Table of Content

  

10 January 2022
Volume 60 Issue 1

Hydrogen sulfide alleviates acute obstructive sleep apnea-induced atrial fibrillation by regulating oxidative stress through glutaredoxin-1

HUANG Huining, DU Juanjuan, SUN Yi, HOU Yinglong, GAO Mei

Journal of Shandong University (Health Sciences). 2022, 60(1):  1-5.  doi:10.6040/j.issn.1671-7554.0.2021.0275

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Objective To explore the mechanism of hydrogen sulfide(H₂S)alleviating atrial fibrillation(AF)induced by acute obstructive sleep apnea(OSA). Methods Sodium hydrosulfide(NaHS)was used as exogenous H₂S donor, and 24 healthy adult male SD rats(aged 8-10 weeks)weighing 320 g to 360g were randomly divided into control group, OSA-induced AF group, NaHS+OSA group and cadmium chloride+NaHS+OSA group, with 6 in each group. The model of AF induced by OSA was established according to previous literature. The rats were sacrificed and left atrial appendages were collected. The expression of glutaredoxin-1 was detected with immunofluorescence and ELISA, and the content of malondialdehyde(MDA)was detected with thiobarbituric acid. Results Compared with the OSA group, the NaHS+OSA group had decreased frequency of AF and shortened duration of AF(P<0.05). Compared with control group, the OSA group had decreased expression of glutaredoxin-1 but increased MDA content. After NaHS was used, the expression of glutaredoxin-1 increased but the MDA content decreased compared with the OSA group(P<0.01). After cadmium chloride was used, the MDA content increased(P<0.01), and the effect of H₂S on alleviating OSA-induced AF disappeared. Conclusion Exogenous application of H₂S alleviate acute OSA-induced AF by regulating oxidative stress through glutaredoxin-1.

Effects and mechanism of histone deacetylase SIRT1 controlled macrophage apoptosis induced by oxidized low density lipoprotein

LI Hui, JIANG Chaoyang, LIU Yan, ZHANG Man

Journal of Shandong University (Health Sciences). 2022, 60(1):  6-12.  doi:10.6040/j.issn.1671-7554.0.2021.0449

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Objective To observe the expression of histone H3 lysine residue 9 acetylation(H3K9Ac)in macrophage apoptosis model induced by oxidized low density lipoprotein(oxLDL), and to explore the controlling mechanism of histone deacetylase-inflammatory factor silencing information regulating protein1(SIRT1)on macrophage apoptosis by gene epigenetics, which was realized by peroxisome proliferator activated receptor γ(PPARγ)signaling pathway. Methods Mouse BALB/c macrophage cell line RAW264.7 was cultured with 50 μg/mL oxLDL. The cells were divided into control group(treated with double distilled water)and experimental group(treated with 50 μg/mL oxLDL). The number of apoptotic cells and protein expressions of interleukin(IL-6), SIRT1, H3K9Ac and PPARγ were detected. In addition, the experimental group was treated with SIRT1 stimulant(resveratrol, final concentration 50 nmoL/L)and SIRT1 inhibitor(nicotinamide, final concentration 50 nmoL/L). The apoptosis and protein expressions of SIRT1, H3K9Ac, PPARγ and phosphorylated peroxisome proliferator-activated receptor γ(Ser112 site)［pPPARγ(S112)］ after SIRT1 overexpression or inhibition were detected. The cell apoptosis was detected with Hoechst fluorescence apoptosis staining. The protein expressions of IL-6, SIRT1, H3K9Ac, PPARγ and pPPARγ(S112)were detected with Western blotting. Results The number of apoptotic cells in the experimental group was higher than that in the control group ［(84.88±5.89)vs(7.13±3.31), P<0.01］. The relative protein expressions of IL-6 and H3K9Ac in the experimental group were higher than those in the control group ［(0.50±0.01)vs(0.20±0.02),(0.32±0.02)vs(0.20±0.03), P<0.01］, while the relative protein expressions of SIRT1 and PPARγ in the experimental group were lower than those in the control group ［(0.20±0.01)vs(0.30±0.02),(0.11±0.02)vs(0.20±0.03), P<0.01］. The number of apoptotic cells in the SIRT1 stimulant group was lower than that in the experimental group ［(28.63±6.44)vs(84.88±5.89), P<0.01］, while the number of apoptotic cells in the SIRT1 inhibitor group was higher than that in the experimental group ［(266.88±35.10)vs(84.88±5.89), P<0.01］. In the SIRT1 stimulant group, the relative protein expressions of SIRT1 and PPARγ were higher than those in the experimental group ［(0.27±0.03)vs(0.20±0.01),(0.20±0.02)vs.(0.11±0.02), P<0.01］, while the expressions of H3K9Ac and pPPARγ(S112)were lower ［(0.21±0.02)vs(0.32±0.02),(0.04±0.00)vs(0.12±0.02), P<0.01］. In the SIRT1 inhibitor group, the relative expressions of SIRT1 and PPARγ were lower than those in the experimental group ［(0.10±0.01)vs(0.20±0.01),(0.06±0.01)vs(0.11±0.02), P<0.01］, while the expressions of H3K9Ac and pPPARγ(S112)were higher ［(0.56±0.01)vs(0.32±0.02),(0.18±0.03)vs(0.12±0.02), P<0.01］. Conclusion The gene epigenetics with abnormal histone acetylation modification is involved in the occurrence and development of macrophages apoptosis exposed to oxLDL. In oxLDL-induced macrophage apoptosis model, the expression of histone deacetylase SIRT1 decreases, resulting in a high expression of H3K9Ac, while the downstream PPARγ expressed at a low level and the expression of PPARγ phosphorylation increases. Up-regulation of SIRT1 can reverse the expression of those factors, and improve macrophage apoptosis. SIRT1 has positive regulation on PPARγ signal channel with the anti-inflammatory and anti-apoptosis effects, which are not only related to histone regulating PPARγ expression at gene transcription level, but also to the effects on PPARγ phosphorylation modification after post-translational.

