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10 January 2021
Volume 59 Issue 1
Quantitative analysis of the loss of sensitivity in the nucleic acid detection of SARS-CoV-2
DONG Hongjie, ZHANG Junmei, WANG Hongwei, WANG Maofeng, ZHANG Kundi, ZHANG Fengyu, WANG Shuai, HU Wei, XIE Shiling, GU Lichuan
2021, 59(1):  1-7.  doi:10.6040/j.issn.1671-7554.0.2020.1069
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Objective To conduct the quantitative analysis of SARS-CoV-2 nucleic acid detection sensitivity loss, and to provide support for improving the detection process and solving the false negative problem. Methods The N gene pseudovirus was taken as the sample, the factors that might affect the diagnostic sensitivity in nucleic acid extraction method, pH of preservation solution, volume of preservation solution used for nucleic acid extraction were analyzed and optimized systematically, and the optimized detection method was compared with the current conventional detection method. Results The detection sensitivity could be improved by extraction of nucleic acid by centrifugal column method and using acid sample preservation solution. With the increase of the volume of the preservation solution, the pseudovirus was released more fully. When the volume of the preservation solution reached 3 mL, the pseudovirus was almost completely eluted. The detection sensitivity exhibited more than ten times the difference when 200 μL and 3 mL preservation solution were used to extract nucleic acid, respectively. When the whole preservation samples was extracted by centrifugal column method, and 12 μL template was added into the PCR system, the detection sensitivity could reach 70 copies/mL; when 200 μL preservation sample was taken to extract the nucleic acid, and 4 μL template was added into the PCR system, the detection sensitivity was 700 copies/mL. Conclusion The novel coronavirus specimens are stored in the slightly acidic sample, and the nucleic acid is extracted by centrifugation column method using as many preservation solution samples as possible, and the largest number of nucleic acid templates are added into the PCR system. The sensitivity of the nucleic acid detection method is 10 times higher than that of the conventional detection method.
CDK7 inhibitor THZ1 increases the radiosensitivity of human glioma cell line U251
LI Wenqing, YE Lan, JIANG Yuhua
2021, 59(1):  8-13.  doi:10.6040/j.issn.1671-7554.0.2020.1297
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Objective To investigate the effects of cyclin-dependent kinase 7(CDK7)inhibitor, THZ1, on the radiosensitivity of human glioma cell line U251 in vitro. Methods U251 cells were cultured in vitro. The toxic effects of THZ1 on U251 cells was detected with MTT. The cell survival curves were drawn at different concentrations of THZ1(0, 8, 16, 32, 64, 128, 256, 512 noml/L). IC50 and IC20 were calculated and IC20 was used as the concentration for subsequent experiments. The effects of X-ray combined with THZ1 on U251 was detected with clone formation experiment. Radiosensitivity parameters were calculated and the curve of colony formation number was drawn. Cell cycle distribution in each treatment group was detected with flow cytometry. The expressions of CDK7 cyclin, Bax apoptosis-related proteins and γH2AX were detected with Western blotting. One-factor analysis of variance was used for comparison among groups. Independent sample t test was used for comparison between groups. Factorial design analysis of variance was used for two-factor comparison among groups. Results THZ1 inhibited U251 proliferation in a concentration- and time-dependent manner. THZ1 inhibited CDK7 cyclin. X-ray(6 Gy)combined with IC20 concentration of THZ1(10 nmol/L)reduced the cloning ability of U251(the ratio of enhancing sensitivity being 1.478), decreased the percentage of G0/G1 phase from 67% to 11%, increased the percentage of G2/M phase from 12% to 70%, and increased the expressions of Bax apoptosis-related proteins and γH2AX. Conclusion THZ1 can increase the radiosensitivity of U251. The possible mechanism is that THZ1 combined with X-ray inhibits the repair ability of cells, induces cell apoptosis, regulates expressions of apoptosis-related proteins, and intervenes in the cell cycle.
