Table of Content

  

10 July 2023
Volume 61 Issue 7

基础医学

Effects of methyltransferase PRMT5 on stabilizing USP15 to promote the occurrence and development of breast cancer

JIN Shan, GAO Jie, XIE Yujiao, ZHAN Yao, DU Tiantian, WANG Chuanxin

Journal of Shandong University (Health Sciences). 2023, 61(7):  1-11.  doi:10.6040/j.issn.1671-7554.0.2023.0132

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Objective To explore the mechanism by which protein arginine methyltransferase 5(PRMT5)up-regulates the expression of ubiquitin-specific protease 15(USP15)through methylation, thereby promoting the occurrence and development of breast cancer. Methods Gene Expression Profiling Interactive Analysis(GEPIA2)online database and Kaplan-Meier plotter survival curve analysis were used to explore the difference in the expression of PRMT5 in tumor tissue and normal tissue and its relationship with prognosis. The protein bound with PRMT5 was obtained with immunoaffinity purification and silver staining combined with mass spectrometry analysis. After PRMT5 was overexpressed or knocked down in MCF-7 cells with lentiviral stabilizing technology, the expressions of related proteins were detected with quantitative real-time PCR(qRT-PCR)and Western blotting. After USP15 was overexpressed or knocked down with plasmid or small interfering RNA(siRNA)transfection, the expressions of related proteins were determined with qRT-PCR and Western blotting, and the proliferation and invasion ability of breast cancer cells were detected with CCK8, colony formation and Transwell assay. After the activity of PRMT5 methyltransferase was inhibited with EPZ015666(GSK3235025)small molecule inhibitor, the changes of related proteins were determined with Western blotting, and the effects on the proliferation and invasion ability of breast cancer cells were assessed with CCK8 and Transwell assay. Results PRMT5 was highly expressed in breast cancer patients and was associated with poor prognosis. PRMT5 and USP15 interacted with each other. In breast cancer cell MCF-7, after overexpression of FLAG-PRMT5, the protein expression of USP15 was significantly increased, while the mRNA level remained unchanged. After the expression of PRMT5 was knocked down, the protein level of USP15 decreased, but the mRNA level did not change. In MCF-7 cells, overexpression of Myc-USP15 significantly decreased the mRNA and protein levels of FBXW7, but increased the proliferation and invasion ability, while knockdown of USP15 had the opposite results. After EPZ015666 inhibited the methyltransferase activity of PRMT5, the proliferation and invasion ability of cells were decreased by reducing the protein level of USP15. Conclusion PRMT5 interacts with USP15 in breast cancer cells and upregulates the protein level of USP15 in a methyltransferase activity-dependent manner. The increase of USP15 can inhibit the transcriptional activation of F-box and WD repeat domain-containing 7(FBXW7)gene by catalyzing the deubiquitination modification of histone H2BK120ub, promote breast cancer cell proliferation and epithelial to mesenchymal transition(EMT), and promote the occurrence and progress of breast cancer. These findings suggest that PRMT5 is a potential diagnostic and therapeutic target for breast cancer.

Expressions and clinical significance of DEC2 and HIF-2α in gastric cancer

FAN Rong, LI Binbin, MA Xiaoli, WANG Yunshan, JIA Yanfei

Journal of Shandong University (Health Sciences). 2023, 61(7):  12-18.  doi:10.6040/j.issn.1671-7554.0.2022.1290

