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10 August 2021
Volume 59 Issue 8
Latest research advances on factors that influence endometrial receptivity
CHEN Zijiang, YAN Junhao
2021, 59(8):  1-7.  doi:10.6040/j.issn.1671-7554.0.2021.0861
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Good endometrial condition is essential to successful pregnancy. Endometrial receptivity, the capability of endometrium to receive embryo, will improve during the window of implantation in menstruation cycle, indicating the accurate time for implantation. As reported, 2/3 cases on embryo implantation failure or pregnancy loss were attributed to endometrial dysfunction. Evidence based on studies about bad endometrial receptivity and exact mechanism thereof, will provide effective approaches for diagnosis and treatment of these dysfunctions. In this review, we elaborated multiple underlying factors that influence endometrial receptivity, hoping to provide reference for further studies on pathophysiological mechanisms of endometrium in embryo implantation failure or pregnancy loss.
Molecular mechanisms of NK cells involved in endometriosis and its associated infertility
SHAN Jing, WANG Xiaoqiu, LI Dajin
2021, 59(8):  8-13.  doi:10.6040/j.issn.1671-7554.0.2021.0958
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As the first line of defense of the immune system, NK cells are involved in the occurrence and development of a variety of autoimmune diseases, infectious diseases, and tumors. NK cells in different states of activation have different functions, which are closely related to the outcome of the disease. Although endometriosis(EMS)is a common and benign gynecological disease, the growth characteristics of ectopic foci are similar to tumors, and the damaged eutopic endometrium is associated with abnormal embryo implantation, which is an important cause of EMS-related infertility. Although it has been established that the abnormal immune microenvironment is an important factor promoting the growth of ectopic foci, and NK cells are the key cells in ectopic milieu, the in-depth functional regulation mechanism and its potential role played in endometrial injury are still poorly understood. This article updates the research progress of NK cells in the pathogenesis of EMS, in order to provide better understanding of the pathogenesis of EMS and EMS-related infertility, and new ideas for the prevention, diagnosis and treatment of EMS and EMS-related infertility.
Application progress of anticoagulant drugs in the treatment of recurrent adverse pregnancy
ZHANG Jianping, LUO Yinger
2021, 59(8):  14-19.  doi:10.6040/j.issn.1671-7554.0.2021.0825
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Adverse pregnancy includes spontaneous abortion, fetal growth restriction, preeclampsia, premature delivery, oligohydramnios, and so on. Antiphospholipid antibody syndrome and other prethrombotic states can lead to the bodys pathological hypercoagulable state, causing the above-mentioned complications. Anticoagulant and antiplatelet drugs can not only anticoagulate and improve placental blood flow, but also have anti-inflammatory and complement inhibition effects to regulate the function of trophoblasts. Therefore, single or combined anticoagulant or antiplatelet drugs are widely used in patients with recurrent adverse pregnancy. This article will review the application progress of anticoagulant drugs in recurrent adverse pregnancy.
A rheumatologists perspective on reproductive immunology
YANG Xiuyan, ZHANG Jianyu
2021, 59(8):  20-23.  doi:10.6040/j.issn.1671-7554.0.2021.0866
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Reproductive immunology has become an important branch of reproductive medicine, where the concept of protecting the conceptus from immune attack at the maternal-fetal interface has been gradually applied in clinical practice. This article reviews reproductive problems from a rheumatologists perspective, including antiphospholipid syndrome, reproductive problems associated with autoimmune conditions and immunopathological classification of endometrium by endometrial biopsy which may be of great significance in the study of reproductive immunity.
Research progress of maternal-fetal immunomodulatory mechanism
QIAO Chong, WANG Tingting
2021, 59(8):  24-31.  doi:10.6040/j.issn.1671-7554.0.2021.0794
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The maternal-fetal interface develops tolerance to the homohemiallogeneic fetus while maintaining defense against infection, which has aroused great concern in reproduction and immunology. The maternal-fetal interface is a key site for the establishment and maintenance of normal pregnancy, which is composed of trophoblast cells, decidual immune cells and decidual stromal cells. Studies on the immune mechanism of the maternal-fetal interface help to elucidate the pathogenesis of many human pregnancy complications. In this paper, the research achievements of maternal-fetal immunity in recent years are summarized, and the key cellular functions of maternal-fetal interface and the interactions between cells and cytokines are described, aiming to elaborate the mechanism of maternal-fetal immune regulation.
