Table of Content

  

10 April 2022
Volume 60 Issue 4

Expert overview


Expert Overview

Cognitive behavioral therapy of suicidality

Xianyun LI,Fude YANG

Journal of Shandong University (Health Sciences). 2022, 60(4):  1-9.  doi:10.6040/j.issn.1671-7554.0.2021.0016

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An individual's suicidality or suicidal behavior is caused by biological, psychological, and sociological factors. Usually, the biological susceptibility and social factors of individual's suicidality are unable or quite difficult to be changed, but the individuals with suicidality (patients) can learn to change their dysfunctional cognition or behavior and make their cognition and behavior more adaptive and helpful after accepting cognitive behavior therapy(CBT). Then the patients can gradually feel that they have a way to alleviate pain and stay away from suicide. The effectiveness of cognitive behavioral therapy in suicide prevention and intervention among the people with high risk factors has been confirmed by research.

Review of machine learning used in the field of suicide

Li KUANG,Xiaoming XU,Qi ZENG

Journal of Shandong University (Health Sciences). 2022, 60(4):  10-16.  doi:10.6040/j.issn.1671-7554.0.2021.0175

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A total of 800, 000 people die of suicide every year over the world, and the number of attempted suicides is about 20 times number of suicide. Suicide not only is a serious public health event, but also significantly and far-reachingly impact on people around suicides. More accurate, convenient, and timely prediction of suicidal behavior has always been the goal of researchers. This study summarized the researches on machine learning applied to suicidal ideation and behavior in the past 5 years, analyzed the effectiveness and feasibility of machine learning for suicide research, made recommendations, and provided a direction for future research.

Study on the mechanism of Suvorexant treatment ameliorates learning and memory impairment in chronic sleep deprivation mice model

SHAO Na, YIN Hao, LI Yaran, ZHANG Baokun, HUANG Weiwei, LU Shanshan, TANG Jiyou

Journal of Shandong University (Health Sciences). 2022, 60(4):  17-23.  doi:10.6040/j.issn.1671-7554.0.2021.0264

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Objective To observe the effects of Orexin dual receptor antagonist(Suvorexant)on learning and memory in chronic sleep deprivation(SD)mice, and to explore the role of astrocytes in Orexin system affecting learning and memory in SD mice model. Methods Wild-type mice aged 8-10 weeks were randomly divided into 4 groups: control group, saline control group, chronic SD group and Suvorexant intervention group. The mice were subjected to sleep disturbance for 4 weeks by simulating artificial stroking with a sleep deprivation chamber with 20 hours per day. And during SD, the Suvorexant intervention group was given an intraperitoneal injection of Suvorexant at the same time(30 mg/kg, 4 weeks); the spatial learning and memory of mice were evaluated with Morris water maze, and the expression of Orexin-A in the lateral hypothalamus and the expression of astrocyte marker glialfibrillary acidic protein(GFAP)in the hippocampus were observed with immunohistochemistry and Western blotting. Results The expression of Orexin-A was significantly increased in the lateral hypothalamus after 4 weeks of SD, and there was no difference in body weight among the groups during the intervention. Suvorexant treatment significantly improved learning and memory after chronic SD. Compared with the SD group, the Suvorexant intervention group had decreased escape latency and an increased number of platform crossings(P<0.05). The expression of GFAP protein increased in the hippocampus of SD mice, and the morphological manifestations showed that the cells were reactive: the cell body was enlarged, the synapse became longer, and the expression in the positive area was significantly increased. Compared with the SD group, the Suvorexant intervention group had decreased expression of GFAP(P<0.05). Conclusion Suvorexant treatment improves spatial learning and memory in chronic SD mice and reduces the expression of reactive astrocytes in the hippocampus, and the activation of astrocytes may be involved in this process.

Mouse breast cancer induces changes of the microenvironment in pre-metastatic lung tissue

ZHAO Tingting, QI Yana, ZHANG Ying, YUAN Bing, HAN Mingyong

Journal of Shandong University (Health Sciences). 2022, 60(4):  24-29.  doi:10.6040/j.issn.1671-7554.0.2021.1392

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Objective To explore lung tissue changes and possible mechanisms before breast cancer metastasis. Methods A total of 20 female BALB/c mice were randomly divided into the experimental group and control group, with 10 mice in either group. Breast cancer cells were suspended in serum free medium and injected into the fourth pair of breast glands on the abdominal wall of mice in the experimental group, while equal amounts of PBS was injected into the same site in mice in the control group. On day 0, 7, 14, 21 and 28 after injection, 2 mice from both groups were sacrificed, their lung tissues were fixed with 4% paraformaldehyde, embedded in paraffin and sectioned. The histopathological changes were observed with HE staining; the expressions of fibronectin, type I collagen and CD31 were detected with immunohistochemistry and semi-quantitatively analyzed with Image-Pro Plus 6.0 software system. Results Compared with the control group, the experimental group had increased tumor volume but decreased weight. HE staining showed the number of inflammatory cells in lung tissue increased and the normal physiological structure was destroyed in the experimental group. Immunohistochemistry showed significant differences in the expressions of fibronectin, type Ⅰ collagen and CD31 between the two groups(all P<0.001). Conclusion In the pre-metastatic stage, malignant breast tumor can change the microenvironment of lung tissue, induce pulmonary inflammation response and promote the metastasis of tumor.

