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Table of Content

    05 October 2020, Volume 40 Issue 10
    Original Articles
    Application of hsa-miR-10a-5p in severe community acquired pneumonia
    YE Jun, LIU Dan-yu, HE Quan, HUANG Feng-ming, ZHU Hua-dong, XU Jun, JIANG Cheng-yu
    2020, 40(10):  1313-1319. 
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    Objective To explore the role of hsa-miR-10a-5p in severe community acquired pneumonia (SCAP) and to evaluate the potential of hsa-miR-10a-5p as a SCAP biomarker. Methods microRNA sequencing (27 SCAP blood samples and 10 healthy control blood samples) and bioinformatics methods were used to explore hsa-miR-10a-5p as a potential marker of the severity of community acquired pneumonia. The role of hsa-miR-10a-5p in SCAP was examined in combination with mRNA sequencing (41 SCAP blood samples and 10 healthy control blood samples), target gene prediction, and gene functional enrichment analysis. Results hsa-miR-10a-5p level was significantly down-regulated in SCAP, with more down-regulation in the death group. The level of hsa-miR-10a-5p was negatively correlated with the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, and the area under the receiver operating characteristic curve (AUC) of the microRNA level predicting SCAP prognosis was 0.776. When SCAP occurred, the predicted targeted gene of hsa-miR-10a-5p regulated biological processes and pathways whick were closely related to the development of pneumonia. Conclusions hsa-miR-10a-5p can indicate the severity of community acquired pneumonia and predict the prognosis as a potential biomarker.
    HK2 promotes migration and proliferation of human cervical cancer cell lines
    LEI Dan, ZHANG Yan-ru, CHEN Qian, LI Lu, CUI Nan
    2020, 40(10):  1320-1327. 
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    Objective To investigate the molecular mechanism of HK2 on promoting cell proliferation and migration through p-ERK1/2 in cervical cancer cell line HeLa. Methods Expression of HK2 in cervical cancer cell lines was detected by Western blot and immunocychemistry. Over-expressed HK2 cell line(HeLa-HK2) was established by using G418. Wound-healing and Transwell cells assays were used to detect the migratory and invasive potential in HeLa-HK2 and in control cell lines. Cell growth curves, MTT assay and flow cytometry were used to detect cell proliferation, cell viability and cell cycle. The expression of ERK1/2, p-ERK1/2, cyclin A and Slug was detected by using Western blot and immunocytochemistry. The ERK inhibitor (FR180204) was used to inhibit expression of ERK1/2 and p-ERK1/2, and the potential of cell proliferation, migration and invasion was observed in these cells. Results HeLa-HK2 cells that stably expressing HK2 was successfully constructed. HK2 enhanced cell migration, invasion and growth potential in HeLa cells. The expression of ERK1/2, p-ERK1/2, cyclin A and Slug was higher in HeLa-HK2 cells than those in control cells. The protein level of ERK1/2, p-ERK1/2, cyclin A and Slug was decreased in FR180204 treated HeLa-HK2 cells, and the potential of growth, migratory and invasive were also attenuated by FR180204 in HeLa-HK2 cells. Conclusions HK2 promotes cell growth, migration and invasion in HeLa cells by up-regulating expression of cyclin A and Slug through stimulating p-ERK1/2.
    Bioinformatics analysis and verification of the long non-coding RNA lnc-DC
    HU Xue-ting, WU Xiao-feng, XU Xiang
    2020, 40(10):  1328-1334. 
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    Objective To obtain the relevant information of human long non-coding RNA lnc-DC by bioinformatical analysis and to confirm its expression and the regulator concerned in the skin. Methods The expression of lnc-DC in human normal tissues was downloaded from NCBI and confirmed by FISH;Transcription factors bind to lnc-DC promoter were predicted by JASPAR and confirmed by siRNA and qPCR; The proteins potential bind to lnc-DC were predicted by catRAPID; lnc-DC binding proteins were analyzed by Enrichr. Results lnc-DC was highly expressed in esophagus and skin; Transcription factors like GATA3 bound to lnc-DC promoter; RNA binding proteins U2AF2,HNRDL,TIAR,PTBP1 and TIA1 potential bound to lnc-DC. Conclusions The bioinformatics online tools may predict transcription regulators and molecular mechanisms of lnc-DC, indicating the important role of GATA3 regulated lnc-DC in the maintenance of normal skin function.
    GPRC5A promotes migration and invasion of human osteosarcoma cell line 143B
    SONG Qi, CHENG An-yuan, YU Ling, XU Li
    2020, 40(10):  1335-1341. 
