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2021 Vol. 51, No. 10 Published: 2021-10-25   775 The role of FGF21 in regulating the ameliorative effect of fenofibrate on hepatic lipid metabolism LI Dan,XIE Wei, YU Ning, YU Qiongli, SHI Yaru, ZHANG Yingchao, LIN Zhuofeng. DOI: 10.3969/j.issn.2095-9400.2021.10.001 Objective: To investigate the regulating effect of fenofibrate on liver lipid metabolism in mice mediated by fibroblast growth factor 21 (FGF21). Methods: Experimental mice were divided into four groups, all fed a high-fat diet: wild-type control group (WT+HFD+CTL), wild-type fenofibrate treatment group (WT+HFD+FF), FGF21 knockout control group (FGF21 KO+HFD+CTL), FGF21 knockout fenofibrate treatment group (FGF21 KO+HFD+FF). ELISA was used to detect FGF21 and Adiponectin in mouse serum; HE and Oil Red O staining were used to detect hepatic morphological changes and lipid accumulation in liver tissue respectively;TG and TC assay kits were used to detect changes in serum TG and TC; qRT-PCR was used to detect the mRNA expression of PPARα, FGF21, hepatic cholesterol regulatory element binding protein Srebp-2, genes regulating lipid oxidation, catabolism and transport (Acaca, Acacb, ABCG5, ABCG8, Cyp7a1), PPARγ and Adiponectin.Results: Fenofibrate treatment for 4 weeks significantly up-regulated the expression levels of PPARα and FGF21 in mice liver, inhibited the increase of body mass, down-regulated the level of abnormal serum lipids and reduced the lipid deposition in liver (P<0.05). The protective effect induced by fenofibrate was somewhat diminished by the deletion of FGF21 gene. HE and Oil Red O staining showed that the knockdown of FGF21 gene diminished the ameliorative effect of fenofibrate on hepatic lipid accumulation in HFD-fed mice. In terms of molecularmechanisms, fenofibrate treatment significantly up-regulated the expression of metabolic regulatory genes (Acacb, ABCG5, Cyp7a1, etc.) for lipid oxidation, catabolism and transport, and down-regulated the expression of Srebp-2, a hepatic cholesterol regulatory element binding protein (P<0.05). However, these effects were significantly inhibited by FGF21 gene deletion (P<0.05). Meanwhile, FGF21 knockdown significantly inhibited fenofibrate induced upregulation of PPARγ and Adiponectin mRNA expression and elevated serum levels of Adiponectin (P<0.05). Conclusion: FGF21 mediates the biological effect of fenofibrate on anti-fatty liver lesions. 2021 Vol. 51 (10): 775-781 [Abstract] ( 748 ) HTML (1 KB)  PDF (1687 KB)  ( 698 ) 782 The mechanism of lncRNA TTN-AS1 in regulating gastric cancer cell migration, invasion and EMT by targeting miR-204-3p ZHAO Jing, LI Meng, YE Cheng, DAI Jinfeng, Fan Yihong DOI: 10.3969/j.issn.2095-9400.2021.10.002 Objective: To explore the role of lncRNA TTN-AS1 in regulation the migration, invasion and epithelial-mesenchymal transition (EMT) of gastric cancer cells by targeting miR-204-3p. Methods: qRT-PCR method was used to detect the expression of TTN-AS1 and miR-204-3p in gastric cancer tissues and adjacent tissues. In vitro culture of human gastric cancer cell AGS, si-NC, si-TTN-AS1, miR-NC, miR-204-3p mimics, si-TTN-AS1 and anti-miR-NC, si-TTN-AS1 and anti- miR-204-3p were transfected into AGS cells. The qRT-PCR method was used to detect the expression of TTN-AS1 and miR-204-3p in AGS cells. The Transwell chamber assay was employed to monitor migration and invasion capabilities. The dual luciferase reporter experiment was used to detect the targeting relationship of TTN-AS1 and miR-204-3p. Results: The expression level of TTNAS1 in gastric cancer tissues was increased by about 2.90 times (P<0.05), and the expression level of miR-204-3p was decreased by about 0.57 times compared with adjacent tissues (P<0.05). Transfection of si-TTN-AS1 or transfection of miR-204-3p mimics could significantly reduce the number of migrating and invading cells (P<0.05). TTN-AS1 could target miR-204-3p, which was confirmed by the dual luciferase report experiment.Co-transfection of si-TTN-AS1 and anti-miR-204-3p could significantly increase the number of migrating and invading cells (P<0.05). Conclusion: The inhibition of TTN-AS1 expression could inhibit gastric cancer cell migration, invasion and EMT transformation by up-regulating the expression of miR-204-3p. 2021 Vol. 51 (10): 782-786，792 [Abstract] ( 752 ) HTML (1 KB)  PDF (1980 KB)  ( 788 ) 787 The prediction value of early hematoma expansion after intracerebral hemorrhage based on clinical features and noncontrast CT radiomic feature models XU Lei, GE Huaizhi, ZHANG Zhijing, CHEN Bo,CHENG Jianmin, WU Aiqin DOI: 10.3969/j.issn.2095-9400.2021.10.003 Objective: To investigate the predicting value of early hematoma expansion after intracerebral hemorrhage based on clinical and non-contrast CT radiomic feature machine learning models. Methods: A total of 261 cases of acute early spontaneous intracerebral hemorrhage from the Second Affiliated Hospital of Wenzhou Medical University from January 2018 to May 2020 were collected. Patients were assigned as hematoma expansion group and non-hematoma expansion group according to the presence of early hematoma expansion. All samples were divided into training set (182) and testing set (79) randomly according to ratio of 7:3. Regions of interest of lesions were delineated by 3D Sicer software. Radiomic features were extracted and clinical features (demographic and CT imaging features) of each patient were collected. Least absolute shrinkage and selection operator (LASSO) was used to select radiomic features. Univariate analysis and multivariate logistic regression analysis were used to select clinically predictive independent risk factors. Logistic regression models for predicting invasiveness of pulmonary adenocarcinoma were established based on clinical features, radiomic features and clinical features combined with radiomic features. Receiver operating characteristic curve andarea under curve were used to evaluate the predictive performance of models. Results: A total of 396 radiomic features were extracted from CT images, of which 7 radiomic features with discriminative significance were selected after dimensionality reduction by least absolute shrinkage and selection operator (LASSO). A total of 10 clinical features were collected, and swirl sign, black hole sign and irregular shape were found to be independent risk factors for predicting HE after univariate analysis and multivariate Logistic regression analysis (P<0.05).Predictive performance of the radiomic feature model, clinical feature model and combined model were as follows: in the training set, AUC was 0.924, 0.836 and 0.968, specificity was 91.4%, 81.0% and 95.2%, sensitivity was 81.8%, 78.4% and 84.4%; in the testing set, AUC was 0.919, 0.796 and 0.929, specificity was 81.8%, 77.5% and 88.1%, sensitivity was 76.1%, 64.5% and 80.4%. Conclusion: Logistic regression model based on clinical and CT radiomic features has certain predictive efficiency for early hematoma expansion after intracerebral hemorrhage. 2021 Vol. 51 (10): 787-792 [Abstract] ( 732 ) HTML (1 KB)  PDF (1565 KB)  ( 1255 ) 793 The impact of final kissing balloon inflation on anatomical structure in single-stent technique strategy for left-main bifurcation lesion: a serial IVUS study Lin Qingcheng, Zhu Qianli, Huang Weijian, Shan#br# Peiren DOI: 10.3969/j.issn.2095-9400.2021.10.004 Objective: To investigate the impact of final kissing balloon inflation (FKBI) on anatomical structure in single-stent crossover technique for left main artery bifurcation lesions with serial intravascular ultrasound (IVUS) imaging. Methods: Totally, 36 patients with left main artery bifurcation lesions were prospectively enrolled,and treated with single-stent crossover strategy. Serial IVUS pullback examinations