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Objective To investigate the expressions of differentiated embryonic chondrocyte gene 2(DEC2)and hypoxia inducible factor-2α(HIF-2α)and their relationship with the clinicopathological parameters of gastric cancer. Methods The gastric cancer cell lines MKN45 and HGC27 were divided into the experimental groups(hypoxia for 72 hours)and the control group(normoxic for 72 hours). The mRNA and protein expressions of DEC2 and HIF-2α were detected. The overexpression plasmid DEC2 was transfected into the cell lines to detect the protein expressions of DEC2 and HIF-2α. The expressions of DEC2 and HIF-2α in 60 cases of gastric cancer tissues and corresponding adjacent gastric mucosa tissues were detected with immunohistochemical staining, and their correlation was analyzed. Results After hypoxia treatment, the mRNA and protein expressions of DEC2 were significantly decreased in the experimental groups compared with the control groups, while the expressions of HIF-2α were increased. After overexpression of DEC2, the expression of HIF-2α decreased. The expression of DEC2 in gastric cancer tissues was significantly lower than that in adjacent gastric mucosa tissues(χ2=20.512, P<0.001), while the expression of HIF-2α was higher(χ2=11.172, P=0.001). The expressions of DEC2 and HIF-2α were significantly correlated with the depth of tumor invasion, lymph node metastasis and clinical stage, and the expressions of DEC2 and HIF-2α were negatively correlated with each other(P<0.001). Conclusion DEC2 is lowly expressed in gastric cancer cells and tissues, while HIF-2α is highly expressed. They are negatively correlated with other and closely related with the tumor development and metastasis.

Protective effects of supplementing various trace elements on rats with high-sucrose diet

QI Shaojun, TANG Yanjin, ZHANG Zhengduo, WU Hong, ZHANG Jiacheng, QIN Chuan, LIU Rui, GAO Xibao

Journal of Shandong University (Health Sciences). 2023, 61(7):  19-26.  doi:10.6040/j.issn.1671-7554.0.2022.1258

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Objective To observe the effects of supplementation of multiple trace elements on the anti-inflammatory and antioxidant functions in rats with high-sucrose diet. Methods A total of 40 male Wistar rats were randomly divided into blank group, trace elements(TE)group, high-sucrose diet(HSD)group and high-sucrose diet + trace elements(HSD+TE)group, with 10 rats in each group. Normal saline or a mixture of 11 trace elements(B, V, Cr, Mn, Fe, Co, Cu, Zn, Se, Sr and Mo)was given daily by gavage to the rats. After 20 weeks, the changes of body weight, tissue weight, serum glucose content, oxidative stress and inflammatory markers were measured. Results High-sucrose diet induced a noticeable increase in body weight and serum glucose content(P<0.05), and significantly caused oxidative stress and inflammation(P<0.05). In addition, the supplementation of trace elements significantly inhibited the increase of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)induced by trace element deficiency and high-sucrose diet(P<0.05), but promoted the secretion of interleukin-4(IL-4)and interleukin-10(IL-10)(P<0.05). The supplementation of trace elements inhibited the decrease of the activities of catalase(CAT), total superoxide dismutase(T-SOD)and glutathione peroxidase(GSH-Px)in serum and spleen(P<0.05), reduced the production of malondialdehyde(MDA)(P<0.05), and increased serum glutathione reductase(GR)and total antioxidant capacity(T-AOC)in serum of rats with high-sucrose diet(P<0.05). Maintaining the balance of trace elements prevented weight gain caused by high-sucrose diet(P<0.05). Conclusion The supplementation of multiple trace elements to rats on a high-sucrose diet has a good effect on the prevention of diabetes, which can effectively control the increase of blood glucose level, enhance the antioxidant capacity, reduce the inflammatory response and prevent the weight gain.

Effects of Dexmedetomidine on the gene expressions of SH-SY5Y cells by RNA high-throughput sequencing

GUAN Wei, BAI Yunfeng, DU Shengjie, WANG Yuelan, LI Ximing

Journal of Shandong University (Health Sciences). 2023, 61(7):  27-33.  doi:10.6040/j.issn.1671-7554.0.2022.1434