Repairing effect of a self-constructed chitosan nerve conduit on facial nerve injury in rats

XU Feifei, CHEN Qingwen, WANG Dongqin, DING Bixiao, WU Hao, YANG Yumin

Journal of Shandong University (Health Sciences). 2022, 60(1):  13-20.  doi:10.6040/j.issn.1671-7554.0.2021.1002

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Objective The facial nerve defect of model rats was repaired with a chitosan artificial nerve conduit independently constructed by the Key Laboratory of Nerve Regeneration of Nantong University in order to evaluate its role in facial nerve function recovery and regeneration. Methods A total of 24 rats were divided into 3 groups, with 8 in each group. The defect models of superior buccal branch of right facial nerve were established and treated with autogenous nerve overturning bridging(autogenous nerve group), chitosan nerve conduit bridging(chitosan group)and amputation(amputation group)respectively. The recovery of innervation function of facial nerve was evaluated with whisker motor score at 2, 4, 6, 8, 10 and 12 weeks after treatment. The diameter, thickness and number of layers of myelin sheath and axon of contralateral normal nerve and the facial nerve 12 weeks after treatment were observed with immunohistochemical double staining and transmission electron microscope. Results After the analysis of tentacle motor score with generalized linear mixed effect model(GLMMs), the main effects of grouping and time were statistically significant(P<0.05), and the interaction between grouping and time was statistically significant(P<0.05). The recovery of tentacle motor function began to appear in autologous nerve group and chitosan group at 4 and 6 weeks after treatment, respectively. There was no significant difference between autologous nerve group and chitosan group 12 weeks after operation(P>0.05). There was no recovery of tentacle motor function in amputation group. Morphological observation and transmission electron microscope showed that regenerated nerves were found in autologous nerve group and chitosan group. There were significant differences in the diameter of myelinated nerve fibers(F=36.734, P<0.05), sheath thickness(F=67.307, P<0.05)and the number of regenerated myelin sheath layers(F=75.213, P<0.05)in autologous nerve group, chitosan group and the contralateral normal nerves. The diameter of the myelinated nerve fiber, sheath thickness and the number of regenerated myelin sheath layers in chitosan group were significantly different from those in autologous nerve group(P<0.05). Conclusion The chitosan artificial nerve conduit can promote the regeneration and functional recovery of facial nerve injury, which provides a basis for clinical repair of peripheral nerve besides sciatic nerve and radial nerve.

