Table of Content

  

10 August 2022
Volume 60 Issue 8

Sentinel lymph node biopsy of breast cancer in the era of precision medicine

YANG Qifeng, ZHANG Ning

Journal of Shandong University (Health Sciences). 2022, 60(8):  1-5.  doi:10.6040/j.issn.1671-7554.0.2022.0612

Abstract ( 1017 )   HTML ( 12 )   PDF (4121KB) ( 217 )   Save

References | Related Articles | Metrics

Sentinel lymph node biopsy of breast cancer, which can avoid axillary lymph node dissection and its complications, has become one of the standard surgical methods for patients with early breast cancer. However, in the era of precision medicine, the clinical implementation of sentinel lymph node biopsy has problems such as inaccurate localization and excessive lymph node resection. In response, our research team has established the Qilu Procedure for precise sentinel lymph node biopsy, proposed the concept of fine anatomy of the sentinel lymph node region, and reported the anatomical variation of sentinel lymph nodes and the positional relationship with the upper extremity draining lymph nodes. The results of this study have important implications for the understanding of axillary lymphatic drainage and operation of axillary lymph nodes in patients with early breast cancer.

Potential intervention effects of 5-methyltetrahydrofolate on atherosclerosis in rats

WU Hong, ZHANG Zhengduo, TANG Yanjin, QI Shaojun, GAO Xibao

Journal of Shandong University (Health Sciences). 2022, 60(8):  6-13.  doi:10.6040/j.issn.1671-7554.0.2021.1598

Abstract ( 918 )   PDF (1775KB) ( 185 )   Save

References | Related Articles | Metrics

Objective To investigate the potential intervention properties and possible mechanism of 5-methyltetrahydrofolate(5-MTHF)on atherosclerosis in rats. Methods Rat atherosclerosis models were established with a high-fat diet combined with vitamin D2. A total of 48 male Wister rats were randomly divided into control group, model group, 5-MTHF low-dose and high-dose groups(0.5 mg/kg, 2 mg/kg), with 12 rats in each group. The rats were sacrificed 6 weeks later, and the contents of folate, homocysteine, blood lipid, oxidative stress, inflammatory factors, and endothelial factors in the serum were measured. The pathological changes in the aorta were observed with HE staining. The mRNA expressions of nuclear factor-κB p65(NF-κB p65)and lectin-like oxidized low-density lipoprotein receptor-1(LOX-1)in aorta were detected with qRT-PCR. Results Compared with the control group, the model group had decreased body weight(P<0.05), increased levels of serum total cholesterol(TC), triglyceride(TG), low-density lipoprotein(LDC-C)(P<0.001), decreased level of high-density lipoprotein(HDL-C)(P<0.001), and smooth muscle cell hyperplasia and diffuse lipid plaques in the aorta, suggesting that the atherosclerosis models were established successfully. The serum folate content in the model group was not significantly different from that in the control group(P>0.05), but the homocysteine concentration increased by 77.47%(P<0.001). Compared with the model group, the 5-MTHF low- and high-dose groups had increased serum folate level(P=0.042, P<0.001)but decreased homocysteine concentration(P=0.046, P<0.001). Low-dose 5-MTHF did not significantly improve dyslipidemia, nitric oxide synthase(NOS), superoxide dismutase(SOD), glutathione peroxidase(GSH-Px)activities, nitric oxide(NO), malondialdehyde(MDA), inflammatory tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), interleukin-6(IL-6), endothelin-1(ET-1), soluble intercellular adhesion molecule 1(sICAM-1), and mRNA expressions of NF-κB p65 and LOX-1(P>0.05). In the 5-MTHF high-dose group, serum TC and LDC-C contents decreased(P=0.023, P=0.036), HDL-C level increased(P=0.035); NO concentration, NOS and SOD activities increased(P=0.035, P=0.022, P=0.04); MDA, TNF-α, IL-6 and ET-1 contents decreased(P=0.022, P=0.045, P=0.024, P=0.045), but the GSH-Px activity was significantly enhanced(P=0.007); the mRNA expression of LOX-1 was down-regulated(P=0.038)but the down-regulation of the mRNA expression of NF-κB p65 was not statistically significant(P>0.05). 5-MTHF had no regression effects on plaques in atherosclerotic rats, but high-dose 5-MTHF reduced smooth muscle cell proliferation and foam cell aggregation in plaques. Conclusion 5-MTHF can improve dyslipidemia, oxidative stress and inflammation, reduce foam cell aggregation and smooth muscle cell proliferation, but does not reduce atherosclerotic plaques in atherosclerotic rats, probably by reducing homocysteine level, inhibiting oxidative stress and down-regulating the mRNA expression of LOX-1.

