1
Zhonghua Yi Xue Za Zhi
. 2020 Jun 16;100(23):1800-1804. doi: 10.3760/cma.j.cn112137-20191025-02319.
[Comparative Analysis of Serum Glutamate and Gamma-Aminobutyric Acid Levels in Patients With Bipolar Depressive Disorder and Major Depression Disorder]
[Article in Chinese]
J W Liao 1, S S Wang 2, H H Yang 1, P Ma 1, C R Li 1, J Y Pan 1
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PMID: 32536126 DOI: 10.3760/cma.j.cn112137-20191025-02319
Abstract in English , Chinese
Objective: To investigate the difference of serum glutamate (Glu) and gamma- aminobutyric acid (GABA) levels between depressive patients and bipolar disorder patients with depressive episodes. Methods: From May 2018 to March 2019, forty-seven patients with depression (depression group) and 45 patients with bipolar depressive episode (bipolar depression group) were selected from the department of psychiatry, the First Affiliated Hospital of Jinan University, and 41 healthy controls (healthy control group) were simultaneously recruited from the community. The subjects' depression and anxiety were assessed by 17 items of Hamilton depression scale (HAMD-17) and Hamilton Anxiety Scale (HAMA). The serum levels of Glu, GABA and Glu decarboxylase (GAD) were detected by enzyme-linked immunosorbent assay (ELISA) . Results: The serum Glu level ( (36±7) mg/L, (37±7) mg/L vs (28±4) mg/L, F=10.97, P<0.01) and Glu/GABA ratio (5.77±0.35, 8.18±0.24 vs 3.35±0.33, F=37.68, P<0.01) in depression and bipolar depression groups were higher than those of healthy control group, while the GABA level ((6.1±0.7) μmol/L,(4.1±0.8) μmol/L vs (8.1±1.2) μmol/L, F=21.61, P<0.01) and GAD ((31±6) U/L, (31±6) U/L vs (35±6) U/L, F=5.61, P<0.01) were lower than those of healthy control group. The level of serum GABA in bipolar depression group was lower than that in depression group. However, Glu/GABA was higher in bipolar depression group than that in depression group (P<0.01). The level of serum GABA in depression group was negatively correlated with HAMD sleep disorder factor (r=-0.46, P=0.01). Conclusions: Both depression and bipolar depression have abnormal levels of Glu, GABA neurotransmitters and imbalance between Glu and GABA in peripheral blood circulation. Moreover, these abnormalities are more obvious in patients with bipolar depression.

Keywords: Bipolar disorder; Depressive disorder; Gamma-aminobutyric acid; Glutamic acid.

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2
Zhonghua Yi Xue Za Zhi
. 2020 Jun 9;100(22):1704-1707. doi: 10.3760/cma.j.cn112137-20190910-02001.
[Study on the Effect of Simple Incision of Ventral Tunica Albuginea on the Correction of Penile Curvature in Hypospadias]
[Article in Chinese]
Y D Shen 1, L F Zhu 1, C Tao 1, W Ru 1, Y J Zhao 1, Z Wang 1, F Yang 1, D X Tang 1, Y He 2, X P Wang 2
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PMID: 32536089 DOI: 10.3760/cma.j.cn112137-20190910-02001
Abstract in English , Chinese
Objective: To investigate the therapeutic effect of simple tunica albugineaincision and ventral penile lengthening surgery on the correction of penile curvature due to asymmetry of the cavernous bodies in hypospadias. Methods: A retrospective analysis was performed in 39 children with hypospadias who underwent simple tunica albuginea incision and ventral penile lengthening surgery for correcting asymmetry of the cavernous bodies from January 2016 to December 2018(36 of them were from Department of Pediatric Urology surgery, The Children's Hospital, Zhejiang University School of Medicine, and 3 from Department of Urology surgery, Affiliated Hospital ofJiaxing University), all of whom aged from 0.5 to 5, with a median age of 1.1 years. During the first stage of the operation, firstly penile skin and sarcoma was released by completely degloving the skin and fascia of penis, secondly the factor of short urethral plate was solved by transection of urethral plate, and then the dorsal length of penis (A), the ventral length of the penis before and after straightening by incision of tunica albuginea (B and C) were measured and recorded; onto the second stage of the operation, an artificial erection test was performed to observe the curvature of the penis, the dorsal and ventral length of the penis (D and E) were measured. The dorsal and ventral length of the penis before and after straightening were compared. Results: The dorsal length of penis (A) was 33-39(35.6±3.2) mm, the length of ventral length of penis before straightening (B) was 28-35 (29.8±2.8) mm and the length of ventral length of penis after straightening (C) was 32-38 (34.3±2.1) mm, which were measured during the first stage of operation, and the difference between B and C was statistically significant (P<0.05), while the difference between A and C was not statistically significant (P>0.05). The dorsal length of penis (D) was34-41 (36.4±2.5) mm and the ventral length of penis (E) was 33-40 (35.7±3.6) mm, which were measured during the second stage of operation, and there was no significant difference between D and E (P>0.05). The degree of penile curvature at the time of erection was less than 15° by measuring with the side photos in all patients during 0.5 to 2.5 years of follow-ups with an average of 1.7 years. Conclusions: Penile curvature due to the asymmetry of the cavernous bodies could be effectively corrected by simple incision of ventral tunica albuginea, which showed a good result of early follow-up. The effect of this surgery on ventral penile straightening could be verified by measuring and comparing the ventral and dorsal length of penis during surgery.

Keywords: Hypospadias; Penile curvature; Staged operation; Tunica albuginea.

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3
Zhonghua Yi Xue Za Zhi
. 2020 Jun 16;100(23):1773-1777. doi: 10.3760/cma.j.cn112137-20200302-00546.
[Associated Factors of Different Fatigue Dimensions in Elderly Patients With Rheumatoid Arthritis]
[Article in Chinese]
M X Lao 1, W T Liu 2, N N Li 2, M L Ding 1, L Q Liang 2, Z P Zhan 2, D Y Chen 2
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PMID: 32536121 DOI: 10.3760/cma.j.cn112137-20200302-00546
Abstract in English , Chinese
Objective: To investigate the associated factors of different dimensions of fatigue in elderly patients with rheumatoid arthritis (RA). Methods: A cross-sectional analysis was performed in the elderly outpatients with RA (age ≥ 60 years) in the First Affiliated Hospital of Sun Yat-sen University from January 2018 to June 2019. Fatigue was measured by Multidimensional Fatigue Inventory-20 (MFI-20) and 36-item Short Form Health Survey-Vitality (SF-36-VT). Physical fatigue and mental fatigue were subsequently measured by MFI-20 subscales. Results: A total of 104 patients were included. Male-to-female ratio was 1∶3.3. The average age was (68±6) years. The MFI-20 score and SF-36-VT score were 60±14 and 64±20, respectively. The score of physical fatigue measured by MFI-20 was 14±3, and mental fatigue scored 10±4 (P<0.001). Arthralgia, disease activity, disability, insomnia, depression and anxiety were correlated with fatigue assessed by MFI-20 (correlated coefficient: 0.48-0.62). Multivariable regression analysis showed that arthralgia and depression were associated with physical fatigue (Standardized regression coefficients were 0.44 and 0.38, respectively). Insomnia, depression and anxiety were associated factors of mental fatigue (Standardized regression coefficients were 0.20, 0.32 and 0.24, respectively). Conclusions: Elderly patients with RA experiencehigh level of fatigue, mainly presenting as physical fatigue. Arthralgia and depression mainly affect physical fatigue, and arthralgia is a critical factor. Insomnia, depression and anxiety are associated with mental fatigue.

Keywords: Aged; Arthritis, rheumatoid; Depression; Fatigue; Pain.

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4
Zhonghua Yi Xue Za Zhi
. 2020 Jun 9;100(22):1725-1729. doi: 10.3760/cma.j.cn112137-20200212-00265.
[Changes of Retinal Structure After Systemic Immunosuppressive Treatment in Eyes With Vogt-Koyanagi-Harada Disease]
[Article in Chinese]
X S Cao 1, Y P Zhang 1, H X Ji 1, X Jiao 1, H Wang 1
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PMID: 32536094 DOI: 10.3760/cma.j.cn112137-20200212-00265
Abstract in English , Chinese
Objective: To assess structural changes in retina after systemic immunosuppressive treatment in Vogt-Koyanagi-Harada (VKH) disease using spectral-domain optical coherence tomography (SD-OCT). Methods: The clinical data of 17 VKH cases (34 eyes) who consecutively attended the Beijing Tongren Hospital between December 2015 and December 2019 were retrospectively reviewed. All the patients had acute or subacute onset, and underwent high-dose systemic corticosteroid and/or immunosuppressive treatment, with a followed-up time of at least 6 months. At the end of follow-up, the intraocular inflammation was controlled, and oral prednisone was withdrawn or being adjusted to less than 10 mg/day. The SD-OCT features of the included eyes were analyzed before treatment, 1 week, 1 month and 3 months after treatment, and at the last visit. Results: A total of 17 cases (34 eyes; 6 males and 11 females) were included, with an age of (42.2±10.6) years, and were followed up for (9.4±3.3) months. At 1 week after initiating treatment, the percentage of the eyes with extensive/multiple or multifocal retinal detachment in the macular region, membranous structures and intraretinal cysts, and undulations and bumps of retinal pigment epithelium (RPE) decreased (5.9% vs 100%, 2.9% vs 47.1%, 5.9% vs 70.6%, 11.8% vs 58.8%, respectively, all P<0.001). There was statistical significant difference of the percentage of ellipsoid zone and external limiting membrane (ELM) disruptions before treatment, at 3 months and the last visit (100% vs 35.3%, 64.7% vs 52.9%, 41.2% vs 26.5%, respectively, all P<0.001). At the last visit, there were statistical significant differences of the best corrected vision acuity (BCVA) between the intact ellipsoid zone group (20 eyes) and the discontinuous group (14 eyes), as well as between the intact ELM group (25 eyes) and the discontinuous group (9 eyes), respectively [0 (0, 0.05) vs 0.10 (0.03, 0.33) (log MAR), P=0.004; 0 (0, 0.07) vs 0.22 (0.05, 0.40) (log MAR), P=0.005]. Conclusions: The edema of choroid and retina subsided obviously at 1 week after initiating treatment. The extent of damage and recovery ability of ellipsoid zone and ELM were different before treatment, at 3 months and the last visit. At the last visit, the outer retinal layers failed to recover completely in some patients, and were related to the BCVA.

Keywords: Glucocorticoids; Tomography, optical coherence; Uveomeningoencephalitic syndrome.

