Table of Content

  

10 January 2023
Volume 61 Issue 1

基础医学

Protective effects of grape seed proanthocyanidin extract on rats with diabetic kidney disease from the perspective of SIRT1/PGC-1α pathway

SONG Yiyun, YU Hui, GAO Zhaoli, LI Xianhua

Journal of Shandong University (Health Sciences). 2023, 61(1):  1-9.  doi:10.6040/j.issn.1671-7554.0.2022.0947

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Objective To explore the protective effects of grape seed proanthocyanidin extract(GSPE)on rats with diabetic kidney disease(DKD)via silent information regulator 1(SIRT1)/peroxisome proliferator-activator receptor γ coactivator 1α(PGC-1α)signaling pathway. Methods A total of 40 male Sprague Dawley(SD)rats were randomly divided into control, control treatment, model and treatment groups, with 10 rats in each group. The diabetic rat models were induced by intraperitoneal injection of streptozotocin(STZ). Rats in the control treatment and treatment groups received GSPE gavage, while rats in the control and model groups were given equivalent amount of normal saline for 12 weeks. The blood glucose, serum creatinine and urinary microalbumin were detected. The pathological changes of renal tissue were observed with periodic acid Schiff(PAS)staining. Mitochondrial morphology was observed with a transmission electron microscopy. The apoptosis of renal tissue cells was evaluated with Tunel staining. The protein levels of SIRT1/PGC-1α signaling pathway-related molecules of mitochondrial biogenesis, including SIRT1, PGC-1α, nuclear respiratory factor 1(NRF1), and mitochondrial transcription factor A(TFAM)were determined with immunohistochemistry and Western blotting, respectively. Results Compared with the control group, the model group had significantly increased blood glucose ［(39.38±4.18)mmol/L vs(8.21±3.57)mmol/L］, serum creatinine ［(55.83±3.72)μmol/L vs(40.00±2.49)μmol/L］ and urinary microalbumin ［(10.98±3.36)mg/L vs(1.22±0.23)mg/L］(P<0.05). Compared with the control group, the model group had severer histopathological damages and mitochondrial fragmentation in the renal tissue, more significant apoptosis ［(31.81±8.84)% vs(0.50±0.35)%］(P<0.05), but significantly lower expressions of SIRT1(0.34±0.13 vs 0.66±0.06), PGC-1α(0.32±0.03 vs 0.71±0.13), NRF1(0.05±0.01 vs 0.21±0.02), and TFAM(0.06±0.03 vs 0.33±0.06)(P<0.05). Compared with the model group, the treatment group had significantly decreased levels of blood glucose ［(27.26±3.93)mmol/L vs(39.38±4.18)mmol/L］, serum creatinine ［(43.50±1.70)μmol/L vs(55.83±3.72)μmol/L］, urinary microalbumin ［(4.05±2.06)mg/L vs(10.98±3.36)mg/L］ and cell apoptosis ［(4.90±1.62)% vs(31.81±8.84)%］(P<0.05), but significantly increased expressions of SIRT1(0.55±0.05 vs 0.34±0.13), PGC-1α(0.62±0.14 vs 0.32±0.03), NRF1(0.16±0.02 vs 0.05±0.01), and TFAM( 0.26±0.06 vs 0.06±0.03)(P<0.05). Conclusion GSPE may improve mitochondrial biogenesis in DKD rats by regulating SIRT1/PGC-1α signaling pathway, and thus playing a protective role.

Inhibitory effect and mechanism of astragaloside Ⅱ on renal clear cell carcinoma cells

ZHAO Kai, YIN Xinbao, ZHANG Zongliang, WANG Zhenlin, ZHU Guanqun, WANG Ke

Journal of Shandong University (Health Sciences). 2023, 61(1):  10-16.  doi:10.6040/j.issn.1671-7554.0.2022.0885