Protective effects and molecular mechanism of puerarin on sorafenib-induced cardiotoxicity

JIANG Hui, WEI Tian, LI Jianping, WANG Cong

Journal of Shandong University (Health Sciences). 2022, 60(8):  14-22.  doi:10.6040/j.issn.1671-7554.0.2022.0250

Abstract ( 657 )   PDF (8514KB) ( 139 )   Save

References | Related Articles | Metrics

Objective To elucidate the protective effects and molecular mechanism of puerarin on sorafenib-induced cardiotoxicity via inhibiting the ferroptosis of cardiomyocytes. Methods In the cell study, primary cardiomyocytes were isolated and treated with dimethyl sulfoxide(DMSO), sorafenib, sorafenib+deferoxamine, sorafenib+ferrostatin-1(Fer-1), and sorafenib+puerarin, respectively. The cell viability, lactate dehydrogenase(LDH)release, lipid ROS, and malondialdehyde(MDA)level were measured. The cell morphology was observed with microscopy. At 0, 12, 24, 36, 48, 60 and 72 h after treatment, cardiomyocytes were harvested and the classic marker of endoplasmic reticulum(ER)stress, glucose-regulated protein 78(GRP78)protein was detected with Western blotting. Cardiomyocytes were treated with sorafenib, sorafenib+puerarin, sorafenib+puerarin+thapsigargin, and sorafenib+puerarin+thapsigargin, respectively. The cell viability, LDH release, lipid ROS, MDA level and GRP78 level were measured. In the mice study, 40 C57BL/6J mice were divided into the control, puerarin, sorafenib, and sorafenib+puerarin groups. The level of serum creatine kinase MB isoenzyme(CK-MB)was determined with ELISA. The heart weight/tibia length(HW/TL)was evaluated. The cross-sectional area(CSA)was measured after Masson staining. The ROS, MDA and GRP78 levels of cardiac tissue were measured. Results In the cell study, compared to the DMSO group, the sorafenib group had decreased cell viability, increased LDH release, increased lipid ROS, MDA and GRP78 levels(all P<0.01). Compared with the sorafenib group, the sorafenib+Fer-1 group, sorafenib+deferroamine group and sorafenib+puerarin group had increased cell viability, decreased LDH release, decreased vacuolation, decreased lipid ROS, MDA and GRP78 levels(all P<0.05). The interactions between ER stress inducers thapsigargin and puerarin on GRP78 level, cell viability, LDH release and MDA level were statistically significant(all P<0.05). In the mice study, sorafenib administration caused elevated CK-MB level, decreased HW/TL, larger CSA of surviving cardiomyocytes, increased lipid ROS level and MDA content, and upregulated level of GRP78, which could all be inhibited by puerarin(all P<0.05). Compared with the sorafenib group, the sorafenib+puerarin group had decreased level of CK-MB, increased HW/TL, decreased CSA, decreased ROS, MDA and GRP78 levels(all P<0.05). Conclusion Puerarin inhibits sorafenib-induced ferroptosis of cardiomyocytes via inhibiting ER stress, which might be triggered by lipid ROS. Puerarin has a promising role in alleviating sorafenib-related cardiotoxicity.

Trillium Saponins ameliorates pulmonary fibrosis in rats by inhibiting TGF-β/Smad3 and Wnt/β-catenin signaling pathways

ZHANG Bingfen, ZHOU Shenghong, WANG Zhe

Journal of Shandong University (Health Sciences). 2022, 60(8):  23-29.  doi:10.6040/j.issn.1671-7554.0.2022.0011