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5
Zhonghua Yi Xue Za Zhi
. 2020 Jun 2;100(21):1617-1622. doi: 10.3760/cma.j.cn112137-20191113-02468.
[The Value of Spectral CT-based Radiomics in Preoperative Prediction of Lymph Node Metastasis of Advanced Gastric Cancer]
[Article in Chinese]
R Wang 1, J Li 2, M J Fang 3, D Dong 3, P Liang 1, J B Gao 1
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PMID: 32486595 DOI: 10.3760/cma.j.cn112137-20191113-02468
Abstract in English , Chinese
Objective: To investigate the spectral CT-based radiomics in predicting preoperatively the lymph node metastasis (LNM) of advanced gastric cancer. Methods: From January 2014 to October 2018, the spectral CT imaging and clinical data of 196 gastric adenocarcinoma patients confirmed by pathology in the First Affiliated Hospital of Zhengzhou University were retrospectively enrolled (training set and test set were randomly divided according to the ratio of 1∶1). These 196 patients include143 males and 53 females, aged from 28 to 81 years, with an average age of (59±11) years, and were divided into nodular metastasis group and non-metastasis group according to clinicopathological data. The spectral parameters were measured and calculated, and the CT-reported lymph node (LN) status from CT images were obtained. 273 radiomics features were extracted from the dual-phases CT images in different energy level (40, 65 and 100 keV) to build the radiomics signature respectively. Univariate analysis was used to compare the differences of spectral parameters and radiomics features between two groups, and then the significant indicators were put into multivariable logistic regression analysis to construct combined prediction model and radiomics nomogram. In addition, the performance of prediction model in training and test set were measured using the receiver operating characteristics (ROC) curves and were compared using DeLong test. Results: Both in training set and in test set, the iodine concentration (IC) of tumor in venous phase (VP) in nodular metastasis group were higher than that in non-metastasis group [training set: 22.98 (100 mg/L)>20.31 (100 mg/L), P=0.086; test set: 25.14 (100 mg/L)>21.07 (100 mg/L), P=0.009]. The CT-reported LN status showed significant differences between the two group (P<0.001, P=0.001). The radiomics signatures 40 keV-arterial phase, 65 keV-venous phase, IC-VP of tumor and CT-reported LN status were independent indicators for prediction of preoperative LNM of advanced gastric cancer in combined prediction model (P<0.05). The radiomics nomogram predicated LNM with an area under curve (AUC) and 95% confidence interval (CI) of 0.822 (0.739-0.906) in training set and 0.819(0.732-0.906) in test set, and there were no significant differences in AUC between two sets (P>0.05). Conclusions: The spectral CT-based radiomics can be used to quantitatively predict the LNM of advanced gastric cancer preoperatively.

Keywords: Lymph nodes; Radiomics; Spectral imaging; Stomach neoplasms.

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6
Zhonghua Yi Xue Za Zhi
. 2020 Jun 9;100(22):1750-1755. doi: 10.3760/cma.j.cn112137-20200425-01309.
[Effect of Exosome-Derived miR-223 From Macrophages on the Metastasis of Gastric Cancer Cells]
[Article in Chinese]
P M Zheng 1, H J Gao 2, J M Li 3, P Zhang 3, G Li 1
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PMID: 32536099 DOI: 10.3760/cma.j.cn112137-20200425-01309
Abstract in English , Chinese
Objective: To investigate the effect and mechanism of exosome-derived miR-223 from macrophage on gastric cancer (GC) cell metastasis. Methods: Exosomes isolated from macrophages culture medium were characterized and cocultured with GC cell, the miRNA level was detected by qRT-PCR. The migration and invasion of GC cell were detected by transwell. The internalization of exosomes, transfer of miR-223 was observed by immunofluorescence. Macrophage were transfected with a miR-223 inhibitor or negative control, transwell and scratch test were employed to explore the effect of macrophage derived exosome on the migration and invasion of GC cell. Western blot and RT-PCR assay were performed to uncover the underlying mechanisms of miR-223 and PTEN-PI3K/AKT pathway. Results: This study showed that macrophage and macrophage-derived exosomes promoted the migration and invasion of gastric cancer cell(253.2±6.3, 451.8±12.8, 453.4±14.4, all P<0.01, and 98.4±5.1, 276.5±10.3, 257.3±8.5, all P<0.01, respectively). miR-223 was enriched in macrophage-derived exosomes, which was transferred to the co-cultivated gastric cancer cells. miR-223 knockdown in macrophage reversed the migration and invasion of exosomes on gastric cancer cells(215.6±9.2, 402.5±11.6, 253.7±10.4, all P<0.01, and 91.5±8.2,263.4±9.3,105.8±9.3,all P<0.01, respectively).Functional studies revealed that exosomal miR-223 derived from macrophage promoted the metastasis of GC cells via the PTEN-PI3K/AKT pathway. In addition, itshowed thatthe actin cytoskeleton was altered, and multiple proteins associated with epithelial-mesenchymaltransition (EMT) were upregulated. Conclusion: Exosomal transfer of macrophage-derived miR-223 promote the metastasis of GC cells through targeting the PTEN-PI3K/AKT pathway.

Keywords: Exosome; Gastric cancer; Macrophage; Metastasis; miR-223.

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7
Zhonghua Yi Xue Za Zhi
. 2020 Jun 2;100(21):1648-1653. doi: 10.3760/cma.j.cn112137-20191106-02411.
[Isolated Biceps Tenodesis by Double Row for Pulley Lesions]
[Article in Chinese]
D M Li 1, W M Wang 2, H Luo 3, X J Ma 1, S B Huang 1, Z A Qu 1
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PMID: 32486600 DOI: 10.3760/cma.j.cn112137-20191106-02411
Abstract in English , Chinese
Objective: To explore clinical outcome of isolated arthroscopic biceps tenodesis by double row for pulley lesions. Methods: Forty-nine patients with pulley lesions were treated from July 2017 to June 2018 in the Department of Sport Medicine, the Affiliated Zhongshan Hospital of Dalian University by isolated arthroscopic biceps tenodesis by double row. Patients were divided into 2 groups according to the intraoperative damage of the pulley system. In group A, there were 16 patients with isolated superior glenohumeral ligament/coracohumeral ligament (SGHL/CHL) complex lesions, including 9 males and 7 females, aged (55±6) years. In group B, there were 33 patients (15 males and 18 females, aged (57±8) years) with SGHL/CHL complex and adjacent supraspinatus tendon and/or subscapularis tendon articular-side partly tears. Patients in two groups were treated with different isolated arthroscopic biceps tenodesis by double row. Constant-Murley shoulder score and pain visual analogue scale (VAS) score were assessed before operation and 3, 6, 12 months after the operation. Postoperative complications were also recorded in two groups. The t test was used to compare the quantitative data within and between two groups. Results: All 49 patients were followed up for 12 to 24 months with an average of (17±6) months. The first-stage healing was achieved in all incisions in the two groups. No surgical complications related to revision, infection, Popeye syndrome and cramping pain were observed in either group. There was 1 case treated by secondary arthroscopy for retrauma in group B. The Constant-Murley shoulder score in group A before the operation was 46±10, and it was increased to 89±9 at the 12 months post operation(t=-22.637, P<0.05); and it was 39±10 and 87±8 before and 12 months after the operation respectively in group B (t=-44.849, P<0.05). The VAS scores in the two groups were both decreased significantly at the 12 months post operation when compared with those before the operation (0.68±0.70 vs 5.25±0.27 and 0.72±0.83 vs 5.69±0.84, respectively) (t=29.007, 37.079, both P<0.05). Conclusion: Isolated arthroscopic biceps tenodesis by double row can relieve pain, recover functions of shoulder joint effectively, and achieve a satisfactory outcome in the treatment of pulley lesions.

Keywords: Arthroscopy; Biceps tendon; Pulley system; Shoulder joint.

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8
Zhonghua Yi Xue Za Zhi
. 2020 Jun 2;100(21):1634-1639. doi: 10.3760/cma.j.cn112137-20200227-00482.
[Study on the Expression of Non-Coding microRNA-376b-3p in Serum Exosomes of Patients With Malignant Glioma and the Mechanism of Anti-Angiogenesis]
[Article in Chinese]
J Jiang 1, S Wang 2, Q H Meng 1, R Yu 1, S C Wei 1, J Wang 1, C C Qu 1, C W Wang 1
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PMID: 32486598 DOI: 10.3760/cma.j.cn112137-20200227-00482
Abstract in English , Chinese
Objective: To screen the different microRNAs in the serum exosomes of patients with malignant glioma, to explore the effect of non-coding microRNA-376b-3p (miR-376b-3p) on the proliferation, invasion and tumor vasculogenic mimicry of glioma cells, and to verify its targeting effect on HOXD10. Methods: HiSeq/MiSeq high-throughput sequencing was used to screen the different microRNA expression profiles, target genes and action pathways in the serum exosomes of patients with malignant glioma. Samples were used to evaluate the expression of candidate microRNAs in serum exosomes of high-grade gliomas. The effects of miR-376b-3p on the proliferation, invasion and angiogenesis of glioma cells were detected by MTT assay, Transwell migration assay and Matrigel vasculogenic mimicry assay. The mRNA and protein expression of HOXD10 were detected to evaluate the regulatory effect of miR-376b-3p on it. Results: There were 144 different expression microRNAs in the serum exosomes between malignant glioma and the normal control. Focal adhesion and tumor protein polysaccharides were involved in the regulation of glioma enriched by KEGG(Kyoto Encyclopedia of Genes and Genomes). MiR-376b-3p was down regulated in malignant glioma, and AUC of malignant glioma was 0.85 (P<0.01). MTT test showed that the proliferation ability of miR-376b-3p inhibitor group was higher than that of the control group, and that of miR-376b-3p mimic group was lower than that of the control group. Transwell migration test showed that the number of transmembrane cells in miR-376b-3p inhibitor group was higher than that in NC inhibitor group, and the number of transmembrane cells in miR-376b-3p mimic group was lower than that in NC mimic group. The number of tubes of vasculogenic mimicry in miR-376b-3p mimic group was lower than that in NC mimic group. MiR-376b-3p inhibitor decreased the expression level of HOXD10 mRNA and protein, and miR-376b-3p mimic increased the expression level of HOXD10 mRNA and protein. Conclusions: MiR-376b-3p is down-regulated in the serum exosomes of malignant glioma patients. The up-regulated miR-376b-3p can reduce the proliferation and invasion of glioma cells, inhibit the formation of vasculogenic mimicry, and increase the expression of HOXD10, which is expected to inhibit the formation of two forms of angiogenesis at the same time. MiR-376b-3p may be a new therapeutic target of anti-angiogenesis for malignant glioma.

Keywords: Exosomes; Glioma; microRNA.

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9
Zhonghua Yi Xue Za Zhi
. 2020 Jun 9;100(22):1741-1744. doi: 10.3760/cma.j.cn112137-20191212-02707.
[Clinical Analysis of Intravenous-Cardiac Leiomyomatosis]
[Article in Chinese]
Y Zhao 1, Z H Huang 1, W Fu 1, T S Liu 1, R Dong 1
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PMID: 32536097 DOI: 10.3760/cma.j.cn112137-20191212-02707
Abstract in English , Chinese
Objective: To summarize the clinical characteristics, treatment and prognosis of patients with right intravenous-cardiac leiomyomatosis, and provide references for clinical diagnosis and management. Methods: The clinical data of 22 patients who were admitted to Department of Cardiac Surgery in Beijing Anzhen Hospital from November 2009 to July 2019 were retrospectively reviewed. The long-term prognosis of the patients was also evaluated. Results: All patients were women, with an age of (48.1±6.3) years. The clinical manifestations of patients lacked specificity. Among them, 14 patients had a history of uterine leiomyoma, 12 had hysterectomy, and 5 had abortions. Twenty patients underwent tumor resection. One-stage operation was performed in 15 cases, while staging surgery was performed in 5 cases. Ten cases underwent tumor resection under cardiopulmonary bypass. One case underwent a tricuspid valve annuloplasty at the same time. There was no death early in postoperative period. Early complications included deep venous thrombosis (2 cases), type Ⅱ atrioventricular block (1 case), pleural effusion (1 case) and incision infection (1 case). In the long-term follow-up (3 years), one case died of tumor recurrence-associated circulatory failure. Among the rest of the patients, the quality of life was satisfying, and cardiac function was between grade Ⅰ and Ⅱ, with no recurrence or metastasis. Conclusions: Patients with intravenous-cardiac leiomyomatosis are lack of specific manifestations. Early diagnosis is crucial for the treatment of this disease. Tumor resection is an effective treatment, which can improve the quality of life and long-term survival of patients.