Association between serum β-sheet level and coronary heart disease

XIE Jiaying, QI Jia, SONG Ming, LI Yulin, WANG Di, JIA Xu, ZHANG Wei, ZHONG Ming, SHANG Yuanyuan

Journal of Shandong University (Health Sciences). 2022, 60(1):  21-26.  doi:10.6040/j.issn.1671-7554.0.2021.1328

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Objective To investigate the relationship between serum β-sheet level and coronary heart disease(CHD). Methods A total of 223 CHD patients and 56 healthy controls were recruited. Baseline information, coronary lesion-related indicators and peripheral blood samples were collected. Serum protein β-sheet level was determined with thioflavin T fluorescence. The relationship between β-sheet level and CHD was analyzed with multivariate Logistic regression. Results Serum ThT fluorescence intensity increased significantly in CHD group(P<0.05 or P<0.01). The β-sheet level was positively correlated with waist-hip ratio, age, heart rate, diastolic blood pressure, glycosylated hemoglobin(HbA1C), low density lipoprotein cholesterol(LDL-C), sodium(Na), white blood cell(WBC)and lactic dehydrogenase(LDH), as well as with the history of hypertension, smoking, diabetes, hyperlipidemia and family history of CHD(P<0.05 or P<0.01). Serum β-sheet level, sex, systolic blood pressure, triglyceride(TG), glucose(Glu)and homocysteine(Hcy)were independent risk factors for CHD(P<0.05 or P<0.01). Conclusion The serum β-sheet level increases in CHD patients, which is an independent risk factor for CHD, and independent of known risk factors such as LDL-C.

Novel pathogenic gene variants in a pedigree with nonsyndromic hearing loss

LI Xingxing, ZHOU Yongan, LI Zhe, BAI Yuan

Journal of Shandong University (Health Sciences). 2022, 60(1):  27-33.  doi:10.6040/j.issn.1671-7554.0.2021.0363

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Objective To explore the genetic basis of a pedigree with nonsyndromic hearing loss(NSHL). Methods Peripheral blood samples of all family members were collected and whole-exome sequencing(WES)technique was performed in four members. Then Sanger sequencing was performed in all members to identify the genetic cause of the disease and pathogenicity was detected with cytology. Results All patients in this pedigree carried PCDH15c.4765delC(p.Leu1589Serfs*13)and CDH23c.9617G>A(p.Arg3206His)heterozygous variants, while other members carried PCDH15c.4765delC(p.Leu1589Serfs*13)or CDH23c.9617G>A(p.Arg3206His)single heterozygous variant, of which PCDH15c.4765delC was an unreported new variant. The frame shift mutation of PCDH15 gene caused a truncated protein and its expression decreased significantly. Immunofluorescence showed that mutant proteins accumulated in cytoplasm, which might be caused by the gene variant. Conclusion The PCDH15c.4765delC(p.Leu1589Serfs*13)and CDH23c.9617G>A(p.Arg3206His)digenic variants may cause the NSHL in the pedigree. The detection of new variant enriches the variants spectrum of deafness-causing genes and enables genetic counseling and prenatal diagnosis of the family.

Expressions and significance of CDC7 and MCM4 in 105 cases of cervical lesions

CHEN Quancai, HAN Sai, LIU Lu, SUN Yu, YOU Xuewu, ZHANG Junhua, ZHANG Youzhong

Journal of Shandong University (Health Sciences). 2022, 60(1):  34-39.  doi:10.6040/j.issn.1671-7554.0.2021.0274