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    Objective To investigate the effect and mechanism of GPRC5A (G protein-coupled receptor family C, member 5, group A) gene on the migration and invasion of osteosarcoma cell line 143B. Methods Differentially expressed genes in metastatic tumors were screened out from the GSE32981 data set, and the survival analysis of the differentially expressed genes was performed in combination with the TCGA database. CCK8 experiment, scratch experiment and Transwell invasion experiment were carried out to detect the effect of GPRC5A knockdown or overexpression on osteosarcoma cell proliferation, migration and invasion. Western blot and RT-qPCR detected the effect of GPRC5A knockdown or over-expression on protein and mRNA levels of EMT related genes. Results The expression of 299 genes was changed in metastatic osteosarcoma, and 37 genes closely related to the survival of osteosarcoma patients were further screened out combined with TCGA database. The results of cell experiments showed that GPRC5A had no effect on the proliferation of osteosarcoma cells, but GPRC5A over-expression could significantly promote osteosarcoma cells migration and invasion(P<0.05). GPRC5A overexpression promoted the expression of EMT-related proteins N-Cad and Vim, and inhibited the expression of E-Cad(P<0.05). Conclusions GPRC5A is closely related to the survival of osteosarcoma patients and may promote the migration and invasion of osteosarcoma cells by inducing EMT, so it is believed to be a potential target for anti-osteosarcoma metastasis drugs.
    Effect of abdominal paracentesis drainage on TLR4 expression in liver of rats with early severe acute pancreatitis
    CHEN Zhen-yu, HUANG Qi-lin, SUN Hong-yu, LIU Li-ye, WEN Yi
    2020, 40(10):  1342-1347. 
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    Objective To investigate the effect of abdominal paracentesis drainage (APD) on TLR4 expression in the liver of rats with early severe acute pancreatitis (SAP) and its significance. Methods The rats were randomly divided into sham operation group (sham group), SAP group(SAP model was established by retrograde injection of 5% sodium trasulfide cholate into the pancreatic bile duct) and SAP+APD group(drainage tube was placed and fixed on the basis of SAP). HE staining, automatic biochemical analyzer, ELISA, real-time PCR and Western blot were used to detect relevant indexes. Results Compared with sham group, the pathological injury of liver and pancreas were significantly worse and the pathological scores were significantly increased in the SAP group (P<0.05), the activityies of serum amylase and lipase, serum indicators related to liver function, and serum levels of TNF-α, IL-1β were also significantly increased (P<0.05); The mRNA and protein expressions of TLR4, the protein expression of NF-κB p65, TNF-α, IL-1β , and the phosphorylation levels of NF-κB p65 in liver tissues in the SAP group were significantly up-regulated than those in the sham group (P<0.05); After APD intervention,the above indicators were significantly alleviated (P<0.05). Conclusions Implementation of APD can significantly decrease the expression of TLR4 in liver tissue of rats with early SAP, inhibit the activation of downstream NF-κB signaling pathway, thus relieve the degree of liver injury.
    Inhibition of DKK2 in hepatocellular carcinoma cell lines by hepatitis B virus X protein
    WANG Xiao-yan, DU Hong, WANG Wei, QUAN Hui-qin
    2020, 40(10):  1348-1352. 
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    Objective To analyze the effect of hepatitis B virus X protein on the expression of DKK2 in different hepatoma cell lines and its possible mechanism. Methods HepG2 and SMMC7721 cells were infected by Ad-HBx, and X gene expression was detected by immunofluorescence and PCR, and protein level of DKK2 was detected by Western blot. The hepatoma cell lines were incubated with methylated transferase inhibitor (DAC), the expressions of DKK2, Dnmt1, Dnmt3a and Dnmt3b were detected by Western blot. By silencing the methyltransferase, the expression of DKK2 was detected by Western blot. Results After HepG2 and SMMC7721 being infected with Ad-HBx, the relative expression of HBx mRNA was up-regulated by 61.12 times and 50.24 times respectively (P<0.05), the protein expression of DKK2 was down-regulated by 1.61 times (P<0.05) and 3.33 times (P<0.05), and the protein expression of Dnmt1 and Dnmt3a was significantly increased. Compared with the Ad-HBx infection group, DKK2 protein expression was up-regulated by 2.27 times(P<0.05), Dnmt3a protein expression was significantly down-regulated, Dnmt1 and Dnmt3b protein level was not significantly changed after DAC treatment. By silencing Dnmt1 and Dnmt3a, DKK2 protein expression was significantly up-regulated. Conclusions HBx inhibits the expression of DKK2 by up-regulation of Dnmt3a and Dnmt1, and then activates the Wnt/β-catenin signaling pathway, which is involved in the occurrence of HBV related liver cancer.