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Objective To investigate the effect of astragaloside Ⅱ(As Ⅱ)on the proliferation of renal clear cell carcinoma 786-O cells and its potential mechanism. Methods The inhibitory effect of As Ⅱ on the growth and colony formation of 786-O cells was detected by MTT assay and cloning assay. Cell flow cytometry was used to detect the apoptosis-inducing effect of AS Ⅱ. Subsequently, Western blotting was used to detect the changes of PI3K-AKT-mTOR pathway protein and apoptosis executioner protein in cells treated with different concentrations of As Ⅱ. After co-treatment of cells with PI3K-AKT-mTOR pathway activator IGF-1 and As Ⅱ, flow cytometry was used to detect the changes of apoptosis and further verify the role of PI3K-AKT-mTOR pathway in apoptosis induction. Results As Ⅱ inhibited the proliferation of 786-O cells in a concentration- and time-dependent manner, with an interaction between time and concentration(F_time=513.00, P<0.001; F_{concentration}=1 678.00, P<0.001; F_{time×concentration}=18.23, P<0.001), and inhibited cell colony formation. As Ⅱ induced apoptosis and increased the expression of cleved caspase-3, an apoptotic executioner protein(P_{0 μmol/L As Ⅱ group vs 10 μmol/L As Ⅱ group}=0.013 9,P_{0 μmol/L As Ⅱ group vs 20 μmol/L As Ⅱ group}<0.001). As Ⅱ inhibited the phosphorylation of PI3K, AKT and mTOR proteins(p-PI3K: P_{0 μmol/L As Ⅱ group vs 20 μmol/L As Ⅱ group}=0.032 4;p-mTOR: P_{0 μmol/L As Ⅱ group vs 10 μmol/L As Ⅱ group}=0.004 1,P_{0 μmol/L As Ⅱ group vs 20 μmol/L As Ⅱ group}<0.001;p-AKT:P_{0 μmol/L As Ⅱ group vs 10 μmol/L As Ⅱ group}=0.003 2,P_{0 μmol/L As Ⅱ group vs 20 μmol/L As Ⅱ group}=0.001 2). IGF-1 reversed the phosphorylation of AKT by As Ⅱ(P=0.006 8), and attenuated the apoptosis-inducing effect of As Ⅱ on 786-O cells. Conclusion As Ⅱ can inhibit the proliferation and colony formation of renal carcinoma 780-O cells, and up-regulate the expression of cleved caspase-3 by inhibiting the phosphorylation of PI3K-AKT-mTOR signaling pathway, which in turn induces apoptosis.

LncRNA ZNF528-AS1 promotes tamoxifen resistance and progression of breast cancer

ZHANG Jianshu, ZHANG Hanwen, ZHAO Wenjing

Journal of Shandong University (Health Sciences). 2023, 61(1):  17-26.  doi:10.6040/j.issn.1671-7554.0.2022.1064

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Objective To investigate the effects of long non-coding RNA(LncRNA)ZNF528-AS1 on tamoxifen resistance and progression of breast cancer as well as the potential regulatory mechanism. Methods The differentially expressed lncRNAs among tamoxifen-resistant breast cancer cells/xenograft tissues and parent cells/ xenograft tissues were analyzed with RNA-seq high-throughput sequencing technology, and candidate lncRNAs associated with tamoxifen resistance were screened. The expressions of candidate lncRNAs were verified with quantitative real-time PCR(qRT-PCR). Breast cancer cells were transfected with liposomes to construct ZNF528-AS1 overexpression and knockdown cell models. The effects of ZNF528-AS1 on the proliferation, tumor stemness and tamoxifen resistance were detected with MTT, colony formation, mammosphere formation, and EdU assays. The role of ZNF528-AS1 in the metastasis of breast cancer was evaluated with Transwell migration and invasion assays. The downstream regulatory pathways of ZNF528-AS1 were detected with RNA-seq high-throughput sequencing and bioinformatics analysis, and verified with Western blotting and functional experiments. Results The differentially expressed lncRNAs were screened out and verified. ZNF528-AS1 was significantly upregulated in tamoxifen-resistant cells. Overexpression of ZNF528-AS1 in breast cancer cells promoted cell proliferation, colony formation ability, tumor stemness, and tamoxifen resistance. In addition, ZNF528-AS1 overexpression enhanced the migration and invasion abilities of breast cancer cells. ZNF528-AS1 knockdown reduced cell proliferation, tamoxifen resistance, tumor stemness, migration, and invasion. ZNF528-AS1 overexpression might be involved in the regulation of transforming growth factor(TGF-β)signaling pathway. ZNF528-AS1 activated both canonical and non-canonical TGF-β signaling pathways. TGF-β pathway inhibitor SB431542 reversed the proliferation, migration and invasion of breast cancer cells enhanced by ZNF528-AS1 overexpression. Conclusion ZNF528-AS1 can promote tamoxifen resistance and progression of breast cancer, and its mechanism might be related to the activation of TGF-β pathway.

