Table of Content

  

10 June 2020
Volume 58 Issue 6

Clinical, muscle pathological and genetic analyses of a centronuclear myopathy pedigree with a mutation in MTM1 gene

GENG Hongzhi, LI Wei, YAN Chuanzhu, LYU Xiaoqing, LIN Pengfei

Journal of Shandong University (Health Sciences). 2020, 58(6):  1-7.  doi:10.6040/j.issn.1671-7554.0.2020.048

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Objective To explore the clinical, pathological and gene mutation characteristics of a family with centronuclear myopathy. Methods A family of centronuclear myopathy was recently confirmed by clinical diagnosis and muscle pathology in the Neuromuscular Pathology Laboratory of our hospital. The clinical data of patients were analyzed in this family, including onset age, symptoms, muscle strength, serum creatine kinase(CK)and electromyography. Muscle biopsy was performed on the proband, frozen muscle tissue specimens was stained with routine staining, and then immunohistochemistry and enzyme staining were conducted. Then DNA was extracted from the peripheral blood of the proband for high-throughput sequencing, neuromuscular disease-related genes were analyzed, and a missense mutation of MTM1 gene was found. Subsequently, the peripheral blood of the patients parents and other family members were sampled for Sanger sequencing, the sequencing results were compared with the normal sequence, and the pathogenicity of the mutation was analyzed. Results There were 3 patients in the pedigree. The proband felt limb weakness since childhood, ptosis of eyelids, weakness of facial muscles, and was unable to run and lift heavy objects. He had long and narrow face, inverted V-shaped upper lip, slender fingers and toes, and progressive aggravation of symptoms. Physical examination showed that the probands bilateral eyes could not close completely, the parotid force was weak, the speech was ambiguous, the proximal muscle strength of extremities was grade 4-, and the distal muscle strength was grade 4+. The probands serum CK increased slightly, and electromyography showed myogenic damage. The other two patients had similar symptoms. The muscle pathology of the proband showed typical central nuclear myopathy: the sizes of muscle fibers were obviously different; central nuclear muscle fibers significantly increased and accounted for 60% of all muscle fibers; type I fibers were atrophic with type I fiber predominance; nicotinamide adenine dinucleotide-tetrazolium reductase(NADH-TR)staining showed most centronuclei were surrounded by a rim of accentuated staining and characteristic radiating sarcoplasmic strands. Gene sequencing confirmed that the proband and the other two patients carried the missense mutation(p.D84V)of MTM1 gene, and the mutation was co-segregated with the phenotype in the family. By reviewing literature and searching databases, we confirmed that the mutation had never been reported before. Bioinformatics analysis predicted that the mutation was a possible pathogenic mutation. Based on the comprehensive analysis of the patients phenotype, muscle pathology, prediction of mutation pathogenicity and co-segregation of the mutation with phenotype in the family, the MTM1 gene c.251A>T mutation was the pathogenic mutation of the family. Conclusion This study confirms a pedigree with central nuclear myopathy by clinical examination, pathological staining of muscle biopsy and genetic analysis. Genetic analysis shows that MTM1 gene c.251A>T(p.D84V)is the pathogenic mutation of this pedigree. This mutation is reported for the first time at home and abroad. This study expands the mutation spectrum of MTM1 gene.

Prediction of the association between genes and glioblastoma based on databases

TIAN Baorui, ZHANG Yongchao, HAN Xiaoyang, TIAN Yingying, WANG Chuanxi

Journal of Shandong University (Health Sciences). 2020, 58(6):  8-13.  doi:10.6040/j.issn.1671-7554.0.2019.1449

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Objective To explore the key genes related to prognosis of glioblastoma(GBM)and to investigate their potential as regulatory genes of GBM. Methods Based on the cancer genome atlas(TCGA)database, GBM prognosis related genes and their expression-related genes were screened with GEPIA. The gene expression patterns in GBM patients and healthy controls were analyzed. The correlation between clinical parameters and target genes in GBM patients was analyzed with LinkedOmics. Results The expressions of SAMD13, FAM20C, FUCA1 and RARRES1 were related to both disease-free survival(DFS)and overall survival(OS)in GBM patients. The four genes expressed differently in GBM patients and healthy controls. Kyoto encyclopedia of genes and genomes( KEGG )and gene ontology(GO)analyses showed these genes were closely involved in the oncogenesis and progression of GBM. Conclusion SAMD13, FAM20C, FUCA1 and RARRES1 have the potential to serve as regulatory genes and diagnostic markers of GBM, and they are closely involved in GBM-related regulatory mechanism.

