Table of Content

05 November 2024, Volume 44 Issue 11

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Special Issues: Electrical Impedance Tomograph

Research progress of electrical impedance tomography in respiratory management and brain injury

WANG Chunmei

2024, 44(11):  1481-1481.  doi:10.16352/j.issn.1001-6325.2024.11.1481

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Research progress on electrical impedance tomography for perioperative respiratory management

ZHAO Lun, Adelijiang·MAIMAITIMING, YU Xueyuan, WANG Chunmei, Tunisha·AIHEMAITI

2024, 44(11):  1482-1486.  doi:10.16352/j.issn.1001-6325.2024.11.1482

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Electrical impedance tomography (EIT) is a non-invasive imaging technique that generates cross-sectional images of chest by measuring changes in impedance as electric currents passing through human body. In perioperative respiratory management, EIT provides a real-time, consecutive monitoring of lung ventilation and perfusion status, guiding respiratory management of perioperative patients including medication for COPD and asthma, personalized PEEP settings for specific patient populations, lung protection for pediatric perioperative cases, and predicting postoperative pulmonary complications. Application of EIT in the perioperative period helps clinicians to manage patient respiratory status more accurately, reduces complications and improves outcomes. Through real-time monitoring and individualized treatment guidance, EIT enhances the safety and effectiveness of perioperative respiratory management, becoming an essential part of the operating room. This review summarises the application of EIT in the perioperative period, aiming to provide reference for the clinical application of EIT.

Application of electrical impedance tomography in the diagnosis and treatment of acute respiratory distress syndrome

LIU Bo, NING Yachan, ZHANG Xiaoran, WANG Chunmei

2024, 44(11):  1487-1491.  doi:10.16352/j.issn.1001-6325.2024.11.1487

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Electrical impedance tomography (EIT) is an emerging imaging technology developed at the end of the last century, which has outstanding advantages such as non-invasiveness, non-radiation, smart, low cost and easy operation. This article reviews the development, principles and clinical application of electrical impedance tomography in diagnosis, decision-making of clinical management of acute respiratory distress syndrome. The article also provides suggestions for the future development of EIT in terms of more clinical research, improving technical accuracy, cost/effectiveness and training of staff.

Research progress on electrical impedance tomography guiding positive end-expiratory pressure setting during mechanical ventilation

SONG Lipo, WANG Chunmei

2024, 44(11):  1492-1498.  doi:10.16352/j.issn.1001-6325.2024.11.1492

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At present, the strategy of setting the optimal positive end-expiratory pressure (PEEP) for mechanical ventilation still needs further clinical exploration. Electrical impedance tomography (EIT) is a newly developed technology at the end of the 20th century. It can monitor pulmonary ventilation in real time, so is extensively important to optimal PEEP setting. This review summarizes the principles of using EIT to guide PEEP setting, monitoring respiratory system compliance, spatial distribution, temporal distribution, local lung perfusion and other information published in recent years, analyzes the basic and clinical research information related to PEEP effect and its application in individualized PEEP setting.

Application value of electrical impedance tomography in assessment of patients with brain injury

NING Yachan, YAN Bin, LIU Bo, WANG Chunmei

2024, 44(11):  1499-1503.  doi:10.16352/j.issn.1001-6325.2024.11.1499

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Electrical impedance tomography (EIT) estimates the spatial distribution of tissue electrical properties by measuring the transfer impedance between surface electrodes. which has shown great potential in medical imaging, especially in the evaluation of brain injury patients. This review introduces the application of EIT in the evaluation of brain injury patients, including diagnosis and monitoring of stroke, cerebral edema, and epileptic foci. In stroke research, consecutive and real-time EIT monitoring may support early diagnosis of intracranial lesions, identification of stroke types, and improvement of prognosis. For cerebral edema, EIT can monitor intracranial pressure in real-time and evaluate the effectiveness of dehydration treatment. EIT is used for lesion localization and seizure monitoring. The review also summarizes the existing problems of EIT and technical challenges that may orient future research as well as clinical application.