临床医学

Association among pericoronary fat attenuation index, CT high-risk plaque and degree of coronary artery stenosis in 449 patients

ZHANG Runzhi, GU Hui, LI Yani, YANG Shifeng, GAO Yan, WANG Ruopeng, WANG Ximing

Journal of Shandong University (Health Sciences). 2023, 61(1):  27-31.  doi:10.6040/j.issn.1671-7554.0.2022.0708

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Objective To obtain pericoronary fat attenuation index(FAI)based on the third-generation dual-source coronary artery CT angiography(CCTA), and to explore the association among FAI, CT high-risk plaque, and degree of coronary artery stenosis. Methods Clinical data of 449 patients who underwent CCTA in our hospital during Jan. 2020 and Jun. 2021 were retrospectively analyzed. According to the existence of CT high-risk plaque, the patients were divided into the high-risk plaque group(n=226)and non-high-risk plaque group(n=223). Perivascular FAI of the right coronary artery was measured and compared between the two groups. The diagnostic values of FAI and FAI plus degree of stenosis for CT high-risk plaques were assessed using receiver operating characteristic(ROC)curve. According to the degree of coronary artery stenosis, the high-risk plaque group was subdivided into three groups: group 1(1%-49%), group 2(50%-99%), and group 3(100%), and the differences in FAI were compared. Results FAI was(-81.54±7.46)HU and(-90.12±7.23)HU in the high-risk plaque group and non-high-risk plaque group, respectively(P<0.001). ROC curve showed that the area under ROC curve(AUC)of FAI and FAI plus degree of stenosis in the diagnosis of CT high-risk plaques were 0.800 and 0.849, respectively; the sensitivity were 79.65% and 80.53%, respectively; the specificity were 74.44% and 79.37%, respectively. The optimal threshold for FAI to diagnose CT high-risk plaques was -86.5 HU. In the high-risk plaque group, the FAI of the three groups were as follows:(-84.76±8.23)HU,(-80.41±6.59)HU, and(-77.07±4.50)HU, respectively(P<0.001). Conclusion FAI is a new imaging marker for the sensitive monitoring of coronary inflammation levels, and higher FAI is associated with greater plaque risk.

Comparison of cerebrospinal fluid detection in 53 patients with neuromyelitis optica spectrum disorder and 11 patients with multiple sclerosis

HOU Shaojin, WANG Yunfeng, CAO Lili, LIU Xuewu, ZHAO Xiuhe, WANG Shengjun

Journal of Shandong University (Health Sciences). 2023, 61(1):  32-37.  doi:10.6040/j.issn.1671-7554.0.2022.1074

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Objective To investigate the cytological, biochemical and oligoclonal band results of cerebrospinal fluid(CSF)between patients with aquaporin-4 immunoglobulin(AQP4-IgG)positive neuromyelitis optica spectrum disorder(NMOSD)and multiple sclerosis(MS). Methods A total of 53 AQP4-IgG seropositive NMOSD patients(NMOSD group)and 11 MS patients(MS group)who met the inclusion criteria were selected. Lumbar puncture was completed within 48 hours after admission and CSF cytology, biochemistry and oligoclonal band detection were performed to compare the results. Results There was no significant difference in sex ratio between the two groups(P=0.665), while the NMOSD group had significantly older age than the MS group(P=0.043). Although there was no significant difference in the proportion of increased CSF white cell count between the two groups(P=0.074), the NMOSD group had higher count than the MS group(P=0.028). The lactate level in NMOSD group was significantly higher than that in MS group(P=0.041). No statistical differences were found in the other variables between the two groups(P>0.05). According to the clinical and imaging results, the NMOSD patients were divided into "myelitis", "optic neuritis" and "brain lesion" subgroups, whose white cell count increased by 81.3%(26/32), 60%(3/5)and 50%(3/6), respectively. Monocytes and lymphocytes were present in all NMOSD samples. Neutrophils were detected in only 3 NMOSD patients and no neutrophils were observed in MS patients. In addition, CSF white cell count was significantly correlated with the spinal cord lesion length in NMOSD myelitis patients, while CSF total protein, IgG/M/A and lactate levels were not significantly correlated with the spinal cord lesion length. Conclusion The white cell count and lactate levels in CSF of AQP4-IgG seropositive NMOSD patients are higher than those of MS patients. The white cell count in CSF is correlated with spinal cord injury.