Effects of medical ozone on the expression of PPARγ and autophagy in chondrocytes of osteoarthritis in rats

SUN Panpan, ZHAO Xu, LIN Xiaowen, FU Zhijian

Journal of Shandong University (Health Sciences). 2020, 58(6):  14-21.  doi:10.6040/j.issn.1671-7554.0.2020.111

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Objective To investigate the effects of ozone(O₃)on the expressions of peroxisome proliferators-activated receptor γ(PPARγ)and autophagy-related proteins in rat osteoarthritis chondrocytes and the role of PPARγ in ozone-induced autophagy of chondrocytes. Methods Wistar rats within 3 days of birth were chosen and the articular cartilage of extremities were obtained for the isolation and culture of primary chondrocytes. The chondrocytes were identified with toluidine blue staining and type II collagen immunofluorescence. The cells were stimulated with 10 ng/mL interleukin-1β(IL-1β)for 24 h to construct osteoarthritis chondrocytes models. After that, osteoarthritis chondrocytes were treated with different concentrations of ozone for 30 min, the effects on cell activity were detected by CCK-8 assay and the optimal O₃ concentration of 30 μg/mL was selected. After IL-1β treatment, PPARγ-specific inhibitor GW9662 was added to the osteoarthritis chondrocytes and treated for 12 h, which were then treated with 30 μg/mL O₃. The primary chondrocytes were randomly divided into control group, IL-1β group, IL-1β+O₃ group, control+O₃ group, IL-1β+O₃+GW9662 group and IL-1β+GW9662 group. The expressions of PPARγ and autophagy-related proteins including LC3 Ⅱ, P62 and Beclin-1 were detected with Western blotting. The expressions of LC3B and P62 were detected with immunofluorescence staining. Results Toluidine blue staining and type II collagen immunofluorescence identified the cultured cells were chondrocytes. The cell activity was improved with 30 μg/mL ozone(P<0.05), and decreased with 50 and 70 μg/mL ozone(P<0.05). The 30 μg/mL ozone increased the expressions of PPARγ, LC3Ⅱ and Beclin-1, while decreased the level of P62(P<0.05). GW9662(20 mmol/mL)inhibited the up-regulation effect of ozone on the levels of LC3Ⅱ and Beclin-1, and reversed the inhibition of ozone on P62. Conclusion Ozone at 30 μg/mL can promote autophagy of osteoarthritis chondrocytes, and activation of PPARγ can promote ozone-induced autophagy in osteoarthritis chondrocytes.

Clinical features and comparison of medical and surgical efficacies of infective endocarditis in 80 patients in a tertiary hospital

LI Yang, WANG Zhongsu, LIU Luqi, LIU Tianqi, WANG Dong, LIU Xue, WANG Minghua, HOU Yinglong

Journal of Shandong University (Health Sciences). 2020, 58(6):  22-27.  doi:10.6040/j.issn.1671-7554.0.2019.1167

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Objective To provide evidence for the diagnosis and treatment of infective endocarditis by analyzing the etiology, clinical features, complications and prognosis of patients treated in a local tertiary hospital. Methods Clinical data of 80 patients with infective endocarditis treated during March 2014 and December 2018 were retrospectively analyzed, including demographic characteristics, heart disease, clinical manifestations, comorbidities, pathogenic bacteria, and echocardiographic manifestations. The efficacies of medical and surgical treatments were compared. Results The majority of patients were young and middle-aged males. Fever was the most common clinical manifestation and heart failure was the most common complication. The positive rate of blood culture was 57.5%, and the pathogenic bacteria were mainly gram-positive coccus, especially staphylococcus aureus, followed by streptococcus aureus. Primary heart disease occurred in 90% of the patients, mainly non-rheumatic disease involved the aortic valve and mitral valve, and 30 patients underwent cardiac surgery. Ultrasound showed a high positive rate of cardiac vegetations, mainly attached to the left cardiac system. There were no significant differences in the treatment outcomes among patients with different ages, fever or heart murmur. Surgical treatment yielded better results than medical treatment. Conclusion The majority of adult with infective endocarditis are young and middle-aged males. Fever is the most common clinical manifestation, and heart valves are often involved. The major pathogenic microorganism is staphylococcus aureus. As surgical treatment is more effective than medical treatment, it is highly recommended for selected patients.