Applications and progress of immunotherapy in repeated implantation failure
DENG Xiaohui, GUO Ling
2021, 59(8):  32-37.  doi:10.6040/j.issn.1671-7554.0.2021.0877
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Repeated implantation failure(RIF)is a hot and difficult issue in the field of modern reproductive medicine, with numerous and complex pathogenic factors. With the rise of reproductive immunology, recent studies have found that immune factors play an important role in the process of embryo implantation, and targeted immunotherapy can improve the pregnancy outcome of some patients. This article reviews the pathogenesis of RIF immune factors and the progress in the application of related immunotherapy methods, hoping to provide references for future basic research and clinical treatment.
Role of immunosuppressants in rheumatic disease-associated recurrent spontaneous abortion
GUO Yunfei, SHU Qiang
2021, 59(8):  38-43.  doi:10.6040/j.issn.1671-7554.0.2021.0935
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One of the main causes of recurrent spontaneous abortion(RSA)is the combination of rheumatologic diseases. In recent years, immunosuppressive agents have gradually taken the main role in the treatment of patients with RSA combined with rheumatologic diseases, and their therapeutic effects are generally recognized. Since RSA combined with rheumatic immune disease involves several disciplines, the indications and dosage of immunosuppressants need to be further standardized. In this paper, we review the existing domestic and international literature in terms of the definition of RSA, the correlation between rheumatic diseases and RSA, and the use of immunosuppressive drugs, in order to improve the readers understanding of related diseases and drugs, and to provide reference for clinicians to make rational decisions in practice.
Adiponectin alleviated angiotensin II induced myocardial hypertrophy through sFRP2 and the related pathways
MENG Tingting, WANG Shuya, WU Huihui, CHEN Jiamin, ZHENG Yan, LI Ying, SU Guohai
2021, 59(8):  44-52.  doi:10.6040/j.issn.1671-7554.0.2021.0228
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Objective To explore whether adiponectin(APN)involves in the regulation of angiotensin Ⅱ(Ang Ⅱ)-induced myocardial hypertrophy through secreted frizzled-related protein 2(sFRP2)and to determine the related pathways. Methods Neonatal rat ventricular myocytes(NRVMs)were isolated from 3-day-old Wistar rats to detect the expression of α-SMA, a NRVMs cytoskeleton protein with immunofluorescence. NRVMs were divided into control group, 1 nmol/L group, 10 nmol/L group, 100 nmol/L group and 500 nmol/L group to detect the effects of different concentrations of Ang Ⅱ on NRVMs. NRVMs were then divided into control group, Ang Ⅱ group, APN+Ang Ⅱ group, Ang Ⅱ+APN+si-sFRP2 group, Ang Ⅱ+APN+LiCl group, APN group, SP600125+Ang Ⅱ group and SB203580+Ang Ⅱ group to explore the effects of APN on Ang Ⅱ. The expression of sFRP2 and activation of Wnt/β-catenin and p38/JNK pathways in each group were determined with Western blotting. The indexes related to myocardial hypertrophy and sFRP2 mRNA in each group were determined with qPCR. Results ANP and BNP were increased(FANP=27.30, P=0.002; FBNP=38.18, P=0.002), expressions of p-p38 and p-JNK were increased(Fp-JNK=57.65, P<0.001; Fp-p38=8.880, P=0.018)and expression of sFRP2 was down-regulated(FAngⅡ=47.53, P<0.001)with Ang Ⅱ treatment for 24 hours compared with control group. APN pretreatment decreased the expressions of ANP and BNP(FANP=101.8, P<0.001; FBNP=51.14, P<0.001), up-regulated the expression of sFRP2(F=88.93, P<0.001), and inhibited the activation of Wnt/β-catenin(F=41.33, P=0.006)and p38/JNK pathways(Fp38=73.42, P<0.001; FJNK=39.28, P=0.002)compared with the Ang Ⅱ group. The treatment of p38/JNK pathway inhibitors achieved the effects of APN pretreatment(FANP=122.9, P<0.001; FBNP=202.3, P<0.001). Conclusion APN may inhibit Ang Ⅱ induced myocardial hypertrophy by up-regulating sFRP2 and inhibiting the activation of Wnt/β-catenin and p38/JNK pathways.