Association between carotid calcification and MRI overall burden in 282 cases of cerebral small vessel disease

ZHAO Enju, ZHAO Shuo, GUO Yunliang, WANG Ximing

Journal of Shandong University (Health Sciences). 2023, 61(1):  38-44.  doi:10.6040/j.issn.1671-7554.0.2022.1150

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Objective To investigate the association between carotid calcification and total burden of cerebral small vessel disease(CSVD). Methods Clinical data of 282 CSVD patients who underwent both computed tomography angiography(CTA)and magnetic resonance imaging(MRI)during Jan. 2020 and Jan. 2022 were retrospectively analyzed. Characteristics of carotid calcification(presence, size, number, location, and rim sign)and CSVD total burden(lacunes, white matter hyperintensities, microbleeds, enlarged perivascular space)were assessed. The association between carotid calcification and total burden of CSVD was determined with ordinal multivariable logistic regression. Results Carotid calcification was detected in 125(44.3%)patients. The total burden of CSVD rose significantly with the increasing incidence of carotid calcification(χ2=13.814, P=0.003). There were significant differences in the number(χ2=16.754, P=0.010), location(χ2=17.776, P=0.007)and size(χ2=28.943, P<0.001)of calcification in different CSVD total burden groups, while no significant difference was discovered in rim sign(χ2=4.867, P=0.182). Compared with CSVD 0 group, CSVD 3+ group showed higher incidences of multiple, surface and thick/mixed calcifications. After age, gender, hypertension, diabetes, hyperlipidemia and carotid artery stenosis were adjusted and indexes were remodeled, carotid calcification was an independent risk factor for CSVD total burden(OR=3.687, 95%CI: 1.013-13.423, P=0.048). Conclusion Carotid calcification is closely related to the CSVD total burden, which can act as a potential predictor of the severity of CSVD and help the clinical prevention and treatment.

Comparison of the euploidy rate of PGT-A tested embryos between long GnRH agonist and GnRH antagonist protocols

YU Wenhao, ZHANG Qian, SUN Mei, LI Hongchang, ZHU Yueting, JIANG Wenjie, YAN Junhao

Journal of Shandong University (Health Sciences). 2023, 61(1):  45-50.  doi:10.6040/j.issn.1671-7554.0.2022.1013

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Objective To investigate the use of gonadotropin-releasing hormone(GnRH)analog on embryonic euploidy rate as well as clinical pregnancy rate(CPR)in preimplantation genetic testing for aneuploidy(PGT-A)cycles. Methods From Jan. 2017 to Oct. 2020, young women with good ovarian reserve who underwent PGT-A cycles were selected, including 359 cycles and 1,475 blastocysts. The subjects were divided into the antagonist group(n=157)and agonist group(n=202). The baseline parameters, ovulation induction and ovulation cycle parameters of the two groups were determined with univariate analysis, and parameters with statistically significant differences were included in multivariate Logistic regression analysis. The primary parameter was the euploidy rate, and secondary parameter was CPR. Results No statistically significant differences were found in the good-quality blastocysts rate from meiosis Ⅱ(MⅡ)oocytes(41.4% vs 42.9%, P=0.335), embryonic euploidy rate(56.1% vs 52.6%, P=0.171), and CPR(69.2% vs 63.2%, P=0.289)of cryo-thawed embryo transfer(CET). After female age, body mass index(BMI), number of MⅡ oocytes, polycystic ovarian syndrome(PCOS)diagnosis, dosages of gonadotropins(Gn)and human chorionic gonadotropin(HCG)were adjusted, the selection of GnRH analog to achieve pituitary suppression did not affect the embryonic euploidy rate or CPR(P>0.05). For young patients with good ovarian reserve, there was a low statistically significant association between the number of oocytes retrieved and embryonic euploidy rate(P=0.04, OR=1.02, 95%CI: 1.00-1.04). Conclusion Stimulation with long GnRH agonist protocol and GnRH antagonist protocol results in a fairly similar embryonic euploidy rate and clinical pregnancy rate for young patients with ideal ovarian reserve. The findings support the flexible use of GnRH analogs to optimize treatment for this group of patients.