Gaussian process model for risk assessment of readmission for patients with chronic heart failure within one year

ZHANG Chuanbei, LI Fang, ZHAI Chunxiao, YU Yongming, SHU Minglei, WANG Yidan, XU Liangdong, HAO Enkui

Journal of Shandong University (Health Sciences). 2020, 58(6):  28-33.  doi:10.6040/j.issn.1671-7554.0.2019.1442

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Objective To explore the predictive value of a 1-year readmission risk assessment for patients with chronic left ventricular systolic function(LVSD)by using a Gaussian process model(GPM)and echocardiographic parameters. Methods A total of 290 patients with chronic LVSD were collected, and re-hospitalization within one year was the end point of the study. All patients underwent routine echocardiography to collect data including mitral regurgitation, tricuspid regurgitation, pleural effusion, pericardial effusion, pulmonary artery systolic pressure, left ventricular diameter and left ventricular ejection fraction. The 290 patients were randomly divided into 70% training group(modeling group)and 30% testing group(prediction group). The information interaction analysis on the training dataset was carried out with machine learning algorithms. The importance of each parameter was evaluated, and echocardiographic parameters were merged to establish GPM. Subsequently, the readmission risk of the testing dataset was analyzed using GPM. In addition, the risk of all patients was predicted with the echocardiography parameter scoring system. Finally the two methods were compared with receiver operating characteristic(ROC)curve. Results GPM information interaction analysis showed the weights of echocardiographic parameters were: mitral regurgitation 23.64%, tricuspid regurgitation 22.09%, pleural effusion 16.18%, pericardial effusion 14.36%, pulmonary artery contraction pressure 9.04%, left ventricular diameter 8.86%, and left ventricular ejection fraction 5.83%. Based on GPM and echocardiography parameter scoring system, the area under the ROC curve(AUC)was 83.10%(95% CI: 0.797-0.864), 70.60%(95% CI: 0.647-0.765), respectively. Conclusion GPM based on echocardiographic parameters can well predict the readmission risk of LVSD patients within one year, and it is superior to echocardiography parameter scoring system.

Epidemiological and clinical characteristics of children infected with SARS-CoV-2 in Shandong Province

CAO Aihua, DUAN Chunhong, QIU Bingping, LU Ling, LI Keliang, LIU Xuegong, ZHOU Zhiyuan, SUN Jianhua, JU Xiuli

Journal of Shandong University (Health Sciences). 2020, 58(6):  34-40.  doi:10.6040/j.issn.1671-7554.0.2020.335

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Objective To explore the epidemiological and clinical characteristics of children infected with SARS-CoV-2 in Shandong Province. Methods A total of 37 children patients diagnosed by novel coronavirus nucleic acid detection positively from January 26 to February 29, 2020 in Shandong Province were collected. The epidemiological history was retrospectively analyzed and the clinical characteristics, laboratory results, treatment and outcome of 21 patients among them were summarized. Results Among the 37 cases, 12 cases(32.4%)had a history of travel or residence in Wuhan within 2 weeks before the onset, 33 cases(89.2%)had a history of contact with confirmed patients and 31 cases(83.8%)had aggregation. Among the 21 patients who had available clinical data, 10 were diagnosed as mild(47.6%), 11 were diagnosed as common(52.4%), and there were no severe or critical types. Common symptoms at onset of illness were fever, cough, and headache. About 33.3% of patients had decreased WBC count. Comparied with normal, the serum level of PCT was increased, C3 and C4 decreased, creatine kinase-MB(CK-MB)increased, CRP and ESR did not change in most of the patients. CT showed that 52.4% of the patients had typical pneumonia. The interferon, lopinavir and ritonavir, ribavirin, oseltamivir and Chinese medicines were the main treatments. All patients went well. Conclusion Most of the children infected with SARS-CoV-2 in Shandong Province were aggregation with families. These children were mainly mild or common types, and even asymptomatic patients. Chest CT remains an important method for diagnosis of children infected with SARS-CoV-2.

Value of CT radiomics analysis of cavity characteristics in differentiating pulmonary disease of nontuberculous mycobacterium from tuberculosis

YAN Qinghu, CUI Jia, YANG Chuanbin, WANG Wuzhang, YU Dexin, CHAI Xiangfei

Journal of Shandong University (Health Sciences). 2020, 58(6):  41-46.  doi:10.6040/j.issn.1671-7554.0.2020.130

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Objective To analyze the value of computer tomography(CT)radiomics features on differentiating nontuberculous mycobacteria(NTM)lung diseases with cavity from pulmonary tuberculosis with similar cavity. Methods Clinical data of 51 pulmonary NTM patients and 42 pulmonary tuberculosis patients with similar cavity from February 2013 to March 2018 in Shandong Provincial Chest Hospital and Qilu Hospital of Shandong University were retrospectively analyzed. Double-blind method was used to observe and sketch CT images, and 198 cavities of volume of interests(VOI)were drawn by two experienced radiologists, and then 80% of VOI cavities were allocated to training data set and 20% to verification data set by using random number generated by computer. A total of 1 409 radiomics features extracted from Radcloud platform were used to analyze the differences in CT cavity characteristics of the two diseases. The best features were selected by variance threshold method, K best method and Lasso algorithm. The receiver operating characteristic(ROC)curves were analyzed by three supervised learning classifiers(KNN, SVM and DT). Results A total of 94 best features were selected. The different learning classifiers showed that the lowest and the highest AUC values of validation set were 0.95 and 1.00, respectively. The sensitivity and specificity of the verification set were more than 0.95. The fine performance of the three classifiers was obtained by using four indicators(precision, recall rate, F1 score and support degree). Conclusion Some valuable cavity features can be extracted via CT radiomics, and are helpful for the differential diagnosis between the pulmonary NTM and pulmonary tuberculosis, which may make up for the lack of visual observation of the common CT images.