Keywords: Heart neoplasms; Intravenous-cardiac leimyomatosis; Prognosis.

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10
Zhonghua Yi Xue Za Zhi
. 2020 Jun 16;100(23):1820-1825. doi: 10.3760/cma.j.cn112137-20190924-02105.
[Effects of Maslinic Acid on Isoproterenol-Induced Myocardial Fibrosis in Mice]
[Article in Chinese]
Z Guo 1, D Fan 1, F Y Liu 1, C Y Kong 1, Q Z Tang 1
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PMID: 32536130 DOI: 10.3760/cma.j.cn112137-20190924-02105
Abstract in English , Chinese
Objective: To investigate the effect of maslinic acid (MA) on isoproterenol (ISO)-induced myocardial fibrosis in mice. Methods: ISO was used to induce myocardial fibrosis in adult male C57BL/6 mice, and MA was administered for two weeks to detect the effects of MA on cardiac function and fibrosis. Molecular changes of fibrosis markers and signaling pathways were detected by RT-PCR and western blotting. Phosphate buffer saline (PBS), PBS+SB203580 (p38 MAPK inhibitor), PBS+MA, ISO, ISO+SB203580, ISO+MA were added to the primary cultured rat fibroblasts. Cells were collected after 48 h for subsequent detection. Results: In this study, the mouse model of myocardial fibrosis was successfully established. The left ventricular faction shortening (FS) and maximum rate of rise and maximum rate of fall of pressure in left ventricular chamber (±dp/dt) of the ISO+MA group were significantly higher than those of the ISO group ((35.1±1.8)% vs (28.5±2.6)%, (7 256±153) mmHg/s vs (6 402±240) mmHg/s, (7 156±163) mmHg/s vs (6 319±219) mmHg/s, all P<0.05). The levels of interstitial and perivascular collagen deposition in the ISO+MA group were higher than those in the ISO group (P<0.05), the relative mRNA levels of COL-1, COL-3 and TGF-β in the ISO+MA group were significantly lower than those in the ISO group, with the relative expression levels of 1.70±0.24 vs 3.69±0.34, 1.72±0.56 vs 4.84±0.82, 1.52±0.19 vs 2.64±0.29, respectively (all P<0.05). The phosphorylation levels of p38 MAPK, Smad3 and protein expression level of TGF-β1 in ISO+MA group were lower than those in ISO group (relative expression levels were 1.67±0.35 vs 2.61±0.58, 1.68±0.23 vs 2.52±0.19,1.56±0.15 vs 2.48±0.26, respectively, all P<0.05). The results of in vitro cell experiments showed that the mRNA levels of COL-1, COL-3 and TGF-β in the SB203580 and MA groups were significantly lower than those in the ISO group (relative expression levels were 2.25±0.51, 2.16±0.48 vs 5.29±1.21; 1.58±0.34, 1.69±0.29 vs 4.97±1.32; 1.41±0.31, 1.55±0.38 vs 3.53±0.56, respectively, all P<0.05). The phosphorylation levels of p38 MAPK and Smad3 in the SB203580 MA groups was significantly lower than those in the ISO group, and the protein expression level of TGF-β1 was lower than that in the ISO group (1.81±0.18, 1.77±0.16 vs 2.56±0.32; 1.85±0.21, 1.81±0.17 vs 2.48±0.37; 1.84±0.24, 1.72±0.17 vs 2.52±0.29, all P<0.05). Conclusion: Maslinic acid can inhibit the phosphorylation of p38 MAPK, thereby preventing the canonical TGF-β1/Smads fibrosis signaling pathway to achieve an anti-fibrosis role.

Keywords: Maslinic acid; Myocardial fibrosis; TGF-β1 signal pathway; p38 MAPK.

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11
Zhonghua Yi Xue Za Zhi
. 2020 Jun 2;100(21):1654-1657. doi: 10.3760/cma.j.cn112137-20191029-02340.
[Diagnostic Accuracy of Liver and Spleen Stiffness by Two Dimensional Shear Wave Elastography for Portal Hypertension in Hepatitis B-related Cirrhosis]
[Article in Chinese]
Y L Zhu 1, H Ding 1, T T Fu 1, Z T Xu 1, L Y Xue 1, S Y Chen 2, W P Wang 1
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PMID: 32486601 DOI: 10.3760/cma.j.cn112137-20191029-02340
Abstract in English , Chinese
Objective: To assess the diagnostic accuracy of liver and spleen stiffness measured by two dimensional shear wave elastography (2D-SWE) in hepatitis B-related cirrhosis. Methods: The clinical data of fifty-eight hepatitis B-related cirrhosis patients were collected in Zhongshan Hospital, Fudan University from September 2017 to April 2018. Pearson's correlation analyses were used to assess the relationship between liver/spleen stiffness (L-SWE and S-SWE) and hepatic venous pressure gradient (HVPG), as well as the comparison with serological model. The SWE diagnostic performances of Liver (L-SWE), Spleen (S-SWE) were also evaluated. Results: Of all 58 patients, 47 were found HVPG ≥10 mmHg, diagnosed as clinically significant portal hypertension (CSPH) and severe portal hypertension (SPH), which patients are at increased risk of developing complications. Thirty-four patients were found HVPG≥12 mmHg, diagnosed as SPH, which patients were at increased risk of variceal bleeding. Moderate positive correlation was found between L-SWE and HVPG (r=0.42, P<0.01), and S-SWE were significantly correlated with HVPG (r=0.68, P<0.01), while serological models and HVPG were slightly correlated (r=0.36 and 0.28, all P<0.01). The area under the receiver operating characteristic curves of L-SWE, S-SWE and the combination for CSPH were 0.78, 0.88 and 0.89. When L-SWE was>12.86 kPa or S-SWE was>35.73 kPa, patients were at increased risk of developing complications. The area under the receiver operating characteristic curves for SPH were 0.68, 0.81 and 0.77 and the S-SWE had the highest specificity, so when S-SWE was>41.5 kPa, patients were at increased risk of variceal bleeding. Conclusion: L-SWE and S-SWE are reliable and promising non-invasive parameters to assess CSPH and SPH.

Keywords: Elasticity imaging techniques; Hepatic veins; Hypertension, portal; Liver cirrhosisi.

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12
Zhonghua Yi Xue Za Zhi
. 2020 Jun 16;100(23):1778-1782. doi: 10.3760/cma.j.cn112137-20200302-00555.
[Pathogenicity and Drug-Resistance Analysis of Candida glabrata in Patients With Oral Candidiasis]
[Article in Chinese]
C He 1, Y Song 1, X K Chang 1
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PMID: 32536122 DOI: 10.3760/cma.j.cn112137-20200302-00555
Abstract in English , Chinese
Objective: To investigate the detection rate, population features and in vitro antifungal drug susceptibility of Candida glabrata in patients with oral candidiasis. Methods: The saliva fungi culture cases and the ratio of Candida glabrata in patients with oral candidiasis were analyzed during 2014-2018. Fungal species were identified by CHROMagar Candida chromogenic medium and API 20C AUX yeast identification kit. Sixty strains with cfu≥200/ml were collected and performed the in vitro antifungal susceptibility tests by using ATB FUNGUS 3 susceptibility kit. Results: The number of patients with oral candidiasis was 12 401 and the ratio of Candida glabrata was 3.44% (427/12 401) from 2014 to 2018. The positive ratio of infection increased with age increasing.The positive rate of female aged 41 to 50 years old began to increased. Female aged more than 50 years old subgroups demonstrated the tendency towards increased positive rates with increasing age. It was found out through clinical data analyzing that the patients with oral candidiasis were the most and oral lichen planus, Sjögren's syndrome and xerostomia carrying high quantity ratios of infection. Candida glabrata had highest resistance(8.3%) to the fluconazole, 6.7% of the isolates were of non-WT phenotype to itraconazole and voriconazole, all of the isolates were of WT phenotype to amphotericin B. Conclusions: The ratio of infection in the patients with oral candidiasis increased with age increasing and the olders are susceptible to infection. Candida glabrata has a certain resistance to azoles and clinically reasonable use of antifungal drugs according to the results of drug susceptibility is very important.

Keywords: Candida glabrata; Infection; Microbial sensitivity tests; Mouth.

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13
Zhonghua Yi Xue Za Zhi
. 2020 Jun 16;100(23):1768-1772. doi: 10.3760/cma.j.cn112137-20200210-00230.
[Value of Magnetic Resonance Imaging Texture Analysis in Evaluating Renal Allograft Injury]
[Article in Chinese]
L Pan 1, Z Y Xing 2, W Xing 1, J Chen 1, J L Ding 1, T T Zha 1, Y W Zhang 1
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PMID: 32536120 DOI: 10.3760/cma.j.cn112137-20200210-00230
Abstract in English , Chinese
Objective: To explore the value of magnetic resonance imaging (MRI) texture analysis in evaluating renal allograft injury. Methods: A retrospective review was performed on sixty-six patients who underwent allograft renal transplantation (42 males, 24 females; age range, 22-63 years; mean age, (40±10) years) between November 2013 and December 2016. All the patients were divided into three groups according to their eGFR on the day of MRI examination: normal renal allograft function (nRAF) group (n=15), mild to moderate renal allograft injury (mRAI) group (n=18), and severe renal allograft injury (sRAI) group (n=33). All the patients underwent conventional T(2) weighted image (T(2)WI), susceptibility weighted imaging (SWI), and blood-oxygen level dependent (BOLD) MRI examination. MRI texture features of renal allograft were extracted. The texture features based on T(2)WI, SWI, and BOLD with absolute correlation coefficient of eGFR greater than or equal to 0.3 (P<0.05)and also with the highest Z value for Boruta algorithmwere selected. The diagnostic performance of the selected texture features in differentiating the three groups was assessed by receiver operating characteristic (ROC) curve analysis. Results: T(2)WI_Perc.50%, SWI_Perc.01%, BOLD_S(4,4)Contrast, and BOLD_S(5,5)Correlat with absolute correlation coefficient of eGFR greater than or equal to 0.3 (P<0.05) and also with the highest Z value for Boruta algorithm were selected. The AUC for T(2)WI_Perc.50%, SWI_Perc.01%, and BOLD_S(5,5)Correlat in differentiating the nRAF group with the mRAI group was 0.785, 0.720, and 0.700. The AUC for T(2)WI_Perc.50%, SWI_Perc.01%, BOLD_S(4,4)Contrast, and BOLD_S(5,5)Correlat in differentiating the nRAF group with the sRAI group was 0.687, 0.733, 0.784, and 0.737.The AUC for BOLD_S(4,4) Contrast in differentiating the mRAI group with the sRAI group was 0.667. Conclusion: MRI texture analysis can provide valuable information for evaluating renal allograft injury.