Analysis of prenatal screening and diagnostic methods in 10,265 cases of advanced maternal age

CI Qianqian, WU Shengying, WAN Qiuhua, MA Yunrong, ZHAO Jianwen, ZHANG Jian

Journal of Shandong University (Health Sciences). 2023, 61(1):  51-57.  doi:10.6040/j.issn.1671-7554.0.2022.0704

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Objective To explore the prenatal screening and diagnostic strategies for advanced pregnancy with different risk factors. Methods From January 2018 to December 2020, clinical data of 10,265women of advanced maternal agetreated in Jining Maternal and Child Health and Family Planning Service Center were retrospectively analyzed. The patients were divided into two groups: advanced age group(n=10,016)and advanced age with high-risk factors group(n=249). The advanced age group was subdivided into 7 groups: 35-year old group(n=2,030), 36-year old group(n=2,077), 37-year old group(n=1,592), 38-year old group(n=1,024), 39-year old group(n=969), 40-year old group(n=792), and >40-year old group(n=1,352). The prenatal screening and diagnostic results were analyzed among the groups. A young age group(n=8,364)was selected as the controls. Results Compared with the young age group(1.67‰, 14/8364), the 38-, 39-, 40- and >40 year-old groups had significantly inreased incidence of chromosomal aneuploidy abnormalities(P<0.001, P=0.012, P<0.001, P<0.001). An additional 36 cases of copy number variation(CNV)were detected by chromosomal microarray analysis(CMA)［8.22%(36/438)］. The incidences of chromosomal aneuploidy and chromosomal CNV were much higher in advanced age with high-risk factors group than in advanced age group(all P<0.001). Conclusion The incidence of fetal chromosomal abnormalities is increased in women of advanced maternal age. A comprehensive clinical assessment of risk factors should be performed to select an individualized prenatal screening and diagnosis strategy.

Outcomes of kidney transplantation after surgical treatment in 4 patients with refractory secondary hyperparathyroidism

GUO Haonan, HE Qingqing, ZHOU Peng, LI Xiaolei, ZHUANG Xiaoxuan, YUE Tao, GAO Yuan, XU Jing, SHAO Changxiu, LI Chenyu, ZHUANG Dayong

Journal of Shandong University (Health Sciences). 2023, 61(1):  58-61.  doi:10.6040/j.issn.1671-7554.0.2022.0819

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Objective To analyze the timing of parathyroidectomy(PTx)in patients with refractory secondary hyperparathyroidism(rSHPT)willing to receive kidney transplantation and to explore the impact of surgery on kidney transplantation. Methods The clinical data of 4 patients who underwent PTx for rSHPT and then kidney transplantation(KTx)during Apr. 2010 and Dec. 2021 were retrospectively analyzed. The clinical parameters before and after the two surgeries were compared with Kruskal-Wallis test. Results All patients underwent total parathyroidectomy with auto-transplantation(tPTx+AT). After surgery, clinical symptoms such as skeletal pain and skin pruritus were completely relieved, and both parathyroid hormone(PTH)and serum phosphate returned normal. Before KTx, serum calcium returned to the normal level in one patient and slightly below normal in the other three patients. After KTx, during the follow-up of 52(6-100)months, the grafted kidney function was stable, estimated glomerular filtration rate(eGFR)increased from 5.35(4.50-5.80)(mL/min)preoperatively to 83.80(68.60-95.60)(mL/min)postoperatively(P=0.021), and no complications such as transplanted kidney insufficiency or graft dysfunction occurred. Conclusion For rSHPT patients willing to undergo kidney transplantation, total parathyroidectomy with auto-transplantation is suggested.