Expression and role of toll-like receptor 4 in adenomyosis

WANG Bingyu, YANG Yang, CHAO Lan

Journal of Shandong University (Health Sciences). 2020, 58(6):  47-52.  doi:10.6040/j.issn.1671-7554.0.2019.1452

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Objective To explored the role of toll-like receptor 4(TLR4)in the pathogenesis of adenomyosis(AS)and the relationship with apoptosis. Methods The protein and mRNA expressions and distribution of TLR4 in the endometrium of AS patients and normal controls were detected with Western blotting, real-time PCR and immunohistochemistry, respectively. The cell apoptosis was determined with TUNEL. After the expression of LTR4 in h-ESC cell line was activated with lipopolysaccharide(LPS), the level of apoptosis was detected with flow cytometry in order to evaluate the effect of TLR4 on apoptosis. Results The protein expression( P=0.0128)and mRNA expression(P=0.0197) of TLR4 were lower in AS endometrium than in normal endometrium. TLR4 mainly distributed in the glandular epithelial cytoplasm in endometrium, and TLR4 expression was lower in AS endometrium than in normal endometrium (P=0.0160). The apoptosis level was lower in AS endometrium than in normal endometrium (P=0.0024). After TLR4 was activated in h-ESC cell line, the number of cells in the lower right quadrant increased, indicating elevated apoptosis. Conclusion TLR4 plays an important role in adenomyosis by regulating apoptosis.

Correlation between thyroid hormonal levels and clinical characteristics of 142 women with breast cancer

GUO Tian, FU Yilin, GAO Ling, SONG Yongfeng, FU Guobin, GENG Chong, WANG Weibo

Journal of Shandong University (Health Sciences). 2020, 58(6):  53-59.  doi:10.6040/j.issn.1671-7554.0.2020.112

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Objective To explore the relationship between clinical characteristics of female breast cancer and thyroid hormonal levels. Methods The clinical data of 142 female breast cancer patients were collected, including basic characteristics, tumor characteristics, thyroid function, and so on. The patients were classified into different groups according to age, menstrual status, tumor size, degree of metastasis, TNM stage, pathological grade, estrogen receptor, diabetes, surgery, chemotherapy and tumor markers. The differences in thyroid hormonal levels were statistically analyzed among the groups. Results (1) There was statistically significant difference in free triiodothyronine(FT3)level among the non-metastasis group, local lymph node metastasis group and distant metastasis group(F=11.565, P<0.001). The distant metastasis group had higher FT3 level than non-metastasis group ［(5.10±0.51)vs(4.67±0.45)pmol/L, P<0.001］ and local lymph node metastasis group ［(5.10±0.51)vs(4.58±0.49)pmol/L, P<0.001］. There was statistically significant difference in free thyroxine(FT4)level among the three groups(F=5.730, P<0.05). The non-metastasis group had higher FT4 level than local lymph node metastasis group ［(16.77±2.59)vs(15.26±2.15)pmol/L, P=0.001］ and distant metastasis group ［(16.77±2.59)vs(15.75±2.08)pmol/L, P=0.053］. When age, menstrual status, estrogen receptor, diabetes, surgery and chemotherapy were taken as covariates, there was significant difference in FT3 level among the three groups(F=6.810, P<0.05). The distant metastasis group had higher FT3 level than local lymph node metastasis group ［(5.10±0.12)vs(4.58±0.07)pmol/L, P<0.001］ and non-metastasis group ［(5.10±0.12)vs(4.67±0.06)pmol/L, P<0.001］, and local lymph node metastasis group had lower FT3 level than non-metastasis group ［(4.58±0.07)vs(4.67±0.06)pmol/L, P<0.001］. The was significant difference in FT4 level among the three groups(F=3.855, P<0.05). The local lymph node metastasis group had lower FT4 level than non-metastasis group ［(15.25±0.37)vs(16.52±0.32)pmol/L, P<0.001］ and distant metastasis group ［(15.25±0.37)vs )16.34±0.60)pmol/L, P<0.001］. (2) The surgical group had higher FT3 level than non-surgical group ［(4.86±0.59)vs(4.66±0.44)pmol/L, t=2.354, P<0.05］. (3) The chemotherapy group had higher FT3 level than non-chemotherapy group ［(4.95±0.50)vs(4.62±0.48)pmol/L, t=3.862, P<0.001］, but lower FT4 level ［(15.38±2.02)vs(16.49±2.57)pmol/L, t=-2.593, P<0.05］. Conclusion Thyroid hormones are associated with the metastasis of breast cancer. Both surgery and chemotherapy may affect the levels of thyroid hormones.