Original Articles

Gnathodiaphyseal dysplasia caused by mutations in ANO5

ZHENG Chaoqun, CUI Geping, REN Xiuzhi, ZHAO Xiuli

2024, 44(11):  1504-1509.  doi:10.16352/j.issn.1001-6325.2024.11.1504

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Objective To identify the clinical features and pathogenic variants in two unrelated families with gnathodiaphyseal dysplasia (GDD), a rare genetic bone disorder. Methods Facial and limb deformities and skeletal morphology were observed in the probands and their family members. Peripheral blood samples (3-4 mL) were collected from the probands and their parents. Genomic DNA was extracted by standard phenol-chloroform method. Whole exome sequencing (WES) was performed to screen for candidate pathogenic gene variants of the probands. PCR-Sanger sequencing was used to validate the candidate pathogenic variants in the probands and their family members. The pathogenic variants responsible for GDD in the target families were determined through co-segregation of the pathogenic variants in the affected families, evolutionary conservation at the mutation sites,population allele frequency analysis and bioinformatics analysis. Results Heterozygous missense variants in the ANO5 gene were identified in both GDD probands. In family 1, the pathogenic variant was c.1 066T＞G located in the exon 11 of the ANO5 gene, while in family 2, the pathogenic variant was c.1 553G＞A located in the exon 15 of the ANO5. These two variants resulted in the substitutions of amino acid cysteine with glycine at position 356 (p.Cys356Gly) and amino acid glycine with glutamic acid at position 518 (p.Gly518Glu) in the ANO5 protein, respectively. Conclusions This study first identified the pathogenic variant c.1 066T＞G (p.Cys356Gly) in Chinese population, provided important evidence for prediction of disease prognosis and development of potential prenatal genetic diagnosis.

Isolation, culture and characterization of neural crest cells from lung tissue of mT/mG;Wnt1-Cre mice

DONG Xiaowen, LI Yongxin, GONG Xiaoxue, FENG Lingfang, CHEN Junfei, YAO Jiahui, LOU Jianlin

2024, 44(11):  1510-1515.  doi:10.16352/j.issn.1001-6325.2024.11.1510

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Objective To isolate and culture neural crest cells (NCCs) from lung tissue of mice and to identify the characteristics of the cells in order to provide a new cell model for studying lung injury and injure repair. Methods The mT/mG dual-fluorescence reporter mice and Wnt1-Cre transgenic mice were hybridized, and mT/mG; Wnt1-Cre transgenic mice were screened to obtain enhanced green fluorescent protein (EGFP) permanently labeled NCCs. Cell suspension of mouse lung tissue was prepared by enzymolysis. EGFP⁺ cells (namely NCCs) were harvested by flow cytometry. Primary culture was performed with DMEM/F12 culture medium optimized in the laboratory, NCCs was characterized by immunofluorescence microscopy. Then NCCs differentiation was directed by mouse bone marrow mesenchymal stem cells osteogenic induction. Results The mT/mG of EGFP permanently labeled NCCs was successfully obtained by hybridization and high-purity NCCs were isolated from Wnt1-Cre transgenic mice lung tissue. They can be cultured in vitro and with spindle morphology which was,similar to fibroblast adherent proliferation. NCCs expressed the neural crest stem cell marker Sox10 and induced to differentiate into osteoblasts. Conclusions NCCs isolated and cultured from lung tissue of mT/mG;Wnt1-Cre transgenic mice show stable proliferation and have the characteristics of neural crest stem cells, which may function as a potential cell model for research on lung tissue injury and the mechanism of repair.

Prevalence and risk factors of sarcopenia in patients with multiple system atrophy

FU Jin, LIU Yanping, WANG Han, WANG Rui, YU Kang

2024, 44(11):  1516-1521.  doi:10.16352/j.issn.1001-6325.2024.11.1516

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Objective To find the prevalence of sarcopenia in patients with multiple system atrophy(MSA)and to explore the muscle related risk factors that affect the ability if living and exercise of patients. Methods Through a cross-sectional study, patients with Parkinson's disease(PD) and movement disorders who visited the multidisciplinary outpatient clinic of Peking Union Medical College Hospital from October 2022 to December 2023 were included. Their demographic data and disease duration were collected. The modified Barthel Index (simplified Chinese version) was applied to evaluate the participants' living ability. The severity of movement disorders and non-motor symptoms were evaluated by the Unified PD rating scale. The body composition, grip strength, SARC-F score were used to evaluate the muscle condition of patients and the diagnosis of sarcopenia and pre sarcopenia were made according to EWGSOP2. Results Among 44 patients included in this study, 8(18.8%) were diagnosed with sarcopenia, 17(38.6%) were pre-sarcopenia and 19(43.2) had normal muscle condition. There were significant differences in disease-related clinical characteristics among the three groups. MSA patients were characterized by older age(P＜0.01).They had lower BMI (P＜0.01), and worse disease symptom score (P＜0.01), SARC-F score(P＜0.05), and activity score (P＜0.01), significantly reduced fat removal weight (P＜0.01) and phase angle (P＜0.05). Regression analysis showed that SARC-F score, grip strength, limb skeletal muscle index and fat free weight were all independent risk factors affecting the ability of living and exercise of MSA patients. Conclusions The preval-ence of MSA sarcopenia is higher and sarcopenia is closely associated with more severe clinical illness and lower living ability. It is an independent risk factor for increased living ability score and motor function score.