Deubiquitinase USP35 promotes the cells migration and invasion of non-small cell lung cancer

CHEN Zhaobo, FANG Min, XUE Haoran, LIU Chunyan

Journal of Shandong University (Health Sciences). 2022, 60(4):  30-37.  doi:10.6040/j.issn.1671-7554.0.2021.1108

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Objective To investigate the effects of deubiquitinase ubiquitin-speci cproteases 35(USP35)on the migration and invasion of non-small cell lung cancer(NSCLC). Methods The protein expression of USP35 in a panel of 7 human NSCLC cell lines was examined with Western blotting. USP35 overexpression plasmids and control plasmids were transfected into H1299 cells, while USP35 knockdown plasmids and control plasmids were transfected into Anip973 cells according to Lipofectamine 2000 instructions. The migration of NSCLC cells was analyzed using Transwell blank chambers, and the invasion was analyzed using the Transwell chambers containing matrigel substrate gels. The protein expressions of E-cadherin and Vimentin were detected with Western blotting after USP35 overexpressing or silencing in aforementioned cell lines. Results Of the 7 NSCLC cell lines tested, USP35 expression was the lowest in H1299 cells, and the highest in Anip973 cells. Compared with transfected USP35 control plasmids, transfected USP35 overexpression plasmids had significantly increased migration and invasion, down-regulated E-cadherin, and up-regulated Vimentin expressions. Compared with transfected USP35 control plasmids, the Anip973 cells of transfected USP35 knockdown plasmids had significantly reduced migration and invasion, up-regulated E-cadherin, and down-regulated Vimentin expressions. Conclusion USP35 plays a critical role in the migration and invasion of NSCLC cells, hence may become a therapeutic option for NSCLC.

Efficacy of additional idebenone in the treatment of 34 patients with Parkinsons disease with depression

ZHAO Hailong, WANG Hao, FANG Yuqing, MAO Fei, ZHAO Zhangning, TIAN Xiangqi, XU Xinrong, WANG Min, LI Xiuhua

Journal of Shandong University (Health Sciences). 2022, 60(4):  38-44.  doi:10.6040/j.issn.1671-7554.0.2021.1381

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Objective To observe the efficacy of idebenone in the treatment of Parkinsons disease with depression(PDD), and to explore its neuroprotective mechanism. Methods A total of 68 PDD patients were randomly divided into control group(n=34)and observation group(n=34). The control group received oral Dobasil tablets and Piribedil sustained-release tablets for 12 weeks. The initial dose of Dobasil tablets was 0.125 g/time, 3 times a day, and the highest dose was ≤0.75 g/d. The initial dose of Piribedil sustained-release tablets was 50 mg/time, once a day, and the maximum dose was 50 mg/time, 3 times a day. The observation group received oral idebenone plus the same treatment as the control group for 12 weeks. The dose was 30 mg/time, 3 times a day. The changes of Hamilton Depression Scale(HAMD)and its factor scores, Hamilton Anxiety Scale(HAMA)and its factor scores, Unified Parkinsons Scale-Ⅲ(UPDRS-Ⅲ), Parkinsons Disease Sleep Scale(PDSS), Mini Mental State Examination Scale(MMSE), 39-item Parkinsons Disease Questionnaire(PDQ-39)and superoxide dismutase(SOD)in the peripheral blood were monitored in the two groups. Results After treatment, the total score of HAMD and all factors in both groups were decreased. Except for weight loss and diurnal changes, the total score of HAMD and the scores of anxiety/somatization, cognitive impairment, block, sleep disorder and despair were significantly lower in the observation group than in the control group(P<0.05). The total score of HAMA and the scores of mental anxiety and somatic anxiety were decreased in both groups(P<0.05), and were significantly lower in the observation group than in the control group(P<0.05). The scores of UPDRS-Ⅲ were decreased in both groups(P<0.05), and were significantly lower in the observation group than in the control group(P<0.05). The PDSS scores were increased in both groups(P<0.05), and were significantly higher in the observation group than in the control group(P<0.05). The MMSE scores were increased in both groups(P<0.05), and were significantly higher in the observation group than in the control group(P<0.05). The PDQ-39 scores were decreased in both groups(P<0.05), and were significantly lower in the observation group than in the control group(P<0.05). The level of SOD was increased in the observation group but decreased in the control group, and the difference was statistically significant(P<0.05). Conclusion Additional idebenone can improve the depression, motor and some non-motor symptoms, increase the level of SOD in peripheral blood and improve the quality of life.