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Objective To investigate the potential mechanism of Dexmedetomidine in brain protection by analyzing its effects on the gene expression of SH-SY5Y cells. Methods SH-SY5Y cells were cultured and divided into the experimental group(T group, biological replicate n=3)and control group(C group, biological replicate n=3). The experimental group was stimulated with Dexmedetomidine for 48 hours, while the control group was treated with DMSO under the same conditions. RNA was extracted with Trizol reagent and sequenced with Illumina Novaseq. The differentially expressed genes between the two groups were identified with Limma, and analyzed with gene ontology(GO)enrichment analysis and Kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment analysis. Results A total of 211 differentially expressed genes were identified, including 105 up-regulated and 106 down-regulated ones. The expressions of FGF1, GNG13 and P2RY4 were significantly different between the two groups, and the difference folds were 2.23, 2.00 and 6.56, respectively. GO enrichment analysis showed that the differentially expressed genes were mainly enriched in phospholipase C-activating G protein-coupled receptor signaling pathway, regulation of protein kinase B signaling and BMP signaling pathway, while KEGG pathway enrichment analysis revealed that they were mainly enriched in leukocyte transendothelial migration. Conclusion Genes including FGF1, GNG13 and P2RY4 may be involved in the protective effects of Dexmedetomidine on brain. Dexmedetomidine protects the central nervous system through inflammatory mechanism.

Influencing factors of PC12 cell injury induced by high glucose and the protective effects of catalpol

LIU Fengqi, GAO Feng, XUE Caicai, QIAO Xiumei, WANG Jinhong

Journal of Shandong University (Health Sciences). 2023, 61(7):  34-39.  doi:10.6040/j.issn.1671-7554.0.2023.0272

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Objective To investigate the damaging effects of high glucose(HG)on rat adrenal pheochromocytoma PC12 cells under different conditions, to analyze the influencing factors of establishing a model of cell injury induced by HG, and to explore the protective effects of catalpol. Methods PC12 cells were seeded with a density of 1×10³, 1×10⁴, 1×10⁵ cells/mL. HG was added into the medium at 24 and 48 hours after seeding. The final concentrations of glucose were 30, 40, 50 and 75 mmol/L. PC12 cells damaged by HG were divided into HG30, HG40, HG50 and HG75 groups accordingly. Control cells were treated with equal volume of physiological saline. After HG acted for 24, 48, and 72 hours, respectively, the cell survival rate was measured with MTT. After the cell injury model was established, cells were divided into control group, model group, low catalpol dose group(1×10^-5mol/L)and high catalpol dose group(1×10^-4mol/L). The reactive oxygen species(ROS)content was detected with ELISA and fluorescent probe. The lactate dehydrogenase(LDH)content was measured with ELISA. Results Under different glucose conditions, compared with the control group, the cells in HG30 group had unchanged(P>0.05)or decreased survival rate(P<0.05), while the cells in HG40, HG50, and HG75 groups had decreased survival rate(P<0.05 or P<0.01). Compared with the control group, the model group had increased ROS and LDH contents(both P<0.01). Compared with model group, the low and high catalpol dose groups had increased survival rate(P<0.01), and decreased ROS and LDH contents(P<0.01). Conclusion Injury in PC12 cells induced by HG is influenced by factors such as cell planting density, glucose concentration and action duration. The HG induced PC12 cell injury model can be established stably by a final concentration of 50 mmol/L glucose acting on cells seeded with a density of 1×10⁴ cells/mL for 24 hours. Catalpol plays a protective role on the model.

Exploration of the biased signaling pathway of the fusion protein of CCKAR and downstream effector

HE Yonghao, XIAO Peng, WANG Yijing, ZHANG Daolai

Journal of Shandong University (Health Sciences). 2023, 61(7):  40-46.  doi:10.6040/j.issn.1671-7554.0.2023.0120