PTGS2 affects prognosis of colon cancer patients through regulation of cell proliferation and antioxidant capacity

HE Yangzhige, JIANG Xu, ZHANG Zhiwen, GONG Yiyi

2024, 44(11):  1522-1529.  doi:10.16352/j.issn.1001-6325.2024.11.1522

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Objective To investigate the effect and potential molecular mechanism of PTGS2 on the prognosis of colon cancer patients. Methods The transcriptomic and proteomic data of pan-cancer were collected from TCGA, HPA, UALCAN and other databases, and the expression pattern and prognostic value of PTGS2 were analyzed by combining the clinical data such as staging, histology, survival time and so on. Based on GSEA, the biological functions which were significantly activated in patients with high expression of PTGS2 were identified and the colon cancer cell line SW480 was used as an example for in vitro validation. PTGS2 over-expressing cell strains were constructed, and the effect on cell proliferation was determined by CCK8 method. Different concen- trations of H₂O₂ were used to form gradient oxidative stress, and the changes in cell antioxidant capacity were detected. The regulatory mechanism was preliminarily verified by Western blot. Results The transcription and expression of PTGS2 were found to be significantly up-regulated in colon cancer patients (P＜0.05), and the increased expression of PTGS2 was associated with an increased mortality risk (P＜0.05). Data analysis and in vitro experiments showed that over-expression of PTGS2 may promote the proliferation of colon cancer cells by activating the mTOR pathway. The antioxidant effect of cells was regulated by up-regulating oxidative stress regulatory proteins SOD2 and NRF2. Conclusions PTGS2 is a potential risk factor for colon cancer and its over-expression promotes cell proliferation, enhances cell antioxidant effect and is associated with poor prognosis of colon cancer patients.

Down-regulation of FGFR3 expression aggravates the damage of articular chondrocyte superficial zone cells in mice

GUAN Yunbo, LI Chao, XU Cheng, SUN Xiaofei, BAI Xuedong, HE Qing, WANG Zuqiang

2024, 44(11):  1530-1537.  doi:10.16352/j.issn.1001-6325.2024.11.1530

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Objective To investigate the effect of fibroblast growth factor receptor 3 (FGFR3) on articular cartilage superficial zone cells (SPZCs). Methods C57 mice were randomly divided into two groups: a sham operated group (sham group) and a group of surgically induced unstable medial meniscus model group (DMM group). The histological morphology of articular cartilage was microscopied by Safranin O/Fast Green-stained in 4 weeks and 8 weeks after surgery. Apoptosis and FGFR3 protein expression were detected by immunohistochemical staining microscopy. Primary SPZCs were separated and randomly divided into control group and Fgfr3 knockdown treatment group. The genes and protein expression related to chondrocyte extra cellular matrix synthesis, degradation and chondrocytehypertrophy were detected by RT-qPCR and Western blot. Results Compared with the sham group, the keen cartilage of mice in DMM group showed a pioneer damage of SPZCs after surgery; Immunohistochemistry results showed an increase in chondrocyte apoptosis and a decrease in expression of MMP-13 and FGFR3(P＜0.05). Primary SPZCs were transfected with small interfering RNA (siRNA) to knockdown Fgfr3; RT-qPCR results showed that the mRNA expression of genes related to the synthesis of cartilage extracellular matrix aggrecan and Col2 was reduced; And the mRNA expression of extracellular matrix degradation-related genes Mmp13 and Adamts5 was increased. The mRNA expression of chondrocyte hypertrophy-related genes Col10 and Mmp13 was increased. Western blot and RT-qPCR results were consistent and the expression l of MMP13 protein was significantly increased, while the expression of collagen Ⅱ and aggrecan protein was significantly decreased (P＜0.05). Conclusions Knockdown of Fgfr3 induces damage to primary SPZCs in mice resulting in early osteoarthritis (OA) development.