    Influence of follicular fluid thyroid stimulating hormone on laboratory indicators of assisted reproductive technology
    WANG Xue-ying, GUO Wei, XIE Cong-cong, YAO Guan-feng, GUO Xiao-li, HE Wei, LIU Xiao-qun
    2020, 40(10):  1353-1357. 
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    Objective To evaluate the association between thyroxin(TH) level and thyroid stimulating hormone (TSH) in follicular fluid (FF) and in serum and whether TSH affects laboratory indicators predicting assisted reproductive technology outcomes. Methods This study enrolled 142 women undergoing ART. According to the concentration of TSH in follicular fluid, the volunteers were divided into three groups: TSH<2.5 mIU/L (group A), 2.5≤TSH<4 mIU/L (group B) and TSH≥4 mIU/L (group C). Blood samples on day 2 or 3 of menstruation and the first tube of clear, blood free follicular fluid on the day of retrieval oocytes were collected to detect the levels of TSH, fT4 and fT3 with electrochemical luminescence method. Results 1)The average number of eggs obtained in group A was significantly lower than group B and group C, that of group B was significantly lower than that in group C (P<0.05); The rate of MII in group C was significantly lower than that in group A and group B(P<0.05); The fertilization rate of ICSI in group B was significantly higher than group A and group C (P<0.05);The available embryo rate in group C was significantly lower than group A and group B (P<0.05); However, the blast cyst utilization rate in group C was significantly higher than that in group A and group B (P<0.05). 2)There was a positive correlation between TSH concentration in follicular fluid and blood concentration (P<0.05), and between TSH concentration in follicular fluid and fT3 concentration (P<0.05). Conclusions TSH level in follicular fluid is positively correlated with TSH level in basal serum. TSH ≥ 4 mIU/L in follicular fluid on the day of oocyte retrieval may have some effects on ART outcome.
    Noninvasive ocular surface analyzer evaluates non-aggressively the ocular surface of patients with dry eye disease
    CHEN Guo-ling, WANG Xing-fu, HAN Yi-ping, BAO Yin-lei, LIU Shao-hua, MA Guang-feng
    2020, 40(10):  1358-1361. 
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    Objective To evaluate the clinical use of noninvasive ocular surface analyzer in checking the ocular surface of dry eye disease (DED) patients. Methods A total of 100 eyes were covered in this study, in which 50 eyes were from DED patients (named DED group) and 50 eyes were from healthy volunteers(named control group). All subjects completed following examinations and tests: detailed medical history, ocular surface disease index (OSDI) questionnaire, the first noninvasive tear breakup time(NIBUTf) and morphological characteristics of meibomian glands examined by a noninvasive ocular surface analyzer, tear breakup time by fluorescein (FBUT),corneal fluorescein staining (CFS),the eyelid, and ocular surface organization checked by the slit lamp micros-cope. Results Compared with the control group, OSDI score of DED group was significantly higher (P<0.01). NIBUTf had a positive correlation with FBUT(P<0.01). The NIBUTf and FBUT were shorter, while the scores of meibomian gland loss (MGL) and CFS were higher in DED group (all P<0.01). NIBUTf had a negative correlation with MGL score and OSDI score (all P<0.01). All subjects accepted the examinations with signed the informed consent form, and the same examination was performed by the same inspector. Conclusions The non-inva- sive ocular surface analyzer may detect the tear film stability and meibomian gland loss by a non-contact way, and it has important clinical potential to evaluate the ocular surface of dry eye patients objectively.
    miR-17-5p targeting ALDH2 reduces the damage of human lung adenocarcinoma alveolar basal epithelial tissue cell line A549 induced by Streptococcus pneumoniae
    LI Wei-wei, GE Bin, DENG Tao, TANG Jian-jun, LUO Cai-yuan, FENG Sheng-fang, MAO Yu
    2020, 40(10):  1362-1368. 