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Objective To explore the expressions and clinical significance of cell division cycle 7(CDC7)and minichromosome maintenance protein 4(MCM4)in cervical cancer and precancerous lesions. Methods The expressions of CDC7 and MCM4 in 30 cases with normal cervix, 30 cases with grade I cervical intraepithelial neoplasia(CINⅠ), 25 cases with CIN Ⅱ-Ⅲ, and 50 cases with cervical cancer were detected with immunohistochemistry. The expressions were compared with Ki67, and their correlation with the clinicopathological characteristics of cervical cancer was analyzed. Results (1) The positive expression rate of CDC7 in normal cervical tissues, CINⅠ, CINⅡ-Ⅲ, and cervical cancer tissues was 6.7%, 26.7%, 56.0% and 78.0%, respectively, which was moderately and positively correlated with the lesion degree(r_s=0.625, P<0.001). The positive expression rate of MCM4 in the 4 groups was 26.7%, 36.7%, 64.0% and 88.0%, respectively, which was moderately and positively correlated with the lesion degree(r_s=0.680, P<0.001). The positive expression rate of Ki67 in the 4 groups was 10.0%, 26.7%, 60.0% and 84.0%, respectively, which was moderately and positively correlated with the lesion degree(r_s=0.660, P<0.001). (2) The positive expression level of CDC7 was correlated with the pathological grade, lymphatic metastasis and depth of muscular invasion of cervical cancer(P=0.024, P=0.033, P=0.023). The positive expression level of MCM4 was correlated with the pathological grade and depth of muscular invasion of cervical cancer(P=0.010, P=0.003). The positive expression level of Ki67 was correlated with the pathological grade, lymphatic metastasis and depth of muscular invasion of cervical cancer(P=0.009, P=0.016, P=0.021). (3) The expression levels of CDC7 and MCM4 were positively correlated in cervical cancer tissues(P=0.001). (4) After multivariate adjustment, the positive expressions of CDC7, MCM4 and Ki67 were risk factor for the severity of cervical lesions. Conclusion CDC7 and MCM4 are highly expressed in CIN and cervical cancer, which suggests that they have potential clinical value as reference indicators for the diagnosis and treatment of CIN and cervical cancer.

Correlation between P16 protein and TCT, HR-HPV and its efficacy in the diagnosis of different cervical lesions

CAI Chunfang, YI Danni, GUO Zhiliang, HE Yaojuan

Journal of Shandong University (Health Sciences). 2022, 60(1):  40-47.  doi:10.6040/j.issn.1671-7554.0.2021.0605

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Objective To investigate the correlation between P16 protein and thin-layer liquid-based cytology(TCT)and high-risk human papillomavirus(HR-HPV), and to explore its diagnostic efficacy for different cervical lesions. Methods A total of 1,096 female patients treated during July 2018 and Dec. 2020 were randomly selected as the research objects. Cervical cell samples were collected and TCT was detected by PAP staining. According to the TCT results, the patients were divided into no intraepithelial or malignant lesions(NILM)group, atypical squamous cells of unknown significance(ASC-US)group, high grade squamous intraepithelial lesions were not excluded(ASC-H)group, low grade squamous intraepithelial neoplasia(LSIL)group, high grade squamous intraepithelial neoplasia(HSIL)group and squamous cell carcinoma(SCC)group. HR-HPV was detected by hybridization capture method. According to the HR-HPV results, the patients were divided into HR-HPV negative group, HR-HPV and other 12 subtypes positive group, and HR-HPV16/18 subtypes positive group. The P16 protein was detected with SP two-step staining. The correlation between P16, TCT and HR-HPV was analyzed. Among all patients, 272 underwent colposcopic pathological biopsy, and the pathological biopsy results were taken as the gold standard to compare the diagnostic efficacies of P16, TCT and HR-HPV alone and in combination for lesions above HSIL. Results (1) The positive rate of P16 protein increased with the level of TCT diagnosis(χ2=75.17, P<0.001). The positive rate of P16 protein in ASC-US, ASC-H, LSIL, HSIL and SCC groups was significantly higher than that in NILM group(P<0.001). (2) There was a rising tendency of positive rate of P16 protein from the HR-HPV negative group, to HR-HPV and other 12 subtypes positive group and to HR-HPV 16/18 subtypes positive group(χ2=137.77, P<0.001). There was significant difference in the positive rate of P16 protein between HR-HPV 16/18 subtypes positive group and HR-HPV and other 12 subtypes positive group(χ2=12.26, P<0.001), and HR-HPV negative group(χ2=112.77, P<0.001). (3) The positive rate of P16 protein increased with the level of cervical pathological diagnosis(χ2=47.58, P<0.001). The positive rate of P16 protein in HSIL and SCC groups was significantly higher than that in chronic cervicitis LSIL group(P<0.001). (4) When age was taken as an influencing factor, there was significant difference in expression of P16 protein among patients with different cervical lesions(χ2=9.15, P=0.03). (5) The combined detection method had the highest sensitivity; TCT had the highest coincidence rate; P16 detection had the largest Youden index. Conclusion The expression of P16 protein is correlated with the results of TCT and HR-HPV; P16 detection has high diagnostic efficiency for lesions above HSIL.