Keywords: Kidney transplantation; Magnetic resonance imaging; Texture analysis.

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14
Zhonghua Yi Xue Za Zhi
. 2020 Jun 2;100(21):1668-1675. doi: 10.3760/cma.j.cn112137-20191101-02376.
[microRNA-16-5p Targeted Tetraspanin 15 Gene to Inhibit the Proliferation, Migration and Invasion of Osteosarcoma Cell Through Phospoinositide 3-kinase/protein Kinase B Signaling Pathway]
[Article in Chinese]
J B Yu 1, H J Zhang 2, L W Yan 3, F Chang 1, Z W Jia 1, X R Yang 4
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PMID: 32486604 DOI: 10.3760/cma.j.cn112137-20191101-02376
Abstract in English , Chinese
Objective: To study the effects of miR-16-5p on proliferation, migration and invasion of osteosarcoma cells and its mechanism. Methods: Quantitative polymerase chain reaction (qPCR) and Western blotting were used to detect the mRNA and protein expression of miR-16-5p and TSPAN15 in human normal osteoblasts hFOB 1.19 and osteosarcoma cells MG63, Saos2 and HOS. The miR-16-5p or si-TSPAN15 was transfected into MG63 cells to observe its role in cell proliferation, migration and invasion. Cell proliferation was measured with MTT assay, cell migration and invasion were examined by Transwell, and the protein expression of CyclinD1, matrix metalloproteinase 2 (MMP-2), MMP-9, tetraspanin 15 (TSPAN15), phospha-tidylinositol3-kinase(p-PI3K) and phospha-protein kinase B(p-AKT) were determined by using Western blotting. The starbase website prediction combined with dual luciferase gene reporter assay was performed to analyze the targeting relationship between miR-16-5p and TSPAN15. miR-16-5p and pcDNA-TSPAN1 were co-transfected to assess the effect of high expression of TSPAN15 on overexpression of miR-16-5p-induced proliferation, migration and invasion of MG63 cells. Data comparison between the two groups was performed by using t test. Results: Compared with hFOB 1.19 cells (1.00±0.12), the expression of miR-16-5p was significantly decreased in MG63, Saos2 and HOS cells (0.32±0.05, 0.40±0.04, 0.45±0.06, respectively)(F=156.204, P<0.05), and TSPAN15 mRNA and protein levels were greatly increased (F=71.718, 110.350, both P<0.05). Overexpression of miR-16-5p obviously reduced the expression of CyclinD1, MMP-2, MMP-9 protein, cell viability, cell migration and invasion (F=150.136,117.228, 154.971, 89.479, 98.373, 130.880, all P<0.05) in MG63 cells. Knockdown of TSPAN15 greatly reduced CyclinD1, MMP-2, MMP-9 protein levels, cell survival rate, cell migration, and invasion number (F=93.206, 107.030, 109.326, 115.625, 146.113, 139.300, all P<0.05). Overexpression of miR-16-5p markedly decreased the expression of p-PI3K and p-AKT protein in MG63 cells (F=156.755, 181.419, both P<0.05). miR-16-5p targeted to regulate the expression of TSPAN15. High expression of TSPAN15 partially reversed the inhibitory effect of miR-16-5p on TSPAN15, CyclinD1, MMP-2, MMP-9, p-PI3K, p-AKT protein expression, cell viability, cell migration number and invasion number in MG63 cells. Conclusion: miR-16-5p inhibits the proliferation, migration and invasion of osteosarcoma cells by targeting the TSPAN15 gene and regulating the PI3K/AKT signaling pathway.

Keywords: Osteosarcoma; Phospha-tidylinositol3-kinase/protein kinase B signaling pathway; Proliferation; Tetraspanin 15; microRNA-16-5p.

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15
Zhonghua Yi Xue Za Zhi
. 2020 Jun 2;100(21):1662-1667. doi: 10.3760/cma.j.cn112137-20191113-02469.
[Effect of Different Mechanical Ventilation Modes on Patient-Ventilator Synchrony and Diaphragm Function in Rabbit Model of Acute Respiratory Distress Syndrome]
[Article in Chinese]
X Y Wu 1, J J Yin 1, J Q Yu 1, R Q Zheng 1
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PMID: 32486603 DOI: 10.3760/cma.j.cn112137-20191113-02469
Abstract in English , Chinese
Objective: To observe the effect of different modes of mechanical ventilation on patient-ventilator synchrony and diaphragm function in rabbits with acute respiratory distress syndrome(ARDS). Methods: Eighteen New Zealand rabbit models of ARDS were induced by intratracheal infusion hydrochloric acid until the oxygenation index (PaO(2)/FiO(2)) was less than 200 mmHg, and then divided into three groups with random number: assisted-controlled mechanical ventilation (A/C) group, pressure support ventilation (PSV) group and neurally adjusted ventilatory assist (NAVA) group. All of them were ventilated for four hours with the targeted tidal volume (V(T)) (6 ml/kg) and the positive end-expiratory pressure (PEEP) titrated with the maximum oxygenation method. Gas exchange, pulmonary mechanics and patient-ventilator synchrony were determined during 4 h of ventilation and the concentrations of malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione (GSH) in diaphragm were measured after 4 h of ventilation. The q test was used for the multiple comparison of the sample mean. Results: There were no significant differences in PaO(2)/FiO(2) between three groups during ventilation 1-4 h (F=1.029, P>0.05). The V(T) in NAVA group was obviously lower than that in PSV group and the respiratory rate (RR) and the electrical activity of diaphragm(EAdi) were higher than those in A/C group(all P<0.05).The trigger delay and off cycle delay the in NAVA group were markedly lower than those in A/C and PSV group during ventilation 1-4 h(F=14.312, 9.342, both P<0.05). Asynchrony index in NAVA group (3.1%±1.0%) was obviously lower than those in A/C group (22.3%±5.2%) and PSV group(8.4%±2.3%) (F=7.192, P<0.05). In NAVA group, peak EAdi (EAdi(peak)) and peak airway pressure (Ppeak) were markedly correlated (r=0.97±0.16, P<0.05), while Ppeak delivery in A/C and PSV group was not correlated to EAdi(peak) (r=0.38±0.13,0.46±0.15, both P>0.05).Compared with A/C group, the concentration of MDA in the diaphragm in NAVA group was obviously lower(P<0.05). SOD and GSH level inthe diaphragm in NAVA group were both obviously higher than those in A/C group (both P<0.05). Conclusions: It is helpful to avoid eccentric contraction of diaphragm, lessen oxidative stress and alleviate ventilator-related diaphragm dysfunction by keeping spontaneous breathing as far as possible and subject-ventilator synchrony when ventilation in ARDS with NAVA.

Keywords: Diaphragm electrical activity; Diaphragm function; Mechanical ventilation; Respiratory distress syndrome, adult; Subject-ventilator synchrony.

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16
Zhonghua Yi Xue Za Zhi
. 2020 Jun 9;100(22):1736-1740. doi: 10.3760/cma.j.cn112137-20200106-00033.
[Analysis of Clinicopathological Features of Clear Cell Tumor of the Lung]
[Article in Chinese]
Y Liu 1, X H Zhang 2, B T Wang 2, L L Shen 3, J Yuan 4, W Chen 4, J Gao 4, H Y Shi 4
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PMID: 32536096 DOI: 10.3760/cma.j.cn112137-20200106-00033
Abstract in English , Chinese
Objective: To analyze the clinicopathological features of clear cell tumor of the lung (CCTL). Methods: A total of 9 cases were collected from August 2008 to August 2019 in the Department of Pathology of the First Medical Center of PLA General Hospital and Hainan Hospital of PLA General Hospital. Their clinical data, pathological characteristics, immunohistochemical staining and special staining results were summarized and analyzed. Results: There were 3 males and 6 females, aged from 28 to 70 years (average 52.2 years). All tumors were located in the peripheral part of the lung, and were solitary in 8 cases, and multiple (24 nodules) in 1 case. The lesion was round or oval, with clear boundary. The diameter of the nodule was 0.5-5.5 cm. Histologically, the tumor cells were oval, short fusiform or polygonal, with obvious nucleoli. The tumor cells were mostly distributed in sheet around thin-walled vessels, and there was hyaline degeneration around the blood vessels. Neither necrosis nor mitosis could be seen. Immunohistochemical staining showed tumor cells were diffusely positive for Vimentin, and CD34, Melan-A, specific monoclonal antibody against melanoma (HMB45) and S-100 were positive with different degrees. Broad spectrum cytokeratin (CK), epithelial membrane antigen (EMA), smooth muscle actin (SMA), desmin, CD10, paired box gene 8 (PAX-8) or myomodulatory protein (Myo-D1) were all negative. The positive index of the proliferating cell nuclear antigen (Ki-67) was low. Schiff dyeing with periodate (PAS) staining was positive, PAS staining of glycogen digested by amylase (d-PAS) staining was negative. All the tumors in the nine cases were resected and patients were followed up for 5-137 months. Except 1 case was lost for follow-up, the other 8 cases survived without recurrence or metastasis of the disease. Conclusions: CCTL is a rare benign tumor, most of which are single, few of which can be multiple; histopathological characteristics and immunohistochemical staining are helpful for diagnosis and differentiated diagnosis. After complete resection, the prognosis was good. However, when histological features indicating malignancy, intense follow-up should be considered.

Keywords: Clear cell tumor, lung; Disease attributes; Pathology.

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17
Zhonghua Yi Xue Za Zhi
. 2020 Jun 16;100(23):1812-1815. doi: 10.3760/cma.j.cn112137-20191023-02305.
[Five Cases of Optic Neuropathy Associated With Varicella Zoster Virus Infection]
[Article in Chinese]
C Meng 1, C T Lai 1, Y Jing 1, H L Sun 1, H Q Jiang 1, Q L Yang 1, L Liu 1, J W Wang 1
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PMID: 32536128 DOI: 10.3760/cma.j.cn112137-20191023-02305
Abstract in English , Chinese
Objective: To investigate the clinical characteristics, treatment and prognosis of optic neuropathy associated with varicella zoster virus (VZV). Methods: Five cases of optic neuropathy associated with VZV infection from Department of Neurology between January 1, 2014 and March 31, 2019 were retrospectively collected. The clinical manifestations, treatment and prognosis were analyzed. Results: There were 7 eyes involved in 5 cases, 3 cases (3/5) involved only one eye, and 2 cases (2/5) involved both optic nerves. During the follow-up time, no recurrence was found. Severe visual impairment occurred in 4 eyes (4/7) and non-severe visual impairment in 3 eyes (3/7). Visual acuity improved significantly in 1 eye (1/7), turned better in 2 eyes (2/7), and remained unchanged in 4 eyes (4/7). In acute phase, abnormal signals of optic nerve and/or sheath were observed on MR images. Case 3 received antiviral and hormone therapy on the second day after the onset of the disease, and the visual acuity recovered well; the other 4 cases had poor prognosis. Conclusions: Head and face VZV infection can cause serious optic neuropathy, leading to severe visual dysfunction, and poor prognosis, but recurrence is rare. Early intravenous administration of antiviral drugs (acyclovir is the best) and hormones are recommended for VZV infection in this area. It is best to use drugs within 72 hours in order to avoid and reduce secondary optic neuropathy as far as possible.