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    Objective To investigate the effect of miR-17-5p expression on the injury of human lung adenocarcinoma alveolar basal epithelial cell line A549 induced by Streptococcus pneumonia and its mechanism. Methods A549 cells was divided into control group,infected group(1×108 CFU/mL S.pneumoniae),anti-miR-17-5p intervention group (transfected with anti-miR-17-5p before S.pneumoniae infection),anti-miR-NC intervention group (transfected with anti-miR-NC before S.pneumoniae infection), and pcDNA-ALDH2 intervention group(trans- fected with pcDNA-ALDH2 before S.pneumoniae infection),and pcDNA intervention group (transfected with pcDNA before S.pneumoniae infection).The level of miR-17-5p and ALDH2 mRNA was detected by RT-qPCR. IL-6 and IL-10 in cell culture supernatant were detected by enzyme-linked immunosorbent assay. Apoptosis was detected by flow cytometry. ALDH2, Bcl-2 and Bax protein were detected by Western blot. Dual luciferase assay verified the targeting relationship between miR-17-5p and ALDH2. Results Compared with the control group, the level of miR-17-5p in the infected group was significantly increased (P<0.05), while mRNA and the protein concentration of ALDH2, IL-10 and Bcl-2 were significantly decreased (P<0.05). However, apoptotic rate and the levels of IL-6 and Bax were significantly increased (P<0.05). Compared with the infected+anti-miR-NC group, IL-10 and Bcl-2 in the infected+anti-miR-17-5p group were significantly increased(P<0.05), the apoptotic rate, IL-6 and Bax were significantly decreased (P<0.05). Compared with the infected+pcDNA group, the levels of IL-10 and Bcl-2 in the infected+pcDNA-ALDH2 group were significantly increased (P<0.05), and the apoptotic rate and the levels of IL-6 and Bax were significantly decreased (P<0.05).miR-17-5p negatively regulated ALDH2 expression.Inhibition of ALDH2 expression reversed the effect of inhibiting miR-17-5p expression on S.pneumoniae-induced A549 cells damage. Conclusions Inhibition of miR-17-5p expression reduces S.pneumoniae-induced the damage of the cell line A549 by regulating ALDH2.
    Dehydrocostuslactone inhibits proliferation and promotes apoptosis of human hepatocellular carcinoma cell line HepG2
    MIAO Jia-wei, CHEN Jie, DENG Xue-song, XIONG Shu, LI Guo-li, MA Qiang
    2020, 40(10):  1369-1373. 
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    Objective To investigate the effects of dehydrocostuslactone treatment on the proliferation and apoptosis of human HepG2 cells and potential mechanisms. Methods HepG2 cells were divided into 6 groups incubated with different concentration of Dehydrocostuslactone. The cell proliferation was evaluated by MTT assays, and Hoechst 33258 fluorescence staining was conducted to observe apoptosis of cells subsequently.The expression of p-IκBα, IκBα, nuclear p65 and total p65 proteins in HepG2 cells were measured using Western blot. Results Compared with the control group, dehydrocostuslacton,in a dose dependent manner, significantly inhibited the proliferation of HepG2 cells with impressive profile of apoptosis (P<0.05 or P<0.01). Dehydrocostuslactone, at concentrations of 10, 20 and 30 μmol/L, resulted in a significantly decrease of p-IκBα and nuclear p65 expression (P<0.05 or P<0.01) and an increased IκBα expression (P<0.05 or P<0.01), whereas no marked effect on total p65 expression was observed. Conclusions Dehydrocostuslactone inhibits proliferation and promotes apoptosis of HepG2 cells, the mechanism may be explained by the down-regulation of NF-κB pathway in HepG2 cell.
    Biosafety of 3D printed titanium alloy porous materials to osteoblast cell line MC3T3-E1
    JING Li, SHI Wen, CAO Yu, LIU Rui-sai, LIU Lu, LI Jian-yu, LIU Hui
    2020, 40(10):  1374-1380. 
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    Objective To prepare 3D-printed porous materials of titanium alloy by electron beaming melting (EBM) and to confirm its biosafety to osteoblasts (OB). Methods Three topological structures of titanium alloy porous materials (2.0 mm, 2.25 mm and 2.5 mm Dode-Medium structure) were prepared by 3D printing technology. The extracts of titanium alloy porous materials were collected at multiple time points (24,48,72,96 h) and used for in vitro culture of osteoblasts cell line MC3T3-E1. The relative growth rate (RGR) of osteoblasts was cal-culated by MTT test. The morphological observation of osteoblasts was performed by HE staining. The activity of ALP was determined for analyzing the differentiate capacity of osteoblasts. The expressional level of Col Ⅰ in osteoblasts was assessed by immunofluorescence staining. Results Following incubation with extracts of titanium alloy porous materials, the osteoblasts were found to adhere and proliferate actively. There was no significant difference in the RGR of osteoblasts between extract group and the negative control group of DMEM. However, the RGR of osteoblasts increased significantly in extract groups compared with that in the positive control group of DMSO (P<0.01). The cytotoxic degree of osteoblasts in extract groups was all less than or equal to 1. There was no significant difference in the level of ALP and Col Ⅰ of osteoblasts between extract groups and the negative control group of DMEM. However, the level of ALP and Col Ⅰ of osteoblasts enhanced significantly in extract groups compared with that in the positive control group of DMSO (P<0.01). Conclusions The extracts of titanium alloy materials do not affect the proliferation and differentiation of osteoblasts in vitro that confirmed its biosafety.