Abstract ( 802 )   PDF (7396KB) ( 93 )   Save

References | Related Articles | Metrics

Objective To investigate the treatment and mechanism of Trillium Saponins in rats with pulmonary interstitial fibrosis. Methods Fifty male SD rats were divided into 5 groups, namely the control group, the model group, and the low, medium, and high Trillium Saponins treatment groups, with 10 in each group. Except the control group, the other groups were injected with bleomycin 5 mg/kg through tracheal intubation. A rat model of pulmonary fibrosis was established. The treatment group was given 25, 50 and 100 mg/(kg·d)Trillium Saponins by gavage the next day. After 28 days of treatment, the rats were sacrificed, and blood and lung tissues were taken. The lung tissue was weighed and the lung coefficient was calculated. HE staining and Masson staining were used to observe rat lung histopathology. The expression of interleukin-1β(IL-1β), tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), malondialdehyde(MDA)and reactive oxygen species(ROS)and the activity of superoxide dismutase(SOD)were detected by ELISA kit. Western blotting experiment was employed to detect the protein expression levels of transforming growth factor-β(TGF-β)1, Smad3, Wnt3a, β-catenin, glycogen synthase kinase-3β(GSK-3β), fibronectin, Collagen Ⅰ and α-SMA in lung tissue. Results Compared with the model group, lung coefficient was decreased, inflammatory cell infiltration, collagen deposition and fibrocytosis was reduced, the expression of IL-1β, TNF-α, IL-6, MDA and ROS levels was decrease, the activity of SOD was increased, the expression of fibronectin, Collagen Ⅰ, α-SMA, TGFβ1, Smad3, Wnt3a, β-catenin and GSK-3β proteins was inhibited in lung tissue of low, medium, and high Trillium Saponins treatment groups. Conclusion Trillium has anti-inflammatory and anti-oxidant properties, and can inhibit the activation of TGF-β/Smad3 and Wnt/β-catenin signaling pathways to protect against pulmonary fibrosis.

Comparison of the efficacy between semicircular canal plugging and labyrinthectomy for intractable Menieres disease

TIAN Chaoqun, LYU Yafeng, LI Xiaofei, SONG Yongdong, KONG Ligang, FAN Zhaomin, WANG Haibo, ZHANG Daogong

Journal of Shandong University (Health Sciences). 2022, 60(8):  30-33.  doi:10.6040/j.issn.1671-7554.0.2021.1171

Abstract ( 1365 )   PDF (1002KB) ( 278 )   Save

References | Related Articles | Metrics

Objective To compare the long-term efficacy of semicircular canal plugging(SCP)versus labyrinthectomy in the treatment of intractable Menieres disease(MD). Methods A total of 70 MD patients with complete medical document who underwent SCP(n=56)and labyrinthectomy(n=14)in our hospital during March 2015 and March 2016 were retrospectively analyzed. The outcomes after two-year follow-up were compared. Results The total rate of vertigo control in the SCP group was 96.4%(54/56), with 45 cases(80.4%)of class A control and 9(16.1%)of class B control, while the total rate of vertigo control in the labyrinthectomy group was 100%(14/14), and all cases had class A control, with no significant difference between the two groups(P>0.05). The rat of hearing loss in the SCP group was 28.6%(16/56), while all cases in the labyrinthectomy group lost their hearing(14/14), and the rate was lower in the SCP group than in the labyrinthectomy group(P<0.001). There were no significant differences in the abnormality rates of cVEMP and oVEMP in the SCP group before and after surgery(P>0.05), while the differences were significant in the labyrinthectomy group(P=0.014; P=0.006). The time of balance recovery was(16.5±5.19 )days in the SCP group and(25.07±7.87)days in the labyrinthectomy group, which was significantly different(P<0.001). Conclusion SCP is more effective than labyrinthectomy in the treatment of intractable advanced MD.

Construction of a prognostic risk model of pyroptosis-related genes in breast cancer based on database

HE Shiqing, LI Wanwan, DONG Shuqing, MOU Jingyi, LIU Yuying, WEI Siyu, LIU Zhao, ZHANG Jiaxin

Journal of Shandong University (Health Sciences). 2022, 60(8):  34-43.  doi:10.6040/j.issn.1671-7554.0.2021.1339