Effects of naringenin on acute lung injury induced by sepsis via regulating the activation of NLRP3 inflammasome in macrophages
JIANG Yong, SONG Jiangang, ZHU Daxia, LIU Lijian
2021, 59(1):  14-21.  doi:10.6040/j.issn.1671-7554.0.2020.1230
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Objective To investigate the effects of naringenin(NAR)on sepsis-induced acute lung injury by regulating the activation of NOD-like receptor protein 3(NLRP3)inflammasomes in macrophages. Methods A total of 60 male SD rats were divided into sham operation group, model group, low-dose NAR group(L-NAR, 25 mg/kg)and high-dose NAR group(H-NAR, 75 mg/kg)by random digital table method, with 15 rats in each group. The rat models of sepsis were prepared by cecal ligation and puncture(CLP), and different concentrations of NAR were intraperitoneally injected at 6, 12, and 18 h after the operation. At 24 h after CLP, blood samples were taken with internal carotid artery cannula to measure oxygenation index(OI). The bronchoalveolar lavage fluid(BALF)was collected and macrophages were isolated. The mRNA and protein expressions of NLRP3, apoptosis associated speck like protein containing a CARD(ASC)and caspase-1 in the macrophages were detected with RT-PCR and Western blotting, respectively. The wet/dry ratio(W/D)of lung tissues was determined, and the histopathological changes were observed with HE staining. The level of macrophages in lung tissues was detected with immunofluorescence staining, and the levels of interleukin-1β(IL-1β)and interleukin-1β(IL-18)in lung tissues and BALF were determined with ELISA. Results (1) Compared with the sham group, the model group had severer lung tissue injury, elevated lung histopathological score, W/D and macrophage level(P<0.05), decreased OI(P<0.05), increased expressions of IL-1β and IL-18 in lung tissues and BALF, as well as increased NLRP3 mRNA(1.027±0.064 vs 5.567±0.208)and protein(0.043±0.001 vs 1.242±0.065), ASC mRNA(0.993±0.035 vs 5.000±0.200)and protein(0.018±0.001 vs 0.433±0.060), and caspase-1 mRNA(0.973±0.038 vs 7.667±0.351)and protein(0.101±0.001 vs 0.959±0.078)in macrophages(P<0.05). (2) Compared with the model group, the H-NAR group showed improved lung tissue injury, decreased lung histopathological score, W/D and macrophage level(P<0.05), increased OI(P<0.05), decreased expressions of IL-1β and IL-18 in lung tissues and BALF, as well as decreased NLRP3 mRNA(5.567±0.208 vs 3.367±0.473)and protein(1.242±0.065 vs 0.172±0.023), ASC mRNA(5.000±0.200 vs 3.433±0.404)and protein(0.433±0.060 vs 0.121±0.010)and caspase-1 mRNA(7.667±0.351 vs 4.000±0.200)and protein(0.959±0.078 vs 1.020±0.088)in macrophages(P<0.05). (3) There were no significant differences in the indicators between the L-NAR group and model group(P>0.05). Conclusion Naringenin can alleviate acute lung injury in sepsis rats, and the mechanism may be related to the inhibition of the activation of NLRP3 inflammasomes in alveolar macrophages.
Optimization of rat tympanosclerosis model and the correlation between tympanosclerosis and high expression of fibronectin
QIU Jingjing, WU Ting, MOU Yakui, CUI Limei, GUO Wentao, HAN Fengchan, SUN Yan
2021, 59(1):  22-27.  doi:10.6040/j.issn.1671-7554.0.2020.1390
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Objective To explore the optimization of tympanosclerosis model, and to investigate the expression of fibronectin and its role in the pathogenesis of tympanosclerosis. Methods A total of 60 Sprague-Dawley rats were randomly divided into 3 groups, with 20 in each group. In group A, neither ears were treated; in group B, Streptococcus pneumoniae was injected once into the right ears while the left ears were not treated; in group C, Streptococcus pneumoniae was injected twice into the right ears while the left ears were not treated. The formation of tympanosclerosis was observed with otomicroscope after 8 weeks. The morphological changes were observed with hematoxylin-eosin(HE)staining, the expression location of fibronectin was determined with immunohistochemical staining(IHC), and the expression level of fibronectin was detected with Western blotting. Results In group A, the tympanic membranes of all rats were normal, while in groups B and C, 35% and 78.9% of the tympanic membranes had tympanosclerosis. Obvious inflammatory infiltration and fibrous tissue hyperplasia could be seen in the middle ear mucosa of tympanosclerosis rats. Fibronectin was mainly located in submucosa. The expression level of fibronectin was 0.254±0.117, 1.154±0.163 and 1.111±0.622, respectively, in the three groups, with significant differences(F=6.768,P=0.006). Pairwise multiple comparison showed that there was significant difference in the expression of fibronectin among A1, B1 and C1 groups(P=0.013, P=0.018). Conclusion Two injections of Streptococcus pneumoniae can increase the success rate of modeling. Fibronectin is related to the pathogenesis of tympanosclerosis.