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Objective To explore the biased signaling pathway of cholecystokinin A receptor(CCKAR), in order to design specific drugs for the treatment of diabetes, and to provide new ideas for the study of other G protein-coupled receptor(GPCR)biased signaling pathways. Methods The fusion proteins between the receptor and Gα subunit or β-arrestin-1 were constructed to study their biased signaling pathways. Under the premise of normal expression of fusion proteins, the cAMP accumulation assay was used to detect the change of intracellular cAMP content after the stimulation of sulfated cholecystokinin fragment 26-33 amide(CCK-8s). Calcium imaging technique was used to detect the change of intracellular calcium ion after the stimulation of CCK-8s. Western blotting was used to detect the phosphorylation of extracellular regulated protein kinase(pERK)and Bcl-2 death promoter(pBad)after the stimulation of CCK-8s. Results CCKAR-Gs/Gq/β-arrestin-1 was stably expressed in HEK293 cells; CCKAR-Gs produced a high cAMP signal; CCKAR produced a low cAMP signal; CCKAR-Gq/β-arrestin-1 did not cause cAMP signal. CCKAR-Gq had stronger calcium signal than CCKAR-Gq. CCKAR-β-arrestin-1 had a specific signal bias and significantly increased the phosphorylation level of the downstream ERK and Bad proteins. Conclusion The artificial CCKAR fusion protein can effectively and preferentially activate the downstream signaling pathways of CCKAR, and selectively perform physiological functions regulated by different signaling pathways.

临床医学

Factors influencing the degrees of fatigue after complete revascularization interventions in 152 patients with nonacute myocardial infarction

ZHANG Hengzhe, HOU Xiaohui, Arezou Bikdeli, LI Daqing

Journal of Shandong University (Health Sciences). 2023, 61(7):  47-54.  doi:10.6040/j.issn.1671-7554.0.2023.0328

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Objective To investigate the factors influencing the degrees of fatigue in patients with nonacute myocardial infarction after complete revascularization interventions. Methods Clinical data and psychological self-assessment scales were collected from 152 patients at the third month after complete revascularization interventions. Fatigue was classified into 3 levels according to the Multidimensional Fatigue Inventory(MFI-20): mild(20<MFI-20≤40), moderate(40<MFI-20≤60), and severe(MFI-20>60). The observation indicators were assessed with univariate analysis, and those with statistical and clinical significance were included to Logistic regression model toidentify the influencing factors. Results With the mild fatigue group as the baseline group for comparison, after adjustment of gender, age and examination findings, the risk factors for increasing fatigue included Gensini score(OR=0.984, 95%CI: 0.969-1.000, P=0.048), glycosylated hemoglobin(OR=0.795, 95%CI: 0.651-0.971, P=0.025), anxiety status(OR=0.379, 95%CI: 0.122-0.850, P=0.043), and depressive status(OR=0.461, 95%CI: 0.205-0.965, P=0.041); protective factors for decreasing fatigue were thyrotropin(OR=1.251, 95%CI: 1.025-1.528, P=0.028), hemoglobin(OR=1.027, 95%CI: 1.002-1.052, P=0.034), sleep quality(OR=13.531, 95%CI: 5.317-34.432, P<0.001), and grade of physical exercise(OR=7.389, 95%CI: 2.895-18.878, P<0.001). Conclusion Improving sleep quality and increasing exercise grade, together with relieving anxiety and depression, controlling glycated hemoglobin, and improving blood oxygenation and thyroid function may improve fatigue symptoms.

Differences in CT- FFR of coronary arteries with different cardiac cycles and influencing factors

ZHANG Hua, WANG Peiyuan, CHANG Na, XU Tianqi, YUAN Xianshun, WANG Ximing

Journal of Shandong University (Health Sciences). 2023, 61(7):  55-62.  doi:10.6040/j.issn.1671-7554.0.2023.0322

