidence of old cerebral infarction than the general population,and old cerebral infarction is an independent risk factor of NPDR.
Liver diseases are a group of common digestive disorders with complex etiologies.Exosomes are extracellular membrane vesicles released by cells,they mediate intercellular communication by their proteins,nucleic acids and lipids,and regulate the biological activity of recipient cells.Immune cell-derived exosomes play an important role in the occurrence and development of various liver diseases as viral hepatitis,liver fibrosis and hepatocellular carcinoma.Being a potential new way for the treatment of liver diseases,immune cell-derived exosomes have become a research hotspot in recent years.This paper reviews the research progress on the role of immune cell-derived exosomes in liver diseases.
Objective To compare the influences of general anesthesia versus epidural anesthesia on hemodynamics in caesarean section and prognosis of parturients with severe pulmonary arterial hypertension(PAH),and to investigate the influencing factors of prognosis of parturients with severe PAH.Methods Fifty-one parturients with severe PAH received cesarean section in the First Affiliated Hospital of Zhengzhou University from January 1,2015 to December 31,2022,and were divided into general anesthesia group(n=20)and epidural anesthesia group(n=31)according to the mode of anesthesia.The clinical data as hemoglobin and albumin before operation were compared between two groups.The hemodynamic indicators(systolic blood pressure,diastolic blood pressure,heart rate,blood oxygen saturation)at the time of entry to operating room(T1),lowest point after anesthesia(T2),at the delivery(T3),lowest point after delivery(T4),and end of anesthesia(T5),intraoperative blood loss,intraoperative urine volume,total intraoperative fluid intake,operation lasting time,postoperative mechanical ventilation,length of postoperative hospital stay,length of postoperative ICU stay,postoperative pulmonary artery pressure,and postoperative laboratory indicators were recorded.The neonatal Apgar score,and postoperative in-hospital complications of parturients(pulmonary infection,heart failure,death)were recorded.Multivariate logistic regression analysis was done to identify the influencing factors of poor prognosis after cesarean section in parturients with severe PAH.Results The preoperative albumin level was lower in general anesthesia group[31.65(28.53,33.83)g/L]than that in epidural anesthesia group[34.50(30.90,37.40)g/L](Z=-2,181,P=0.029),the systolic blood pressures[(109.95±16.35),(93.10±11,35)mmHg]and diastolic blood pressures[(64,50±8.43),(55.30±6.62)mmHg]at T2 and T4 in general anesthesia group were lower than those in epidural anesthesia group[(120.39±14.73),(105.32±12.03)mmHg;(71.03±11.26),(60.52±9.63)mmHg](P＜0.05),and there were no significant differences in the hemodynamic indicators at the other time points(P＞0.05).The postoperative mechanical ventilation rate was higher in general anesthesia group(50,00％)than that in epidural anesthesia group(9.68％)(x2=10.407,P=0.001),and there were no significant differences in the intraoperative blood loss,intraoperative urine volume,intraoperative fluid intake,operation lasting time,length of postoperative ICU stay,length of postoperative hospital stay,neonatal Apgar score,postoperative incidences of pulmonary infection,heart failure and death,postoperative pulmonary artery pressure,and postoperative levels of hemoglobin,albumin,total bilirubin,creatine kinase isoenzyme and estimated glomerular filtration rate between two groups(P＞0.05).Preoperative NYHA cardiac function classification(OR=42.621,95％CI:1.457-1 246.758,P=0.029)and preoperative pulmonary artery pressure(OR=1.096,95％CI:1.014-1.183,P=0.020)were the independent influencing factors of poor prognosis of parturients with severe PAH after cesarean section.Conclusion Epidural anesthesia is superior to general anesthesia in stabilizing hemodynamics during cesarean section in severe PAH parturients,and those with preoperative PAH and NYHA cardiac function classification Ⅲ-Ⅳ are at a high risk of poor prognosis.
Objective To analyze the clinical data of two fetuses with suspected Meckel-Gruber syndrome(MKS)and their parents,and to investigate the characteristics of gene mutation.Methods One couple with two suspected MKS fetuses received genetic counseling in Henan Provincial People's Hospital in March 2021.The pregnancy history of the mother and ultrasound image data of her two fetuses during pregnancy were collected,and the fetal renal cysts,brain structure abnormalities,facial structure abnormalities,and amniotic fluid volume were recorded.Genomic DNA was extracted from the peripheral blood of the parents and the skin tissues of two fetuses.Microduplications/deletions above 100 kb were detected by chromosome microarray analysis,and were compared with Human Genome Variation and DECIPHER database.The whole exome of fetus 2 was sequenced by high-throughput sequencing to determine the gene mutations,and fetus 1 and their parents were verified by PCR-Sanger sequencing.Bioinformatics software was used to predict the pathogenicity of mutations and to analyze the conserved nature of mutation sites.The mutations were graded and evaluated for pathogenicity according to ACMG guidelines.Results The mother experienced 4 pregnancies,in which 2 fetuses were diagnosed with MKS,and the other two fetuses ceased development.The typical characteristics of MKS infetus 1 and 2 included brain structure abnormalities and polycystic kidneys.Fetus 1 was complicated with facial structure abnormality and oligoamniotic fluid.No chromosome deletion/duplication of above 100 kb was detected in fetus 1 and 2 and their parents.Compound heterozygous variants c.978+1G＞A and c.1175C＞G(p.Pro392Arg)in TMEM67(NM_153704)were detected in fetus 1 and 2,in which c.978+lG＞A was from the father,which was a splice site mutation and was rated as pathogenic by ACMG;c.1175C＞G was derived from the mother and was a missense mutation with ACMG rating as likely pathogenic.Unipro UGENE software indicated that TMEM67 gene c.1175 was highly conserved in 6 species.Meanwhile,SIFT,Polyphen and Mutationtaster softwares showed that TMEM67 gene c.1175C＞G was pathogenic.Conclusion The compound heterozygous variants c.978+1G＞A and c.1175C＞G(p.Pro392Arg)in TMEM67(NM_153704)gene may be the genetic pathogenicity for the pedigree with MKS.