Effect of Fangxian Decoction on rats with radiation pneumonia and its mechanism
GUO Man, LIU Peng, LONG Lin
2021, 59(8):  53-60.  doi:10.6040/j.issn.1671-7554.0.2021.0008
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Objective To study the effect of Fangxian Decoction on lung tissue pathology, lung surface active substance binding protein and inflammatory factors of rats with radiation pneumonia, and to explore the efficacy and mechanism of Fangxian Decoction in the treatment of radiation pneumonia. Methods Ninety SPF male SD rats were randomly divided into blank group, model group and 3 treatment groups(low-dose group, middle-dose group and high-dose group), and 6mV X-rays with the total dose of being 20 Gy were used to irradiate the whole chest of rats in the treatment groups and model group to build the model of the rats with radiation pneumonia. The treatment groups were given Fangxian Decoction by gavage, and the model group and the blank group were given the same amount of normal saline by gavage. Gavage medication on the first day of irradiation until 6 weeks after irradiation. Six rats were selected from each group in the second, fourth, and eighth week after irradiation to observe the pathological changes of lung tissue under HE staining light microscope, detect the levels of interleukin-3(IL-3), interleukin-6(IL-6), interleukin-7(IL-7), tumor necrosis factor-α(TNF-α), transforming growth factor-β(TGF-β), C-reactive protein(CRP), and lung surfactant binding protein(SP-A, SP-D)by immunohistochemical method, and make correlation analysis. Results Compared with the model group, the rats in the treatment groups had less or no pulmonary congestion and edema, inflammatory cell infiltration, and collagen fiber proliferation in the interstitium. Compared with the blank group, the IL-3, IL-6, IL-7, TNF-α, TGF-β, and CRP levels in the model group and treatment groups were significantly increased(medium-dose treatment for 4 weeks, P values were 0.012, 0.033, 0.027, 0.018, 0.024, and 0.009, respectively), SP-A and SP-D levels were significantly reduced(middle dose treatment for 4 weeks, P values were 0.004 and 0.005, respectively). Compared with the model group, IL-3, IL-6, IL-7, TNF-α, TGF-β, CRP levels were significantly reduced(P<0.05), and SP-A and SP-D levels were significantly increased(P<0.05)in treatment groups. Analysis of the correlation results showed that IL-6 was strongly negatively correlated with SP-A and SP-D, IL-3 and IL-7 were negatively correlated with SP-A and SP-D, and TNF-α and TGF-β were weakly positively correlated with SP-A and SP-D. The effects of different doses of treatment groups on the pathology of rat lung tissue and the detected humoral factors were dose-dependent. Conclusion Fangxian Decoction has a clear effect on improving the inflammatory degree of radiation lung injury. The changes of SP-A and SP-D are related to IL-3, IL-6, IL-7, TNF-α and TGF-β. It is speculated that the mechanism of Fangxian Decoction is through up-regulation of SP-A and SP-D levels and inhibiting the release of inflammatory factors IL-3, IL-6, and IL-7.