Effect of cetrorelix on early moderate and severe ovarian hyperstimulation syndrome

HA Lingxia, LI Weixia, WU Yangyang, YIN Ting, LI Yufeng

Journal of Shandong University (Health Sciences). 2020, 58(6):  60-64.  doi:10.6040/j.issn.1671-7554.0.2020.109

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Objective To assess the effectiveness of cetrorelix on preventing early moderate and severe ovarian hyperstimulation syndrome(OHSS)in high-risk women. Methods A total of 263 patients with high-risk OHSS undergoing cryopreservation of all embryos were randomly divided into two groups: the control group(n=148)received symptomatic treatment including hydroxyethyl starch, metformin, aspirin, and glucocorticoid administration on day of oocyte retrieval. The cetrorelix group(n=115), in addition to symptomatic treatment, started 0.25 mg of cetrorelix daily on day of oocyte retrieval for 3 or 5 days. On day 3 and day 5 post-oocyte retrieval(POR), serum estradiol(E₂)levels, hematocrit values, white blood cell(WBC)count, liver markers and coagulation/fibrinolysis parameters were detected, and maximal ovarian diameter(MOD)and ascites volume were assessed by ultrasound scanning. The incidence and severity of early moderate and severe OHSS were evaluated. Results Compared with the control group, E₂ level were significantly lower in the cetrorelix group on day 3 and day 5 POR(P<0.05), and the percent of elevated WBC and fibrinogen were significantly lower in the cetrorelix group on day 5 POR(P<0.05). The incidence of moderate and severe OHSS, frequency of aspiration of the ascitic fluid and hospitalization rate was significantly lower in the cetrorelix group(P<0.05). Conclusion Combined with cryopreservation of all embryos, cetrorelix decreases serum E₂ levels, improves coagulate functions, and effectively reduces the incidence of early moderate and severe OHSS in high-risk women.

CT-guided ¹²⁵I seeds implantation for the treatment of malignant retroperitoneal tumor: an analysis of 55 cases

WANG Hao, LU Jian, CHEN Li, ZHA Junhao, GUO Jinhe

Journal of Shandong University (Health Sciences). 2020, 58(6):  65-70.  doi:10.6040/j.issn.1671-7554.0.2019.1198

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Objective To evaluate the efficacy and safety of CT-guided ¹²⁵I seeds implantation for the treatment of retroperitoneal malignant tumors. Methods A total of 55 patients with 69 lesions, which were unresectable, postoperative recurrent or metastatic, received ¹²⁵I seeds implantation under CT guidance. CT scan was performed within 1 week before the implantation. The contour of tumor target area was outlined with the treatment planning system, and the required radiation dose, number of seeds and spatial arrangement were calculated. Then CT-guided ¹²⁵I seeds implantation was performed. Follow-up was carried out at an interval of 2 month to evaluate the disease control rate, pain relief rate and treatment-related adverse events. Results All operations were successful. CT images 2 months after implantation showed complete response, partial response, stable disease and progressive disease in 9, 18, 36 and 6 lesions, respectively. The overall response rate was 39.1%, and local control rate was 91.3%. The overall response rate was 40.6% and 37.7%, and local control rate was 89.9% and 87.0%, respectively, 4 and 6 months after operation. In the 24 patients who had back or abdominal pain,12(50%)cases were relieved 7 days after the implantation. No treatment-related death occurred. Pain at puncture site was observed in 15 patients(27.3%), and only 1 patient need analgesic treatment to relieve. No complications, such as bleeding, intestinal fistula, radiation enteritis, or bone marrow suppression, were observed. Conclusion CT-guided ¹²⁵I seeds implantation is safe and effective for the treatment of malignant retroperitoneal tumors. For patients with unresectable, postoperative recurrent or metastatic retroperitoneal tumors, CT-guided ¹²⁵I seeds implantation may be a salvage strategy.