A case report of parathyroid carcinoma with parathyroid crisis as the primary clinical manifestation

ZENG Yanping, YAN Shengtao, LIU Xiaoyu, JIANG Ziqing

Journal of Shandong University (Health Sciences). 2023, 61(1):  62-68.  doi:10.6040/j.issn.1671-7554.0.2022.0851

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Objective To analyze and report the diagnosis and treatment of a case of pathologically confirmed parathyroid carcinoma with parathyroid crisis as the primary clinical manifestation, in order to improve clinicians understanding of this rare disease. Methods Clinical and laboratory examination data of a patient initially diagnosed as parathyroid crisis and finally diagnosed as parathyroid carcinoma were collected and analyzed, and relevant literature was reviewed. Results A 70-year-old female was admitted due to disorder of consciousness, severe hypercalcemia, abnormal elevation of parathyroid hormone(PTH), pneumonia, renal insufficiency, and venous thrombosis of lower limbs. After anti-infection, salmon calcitonin, desumumab, anticoagulation, and other treatments, the patients condition improved for a time, but then deteriorated again. After secondary evaluation, upgraded anti-infection, sinacaser hydrochloride tablets for hypercalcemia and dilation, the patients condition was stabled and improved, which created conditions for surgical treatment. Parathyroid carcinoma was finally confirmed by postoperative gross pathological specimens. Conclusion Peripheral thyroid nodules, serum calcium >3.5 mmol/L, and PTH >10 times of the upper limit of normal value, suggest the possibility of parathyroid carcinoma. The combination of neck ultrasound and ^99mTc-MIBI can improve the detection accuracy. Surgery is still the key to treatment, although conservative medical treatment can relieve clinical symptoms. Extended resection margin may benefit tumor clearance, but there is no unified standard at present. Due to the high recurrence rate of this disease, long-term follow-up and timely treatment may improve the survival rate.

Vaginal delivery after myomectomy in the first trimester of pregnancy: a case report and literature review

ZHANG Hongyuan, GU Yongzhong

Journal of Shandong University (Health Sciences). 2023, 61(1):  69-73.  doi:10.6040/j.issn.1671-7554.0.2022.0981

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Objective To explore the feasibility of myomectomy in early pregnancy, and the choice of delivery mode and timing after myomectomy in pregnancy. Methods A retrospective analysis was performed on the clinical data of a patient with vaginal delivery after myomectomy in the first trimester of pregnancy in Shandong Provincial Hospital Affiliated to Shandong First Medical University, and the relative literature were reviwed. Results The patient underwent myomectomy under general anesthesia on the 32nd day of gestation, and underwent regular obstetric examination during pregnancy. The process went smoothly. Finally, the patient underwent vaginal delivery at the 41st week of gestation after artificial rupture of the membranes, and recovered well. Conclusion Myomectomy in early pregnancy can be tried, and elective cesarean section can be performed at 36-38⁺⁶ weeks in the third trimester of pregnancy after myomectomy during pregnancy. If the integrity of myometrium is not significantly damaged during myomectomy, vaginal delivery can be tried under close supervision, and the gestational age of delivery can be extended to 41 weeks. For pregnant women who underwent myomectomy, induction of labor after 40 weeks is not recommended.

医学心理学

Effects of psychological capital on occupational burnout in operating room nurses: the mediating role of flow at work and the moderation of gender

GAO Yiming, ZHAO Xiangyu, WANG Qing, ZHOU Miao, LI Ping

Journal of Shandong University (Health Sciences). 2023, 61(1):  74-79.  doi:10.6040/j.issn.1671-7554.0.2022.0569

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Objective To explore the association between psychological capital(Psycap), flow at work and occupational burnout among operating room nurses, and to analyze the mediating effect of flow at work between psychological capital and occupational burnout, as well as the moderating effect of gender. Methods Convenience sampling method was used to select 293 nurses from tertiary class A hospitals in Shandong Province from Aug. to Dec. 2021, who were surveyed with General Information Questionnaire, Positive Psychological Capital Questionnaire, Nurse work related flow Questionnaire and Maslach Burnout Inventory. Results The total score of occupational burnout was(35.72±19.55). Psychological capital was negatively related to occupational burnout(r_s=-0.48, P<0.01), but positively related to flow at work(r_s=0.54, P<0.01). Flow at work was negatively related to occupational burnout(r_s=-0.40, P<0.01), partially mediated the relationship between psychological capital and occupational burnout, and the mediating effect size was 22%. Gender moderated the relationship between flow at work and occupational burnout. Flow at work was more significant in predicting occupational burnout among male nurses. Conclusion The occupational burnout of operating room nurses deserves attention, and improving psychological capital and flow at work may help alleviate burnout, especially among male nurses.