A comparative analysis of the effects of natural cycle combined with luteal ovarian stimulation and dual ovarian stimulation
CHEN Wei, GUO Qingqing, XU Jin, FANG Yuan, SUN Mei, SHENG Yan
2021, 59(8):  61-66.  doi:10.6040/j.issn.1671-7554.0.2021.0708
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Objective To compare the pregnancy outcome and cost-effectiveness of nature cycle with luteal phase stimulation(NLPS)and dual ovarian stimulation(DuoS). Methods A total of 376 cycles in 356 patients were enrolled in this retrospective cohort study, including 137 cycles using NLPS and 239 cycles using DuoS protocols. Basic characteristics of patients, treatment variables, outcomes, average cost per cycle, and the cost-effectiveness for one good quality embryo were compared between the two groups. The luteal phase and follicular phase outcomes and cost-effectiveness ratio were also compared. Results There were no differences between NLPS and DuoS groups in the numbers of oocyte retrieval(P=0.41), two pronuclei(2PN)(P=0.74), good quality embryos(P=0.10), and the rate of clinical pregnancy(P=0.08). The cost per cycle was lower in NLPS(P<0.01), but the cost-effectiveness for one good quality embryo was better in DuoS. The numbers of oocyte retrieval, 2PN, and good quality embryos were higher after LPS(3.47±4.26 vs 1.13±1.21, Z=-8.59, P<0.01; 2.03±2.59 vs 0.62±0.87, Z=-7.77, P<0.01; 0.80±1.27 vs 0.24±0.50, Z=-6.52, P<0.01). The cost per cycle was higher in LPS, but the cost-effectiveness was also better(P<0.01). Conclusion NLPS shows same clinical outcome compared with DuoS, but has lower cost per cycle. DuoS has better cost-effective to obtain one good quality embryo. LPS contributes more to the final outcome and is more economical compared to follicular phase stimulation within the same cycle.
Simulation of upper airway hydrodynamic characteristics in 30 skeletal Class Ⅲ children with hypertrophic tonsils before and after tonsillectomy
WANG Yanhai, LIU Yinli, LIU Dongxu
2021, 59(8):  67-73.  doi:10.6040/j.issn.1671-7554.0.2021.0148
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Objective To construct the real three-dimensional models of skeletal Class Ⅲ children with hypertrophic tonsils to evaluate the hydrodynamic characteristics of their upper airways before and after tonsillectomy using computational fluid dynamics(CFD), and to provide theoretical basis when doctors develop treatment protocols for them. Methods Computed tomography images of 30 skeletal Class Ⅲ children with hypertrophic tonsils were collected and these patients were divided into groups A(tonsil grade=Ⅲ, n=18)and B(tonsil grade =Ⅳ, n=12). Three-dimensional models of their upper airways preoperative(T1)and postoperative(T2)were reconstructed. Simulations were then conducted using CFD. Measurements included area average pressure and area average velocity of representative planes(a: the plane of choana; b: minimum section of nasopharynx; c: the junction of nasopharynx and velopharynx; d: minimum section of velopharynx; e: the junction of velopharynx and glossopharynx; f: the plane of glossopharynx where tonsils were the biggest; g: the junction of glossopharynx and hypopharynx; h: the lowest plane of hypopharynx), maximal velocity(Vmax)and minimal pressure(Pmin)in plane f, maximal velocity of pharynx(Pharynx-Vmax), maximal velocity in upper airway(UA-Vmax), airflow resistance in pharynx(Rpharynx), pressure drop from choana to plane f(dP)and dP to flow ratio(PQR). Results The area average pressure and area average velocity in planes of subjects in group B decreased in T2 period. The differences of area average pressure in plane a, b, c, d, e, f, g and area average velocity in plane d, e, f, g, h were statistically significant(P<0.05). The cross-sectional parameters in group A also showed a downward trend in T2. The difference of area average pressure in plane b was statistically significant(P<0.05). For Vmax, Pmin, Pharynx-Vmax, UA-Vmax, Rpharynx, dP and PQR, the differences of subjects in group B were statistically significant(P<0.05)from T1 to T2, while those in group A were not significant(P>0.05). Besides area average velocity in planes a, b, c and area average pressure in plane h, the differences of the other measurements in groups A and B were statistically significant(P<0.05)at T1, but not significant(P>0.05)at T2. Conclusion From the point of CFD, tonsillectomy can change hydrodynamic characteristics significantly in skeletal Class III children with grade IV tonsil hypertrophy, while the same therapy can not influence those with grade III hypertrophy.