Caregiver burden and influencing factors of 128 patients with Parkinsons disease

LIU Liwen, MA Jun, LI Peizheng, ZHANG Xiufang, LIU Yiming

Journal of Shandong University (Health Sciences). 2022, 60(4):  45-49.  doi:10.6040/j.issn.1671-7554.0.2021.1250

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Objective To explore the current situation and influencing factors of caregiver burden of patients with Parkinsons disease so as to reduce caregiver burden. Methods A total of 128 patients with Parkinsons disease treated during Mar. 2017 and Oct. 2019 and their caregivers were enrolled. The general information of patients were assessed with Movement Disorder Society Unified Parkinsons Disease Rating Scale(MDS-UPDRS), Hoehn Yahr Stage, Self-perceived Burden Scale, Parkinsons Disease Sleep Scale(PDSS), Epworth Sleepiness Scale(ESS), Neuropsychiatric Inventory(NPI), Hamilton Anxiety Scale(HAMA), and Hamilton Depression Scale(HAMD). According to the diagnostic criteria of fragmented sleep and statistics of fragmented sleep in PDSS scale, the patients with fragmented sleep were evaluated. The caregiver burden was assessed with Zarit Caregiver Burden Interview(ZBI). The influencing factors were determined with univariate and multivariate Logistic regression analysis. Results There were statistically significant differences in disease course, HY stage, UPDRSIII score, segmented sleep, self-perceived burden, HAMA score, HAMD score, PDSS score, ESS score, NPI score and ZBI score. Self-perceived burden, caregivers neuropsychiatric distress, fragmented sleep, and disease severity(Hoehn-Yahr scale)were independent risk factors of caregiver burden. Conclusion Patients with Parkinsons disease should be diagnosed and treated early, and the sleep quality should be improved on the basis of standardized medication. Paying attention to patients feelings and self-perceived burden can help to reduce the caregiver burden.

Evaluation of CD4⁺CD25⁺FoxP3⁺ regulatory T cells and FoxP3 mRNA expression in 20 NMOSD patients

LI Honghao, YU Jing, CHEN Yali, GUO Shougang

Journal of Shandong University (Health Sciences). 2022, 60(4):  50-54.  doi:10.6040/j.issn.1671-7554.0.2021.1525

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Objective To assess the percentage of CD4⁺CD25⁺FoxP3⁺ regulatory T(Treg)cells and the mRNA expression of forkhead box protein 3(FoxP3)in patients with neuromyelitis optica spectrum disorders(NMOSD). Methods The case-control study compared 20 NMOSD patients with 20 healthy controls. The mononuclear cells in peripheral blood were collected. The percentage of CD4⁺CD25⁺FoxP3⁺ Treg cells was measured with flow cytometry using specific monoclonal antibodies recognizing CD4, CD25 and FoxP3 markers. FoxP3 gene expression was determined with real-time polymerase chain reaction. The expressions of transforming growth factor β1(TGF-β1), interferon γ(IFN-γ), and interleukin 10(IL-10)were determined with enzyme-linked immunosorbent assay. Results The percentage of CD4⁺CD25⁺FoxP3⁺ Treg cells and the mRNA expression of FoxP3 were significantly decreased in NMOSD patients compared with those in the controls(P<0.05). NMOSD patients had significantly increased IFN-γ(P<0.05)but decreased IL-10(P<0.05)levels, while there was no significant difference in the level of TGF-β1. Conclusion NMOSD may be associated with an abrogated function of circulating CD4⁺CD25⁺FoxP3⁺ Treg cells and a decreased level of FoxP3 gene expression.

Expressions and clinical significance of PARP-1 and HIF-1α in adenomyosis tissues and primary cells

XU Ge, LI Qing, ZHANG Cancan, TIAN Yongjie

Journal of Shandong University (Health Sciences). 2022, 60(4):  55-61.  doi:10.6040/j.issn.1671-7554.0.2021.0472