Comparison of efficacy of gamma knife radiosurgery and microvascular decompression in the treatment of primary trigeminal neuralgia
WANG Liangliang, ZHANG Ming, SUN Zhenwei, DING Shouluan, FAN Yuefei, WANG Chengwei
2021, 59(1):  28-33.  doi:10.6040/j.issn.1671-7554.0.2020.0686
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Objective To compare the efficacy and safety of gamma knife surgery(GKS)and microvascular decompression(MVD)for primary trigeminal neuralgia(PTN). Methods A total of 76 patients with PTN were included in this study since 2016(GKS: 40 cases, MVD: 36 cases). The maximum follow-up lasted for 40 months. The efficacy and complication rate of the two treatment methods were evaluated with t-test and Wilcoxon signed rank sum test. Results The difference between preoperative and postoperative BNI was statistically significant(GKS: Z=-5.069, P<0.001; MVD: Z=-5.292, P<0.001). The pain relief effect time after GKS was significantly longer than that after MVD [GKS:(75.00±115.50)days; MVD:(2.0±0.00)days], and the difference was statistically significant(U=248.5, P<0.001). There was significant difference in the degree of pain relief between the MVD group and GKS group(U=500, P=0.013). The complication rate of MVD(38.9%)was higher than that of GKS(20.0%), but the difference was not statistically significant(χ2=3.287, P=0.070). There was statistically significant difference in the costs [GKS:(12 236±1 831)yuan, MVD:(37 671±5 221)yuan, U=2.0, P<0.001]. Conclusion Both GKS and MVD are effective measures in the treatment of PTN. MVD can obtain immediate pain relief but it has higher surgical risks and costs than GKS. As a safe and minimally invasive treatment, GKS takes a long time for pain relief. Individualized, comprehensive treatment plans should be developed according to the specific conditions of patients.
Clinical analysis of outcomes of 84 pregnant women with pulmonary hypertension
JIA Mingwang, LIAO Guangyuan, XIONG Mingmei, XU Wenting, WANG Yinling, WANG Yichun
2021, 59(1):  34-39.  doi:10.6040/j.issn.1671-7554.0.2020.0513
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Objective To analyze the clinical data of 84 pregnant women with pulmonary hypertension(PH)retrospectively, and to provide evidence for the treatment plan and prognosis assessment of the patients. Methods A total of 84 pregnant women with PH who hospitalized in The Third Affiliated Hospital of Guangzhou Medical University from October 2017 to September 2019 were enrolled. The difference of clinical data, including age, gestational age, WHO functional class, pulmonary artery systolic pressure, mode of delivery, inpatient days, ICU admission, cost of treatment, the incidence of complications, maternal death and fetal death, in idiopathic pulmonary arterial hypertension(iPAH)group, pulmonary arterial hypertension associated with congenital heart disease(CHD-PAH)group, pulmonary hypertension caused by left heart disease(LHD-PH)group and pulmonary arterial hypertension associated with other disease(oPAH)group were analyzed. Then the patients were grouped by three ways, including clinical conditions, pulmonary artery systolic pressure and World Health Organization(WHO)functional class, and the prognosis was comparied. The One-Way ANOVA test, Kruskal-Wallis H test and Fishers exact test analyses were mainly used for statistical analysis of data. Results Most of pregnant women with PH were iPAH, CHD-PAH, LHD-PH, and oPAH types. Grouped by clinical conditions, WHO functional class and pulmonary artery systolic pressure were statistically different on the whole for the iPAH, CHD-PAH, LHD-PH, and oPAH groups(both P<0.001). The rates of mortality in the four groups were statistically different on the whole, in which iPAH group was higher than CHD-PAH group(P=0.006), LHD-PH group(P<0.001)and oPAH group(P=0.004). The ICU admission in the four groups were statistically different on the whole, in which iPAH group was higher than LHD-PH group(P=0.001)and oPAH group(P=0.009). Grouped by pulmonary arterial systolic blood pressure, the mortality were statistically different on the whole for ≥90 mmHg group, 70-89 mmHg group, 50-69 mmHg group and 30-49 mmHg group(P<0.001), in which ≥90 mmHg group was higher than 30-49 mmHg group(P<0.001)and 50-69 mmHg group(P=0.015); the ICU admissions in the four groups were statistically different on the whole(P<0.001), in which 90 mmHg group was higher than 30-49 mmHg group(P<0.001)and 50-69 mmHg group(P=0.044), and 70-89 mmHg group was higher than 30-49 mmHg group(P<0.001). Grouped by WHO function, the mortality, ICU admission and hospitalization costs were statistically different on the whole(P=0.013,P<0.001,P=0.008),in which WHO function Ⅳ grade group was higher than WHO function Ⅰ grade group(P=0.046,P=0.003,P=0.040). Conclusion Outcomes of pregnant women with PH are poor in iPAH type, the preoperative preparation, maybe extracorporeal membrane oxygenation(ECMO)should be made. The clinical conditions, pulmonary artery systolic pressure, and WHO functional class should be considered in assessment of the patients outcomes.