    Interpretation of CMIA test results of syphilis antibody in children
    SONG Qin-wei, WANG Ya-lin, LIU Zhi-yuan, ZHANG Yi, GAO Shuang, MA Li-juan
    2020, 40(10):  1381-1384. 
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    Objective To explore how to correctly interpret the results of CMIA screening for anti-treponema pallidum specific antibody(S/CO > 1) in children. Methods From July 2018 to June 2019, 23 038 patients had been screened for anti-TP antibody by CMIA, the positive results(S/CO > 1) were re-examined by Treponema pallidum particle agglutination assay(TPPA), TP nonspecific antibody was checked by tolulized red unheated serum test(TRUST) and TP specific IgG and IgM antibody were confirmed by Western blot. Results Totally 23 038 patients were screened for anti-TP antibody by CMIA, among them 141 were positive(S/CO>1) with and the positive rate as 0.61%(141/23 038). The re-test results of 141 children(S/CO>1) were as follows: the number of positive cases of TRUST, TPPA, IgG and IgM were 2(1.42%, 2/141), 7(4.96%, 7/141), 13(9.22%, 13/141) and 6(4.25%, 6/141), respectively. In addition, 11 cases with S/CO>10, including the number of positive cases of TRUST, TPPA, IgG and IgM were 2(18.18%, 2/11),7(63.64%,7/11), 10(90.91%, 10/11) and 3(27.27%, 3/11) , respectively, 10(90.91%, 10/11) cases of parents had syphilis history and 9(81.82%, 9/11) cases were younger than 6 months. Conclusions Screening the children with Treponema pallidum by CMIA, when the S/CO<10, the false-positive rate was high when the S/CO<10, which must be excluded by confirmatory methods. The correct interpretation of syphilis test results should combine with the age of the child and the history of syphilis of his or her parents.
    Age of onset and course of urinary stone are related with renal function damage
    QIAO Yi, XIAO He, FAN Xiao-hong, SHI Bing-bing, JI Zhi-gang, LI Han-zhong
    2020, 40(10):  1385-1388. 
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    Objective To evaluate the correlation of age of onset, course of stone with renal function among urinary stone patients. Methods Totally 183 patients' history data were reviewed, including age of onset for stone, course of stone and eGFR. We evaluated correlation of age of onset, course of stone with eGFR by multivariate linear regression, to find potential relationship of urinary stone with renal function damage. Results With higher level of renal function, mean course of stone was longer among urinary stone patients. Meanwhile, among patients with renal function at 1-3 level, mean age of onset also increased as level of renal function increasing. Furthermore, multivariate linear regression revealed that age of onset, course of stone and eGFR were in linear correlation. Conclusions With older age of onset for stone and/or longer course of stone, patients' renal function is impaired more seriously with lower eGFR among urinary stone patients.
    Expression of WNT10B is increased in lung squamous cell carcinoma
    LU Lin, GU Yi-xun, XU Xing-xiang, MIN Ling-feng, CHEN Yan-liang, WANG Xiao-lin, CHEN Yong
    2020, 40(10):  1389-1393. 
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    Objective To detect the expression of WNT10B in lung squamous cell carcinoma and to explore the correlation with pathologic feature and prognosis. Methods We collected 75 cases tissue chips of lung squamous cell carcinoma with follow-up information from Shanghai Outdo Biotech Co., ltd. The expression of WNT10B protein was examined by immunohistochemistry. Chi-squared test was used to analyze the correlation between WNT10B expression and pathological factors. Survival analysis, log-rank test and Cox proportional hazard model were employed to analyze the relationship between WNT10B expression and prognosis of patients. Results The expression of WNT10B in cancerous tissue was significantly higher than matched adjacent non-cancerous tissue (P<0.001). High expression of WNT10B was significantly correlated with T stage and tumor differentiation (P<0.05). WNT10B expression was correlated with the prognosis of patients (P<0.05) and WNT10B was an independent correlation factor for the prognosis (P<0.05). Conclusions WNT10B is involved in the occurrence and development of lung squamous cell carcinoma and is expected to be a new tumor marker and prognosis indicator.
    Clinical Sciences
    Effects of high tibia closed osteotomy and open osteotomy on posterior tibia slope and patellar height
    JI Song-jie, HUANG Ye, WANG Da-cheng, ZHANG Jin-qing, LI Yu-jun, JIANG Xu, ZHOU Yi-xin
    2020, 40(10):  1394-1398. 