Dexmedetomidine alleviates myocardial injury and inflammation in diabetic myocardial ischemia-reperfusion rats

LIU Bin, LIU Wenping, JIN Tao

2024, 44(11):  1538-1543.  doi:10.16352/j.issn.1001-6325.2024.11.1538

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Objective To explore the effect and mechanism of dexmedetomidine (DEX) on myocardial injury and inflammation of rats with diabetic myocardial ischemia-reperfusion(MI/R). Methods The rats were divided into sham group, model grousp[The type 2 diabetes mellitus (T2DM) model was replicated by feeding high-fat and high-sugar combined with streptozotocin injection; MI/R injury model was replicated by coronary artery ligation], DEX group (T2DM model rats were injected with 10 μg/kg DEX through tail vein), antagomir NC group(T2DM model rats were injected with 10 μg/kg DEX and antagomir NC through tail vein), miR-490-3p antagomir group (T2DM model rats were injected with 10 μg/kg DEX and miR-490-3p antagomir via tail vein). RT-qPCR was applied to detect the expression of miR-490-3p and forkhead box O1(FOXO1) mRNA; Blood glucose meter was applied to measure fasting blood glucose (FBG) in rats; The level of fasting insulin(FINS), creatine kinase isoenzyme(CK-MB), lactate dehydrogenase(LDH) and inflammatory factors interleukin-1β(IL-1β) and tumor necrosis factor-α(TNF-α) was measured by ELISA; HE staining microscopy was applied to observe pathological damage of myocardial tissue; TTC staining microscopy was applied to determine the size of myocardial infarction; Dual luciferase assay was applied to verify the relationship between miR-490-3p and FOXO1; Western blot was applied to detect the expression of FOXO1 protein in myocardial tissue. Results Compared with the sham group, the FBG, FINS, CK-MB, LDH, IL-1β, TNF-α, myocardial infarction area, FOXO1 mRNA and protein expression in model group were all increased , while miR-490-3p expression decreased (P＜0.05); Compared with the model group, the FBG, FINS, CK-MB, LDH, IL-1β, TNF-α, myocardial infarction area, FOXO1 mRNA and protein expression in rats from DEX group decreased, the miR-490-3p expression increased(P＜0.05); Down regulation of miR-490-3p was able to significantly baffle the improvement of DEX on myocardial injury and inflammation in diabetes MI/R rats(P＜0.05); FOXO1 had a target-specific regulatory relationship with miR-490-3p. Conclusions DEX may inhibit inflammation and alleviate myocardial injury induced by MI/R in diabetic rat models by regulating the miR-490-3p/FOXO1 axis.

Diammonium glycyrrhizinate alleviates lung injury in rat models with lung tuberculosis

CAO Peiqian, WANG Zhigang, MIAO Xuehong

2024, 44(11):  1544-1550.  doi:10.16352/j.issn.1001-6325.2024.11.1544

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Objective To investigate the effect of diammonium glycyrrhizinate (DG) on pulmonary injury of rats with pulmonary tuberculosis. Methods The rat models of pulmonary tuberculosis were constructed and then the animals were randomly divided into model group, diammonium glycyrrhizinate treatment groups (low-dose, medium-dose and high-dose) groups, high dose of diammonium glycyrrhizinate plus peroxisome proliferator-activated receptor γ(PPARγ) inhibitor group (H-DG+GW9662 group), and another 18 rats were selected as control group. The colony count of Mycobacterium tuberculosis(Mtb) in lung tissue was detected. HE staining microscopy was applied to detect lung histopathology. TUNEL was applied to detect apoptosis of lung tissue cells. ELISA was applied to detect serum level of inflammatory factors. Western blot was applied to measure PPARγ, phosphorylated p38 mitogen-activated protein kinase(p-p38MAPK) and p38 mitogen-activated protein kinase (p38MAPK) in lung tissue. Results Compared with the control group, the lung tissue structure in model group was severely damaged with a large number of proliferative tuberculosis nodules, changes of alveolar morphology, inflammatory cell infiltration and even caseous necrosis were found, and the number of tuberculosis colonies, apoptosis rate, TNF-α, IL-6, IFN-γ, COX-2 levels, and p-p38MAPK/p38MAPK expression were all increased, while PPARγ expression was decreased(P＜0.05). In L-DG, M-DG, H-DG groups improvement of lung tissue structure, alveolar morphology, inflammatory cell infiltration, and caseous necrosis were found as compared to the model group, while the counting number of tuberculosis colonies decreased and rate of cell apoptosis decreased. The level of TNF-α, IL-6, IFN-γ, COX-2 and expression of p-p38MAPK/p38MAPK reduced, the expression of PPARγ all increased. The H-DG group showed the most significant changes(P＜0.05). GW9662 treatment significantly reversed the improvement of DG on pulmonary injury in rats with pulmonary tuberculosis. Conclusions DG improves lung injury in rats with pulmonary tuberculosis and its mechanism is potentially related to the activation of PPARγ pathway and inhibition of p38MAPK pathway.