Experience in the treatment of 86 cases of type Ⅲ cesarean scar pregnancy
HUO Suxia, LIU Wei, WANG Xin
2021, 59(1):  40-44.  doi:10.6040/j.issn.1671-7554.0.2020.1058
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Objective To explore the treatment strategy of type Ⅲ cesarean scar pregnancy(CSP). Methods The records of 86 patients with type Ⅲ CSP treated in our hospital in the last decade were retrospectively reviewed. According to the surgical methods, the patients were divided into three groups. Group A(n=30)underwent curettage after uterine artery embolization, group B(n=18)received hysteroscopic curettage, and group C(n=38)received laparoscopy combined with hysteroscopic curettage and uterine scar repair. The gestational age, diameter of gestational sac, myometrium thickness, preoperative serum β-human chorionic gonadotropin(β-hCG)level, intraoperative blood loss, decrease of postoperative serum β-hCG, hospitalization time and success rate were compared among the three groups. The quantitative data involved multiple groups of one-way ANOVA or nonparametric test, and the classified data were analyzed by Chi-square test. Results There were no significant differences in maternal age, cesarean frequency and interval since the last cesarean section among the three groups(P>0.05). Gestational sac diameter was larger in group A and group C than in group B(F=52.196, P<0.001). Myometrium thickness was lower in group A and group C than in group B(H=42.553, P<0.001). Preoperative serum β-hCG was significantly higher in group A and group C than in group B(H=9.173, P=0.010). The other pairwise comparisons had no statistical significance. The median amount of intraoperative blood loss was higher in group C than in group A and group B(H=17.211, P<0.001). The success rate in groups A, B and C was 86.67%, 88.89% and 97.37%, respectively, with no significant difference(χ2=3.072, P=0.190). The mean decrease of postoperative serum β-hCG in group C was the fastest(H=14.238, P=0.001). Conclusion For type Ⅲ CSP with gestational sac or mass ≤3 cm and scar thickness ≥2 mm, hysteroscopic curettage can be selected. For gestational sac or mass >3 cm and scar thickness <2 mm, laparoscopy combined with hysteroscopic curettage is recommended. Uterine artery embolization can be used as a supplementary treatment when massive bleeding occurs after primary treatment instead of a preventive measure before curettage.
Application of da Vinci robotic thyroidectomy for thyroid cancer in children and adolescents
ZHUANG Dayong, HE Qingqing, LI Xiaolei, ZHOU Peng, YUE Tao, XU Jing
2021, 59(1):  45-48.  doi:10.6040/j.issn.1671-7554.0.2020.1240
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Objective To explore the surgical safety and oncological completeness of da Vinci robotic thyroidectomy via bilateral axillary approach for children and adolescents with thyroid cancer. Methods The clinical data of 45 cases of thyroid cancer treated with da Vinci robotic thyroidectomy were collected and reviewed. The patients included 12 boys and 33 girls, aged 13 to 22 years, average(18.49±3.38)years. The surgical safety and oncological completeness were evaluated postoperatively. All patients were followed up by outpatient visits and telephone calls. The cosmetic outcomes were evaluated with numerical scoring system 1 month after operation. Results All operations were successful, with no conversion to open surgery. An average of 17.4 lymph nodes in the central area/case were resected, 5.9 of which were positive; an average of 18 lymph nodes/case in the lateral area were resected, 4.6 of which were positive. No serious complications such as permanent recurrent laryngeal nerve injury, hypoparathyroidism, hemorrhage or chylous leakage occurred. The average hospital stay was(6.9±0.4)days. In a postoperative follow-up of 1 to 64 months, the incision cosmetic score was(9.6±0.3). No recurrence happened. Conclusion The da Vinci robotic thyroidectomy via bilateral axillary breast approach is safe and effective for the treatment of thyroid cancer in children and adolescents. It can leave no scar on patients neck, achieve satisfactory cosmetic effects, reduce postoperative psychological trauma, and improve patients quality of life.
Analysis of clinicopathological characteristics of 3 514 cases of breast cancer over 9 years
YOU Xueting, TIAN Xingsong
2021, 59(1):  49-54.  doi:10.6040/j.issn.1671-7554.0.2020.1112
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Objective To analyze the clinicopathological characteristics of breast cancer. Methods The clinicopathological data of 3 514 patients who underwent surgery in Department of Breast and Thyroid Surgery of Provincial Hospital Affiliated to Shandong University during July 2010 and June 2018 were retrospectively analyzed. All information was obtained from the medical records. The clinicopathological characteristics were described and analyzed using the relative number and constituent ratio. Results The gender ratio(male/female)was 1.00∶318.45, median age of onset was 50, peak age of onset was 40-50, and the highest peak age was 45-50. Synchronous bilateral and multifocal/multicentric breast cancer accounted for 1.05% and 5.07% of all cases, respectively. The main pathological type was invasive ductal carcinoma, followed by intraductal carcinoma. There were significant differences in the constituent ratio of pathological types(P<0.001); interannual constituent ratio of TNM stage 0 and stage Ⅰ(P=0.004, P=0.009); annual constituent ratio of histological grade Ⅱ,Ⅱ-Ⅲ, and Ⅲ(P<0.001); annual constituent ratio of Luminal A, Luminal B and HER-2 positive(HR negative)types(P<0.001, P<0.001, P=0.032); constituent ratio of breast cancer complicated with hyperplasia of mammary glands(P=0.047); proportion of vascular invasion(P=0.018); and lymph node metastasis(P=0.003). Conclusion The clinicopathological characteristics of 3 514 breast cancer patients, including age of onset, gender ratio, pathological types, molecular classifications and stages over 9 years are elucidated, which can provide reference for the study of clinicopathological characteristics of breast cancer patients in Shandong Province.