Abstract ( 1225 )   PDF (17231KB) ( 215 )   Save

References | Related Articles | Metrics

Objective To explore the prognostic value of pyroptosis-related differentially expressed genes(DEGs)in breast cancer and to construct a prognostic risk model. Methods Gene sequencing and clinical data of breast cancer were downloaded from The Cancer Genome Atlas(TCGA)and Gene Expression Ominibus(GEO)to screen for pyroptosis-related DEGs. A cluster analysis was performed on breast cancer patients. The model of TCGA cohort was established by the least absolute shrinkage and selection operator(LASSO)method, which was then evaluated with Kaplan-Meier survival curve, receiver operating characteristic curve(ROC), univariate and multivariate Cox regression independent prognostic factor analysis. The GEO cohort was used as the validation set. Enrichment of DGEs was analyzed with GO, KEGG, and ssGSEA. Results Pyroptosis-related DEGs were screened, cluster analysis showed that the overall survival(OS)of C2 group was prolonged, and the difference was statistically significant?(P=0.020). K-M survival analysis showed that OS was shortened in the high-risk group(P<0.001 in the TCGA cohort, P=0.018 in the GEO cohort). The area under the ROC curve(AUC)showed that the model had certain predictive ability. Univariate and multivariate Cox regression showed that age, M and N stage, and risk score were independent predictors of OS. GO, KEGG and ssGSEA analyses confirmed that pyroptosis-related DEGs were related to immune inflammatory factors and pathways. Conclusion This study constructed a prognostic risk model of breast cancer composed of 9 pyroptosis-related genes, which can provide reference for the risk and prognosis assessment of breast cancer patients.

Efficacy and prognostic factors of gamma knife in treating 81 cases of brain metastases from lung cancer

GAO Zhongxia, ZHANG Ming, FAN Mingde, TAN Chenyang, WANG Mengdi, WANG Chao, FAN Yuefei, DING Shouluan, WANG Chengwei

Journal of Shandong University (Health Sciences). 2022, 60(8):  44-49.  doi:10.6040/j.issn.1671-7554.0.2021.1380

Abstract ( 1747 )   PDF (1482KB) ( 257 )   Save

References | Related Articles | Metrics

Objective To evaluate the efficacy of gamma knife in the treatment of brain metastases from lung cancer and to analyze factors affecting survival. Methods A total of 81 patients with brain metastases from lung cancer who received gamma knife treatment in the Neurosurgery Department of our hospital during May 2016 and June 2020 were selected for a retrospective study, and a database was established after follow-up. Overall survival was defined as the period from the time receiving gamma knife to the date of death or end of follow-up or the first loss of follow-up. The 6-month, 1-year and 2-year survival rate were calculated with Kaplan-Meier method, and the survival curve was plotted. The differences in survival rates were analyzed with Log-rank test. Factors affecting survival were analyzed with Cox multivariate regression. Results All patients were followed up, and 36 of the 81 patients died(44.44%)at the end of follow-up. The median overall survival was 23 months(95%CI: 14~26). The 6-month, 1-year and 2-year survival rate were 82.84%, 63.53% and 43.35%, respectively. The total volume of metastases(HR: 1.158, 95%CI: 1.079~1.242, P<0.001), age(HR: 2.666, 95%CI: 1.257~5.657, P=0.010 6), and marginal dose(HR: 0.392, 95%CI: 0.167~0.922, P=0.031 8) were factors affecting survival. Conclusions Patients with brain metastases from lung cancer who received gamma knife treatment in this study gained good efficacy, and their survival rate and survival time were improved. The total volume of metastases ≥16cm3, age ≥70 years, and marginal dose <17Gy were adverse prognostic factors(P<0.05).

Effects of different approaches of quadrates lumborum block on postoperative recovery of patients undergoing radical gastrectomy

FU Jia, WANG Lulu, HU Shuai, CHEN Zheping, LIU Dongyi, LI Qingsong, LU Guodong, ZHANG He, ZHAO Xin, FENG Chang

Journal of Shandong University (Health Sciences). 2022, 60(8):  50-57.  doi:10.6040/j.issn.1671-7554.0.2022.0236