Galangin alleviates inflammation in rat models with hepatitis B

WANG Wei, MU Baolong, ZHANG Wenshuang, WU Qinglei, ZHANG Huihui, CAO Zhili

2024, 44(11):  1551-1556.  doi:10.16352/j.issn.1001-6325.2024.11.1551

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Objective To explore the effect of galangin (Gal) on inflammation in hepatitis B rats. Methods The rats were randomly divided into control group, hepatitis B group, Gal-L and Gal-H groups, positive drug lamivudine group and Gal-H+AMPK inhibitor (compound C) group with 12 in each. After modeling, medication treatment was performed once a day for 8 weeks. The level of alanine aminotransferase (ALT), total bilirubin (TBIL) and aspartate aminotransferase (AST) in the serum of rats were detected. HE staining microscopy was applied to detect pathological changes in liver tissue. TUNEL staining microscopy was applied to detect cell apoptosis in liver tissue. Chromatin immuno-precipitation was applied to detect HBV viral load in liver tissue. ELISA was applied to detect the levels of monocyte chemotactic protein-1(MCP-1), interleukin-12(IL-12), and tumor necrosis factor-α(TNF-α) in liver tissue. Western blot was applied to detect the expression of caspase-3, Bcl-2 associated X protein (Bax), p-AMPK and SIRT1 proteins in liver tissue. Results Compared with hepatitis B group, the liver damage of rats in the Gal-L group, Gal-H group and lamivudine group was alleviated; The level of serum AST, TBIL, and ALT, apoptosis rate, HBV viral load and the level of MCP-1, IL-12, TNF-α as well as the expression of caspase-3 and Bax proteins in liver tissue were all reduced. The expression of p-AMPK and SIRT1 proteins in liver tissue increased(P＜0.05). Compound C baffled inhibitory effects of high-dose Gal on inflammation, cell apoptosis, and HBV viral load in liver tissue of hepatitis B rats. Conclusions The mechanism of Gal in inhibiting inflammation, cell apoptosis and HBV virus replication in hepatitis B rats is potentially attributed to up-regulation of the AMPK/SIRT1 pathway.

Correlation between muscle strength levels with bone mineral density and bone metabolism indices at different menopausal stages

WANG Dongyang, LIN Xinchao, LI Ruochen, YANG Qiaohui

2024, 44(11):  1557-1562.  doi:10.16352/j.issn.1001-6325.2024.11.1557

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Objective To investigate the correlation between muscle strength level and bone mineral density and bone metabolism indexes in postmenopausal women in Beijing. Methods Postmenopausal women who were investigated by on-site questionnaires and followed by bone mineral density examination in Beijing from September 2017 to May 2018 were recruited as study subjects. They were divided into early menopausal group, middle menopausal group, late menopausal group, and twilight menopausal group according to the years of menopause. Changes in grip strength, 5 times sit-to-stand test (FTSST) with bone mineral density (BMD) and bone metabolism indexes were observed in the four groups and their correlations were analyzed. Results A total of 815 cases of postmenopausal women were included. At different menopausal stages, muscle strength was all found to decrease with the increase of menopausal years (P＜0.05), there was non-significance of different bone metabolism indexes among the four groups(P＞0.05); Femoral neck and lumbar spine BMD decreased with the increase of menopausal years(P＜0.05). Maximum grip strength was positively correlated with both femoral neck and lumbar spine BMD (R=0.158, P＜0.05; R=0.130, P＜0.05). There was no correlation between muscle strength and bone metabolism indexes (P＜0.05). Conclusions Different bone metabolism indexes are not associated with muscle strength in menopausal women. Maximum grip strength is positively correlated with bone mineral density, which can be used as an auxiliary screening tool for osteoporosis (OP) in women. The FTSST suggests that the lower limb muscle strength of menopausal women decreases with age, which can be used as one of the indicators for predicting the risk of falls in menopausal women.

Activation of PI3K/AKT/mTOR pathway can alleviate inflammation in acute pancreatitis of rat model