Morphological observation of the CBCT image about the furcation groove and root canal of 800 maxillary first premolars
YIN Zengzheng, NIE Xiaokun, WANG Yu, MA Zhide, XIONG Shijiang
2021, 59(8):  74-79.  doi:10.6040/j.issn.1671-7554.0.2021.0269
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Objective To investigate the number of roots, root canal types, incidence of furcation groove and morphological characteristics of the maxillary first premolars, so as to provide theoretical basis for the clinical diagnosis and treatment. Methods CBCT images of 800 maxillary first premolars from 400 patients treated at Shandong University Stomatological Hospital were observed. Based on the Vertucci classification, the morphology of the root and root canal were determined, and a morphological study on the maxillary first premolars with furcation groove was conducted. Results The most common root type of maxillary first premolars was 1 root(62.6%), followed by 2 roots(36.1%), and 3 roots(1.3%). The most common root canal type was type Ⅳ(44.0%), followed by type Ⅱ, type Ⅰ and type Ⅲ. The furcation groove was observed in 61.6% of the double-rooted maxillary first premolars, the average depth of the groove was 0.60 mm, the average length was 3.25 mm, and the average value of the minimum thickness of the corresponding palatal sidewall was 0.59 mm. Conclusion The shape of the root and root canal of the maxillary first premolar is complex, and the presence of the furcation groove further increases the difficulty of root canal treatment. Observing the morphology of root, root canal and furcation groove of the maxillary first premolars can help dentists understand the anatomical characteristics and improve the success rate of root canal treatment.
Effects of valproic acid on the survival and tumor recurrence of 134 patients with glioma treated with radiotherapy
SUN Qingjie, ZHANG Yisha, GUAN Shanghui, FENG Zhihui
2021, 59(8):  80-85.  doi:10.6040/j.issn.1671-7554.0.2021.0440
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Objective To analyze the effects of valproic acid(VPA)on the prognostic survival and tumor recurrence of patients with glioma treated with radiotherapy, so as to provide a clinical basis for the study of the effect of VPA on enhancing the inhibition of tumor growth by radiation and prolonging the survival time of patients. Methods The clinical and follow-up data of 134 glioma patients who underwent surgery and radiotherapy in the Oncology Department of Qilu Hospital, Shandong University during 2012 and 2016 were retrospectively analyzed. The effects of VPA on overall survival(OS)and progression-free survival(PFS)were analyzed with multivariate Cox proportional hazard model. Results The median OS and PFS were 49 and 52 months, respectively. Univariate analysis showed VPA, pathological grade, age and chemotherapy were associated with the prognosis(P<0.05). Multivariate analysis showed, after adjustment of age, pathological grade and the effects of chemotherapy, VPA improved the OS(HR=0.49, 95%CI: 0.30-0.80)and PFS(HR=0.56, 95%CI: 0.33-0.93). Conclusion VPA can significantly prolong the survival time of patients with glioma and reduce tumor recurrence.
Clinical experience of 110 cases of orthotopic heart transplantation
ZOU Junyi, ZHANG Hui, ZHANG Xinjie, LI Zijia, XU Minglei, WANG Dong
2021, 59(8):  86-91.  doi:10.6040/j.issn.1671-7554.0.2021.0619
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Objective To summarize the clinical experience of orthotopic heart transplantation in 110 cases. Methods Clinical data of 110 cases of heart transplantation in Shandong Provincial Heart Transplantation Center during the past 17 years were retrospectively reviewed. The perioperative management, maintenance of immunosuppression, infection monitoring, management of postoperative complications and follow-up guidance were summarized. Results The success rate of operation was 94.5%. The main postoperative complications were right heart insufficiency(8.18%), organ failure(15.76%), acute rejection(10.91%), lung infection(42.31%)and diabetes(8.18%). Different treatment methods were used and satisfactory results were achieved. During the median postoperative follow-up of 37(1-208)months, the 1-year, 3-year and 5-year survival rates were 95.5%, 84.2% and 70.3%, respectively, and 9 cases survived for more than 10 years. Conclusion Heart transplantation is the most effective treatment for end-stage heart diseases. The key is the success of surgery. Before surgery, we evaluated donor and recipient conditions, matched recipient quality, and tested liver and kidney functions. After surgery, we timely individualized anti-rejection treatment and monitored drug concentration, especially used drug therapy, ventilator, mechanical circulation, continuous renal replacement and plasma exchange, and achieved satisfactory short-term and long-term results.