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Objective To explore the expressions and significance of poly(ADP-ribose)polymerase-1(PARP-1)and hypoxia inducible factor-1(HIF-1α)in adenomyosis(AM)tissues and normal endometrial tissues. Methods The expressions of PARP-1 and HIF-1α in the eutopic and ectopic endometria of women with AM and in normal endometria were detected with immunohistochemistry. The primary interstitial cells were extracted from the eutopic and ectopic endometria of patients with AM. After the expression of PARP-1 was knocked down, the change of HIF-1α expression was measured. Results Immunohistochemistry results showed that the expression of PARP-1 was higher in the eutopic(26/31 vs 4/10, P=0.006)and ectopic(24/31 vs 4/10, P=0.027)endometria of AM than in normal endometria; the expression of HIF-1α was higher in the eutopic(24/31 vs 3/10, P=0.006)and ectopic(23/31 vs 3/10, P=0.012)endometria of AM than in normal endometria. There was a positive correlation(r=0.357, P=0.038 in eutopic endometrial tissues; r=0.519, P=0.002 in ectopic endometrial tissues)between expressions of PARP-1 and HIF-1α, but there was no significant difference in the expressions of PARP-1(P=0.052)and HIF-1α(P=0.767)in the eutopic and ectopic endometria of adenomyosis. Western blotting results showed that the expression of PARP-1 in ectopic endometrial interstitial cells of AM was higher than that in eutopic endometrial interstitial cells(P=0.025), and PARP-1 was highly expressed in eutopic(P<0.001)and ectopic(P<0.001)endometrial interstitial cells of AM compared with normal endometrial interstitial cells. After PARP-1 knockdown, the expressionin eutopic endometria(t=4.786, P=0.003), ectopic endometria(t=9.458, P<0.001), and normal endometria(t=5.740, P=0.001)was significantly reduced, and the reduction of ectopic endometrial interstitial cells in AM was the most obvious. There was no significant difference in the expression of HIF-1α in eutopic and ectopic endometrial interstitial cells of AM(P=0.896), and the expression of HIF-1α in eutopic endometrial stromal cells(P<0.001)and ectopic endometrial stromal cells(P<0.001)was higher than that in normal endometrium interstitial cells. After PARP-1 knockdown, the expression of HIF-1α in eutopic endometria of AM(t=15.768, P<0.001), ectopic endometrial cells(t=3.459, P=0.025), and normal endometria(t=4.221 5, P=0.014)was significantly lower than before. Conclusion Both PARP-1 and HIF-1α may be involved in the development of AM, and the expression of PARP-1 may affect the expression of HIF-1α.

Reproductive choices and pressure in 3,512 women of childbearing age in a hospital in Hebei Province

YANG Congpin, LUO Zhuoye, XU Xiuhua, LI Aimin, HAO Guimin

Journal of Shandong University (Health Sciences). 2022, 60(4):  62-67.  doi:10.6040/j.issn.1671-7554.0.2021.1428

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Objective To analyze and investigate the current situation of fertility and fertility-related pressure in couples of childbearing age in Hebei Province. Methods A total of 3,512 married women who underwent physical examination in the Reproductive Medicine Department of the Second Hospital of Hebei Medical Uiversity were selected during Jan.2019 and Dec.2020 as the research objects. According to their willingness to bear children, they were divided into the willing group(n=2,885)and unwilling group(n=627). The Fertility Problem Inventory(FPI)was used to evaluate fertility pressure. The impacts of age, education level, husband-wife relationship, mother-in-law and daughter-in-law relationship, per capita monthly household income, household registration, occupation, family type, marital status, type of residence, physical condition, and children on the reproductive choices of couples were investigated. The risk factors of reproductive choices were assessed with binary Logistic regression. Results Univariate analysis showed age, husband-wife relationship, mother-in-law and daughter-in-law relationship, per capita monthly household income, household registration, occupation, family type, type of residence, and physical condition were the influencing factors of reproductive choices(χ2=293.486, 57.562, 21.619, 24.150, 55.434, 167.625, 30.897, 363.966, 48.487, P<0.001). There was significant difference in FPI score between the two groups(P<0.001). Age, per capita monthly household income, occupation, family type, type of residence, and children were factors of fertility-related pressure(t/F=28.405, 5.412, 5.892, 5.213, 22.873, 2.240, P<0.001). The result of binary Logistic regression analysis showed that, advanced age(P<0.001), poor husband-wife relationship(P<0.001), poor mother-in-law and daughter-in-law relationship(P<0.001), high monthly household income(P<0.001), rural household registration(P<0.001), farmer as occupation(P<0.001), non-husband-wife family type(P<0.001), poor physical condition(P<0.001)were independent influencing factors of willingness to bear children. Conclusion The willingness of women of childbearing age to have children are related to husband-wife relationship, mother-in-law and daughter-in-law relationship, economic status, husband and wifes personal situation, occupation and household registration. The fertility-related pressure mainly comes from age, husband and wifes personal situation, economic status and mother-in-law and daughter-in-law relationship.