Relationship between fear of missing out and social media fatigue among 306 college students: the chain mediating role of sleep quality and negative emotions

SONG Dongyu, LIU Yuzhou, CHANG Lixia, ZAHNG Qin, LI Yuli

Journal of Shandong University (Health Sciences). 2023, 61(1):  80-85.  doi:10.6040/j.issn.1671-7554.0.2022.0579

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Objective To Explore the mediating role of sleep quality and negative emotions between fear of missing out and social media fatigue among university students. Methods A total of 306 university students were surveyed with Fear of Missing Out Scale, Social Media Fatigue Scale, Pittsburgh Sleep Quality Index Scale, and the Chinese Versions of the Depression-Anxiety-Stress Scale(DASS-21). Results There were positive correlations among fear of missing out, social media fatigue, sleep quality and negative emotions. The fear of missing out positively predicted social media fatigue. Sleep quality and negative emotions mediated separately and in a chain between fear of missing out and social media fatigue. The effects of all dimensions of negative emotions held. Conclusion Sleep quality and negative emotions can provide an explanatory mechanism for the effects of fear of missing out on social media fatigue. College students fear of missing out can affect their level of social media fatigue both directly and indirectly through the independent mediating effects of sleep quality, negative emotions, and sleep quality-negative emotion chain.

公共卫生与管理学

Construction of intelligent auxiliary diagnostic model for acute myocardial infarction

LIN Yang, YAN Haosen, CHEN Qi, CHEN Yuxi, WANG Jiu

Journal of Shandong University (Health Sciences). 2023, 61(1):  86-93.  doi:10.6040/j.issn.1671-7554.0.2022.1086

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Objective To explore the use of patients clinical manifestations and conventional laboratory test indexes to construct an intelligent auxiliary diagnostic model of acute myocardial infarction(AMI)and its application, so as to provide reference to computer-aided diagnosis of AMI in primary hospitals. Methods The clinical data of 207 suspected AMI patients treated in a tertiary hospital in Yantai during 2018 and 2020 were retrospectively analyzed. After diagnosis by gold standard coronary angiography, 107 patients were confirmed to have AMI(case group)while 100 had not(control group). Based on single factor analysis, Lasso-logistic regression was used to establish a model, which was verified with 10-fold cross-validation. Results Creatine kinase isoenzyme, C-reactive protein, ECG abnormalities, persistent retrosternal or precordial crushing pain, nausea and vomiting were used as independent influencing factors for the diagnosis of AMI to construct the prediction model. The area under the receiver operating characteristic curve(AUC), 95%CI, sensitivity and specificity were 0.903, 0.896-0.944, 0.910 and 0.794, respectively. The AUC of 10-fold cross-validation was 0.825. Conclusion If correct diagnosis is guaranteed, the indicators of this model are easily accessible and cost-saving, and are suitable for early screening of AMI and monitoring of secondary infarction.

Construction of predictive models of radioiodine therapy based on machine learning

JU Yanli, WANG Lihua, CHENG Fang, HUANG Fengyan, CHEN Xueyu, JIA Hongying

Journal of Shandong University (Health Sciences). 2023, 61(1):  94-99.  doi:10.6040/j.issn.1671-7554.0.2022.1111