A case report of maturity-onset diabetes of the young13

LI Lintong, HOU Xinguo, QIN Jun, LIANG Kai, REN Jianmin

Journal of Shandong University (Health Sciences). 2020, 58(6):  71-75.  doi:10.6040/j.issn.1671-7554.0.2019.1283

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Objective To investigate the clinical manifestations, diagnosis and treatment of maturity-onset diabetes of the young13(MODY13). Methods One patient with MODY13 was examined after admission, and whole exome test was performed. Results Whole exome test showed that there was a mutation in potassium channel, inwardly rectifying subfamily J, member 11(KCNJ11). The treatment plan was adjusted. After glimepiride was administered, symptoms of diabetes were effectively improved. Conclusion The diagnosis of MODY13 requires genetic testing. After confirmation, medication and diet should be adjusted according to patients age to control blood glucose.

Expressions and clinical significance of Beclin-1, P62 and Ki67 in different parts of nasal polyps

SUN Wenkai, SUN Hui, WU Xinfang, GAO Wei, MENG Zhaotun, LI Qin

Journal of Shandong University (Health Sciences). 2020, 58(6):  76-82.  doi:10.6040/j.issn.1671-7554.0.2020.105

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Objective To investigate the role and mechanism of autophagy and proliferation in the development of nasal polyps(NPs)by detecting the expressions and relevance of autophagic markers Beclin-1 and P62 and proliferator Ki67 in the pedicle and body of NPs. Methods NP tissues of 46 patients with chronic rhinosinusitis with nasal polyps(CRSwNP)were collected during July 2018 and May 2019 in Linyi Peoples Hospital as experimental group(pedicle subgroup and body subgroup), and normal nasal septum mucosa of 10 patients with septum deviation were taken as control group. Samples in the experimental group were stained with hematoxylin-eosin(HE)and pathological types were determined based on eosinophil infiltration. The protein expressions of Beclin-1, P62 and Ki67 in the two subgroups and control group were detected with immunohistochemistry(IHC). The expressions of Beclin-1 and P62 were detected with Western blotting. The correlation among Beclin-1, P62 and Ki67 was analyzed with Spearman rank correlation assay. Results There was no significant association between expressions of Beclin-1, P62 and Ki67 and pathological types of NPs(P>0.05). Beclin-1 expression was significantly lower in pedicle subgroup than in body subgroup, and was lower than that in the control group(H=71.835, P<0.05). P62 expression was significantly higher in pedicle subgroup than in body subgroup, and was higher than that in the control group(H=74.666, P<0.05). Ki67 expression was significantly higher in pedicle subgroup than in body subgroup, and was higher than that in the control group(H=76.716, P<0.05). Beclin-1 was negatively correlated with P62(r_s=-0.674, P<0.05). Ki67 was negatively correlated with Beclin-1(r_s=-0.640, P<0.05)but positively correlated with P62(r_s=0.708, P<0.05). Conclusion Expressions of Beclin-1, P62 and Ki67 are different between pedicle and body in NPs, and there is negative correlation between Beclin-1, P62 and Ki67. The expressions of Beclin-1 and P62 are lower while expression of Ki67 is higher in pedicle than in body, indicating that Ki67 may promote the occurrence and development of NPs.

Analysis of glove perforation in 50 cases of orthognathic surgery

ZHANG Xinlian, LYU Xia, JIA Tingting, SUN Zhixin, LI Qing, ZHANG Fenghe

Journal of Shandong University (Health Sciences). 2020, 58(6):  83-86.  doi:10.6040/j.issn.1671-7554.0.2019.1163

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Objective To explore the occurrence of glove perforation in orthognathic surgery in order to reduce its occurrence and prevent cross infection. Methods A total of 472 gloves used in 50 orthognathic surgeries were collected during Mar. 2018 and Sep. 2019 in the Department of Oral and Maxillofacial Surgery, of School and Hospital of Stomatology, Cheeloo College of Shandong University. The gloves were observed with naked eyes during and after surgery, and then were filled with water to observe the perforation rate, site, and occurrence rate in different types of orthognathic surgeries. Results Altogether 84 gloves perforated, 30.07% of which were worn by dominant surgeons. Perforation was most likely to occur in the left index finger, and in operations like sagittal split of mandible. Conclusion In orthognathic surgery, most glove perforations were detected by visual observation, which are likely to occur in the dominant surgeons left index finger and in operations such as sagittal split of mandible. In order to reduce cross infection, surgeons had better put on double-layer gloves for protection.