Diagnostic value of CT radiomics nomogram for adrenal lipid-poor adenoma and nodular hyperplasia

YUAN Hongtao, JI Congshan, KANG Bing, QIN Songnan, YU Xinxin, GAO Lin, WANG Ximing

Journal of Shandong University (Health Sciences). 2022, 60(4):  68-75.  doi:10.6040/j.issn.1671-7554.0.2021.1619

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Objective To investigate the value of radiomics nomogram based on non-contrast CT in the differential diagnosis of adrenal lipid-poor adenoma and adrenal nodular hyperplasia. Methods Clinical data of 44 patients with adrenal lipid-poor adenoma and 55 with nodular hyperplasia confirmed by pathology were retrospectively analyzed. Radiomics features extracted from non-contrast CT and radiomics score(Radscore)were calculated to construct a radiomics model. Clinical factors were selected to construct a clinical model. Radiomics nomogram was constructed combining clinical factors and Radscore. The diagnostic values of the three models were compared. Results A total of 13 features were selected to establish the radiomics model. The area under the receiver operator characteristic curve(AUC), sensitivity and specificity of the radiomics model were 0.91, 84.6% and 81.3%, respectively. Both univariate and multivariate Logistic regression showed that renin and maximum diameter were the independent influencing factors in the differential diagnosis of adrenal lipid-poor adenoma and adrenal nodular hyperplasia. The AUC, sensitivity and specificity of the clinical model were 0.57, 53.9% and 68.8%. respectively. The AUC, sensitivity and specificity of the radiomics nomogram were 0.94, 84.6% and 93.8%, respectively. The diagnostic efficiency of the radiomics model and nomogram was significantly higher than that of the clinical model(z=3.188, P<0.001; z=3.409, P<0.001). Conclusion The radiomics nomogram based on non-contrast CT has a high efficiency in the differential diagnosis of adrenal lipid-poor adenoma and nodular hyperplasia.

Effects of traditional Chinese medicine fumigation combined with extracorporeal shock wave therapy on 72 cases of femoroacetabular impingement syndrome and serum inflammatory factor

SUN Jiye, WANG Ziou, SUN Xiaowei, LI Hongtao

Journal of Shandong University (Health Sciences). 2022, 60(4):  76-81.  doi:10.6040/j.issn.1671-7554.0.2022.0030

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Objective To explore the clinical efficacy of traditional Chinese medicine(TCM)fumigation combined with extracorporeal shock wave in the treatment of femoroacetabular impingement syndrome(FAI)and the effects on the level of serum inflammatory factors. Methods A total of 72 patients with FAI treated in the Outpatient and Inpatient Departments during Dec. 2019 and Sep. 2021 were divided into the observation group and control group randomly, with 36 cases in either group. The control group was treated with extracorporeal shock wave of divergent mode, pressure 2.0-3.0 bar, 3 000-4 000 times once every 3 days. The observation group received the same treatment as the control group, plus fumigation once a day for 30 min. Both groups were treated for 30 days. The visual analogue score(VAS), Harris hip score(HHS), serum matrix metalloproteinase-13(MMP-13), interleukin-1β(IL-1β)level, quality of life and safety of treatment before treatment and 4 weeks after treatment were analyzed with SPSS 26.0 software to compared the clinical efficacy. Results After treatment, the total effective rate of the observation group was higher than that of the control group(P<0.05). The VAS and HHS scores of the two groups were improved compared with those before treatmnt, and the improvement in VAS and HHS of the observation group was more obvious than that of the control group(P<0.05). The levels of MMP-13 and IL-1β in both groups were lower than those before treatment, and those in the observation group were lower than those in the control group(P<0.05). The quality of life score of both groups was higher after treatment, and that of the observation group after treatment was higher than that of the control group(P<0.05). There was no statistical significance in the treatment safety between the two groups(P>0.05). Conclusion The combination of TCM fumigation and extracorporeal shock wave has a significant effect on alleviating the local pain of FAI, improving the functional activities of hip joint and reducing the levels of serum inflammatory factors. Meanwhile, it can effectively avoid the adverse reactions of oral drugs and damage caused by surgery. Therefore, it is worthy of clinical application.

Analysis of 7 cases of anti-H factor antibody-positive hemolytic uremic syndrome

KONG Xinxin, SUN Shuzhen, LI Qian, CHEN Yuan, ZHOU Aihua, WANG Li, YAO Xiujun

Journal of Shandong University (Health Sciences). 2022, 60(4):  82-86.  doi:10.6040/j.issn.1671-7554.0.2021.0589