Clinical characteristics and placental pathology of bloodstream infection in 50 pregnant women

LI Yan, LIU Jing, LI Juan, YANG Qiuhong

Journal of Shandong University (Health Sciences). 2022, 60(1):  48-54.  doi:10.6040/j.issn.1671-7554.0.2021.0516

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Objective To analyze the clinical characteristics and placental pathology of bloodstream infection in pregnant women. Methods A total of 50 pregnant women with bloodstream infection during Aug. 1, 2016 and Aug. 1, 2020 were selected as the bloodstream infection group, and another 50 pregnant women without blood stream infection were selected as the control group. The age, delivery mode, infection time, application of special antibiotics, fetal distress, stillbirth, abortion, premature delivery, neonatal infection, septic shock, maternal death, placenta maternal inflammatory reaction, placenta fetal inflammatory reaction and other indicators were analyzed. The pathogenic bacteria isolated from blood culture in the bloodstream infection group were collected, the distribution of pathogenic bacteria was analyzed, and the drug sensitivity results of the pathogenic bacteria with the highest detection rate were analyzed. Results The use of special antibiotics in the bloodstream infection group was higher than that in the control group(P<0.001). The bloodstream infection group had higher probability of septic shock(P=0.041), premature delivery(P=0.007), abortion(P=0.012), stillbirth(P=0.041), neonatal infection(P=0.022), placental maternal inflammation(P=0.006)and placental fetal inflammation(P=0.003)than the control group. The top 6 pathogenic bacteria were Escherichia coli(50%), Listeria(10%), Enterococcus faecalis(8%), Streptococcus pyogenes(6%), Streptococcus agalactiae(4%), Staphylococcus aureus(4%). Escherichia coli was sensitive to cefoxitin, ceftazidime, tobramycin, and ampicillin/sulbactam(≥80%). The sensitivity rates to meropenem, imipenem, amikacin, cefoperazone/sulbactam, piperacillin/tazobactam and ticacillin/clavulanate were over 95%. Conclusion Bloodstream infection seriously threatens the life and health of mothers and children. Escherichia coli has the highest infection rate, and Streptococcus pyogenes and Listeria also have serious harm to mothers and children. For pregnant women with fever, early standardized blood culture and targeted selection of sensitive antibiotics can improve the prognosis and reduce the mortality of mothers and children.

Afinite element analysis of three different fusion methods of lumbar internal fixation

LI Mingbo, HUANG Yanbo, REN Dongcheng, LIU Juncheng, TAN Chengshuang, XU Jixi, DING Jinyong

Journal of Shandong University (Health Sciences). 2022, 60(1):  55-64.  doi:10.6040/j.issn.1671-7554.0.2021.0609

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Objective To observe the biomechanical differences between the operative segments and adjacent segments of three different lumbar internal fixation and fusion methods. Methods Three models of L_4-5 internal fixation fusion mode were constructed, including oblique lateral interbody fusion(OLIF)model, unilateral minimally invasive surgery-transforaminal lumbar interbody fusion(MIS-TLIF)model, and bilateral MIS-TLIF model. Six stress states as normal body were simulated, including forward flexion, extension, left flexion, right flexion, left rotation and right rotation. The changes of the peak stress of the intervertebral disc, the maximum displacement of the vertebral body, the peak stress of the cage, the peak stress of the internal fixation, the peak stress of the endplate under L₃ and the peak stress of the endplate on L₄ in each model under 6 different motion states were observed and analyzed. Results Among the three models, the OLIF model was significantly lower than the other two models in terms of the peak stress in the intervertebral disc at L_3-4, the maximum displacement of the vertebral body at L₃, the peak stress of internal fixation and the peak stress of the endplate under L₃. In comparison of the stress peak of the cage, the stress peak of the OLIF internal fixation model was significantly lower than that of the unilateral MIS-TLIF model, but in most cases, it was greater than that of the bilateral MIS-TLIF model. However, the stress peak of the cage in the unilateral MIS-TLIF internal fixation model was significantly higher than that in the bilateral MIS-TLIF model. In comparison of internal fixed stress peak, the OLIF model had the best biomechanics, followed by the bilateral MIS-TLIF, and the unilateral MIS-TLIF. Conclusion Among the three finite element research models, OLIF model has the best biomechanical effect and relatively small surgical injury, which provides a reference value for clinicians in the choice of surgery.

