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2021 Vol. 51, No. 11 Published: 2021-11-25   861 The inhibiting effect of exosomal ciRS-7 derived from cancer associated fibroblasts on glycolysis of pancreatic cancer cells via miR-7/IGF1R axis GU Dianna, CHEN Hanbin, QIAN Fangjing, CHEN Yang,YE Zhiqiang DOI: 10.3969/j.issn.2095-9400.2021.11.001 Objective: To investigate the effect of exosomal ciRS-7 derived from cancer associated fibroblasts (CAFs) on glycolysis of pancreatic cancer cells. Methods: Exosomes derived from CAFs were extracted by ultracentrifugation, and the real-time quantitative polymerase chain reaction (RT-qPCR) was used to detect the expression of exosomal ciRS-7 and the mRNAs of key glycolytic enzymes in pancreatic cancer cells.ciRS-7-WT or ciRS-7-MT was used to verify the relationship between ciRS-7 and miR-7 in pancreatic cancer by Dual Luciferase Reporter Assay. The protein changes of IGF1R/AKT axis in pancreatic cancer were analyzed by Western blot. Results: The expression of ciRS-7 was up-regulated in the exosomes derived from CAFs. The exosomes released by CAFs promoted glycolytic metabolism and proliferation of pancreatic cancer cells. The exosomes released by pancreatic CAFs with ciRS-7 knock-down could inhibit the expression of glycolysis-related genes in pancreatic cancer cells. And ciRS-7 promoted glycolysis in pancreatic cancer cells through modulating the miR7/IGF1R/AKT pathway. Conclusion: Exosomal ciRS-7 was up-regulated in pancreatic CAFs, and the downregulation of ciRS-7 expression in CAFs could suppress the glycolysis metabolism in pancreatic cancer cells. 2021 Vol. 51 (11): 861-866 [Abstract] ( 1132 ) HTML (1 KB)  PDF (1871 KB)  ( 664 ) 867 Quantitative evaluation of myocardial work by ultrasonic pressure-strain loop in patients with pulmonary arterial hypertension WANG Jian, YANG Menghui, SUN Lingyue, SHEN Xuedong, SHEN Jieyan DOI: 10.3969/j.issn.2095-9400.2021.11.002 Objective: To investigate the feasibility of pressure-strain loops (PSL) for quantitative assessment of left (LV) and right ventricular (RV) myocardial work in patients with pulmonary arterial hypertension (PAH).Methods: Forty patients with PAH were enrolled in outpatient as PAH group, and twenty healthy controls were recruited during the same period. Upper arm cuff pressure measurements and conventional transthoracic cardiac ultrasound were completed for all subjects, and myocardial work parameters of LV and RV were evaluated using PSL to obtain four main parameters, including global work efficiency (GWE), global work index (GWI), global constructive work (GCW) and global wasted work (GWW). The difference of myocardial work parameters between the two groups was compared, and further comparison was made between different myocardial work parameters under different cardiac function, with an analysis of the correlation between myocardial work parameters and conventional ultrasonic parameters. Results: Compared with control group, PAH group had increased LVGWW, RVGWI, RVGCW and RVGWW significantly (P<0.001). Moreover, LVGWE, LVGWI,LVGCW and RVGWE were significantly lower than those of control group (P<0.01). With the deterioration of cardiac function, LVGWE and LVGWI showed a significant decline, while LVGWW increased significantly. There was a significant correlation between RVGWW and cardiac function status, and RVGWE was significantly different between patients with WHO-FC I/II and III/IV. Correlation analysis showed that the majority of myocardial work parameters correlated well with conventional ultrasonic assessments (P<0.05). Conclusion: PSL can well quantify left and right cardiac function in patients with PAH, which provides a new basis for clinical management of patients. 2021 Vol. 51 (11): 867-872, 880 [Abstract] ( 752 ) HTML (1 KB)  PDF (1710 KB)  ( 701 ) 873 Clinical significance of GST-π, Ki-67 and BMI in the prognosis of rectal cancer HUANG Chongjie, HONG Huang, LIU Changbao, CAO Weilan, HUANG Yingpeng, WANG Zhonglin DOI: 10.3969/j.issn.2095-9400.2021.11.003 Objective: To explore the relationship between the expression of GST-π, Ki-67, BMI and the clinical biological characteristics of rectal cancer patients and its clinical significance. Methods: A retrospective collection of 308 patients with rectal cancer who underwent surgery in the Second Affiliated Hospital of Wenzhou Medical University from January 2010 to January 2013 was completed and