Keywords: Optic neuritis; Optic perineuritis; Varicella zoster virus.

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18
Zhonghua Yi Xue Za Zhi
. 2020 Jun 9;100(22):1699-1703. doi: 10.3760/cma.j.cn112137-20190913-02031.
[Novel Compound Heterozygous LoF Mutations in SRD5A2 May Result in Disorders of Sex Development]
[Article in Chinese]
C C Yao 1, R H Tian 1, P Li 1, H X Chen 1, E L Zhi 1, Y H Huang 1, L Y Zhao 1, C Yang 1, L Zhang 1, Y J Li 1, X Li 2, Z Li 1
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PMID: 32536088 DOI: 10.3760/cma.j.cn112137-20190913-02031
Abstract in English , Chinese
Objective: To investigate the novel genetic cause associated with hypospadias and the strategy for preventing offspring genetic defects in these patients. Methods: In March 2019, a patient with gonadal dysplasia (hypospadias associated with cryptorchidism) was referred to Shanghai General Hospital. His secondary sex characters, level of sex hormones and the development of male reproductive system was assessed through physical examination, sex hormone examination, male reproductive system B-ultrasound and computed tomography (CT). Whole-exome sequencing (WES) was preformed to investigate the pathogenic genetic variations associated with hypospadias and cryptorchidism. Also, Sanger sequencing was conducted to verify the WES results in the pedigree. Semen analysis was used to assess the fertility of the proband and the SRD5A2 gene analysis of his spouse was performed to assess the risk of genetic defects in the offspring. Results: The patient suffered from gonadal dysplasia (hypospadias associated with cryptorchidism). Physical examination showed an inverted triangular distribution of pubic hair, small penis and the volume of the testis was 8 ml. Sex hormone examination revealed the level of FSH, LH, Pituitary prolactin (PRL), estrogen (E(2)), testosterone (T), and sex hormone-binding globulin (SHBG) was 25.81 U/L, 10.84 U/L, 21.09 μg/L, 153 pmol/L, 16.95 nmol/L, and 36.15 nmol/L respectively. B-ultrasound and computed tomography (CT) showed left inguinal testis. Also, semen analysis illustrated that the volume was 0.05 ml and sperm concentration<2×10(6)/ml, suggesting oligospermia in this case. WES sequencing and Sanger sequencing showed compound heterozygous LoF mutations in SRD5A2 [NM_000348.3:C.679C>T(p.Arg227Ter) and NM_000348.3:C.16C>T(p.Gln6Ter)] in this patient. And there were no pathogenic genetic variations of SRD5A2 in the spouse. Conclusion: Novel compound heterozygous LoF mutations in SRD5A2[NM_000348.3:C.679C>T(p.Arg227Ter) and NM_000348.3:C.16C>T(p.Gln6Ter)] may be the primary cause of disorders of sex development.

Keywords: Disorders of sex development; Gene mutations; SRD5A2.

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19
Zhonghua Yi Xue Za Zhi
. 2020 Jun 2;100(21):1629-1633. doi: 10.3760/cma.j.cn112137-20190911-02011.
[Comparison of the Accuracy of Predicting Prognosis of Brain Function in Patients After Cardiopulmonary Cerebral Resuscitation With Two Kinds of Electroencephalogram Techniques Combined With Neuron-Specific Enolase]
[Article in Chinese]
J P Lu 1, C H Che 1, H P Huang 1
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PMID: 32486597 DOI: 10.3760/cma.j.cn112137-20190911-02011
Abstract in English , Chinese
Objective: To compare the accuracy of electroencephalography (EEG) grading or amplitude-integrated electroencephalography (aEEG) grading combined with NSE in predicting brain function prognosis after cardiopulmonary cerebral resuscitation (CPR) in adults. Methods: The patients who were admitted to Fujian Medical University Union Hospital after CPR from January 2015 to June 2019 were enrolled. Demographic data, Glasgow coma scale (GCS), blood neuron specific enolase (NSE), EEG grading and aEEG grading were collected. The main clinical outcome was the prognosis of brain function (Glasgow-Pittsburgh cerebral performance category, CPC) in patients at 3 months after CPR. Accordingly, the patients were divided into two groups: favorable prognosis group and poor prognosis group, and relevant parameters were compared between the two groups. The predictive ability of EEG grading or aEEG grading combined with NSE for brain function prognosis was evaluated by receiver operating characteristic (ROC) curve. Results: A total of 57 patients were enrolled, with 34 males and 23 females. The average age was (65±19) years old. In terms of Young EEG scales, there was 16 grade 1 cases (28.1%), 24 grade 2-5 cases (42.1%) and 17 grade 6 cases (29.8%), respectively. As for aEEG grading, there was 11 grade Ⅰ cases (19.3%), 25 grade Ⅱ cases (43.9%) and 21 grade Ⅲ cases (36.8%), respectively. There was no significant difference of age, sex, length of stay between the two groups (all P>0.05). However, there was significant difference of EEG grading scale, aEEG grading, GCS grading and NSE between the two groups (all P<0.05). The area under curve (AUC) of NSE, EEG grading and aEEG grading for predicting brain function prognosis was 0.81, 0.82 and 0.85, respectively (all P<0.01). In aEEG grading combined with NSE group, the AUC of was 0.92, and the optimal cut-off point was 4.5, with a sensitivity of 95.8% and a specificity of 79.0%. In EEG grading combined with NSE group, the AUC was 0.90, and the optimal cut-off point was 3.6, with a sensitivity of 92.1% and a specificity of 77.0%. Conclusions: aEEG grading combined with NSE is more accurate in predicting prognosis in patients with cardiopulmonary cerebral resuscitation when compared to EEG grading. Considering its feasibility, aEEG grading combined with NSE is more suitable for clinical application.

Keywords: Amplitude-integrated electroencephalogram; Brain function prognosis; Cardio-pulmonary resuscitation; Neuron specific enolase.

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20
Zhonghua Yi Xue Za Zhi
. 2020 Jun 9;100(22):1720-1724. doi: 10.3760/cma.j.cn112137-20191030-02355.
[Long-term Prognosis of Drug Eluting Stents Implantation in Elderly Patients With Unprotected Left Main Coronary Artery Disease]
[Article in Chinese]
Y Pan 1, Q Qiu 2, Y Mu 2, Z Wu 3, X P Yu 1, J Q He 1
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PMID: 32536093 DOI: 10.3760/cma.j.cn112137-20191030-02355
Abstract in English , Chinese
Objective: To analyze the clinical characteristics and long-term prognosis of implantation of drug-eluting stents (DES) for elderly patients with unprotected left main artery (ULM) disease. Methods: A total of 414 patients (327 males and 87 females) who underwent DES implantation were enrolled in the Department of Cardiology, Beijing Anzhen Hospital from January 2005 to March 2010, with a mean age of (61.5±10.7) years old. The patients were divided into two groups according to age: 300 cases in the group of age <70 years old, and 114 cases in the group of age ≥70 years old. The clinical characteristics and long-term prognosis of two groups were compared. Results: In the group of age ≥ 70 years old, the proportion of female was higher (31.6% vs 17.0%, P=0.001) and the incidence of chronic total occlusion (CTO) (P=0.020), hypertension (P=0.018) and cerebrovascular disease (P=0.013) were higher than those in the group of <70 years old. All-cause mortality and cardiac mortality were also higher than those in the group of <70 years old (P=0.025, P=0.013). The follow-up period was (21.4±9.6) months. After adjusting for multiple clinical factors, there were no statistical differences of incidence of the total major adverse cardiac and cerebral events (MACCE), myocardial infarction, cerebrovascular events, and revascularization recurrence between the two groups. But all-cause mortality (HR=3.790, 95%CI: 1.271-11.298, P=0.017) and cardiac mortality (HR=17.424, 95%CI: 2.440-124.410, P=0.004) in the group of age ≥70 years old were still remarkably higher than those in the group of <70 years old. Conclusions: Age is an independent risk factor for increased mortality after DES stent implantation in ULM disease. DES stent implantation in age ≥70 years old patients with ULM disease is considered feasible, but it needs to be treated with caution.

Keywords: Aged; Coronary artery disease; Drug-eluting stent; Unprotected left main artery disease.

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21
Zhonghua Yi Xue Za Zhi
. 2020 Jun 2;100(21):1658-1661. doi: 10.3760/cma.j.cn112137-20190917-02057.
[Investigation Into the Timely Return Visit Rates After First Interview in Adolescent Clients to the Psychiatric Outpatient Clinic of a General Hospital]
[Article in Chinese]
M H Chen 1, F L Qu 1, L N Zhou 1, L Ye 1, X L Wang 1
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PMID: 32486602 DOI: 10.3760/cma.j.cn112137-20190917-02057
Abstract in English , Chinese
Objective: To investigate the timely return visit rates after first visits of adolescent clients to the psychiatric outpatient clinic in a general hospital and analyze the relevant factors. Methods: All adolescent clients firstly visited psychiatric outpatient clinic of the Third Affiliated Hospital of Sun Yat-sen University from May to October 2018 were surveyed. The timely return visit was defined as the return visit within one month after the first visit and the timely return visit rate (RVR) was calculated. Chi-square test and binary Logistic regression were used to compare the RVR subgroup differences and relevant factors. Reasons for non-attendance at the return visit were acquired by the telephone follow-up. Results: A total of 1 121 cases were enrolled, with an age of (16.0±1.6) years, 85.8% of them were students, and the overall RVR was 62.7% (703/1 121). The highest RVR was found in those who hoped for drug treatment (69.8%) and the lowest in those who did not accept drug treatment (55.8%) (χ(2)=9.028, P=0.029). The highest RVR was found in hospitalized patients (97.6%), followed by outpatient pharmacotherapy group (61.2%) and keeping observation and self-adjustment group (45.3%) (χ(2)=82.269, P<0.001). The RVR of patients prescribed mood stabilizers was significantly higher than that of non-users (χ(2)=9.498, P=0.002). Logistic regression analysis showed the main factors that affect the timely return visit included treatment regimens and prescribing of mood stabilizers. Results of telephone follow-up of clients with non-attendance showed that the main reasons were symptoms alleviation (68.4%) and various visiting barriers (14.3%). Conclusions: Clients with active attitude towards pharmacotherapy, hospitalization and using mood stabilizers in outpatient have higher RVR rates. Insufficient understanding of systemic therapy remains the main reason why the clients fail to attend the return visit in time.

Keywords: Adolescent; Follow-up; Outpatient clinic; Psychiatry department; Return visit rate.