Oculus Keratograph in the evaluation of ocular surface in patients with meibomian gland dysfunction

ZHANG Jingjing, CHEN Guoling, BAO Yinlei, MA Guangfeng

Journal of Shandong University (Health Sciences). 2020, 58(6):  87-91.  doi:10.6040/j.issn.1671-7554.0.2020.620

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Objective To explore the application value of Oculus Keratograph in evaluating the ocular surface in patients with meibomian gland dysfunction(MGD). Methods A total of 46 MGD patients(46 eyes)and 46 healthy controls were enrolled. All subjects received routine ophthalmic examinations to check vision and intraocular pressure. All subjects filled in the ocular surface disease index(OSDI)questionnaire to evaluate ocular symptoms. Eyelid margin, meibomian gland orifice and ocular surface were observed with a slit-lamp microscope. The first noninvasive tear breakup time(NIBUTf), morphological characteristics and loss of meibomian gland were checked with Oculus Keratograph. The correlation among OSDI score, NIBUTf and meibomian gland loss was analyzed with Pearson analysis. Results MGD group and control group had similar age(P=0.354)and male/female ratio(P=0.288). The MGD patients had ocular symptoms such as foreign body sensation, visual fatigue, dryness, blurred vision and photophobia, while the controls seldom had such symptoms and their discomfort was minor. MGD patients had statistically lower OSDI score than the controls(P<0.001). Most MGD patients showed abnormal morphology of eyelid margin and meibomian gland orifice, while the controls had more uniform color of tear film and longer NIBUTf(P<0.001). Common abnormalities like uneven length of meibomian gland, enlargement, tortuous, and loss of meibomian gland were more common in MGD group. MGD group had higher score of meibomian gland loss(P<0.001). OSDI score was negatively correlated with NIBUTf(r=-0.618, P<0.001), while positively correlated with score of meibomian gland loss(r=0.714, P<0.001). Conclusion Oculus Keratograph is able to observe tear film stability and meibomian gland noninvasively and objectively, and it can be used to evaluate the ocular surface in MGD patients.

Small incision gastrocnemius tendon turndown flap to treat 5 cases with chronic Achilles tendon rupture

CHENG Ruilin, HUANG Zheng, LI Zhengxun, ZHANG Ning, HU Yong, XU Wenpeng

Journal of Shandong University (Health Sciences). 2020, 58(6):  92-96.  doi:10.6040/j.issn.1671-7554.0.2019.1306

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Objective To evaluate the efficacy of small incision gastrocnemius tendon turndown flap in the treatment of the chronic Achilles tendon rupture. Methods The clinical data of 5 cases with chronic Achilles tendon rupture treated in our department during Jan. 2017 and Sep. 2019 were retrospectively analyzed, including 4 males and 1 female, average age 46.5(28-67)years old, with 3 ruptures in the left feet and 2 in the right feet. All cases were treated with small incision gastrocnemius tendon turndown flap. After operation, the patients wore a blow-knee cast to hold the ankle at 20° of plantar flexion for 4 weeks, then partial-weightbearing walked with ankle-foot orthosis for 4 weeks, during which the heel height was reduced gradually. All patients were followed up. The efficacy of operation was evaluated with AOFAS ankle-hind foot function score. Results During the follow-up of 6 to 38(average 23)months, the AOFAS score increased from 71.4 pre-operation to 96.4 post-operation. All patients’ incisions was healed in one stage, and no re-rupture occurred. Conclusion Small incision gastrocnemius tendon turndown flap is effective to treat chronic Achilles tendon rupture.

Finite element evaluation of different facet tropism criteria

DING Jinyong, XU Jixi, TAN Chengshuang, LIU Juncheng, LI Mingbo, XIE Weixing, REN Dongcheng

Journal of Shandong University (Health Sciences). 2020, 58(6):  97-103.  doi:10.6040/j.issn.1671-7554.0.2019.1390

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Objective To investigate the biomechanical influence of different lower lumbar spine facet tropism(FT)criteria on the stress on the L4-L5 segment. Methods Symmetric and facet tropism finite element models of L4-L5 segment were created, including symmetrical model FT 0° model(50° facet joint angle at the bilateral side), FT 5° model(a 55° facet joint angle at the left side and a 50° facet joint angle at the right side), FT 10° model(a 60° facet joint angle at the left side and a 50° facet joint angle at the right side), FT 15° model(a 60° facet joint angle at the left side and a 50° facet joint angle at the right side). Seven stress states were simulated, including forward flexion, extension, left flexion, right flexion, left rotation, right rotation pure moments and anterior shear force. Changes of the maximum intradiscal pressure, maximum vertebral body movement and maximum facet contact force in each model under each stress state were analyzed. Results Changes of the maximum intradiscal pressure were consistent with the trend of maximum vertebral body movement. Under the force of anterior shear, flexion, extension, lateral bending and rotation, the maximum intradiscal pressure was FT 15°>FT 10°>FT 5°>FT 0°. The maximum intradiscal pressure was greater than the more sagittal side(right side)when the FT model was rotated to the more coronal side(left side). Under anterior shear force, flexion, extension, lateral bending and rotation, the maximum facet contact force was FT 15°> FT 10°> FT 5°>FT 0°. Under anterior shear force and flexion, the maximum contact force of the asymmetric joint was significantly increased. Conclusion The maximum intradiscal pressure in the FT model of the lower lumbar spine is consistent with the change of vertebral body movement, which increases with the increase of the degree of asymmetry of the facet joint angle between the left side and right side. But the facet tropism of 5° will not cause significant changes in the maximum intradiscal pressure and maximum vertebral body movement. The maximum contact force increases with the degree of asymmetry of the facet joint angle.