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Objective To investigate the differences in the measurement of coronary computed tomography fractional flow reserve(CT-FFR)in diastole and systole and the influencing factors. Methods This study retrospectively included 159 patients with clinically suspected coronary artery disease who underwent coronary computed tomography angiography(CTA)during Jan. 2019 and Dec. 2020 which showed a single plaque in the vessel. Coronary CTA post-processing was performed in both systolic and diastolic phases, and CT-FFR-S and CT-FFR-D were calculated. The relationships between CT-FFR and ΔCT-FFR and heart rate, coronary stenosis degree and plaque type were evaluated. Paired-samples t-test was used to compare the differences between diastolic and systolic CT-FFR. Results A total of 176 vessels from the 159 patients(58.2±11.0 years, 61.0% men)were successfully analyzed. Overall, CT-FFR-D was lower than CT-FFR-S(0.74±0.18 vs 0.76±0.16, P=0.019), whereas ΔCT-FFR-D was higher than ΔCT-FFR-S(0.21±0.17 vs 0.19±0.15, P=0.003). Heart rate and degree of coronary artery stenosis were contributing factors to the differences in CT-FFR and ΔCT-FFR between different phases. In patients with heart rate <80, the differences between CT-FFR and ΔCT-FFR in diastole and systole were statistically significant(P<0.05). In addition, the differences between CT-FFR and ΔCT-FFR in diastole and systole were statistically significant(P<0.05)in obstructive lesions(≥50% stenosis). However, plaque type had no significant effects on CT-FFR and ΔCT-FFR in different phases(P>0.05). Conclusion There are differences in CT-FFR and ΔCT-FFR measured in systole and diastole, and the difference in ΔCT-FFR is more significant. The differences in CT-FFR measurements between different phases are affected by heart rate and coronary stenosis, but not by plaque type.

Attitudes and practices of respiratory physicians regarding the diagnosis and treatment of bronchiectasis: a questionnaire-based cross-sectional study in Shandong Province, China

QI Qian, HAO Tianyu, XU Jiawei, WANG Guanghai, WU Fengjuan, LIU Mingtao, JIANG Peng, DONG Liang, LI Yu

Journal of Shandong University (Health Sciences). 2023, 61(7):  63-71.  doi:10.6040/j.issn.1671-7554.0.2023.0013

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Objective To evaluate the attitudes and practices of respiratory physicians regarding the diagnosis and treatment of bronchiectasis, so as to provide reference for promoting the management strategies of bronchiectasis. Methods During Oct. 2020 and Jun. 2022, a questionnaire survey was conducted among respiratory physicians in 143 hospitals in Shandong Province about the cognition of diagnosis and treatment of bronchiectasis. The cognitive status of physicians at different levels of hospitals and with different professional titles were compared. Results A total of 608 respiratory physicians completed the questionnaire, 24.7% of whom never tested humoral immunity, and 27.6% knew about the Bronchiectasis Severity Index. The cognition of bronchiectasis etiology discrimination and Pseudomonas aeruginosa clearance of physicians from tertiary hospitals was significantly higher than that of those from secondary hospitals(OR=1.952, 95%CI: 1.253-3.041, P=0.003; OR=2.495, 95%CI: 1.543-4.035, P<0.001). Physicians who had read the bronchiectasis guidelines had a higher cognition than those who had not read the guidelines(OR=1.725, 95%CI: 1.027-2.897, P=0.039; OR=2.067, 95%CI: 1.361-3.138, P=0.001). Conclusion The cognition of bronchiectasis management strategies among respiratory physicians, especially those from secondary hospitals in Shandong Province, still needs to be strengthened. It is necessary to continue to promote etiological screening and simplified disease severity assessment methods.

Clinical value of CONUT score in hepatitis B cirrhosis

ZHU Jinyu, GAO Shuai, WANG Kai

Journal of Shandong University (Health Sciences). 2023, 61(7):  72-77.  doi:10.6040/j.issn.1671-7554.0.2023.0091

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Objective To explore malnutrition in patients with hepatitis B cirrhosis based on the controlling nutritional status(CONUT)score, and to analyze the relationship between CONUT score and clinical markers. Methods A total of 298 patients with hepatitis B cirrhosis treated in Qilu Hospital of Shandong University during Jan. 2020 and Aug. 2022 were selected. The first examination data after admission were collected, and the nutritional status was evaluated with CONUT score, which was compared with the results based on body mass index(BMI)and albumin(ALB). Results Based on CONUT score, all patients had different degrees of malnutrition, including 68 cases(22.82%)of mild malnutrition, 176 cases(59.06%)of moderate malnutrition, and 54 cases(18.12%)of severe malnutrition. There were statistically significant differences in CONUT score among patients with different Child grades. Conclusion There are different degrees of malnutrition in patients with liver cirrhosis. The CONUT score is closely related to the severity of liver cirrhosis, and can guide clinical treatment.