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Objective To construct the predictive models for radioactive iodine therapy(RAI)efficacy by machine learning algorithms based on clinical data and radiological parameters of patients with differentiated thyroid cancer(DTC). Methods A total of 1,642 DTC patients treated with RAI during Dec. 2015 and Dec. 2020 were collected. The efficacy was evaluated 6 months after RAI and the core features associated with efficacy were screened out for machine-learning modeling. The patients were divided into the training set(n=973)and validation set(n=669)according to the consultation time(July 2019). In the training set, the Logistic model, random forest model, support vector machine model and Adaboost model were constructed, whose performances were evaluated with the area under the receiver operating characteristic curve(AUC), accuracy and specificity. The calibration and decision curves were drawn to evaluate the accuracy and clinical benefits of the models. The external stability was assessed in the validation set. Results The four predictive models had great predictive performance, having higher predictive accuracy and net benefits than the tumor-node-metastasis(TNM)staging and recurrence risk stratification. The Logistic model was the most effective, with an AUC of 0.827 in the training set and 0.869 in the validation set. Conclusion Predictive models for RAI efficacy built on machine learning have great predictive performance. The developed nomogram can realize individualized and accurate prediction for the therapeutic efficacy of RAI for DTC.

Immediate antiretroviral treatment in 1,926 cases of HIV infection through homosexual transmission in Shandong Province

WANG Jiongjiong, WANG Guoyong, ZHU Xiaoyan, LI Ling, ZHANG Na, LIU Yunxia

Journal of Shandong University (Health Sciences). 2023, 61(1):  100-105.  doi:10.6040/j.issn.1671-7554.0.2022.1031

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Objective To explore the influencing factors of immediate antiretroviral therapy(ART)among newly diagnosed cases of HIV infection through homosexual transmission in Shandong Province, so as to provide reference for the control of HIV transmission. Methods A total of 1,926 cases of HIV infection through homosexual transmission in 2018 were selected as the research objects. Related data were collected with retrospective cohort study. The influencing factors of immediate ART were determined with binary Logistic regression. Results The median baseline age at diagnosis was 31.15 years, the diagnostic CD4 cell level at baseline was 364 cells/μL, and the rate of immediate ART was 73.94%. Those with household registration outside Shandong had lower rate of immediate ART than those in the province(OR=0.59, 95%CI: 0.40-0.87). The detained population had lower immediate ART rate than the key population(OR=0.25, 95%CI: 0.11-0.59). Patients with baseline CD4 cell level of 351-499 and ≥500 cells/μL had lower immediate ART rate than those with ≤350 cells/μL(OR=0.71, 95%CI: 0.53-0.96; OR=0.50, 95%CI: 0.38-0.66). Conclusion It is necessary to improve the immediate ART rate among newly diagnosed cases of HIV infection through homosexual transmission in Shandong Province. In particular, to control the spread of HIV, due attention should be paid to those with household registration outside the province, the detained population and those with high baseline CD4 cell level.

Epidemiological characteristics of mumps incidence in Shandong Province from 2005 to 2021

REN Yan, ZHANG Jingjing, LIU Yongpeng, LIU Hongqing

Journal of Shandong University (Health Sciences). 2023, 61(1):  106-112.  doi:10.6040/j.issn.1671-7554.0.2022.0645

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Objective To analyze the epidemiological characteristics and trends of mumps in Shandong Province from 2005 to 2021, so as to provide reference for the prevention and control of this disease. Methods The monthly incidence data of mumps were collected. The age and vaccination status of the patients were descriptively analyzed. The trend was analyzed with seasonal index and circular distribution method. Results There were 158,271 cases of mumps in Shandong Province from 2005 to 2021. From 2011 to 2013, the incidence was high, with children and adolescents under the age of 20 accounting for a large proportion of the cases. After 2014, more than 90% of residents were immunized. The seasonal index was >100% in January and April-July from 2005 to 2010 and from 2014 to 2021, and >100% in January, April-July and December from 2011 to 2013. Based on the circular distribution results, the peak day from March to August was May 31, and the peak period was May 12 to June 19; the peak day from September to February was December 18, and the peak period was from November 30 to January 3. The peak period of mumps was the longest from 2011 to 2013, and the shortest from 2014 to 2021. Conclusion The incidence of mumps in Shandong Province showed a decreasing trend from 2005 to 2021. Children and adolescents aged 5-14 years are the key population of the disease. Vaccination can effectively prevent the occurrence. It is still necessary to supervise and control mumps every year, and targeted measures should be taken in the year of high incidence.