HAN Chongyi, WANG Jiuji, ZHU Limei, LIU Qian, SUN Jianli

2024, 44(11):  1563-1568.  doi:10.16352/j.issn.1001-6325.2024.11.1563

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Objective To investigate whether activation of PI3K/AKT/mTOR pathway can reduce inflammation in acute pancreatitis (AP) rats. Methods SD rats were grouped into sham surgery group, model group, Gln group, and Gln+LY294002 group (PI3K/AKT/mTOR pathway inhibitors). Intra-abdominal pressure (IAP), ascites volume(AS), serum amylase (AMY), diamine oxidase (DAO), interleukin(IL-1β, IL-6), Tumor necrosis factor (TNF-α) were measured. The pathological change in pancreatic and small intestinal tissues was evaluated by microscopy; The expression of PI3K, Akt and mTOR genes and cytoplasm compact linking protein (ZO-1), compact linking protein (occludin-1), PI3K, Akt and mTOR in ileum of each group were detected. Results Compared with the sham surgery group, the IAP and AS, IL-1β, IL-6, TNF-α, AMY, DAO, and pathological injury scores of pancreas and small intestine in the model group were obviously increased; The expression of PI3K mRNA,Akt mRNA, mTOR mRNA, ZO-1, occludin-1, p-PI3K/PI3K, p-Akt/Akt and p-mTOR/mTOR in rat ileum tissue significantly reduced (P＜0.05). Compared with the model group, the level of IAP and AS, IL-1β, IL-6, TNF-α, AMY, DAO and pathological injury scores of pancreas and small intestine in the Gln group were significantly reduced; The expression of PI3K mRNA, Akt mRNA, mTOR mRNA, ZO-1, occludin-1, p-PI3K/PI3K, p-Akt/Akt and p-mTOR/mTOR in rat ileum tissue was significantly increased (P＜0.05); LY294002 could specifically reverse the therapeutic effect of Gln on acute pancreatitis in rats. Conclusions Activation of PI3K/AKT/mTOR pathway may reduce inflammation and improve gastrointestinal function in rats with acute pancreatitis.

Clinical Sciences

Electrocardiogram P-wave sign is related to new-onset atrial fibrillation of patients with acute myocardial infarction

YANG Duojun, LIU Jinghan

2024, 44(11):  1569-1572.  doi:10.16352/j.issn.1001-6325.2024.11.1569

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Objective To investigate the relationship between dynamic electrocardiogram P-wave sign and new-onset atrial fibrillation (NOAF) in patients with acute myocardial infarction (AMI)(AMI-NOAF). Methods Totally 240 patients with AMI admitted to Wuwei Cancer Hospital were examined by dynamic electrocardiogram. P-wave sign parameters and clinical data of holter electrocardiogram were collected. The relationship between P-wave sign and clinical parameters of AMI patients was analyzed. The patients were divided into NOAF group and nonoccurrence(non-NOAF) group and multivariate Logistic regression model was used to identify the influencing factors of NOAF occurrence in AMI. Results Killip Ⅲ-Ⅳ grade minimum P wave duration (P_min) level was shorter than that of Ⅰ-Ⅱ grade. Maximum P wave duration (P_max) and P wave dispersion (Pd) level were higher than that of Ⅰ-Ⅱ grade(P＜0.05). NOAF occurred in 47 of 240 AMI patients (19.58%). The level of P_min in NOAF group was lower than that in non-NOAF group, and the level of P_max and Pd in NOAF group was higher than that in non-NOAF group(P＜0.05). The heart rate and the proportion of Killip grade Ⅲ-Ⅳ in NOAF group were higher than those in non-NOAF group(P＜0.05). Multivariate Logistic regression analysis showed that Killip Ⅲ-Ⅳgrade, high level of P_max and Pd were independent risk factors for NOAF in AMI (P＜0.05). Conclusions The level of P_min, P_max and Pd are correlated with Killip grading in AMI patients. AMI-NOAF patients have abnormal P-wave sign in holter electrocardiogram. The high levels of P_max and Pd are independent risk factors of AMI and NOAF.

Effects of different anesthesia methods on puerperants and fetus perioperatively undergoing cesarean delivery after epidural labor analgesia

FANG Jinghan, FENG Yingchen, HAN Ruquan

2024, 44(11):  1573-1577.  doi:10.16352/j.issn.1001-6325.2024.11.1573

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Objective To observe the effects of epidural anesthesia and subarachnoid anesthesia on puerperants and fetus perioperatively undergoing cesarean delivery after epidural labor analgesia. Methods A retrospective cohort study was conducted to select and analyze the relevant clinical data of women who had epidural labor analgesia and were converted to cesarean delivery at Beijing Tiantan Hospital. According to the anesthesia method of cesarean section, the participants were divided into the epidural anesthesia(EA) group and the subarachnoid anesthesia(SA) group. That were aimed to compare the effects of the two anesthesia methods on the mother and fetus perioperatively. Results Compared with women in the epidural anesthesia group, women in the subarachnoid anesthesia group had a better anesthesia outcome,visual analogue scale (VAS) scores, frequency (%)[VAS scores 0-3: 5(25%) vs. 14(70%); VAS scores 4-6: 12(60%) vs. 6(30%); and VAS scores 7-10: 3(15%) vs. 6(30%)], and higher perioperative complication rate. There was nonsignificance difference in perio- perative maternal bleeding, neonatal Apgar score, and neonatal umbilical artery blood gas analysis between the two groups. Conclusions In women with epidural analgesia undergoing cesarean section, the anesthesia effect of subarachnoid anesthesia is better than that of the epidural anesthesia. The anesthesiologist must pay attention to prevent complications in the perioperative period.