followed up for 5 years. We analyzed the association of body mass index (BMI) and the expression of tumor markers (Ki-67, GST-π) with clinical features and pathological features of rectal cancer, as well as the correlation between BMI and Ki-67, GST-π expression and its clinical significance in rectal cancer. The relationship between the 5-year survival rate of Ki-67 high-positive patients and BMI was also analyzed. Results: The high positive expression of Ki-67 in rectal cancer is closely related to the depth of infiltration of rectal cancer, TNM staging and poor 5-year survival rate (P<0.05). Compared with the normal BMI group, the high positive expression of Ki-67 and the weight loss group had a lower 5-year survival rate for rectal cancer after surgery (P<0.05) .The positive expression of GST-π in rectal cancer tissue was significantly correlated with weight loss, lymph node metastasis, lower rectal cancer, and higher TNM staging(P<0.05). Conclusion: The combined analysis of the correlation between BMI and GST-π and Ki-67 expression level plays an important role in the clinical evalvation of the malignancy of colorectal cancer and its prognosis. 2021 Vol. 51 (11): 873-880 [Abstract] ( 620 ) HTML (1 KB)  PDF (1584 KB)  ( 895 ) 881 The effect of esketamine combined with dexmedetomidine on children undergoing tonsillectomy LU Guangtao, CHEN Jian, ZHOU Zhili, QIAN Jiashu, LIN Xuezheng DOI: 10.3969/j.issn.2095-9400.2021.11.004 Objective: To investigate the effect of pretreatment with esketamine+dexmedetomidine (DEX) on hemodynamics and emergence agitation (EA) in children undergoing tonsillectomy. Methods: Eighty children from February to December 2020 (ASA class I~II, aged 5 to 13 years) underwent tonsillectomy in Taizhou Central Hospital were randomly divided as group E and group ED, with 40 cases each. Before anesthesia induction,children in group E received esketamine 0.5 mg/kg, while those in group ED received equal volume (10 mL) of esketamine 0.5 mg/kg+DEX 1.0 μg/kg. Pediatric anesthesia emergence delirium (PAED) and face, legs, activity,cry, consolability (FLACC) scales were used to score the EA and pain within 30 min after entering the postanesthetic care unit (PACU). Heart rate (HR) and mean arterial pressure (MAP) were recorded before anesthesia(T0), when extubation (T1), 5 min (T2) and 10 min (T3) after extubation. Operation time, emergence time, PACU residence time, and adverse reactions were also recorded. Results: There was no statistically difference in FLACC scores between the two groups (P>0.05). The PAED score of group ED was significantly lower than that of group E (P<0.05). There were no significant differences in MAP and HR between the two groups at T0, T3,however, HR and MAP in group ED at T1 and T2 were lower than in group E (P<0.05). There were no significant differences in the operation time, emergence time and PACU residence time between the two groups (P>0.05).The incidence of adverse reactions such as dizziness, nausea and vomiting in group ED was obviously lower than in group E (P<0.05). Conclusion: The application of esketamine combined with DEX in children undergoing tonsillectomy can effectively reduce the incidence of emergence agitation, improve hemodynamic stability and decrease adverse reactions, which is of remarkable clinical significance. 2021 Vol. 51 (11): 881-884 [Abstract] ( 537 ) HTML (1 KB)  PDF (1374 KB)  ( 738 ) 885 The value of CT-based radiomic signature in predicting lumbar osteoporosis in the elderly JIANG Lezhen,GUO Yifan, SU Jiehui, LIN Wenxiao, WU Aiqin, BAI Guanghui DOI: 10.3969/j.issn.2095-9400.2021.11.005 Objective: To evaluate the value of radiomic signature based on CT plain scan in predicting lumbar osteoporosis in the elderly. Methods: Sixty-six cases including postmenopausal women and men over 50 years old in the Second Affiliated Hospital of Wenzhou Medical University from July 2020 to October 2020 were studied. All patients received CT plain scan of lumbar spine, of whom 237 lumbar vertebrae from lumbar 1 to lumbar 4 met the study criteria, with 95 osteoporosis and 142 non-osteoporosis. All lumbar vertebrae were stratified randomly into the training group and the validation group in a ratio of 7:3. The cancellous bone of the lumbar vertebrae was delineated layer by layer on CT images using 3D Slicer software to obtain the three-dimensional region of interest (ROI), and the radiomic features were extracted