Risk factors of severe persistent hypotension after carotid artery bifurcation stenting

QU Yongqiang, ZHAO Zeyu, WU Xingyuan, HAN Wei, DUAN Ruisheng, LI Yanbin, LI Heng

Journal of Shandong University (Health Sciences). 2023, 61(7):  78-82.  doi:10.6040/j.issn.1671-7554.0.2023.0067

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Objective To analyze the risk factors of severe persistent hypotension after carotid artery bifurcation stenting. Methods Clinical data of 177 patients(181 lesions)with carotid artery bifurcation stenosis who underwent stenting during Oct. 2014 and Apr. 2022 were retrospectively analyzed. The risk factors for postoperative severe persistent hypotension were analyzed with univariate and multivariate Logistic regression models. Results The incidence of severe persistent hypotension was 53.1%. Univariate analysis showed that large stent diameter, intraoperative use of atropine, balloon dilation diameter >5 mm, eccentric stenosis and severe stenosis were risk factors of severe persistent hypotension. Multivariate analysis indicated that intraoperative use of atropine, balloon dilation diameter >5 mm and severe stenosis were independent risk factors. Conclusions Hemodynamic impairment is a common complication after carotid artery bifurcation stenting. Intraoperative use of atropine, balloon dilation diameter > 5mm and severe stenosis are independent risk factors of severe persistent hypotension.

Effects of different frequencies of repetitive transcranial magnetic stimulation on aphasia in postcerebral infarction patients

LI Guohua, LU Yi, WANG Shengqiu

Journal of Shandong University (Health Sciences). 2023, 61(7):  83-89.  doi:10.6040/j.issn.1671-7554.0.2022.1317

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Objective To compare the efficacy of different frequencies of repetitive transcranial magnetic stimulation(rTMS)in the treatment of aphasia in postcerebral infarction patients. Methods Patients were randomly divided into three groups: low-frequency rTMS(LF-rTMS)group(1 Hz), high-frequency rTMS(HF-rTMS)group(10 Hz), and speech training group. Patients language ability was assessed before treatment, 2, 4 and 12 weeks after treatment. Results The language ability in all three groups improved after treatment. Word-picture matching and aphasia quotients(AQ)reached the peak at 12 weeks and other indicators reached the peak at 4 weeks(P<0.05). Comparison among groups showed that the LF-rTMS group and HF-rTMS group exhibited a more marked improvement than the speech training group in each evaluation indicators at 2, 4 and 12 weeks after treatment(P<0.05). The view naming time of the HF-rTMS group was shorter than that of the LF-rTMS group at 2 and 4 weeks, but the scale of view naming of the LF-rTMS group was better than that of the HF-rTMS group at 2, 4 and 12 weeks(P<0.05). Conclusion Both LF-rTMS and HF-rTMS are beneficial to the recovery of linguistic function in cerebral infarction patients with non-fluent aphasia. The naming time of the HF-rTMS group is shorter, but the scale of naming of the LF-rTMS group is higher.

Diagnostic capacity of electrochemiluminescence immunoassay compared with liquid chromatography-tandem mass spectrometry for vitamin D deficiency in diabetic patients

YU Danfeng, CAO Juan, YU Shijia, DU Lutao, HOU Xinguo

Journal of Shandong University (Health Sciences). 2023, 61(7):  90-95.  doi:10.6040/j.issn.1671-7554.0.2023.0078