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Objective Anti-H factor antibody-positive hemolytic uremic syndrome(HUS)is a severe subtype of HUS. The clinical characteristics, treatment and outcome of children with such disease were discussed to provide reference for clinical diagnosis and treatment. Methods Clinical data of 7 patients with anti-H factor antibody-positive HUS during May 2011 and Dec. 2017 were retrospectively analyzed, including 5 male and 2 female, aged 5.83 to 13.5(mean 7.93)years. The general condition, pre-infection, clinical characteristics, treatment, outcome and 3-8-year follow-up results were analyzed. Results Pre-infection: upper respiratory tract infection symptoms such as fever and cough were discovered in 57.14%(4/7)patients; digestive system symptoms such as vomiting and abdominal pain manifested in 71.42%(5/7)patients. Clinical features: all children were positive for anti-H factor antibody, ADAMTS13 activity was normal, 2 cases of H factor titer were normal, and the other were decreased; All cases showed moderate to severe anemia, thrombocytopenia, hyperbilirubinemia, massive proteinuria, severe acute kidney damage, and low-complement C3. Renal biopsy was performed in 3 cases and genetic testing in 3 cases. Treatment and outcome: all patients in the acute phase were treated with Gamma globulin, plasma exchange and high-dose methylprednisolone, followed by oral glucocorticoids. The outcome was 1 death and 6 relief, with the mean treatment time of 27.83 days. Five patients were treated with immunosuppressive agents due to persistent abnormalities in urine routine. After 3-8 years of follow-up, 4 patients had complete remission and 2 had partial remission; of the 4 cases who repeated amti H factor antibody examination, 2 were negative and 2 were still positive. Conclusion Children with anti-H factor antibody-positive HUS have severe clinical manifestations. On the basis of symptomatic supportive therapy in the acute phase, early use of plasma exchange, Gamma globulin, combined with high-dose methylprednisol impact therapy, can quickly control the condition. Long-term application of immunosuppressive agents can reduce recurrence and prolong the remission period. H factor antibody and C3 may be used as indicators of prognostic monitoring.

Effects of intense pulsed light on erythema telangiectasia rosacea observed with reflection confocal microscope

FAN Mengjiao, HE Qin, LUO Qing, WANG Zhenhua

Journal of Shandong University (Health Sciences). 2022, 60(4):  87-90.  doi:10.6040/j.issn.1671-7554.0.2021.1416

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Objective To observe the changes of skin structure in patients with erythema telangiectasia rosacea before and after intense pulsed light(IPL)treatment observed with reflection confocal microscope(RCM), and to explore the therapeutic mechanism of IPL. Methods A total of 20 patients(35 to 46 years old, Fitzpatrick type Ⅲ to Ⅳ)with erythema telangiectasia rosacea who received IPL treatment for the first time were treated once every 4 weeks, 5 times in a course. The stratum corneum thickness, diameter of capillaries and density of dermal papilla were measured with RCM before the first treatment and 1 month after the last treatment. Results The stratum corneum thickness after IPL treatment was(4.97±0.65)μm, which was not significantly different from that before IPL treatment ［(5.11±0.54)μm］(P=0.249). The mean capillary diameter after treatment was(19.13±4.68)μm, which was significantly shorter than that before treatment ［(23.28±3.52)μm］(P<0.001). The dermal papilla density after treatment was(9.88±1.89)/mm², which was significantly thicker than that before treatment ［(7.77±0.89)/mm²］(P<0.001). The skin aesthetic was significantly improved after treatment, and the patients had a high degree of acceptance of RCM examination and IPL treatment. Conclusion RCM can observe the structural changes of epidermis and superficial dermis of facial skin before and after IPL treatment without invasion. The therapeutic effects of IPL on erythema telangiectasia rosacea are related to the improvement of skin structure.

Pharmacoeconomic evaluation of levosimendan and milrinone in the treatment of 711 patients with severe heart failure complicated with renal injury

DONG Xue, ZHAO Xia, CHENG Zijie, HAN Yi

Journal of Shandong University (Health Sciences). 2022, 60(4):  91-98.  doi:10.6040/j.issn.1671-7554.0.2021.1451

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Objective To investigate the cost-effectiveness differences between levosimendan and milrinone in treating severe heart failure complicated with normal, mild and moderate impaired renal function. Methods A total of 711 patients hospitalized in the Cardiology Department of Shandong Provincial Qianfoshan Hospital due to severe heart failure during Dec. 2016 and Sep. 2019 were enrolled. According to the renal function, the patients were divided into moderate renal injury group(n=299)and normal renal function or mild renal injury group(n=412), and then divided into levosimendan subgroup and milrinone subgroup. The information and clinical outcomes of patients 30 days after drug use were collected through the electronic medical record system and follow-up visits. With “obvious efficiency” with no adverse clinical events, and “efficiency” with no death within 30 days as effectiveness indexes, and the discount adjusted total hospitalization cost as the cost index, a decision tree analysis model was constructed, and cost-effectiveness analysis and one-way sensitivity analysis were performed. Results In the moderate renal injury group, with “obvious efficiency” as the effectiveness index, milrinone had absolute pharmacoeconomic advantages; with “efficiency” as the effectiveness index, each 1% more efficiency of levosimendan costed ￥4 562.64 more than that of milrinone. In the normal renal function or mild renal injury group, the total hospitalization cost of levosimendan was lower than that of milrinone, and each 1% increase in obvious efficiency of milrinone costed ￥400.89 more than that of levosimendan, and each 1% increase in efficiency of milrinone costed ￥1 751.16 more than that of levosimendan. The sensitivity analysis results were robust. Conclusion Based on real-world data, milrinone has an economic advantage over levosimendan in severe heart failure patients with moderate renal injury. For patients with normal renal function or mild renal injury, levosimendan has a moderate economic advantage over milrinone.