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    Objective To compare the clinical outcomes of high tibial closed osteotomy and open osteotomy, as well as the changes in posterior tibia slope and patellar height. Methods A total of 120 patients (155 knees) with high tibial osteotomy performed from January 2017 to June 2018 were collected. Twenty cases (25 knees) used lateral tibial closed wedge osteotomy (LCWHTO), and 100 cases (130 knees) used medial tibial open wedge osteotomy (MOWHTO). The follow-up time was 20.7 months and 18.9 months respectively. Lysholm score and joint mobility (ROM) were evaluated at the last follow-up. The changes of mechanical axis deviation (MAD), proximal medial tibial angle (MPTA), posterior tibia slope(PTS) and M-K index were compared between the two groups of patients. Results In the LCWHTO group, the M-K index was 0.79±0.07 after operation and 0.78±0.08 after operation. There was no change before and after operation 0.78±0.05 before MOWHTO operation was significantly higher than 0.75±0.05 after operation (P<0.05). The postoperative PTS in the LCWHTO group was 8.1°±3.4°, which was significantly lower than the preoperative 10.8°±3.0° (P<0.05); the postoperative PTS in the MOWHTO group was 10.9°±4.0°, and 10.2°±3.1° before operation. No change before and after operation. Conclusions Both LCWHTO and MOWHTO can obtain satisfactory clinical outcomes. LCWHTO reduces PTS and has no effect on the patellar height. MOWHTO has no effect on PTS, but it reduces the patellar height. The choice of osteotomy should be individualized according to the characteristics of the patients.
    Comparison of emergence agitation and recovery quality after hypophysectomy of 3 endocrine types of pituitary tumors
    ZHANG Yu-guan, TANG Shuai, XUE Yang, ZHANG Yue-lun, TIAN Yuan, XING Bing, HUANG Yu-guang
    2020, 40(10):  1399-1402. 
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    Objective To evaluate the emergence agitation and recovery quality of patients with 3 endocrine types of pituitary tumor after transnasal transsphenoidal hypophysectomy. Methods Patients who received pituitary adenoma resection under general anesthesia were enrolled and categorized into three groups: growth hormone group (GH), adrenocorticotropic hormone group (ACTH) and non-functional group (control). Riker Sedation-Agitation Scale (RSAS), the severity of the emergence coughing, headache (by VAS), medical staff satisfaction were recorded in the post-anesthesia care unit. QoR-40 score, headache(by VAS), nausea score (by VRS) and vomiting score, and patient satisfaction were recorded at 24 h postoperatively. Results 163 cases were enrolled in the analysis, including 51 in GH group, 44 in ACTH group and 68 in control group. No significant difference was found regarding the emergence agitation among 3 groups. The ACTH group showed significantly higher nausea VRS score at 24 h after surgery than control group (P<0.01). The headache VAS score of ACTH group was significantly higher than that in control group (P<0.001). The incidence of postoperative sore throat in ACTH group was significantly higher than that in control group (P<0.05). The postoperative QoR-40 score of ACTH group was significantly lower than that of control group (P<0.01). Conclusions The incidences of postoperative nausea, headache and sore throat are significantly increased and the score of QoR-40 is significantly reduced in patients with ACTH pituitary adenoma.
    ASS1 gene mutation in a neonate with citrullinemia type Ⅰ
    LYU Ya-nan, SONG Dong-po, WANG Wei-qing, CHEN Yan-ping
    2020, 40(10):  1403-1406. 
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    Objective To detect blood acylcarnitine and genes in a newborn with suspected citrullinemia, and to detect gene mutations in their parents, so as to clarify their diagnosis and follow-up investigations. Methods Genetic metabolic diseases were screened in the newborn baby using tandem mass spectrometry. Peripheral blood samples were collected from the newborn patient with suspected citrullinemia to detect the products of genetic metabolic diseases. Peripheral blood samples were collected from newborns and their parents for high-throughput sequencing and Sanger sequencing. The blood samples of the newborns and their parents were sequenced and verified, and then the genetic abnormalities were analyzed. Results Tandem mass spectrometry showed that the level of citrulline increased(1 043 μmol/L), the level of citrulline increased to 2 072 μmol/L after recall immediately. Double heterozygous mutations of ASS1 gene in the proband were identified:c.256C>T and c.577G>A,which were confirmed in the parents.The case was diagnosed with citrullinemia type Ⅰ. Conclusions Neonatal tandem mass spectrometry, in combination with a pedigree analysis of the gene sequencing, may support the diagnosis of citrullinemia.
    Mini Reviews
    Advances in the study of esophageal adenocarcinoma cell lines, model develpoment and 3D culture technology
    LIU Dong-jian, YANG Ling
    2020, 40(10):  1409-1415. 