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Objective To analyze the correlation and consistency between the results of liquid chromatography-tandem mass spectrometry(LC-MS/MS)and electrochemiluminescence immunoassay(ECLIA)for the determination of 25-hydroxyvitamin D(25(OH)D)concentration in the serum of diabetic patients, and to explore the optimal cutoff values of the two assays. Methods A total of 209 serum samples were collected from hospitalized diabetic patients, and 25(OH)D concentration was measured with LC-MS/MS and ECLIA, respectively. The correlation and consistency of 25(OH)D concentrations between the two methods were tested with correlation analysis, regression analysis, and consistency test. With LC-MS/MS as the gold standard to evaluate the diagnostic ability of ECLIA in diagnosing vitamin D deficiency, receiver operating characteristic(ROC)curve was used to determine the optimal cut-off value of ECLIA. Results The median concentration of 25(OH)D detected with ECLIA was 18.88 ng/mL, while that detected with LC-MS/MS was 14.61 ng/mL. Compared with LC-MS/MS, ECLIA showed a positive bias(26.402%). The correlation coefficient was 0.491(P<0.001), and the regression equation was Y_LC-MS/MS=-3.486+0.987X_ECLIA. The intraclass correlation coefficient was 0.531. The area under the ROC curve(AUC)using ECLIA was 0.78 when vitamin D deficiency was defined as <20 ng/mL, and the AUC was 0.69 when severe vitamin D deficiency was defined as <20 ng/mL. ROC curve analysis revealed that the optimal cut-off value of vitamin D deficiency was 21.36 ng/mL, with a sensitivity of 74.48%, specificity of 78.13%, and Youden index of 0.53. The optimal cut-off value of severe vitamin D deficiency was 16.68 ng/mL, with a sensitivity of 66.00%, specificity of 70.44%, and Youden index of 0.36. Conclusion A moderate correlation was demonstrated via 25(OH)D concentration detected with ECLIA and LC-MS/MS in diabetic patients, while serum 25(OH)D concentration measured with ECLIA was higher on average than that measured with LC-MS/MS, suggesting that 21.36 ng/mL should be used as the diagnostic cut-off value for vitamin D deficiency and 16.68 ng/mL for severe vitamin D deficiency in diabetic patients.

A clinical analysis of 47 cases of hysterectomy

ZHANG Hongyuan, GU Yongzhong, HOU Zhe

Journal of Shandong University (Health Sciences). 2023, 61(7):  96-100.  doi:10.6040/j.issn.1671-7554.0.2023.0138

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Objective To analyze the risk factors so as to provide a theoretical basis for reducing the rate of obstetric hysterectomy. Methods Clinical data of 47 patients undergoing obstetric hysterectomy during July 2016 and June 2021 were retrospectively analyzed. Results In the past 5 years, the rate of hysterectomy in the Obstetric Department of Shandong Provincial Hospital Affiliated to Shandong First Medical University was 1.22‰. Postpartum hemorrhage ranked the first risk factor for hysterectomy(41 cases), followed by pregnancy with gynecological malignant tumors(3 cases), uterine necrosis caused by puerperal infection(2 cases), and placental implantation after induced labor in the second trimester(1 case). The main cause of postpartum hemorrhage was pernicious placenta previa and accreta(90.24%, 37/41), followed by advanced pregnancy with giant uterine fibroids(4.88%, 2/41), uterine inertia(2.44%, 1/41)and pregnancy acute fatty liver with DIC(2.44%, 1/41). Among 37 cases of pernicious placenta previa and accreta, 19(51.35%)underwent subtotal hysterectomy, and 18(48.65%)total hysterectomy. The average amount of blood loss and blood transfusion in the total hysterectomy cases were higher than those in the subtotal hysterectomy cases(P<0.05). Of the 37 patients with pernicious placenta previa and accreta, 54.05%(20/37)received vascular interventional procedures, including abdominal aortic balloon occlusion and iliac vascular occlusion. The average blood loss of the vascular intervention cases was lower than that of the non-vascular intervention cases(P<0.05). Conclusion Postpartum hemorrhage caused by pernicious placenta previa and accreta is the main cause of hysterectomy. For serious and pernicious cases of placenta previa and accreta, appropriate interventional surgery and subtotal hysterectomy can reduce blood loss and improve the prognosis.