Help-seeking willingness, help-seeking behaviors and influencing factors in middle school students with suicidal ideation

SHEN Yufei, ZHAO Mei, HU Mi

Journal of Shandong University (Health Sciences). 2022, 60(4):  99-106.  doi:10.6040/j.issn.1671-7554.0.2021.0223

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Objective To explore the prevalence and influencing factors of help-seeking willingness and help-seeking behaviors in middle school students with suicidal ideation in the past year, so as to lay a foundation for suicide prevention among middle school students. Methods A total of 3 669 students from 4 middle schools in Changsha were collected with stratified multi-stage cluster random sampling. The help-seeking willingness and help-seeking behaviors of students with suicidal ideation in the past year were surveyed with a self-compiled questionnaire. The general demographic data were described with composition ratio; the differences in influencing factors were inferred with χ2 test; the influencing factors of help-seeking willingness and help-seeking behaviors were determined with binary Logistic regression. Results The prevalence of suicidal ideation among middle school students in Changsha in the past year was 9.08%. The prevalence of help-seeking willingness among students with suicidal ideation was 80.70%, respectively. Most students were willing to ask for help from their good friends. Gender, social support provided by the family, social support provided by the school, and depression symptoms were influencing factors of help-seeking willingness. The prevalence of help-seeking behaviors was 77.22%. For students who had asked for help, good friends were the most popular target. Grade, social support provided by the family, social support provided by the school, and the educational background of the parents were influencing factors of help-seeking behavior. Conclusion The prevalence of help-seeking willingness in middle school students with suicidal ideation is high, while the prevalence of help-seeking behaviors is lower than that of help-seeking willingness. Good friends are the most important targets for help. The help-seeking willingness is related to gender, social support status, and depression symptoms, and the occurrence of help-seeking behaviors is related to grade, social support status, and parental educational background.

Prevalence and risk factors of latent tuberculosis infection among nursing staff in some designated hospitals in Shandong Province

LI Yanli, LI Yan, SHE Kaili, LIU Ying, LIU Weijuan, LI Xiujun, LIU Yinghui

Journal of Shandong University (Health Sciences). 2022, 60(4):  107-112.  doi:10.6040/j.issn.1671-7554.0.2021.1352

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Objective To investigate the prevalence and risk factors of latent tuberculosis infection(LTBI)among nursing staff in some designated hospitals in Shandong Province and provide scientific basis for the management of LTBI high-risk groups and reduction of occupational infection. Methods A questionnaire was designed for 631 nurses working in the designated tuberculosis hospitals from January 2018 to December 2019 and a cross-sectional survey was conducted. Results The latent infection rate was 17.43%. Univariate analysis indicated that education level, unit type, working years related to tuberculosis control, family members having history of tuberculosis and working place had statistical significance(P<0.05). Multivariate binary Logistic regression analysis indicated that the risk of tuberculosis infection increased with the increase of working years related to tuberculosis control. With 2-year as a reference, the risk of working for 6-10 years increased by 3.12 times(OR=3.12, 95%CI: 1.21-8.03), and the risk of working for more than 10 years increased by 5.33 times(OR=5.33, 95%CI: 2.17-13.09); if there were TB cases in family, the risk of infection could be 4.10 times higher(OR=4.10, 95%CI: 2.26-7.41). Conclusion The latent infection rate of nurses in some designated hospitals in Shandong Province is close to that of the general population. LTBI risk increases significantly as caregivers increase their years of tuberculosis control and have family members who have a history of tuberculosis. Preventive measures should be givn priority to the occupational exposed group to block the development of active tuberculosis.

Relationship between medical insurance participation and risk of suicide among rural elderly

ZHAO Sibo, PENG Li, LING Hongxiang

Journal of Shandong University (Health Sciences). 2022, 60(4):  113-118.  doi:10.6040/j.issn.1671-7554.0.2021.0062

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Objective To investigate the relationship between medical insurance participation and risk of suicide among rural elderly. Methods The “2010 China Urban and Rural Elderly Population Tracking Survey Data” were mined. Using a stratified random sampling method of proportional to the scale, elderly aged 60 years and above were surveyed in 20 provinces, autonomous regions, and municipalities. Altogether 7 873 subjects were enrolled, who were surveyed with a questionnaire composed of basic demographic information, medical insurance participation, suicidal behaviors and other related questions. Data collected were analyzed with a binary Logistic regression model. Results The reported risk of suicide among rural elderly was 6.03%, and there was significant differences among groups with different insurance participations(χ²=9.42, P=0.002). The binary Logistic regression model showed that factors related to risk of suicide included health insurance(OR=0.513, 95%CI=0.285-0.922), education level(elementary school: OR=0.718, 95%CI=0.573-0.898; junior high school and above: OR=0.670, 95%CI=0.453-0.989), debt status(OR=1.557, 95%CI=1.236-1.962), financial security(OR=0.719, 95%CI=0.574-0.900), health status(poor: OR=0.768, 95%CI=0.572-1.031; fair: OR=0.307, 95%CI=0.224-0.420; good: OR=0.316, 95%CI=0.206-0.486; very good: OR=0.175, 95%CI=0.061-0.494), chronic diseases(OR=1.970, 95%CI=1.448-2.681), psychological burden(OR=1.027, 95%CI=1.015-1.039), family relationship(OR=0.350, 95%CI=0.253-0.484), and so on. Conclusion Medical insurance participation is significantly related to the risk of suicide. Enhancing the coverage rate and insurance level and improving the rural serious diseases relief system will help improve the mental health of rural elderly and reduce the risk of suicide.