were performed, including the runs of pre-intervention from both left anterior descending artery (LAD, run1) and left circumflex artery (LCX, run2), the run of post-stenting from LAD (run3), and the runs of post-FKBI from both LAD (run4) and LCX (run5). Results: The mean age of these patients was (63.8±12.1) years old, with left main true bifurcation lesion accounting for 22.2%. Compared with IVUS imaging of pre-intervention (run2), the ostium area of LCX was significantly decreased after FKBI [run5, (7.30±3.08)mm2 vs. (6.37±2.66)mm2, P<0.001], as well as vessel area [(13.10±3.27)mm2 vs. (12.47±2.93)mm2, P=0.012], however, there was no significant changes in plaque area [(5.80±2.02)mm2 vs. (6.10±2.09)mm2, P=0.128]. The change in lumen area within the LCX ostium was positivelycorrelated with the change in EEM area (r=0.787, P<0.05), but not with plaque area (r=0.187, P=0.276). Compared with IVUS imaging of post-stenting (run3), FKBI (run4) significantly increased the area at the site of polygon of confluence [POC, (9.80±2.09)mm2 vs. (11.48±2.65)mm2, P<0.05], distal left main [(9.91±1.73)mm2 vs. (11.85±2.38)mm2, P<0.05] and the minimal lumen area (MLA) of the left main [(9.61±1.53)mm2 vs. (11.34±2.33)mm2,P<0.05], decreased stent malapposition phenomena (83.3% vs. 61.1%, P=0.035), but increased the stent asymmetry index significantly (POC: 1.23±0.14 vs. 1.33±0.12, P<0.05; Distal LM: 1.18±0.09 vs. 1.25±0.10, P<0.05; MLA:1.17±0.09 vs. 1.24±0.10, P<0.05). Conclusion: Our analysis showed that carina shift, instead of plaque shift, was the main mechanism of LCX ostium compromise after FKBI in single-stent crossover technique for left-main bifurcation lesions. FKBI increased the stent area of the left main and POC, and decreased stent malapposition phenomena, at the cost of increasing stent symmetric index. 2021 Vol. 51 (10): 793-799 [Abstract] ( 593 ) HTML (1 KB)  PDF (1681 KB)  ( 945 ) 800 The value of enhanced T1WI radiomics in predicting the IDH 1 genotype of mutant and wild type in highgrade gliomas XIA Shuiwei, ZHOU Yongjin, CHEN Chunmiao, CHEN Jiajun, HUI Junguo, CHEN Minjiang, DOI: 10.3969/j.issn.2095-9400.2021.10.005 Objective: To explore the value of radiomics predictive model based on preoperative enhanced T1WI images in predicting the mutant and wild type of isocitrate dehydrogenase-1 (IDH 1) genotype in patients with high-grade gliomas. Methods: A retrospective analysis was conducted of 89 high-grade glioma patients with complete preoperative craniocerebral enhanced T1WI images in the Fifth Affiliated Hospital of Wenzhou Medical University from June 2018 to December 2020, including 32 cases of IDH 1 mutant type (15 cases of WHO grade III, 17 cases of WHO grade IV) and 57 cases of IDH 1 wild type (12 cases of WHO grade III, 45 cases of WHO grade IV). The two groups of patients were randomly divided into training group and validation group with a ratio of 7:3. A.K software was used to extract the texture features from the original enhanced T1WI images,and Kruskal-Wallis test, Spearman correlation analysis, LASSO-regression and ten-fold cross validation were performed for feature dimension reduction and identifying the most characteristic parameters to build the predictive model. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of the model in identifying IDH 1 mutant and IDH 1 wild-type high-grade gliomas. Decision curve analysis (DCA) was used to evaluate the clinical benefit of the model. Results: A total of 396 texture parameters were extracted from theenhanced T1WI images of each patient. Five texture parameters were selected ultimately by LASSO-regression and ten-fold cross validation, and the corresponding radiomics scores (Rad-scroes) were calculated to construct the prediction models of the training group and the validation group. The area under curve (AUC) of ROC of the training group was 0.902 (95%CI: 0.826-0.978), with the sensitivity and specificity being 84.6% and 81.8%, respectively. The AUC of the validation group was 0.844 (95%CI: 0.676-1.000), with the sensitivity and specificity being 77.8% and 80.1%, respectively. DCA showed that the net benefit of the radiomics model was better than that of the untreated model and the all-treated model with a risk threshold ranges from 0.1 to 1.0. Conclusion: The radiomics model based on enhanced T1WI images can effectively identify the IDH 1 mutant and wild type of high-grade glioma. 