Morphological and positional characteristics of the glenoid fossa and mandible in patients with hypodivergent pattern

LYU Wenxin, LIU Yishu

Journal of Shandong University (Health Sciences). 2023, 61(7):  101-108.  doi:10.6040/j.issn.1671-7554.0.2022.1415

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Objective To analyze the morphological and positional characteristics of the glenoid fossa and mandible in patients with hypodivergent pattern by cone beam computed tomography(CBCT). Methods The imaging data of 51 patients were retrospectively analyzed. The patients were divided into hypodivergent group(n=27)and normal group(n=24)according to ∠MP-FH and ∠MP-SN. A total of 17 measurements were used to analyze the mandibular morphology and position. Results There were no significant differences in the shape and size of the glenoid fossa between the two groups(P>0.05). The difference was mainly manifested in the shape and size of the mandible. The posterior inclination of the condyle in the hypodivergent group was significantly smaller than that in the normal group(P<0.01), while the length of the mandibular body was significantly greater(P<0.01). The mandible rotated counterclockwise in patients with hypodivergent pattern. Conclusion The temporomandibular fossa of patients with hypodivergent pattern has no obvious abnormality. The inclination of condyle and the morphology of the mandible should be considered during the orthodontic treatment.

Acute pancreatitis as initial manifestation in a patient with acute myeloid leukemia: a case report and literature review

YANG Wenxin, LIU Yingjiao, GAO Ya, YANG Anyi, ZHOU Hengyu, GAO Juncha

Journal of Shandong University (Health Sciences). 2023, 61(7):  109-117.  doi:10.6040/j.issn.1671-7554.0.2023.0029

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Objective To report the diagnosis and treatment of acute pancreatitis caused by extramedullary infiltration in a patient with acute myeloid leukemia, so as to improve clinicians understanding of the disease. Methods A 61-year-old patient with acute pancreatitis as the initial manifestation caused by acute myeloid leukemia was admitted to Hebei General Hospital on Sep. 20, 2021. Abdominal CT, histopathological analysis and immunohistochemical examination of the peripheral blood and bone marrow were used to confirm the diagnosis. The imaging and clinical manifestations, as well as the diagnosis and treatment of the case were summarized and analyzed. Relevant literatures were retrieved in PubMed, Wanfang Data, CNKI and Chinese Scientific Journal Database developed by VIP from inception to Dec. 2022. The diagnosis and treatment of the disease were summarized and analyzed. Results A total of 25 literatures were collected, including 8 children(5 boys and 3 girls, aged from 10 weeks to 12 years, median 4.5 years)and 17 adults(9 males and 8 females, aged from 19 to 78 years, median 42 years). All 25 cases were confirmed leukemia, including acute lymphoblastic leukemia in 18 cases, acute myeloid leukemia in 5 cases and chronic lymphoblastic leukemia in 2 cases. The main manifestation was acute pancreatitis in 11 cases, complicated with obstructive jaundice in 3 cases, obstructive jaundice in 4 cases, and 7 cases had no specific manifestations of pancreatic invasion. Leukemia cell infiltration was confirmed by pancreatic biopsy in 9 cases, most of which were confirmed by endoscopic ultrasound-guided fine needle aspiration biopsy, and the rest were evaluated comprehensively based on the effects of chemotherapy and imaging findings. The pancreatic lesions were reduced in all patients receiving chemotherapy. Conclusion Clinicians need to improve understanding of the rare sites of extramedullary infiltration of leukemia and the rare etiology of acute pancreatitis. When patients present with hematologic manifestations such as abdominal pain, pancreatic swelling, low-density lesions with decreased platelet abnormalities, it is necessary to consider pancreatitis caused by leukemia. It is recommended to conduct bone marrow biopsy at an early stage, and to start the treatment for leukemia in time after diagnosis.