Therapeutic effects of auricular points sticking with magnetic beads combined with repeated transcranial magnetic stimulation on post-stroke depression

ZHAO Xuan, LI Xiaopeng, LI Jian, TIAN Bin, WANG Guangjun

Journal of Shandong University (Health Sciences). 2022, 60(1):  65-70.  doi:10.6040/j.issn.1671-7554.0.2021.0508

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Objective To investigate the effects of auricular points sticking with magnetic beads combined with repeated transcranial magnetic stimulation(rTMS)on post-stroke depression patients and the effects on the levels of serum transient receptor potential channel 1 protein(TRPC1), serotonin(5-HT), and S100β protein. Methods A total of 120 patients with post-stroke depression were selected and randomly divided into the control group(antidepressant treatment), rTMS group(antidepressant + rTMS), auricular points group(antidepressant + auricular points sticking with magnetic beads treatment), and rTMS + auricular points group(antidepressants + rTMS + auricular points sticking with magnetic beads treatment), with 30 cases in each group and treatment course of 4 weeks. The Hamilton Depression Scale(HAMD)score, clinical efficacy, changes of TRPC1, 5-HT and S100β, and adverse reactions in the four groups were compared. Results Before treatment, there was no significant difference in the HAMD score among the four groups(P>0.05). After treatment, the HAMD score was lower in the rTMS + auricular point group than in other three groups(P<0.05), and the HAMD score in the rTMS and auricular points groups was lower than that in the control group(P<0.05). Before treatment, there were no significant differences in the levels of TRPC1, 5-HT and S100β among the four groups(P>0.05). After treatment, the level of S100β in the rTMS + auricular points group was lower than that in other three groups(P<0.05). The levels of TRPC1 and 5-HT in the rTMS + auricular points group were higher than those in the other three groups(P<0.05). The level of S100β in the rTMS and auricular points groups was lower than that in the control group(P<0.05), and the levels of TRPC1 and 5-HT were higher than in the control group(P<0.05). The total effective rate of the rTMS + auricular points group was higher than that of the other three groups(P<0.05). The total effective rate of the rTMS and auricular points groups was higher than that of the control group(P<0.05). Conclusion Auricular points sticking with magnetic beads combined with rTMS has positive effects in the treatment of post-stroke depression patients, which can effectively adjust the levels of serum TRPC1, 5-HT and S100β, and significantly improve the depression symptoms.

Depression status and associated factors among informal caregivers of patients with critical illness

FU Wenhao, LI Jiajia, FANG Feng, LI Shixue

Journal of Shandong University (Health Sciences). 2022, 60(1):  71-77.  doi:10.6040/j.issn.1671-7554.0.2021.0374

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Objective To explore the depression status and associated factors among informal caregivers of patients with critical illness. Methods Totally 554 patients with critical illness and their informal caregivers in Shandong rural areas were extracted using a multi-stage stratified random sampling method, and the survey was conducted with self-rating depression scale(SDS)and a self-made questionnaire. T-tests for binary variables and one-way ANOVA analyses for polytomous variables were used to assess factors significantly associated with SDS score. Multiple linear regression with OLS method was employed to study how each factor affected SDS score after confounding variables were controlled. Results The SDS score of caregivers was 50.82±13.41, which was higher than the normal score(41.85±10.57). Caregivers with good self-rated health had significantly lower SDS score than those with poor self-rated health(P<0.001, β=-6.88). Caregivers who provided over 13 hours of care per day had significantly higher SDS score(P<0.001, β=5.40). Family economic status had a significant impact on the depressive status among caregivers, with SDS score negatively correlated with total annual per capita income(P=0.007, β=-1.08). In addition, SDS score of caregivers was related to self-rated health and gender of the patients they cared. Conclusion The level of depression in informal caregivers of patients with critical illness in rural areas is high, which should arouse proper attention.