Distribution and antimicrobial resistance of multiple pathogens in 507 males with genital tract infections
ZHAO Lihong, ZHAO Shuping, NIE Shenggang, SUN Jing, JIANG Tongfeng
2021, 59(1):  55-58.  doi:10.6040/j.issn.1671-7554.0.2020.1128
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Objective To analyze the distribution and antimicrobial resistance of multiple pathogens in males with genital tract infections. Methods Multiple pathogens in clinical specimens collected from 7 hospitals in Taian during Sep. 2016 and Sep. 2018 were cultured. Neisseria gonorrhoeae(NG)was cultured on a chocolate tablet containing vancomycin and identified with mass spectrometry, and drug susceptibility was tested with agar dilution method. Ureaplasma urealyticum(UU)was cultured in broth, and drug susceptibility was tested with broth dilution method. Mycoplasma hominis(MH)was tested with IES. Results A total of 507 positive samples were screened out, among which the infection rate of simple UU, simple NG, and multiple pathogens was 39.84%, 23.08%, and 26.43%, respectively. The resistance rate of NG against ciprofloxacin(CIP), penicillin(PEN), and tetracycline(TET)was 96.90%, 96.27%, and 96.65%, respectively. The rate of decreased susceptibility of NG against ceftriaxone(CRO)and cefixime(CFM)was 9.32% and 9.94%, respectively. The susceptibility rates of UU and MH against minocycline(MIN), doxycycline(DOX)and josamycin(JOS)were more than 90%. Conclusion The infection rate of simple UU ranked the first, followed by simple NG. The third-generation cephalosporins such as CRO and CFM remained the first-line therapy for NG infections, and MIN, DOX and JOS were effective antibiotics for UU and MH infections.
Analysis of clinical characteristics of 48 cases of gallbladder adenoma based on different pathological grades
LIANG Li, SUN Bin, ZHANG Hongzhan, YE Fangzhi, FENG Xianguang, ZHANG Kai
2021, 59(1):  59-63.  doi:10.6040/j.issn.1671-7554.0.2020.0742
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Objective To investigate the clinical characteristics and canceration risks of gallbladder adenoma with different pathological grades. Methods The clinical data of 48 cases of gallbladder adenoma were retrospectively analyzed. The patients were divided into different groups according to the pathological grades and canceration risks. Gender, age, associated clinical symptoms, complicated gallstones, single polyp, polyp size, CEA and CA199 were analyzed. Results According to the pathological grades, the patients were divided into 3 groups: simple gallbladder adenoma group(n=24, 50%), gallbladder adenoma with low-grade intraepithelial neoplasia group(n=17, 35.4%), and gallbladder adenoma with high-grade intraepithelial neoplasia group(n=7, 14.6%), which included 2 cases of intramucosal focal carcinoma. The incidence of gallbladder adenoma with intraepithelial neoplasia was 50%, and the overall cancerization rate was 4.2%(2/48). Among the clinical characteristics, age, associated clinical symptoms and polyp size showed significant statistical differences among gallbladder adenoma with different pathological grades(P<0.05). There were significant statistical differences in age, associated clinical symptoms and polyp size between the simple gallbladder adenoma group and intraepithelial neoplasia groups(P<0.05). According to binary Logistic regression analysis, age(OR=5.716, 95%CI: 1.387-23.564)and polyp size(OR=4.442, 95%CI: 1.057-18.675)were the risk factors of canceration. Conclusion Half of gallbladder adenomas are complicated with different grades of intraepithelial neoplasia, with a certain malignant potential.