Establishment and clinical evaluation of a dry fluorescent luminescence technique for joint detection of HBsAg, HCV-Ab, TP-Ab and HIV-Ab
LI Xiaofei, HUI Xingxing, FENG Xiaoyan, LYU Songqin, HUANG Shan,YANG Yongrui
2021, 59(8):  92-98.  doi:10.6040/j.issn.1671-7554.0.2021.0555
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Objective To establish a dry fluorescent luminescence technique for the joint detection of HBsAg, HCV-Ab, TP-Ab and HIV-Ab, and to evaluate its clinical application. Methods Based on immunochromatography and fluorescence luminescence technique, HBsAg, anti-HCV, anti-HIV and anti-TP were detected with double sandwich method. National reference materials were adopted, and clinical samples were tested in parallel with enzyme linked immunosorbent assay(ELISA)to evaluate the performance of the dry fluorescent luminescence technique. Results The detection results of HBsAg, HCV-Ab, TP-Ab and HIV-Ab reference samples met the requirements of national reference standards. In clinical performance evaluation, the detection sensitivities of HBsAg, HCV-Ab, TP-Ab and HIV-Ab were all higher than 95%; the detection specificities of HBsAg, TP-Ab and HIV-Ab were higher than 95%, and the detection specificity of HCV-Ab was 91%. The AUC of the ROC curves were all close to 1. Compared with the ELISA, this technique had total coincidence rates of HBsAg, HCV-Ab, TP-Ab and HIV-Ab all above 94%, and their Kappa values ranged from 0.9 to 1.0. Conclusion The dry fluorescent luminescence technique for the joint detection of HBsAg, HCV-Ab, TP-Ab and HIV-Ab can produce results which are highly consistent with those of ELISA. It is a rapid and simple point-of-care testing method with high sensitivity and specificity, and can meet the needs of clinical detection.
Effect of maternal PM10 and PM2.5 exposure during pregnancy on neonatal birth weight
ZHAI Yifan, WANG Zhaojun, BAI Shuoxin, LIN Shaoqian, WANG Fangyi, DU Shuang, WANG Zhiping
2021, 59(8):  99-106.  doi:10.6040/j.issn.1671-7554.0.2021.0301
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Objective To explore the association between maternal PM10 and PM2.5 exposure during pregnancy and neonatal birth weight, and further determine the critical window period of maternal PM10 and PM2.5 exposure on neonatal birth weight. Methods The study was based on the baseline study of infant asthma birth cohort in Jinan City, the newborns in the study area were selected as the research subjects, and the birth weight of newborns was obtained. Combined with the particulate matter monitoring data of 17 monitoring stations in Jinan City, the longitude and latitude of the mothers residential address during pregnancy and the longitude and latitude of the monitoring station address, the daily individual exposure concentration of each mother during pregnancy was obtained by using the inverse distance weight method, so as to obtain the exposure dose of each mother during the whole pregnancy, the first trimester, the second trimester and the third trimester. The association between maternal PM10 and PM2.5 exposure during pregnancy and neonatal birth weight was explored by using generalized additive model and negative control exposures analysis method, and the exposure dose of three pregnancy periods were included in the model to find the key window period. Results (1) Totally, 4 602 subjects were included in this study, with an average birth weight of(3 420.98±465.27)g. The average exposure concentrations of PM10 and PM2.5 during pregnancy were 114.15 μg/m3 and 54.71 μg/m3, respectively. (2) For every 10 μg/m3 increase of PM10 and PM2.5 exposure during pregnancy, the birth weight of newborn decreased by 30.46 g (P=0.013)and 51.81 g(P=0.028), respectively; there was no significant association between PM10 and PM2.5 exposure and neonatal birth weight in negative control exposure period(PM10: P=0.166; PM2.5: P=0.650). (3) The results of critical window period analysis showed that the birth weight decreased by 11.56 g(P=0.004)and 43.85 g(P<0.001)for every 10 μg/m3 increase of PM10 and PM2.5 exposure concentration during the first trimester, and decreased by 13.09 g(P=0.001)and 44.04 g(P<0.001)during the third trimester. Conclusion Maternal exposure to PM10 and PM2.5 during pregnancy can reduce neonatal birth weight, and the first trimester and the third trimester are the critical exposure window periods.