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    Esophageal adenocarcinoma is a uncommon malignant tumor. The deterioration and metastasis of esophageal adenocarcinoma bring some difficulties and challenges to the treatment of tumor. In recent years, some progress has been made in the study of esophageal adenocarcinoma cell lines. However, there are still many unknown molecular mechanisms in tumor cells, and the differences between esophageal adenocarcinoma cells still need to be further explored. The establishment and development of esophageal adenocarcinoma cell model can be used to study the properties and characteristics of tumor cells, and various tumor cell models provide research tools for the mechanism of esophageal adenocarcinoma pathogenesis, which is conducive to understanding the abnormal expression of genes in tumor cells and the influence factors of microsignaling molecules on tumor proliferation. The 3D-culture of organoid can provide an ideal platform for the study of the heterogeneous properties and microscopic level expression of tumor cells, and provide favorable conditions for the advancement of the study of the properties of tumor cells.
    Progress in drug therapy for COVID-19 infection
    LIU Fang-yuan, SU Xiu-lan
    2020, 40(10):  1416-1420. 
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    The novel coronavirus pneumonia caused by COVID-19 has emerged in Wuhan at the end of Dec. 2019, and then has spread across our country. To date, no specific therapy against the new virus is available. The clinical efficacy of some antiviral drugs, such as remdesivir, chloroquine phosphate, abidor and so on are still need to be further verified. In this article the recent progress on drug therapy for COVID-19 infection is reviewed.
    Progress of the role of epicardium in myocardial repair after myocardial infarction
    SUN Yang, ZHANG Yan
    2020, 40(10):  1421-1425. 
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    The epicardium characterized by high regeneration ability and multidirectional differentiation potential, which can secrete a variety of signal molecules, and play a central role during myocardial infarction repair. Current research approaches aims to activate the adult epicardium, to regulate epicardial differentiation, and to make bioengineered epicardial patch to promote heart regeneration. In this Review, we describe recent advances in the biology of the epicardium and attempts using the epicardium as therapeutic targets for heart repair and regeneration.
    Research progress on hypercoagulable state in patients with acromegaly
    MA Li-yuan, GUO Xiao-peng, XING Bing
    2020, 40(10):  1426-1430. 
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    Acromegaly is associated with systemic complications due to excess serum growth hormone, including cardiovascular diseases, endocrine and metabolic diseases, bone diseases and respiratory diseases. In addition, abnormalities of haemostatic function in patients with acromegaly have been described by several studies recently, including the alterations in coagulation, anticoagulation, fibrinolytic system and platelet function, presenting a potential of hyper-coagulation. Significantly elevated fibrinogen levels, reduced levels of protein C and protein S, and enhanced platelet activity were observed in patients with acromegaly. Some of these abnormalities are reversible after treatment like surgery or medication.
    Medical Education
    Application and evaluation of the flipped classroom in the experimental teaching of medical biochemitry
    JIAO Yi, LIANG Xiao-di, CHEN Yan, Nuerbiye NUERMAIMAITI, GUAN Ya-qun
    2020, 40(10):  1431-1434. 
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    Objective To apply and to evaluate the flipped classroom on experiment course of medical biochemistry. Methods Totally 145 medical students of Grade 2015 and 2016 were enrolled to implement the flipped classroom teaching, Self-Rating Scale of Self-Directed Learning(SRSSDL) and questionnaire survey table were used to analyze the teaching effect. Results Compared with the results of former flipped classroom teaching, the scores learning awareness, learning performance,learning strategies,evaluation and communication skills increased significantly(P<0.05).The self-learning capacity, operation level and innovation capacity also increased. Students have high recognition of flipped classroom. Conclusions It is benefit to improve teaching effect of biochemistry experiment owing to apply flipped classroom correctly and effectively.
    Exploration of strengthening the cultivation of ethical quality in the construction of medical genetics course
    MI Ya-jing, ZHANG Ni, FENG Hao, LIU Jie, GOU Xing-chun, JING Xiao-hong
    2020, 40(10):  1435-1438. 
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    With the completion of the human genome project and the advancement of sequencing technology, the ethical issues involved in medical genetics have become increasingly prominent. This requires the integration of ethical and other ideological elements into classroom teaching of medical genetics, and cultivation of the ethical qualities of medical undergraduates. This paper systematically discusses the reform of medical genetics curriculum focusing on ethical issues from the aspects of syllabus construction, ethical issues, and classroom practice and effect. Strengthening the ethical literacy of medical undergraduates is an inevitable trend in the development of medical genetics, and it is a realistic need for comprehensive education. Besides, the teaching reform based on the ethical problems, is also possible to improve the curriculum construction as a pilot project with a step-by-step remodeling strategy, and comprehensively promote the reformation of education of medical genetics.
    Effect of PBL to improve ultrasonic technology training of residents as shown by Objective Structured Clinical Examination
    LIN Lin, ZHANG Yi-xiu, LI Jian-chu, WANG Ya-hong, CHEN Yun-zhu, CHEN Xue-qi, LYU Ke
    2020, 40(10):  1439-1441. 