A case report of misdiagnosed cerebral amyloid angiopathy-related inflammation and literature review

SONG Luoqing, ZHOU Guoyu, YE Xiang, LU Mei, ZHAO Xinjing

Journal of Shandong University (Health Sciences). 2022, 60(4):  119-122.  doi:10.6040/j.issn.1671-7554.0.2021.1104

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Objective To analyze the clinical manifestations and imaging features of a patient with misdiagnosed cerebral amyloid angiopathy-related inflammation(CAA-RI)in order to improve clinicians understanding of this disease. Methods The clinical data of a patient with CAA-RI were collected and analyzed, and relevant literature was reviewed. Results The patient was a 66-year-old female, admitted due to episodic loss of consciousness accompanied by convulsions for 9 years. Before admission, the patients memory gradually declined for 4 months. Physical examination showed decrease in recent memory, calculation ability and judgment. Brain imaging showed multiple old bleeding signals and local enhancement in the left cerebral hemisphere, multiple ischemic lesions or inflammatory changes in the left side of brain and stratified necrosis of the left occipital cortex. Mini Mental State Examination score was 14. Conclusion CAA-RI has various clinical manifestations. If a middle-aged or elderly patient has cognition impairment, seizure, headache or other neurologic deficits, imaging examination should be conducted. Especially when MRI shows asymmetric white matter hypersignal with multiple cerebral microbleeds, clinicians should be on alert for CAA-RI.

A case report of Barth syndrome

REN Hong, WANG Wei, LIN Yan, LOU Jianwei, JI Kunqian, ZHAO Yuying, YAN Chuanzhu

Journal of Shandong University (Health Sciences). 2022, 60(4):  123-127.  doi:10.6040/j.issn.1671-7554.0.2021.1474

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Objective To investigate the clinical manifestations, imaging features, muscle pathology and genetic analysis of a patient presenting Barth syndrome(BTHS)with TAZ gene mutation, so as to improve clinician’s understanding of the disease. Methods Clinical and laboratory data of a patient with BTHS were collected and analyzed, and relevant literature was reviewed. Results The patient was a 14-year-old boy presenting with growth retardation since childhood. He was admitted to our hospital due to weakness of limbs for more than two months. Physical examination showed bilateral weakness in trapezius, sternocleidomastoid muscles and limbs. Blood routine examination indicated a decrease in neutrophil count. Urine organic acid analysis revealed elevated 3-methylglutaconicaciduria. Muscle MRI showed abnormal signals on FS T₂WI(fat suppression T₂ weighted imaging)in both gluteus maximus muscles and muscles around the tibial epiphysis. Muscle pathology showed mild myogenic lesion. Genetic analysis confirmed that the patient and his mother carried mutation c.589G>A in the TAZ gene. Conclusion Barth syndrome is a clinically and genetically heterogeneous disorder with various onset forms. When patients present with inexplicable decreased neutrophils or myocardial involvement, BTHS should be considered. Early diagnosis, symptomatic treatment and supportive care can improve the quality of life for patients.

Neurofibromatosis type I: a case of novel mutation and review of literature

TIAN Min, CAO Lili, SONG Chengyuan

Journal of Shandong University (Health Sciences). 2022, 60(4):  128-132.  doi:10.6040/j.issn.1671-7554.0.2021.1011

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Objective To report the clinical features of a pedigree of clinically confirmed neurofibromatosis type I(NF1)and a novel mutation of NF1 gene. Methods Clinical data of a proband and his family were reviewed, and a comprehensive medical examination and molecular genetic analysis of all family members were performed. Results A missense mutation in exon 14 of the NF1 gene, c.1586T>G, was detected in the proband and his mother, but not in the non-diseased family members or normal controls. Conclusion We identified a novel missense mutation in the NFI gene, which may be responsible for neurofibromatosis type Ⅰ in this family. In addition, NF1 patients with short stature should receive a cranial MRI to rule out tumors in the saddle area, and a growth hormone stimulation test to assess hormone secretion so as to trace the cause of growth retardation.