Predicting colon cancer prognosis genes and clinical application value based on TCGA database
ZHEN Qiulai, LYU Xinran, YE Hui, DING Xuchao, CHAI Xiaoxue, HU Xin, ZHOU Ming, CAO Lili
2021, 59(1):  64-71.  doi:10.6040/j.issn.1671-7554.0.2020.1033
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Objective To screen the prognostic genes, identify risks and predict prognosis by excavating colon cancer data from TCGA database. Methods The RNA expression data and clinical information of colon cancer patients were downloaded from TCGA database. A proportional hazard regression model was constructed and a risk scoring formula was formed after univariate Cox and multivariate Cox regression analyses. The patients were divided into high-risk and low-risk groups based on the median risk score to determine the mortality risk. The receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to verify the evaluation performance of the model. Survival analysis of prognosis-related genes was performed using R language. The differentially expressed genes were analyzed using GO function and KEGG pathway enrichment. Results Of the 5 544 differentially expressed genes, 27 were associated with overall survival, and 11 were screened to construct the prognostic model, including GABRD, FAM132B, LRRN4, RP11-400N13.2, RP11-108K3.2, RNU6-403P, RP11-429J17.8, LINC01296, RP11-190J1.3, AC002076.10 and CTC-573N18.1. ROC analysis showed that the 5-year survival rate was 39.5%(95%CI: 29.5-53.0)in the high-risk group and 89.6%(95%CI: 82.2-97.7)in the low-risk group, with AUC being0.827, indicating that the model could effectively distinguish patients with high and low risks. Conclusion The risk score obtained from the Cox proportional hazard model genes combined with clinical information can be used to evaluate the prognosis and survival of patients with colon cancer.
Risk factors analysis of 880 cases of open extremity injuries caused by traffic accidents complicated with early infections
SUN Shengfang, MA Huili, JIA Zhuting, LI Mintao
2021, 59(1):  72-77.  doi:10.6040/j.issn.1671-7554.0.2020.1275
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Objective To analyze the risk factors related to early infections of open extremity injuries caused by traffic accidents so as to provide reference for clinical diagnosis, treatment and prevention. Methods A total of 880 patients with open extremity injuries treated during May 2017 and May 2020 were enrolled in this retrospective study, including 629 males and 251 females, median age 43.53±9.78 years. The patients were divided into 3 groups: amputation group(n=19), open fracture group(n=266)and open soft tissue injury group(n=595). Clinical data, including individual characteristics, injuries, hospitality-related indicators and infections, were collected, a Logistic regression model was established, and infection-related risk factors were determined. Results Infections were observed in 7 patients(36.84%)in the amputation group, 26 patients(9.77%)in the open fracture group, and 15 patients(2.25%)in the open soft tissue injury group. The amputation group had the highest first-recorded shock index(median: 1.03)and the highest ICU hospitalization rate(26.32%). Logistic regression analysis showed that infections in the amputation group(OR=17.684, 95%CI: 6.262-49.490)and open fracture group(OR=2.733, 95%CI: 1.453-5.142), blood transfusion within 24 h after injury(≥8 units: OR=25.852, 95%CI: 8.448-77.469; 4-8 units: OR=17.741, 95%CI: 5.785-54.409)and≥2 injury sites(OR=39.731, 95%CI: 18.048-87.467)were independently associated with risks of infections. Conclusion Abbreviated injury scale can be used to predict and evaluate the risks of early infections in open extremity injuries. Amputation, blood transfusion within 24 hours after injury, and multiple injury sites(>2)are risk factors of infections.
Imaging findings of 13 cases of salivary duct carcinoma
CHEN Xiaoli, GUI Zhenchao, GAO Yang, XING Mengyao, XIU Jianjun
2021, 59(1):  78-82.  doi:10.6040/j.issn.1671-7554.0.2020.1070
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Objective To explore the imaging manifestations of salivary duct carcinoma(SDC). Methods The CT and MRI data of 13 confirmed cases of SDC were retrospectively analyzed. Results There were 12 male and 1 female, with a median age of 64 years. CT plain scan and enhanced scan were performed in 12 patients, and MR plain scan was performed in 1 patient. All lesions were single mass, located in the parotid glands(9 cases), submandibular glands(2 cases), sublingual glands(1 case), and minor salivary gland(1 case). Tumors varied in size, with an average long diameter of 3.3 cm. Thirteen tumors had unclear boundary, invading the surrounding tissues to varying degrees, among which 5 had distant metastasis at the time of admission. Inhomogeneous density/signal of lesions in plain scan was found in 11 cases and homogeneous in 2 cases. CT scan showed significant enhancement in 8 cases, moderate enhancement in 3 cases and mild enhancement in 1 case. Coagulative necrosis was observed in 10 CT images, and slight enhancement was seen when the necrosis was incomplete. Coagulative necrosis was observed in 1 MR image, which was surrounded by a low signal fiber ring. Cervical lymph node metastasis was observed in 9 cases. Conclusion The imaging manifestations of SDC has certain characteristics, and the presence of coagulative necrosis can help the diagnosis and differentiation of this disease.