Case Reports

A rare case of pediatric renal paraganglioma

ZHANG Wenqian, ZHOU Yue, TONG Anli

2024, 44(11):  1578-1583.  doi:10.16352/j.issn.1001-6325.2024.11.1578

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Objective To explore the clinical characteristics of renal paraganglioma(PGL). Methods The clinical data of a rare case of renal paraganglioma in a pediatric patient were reported and published cases of renal paragangliomas both domestically and internationally were reviewed. Results A 12-year-old male patient underwent surgery for a right renal mass, with histopathological confirmation revealing a renal paraganglioma. Immunohistochemical staining results were positive for CgA and S-100, while Ki-67 index showed positivity in hot spots at 20%. The SDHB stain was negative. Germline genetic testing detected a heterozygous mutation in exon 6 of the SDHB gene, c.641A＞C(p.Gln214Pro). Following surgery, local radiotherapy was administered to the operative area. A posto- perative ¹⁸F-FDG-PET/CT scan did not reveal any metastatic lesions. A total of 15 cases of renal paraganglioma have been reported at home and abroad since 2001, of which 8 were male and 7 were female, with an average age at diagnosis being (42±17) years old. Only 5 patients had hypertension preoperatively, and only 2 presented with typical clinical symptoms. Out of 8 patients who underwent catecholamine testing before surgery, only 4 demonstrated elevated levels. The maximum tumor diameter was (9.9±7.3) cm, with 67% (10 out of 15 cases) having tumors larger than or equal to 5 cm in diameter. In this group, 30% (3 out of 10 cases) had tumors that were S-100 negative, and 50% (2 out of 4 cases) had tumors with a Ki-67 index of ≥3%. Conclusions Renal paraganglioma is extremely rare, and some patients present without clinical symptoms and with normal catecholamine, making misdiagnosis more likely. Due to the frequent occurrence of large tumors and high Ki-67 indexes, such tumors carry a relatively higher risk of recurrence and metastasis. Therefore, close follow-up is essential after the operation.

Mini Reviews

Advances in cell transplantation combined with other therapeutic strategies in the treatment for vitiligo

LIU Shangkun, WANG Hongjuan, KANG Xiaojing

2024, 44(11):  1584-1588.  doi:10.16352/j.issn.1001-6325.2024.11.1584

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Vitiligo is an acquired depigmentation skin disease characterized by a decrease or loss of function of melanocytes.The conventional treatment for vitiligo include drug therapy, phototherapy and surgical treatment. As an important surgical treatment for vitiligo, cell transplantation is effective especially for the case which is stable, limited or fail to respond to other methods,but the recoloration rate varies greatly. The combination therapy is a better choice to maximize the recoloration of skin lesions in patients with refractory vitiligo. In recent years, reports on the combined strategy of cell transplantation have gradually increased, bringing new hope to improve the rate of discoloration of vitiligo patients. This paper reviews the progress of the application of cell transplantation combination strategy aiming for providing more options for the clinical treatment of refractory vitiligo.

Progress on the role of N-acetyltransferase 10 in tumor development

GU Zhongjia, LAI Siying, CHEN Dunjin, DU Lili

2024, 44(11):  1589-1593.  doi:10.16352/j.issn.1001-6325.2024.11.1589

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N-acetyltransferase10(NAT10) is a protein widely expressed in a variety of tissues and cells. The high expression of NAT10 is closely related to tumor invasion, metastasis and drug resistance. The mechanism of NAT10 promoting tumor genesis and development involves the regulation of cell cycle, mRNA stability, translation efficiency and related pathways due to the changes in the expression or location of NAT10, thus affecting the occurrence, development and prognosis of tumors.

Advances in the role of fibroblasts in gastroesophageal reflux disease

WANG Wei, SUN Yongshun

2024, 44(11):  1594-1597.  doi:10.16352/j.issn.1001-6325.2024.11.1594

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Esophageal damage in gastroesophageal reflux disease (GERD) is a chronic inflammation, and fibroblasts, as esophageal stromal cells, play an important role in the oesophageal mucosal barrier and oesophageal inflammation. Fibroblasts are closely associated with the degree of disease progression in GERD, secreting large amounts of collagen to promote oesophageal mucosal barrier repair during oesophageal damage, regulating immune homeostasis through paracrine signaling, and interacting with immune cells. In addition to secreting inflammatory products, but inappropriate fibroblast activation can induce a pro-inflammatory response. Activation of fibroblasts induces pro-inflammatory and immunosuppressive properties promoting the presence of disease, suggesting that they may play a key role in disease progression.