Abstract ( 709 )   PDF (1081KB) ( 228 )   Save

References | Related Articles | Metrics

Objective To compare the effects of quadrates lumborum block via different approaches on postoperative analgesia, immune function and early recovery in patients undergoing laparoscopic radical gastrectomy. Methods A total of 120 patients selected for laparoscopic radical gastrectomy were randomly divided into group Q1(QLB1), group Q2(QLB2), group Q3(QLB3)and group C, with 30 cases in each group. All groups used the same general anesthesia scheme, but the ultrasound-guided bilateral quadrates lumborum block were through different approaches. The resting and dynamic visual analogue score(VAS)at 0 h, 6 h, 12 h, 24 h and 48 h after operation, use of remedial analgesics within 48 h after operation, and total usage of sufentanil during perioperative period were recoded. The levels of T cell subsets at T0(right before operation), T1(24h after operation)and T2(48h after operation)were recorded. The first time out of bed, first exhaust time, postoperative hospitalization days and incidence of adverse reactions were also recorded. Results At 0 h, 6 h, 12 h, and 2 h after operation, the resting VAS score: group Q2<group Q1<group C(P<0.05), group Q3<group Q1<group C(P<0.05); the dynamic VAS score: group Q2<group Q3<group Q1<group C(P<0.05). The use of remedial analgesics within 48 hours after operation was lower in group Q2 than in the other three groups(P<0.05). The use of sufentanil was higher in group C than in the other three groups(P<0.05). The levels of T cell subsets at different times: T1 < T0(P<0.05), T2 < T0(P<0.05). At T1, the levels of CD3⁺, CD4⁺ and CD4⁺/CD8⁺: group C<group Q1<group Q3<group Q2(P<0.05). At T2, the levels of CD3⁺, CD4⁺ and CD4⁺/CD8⁺: group Q1<group Q3<group Q2(P<0.05), group C<group Q3<group Q2(P<0.05). The first time out of bed and first exhaust time: group Q2<group Q3<group Q1<group C(P<0.05). The postoperative hospital stay was longer in group C than in the other three groups(P<0.05). The incidence of adverse reactions was lower in group Q2 than in group C(P<0.05). Conclusions Ultrasound guided lumbar quadratus block can provide satisfactory analgesia for patients after laparoscopic radical gastrectomy, reduce the effects of surgery on T cell subsets and cellular immunosuppression, accelerate the postoperative rehabilitation and facilitate the prognosis. QLB2 is superior to QLB1 and QLB3 in reducing dynamic pain and immunosuppression.

Clinical characteristics and genetic analysis of early onset epileptic encephalopathy induced by UBA5 gene mutation

LI JUN, LI Baomin, YANG LU

Journal of Shandong University (Health Sciences). 2022, 60(8):  58-62.  doi:10.6040/j.issn.1671-7554.0.2021.1453

Abstract ( 1079 )   PDF (2223KB) ( 169 )   Save

References | Related Articles | Metrics

Objective To explore the clinical characteristics, gene mutations and etiology of patients with early onset epileptic encephalopathy(EOEE)so as to provide reference for the diagnosis. Methods Next-generation sequencing technology was performed for exome sequencing in the genomes of 1 EOEE patient. Suspected mutations were validated with Sanger sequencing in the patient and parents. Results The c.214C>T(p.R72C)heterozygous variation(NM_024818)and c.1141_1144delTCTG chimeric variation(NM_024818)were detected in UBA5 gene, suggesting possible pathogenicity. Conclusion EOEE induced by mutations in the UBA5 gene is very rare. Combined with the previously reported UBA5 cases, mutations in the UBA5 gene may be the etiology of EOEE, which provide a basis for the genetic counselling of the disease.

Expression of ECT2 in uterine corpus endometrial carcinoma and its clinical significance based on bioinformatics database

LIU Teng, MA Yingchun

Journal of Shandong University (Health Sciences). 2022, 60(8):  63-71.  doi:10.6040/j.issn.1671-7554.0.2022.1479

Abstract ( 1070 )   PDF (15017KB) ( 147 )   Save

References | Related Articles | Metrics

Objective To analyze the expression and potential function of ECT2 in uterine corpus endometrial carcinoma(UCEC)through multiple databases and to explore the prognosis. Methods The hub genes of UCEC were screened with GEO, STRING and Cytoscape. Kaplan-Meier analysis was performed in combination with TIMER2.0, UALCAN and Tumor Genome Atlas(TCGA). The differentially expressed genes(DEGs)were screened and functional enrichment analysis was performed using online analysis tools of Linked Omics and Metascape. The correlation between hub genes and pan-cancer immune infiltrating cells was analyzed with TIMER2.0. Results A total of 245 DEGs were screened out. ECT2 was the key gene, and its expression was correlated with the grade, stage, prognosis and survival of UCEC patients. ECT2 was also correlated with tumor proliferation and immune infiltration. Conclusion ECT2 is highly expressed in UCEC and closely related to the dismal prognosis, which may provide a new target for the treatment of this disease.