Occult thyroid carcinoma: a report of a rare case and review of literature
CHAI Jiawei, ZHU Kunbing, LI Yaqiong, WANG Tiantian
2021, 59(1):  83-87.  doi:10.6040/j.issn.1671-7554.0.2020.1148
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Objective To explore the possible causes, clinical characteristics and treatment of occult thyroid carcinoma. Methods The clinical data of a case of occult thyroid carcinoma treated in our department were retrospectively analyzed and literature was reviewed. The etiology, classification, diagnosis and treatment of this rare disease were summarized. Results The possible causes of occult thyroid carcinoma included malignant transformation of ectopic thyroid tissues, limitations of pathological detection and degenerative changes of cancer cells. This disease was difficult to diagnose, and comprehensive methods were necessary to establish the diagnosis. Surgery was the major treatment. During the follow-up of 20 months, there was no disease progression in this case. Conclusion Understanding the clinical features, possible causes, diagnostic methods and surgical methods of all subtypes of occult thyroid carcinoma can improve the diagnosis rate and prognosis.
Hepatolenticular degeneration with myasthenia gravis: a case report
GAO Xiaoli, ZHOU Xueying, ZHOU Shengnian
2021, 59(1):  88-90.  doi:10.6040/j.issn.1671-7554.0.2020.1280
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Objective To investigate the correlation between hepatolenticular degeneration and myasthenia gravis. Methods The clinical data of 1 case of hepatolenticular degeneration with myasthenia gravis were analyzed and relevant literature was reviewed. Results The patient was a 20-year-old female who was diagnosed as hepatolenticular degeneration before. She was readmitted due to ptosis for one month. Fatigue test, neostigmine test, and blood test of anti-acetylcholine receptor antibody(AchR)all showed positive results. The diagnosis of myasthenia gravis with hepatolenticular degeneration was established. After administration of pyridostigmine bromide and prednisone, the patient was discharged with significant improvement of clinical symptoms. Conclusion Myasthenia gravis in this patient may not be associated with hepatolenticular degeneration. But for patients with hepatolenticular degeneration, especially those who take penicillamine, when symptoms of muscle weakness present, myasthenia gravis should be considered.
Risk factors and cumulative effects of suicidal ideation in pregnant women
CHEN Qingyi, ZHANG Xuan, WANG Juan, SUN Jiwei, CAO Danfeng, CAO fenglin
2021, 59(1):  91-94.  doi:10.6040/j.issn.1671-7554.0.2020.0719
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Objective To explore the risk factors of suicidal ideation in pregnant women and their cumulative effects, so as to provide reference for early clinical identification of high-risk groups. Methods A total of 1 825 pregnant women were recruited from the obstetrics clinic of a comprehensive grade Ⅲ first-class hospital in Shandong Province. The social and economic status, pregnancy related situation and history of mental illness were surveyed with a self-made questionnaire. The neurotic personality, history of childhood abuse, negative coping, depression and suicidal ideation were evaluated with Neurotic Subscale of Neuroticism Extraversion Openness Five-Factor Inventory(NEO-FFI), Childhood Trauma Questionnaire(CTQ-SF), Simple Coping Style Scale, and Patient Health Questionnaire-9(PHQ-9). The risk factors and cumulative effects of suicidal ideation were analyzed with binary logistic regression. Results The history of mental illness, depression, neurotic personality, history of childhood abuse, and negative coping(OR=9.669, 1.262, 1.055, 1.047, 1.094, all P<0.05)were risk factors of suicidal ideation in pregnant women. In addition, cumulative risk factors were positively correlated with suicidal ideation(OR=2.751, P<0.001). Conclusion The history of mental illness, depression, neurotic personality, history of childhood abuse, and negative coping are risk factors of suicidal ideation in pregnant women. The risk of suicidal ideation increases with the number of risk factors.
Effects of high-fat diet and selenium concentration on antioxidant function in rats
ZHANG Jijuan, YU Hancheng, WANG Lan, CHEN Nuo, CUI Shumeng, Gao Xibao
2021, 59(1):  95-101.  doi:10.6040/j.issn.1671-7554.0.2020.1358
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Objective To explore the effects of selenium on the antioxidant function of rats under high-fat diet and different safe doses of selenium. Methods A total of 60 SPF Wistar rats(6 weeks old, half male and half female)were randomly divided into normal group, normal+0.3 mg/kg Se group, normal+0.9 mg/kg Se group, high-fat group, high-fat+0.3 mg/kg Se group and high-fat+0.9 mg/kg Se group, with 10 rats in each group. The body weight was measured every 2 weeks. The rats were sacrificed after 8 weeks. Serum selenium, glutathione peroxidase(GSH-Px), superoxide dismutase(SOD), and total glutathione(T-GSH)were measured. Statistical analysis was performed using analysis of variance with factorial design. Results In male rats, the activity of GSH-Px was mainly affected by the concentration of selenium(P=0.002). Dietary factors and selenium concentration could affect the activity of SOD(P=0.005, P=0.050). The concentration of T-GSH was mainly affected by dietary factors(P<0.001). In male rats on a high-fat diet, the activity of GSH-PX and serum concentration of T-GSH increased first and then decreased with the elevation of selenium concentration. Conclusion To some extent, low and medium concentrations of selenium promote the antioxidant function of male rats on a high-fat diet, while the antioxidant function decreases with the elevation of selenium concentration.