Suicidal ideation and influencing factors in 686 medical students

WANG Chao, ZHANG Yilin, ZOU Guangshun, LYU Juncheng

Journal of Shandong University (Health Sciences). 2022, 60(1):  78-85.  doi:10.6040/j.issn.1671-7554.0.2021.0089

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Objective To investigate the rate of suicidal ideation among medical students and the influencing factors, so as to provide theoretical basis for psychological intervention. Methods From May to June 2020, 749 students from various medical colleges and universities were selected by random cluster sampling method and surveyed online with a self-developed Basic Situation Questionnaire and Chinese version of Beck Suicide Ideation Scale. A total of 686 complete and valid questionnaires were collected. The detection of suicidal ideation, protective factors and risk factors were analyzed using univariate and multivariate analyses. Results Suicidal ideation was detected in 62(9.038%)medical students, and there was no statistical significance between genders(P>0.05). However, there were statistically significant differences in the detection rate among variables such as family type, degree of family harmony, relationship with parents, parental divorce or separation, and occurrence of negative events(P<0.05). The average score of students with suicidal ideation was 9.11±4.09, and there was no significant difference in the scores between genders(P>0.05). However, there were significant differences in the scores of variables such as place of residence, mothers educational level, social relations, availability of help during psychological distress, and presence of severe chronic diseases(P<0.05). Binary classification Logistic regression showed that incomplete family type (OR=1.474, P<0.05), unavailability of help during psychological distress(OR=4.269, P<0.05), and chronic diseases(OR=1.989, P<0.05)were risk factors for suicidal ideation. Multiple linear regression showed that residence in rural areas, mother with low education level, severe chronic diseases, and perfectionism affected the scores of suicidal ideation. Conclusion The detection rate of suicidal ideation in medical students in this study is lower than that in previous studies; however, due attention is needed for the psychological intervention aiming at risk factors.

Relationship between exposure to suicidal behaviors and suicide attempt of rural residents

YAO Zhiying, WEI Yanxin, WANG Xinting, ZHANG Jie, JIA Cunxian

Journal of Shandong University (Health Sciences). 2022, 60(1):  86-92.  doi:10.6040/j.issn.1671-7554.0.2021.0347

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Objective To explore the relationship between exposure to suicidal behaviors and suicide attempt of rural residents, and to provide a scientific basis for the formulation of relevant preventive measures. Methods A 1∶1 matched case-control study was designed to collect 610 suicide attempt cases and 610 controls as the case group and the control group in rural areas of Shandong Province. The data of the research subjects were obtained through face-to-face interviews, and the multivariate conditional Logistic regression model was used to analyze the relationship between exposure to suicidal behavior and suicide attempt. Results There was no statistical difference in age between the case group and the control group(31.80±8.01 vs 32.00±7.98, P=0.662), and 61.6%(376/610)were females in each group. Exposure to suicidal behavior, suicide death, and suicide attempt in the case group accounted for 7.0%(43/610), 3.0%(18/610)and 4.0%(25/610), respectively, which were higher than those in the control group(all P<0.05), about 2.0%(12/610), 0.7%(4/610)and 1.3%(8/610), respectively. Multivariate conditional Logistic regression model analysis showed that after adjusting for effects of confounding factors such as gender, age, education level, marital status, family economic status, physical illness, mental illness, anxiety level, social support level, impulsivity level, hopelessness level and other factors, history of exposure to suicidal behavior, history of exposure to suicide death and history of exposure to suicide attempt were all risk factors for suicide attempt, with OR(95%CI)of 4.70(1.78-12.43), 6.85(1.37-34.33)and 3.67(1.07-12.62), respectively. Conclusion Exposure to suicidal behavior is a risk factor for suicide attempt.

Prevalence and influencing factors of polypharmacy in multimorbidity patients in rural areas of Shandong Province

WANG Chunxia, HE Menglu, WANG Haipeng, LI Hui

Journal of Shandong University (Health Sciences). 2022, 60(1):  93-100.  doi:10.6040/j.issn.1671-7554.0.2021.0913