Efficacy of ultrasound-guided sclerotherapy with pingyangmycin and lauromacrogol in 94 cases of cystic lymphatic malformation

WANG Wenjing, LIU Boce, BI Jianhai, HUO Ran

Journal of Shandong University (Health Sciences). 2022, 60(8):  72-78.  doi:10.6040/j.issn.1671-7554.0.2022.0535

Abstract ( 775 )   PDF (2433KB) ( 90 )   Save

References | Related Articles | Metrics

Objective To retrospectively analyze the efficacy and safety of ultrasound-guided percutaneous sclerotherapy with pingyangmycin and lauromacrogol in the treatment of cystic lymphatic malformation(cLM). Methods A total of 94 cLM patients aged 0.5-43 years were enrolled, 75 of whom had onset before 2 years of age(32 cases of macrocystic type, 31 cases of microcystic type, and 31 cases of mixed type). Results The patients received an average of 2.8 times of treatments. During the follow-up of 3.7-39.2 months, the lesion volume reduction was 78.7%, the effective rate of symptom relief was 82.1%, and the satisfaction rate of patients and their families was 85.1%. Side effects occurred in 14 patients, but no serious adverse reactions such as pulmonary fibrosis or allergies were observed. Recurrence occurred in 7 patients, who received a second treatment and had good outcomes. Conclusion Ultrasound-guided percutaneous sclerotherapy with pingyangmycin and lauromacrogol is effective and safe in the treatment of cystic lymphatic malformation, and it is worthy of clinical promotion.

Differences in the upper airway morphology among various sagittal skeletal profiles in adolescents aged 12 to 15 years

WANG Xin, HOU Yingyue, GUO Jing

Journal of Shandong University (Health Sciences). 2022, 60(8):  79-83.  doi:10.6040/j.issn.1671-7554.0.2022.0243

Abstract ( 759 )   PDF (1005KB) ( 365 )   Save

References | Related Articles | Metrics

Objective To determine the differences in the upper airway morphology among different sagittal skeletal profiles in adolescents aged 12 to 15 years. Methods A total of 187 adolescents(91 males and 96 females)who sought orthodontic treatment in the Stomatological Hospital of Shandong University were involved. All participants received cone-beam computed tomography(CBCT). The morphology of the upper airway was measured with Dolphin 11.95. Based on the APDI value, both male and female participants were divided to three groups: skeletal class Ⅰ, skeletal class Ⅱ and skeletal class Ⅲ, respectively. Data collected were statistically analyzed with SPSS software. Results In males, there were significant differences in the velopharyngeal area, the total area of the upper airway in the median sagittal plane, the sagittal diameter of the upper airway and the ratio of the transverse diameter to the sagittal diameter at the level of the posterior nasal spine among the three groups (P<0.05). In females, only the velopharyngeal area showed statistically significant difference among the three groups(P<0.05). Conclusion The morphology of the upper airway shows significant differences in various sagittal skeletal profiles in adolescents aged 12 to15 years.

Diarrhea as the principal presentation of Waldenström macroglobulinemia: a case report and literature review

AN Wen, HUANG Gang, YU Yanbo, ZUO Xiuli, LI Yanqing

Journal of Shandong University (Health Sciences). 2022, 60(8):  84-90.  doi:10.6040/j.issn.1671-7554.0.2021.1377

Abstract ( 804 )   PDF (10511KB) ( 106 )   Save

References | Related Articles | Metrics

Objective To enhance clinicians understanding of the involvement of gastrointestinal tract in Waldenström macroglobulinemia(WM). Methods A case of chronic diarrhea with weight loss diagnosed as WM was reported. Relevant literature was reviewed. Results The WM case was associated with significant gastrointestinal involvement, manifested as chronic diarrhea with weight loss and hypoproteinemia. Small bowel biopsy was negative for amyloidosis. Rituximab in combination with bendamustine soon relieved the diarrhea. Literature about the association of WM with gastrointestinal symptoms was reviewed. Conclusion An increased awareness of the gastrointestinal manifestations of WM may help to explain and treat the indolent, potentially life-threatening lymphatic malignancy.

A case report of hemophagocytic syndrome secondary to talaromyces marneffei infection

JIANG Ziqing, ZENG Yanping, JI Xiaodong, ZUO Junling

Journal of Shandong University (Health Sciences). 2022, 60(8):  91-97.  doi:10.6040/j.issn.1671-7554.0.2022.0417