Analysis of influencing factors of prolonged length of stay in a tertiary hospital based on generalized estimation equation
LI Xiangyi, WANG Qingliang, ZHANG Yongyuan, LIU Yingjun, FEI Jianchun, YANG Jie, ZHANG Yi
2021, 59(1):  102-107.  doi:10.6040/j.issn.1671-7554.0.2020.0983
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Objective To analyze the distribution characteristics and risk factors of inpatients with prolonged length of stay based on generalized estimation equation(GEE). Methods Medical records of inpatients treated in a tertiary hospital in Jinan during Jan. 1, 2015 and Dec. 31, 2019 were collected. The influencing factors of prolonged length of stay were analyzed with GEE. Results A total of 7 613 inpatients with prolonged length of stay were enrolled, accounting for 1.00% of all patients included in the analysis. The departments with the highest number of patients with prolonged length of stay were Cancer Center, Departments of Pediatrics and General Surgery, and most patients had tumors. GEE showed that age, gender, admission route, inter-department transfer, comorbidities, surgeries, unplanned readmission, and discharge route were influencing factors of prolonged length of stay. Conclusion Prolonged length of stay has a significant impact on the overall average length of stay. Effective measures should be taken to strengthen the management of such patients, shorten the average length of stay and improve the utilization of medical resources.
Analysis on the health status and influencing factors of poor people in Sanchunji County of Dong ming
WANG Xiaoxuan, ZHU Gaopei, SUN Na, FENG Jianing, XIAO Yufei, SHI Fuyan, WANG Suzhen
2021, 59(1):  108-114.  doi:10.6040/j.issn.1671-7554.0.2020.0985
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Objective To explore the distribution characteristics and influencing factors of health status of poor population in Sanchunji County of Dong ming City so as to provide reference for developing feasible strategies to promote the health of population in poverty-stricken areas. Methods The health status of poor population and influencing factors were analyzed with multinomial Logistic regression. Results Among the 2 673 poor people surveyed, 1 723(64.5%)were healthy and 950(35.5%)were diseased. Logistic regression showed that the age distributions of people with chronic diseases were 26-35 years(OR=4.891), 35-45 years(OR=4.839)and 46-55 years(OR=8.659). These people generally had 1-4 family members(OR=1.881). Their education levels were elementary school or below(OR=7.975)and junior middle school(OR=5.070). They tended to have poor labor capacity(common labor capacity: OR=0.021; weak labor capacity: OR=0.508). They had low income, and annual net income per capita was 3 000-5 000 yuan(OR=2.609). The age distribution of people with serious diseases were 16-25 years(OR=6.492), 26-35 years(OR=17.805), 36-45 years(OR=28.560)and 46-55 years(OR=28.175). They had no labor capacity(common labor capacity: OR=0.004; weak labor capacity: OR=0.148). Conclusion Diseases reduce the ability to work, which ultimately lead to poverty. Other factors, such as education level, also affect the condition of material life and health status. Special attention should be paid to poor people with chronic diseases to help them regain the labor capacity. Appropriate support policies are to be promoted to improve poor peoples educational level and basic survival skills.
A Study on the influencing factors of online student engagement and learning outcome in preventive medicine undergraduates during COVID-2019 epidemic
LI Jiajia, FANG Feng, LI Mengfei, LIU Yazhuo, LI Shixue
2021, 59(1):  115-121.  doi:10.6040/j.issn.1671-7554.0.2020.1078
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Objective Taking the undergraduate education and preventive medicine for example, this paper examines and evaluates the student engagement and learning outcome in online learning during the period of “suspending classes without stopping learning”, and to explore the influencing factors. Methods All undergraduates of preventive medicine in a university in Shandong Province were surveyed with electronic questionnaire of Student Engagement Scale and Learning Outcome Scale. A total of 3 092 questionairs were enroued. The influencing factors were analyzed with t-test, one-way ANOVA and OLS regression. Results The student engagement score was 42.31, and the learning outcome score was 16.38. Grade, ranking, course type, assignments of preview tasks, share of syllabus, share of preview materials, number of questions/quizzes, and assessment of general performance were the influencing factors of student engagement, while gender, grade, ranking, course type and assignments were the influencing factors of learning outcome. Conclusion On the whole, undergraduates of preventive medicine have medium or low level of online learning engagement, and their self-learning ability is relatively poor. Due attention should be paid to promote the in-depth reform of online teaching through good platform and institutional guarantee so as to increase the level of student engagement and learning outcome.