from each lumbar vertebra. Radiomic features of the training group were dimensionality reduced by the Min-redundancy and Max Relevance (mRMR) and 10 features were retained. The least absolute shrinkage and selection operator (LASSO) logistic regression was then applied to select the optimized subset from the retained features to construct the radiomic signature. The area under the receiver (AUC) of operating characteristic (ROC) curve was used to evaluate the predictive efficacy of the radiomic signature. Calibration curves were used to determine the calibration of the radiomic signature.Results: Of the 1 316 radiomic features extracted, 7 radiomic features significantly associated with lumbar osteoporosis were selected and used to construct radiomic signature. The ROC curves showed that the AUC of the radiomic signature in the training and validation groups were 0.908 (95%CI=0.863-0.952) and 0.935(95%CI=0.873-0.996), respectively. Calibration curves showed that the radiomic signature had good fitting degree in both the training and validation group. Conclusion: The CT-based radiomic signature can be used as a noninvasive tool to evaluate elderly patients with lumbar osteoporosis, which may be helpful to assist clinical decision-making and improve patient prognosis. 2021 Vol. 51 (11): 885-890 [Abstract] ( 641 ) HTML (1 KB)  PDF (1590 KB)  ( 814 ) 891 Long-term outcome of childhood acute lymphoblastic leukemia treated with Chinese Children’s Leukemia Group in China-Acute Lymphoblastic Leukemia 2014 HUANG Tingting, WANG Juxiang, ZHOU Haixia, LI Yuan, CHEN Min, HU Linglong, WANG Yao, HUANG Zhen DOI: 10.3969/j.issn.2095-9400.2021.11.006 Objective: To analyze the long-term efficacy in childhood acute lymphoblastic leukemia cases enrolled in Chinese Children’s Leukemia Group in China-Acute Lymphablastic Leukemia (CCLG-ALL) 2014.Methods: Clinical data of 108 patients diagnosed as ALL and treated with CCLG-ALL2014 protocol between January 2015 and December 2019 in the Department of Hematology-Oncology, the Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University were retrospectively analyzed. The relationship between minimal residual disease (MRD) monitored by flow cytometry and prognosis was analyzed, and Kaplan-Meier method was applied for long-term survival analysis. Results: A total of 108 patients with newly diagnosed ALL included 55 males and 53 females with a mean aged of 5.3 years (ranging from 1.0 to 15.2) years and a follow-up period of 3.3 years (ranging from 1.0-5.9). Totally 107 patients (99%) achieved complete remission. The 3-year event free survival (EFS) and overall survival (OS) rates was (73.4±4.3)% and (92.9±2.6)%, respectively.Relapse occurred in 10 cases, and 7 patients died. The 3-year OS rate of patients with relapsed disease was significantly worse than those without (50±15.8)% vs. (98.4±1.6)%, χ2=44.884, P<0.001). The 3-year OS rate of patients with MRD>5% on day 15 of induction therapy was significantly worse than those with MRD≤5%[(79.9±8.3)% vs. (98.7±1.3)%, χ2=10.547, P=0.001]. The 3-year OS rate was obviously lower in patients with MRD>10% on day 33 of induction therapy. Conclusion: CCLG-ALL2014 protocol is effective for childhood ALL. The accurate risk stratification guided by MRD and individualized treatment can reduce the relapse and improve the long-term survival rate of pediatric ALL. 2021 Vol. 51 (11): 891-895 [Abstract] ( 604 ) HTML (1 KB)  PDF (1451 KB)  ( 1108 ) 896 The association of GLP1R gene polymorphism with the risk of type 2 diabetes mellitus and blood glucose,serum lipids, islet function in Chinese Han population ZHENG Wenwen, ZHENG Chao, ZHOU Xinhe DOI: 10.3969/j.issn.2095-9400.2021.11.007 Objective: To investigate the association of polymorphisms of Glucagon-like peptide-1 receptor (GLP1R) genes rs3765467, rs2268657 and rs6923761 in  Chinese Han type 2 diabetic patients, and its effect on blood glucose, serum lipids metabolism and islet function. Methods: The loci genotyping of GLP1R genes rs3765467, rs2268657 and rs6923761 were detected by kompetitive allele specific PCR, and analyzed in combination with blood glucose, serum lipids and islet function. Results: T2DM group had significantly higher CC genotype and C allele frequencies of GLP1R rs3765467 than the control group (61.0% vs. 51.9%, P=0.040;77.3% vs. 72.3%, P=0.022). In the recessive model, the frequency of rs3765467 CC genotype in T2DM group was greatly