Abstract ( 919 )   PDF (2817KB) ( 94 )   Save

References | Related Articles | Metrics

Objective To analyze the diagnosis and treatment of a patient with hemophagocytic syndrome(HPS)secondary to talaromyces marneffei(TM)infection, in order to improve clinicians understanding of the disease. Methods Clinical and laboratory data of a patient with TM infection secondary to HPS treated in our hospital were collected and analyzed, and relevant literature was reviewed. Results The patient, a 53-year-old man, with no history of malignant tumor or immune deficiency, presented with persistent fever, cough, expectoration, rashes, jaundice, hepatomegaly, splenomegaly, liver function impairment, decrease of hemoglobin and platelets, and increase of inflammation indicators, triglycerides and ferritin. TM was detected with sputum culture and metagenomic next-generation sequencing of peripheral blood. Macrophages were observed with bone marrow smear. After HPS secondary to TM infection was confirmed, the patient was treated with voriconazole and human immunoglobulin combined with glucocorticoid. Conclusion The clinical manifestations of TM infection are non-specific and the disease is difficult to diagnose. HPS secondary to TM infection increases the difficulty of treatment. Treatment should be tailored according to the condition of patients.

Primary biliary cholangitis with bone pain as the main manifestation: a case report

CHEN Shihong, JIANG Dongqing, ZHUANG Xianghua, LI Xiaobo, PAN Zhe, SUN Aili, LOU Nengjun, WANG Dianhui, DU Jiaojiao, SONG Yuwen

Journal of Shandong University (Health Sciences). 2022, 60(8):  98-102.  doi:10.6040/j.issn.1671-7554.0.2022.0699

Abstract ( 1301 )   PDF (3720KB) ( 70 )   Save

References | Related Articles | Metrics

Objective Primary biliary cholangitis(PBC)is a rare autoimmune liver disease, which is one of the rare causes of secondary osteoporosis. In this paper, we will report a case of PBC with bone pain as the main manifestation, in order to arouse clinicians attention to this disease. Methods A case of elderly women with bone pain as the main manifestation was enrolled, and the results of laboratory examinations, bone mineral density and X-ray image of bones were evaluated. The clinical characteristics of PBC with osteoporosis were summarized by reviewing the literature. Results The patient was a 61-year-old female with pain in both hips and knees for more than 1 year. Dual-energy X-ray absorptiometry indicated osteoporosis. The patient showed no symptoms of biliary tract obstruction such as fatigue, skin itching, or yellow staining. However, laboratory examinations showed elevated biliary tract enzyme, including gamma-glutamyl transferase(GGT)and alkaline phosphatase(ALP). Her anti-mitochondrial antibody type Ⅱ(AMA-M2)was positive. These results indicated that her osteoporosis was probably caused by PBC. Conclusion The clinical manifestations of PBC are insidious. PBC should be considered in patients with osteoporosis, especially when the bile duct enzymes are elevated and AMA-M2 is positive.

A case of primary ciliary dyskinesia caused by a novel DNAH5 gene mutation

WANG Lumin, ZHOU Shiying, HUANG Qikun, LIU Yanli

Journal of Shandong University (Health Sciences). 2022, 60(8):  103-108.  doi:10.6040/j.issn.1671-7554.0.2022.0205

Abstract ( 1328 )   PDF (10544KB) ( 93 )   Save

References | Related Articles | Metrics

Objective To explore the clinical characteristics, diagnosis and treatment of primary ciliary dyskinesia(PCD)caused by DNAH5 gene mutation. Methods The clinical data of a child with PCD admitted to our hospital were retrospectively analyzed, including the main symptoms, laboratory examination results, imaging findings, gene detection results, transmission electron microscopy(TEM)results and the diagnosis and treatment progress. Results The child had respiratory distress in the neonatal period; repeated cough, sputum, bronchiectasis and chronic sinusitis in infancy. TEM of bronchial mucosa revealed no cilium and the whole exon sequencing indicated a pathogenic compound heterozygous mutation of DNAH5 gene. The diagnosis of PCD was confirmed. Anti-infection and airway clearance therapy were given in the acute stage, and regular follow-up was performed. Conclusion PCD has a variety of clinical manifestations and lacks a single specific diagnosis test. For suspicious patients, a comprehensive analysis of high-speed video microscopy, immunofluorescence microscopy, TEM and gene detection is required to confirm the diagnosis. Currently, there is no cure for PCD, the aim of treatment is to delay the progression of the disease.