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22
Zhonghua Yi Xue Za Zhi
. 2020 Jun 9;100(22):1711-1714. doi: 10.3760/cma.j.cn112137-20190917-02056.
[The Surgical Treatment of Male Perineum Paget's Disease]
[Article in Chinese]
H Han 1, Y N Niu 1, H E Lei 1, X D Zhang 1, X G Zhou 1, L Tian 1
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PMID: 32536091 DOI: 10.3760/cma.j.cn112137-20190917-02056
Abstract in English , Chinese
Objective: To evaluatethe clinical efficacy and complications of skin graft and flap plastic technique covered the defect in perineal Paget's disease postoperatively. Methods: The study comprised 6 patients diagnosed with perineal Paget's disease at Beijing Chao-Yang Hospital from June 2017 to July 2019, with all available clinical data reviewed. The defects after resection of lesions were reconstructed with skin graft, advancement skin flap during the operation, respectively. The operation time, the skin graft or flap survival situation, intraoperative and postoperative complications were recorded. Results: Of all 6 patients, Ray stage A1consisted of 1 case, A2 5 cases. The age was (68±9) years, the hospitalization time was (14.8±8.1) days, the BMI was (25.6±3.7) kg/m(2), the operation time was (132.0±80.7) min, and the average blood loss was (18.3±11.7) ml. Five cases was with Paget's disease, and 1 case with skin adenocarcinoma with Paget's disease were diagnosed by pathology. The defects of 4 cases and 2 cases after removal of the tumor were reconstructed with scrotal advancement skin flap and skin graft, respectively. The skin graft and flap survived well during afollow-up of (15.3±8.1) months.There has been no local recurrence. The foreskin edema and wound infection were noted in 4 cases and 1 case, respectively. There was no other related complications. Conclusion: Perineal Paget's disease can be managed by resection and immediate reconstruction with skin graft or flap according to the size and location of the defect, and the clinical efficacy is distinct.

Keywords: Paget disease, extramammary; Perineum; Plasticsurgery; Surgical flaps.

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23
Zhonghua Yi Xue Za Zhi
. 2020 Jun 16;100(23):1805-1811. doi: 10.3760/cma.j.cn112137-20200221-00382.
[Cell Morphological Analysis of Hepatosplenic T-cell Lymphoma Gamma-Delta Type]
[Article in Chinese]
P Wu 1, H P Sun 1, L J Wan 1, C Y Zhou 1, T Wang 1, H X Liu 1, H Wang 1
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PMID: 32536127 DOI: 10.3760/cma.j.cn112137-20200221-00382
Abstract in English , Chinese
Objective: To analyze the cell morphological features of hepatosplenic T-cell lymphoma (HSTCL) gamma-delta (γδ) type, differentiate from acute leukaemia (AL). Methods: This was a retrospective study. The clinical data of four cases of HSTCL γδ type who were treated in Hebei Yanda Ludaopei Hospital from 2009 to 2014 were collected. Their initial morphology diagnoses in other hospitals were all acute leukemia or myelodysplastic syndrome (MDS). Morphological analysis and cytochemical stains to their bone marrow (BM) aspiration and peripheral blood (PB) smears were completed when they had no response to previous chemotherapies, and the morphological reports were compared with results of immunophenotyping, chromosome, and T cell receptor (TCR) gene rearrangement. Results: The percentages of malignant cells in four patients' BM aspirations were 7.6%-40.0%, and in two patients' PB was 9% and 10%, respectively. The morphology of four cases had a very high similarity in Wright's stain. Predominantly medium-sized cells were seen, with rich cytoplasm and frequently one big conspicuous nucleolus. The malignant cells resembled blasts, especially monoblasts, but with coarse granular chromatin, more compact than that in monoblasts. When comparing to malignant myeloblast and lymphoblasts, HSTCL cells were larger and more irregular in cell shape, with more abundant cytoplasm and prominent nuclear irregularity. The cytochemistric stain played an important role in differential diagnosis. HSTCL malignant cells showed non-specific esterase (NSE) negative or focal punctate activity which couldn't be inhibited by sodium fluoride. Periodic acid-Schiff (PAS) stain was negative or positive with a form of coarse granules. The myeloperioxdase (MPO) stain was negative. Conclusion: Malignant cells of HSTCL γδ type have very distinct morphological features of mature lymphocytic neoplasm. The quality of Wright's stain, being short of complete cytochemical stains, lacking of awareness of this disease, and acute leukemia or MDS like appearance in some cases, result in the possibility of diagnostic error as malignant blast, and probably are main causes of misdiagnosis of HSTCL γδ type.

Keywords: Diagnostic errors; Lymphoma; T-Lymphocytes.

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24
Zhonghua Yi Xue Za Zhi
. 2020 Jun 16;100(23):1795-1799. doi: 10.3760/cma.j.cn112137-20191212-02716.
[Evaluation of the Systematic Functional Rehabilitation on Rheumatoid Arthritis Patients Following Total Knee Arthroplasty]
[Article in Chinese]
W Han 1, K Wang 2, S Zhang 1, B L Kou 2
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PMID: 32536125 DOI: 10.3760/cma.j.cn112137-20191212-02716
Abstract in English , Chinese
Objective: To evaluate the effects of functional rehabilitation on rheumatoid arthritis patients after the total knee arthroplasty (TKA). Methods: Two hundred rheumatoid arthritis patients (259 knees) were enrolled in this study at Arthritis Clinic and Research Center, Peking University People's Hospital from January 2012 to December 2017. All patients received the primary total knee arthroplasty, followed by a systematic functional rehabilitation. The same procedure of rehabilitation was followed, which consisted of patients' education, resistance training, passive and active range of motion exercise, balance exercise, gait training and daily-activity training. According to the degree of postoperative residual flexion contracture, these patients were divided into three groups: the severe (≥30°), moderate(15°-30°), and mild (≤15°). The outcomes of functional rehabilitation were evaluated among different groups and compared with those before the rehabilitation, which included the active range of motion (AROM), the flexion and extension angle of the knee, pain on the visual analogue scale (VAS). The complications and their impacts on the process of rehabilitation were also studied. Independent t test was applied to compare the data before and after the rehabilitaton. Results: There were 17 males (20 knees) and 183 females (239 knees) in this group, aged (57±13) years with a disease course of (16±10) years. There were significant improvements after the functional rehabilitation, including the flexion angle, the extension angle, AROM and pain VAS (76°±12° vs 112°±9°, 12.9°±10.2° vs 2.4°±4.6°, 63°±15° vs 110°±10° and 3.7±1.2 vs 2.0±0.4, respectively; t=39.0, 15.1, 41.3, 21.2, all P<0.01). The residual flexion contracture after the surgery in 259 knees were all improved, among which 195 knees (75.3%) reached a complete correction. Compared with the mild flexion contracture, the moderate and severe group had a lower complete correction rate (80.2% vs 45.9%, χ(2)=20.15, P<0.05). Total of 141 patients (70.5%) suffered from anemia two days after the surgery. By offering the anti-anemia treatment during the systematic rehabilitation, all cases of anemia were healed. The length of hospital stay was longer in the patients with moderate and severe anemia when compared with that in mild anemia ((13±5) days vs (11±5) days, t=2.2, P=0.028). Conclusion: The systematic functional rehabilitation is an effective treatment for rheumatoid arthritis patients after TKA, which can not only help release the pain after surgery, but also assist patients to achieve a better function of the knee.

Keywords: Arthritis, rheumatoid; Arthroplasty, replacement, knee; Rehabilitation.

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25
Zhonghua Yi Xue Za Zhi
. 2020 Jun 9;100(22):1715-1719. doi: 10.3760/cma.j.cn112137-20191220-02781.
[Detection of Right-To-Left Shunt With Transthoracic Contrast Echocardiography in Patients With Pulmonary Hypertension]
[Article in Chinese]
X G He 1, W M Xie 2, J Wan 2, A L Li 3, Y N Zhai 3, Z G Zhai 2
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PMID: 32536092 DOI: 10.3760/cma.j.cn112137-20191220-02781
Abstract in English , Chinese
Objective: To explore the value of right heart contrast echocardiography in etiological diagnosis and severity assessment of pulmonary hypertension (PH). Methods: A retrospective analysis was conducted on 74 patients who underwent transthoracic contrast echocardiography in China-Japan Friendship Hospital from May 2015 to July 2018, all of whom were diagnosed as PH by right heart catheterization. Patients were divided into three groups according to contrast echocardiography: the intra-cardiac shunt group (<4 cardiac cycles with microbubbles in the left heart); Intrapulmonary shunt group (>4 cardiac cycles with microbubbles in the left heart); non-shunt group. The etiology, partial arterial oxygen pressure (PO(2)), N-terminal pro-brain natriuretic peptide (NT-proBNP), mean pulmonary artery pressure (mPAP), right atrial pressure (RAP), pulmonary vascular resistance (PVR) and cardiac output (CO) were analyzed. Central nervous system complications were also compared among the three groups. Results: Among the 74 patients, right-to-left shunt was found in 28 cases (37.8%) by contrast echocardiography, including 11 cases (14.9%) of intra-cardiac shunt and 17 cases (23.0%) of intrapulmonary shunt. In the 11 cases of intra-cardiac shunt, 7 were diagnosed with congenital heart disease and 4 were patent foramen. Two with hereditary hemorrhagic telangiectasia (HHT) and 1 with pulmonary arteriovenous malformation (PAVM) were included in the 16 cases of intrapulmonary shunt. There was no statistical difference in PO(2), mPAP, PVR, NT-proBNP, RAP, CO and functional class among the three groups (all P>0.05). A total of 5 cases (6.8%) were found with nervous system comorbidities, 4 cases (5.4%) with cerebral infarction and 1 cases epilepsy, and 2 cases of cerebral infarction were diagnosed as paradoxical embolism. Nervous system complications were more common in patients with intra-cardiac shunt than in other groups. Conclusion: While right-to-left shunt detected by contrast echocardiography has no relationship with disease severity, it has complementary value in the etiological diagnosis of PH, and intra-cardiac shunt may increase the risk of nervous system complications.

Keywords: Contrast echocardiography; Heart catheterization; Pulmonary hypertension.