Investigation and analysis of palliative care knowledge and attitude among oncology professionals

QU Yue, WANG Aijun, ZHENG Xing, ZHANG Jinxin, SHI Xiangting, CAO Yingjuan

Journal of Shandong University (Health Sciences). 2020, 58(6):  104-109.  doi:10.6040/j.issn.1671-7554.0.2020.0387

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Objective To investigate the current situation and influencing factors of palliative care knowledge and attitude among medical staff in the Oncology Department. Methods A total of 278 medical staff from the Cancer Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University and Shandong Cancer Hospital were surveyed with Palliative Care Quiz for Nursing(PCQN)and Frommelt Attitude Toward Care of Dying Patients(C-FATCOD)by cluster sampling from July to September 2019. Results The total score of palliative care knowledge was(11.72±2.98). The philosophy and principle of palliative care scored the lowest, with a correct answer rate of 42.75%. The total score of palliative care attitude of the medical staff was(104.37±11.83). There were no significant differences in the knowledge scores of medical staff with different demographic characteristics(P>0.05). There were statistically significant differences in the scores of attitude dimensions among staff with different ages, departments and titles(P<0.05). There were significant differences in the scores of attitude dimensions of staff with different psychosocial spiritual supports(P<0.05). Multiple linear regression analysis showed that Medical Oncology Department, senior professional title, and psychosocial spiritual support of knowledge dimension had significant effects on palliative medical attitude among medical staff(P=0.047, P=0.006, P=0.015). Conclusion Staff in the Department of Oncology do not have good knowledge or attitude of palliative care. Efforts should be made to strengthen the training of palliative care knowledge and enhance the active attitude.

Relationship between social support and negative emotions in adolescent girls: the mediating role of psychological resilience

WANG Xu, CHEN Jing, LEI Wei, ZHAGN Rong, LIU Boya, LIU Kezhi, LIANG Xuemei, ZHANG Tao

Journal of Shandong University (Health Sciences). 2020, 58(6):  110-114.  doi:10.6040/j.issn.1671-7554.0.2019.1438

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Objective To explore the relationship among negative emotions, social support, and psychological resilience in adolescent girls. Methods A total of 1 300 female students in a school of Luzhou City were selected with simple random sampling method and surveyed with the scales of Chinese Short Version Depression Anxiety and Stress Scale(DASS-C21), Connor Davidson Resilience Scale(CD-RISC), and Social Support Rating Scale(SSRS). Results The rates of mild and moderate depression were 20.5% and 5.4%. The rates of mild, moderate, and severe anxiety were 22.4%, 34.2%, and 6.1%, respectively. The rate of mild stress was 3.0%. The total score of negative emotions was negatively correlated with the total score of social support and psychological resilience(r=-0.20,r=-0.18, P<0.01). The total score of social support was positively correlated with psychological resilience(r=0.29, P<0.01). Support utilization negatively predicted anxiety, depression, and stress (OR=0.82, OR=0.83, OR=0.76, P<0.01). Self-strengthening negatively predicted anxiety, depression, and stress (OR=0.94, OR=0.93, OR=0.88, P<0.01). Psychological resilience played a partial intermediary role among subjective support, objective support, support utilization, and negative emotions, and the proportion of intermediary effects accouned for 28.09%, 24.19%, and 16.54% of the total effects. Conclusion Increasing social support and cultivating psychological resilience have a protective effect on adolescent girls emotional behaviors.

Health equity of urban and rural residents in Shandong Province under the background of medical insurance integration

GUO Lei, ZHAO Di, FAN Jiayin, JIA Liying

Journal of Shandong University (Health Sciences). 2020, 58(6):  115-120.  doi:10.6040/j.issn.1671-7554.0.2020.382

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Objective To analyze the health equity of urban and rural residents in Shandong Province, findout the problems, and provide suggestions for improving the life quality and health equity in the background of medical insurance integration. Methods The health status and equity of urban and rural residents in Shandong Province were analyzed using EQ-5D-5L scale and concentration index method. Results Residents with different marital status, educational level, income level and employment status had different health status and health equity. The overall concentration index of two-week illnesses and chronic diseases was -0.076 and -0.130, respectively, which mainly distributed among people with low income level, especially rural residents. Conclusion There is significant difference in the overall health status between urban and rural residents. Urban residents have higher overall health status than rural residents, but also greater health inequality. The basic medical insurance system remains to be improved.