Mendelian randomization study of sleep phenotypes and irritable bowel syndrome

ZHANG Kai, SI Shucheng, LI Jiqing, LIU Xiaowen, ZHAO Yingqi, XUE Fuzhong

Journal of Shandong University (Health Sciences). 2022, 60(8):  109-114.  doi:10.6040/j.issn.1671-7554.0.2022.0290

Abstract ( 1362 )   PDF (1867KB) ( 613 )   Save

References | Related Articles | Metrics

Objective To explore the causal relationship between sleep phenotypes and irritable bowel syndrome(IBS). Methods Mutually independent genetic variants closely related to sleep phenotypes were chosen as instrumental variables from the genome-wide association study database(GWAS)and the Finnish Biobank database(FinnGen). With odds ratio(OR)as an outcome indicator, the causal relationship between sleep phenotypes and IBS was analyzed using MR methods, including inverse-variance weighted(MR-IVW), weighted median, simple median method, robust adjusted contour score method, pleiotropic residual sum, and heterogeneity. Results MR-IVW results showed that short sleep duration and insomnia led to an increased risk of IBS by 147%(OR=2.47, 95%CI: 1.13-5.41)and 18% (OR=1.18, 95%CI: 1.14-1.22), respectively. Morning habits were associated with a 12% lower risk of IBS(OR=0.88, 95%CI: 0.84-0.92). The results of external data validation showed that only insomnia was associated with a statistically significant risk of IBS(P<0.001). After relevant covariates were adjusted with multivariate MR methods, the association effect between insomnia and IBS remained statistically significant(P<0.001). Conclusion Short sleep duration and insomnia will increase the risk of IBS.

Causal association between green space and cancer incidence

WU Xinying, FENG Yiping, CHANG Kaifeng, JIA Xianjie, XUE Fuzhong

Journal of Shandong University (Health Sciences). 2022, 60(8):  115-119.  doi:10.6040/j.issn.1671-7554.0.2022.0339

Abstract ( 786 )   PDF (2406KB) ( 112 )   Save

References | Related Articles | Metrics

Objective To investigate the causal association between green space and cancer incidence. Methods Based on the Health Care Big Data Platform of Shandong Province, resident electronic health records, cancer surveillance data and electronic medical record data of Pingyi County were linked to construct a cancer incidence cohort. Green space exposure was assessed using normalized difference vegetation index(NDVI)derived from satellite remote sensing data. Outcome was defined as the diagnosis of cancer. The association between NDVI and cancer incidence was explored using generalized linear mixed model(GLMM). Negative control exposure based on time-series studies(NCE-TS)method was used to estimate the causal association. Results A total of 917,450 subjects were included in this study, and 9,157 cancer cases were reported during 2012 and 2015, with a cumulative incidence rate of 9.98‰. GLMM results showed that every 0.01 increase in NDVI was associated with a 26.42% reduction in all-sites cancer(OR=0.7358, 95%CI: 0.6417~0.8298). NCE-TS analysis showed that the causal absolute risk of all-sites cancer among population living in high-level NDVI areas was reduced by 2.651%(95%CI: -2.745%~-2.564%), compared with the low-level NDVI areas. And the absolute risk of lung cancer, stomach cancer, esophageal cancer, liver cancer, colorectal cancer, breast cancer and cervical cancer was reduced by 0.147%~0.718%. Conclusion There is a protective causal association between green space and cancer. As an important ecological environment element, green space should arouse attention in the primary prevention of cancer.

Analysis on use of medical insurance fund of compact medical community in Shandong Province

SHAN Ying, ZHAO Yang, LI Cheng, LI Shixue

Journal of Shandong University (Health Sciences). 2022, 60(8):  120-126.  doi:10.6040/j.issn.1671-7554.0.2022.0274

Abstract ( 798 )   PDF (1040KB) ( 129 )   Save

References | Related Articles | Metrics

Objective To analyze the use of medical insurance fund of compact medical community in Shandong Province based on time and space perspective. Methods Based on data from the Medical Community Pilot Information Monitoring Platform of the Health Commission, and with medical insurance fund expenditures, medical insurance fund flow, outpatient expenses and hospitalization expenses as indicators, descriptive analysisand comparative analysis were conducted on the use of pilot medical insurance fund. Results From 2018 to 2020, the total expenditure increased year by year, the expenditure rate within counties increased, and the grassroots expenditure accounted for a relatively low and declining trend. The average outpatient expenditure increased year by year, but the average hospitalized expenses decreased. The development of regions was uneven, and the eastern regions had obvious advantages over the central and western regions. Conclusion A scientific and reasonable medical insurance fund payment mechanism should be established to promote the implementation of hierarchical diagnosis and treatment. The reform of medical insurance payment methods should be accelerated to reduce the personal burden of patients effectively. The leading role of government should be clarified to strengthen the overall planning and balanced development among regions.