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26
Zhonghua Yi Xue Za Zhi
. 2020 Jun 16;100(23):1783-1788. doi: 10.3760/cma.j.cn112137-20200303-00574.
[A Multicenter Randomized Prospective Study of Concurrent Chemoradiation With 60 Gy Versus 50 Gy for Inoperable Esophageal Squamous Cell Carcinoma]
[Article in Chinese]
Y J Xu 1, W G Zhu 2, Z X Liao 3, Y Kong 1, W W Wang 2, J C Li 4, R Huang 5, H He 5, X M Yang 6, L P Liu 7, Z W Sun 7, H J He 8, Y Bao 9, M Zeng 10, J Pu 11, W Y Hu 12, J Ma 13, H Jiang 14, Z G Liu 15, T T Zhuang 16, B X Tan 17, X H Du 1, G Q Qiu 1, X Zhou 1, Y L Ji 1, X Hu 1, J Wang 1, H L Ma 1, X Zheng 1, J Huang 18, A W Liu 19, X D Liang 20, H Tao 21, J Y Zhou 22, Y Liu 23, M Chen 1
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PMID: 32536123 DOI: 10.3760/cma.j.cn112137-20200303-00574
Abstract in English , Chinese
Objective: To determine whether 60 Gy is superior to standard 50 Gy for definitive concurrent chemoradiation(CCRT) in esophageal squamous cell carcinoma (ESCC) using modern radiation technology in a phase Ⅲ prospective randomized trial. Methods: From April 2013 to May 2017, 331 patients from 22 hospitals who were pathologically confirmed with stage ⅢA-ⅣA ESCC were randomized to 60 Gy or 50 Gy with random number table. Total of 305 patients were analyzed, including 152 in 60 Gy group and 153 in 50 Gy group. The median age was 63 years, 242(79.3%) males and 63(20.7%) females. The median length of primary tumor was 5.6 cm. The clinical characteristics between two groups were comparable. All patients were delivered 2 Gy per fraction, 5 fractions per week. Concurrent weekly chemotherapy with docetaxel (25 mg/m(2)) and cisplatin (25 mg/m(2)) and 2 cycles consolidation chemotherapy with docetaxel (70 mg/m(2)) and cisplatin (25 mg/m(2), d1-3) were administrated. The primary endpoint was local/regional progression-free survival (LRPFS). The data were compared with Pearson chi-square test or Fisher's exact test. Results: At a median follow-up of 27.3 months, the disease progression rate was 37.5% (57/152), 43.8% (67/153) in the high and standard-dose group, respectively (χ(2)=1.251, P=0.263). The 1, 2, 3-year LRPFS rate was 75.4%, 56.8%, 52.1% and 74.2%, 58.4%, 50.1%, respectively (HR: 0.95, 95%CI: 0.69-1.31, P=0.761). The 1, 2, 3-year overall survival rate was 84.1%, 64.8%, 54.1% and 85.4%, 62.9%, 54.0%, respectively (HR: 0.98, 95%CI: 0.71-1.38, P=0.927). The 1, 2, 3-year progression-free survival rate was 70.8%, 54.2%, 48.5% and 65.5%, 51.9%, 45.1%, respectively (HR: 0.93, 95%CI: 0.68-1.26, P=0.621). The incidence rates in toxicities between the two groups were similar except for higher rate of severe pneumonitis in high dose group (χ(2)=11.596, P=0.021). Conclusions: The efficacy in disease control is similar between 60 Gy and 50 Gy using modern radiation technology concurrent with chemotherapy for ESCC. The 50 Gy should be recommended as the regular radiation dose with CCRT for ESCC.

Keywords: Esophageal neoplasms; Prognosis; Radiation dose; Radiotherapy; Squamous cell carcinoma.

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27
Zhonghua Yi Xue Za Zhi
. 2020 Jun 2;100(21):1623-1628. doi: 10.3760/cma.j.cn112137-20190920-02077.
[The Impact of Metabolic Syndrome and Its Individual Components on Long-Term Prognosis of Patients Undergoing Percutaneous Coronary Intervention]
[Article in Chinese]
H H Wang 1, S D Jia 1, Y Liu 1, J J Xu 1, Z Gao 1, Y Song 1, X F Tang 1, P Jiang 1, X Y Zhao 1, L Song 1, Y Zhang 1, J Chen 1, Y J Yang 1, R L Gao 1, S B Qiao 1, B Xu 1, J Q Yuan 1, L J Gao 1
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PMID: 32486596 DOI: 10.3760/cma.j.cn112137-20190920-02077
Abstract in English , Chinese
Objective: To investigate the impact of metabolic syndrome (MS) and its individual components on long-term prognosis of patients undergoing percutaneous coronary intervention(PCI). Methods: Patients who underwent PCI in Fuwai Hospital in 2013 were enrolled and divided to two groups: with MS and without MS. The primary endpoint of 2-year follow-up was major adverse cardiovascular events (MACE), including death, myocardial infarction, and repeat revascularization. Results: Of the 10 422 PCI patients, there were 5 656 (54.27%) without MS and 4 766 (45.73%) with MS. Patients in the MS group were younger, tended to be male and had more comorbidities. There were no significant differences between the two groups in the proportion of drug-coated stents and the success rate of interventional therapy. The 2-year follow-up showed that the incidence of MACE in the MS group was significantly higher than that in the MS-free group (12.0% vs 10.0%, P<0.001), which was mainly due to the significantly higher revascularization rate in the MS group than in the non-MS group (9.5% vs 7.9%, P=0.003). Cox's regression analysis showed that MS was an independent risk factor for MACE. In MS component analysis, abnormal glucose metabolism was an independent risk factor for MACE events. Conclusions: Among the patients undergoing PCI, the incidence of MACE in patients with MS is significantly higher than that in patients without MS, and MS was an independent risk factor for MACE. In addition, hyperglycemia is an independent predictor for MACE.

Keywords: Long-term prognosis; Metabolic syndrome; Percutaneous coronary intervention.

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28
Zhonghua Yi Xue Za Zhi
. 2020 Jun 2;100(21):1640-1647. doi: 10.3760/cma.j.cn112137-20191211-02701.
[Application of Mass Spectrometry Combined With Next Generation Sequencing in the Diagnosis of Neonatal Inherited Metabolic Diseases]
[Article in Chinese]
W X Jiang 1, L P Chen 1, H Li 2, Z B Guo 2, Y Yuan 3, B Zhou 3, W Q Lu 1, L Yang 4, B B Wu 4, M L Zhou 1
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PMID: 32486599 DOI: 10.3760/cma.j.cn112137-20191211-02701
Abstract in English , Chinese
Objective: To explore the application value of mass spectrometry (MS) combined with next generation sequencing (NGS) in diagnosing neonatal inherited metabolic diseases (IMD). Methods: The clinical information, metabolites in blood and urine, and gene sequencing results of 19 neonates with IMD coming from the Department of Neonatology of Jiangxi Provincial Children's Hospital from March 2017 to September 2019 were analyzed retrospectively. The metabolites in blood were detected by liquid chromatography tandem mass spectrometry and urine were detected by gas chromatography-mass spectrometry respectively.Meanwhile, the whole bloods were dectected by neonatal genetic disease panel based on NGS. Results: Twelve neonates had the same results between MS and NGS among the 19, 2 had different results from MS to NGS, and 4 had no disease indication by MS but were diagnosed by NGS whose clinical phenotype were partially consistent with NGS results. One of them who did not carry out MS was considered as the diagnosis of IMD because of the detection of gene, and was followed up on this basis. Conclusion: MS could diagnose IMD relatively quickly to guide clinical treatment, and while NGS could verify the results of MS detection. Combination of MS and NGS would understand the cause of disease on genetic level, so as to guide further treatment and genetic consultation.

Keywords: Genetic testing; Metabolic diseases; Newborn; Tandem mass spectrometry.

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29
Zhonghua Yi Xue Za Zhi
. 2020 Jun 9;100(22):1708-1710. doi: 10.3760/cma.j.cn112137-20190910-01997.
[Application of Penile Index in the Diagnosis and Therapeutic Evaluation of Concealed Penis in Children]
[Article in Chinese]
J Sun 1, H T Zhao 1, L Zhong 1, X Y Zou 1
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PMID: 32536090 DOI: 10.3760/cma.j.cn112137-20190910-01997
Abstract in English , Chinese
Objective: To explore the significance of penile index in the diagnosis of concealed penis and the evaluation of therapeutic efficacy. Methods: A retrospective study was conducted on 221 children with phimosis and 113 children with concealed penis aged 6-10, all of whom had undergone circumcision or phalloplasty respectively in Shanghai Children's Medical Center from January 2014 to December 2017. Penile index was measured before and after surgery. The values of phimosis and concealed penis were tested by group t test. Self -control test was performed for values of concealed penis before and after operations. Results: Penile index was 0.78±0.08 in children with phimosis. It was 0.23±0.10 in concealed penis before operation and changed to 0.84±0.11 postoperatively. In children with phimosis and concealed penile, the difference of penile index was statistically significant (P<0.001). The difference of penile index before and after operation was statistically significant (P<0.001) in children with concealed penis. Conclusion: Penile index is an effective index to evaluate the degree of penis exposure.

Keywords: Abnormality; Child; Penis.

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30
Zhonghua Yi Xue Za Zhi
. 2020 Jun 9;100(22):1730-1735. doi: 10.3760/cma.j.cn112137-20200211-00245.
[Evaluation of the Effectiveness of Bronchial Thermoplasty in Patients With Severe Asthma in the Real World Two Years After Bronchial Thermoplasty Treatment]
[Article in Chinese]
Y Nong 1, J T Lin 1, X Chen 1, H Y Long 1, H W Li 1
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PMID: 32536095 DOI: 10.3760/cma.j.cn112137-20200211-00245
Abstract in English , Chinese
Objective: To assess the effectiveness of bronchial thermoplasty (BT) in "real-world" patients with severe asthma at 2 years post therapy. Method: Outcomes of 70 patients with severe asthma undergoing bronchial thermoplasty from March 2014 to November 2017 in China-Japan Friendship Hospital were retrospectively analyzed two years post therapy. The scores of Asthma Control Test (ACT) and Mini Asthma Quality of Life Questionnaire (mini-AQLQ), the number of severe exacerbations, emergency department visits and hospitalizations for asthma symptoms in the past year, indicators of pulmonary function including forced expiratory volume in one second (FEV(1)), FEV(1) as a percentage of predicted value (FEV(1)%pred) and FEV(1)/forced vital capacity (FEV(1)/FVC), maintenance asthma medications, the cost of asthma drugs and the total annual cost of asthma treatment were evaluated and analyzed before and 2 years after BT therapy, and the subjective assessment about effectiveness of BT were given by the patients. Results: Before and 2 years after BT, the numbers of subjects suffering severe exacerbations in the past year were 70 (100%) and 37 (52.9%), and the numbers of total severe exacerbations were 575 and 162 respectively. The numbers of patients having emergency department visits due to asthma exacerbation were 46 (65.7%) and 9 (12.9%), and the numbers of emergency department visits were 186 and 19 respectively. The numbers of patients hospitalized due to asthma exacerbation were 43 (61.4%) and 16 (22.9%), and the numbers of total hospitalizations were 124 and 24, respectively. The rate of severe exacerbation, emergency department visit and hospitalization were significantly reduced two years after the treatment by 71.9%, 88.9% and 83.3% (all P<0.001). The scores of ACT and mini-AQLQ were significantly increased [22 (21, 24) vs 17 (13, 19), (5.57±0.89) vs (3.83±0.92); both P<0.001]. Two years after BT, 4 patients (5.7%) were weaned off inhaled corticosteroids (ICS) and long-acting β(2)-agonist (LABA), while 14 patients (37.8%) were weaned off oral corticosteroid (OCS), with daily dose of ICS and OCS significantly decreased (both P<0.05). The proportion of patients treated with montelukast sodium and theophylline was also significantly reduced after BT (40.0% vs 81.4%, 27.1% vs 71.4%; both P<0.001). In addition, the indicator of FEV(1), FEV(1)%pred and FEV(1)/FVC ratio were all greatly improved two years after the treatment [2.27 (1.84, 2.82) vs 2.10 (1.70, 2.61) L, (76.8±19.5)% vs (72.5±19.8)%, (66.3±13.6)% vs (63.8±13.0)%; all P<0.05]. The annual cost for asthma drug and asthma treatment after BT were significantly decreased (P<0.001). Fifty-nine patients (84.3%) subjectively assessed the treatment as effective. Conclusion: The bronchial thermoplasty in "real-world" patients with severe asthma could significantly improve the asthma control, lung function and quality of life, and reduce severe exacerbations, emergency department visits and hospitalizations for asthma symptoms, while the maintenance asthma medications, the cost of asthma drugs and the total annual cost of asthma treatment are significantly decreased.