2021 Vol. 51 (10): 800-805 [Abstract] ( 655 ) HTML (1 KB)  PDF (1767 KB)  ( 845 ) 806 Effect of islet transplantation on diabetic peripheral neuropathy in diabetic rats CHEN Yanyan, LI Jia,XU Ziqiang, XIA Nian’ge. DOI: 10.3969/j.issn.2095-9400.2021.10.006 Objective: To investigate the protective effect of islet transplantation on diabetic peripheral neuropathy and to explore its possible mechanism. Methods: The diabetic model was established by intraperitoneal injection of streptozotocin in SD rats. Islet transplantation was performed 12 weeks after the diabetic modeling. At week 16 after the diabetic modeling, HE staining, mRNA expression of tumor necrosis factor α (TNF-α), expression of B-cell lymphoma-2 (BCL2), BCL-2 associated X (bax) and caspase3 were detected in sciatic nerve of each group. Results: After islet transplantation, the peripheral nerve axons and myelin sheath of peripheral nerve were obviously improved. Besides, the withdrawal latency to pain stimuli significantly increased, and the mRNA expression of TNF-α was obviously lower. Our study has shown upregulation of BCL-2 downregulation of BAX and caspase3 four weeks after islet transplantation, compared with the diabetic group. Conclusion: Islet transplantation can significantly improve the peripheral neuropathy in diabetic rats, probably through the downregulation of TNF-α, via BCL-2/BAX, caspase3 mediated pathways. 2021 Vol. 51 (10): 806-810 [Abstract] ( 630 ) HTML (1 KB)  PDF (1641 KB)  ( 712 ) 811 Chromosomal analysis of patients with hyperdiploid multiple myeloma HUANG He, LIN Hongdou, GUOWenjian, LI Qian. DOI: 10.3969/j.issn.2095-9400.2021.10.007 Objective: To analyze the clinical features, prognosis and cytogenetic characteristics of multiple myeloma patients with hyperdiploid. Methods: Detailed data of patients diagnosed as multiple myeloma (MM) were collected from the Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University between 2009 and 2018. Bone marrow cells were cultured for a short time and karyotype was detected by routine R-banding analysis and FISH technique. Then, the karyotype characteristics of hyperdiploid patients were screened and analyzed. Furthermore, the survival curve was constructed by Mantel-Cox method, and the overall survival time of hyperdiploid and non-hyperdiploid patients was compared by Log-rank test. Results: The incidence of hyperdiploid MM patients was 22% (33/150), and the most frequent detection rate of trisomy was +5(23/33), +3(18/33), +19(17/33), +9(16/33). The gene ABL, PML, 1q21 amplification and RB1 deletion was common. However, the median survival time of hyperdiploid MM patients was 18.5 months, which had no statistical difference from that of non-hyperdiploid patients (15 months). Meanwhile, recurrent MM patients were also prone to hyperdiploid karyotype. Conclusion: The incidence of hyperdiploidy is frequent in MM, accompanied by trisomy. The diversity of gene expression is very common in the increased chromosomes, which is correlated with the prognosis. 