Mechanisms of arsenic induced gastric cancer

TONG Ling,ZHANG Jingwen,LI Shuai,DUAN Kaipeng

2024, 44(11):  1598-1602.  doi:10.16352/j.issn.1001-6325.2024.11.1598

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Arsenic is a heavy metal element and has been classified as group 1 carcinogens. Humans are mainly exposed to arsenic through drinking water. Long-term exposure to arsenic causes carcinomatous and non-carcinomatous lesions, including gastric carcinoma. At present, the known mechanisms of inorganic arsenic exposure leading to the occurrence and development of gastric cancer mainly include oxidative stress, epigenetic changes and immune regulation. Oxidative stress may change the structure and function of the intestinal epithelium, leading to damage to the intestinal mucosal barrier and then carcinoma. Epigenetic changes are mainly manifested in DNA methylation, histone post-translational modification and miRNA expression, which lead to the occurrence and development of gastric carcinoma. Impairment of the normal function of immune cells such as lymphocytes, dendritic cells, and macrophages may lead to dysbiosis of the gastrointestinal microbiota and development of gastric carcinoma.

Progress of deacetylase SIRTs in pathogenesis of Parkinson's disease

FANG Xue, SHI Jin, LI Haining, YANG Juan

2024, 44(11):  1603-1607.  doi:10.16352/j.issn.1001-6325.2024.11.1603

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Sirtuins(SIRTs), a group of NAD⁺ dependent deacetylases, have attracted considerable attention in the field of neuro-degenerative diseases, especially Parkinson's disease (PD). They have critical impacts on cell survival and death through modulation of various biological processes, such as intracellular metabolism, stress response and DNA repair. In the pathogenesis of PD, Sirtuins play a crucial role and associated with pathophysiological processes such as mitochondrial function, oxidative stress, and neuronal apoptosis. Activation of Sirtuins alleviates dyskinesia and neuronal damage in animal models of PD and also regulates the aggregation and clearance of α-synuclein, a pathological feature of the disease. Therefore, the modulation of Sirtuins is a potential strategy for treating PD.

Mechanism of bone marrow-derived mesenchymal stem cells in the treatment of liver failure

QI Zeqiang, GUO Tingyu, WU Zhinian, WANG Yadong

2024, 44(11):  1608-1612.  doi:10.16352/j.issn.1001-6325.2024.11.1608

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Liver failure is a kind of acute and severe liver disease. Bone marrow-derived mesenchymal stem cells (BM-MSCs) have the function of differentiating into hepatocytes. Promotion of the regeneration of hepatocytes regeneration, inhibition of apoptosis, necrosis and inflammation of hepatocytes, may facilitate repairing damaged liver tissue and improving liver function. BM-MSCs have become a new choice with great application potential in the treatment of liver failure.

Advances in metabolic remodeling of glutamine in pancreatic cancer

LIU Ke, DAI Menghua

2024, 44(11):  1613-1617.  doi:10.16352/j.issn.1001-6325.2024.11.1613

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Pancreatic cancer relies on glutamine (Gln) in its carcinogenesis. Gln metabolism is reprogrammed by multiple oncogenes and their downstream effectors in pancreatic cancer cells. The Gln dependence and its underlying molecular mechanisms can potentially be exploited as therapeutic targets. Recent research on the metabolic remodeling of Gln in pancreatic cancer has primarily focused on the inhibition of key enzymes, the impact on chemotherapy resistance, and the application of Gln antagonists. The progress in understanding Gln metabolism in pancreatic cancer offers valuable insights into potential novel therapeutic strategies.

Medical Education

Practice of standardized multi-scenario comprehensive training for professional graduate students in urology

DONG Dexin,WANG Wenda,ZHANG Yushi

2024, 44(11):  1618-1620.  doi:10.16352/j.issn.1001-6325.2024.11.1618

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Objective To evaluate the application of a standardized multi-scenario comprehensive training system for graduate students majoring in urology. Methods A total of 11 professional graduate students majoring in urology at Peking Union Medical College Hospital from January 2023 to December 2023 were selected, and a multi-scenario comprehensive training system was adopted for their clinical training of urology. After the training was completed, graduate students were assessed and teaching outcomes were evaluated using a survey questionnaire. Results The excellent rate of assessment reached 100%. The standardized multi-scenario comprehensive training system had significantly improved the theoretical and practical performance of graduate students. The feedback from the survey questionnaire showed that the satisfaction from both graduates and teachers was extremely high. Conclusions Applying a standardized multi scenario comprehensive training system to clinical teaching practice in urology can significantly improve the clinical comprehensive capacity of urology professional graduate students. Both the trainers and trainees have high satisfaction with that training system, which is suitable for application and promotion.