Objective To analyze the clinical data of patients with aortic valve disease complicated with coronary artery disease,and to investigate the efficacy and safety of transcatheter aortic valve replacement(TAVR)combined with percutaneous coronary intervention(PCI).Methods Forty-four patients with aortic valve disease complicated with coronary artery disease were treated in Henan Chest Hospital from November 2018 to June 2022.The gender,age and EuroSCOREⅡ were recorded before surgery.Transthoracic echocardiography was performed to record aortic stenosis or insufficiency,transvalvular pressure gradient,maximum aortic flow velocity,and aortic regurgitation area.Coronary CT angiography or coronary angiography was performed to record the location and extent of coronary artery lesions in order to choose simultaneous or staged PCI+TAVR.Transthoracic echocardiographic and electrocardiographic results were reviewed to record the complications such as perivalvular leakage,vascular complications,newly-onset acute myocardial infarction,atrioventricular block,acute kidney injury,gastrointestinal bleeding and stroke before discharge,and 3 and 12 months after surgery.Results In 44 patients,the EuroSCOREII score was 6.18±1.99,the maximum transvalvular pressure gradient was(77.32±38.40)mmHg,the maximum aortic flow velocity was(4.16±1.32)m/s,and the aortic regurgitation area before surgery was(6.16±3.81)cm2.There were 32 patients with main aortic stenosis(pure aortic stenosis in 2 patients,aortic stenosis and insufficiency in 30 patients)and 12 patients with main aortic insufficiency(pure aortic insufficiency in 6 patients,aortic stenosis and insufficiency in 6 patients).The single artery lesions in 37 patients included left main artery lesion in 1 patient,left anterior descending lesions in 19 patients,left circumflex artery lesions in 7 patients,and right coronary artery lesions in 10 patients.Seven patients were found ≥2 lesions.Among 44 patients,3 patients with complex lesions underwent staged surgery(PCI followed by TAVR),41 patients underwent simultaneous TAVR combined with PCI.PCI was performed in 37 patients with single-vessel lesion and 7 with ≥2 lesions.All surgeries were successfully completed.Intraoperative massive hemorrhage developed in 1 patient,hemodynamic collapse developed in 1 patient and extracorporeal membrane oxygenation was applied in 1 patient.There was no intraoperative death,and no moderate or above perivalvular leakage immediately after surgery.Two patients died of multiple organ failure in hospital.In the other 42 patients,atrioventricular block degree Ⅲ occurred in 1 patient and gastrointestinal hemorrhage occurred in 1 patient.Transthoracic echocardiography was done again in 42 patients before discharge,showing the maximum transvalvular pressure gradient of(15.93±10.28)mmHg,the maximum velocity of(1.91± 0.56)m/s,no reflux,and no moderate or above perivalvular leakage.The follow-up lasted for(17.2±7.3)months,showing no vascular complications,newly-onset acute myocardial infarction,acute kidney injury,stroke or death.Conclusion TAVR combined with PCI has a good short-term and medium-term efficacy in the treatment of aortic valve disease complicated with coronary artery disease,with few complications,and staged or simultaneous surgery is selected according to the individual condition of patients.
Objective To compare the changes of volume and circumference of lymphedema before and after complete decongestive treatment(CDT)versus CDT+lymphaticovenular anastomosis(LVA)in patients with secondary lymphedema,and to investigate the efficacy of LVA on lymphedema.Methods Twenty-four patients with lower limb secondary lymphedema were diagnosed and treated in Henan Provincial People's Hospital from January to December 2021,among whom 11 patients received CDT(CDT group)and 13 patients received CDT+LVA(CDT+LVA group).The body mass index,tumor diagnosis time,lymphedema time,tumor treatment method,and affected limb condition were recorded.Before treatment and 1,3 and 6 months after treatment,the volume(△C)and the circumference of lymphedema(△C)were recorded and compared.Results There were no significant differences in the body mass index,tumor diagnosis time,lymphedema time,tumor treatment and affected limb between two groups(P＞0.05).Before treatment,there were no significant differences in the △V[(4 462±1 142)mL vs.(4 582±1 031)mL],△C(ankle)[(92±34)mm vs.(90±33)mm],△C(knee)[(98±39)mm vs.(96±38)mm]and △C(above knee)[(84±33)mm vs.(86±24)mm]between CDT+LVA group and CDT group(P＞0.05).In 1,3 and 6 months after treatment,△V[(2 438±597),(2 129±472),(1 765±422)mL],△C(ankle)[(54±19),(41±11),(36±8)mm],△C(knee)[(60±19),(49±15),(44±12)mm],and △C(above knee)[(68±19),(58±9),(51±10)mm]in CDT+LVA group were smaller than those in CDT group[1 month after treatment:(3 269±982)mL,(70±21)mm,(78±27)mm,(76±21)mm;3 months after treatment:(2 877±527)mL,(58±16)mm,(60±17)mm,(66±12)mm;6 months after treatment:(2 559±507)mL,(44±13)mm,(49±15)mm,(60±15)mm](P＜0.05).The △V,△C(ankle),△C(knee)and △C(above knee)in both groups decreased sequentially before treatment and in 1,3 and 6 months after treatment(P＜0.05).Conclusions Both CDT and CDT±LVA can effectively reduce the degree of limb swelling in patients with secondary lymphedema,and achieve good short-term efficacies.CDT±LVA has a better therapeutic efficacy.