Correlation analysis of dynamic changes of uric acid and incidence of gout in 1,144 cases
MAO Qian, WANG Zhe, GUAN Peixia, LIU Yujie, XIAO Yufei, YANG Yi, CONG Huiwen,WANG Lianyuan, SHI Fuyan, WANG Suzhen
2021, 59(8):  107-112.  doi:10.6040/j.issn.1671-7554.0.2021.0204
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Objective To analyze the correlation between longitudinal dynamic changes of uric acid and gout in male and female populations so as to provide theoretical basis for the early prevention and control of gout. Methods The physical examination data of healthy people from a hospital in Xian, Shannxi Province during 2007 and 2014 were collected. The joint model including linear mixed effects model and Cox proportional risk model was adopted to explore the relationship between uric acid level and gout based on the correlation parameter α, which was run by R 3.6.2 software. Then, based on the normal range of uric acid, grades were classified according to the number of observations. Cox proportional risk model was used to analyze the effects of dynamic changes of uric acid on the incidence of gout. Results A total of 1,144 subjects were enrolled in our study. During the follow-up, 102 individuals developed gout, with 76 males(34.21/10,000/year), and 26 females(16.15/10,000/year). The joint model showed that longitudinal changes in uric acid level were associated with gout incidence in male population(HR=1.014 9, 95%CI: 1.010 6-1.019 2, P<0.001), but there was no correlation between longitudinal changes in uric acid and gout in female population(P>0.05). The Cox model showed that compared with males with normal uric acid level, those with uric acid level returned to normal had the risk of gout increased by 4.458 0-fold(HR=4.458 0, 95%CI: 2.528 0-7.862 0), and by 4.679 0-fold(HR=4.679 0, 95%CI:2.716 6-8.058 0)after uric acid fluctuations. Conclusion The longitudinal fluctuations of uric acid level in healthy male adults could increase the risk of gout. Due attention should be paid to the dynamic changes of uric acid level to reduce the risk of gout.
Evaluation of the efficacy of different regimens for early triple negative breast cancer based on the inverse probability of treatment weighting method
WANG Zhe, LIU Yujie, MAO Qian, GUAN Peixia, BAO Qihan, LI Chengsheng, QIAO Xiaowei, PAN Qingzhong, WANG Suzhen
2021, 59(8):  113-118.  doi:10.6040/j.issn.1671-7554.0.2021.0254
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Objective To evaluate the efficacy of breast conserving surgery with postoperative radiotherapy and mastectomy for patients with early triple negative breast cancer based on inverse probability of treatment weighting(IPTW)method. Methods We extracted the data related to patients diagnosed with T1-2N0M0 triple negative breast cancer from the SEER database during 2010 and 2015, calculated the inverse probability weights by estimating the propensity index through the generalized boosted model(GBM), and analyzed the effects of two local treatment modalities on the survival rate of patients with early triple negative breast cancer after weighting the balanced intergroup covariates. Results After IPTW, the covariates between groups reached complete equilibrium, and log-rank test showed that the overall survival(OS)was better in the breast conserving with postoperative radiotherapy group than in the mastectomy group(P<0.001). The multifactorial Cox regression analysis showed that the breast conserving surgery with postoperative radiotherapy remained to be prognostic beneficial compared to mastectomy(HR=0.74, 95%CI=0.65-0.84, P<0.001). Conclusion Breast conserving surgery with postoperative radiotherapy is more effective than mastectomy in patients with T1-2N0M0 triple negative breast cancer.