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Objective To analyze the disease prevalence of multimorbidity and the types, quantity and rationality of polypharmacy in rural areas of Shandong Province, and to explore the influencing factors. Methods In November 2019, 531 patients with multimorbidity from 16 villages in Shandong Province were selected by multistage random sampling method for questionnaire survey to describe the disease situation, medication quantity and type of the patients. Potential inappropriate medication was evaluated according to the Criteria of Potentially Inappropriate Medications for Older Adults in China(2017 edition). Regression analysis was used to analyze the influencing factors. Results Multimorbidity patients complicated with diseases(2.88±0.95)species; the average number of medication was(3.64±1.65)species, and the polypharmacy patients accounted for 24.5%, mainly cardiovascular and endocrine system medication; potential inappropriate medication accounted for 312 cases(58.8%). Logistic regression results showed that gender, number of chronic diseases, self-rated health status were the influencing factors for polypharmacy(P<0.05), and gender and number of medications were the influencing factors for potential inappropriate medication(P<0.05). Conclusion The proportion of potential inappropriate medication in rural patients with multimorbidity is high. It is necessary to strengthen the comprehensive medication management of rural patients with multimorbidity.

A comparison study of suicidal behavior predictive models of bipolar disorder patients based on two machine learning algorithms

JIANG Zhen, SUN Jing, ZOU Wen, WANG Changchang, GAO Qi

Journal of Shandong University (Health Sciences). 2022, 60(1):  101-108.  doi:10.6040/j.issn.1671-7554.0.2021.0359

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Objective To explore the characteristics of two machine learning algorithms in the construction of suicidal behavior predictive models for bipolar disorder inpatients, and to compare their performance so as to provide a basis for the prevention and control of suicidal behavior of inpatients with bipolar disorder. Methods Clinical data of bipolar disorder inpatients treated during Jan. 2010 and Dec. 2017 were retrospectively analyzed. After the influencing factors of suicidal behavior were screened with Chi-square test analysis, Adaboost and binary Logistic regression were used to construct two suicidal behavior classification models. The characteristics of the two models were compared with recall ratio, precision ratio and F1 value. Results A total of 7,782 bipolar disorder inpatients were enrolled, among whom 1,661 had suicidal ideation or attempted suicide and the rate of suicidal behavior was 21%. Between the two models, Adaboost performed better. Diagnosis subtype and past suicide history were the two most important risk factors in both models. Conclusion There are only slight differences between the two models based on different machine learning algorithms, both having a low average performance. More factors are needed to improve the model performance. Current depression episode or mixed state and past suicide history are the most predictive traits for suicidal behavior in bipolar disorder inpatients. Preventive measures should be taken to address suicidal behavior risks accordingly.

Theoretical framework of suicide risk factors among people living with HIV/AIDS: a qualitative study based on grounded theory

BI Fengying, YAN Dongqin, CHEN Xi, LUO Dan

Journal of Shandong University (Health Sciences). 2022, 60(1):  109-117.  doi:10.6040/j.issn.1671-7554.0.2021.0180

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Objective To determine the risk factors of completed suicide among people living with HIV/AIDS(PLWHA)in Hunan Province, construct the theoretical framework explaining the relationship between the risk factors and completed suicide, and provide evidence for suicide prevention among PLWHA. Methods According to the principle of information saturation, three cities were selected conveniently in Hunan Province and a psychosocial autopsy study for 18 suicides who had committed suicide from 2013 to 2019 was conducted. During November 1, 2019 to January 17, 2020, semi-structured interviews were conducted on two informants for each suicide case. Information on characteristics of suicidal behavior and influencing factors of three levels, which were individual, interpersonal and community, was collected. Grounded theory was conducted to explore the influencing factors of completed suicide using Nvivo 11.0 software. According to the suicide cases, model explaining the relationship between the risk factors and completed suicide was conducted based on the theory of ecological model of suicide prevention. Results Influencing factors of completed suicide could be summarized into three levels: individual, interpersonal and community level. Factors on individual level mainly included physical status, psychological status and personal traits; factors on interpersonal level mainly included family-related factors, social support and life events; and factors on community level mainly included the tolerance of the surrounding environment for AIDS. Factors of the three levels could directly impact suicidal behaviors, as well as interact with each other to lead to the occurrence of suicide. Conclusion Factors on individual, interpersonal and community level have both direct and indirect effect on suicidal behavior among PLWHA. Based on the theoretical framework, interventions targeting for physical and psychological status, major life events, HIV-related stress and reduction of discrimination should be marked as the starting point of suicide prevention.