2021 Vol. 51 (10): 811-816 [Abstract] ( 633 ) HTML (1 KB)  PDF (1497 KB)  ( 1025 ) 817 Radiation dose analysis of dense breast in digital breast tomosynthesis CHEN Xiao, CAO Guoquan,ZHOU Jiahuan, LIN Xiaomin, HE Wenwen, ZHOU Bailin. DOI: 10.3969/j.issn.2095-9400.2021.10.008 Objective: To analyze the radiation dose of dense breast in Digital Breast Tomosynthesis (DBT) and to explore the affecting factors. Methods: A retrospective analysis was performed on 804 sets of images of 201 female dense breast patients undergoing DBT examination from April 2019 to December 2019. Each set of images included DBT tomography and full-field digital mammography (FFDM) images. Photographic position, breast compression thickness, tube current, tube voltage, average glandular dose (AGD) and entrance surface dose (ESE), breast section size and breast density of patients were recorded at the post-processing station. The influence factors of radiation dose of dense mammary gland in DBT examination were analyzed by multi-factor variance and Pearson correlation. Results: Combined with DBT and FFDM images, there was statistical difference (P<0.05) in tube current, AGD and ESE among different gland compression thickness, breast section size and breast density. The thickness of glandular compression was highly correlated with ESE/AGD (r=0.97,P<0.01). Conclusion: When DBT examination is performed on patients with dense breast, the radiation dose,especially ESE, will be gradually up with the increase of breast thickness, size and density. 2021 Vol. 51 (10): 817-821 [Abstract] ( 543 ) HTML (1 KB)  PDF (1467 KB)  ( 643 ) 822 The characteristics of SLC25A13 gene variations of infantile intrahepatic cholestasis with unknown etiology FANG Lingjuan, LIN Xiaochun, XU Zhang, HUANG Kaiyu, CHEN Guiping, YAN Xiumei. DOI: 10.3969/j.issn.2095-9400.2021.10.009 Objective: To investigate the characteristics of SLC25A13 gene variations of infantile intrahepatic cholestasis with unknown etiology. Methods: Infants with intrahepatic cholestasis of unknown etiology who were hospitalized in the Department of Gastroenterology of the Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University from January 2016 to December 2020 were selected. Next generation sequencing was performed to select variations of SLC25A13 gene, and Sanger sequencing was used to identify variations of SLC25A13 gene. Additionally, the two most frequent large- fragment variations of SLC25A13 gene were also detected. Then, the characteristics of SLC25A13 gene variations and its function were analyzed. Results: Genetic testing was performed on 30 infants with intrahepatic cholestasis. SLC25A13 gene pathogenic variants were detected in 12 cases. The frequency of SLC25A13 gene in infantile intrahepatic cholestasis was 40%. The most common variation was c.852_855delTATG, p.M285Pfs*2. A novel variation (c.1808T>C,p.L603P) was identified. Conclusion: Citrin deficiency caused by SLC25A13 gene variation might be the most important cause of infantile intrahepatic cholestasis with unknown etiology, and the c.852_855delTATG,p.M285Pfs*2 was the most common pathogenic variation. The novel variation, which impairs citrin function, has expanded the variation spectrum of SLC25A13 gene. 2021 Vol. 51 (10): 822-826 [Abstract] ( 559 ) HTML (1 KB)  PDF (1393 KB)  ( 687 ) 827 MRI features of postpartum hemorrhage in gravida with placenta accreta sepctrum WU Xiuli, ZHOU Rongzhen, ZHENG Ke, LIN Minjie, WANG Dongnyu. DOI: 10.3969/j.issn.2095-9400.2021.10.010 Objective: To investigate the MRI features of gravida with PAS with an analysis of the risk factors of postpartum hemorrhage after cesarean section. Methods: The clinical data and MRI images of 100 gravida with PAS who underwent prenatal MRI examination and delivered in Taizhou Hospital Affiliated to Wenzhou Medical University from September 2016 to March 2021 were retrospectively analyzed. Thirty-seven gravida with postpartum hemorrhage≥1 000 mL were selected as the observation group (including 16 patients with hysterectomy), and 63 gravida with blood loss less than 1 000 mL were selected as the control group. The differences of MRI features between the two groups were compared, including T2-dark intraplacenta bands,placental/uterine bulge, loss of retroplacental