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    Objective To assess the effect of PBL on OSCE results of residents in ultrasound department. Methods There were 30 trainees from class 2015 and class 2016 for standardized resident training. Fourteen residents from class 2015 received traditional teaching methods and 16 residents from class 2016 received traditional teaching method combined with PBL. The scores of Objective Structured Clinical Examination(OSCE) between the two groups were compared and analyzed to find whether PBL can improve the OSCE results of residents in our department. Results The scores of OSCE including practice and theory of class 2016 were significantly higher than that of class 2015(P<0.05). Conclusions PBL may improve the practical skill and theory level of residents and optimize their professional capacity.
    Application of micro-teaching in surgical training for eight-year program undergraduates of clinical medicine
    PAN Bo, YAO Ru, ZHAO Jun, JIANG Ying-zi, LUO Lin-zhi, PAN Hui
    2020, 40(10):  1442-1445. 
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    Objective To investigate whether integration of micro-teaching into the surgical training may facilitate the learning outcome of eight-year program undergraduates of clinical medicine during their surgical clerkship. Methods Questionnaires were used before and after micro-teaching among the undergraduates to evaluate their confidence in expression and communication as well as attitudes towards micro-teaching. Results The self-rank confidence scores were significantly improved after micro-teaching in virtual situations including out-patient clinics (P<0.05), lecture in surgical ward (P<0.05) and presentation at international symposium (P<0.01). Majority of medical students agreed that micro-teaching was beneficial (100%) whereas classical lecture-based learning (LBL) still indispensable (69.6%). Conclusions micro-teaching improves the confidence of eight-year program undergraduates in term of expression and communication during clerkship and has potential value in surgical teaching.
    Application of enrollment and standardized training of specialists for pulmonary and critical care medicine
    HOU Xiao-meng, ZHANG Yu, LOU Lin-zhi, WANG Meng-zhao, XU Kai-feng
    2020, 40(10):  1446-1448. 
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    Objective According to the guidance for the pilot standardized training system for specialized physicians issued by the National Health and Family Planning Commission (NHFPC) together with other 7 government sectors,the specialist training is aiming for clinicians with sound clinical skills and corresponding scientific research and education capacity in general medicine as well as the specialized clinical disciplines. Methods Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital enrolled the first and second groups of specialist trainees through national registration system, professional assessment with written examination and panel interview. Results Six students were enrolled in the first two groups. The proportion of out-campus enrollment was 33.3%. The matriculates, with ages between 31 to 38, 66.7% were eight-year program graduates with MD degree, 16.7% had bachelor degree, 16.7% had master degree. One student quitted from the training, with a with drawal rate of 16.7%. Conclusions The standardized training of specialized physicians is aimed at clinicians with different educational levels,clinical qualificationsand their social and family social and family backgroundare also more complicated. In order to make the training more effectively, innovational mechanisms and supporting system are critical.
    Correlations of objective structured clinical examination scores and medical residency evaluations
    FAN Jun-ping, ZHOU Jing-ya, QIN Ling, ZHANG Sheng-yu, YE Wei, PAN Hui, LI Hang
    2020, 40(10):  1449-1452. 
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    Objective To identify the correlation of medical residency evaluations and Objective structured clinical examination (OSCE) scores. Methods In 2015, 53 participants for standardized medical residency training at Peking Union Medical College Hospital were included. Before entering the program, every participant took a multi-station OSCE. Each month during training, they were given a comprehensive assessment from their supervisors. An annual score was calculated at the end of the first year. The correlation between two abovementioned scores was examined. Results Participants with longer medical education tended to score higher in OSCE. The correlation coefficient between OSCE and annual evaluation score is 0.68(P<0.01), showing high correlation. In each station, the correlation coefficient between the annual evaluation score and that of computer-based examination, history taking, medical record writing was greater than 0.4. Conclusions OSCE before entering training may predict performance during the residency training thus can be used as an important indicator for residents' stratification and multilevel training.
    A preliminary study on virtual simulation diagnosis and treatment combined with PBL model in standardized training for hematology
    Zulihumaer AISIKAER, XU Pei-pei
    2020, 40(10):  1453-1456. 
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    Objective To evaluate virtual simulated diagnosis and treatment combined with PBL teaching model in resident planning. Methods From 2017-2019,78 doctors from Gulou Hospital affiliated to Nanjing University were randomly divided into control group (traditional teaching mode) and experimental group (virtual simulation diagnosis and treatment combined with PBL mode). Results The theoretical scores and OSCE scores of the experimental group were higher than those of the control group (P<0.05). Conclusions The virtual plus simulated training model of diagnosis and treatment combined with the PBL model is better than the traditional teaching model.