Keywords: Asthma; Bronchial thermoplasty; Therapeutics; Treatment outcome.

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31
Zhonghua Yi Xue Za Zhi
. 2020 Jun 9;100(22):1745-1749. doi: 10.3760/cma.j.cn112137-20190905-01975.
[Expression and Clinical Significance of LRFN4 in Colorectal Cancer Tissue]
[Article in Chinese]
F Zheng 1, X L Zhai 2, W J Wang 1, K P Guo 1, C C Xiao 1, Q C Ni 3
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PMID: 32536098 DOI: 10.3760/cma.j.cn112137-20190905-01975
Abstract in English , Chinese
Objective: To investigate the expression and clinical significance of LRFN4 in colorectal cancer. Methods: A total of 210 cases of colorectal cancer tissues and 228 cases of corresponding surgical margin tissues were collected. Immunohistochemistry was employed to evaluate the expression of LRFN4 in colorectal cancer.The correlation between LRFN4 expression and clinicopathological features of colorectal cancer as well as patient outcome were analyzed. Results: The positive rate of LRFN4 in colorectal cancer and in non-cancer was 55.24%(116/210), and 37.28% (85/228) , respectively.The expression of LRFN4 in colorectal cancer tissues was higher than that in non-cancer tissues(χ(2)=14.196, P<0.001). High expression of LRFN4 was significantly correlated with tumor location(χ(2)=4.133,P=0.042), T staging(χ(2)=6.494,P=0.039), N staging(χ(2)=11.715,P=0.008), TNM staging(χ(2)=13.398,P=0.004), CEA (χ(2)=6.017, P=0.049), but without gender, age, degree of differentiation, M staging(P>0.05).The Kaplan-Meier survival curves indicated that high LRFN4 expression was associated with good survival (P<0.05). In addition, Cox proportional hazards model showed that the high expression of LRFN4(HR=0.585, P=0.018)was an independent risk factor for prognosis in patients with colorectal cancer. Conclusions: The expression of LRFN4 is up-regulated in colorectal cancer, which is significantly correlated with the clinicopathological features and prognosis. High expression of LRFN4 reduced the risk of death in patients with colorectal cancer.

Keywords: Colorectal cancer; LRFN4; Prognosis.

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32
Zhonghua Yi Xue Za Zhi
. 2020 Jun 16;100(23):1816-1819. doi: 10.3760/cma.j.cn112137-20191212-02705.
[Correlation Between Elevation of Brachial Artery Pulse Pressure Increased and Coronary Heart Disease in Different Genders]
[Article in Chinese]
Y Q Si 1, Z J Ding 1, W F Wang 1, W C Shan 1, R J Wang 1, F Shi 1, W W X Sun 1
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PMID: 32536129 DOI: 10.3760/cma.j.cn112137-20191212-02705
Abstract in English , Chinese
Objective: To explore the relationship between elevation of brachial pulse pressure and coronary heart disease in different genders. Methods: A total of 5 116 inpatients with suspected stable coronary heart disease were consecutively enrolled from December 2011 to June 2017 in the Affiliated Hospital of Chengde Medical College, and divided into coronary heart disease group (n=3 694) and non-coronary heart disease group (n=1 422). The clinical data of all inpatients were collected. A binary logistic regression model of coronary heart disease in different genders were separately established. Results: The morbidity of hypertension, dyslipidemia, type 2 diabetes, ischemic stroke and elevated pulse pressure were all higher in the coronary heart disease group than those in the non-coronary heart disease group (all P<0.05). The area under curve (AUC) of pulse pressure in the male group was 0.540, with an optimal diagnostic threshold of 50 mmHg. The AUC of pulse pressure in the female group was 0.612, with an optimal diagnostic threshold of 60 mmHg. Besides hypertension, type 2 diabetes, increase of low-density lipoprotein cholesterol, ischemic stroke, smoking, and aging, elevated pulse pressure was also an independent risk factor for coronary heart disease in both male and female groups (all P<0.05). Additionally, the risk of elevated pulse pressure for coronary heart disease was higher in female group than that of male group (odds ratio (OR): 1.741 vs 1.284, P<0.05). Conclusion: Elevated pulse pressure may be a new risk factor for coronary heart disease, and its risk for coronary heart disease is higher in women than in men.

Keywords: Coronary heart disease; Diagnosis; Pulse pressure; Risk factor.

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33
Zhonghua Yi Xue Za Zhi
. 2020 Jun 2;100(21):1601-1604. doi: 10.3760/cma.j.cn112137-20200404-01080.
[The Choices, Benefits and Risks of Drug Holidays for Treatment of Osteoporosis]
[Article in Chinese]
H Lin 1, Q Wang 2
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PMID: 32486594 DOI: 10.3760/cma.j.cn112137-20200404-01080
Abstract
骨质疏松症治疗的药物假期，是指经过长期治疗取得满意疗效；药物暂停后，患者仍可从抗骨折疗效中获益，而药物不良反应风险将随之降低。药物假期是药物的选择性暂停使用，而非永久性停用。目前有关药物假期的指导决策证据有限，其方案执行应根据患者的临床客观指标，个体化分析而决定。药物假期不适用于高骨折风险人群。.

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34
Zhonghua Yi Xue Za Zhi
. 2020 Jun 16;100(23):1789-1794. doi: 10.3760/cma.j.cn112137-20200304-00586.
[Clinical Features of Intracranial Vessel Involvement in Takayasu's Arteritis]
[Article in Chinese]
Y Q Guo 1, J Du 1, L L Pan 1, X Guo 2
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PMID: 32536124 DOI: 10.3760/cma.j.cn112137-20200304-00586
Abstract in English , Chinese
Objective: To analyze clinical characteristics of intracranial vessel involvement in Takayasu's arteritis (TA). Methods: Retrospectively analyzed 135 hospitalized TA patients' clinical data in Beijing Anzhen Hospital from November 2012 to November 2018. Based on intracranial artery (IA) complicated or not, TA patients were divided into two groups:32 patients within involvement and 103 patients without involvement. The difference in comparison of imaging types, basic data and laboratory test were analyzed. Results: The proportion of TA patients with intracranial vascular involvement was 23.7% (32/135) and the most common site was internal carotid artery (intracranial segment) (59.4%, 19/32). The incidences of hypertension and coronary heart disease were significantly higher in TA patients with intracranial vascular involvement compared with the patients without intracranial involvement (46.9% vs 26.2%, 21.9% vs 6.8%, χ(2)=4.863, 4.460, all P<0.05). The rate of tocilizumab treatment in the intracranial vascular involved group was higher than that in the group without intracranial vascular involvement (40.6% vs 19.4%, χ(2)=5.945, P<0.05). The platelet count in patients with intracranial involvement group was significantly lower than that in patients without intracranial involvement group [(218±55)×10(9)/L vs (272±71)×10(9)/L, t=-3.570, P<0.01], while the hemoglobin [(130±17) vs (121±18) g/L, t=2.363, P<0.05] and triglyceride [1.22(0.75, 1.64) vs 0.92(0.63, 1.21) mmol/L, U=1 017.000, P<0.01] were significantly higher than those without intracranial vascular involvement. Moreover, coronary artery involvement presented more frequently in the intracranial vascular involved group than the group without intracranial vascular involvement (43.8% vs 14.6%, χ(2)=12.331, P<0.01). Logistic regression analysis showed that the incidence of intracranial vascular disease in TA patients with coronary artery involvement was 4 times higher than that in patients without coronary artery lesions (OR=3.965, 95%CI:1.584-9.926, P=0.003). Conclusion: The proportion of intracranial vascular involvement in TA is not rare, TA patients with cardiovascular risk factors should be considered to strengthen imaging examination of intracranial vessels.

Keywords: Cerebrovascular disorders; Takayasu′s arteritis; Treatment outcome.

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35
Zhonghua Yi Xue Za Zhi
. 2020 Jun 9;100(22):1684-1687. doi: 10.3760/cma.j.cn112137-20200301-00527.
[The Controversy and Influence Brought by the Modification of the Diagnostic Standard of Pulmonary Hypertension]
[Article in Chinese]
C M Xiong 1, Z G Zhai 2, C Wang 3
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PMID: 32536087 DOI: 10.3760/cma.j.cn112137-20200301-00527
Abstract
2018年第六届世界肺动脉高压大会上专家提出了修改肺动脉高压的诊断标准，引起国内外专家的广泛争议。我们应该如何看待这个问题呢？国内专家也有困惑。本文详细解析了肺动脉高压的定义、诊断标准的变迁、修改诊断标准的必要性及其带来的影响，提出了我国应对修改肺动脉高压诊断标准的一些建议。.

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36
Zhonghua Yi Xue Za Zhi
. 2020 Jun 9;100(22):1681-1683. doi: 10.3760/cma.j.cn112137-20200303-00575.
[Thoughts on the Application of Plastic Surgical Techniques to Phallus Surgery of Andrology]
[Article in Chinese]
Y F Zhang 1, C Cheng 1, Y Liu 1, S X Ma 1, K X Cheng 1
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PMID: 32536086 DOI: 10.3760/cma.j.cn112137-20200303-00575
Abstract
整形外科是主要对组织缺损或体表器官畸形进行整形修复或再造的学科，其基本理念是组织移植、改善外形和防治瘢痕。阴茎属于男性特有的器官，男科学中融入整形外科理念有助于形成学科鲜明特色。在包皮过长、隐匿性阴茎、尿道下裂以及小阴茎畸形的手术治疗中，均需要应用整形外科技术和理念，实现手术的精细化和个性化，以期获得更好的治疗效果，最终使患者受益。.

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Zhonghua Yi Xue Za Zhi
. 2020 Jun 15;100(0):E023. doi: 10.3760/cma.j.cn112137-20200515-01549. Online ahead of print.
[Population Medicine: A Newly Emerging Subject Healing the Schism Between Preventive Medicine and Clinical Medicine]
[Article in Chinese]
W Z Yang 1, Z W Leng 1, G L Shan 2, C Wang 3
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PMID: 32536042 DOI: 10.3760/cma.j.cn112137-20200515-01549
Abstract
在医学实践中，预防医学与临床医学的裂痕由来已久，其根源性因素在于两类学科一直并行发展，弱化了对医学生大健康意识的培养，固化了医学生的思维。近些年，国际上提出群医学概念，为弥补这一裂痕提出了思路。本文通过回顾群医学的定义、发展、学科建设、人才培养及实践情况，认为当前我国实施健康中国战略，必须通过群医学学科建设推动"以治病为中心"向"以人民健康为中心"的转变，具体措施包括建立完整的涵盖学历教育、毕业后教育、继续教育群医学教育培训体系，在临床及公共卫生实践中灌输群医学理念，建立群医学示范基地并开展宣传倡导推动群医学学科在全国发展。.

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