T2-hypointense, myometrium thinning, bladder wall interruption,focal exophytic mass, abnormal vascularization of placental bed, placenta previa and catastrophe placenta previa,and the independent risk factors of postpartum hemorrhage were analyzed and evaluated. Results: There was statistical difference between the two groups in 8 MRI features except myometrium thinning (P<0.05). Binary Logistic regression analysis showed that T2-dark intraplacenta bands (OR=10.889, 95%CI: 1.021-116.159) and catastrophe placenta previa (OR=5.458, 95%CI: 1.284-23.200) were independent risk factors for postpartum hemorrhage in gravida with PAS (P<0.05). Conclusion: T2-dark intraplacenta bands and catastrophe placenta previa on prenatal MRI prompted an increased risk of postpartum hemorrhage in gravida with PAS, which should be paid attention to by obstetrician. 2021 Vol. 51 (10): 827-831 [Abstract] ( 563 ) HTML (1 KB)  PDF (2559 KB)  ( 684 ) 832 The diagnostic value of ultrasound in ovarian dysgerminoma JIANG Xin, SUN Jieke, XU Shihao, CHEN Lixia DOI: 10.3969/j.issn.2095-9400.2021.10.011 Objective: To analyze the ultrasonographic features of ovarian dysgerminoma and to explore the value of ultrasonography in the diagnosis of ovarian dysgerminoma. Methods: The ultrasonographic features of 21 cases of ovarian dysgerminoma confirmed by operation and pathology in the First Affiliated Hospital of Wenzhou Medical University and the Second Affiliated Hospital of Wenzhou Medical University from January 2009 to June 2020 were retrospectively analyzed. The location, size, shape, boundary, internal echo and blood flow of the tumor were summarized. Results: The age of 21 patients with ovarian dysgerminoma was 13-64 years old, aged (20.8±8.6) in average. Ultrasonography showed that the adnexal area was mainly solid with clear boundary. All the masses were single and large, and 16 cases were lobulated. The internal echo was uneven, with “fibrous vascular septum” and lobular structure seen in 16 cases. In addition, there were necrotic cystic anechoic areas in 10 cases. There was abundant low resistance blood flow in the interior, with blood flow signal of grade III in 18 cases, grade II in 2 cases and grade I in only 1 case. Conclusion: The ultrasonographic manifestations of ovarian dysgerminoma have shown certain characteristics, and the combination with some clinical biochemical indexes is helpful to improve the diagnostic accuracy of the tumor. 2021 Vol. 51 (10): 832-835,840 [Abstract] ( 540 ) HTML (1 KB)  PDF (1638 KB)  ( 712 ) 836 Serological characteristics and gene sequence analysis of rare B (A) subgroup CHEN Jingsi, LIN Jiajin,ZHANG Ying, YOU Wei, JIANG Minghua DOI: 10.3969/j.issn.2095-9400.2021.10.012 Objective: To analyze the serological characteristics and gene sequencing results of rare B(A) subgroup. Methods: Eight specimens with inconsistent positive and negative ABO typing or antigen weakening were collected from the Second Affiliated Hospital of Wenzhou Medical University from March 2013 to June 2021. Polymerase chain reaction sequence-specific primer (PCR-SSP) was used to detect ABO genotyping, direct sequencing method for gene sequencing, polybrene method with type A, B, AB and O donors for cross matching.Results: Eight samples showed AweakB type in routine serological results and B(A) type in gene sequencing,including 2 cases of B(A).04/O.01.02, 2 cases of B(A).02/O.01.02, 2 cases of B(A).04/O.01.01, 1 case of B(A).04/A.01.01, and 1 cases of B(A).02/O.01.01. Main side cross matching with O and B donors was negative,so as the secondary side of cross matching with AB donors. Conclusion: The genotype of rare B (A) subgroup was mainly B(A).04 and B(A).02, with its serological characteristics of “A is weak and B is strong”. 2021 Vol. 51 (10): 836-840 [Abstract] ( 497 ) HTML (1 KB)  PDF (1595 KB)  ( 719 )

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