higher than the control group (61.0% vs. 51.9%, P=0.011). Logistic regression analysis showed that rs3765467 CC genotype was an independent risk factor for T2DM (OR=1.724, 95%CI=1.217-2.443, P=0.002).The HbA1c level of rs3765467 CC genotype was markedly higher than the CT+TT genotype (t=-2.517, P=0.012).The HDL-C level of rs2268657 GG genotype was greatly higher than the GA+AA genotype (t=-2.162, P=0.031).In the T2DM group, the levels of FP-C, HOMA-β and HOMA-IR of rs3765467 CC genotype were significantly lower than the CT+TT genotype (P<0.05). Conclusion: GLP1R rs3765467 polymorphism may be associated with the risk of T2DM in Chinese Han population and GLP1R gene polymorphism may affect blood glucose,serum lipids metabolism and islet β-cell function. 2021 Vol. 51 (11): 896-901 [Abstract] ( 582 ) HTML (1 KB)  PDF (1433 KB)  ( 868 ) 902 Effect of hysteroscopy on clinical outcome of patients with minimal endometrial lesions and failed transplantation YE Jinbin, SU Weijue, FU Yanghua, ZHAO Junzhao DOI: 10.3969/j.issn.2095-9400.2021.11.008 Objective: To investigate whether hysteroscopy can improve the clinical outcome of the asymptomatic infertility with minimal endometrial lesions after the failure of in vitro fertilization-embryo transfer (IVF-ET) but before reimplantation. Methods: The clinical data of female infertility once failed in IVF-ET treated with freeze-thaw embryo transfer (FET) from July 2018 to September 2020 were retrospective analyzed.The number of cases in the control group was 225, which did not undergo hysteroscopy, while 114 cases treated with FET after hysteroscopy were in the hysteroscopy group. In the hysteroscopy group, 49 cases of all with normal uterine cavity diagnosed by hysteroscopy were in the normal group, while 65 cases treated by transcervical resection of endometrial polyp were in the polyp group. The preoperative ultrasonic results, general clinical data, clinical outcome of all cases were statistically analyzed. Results: The result of ultrasound diagnosis in 142 patients who had failed in transplantation showed that the sensitivity of ultrasound diagnosis was only 22.6%. The miscarriage rate of hysteroscopy group was lower than the control group, and the living rate in the hysteroscopy group was also higher than the control group (8.2% vs. 20.2%, P=0.040; 49.1% vs. 37.8%, P=0.045), with significant difference. There was no significant difference in clinical outcome (P>0.05) between the normal group and the polyp group, the control group and the normal group. Conclusion: For asymptomatic infertility with normal uterine cavity diagnosed by transvaginal sonography but failed in IVF-ET, hysteroscopy is recommended in diagnosis and treatment before reimplantation. 2021 Vol. 51 (11): 902-906 [Abstract] ( 579 ) HTML (1 KB)  PDF (1375 KB)  ( 542 ) 907 Clinical analysis of ischemic colitis combined with mesenteric angiography LIN Ruoyang, XIA Yongsheng,HUANG Zhiming DOI: 10.3969/j.issn.2095-9400.2021.11.009 Objective: To investigate the clinical characteristics of ischemic colitis and analyze the relationship between biochemical indexes, mesenteric CTA, mesenteric artery contrast-enhanced ultrasonography and endoscopic manifestations. Methods: Patients who were clinically diagnosed with ischemic colitis from February 2019 to October 2020 were enrolled, who were divided as mild group and severe group according to colonoscopy manifestations. The differences between the two groups were investigated and compared in clinical symptoms,biochemical examination, pathology of colonoscopy, mesenteric CTA, and angiography results. Results: Blood leukocyte count, prothrombin time, creatinine level and CRP level were significantly higher in severe group than in mild group (P<0.05), with statistical difference in mesenteric artery CTA examination between the mild and severe groups (P=0.014). The positive rate of mesenteric contrast-enhanced ultrasound was higher in severe group than in mild group, with no significant difference (P=0.108). The difference between the positive rate of mesenteric artery CTA and the positive rate of mesenteric artery contrast-enhanced ultrasound was statistically significant in all enrolled patients (P=0.035). Conclusion: The colonoscopy difference in patients with ischemic colitis is significantly related to white blood cell count, prothrombin time, creatinine, CRP level. The choice between mesenteric artery CTA and mesenteric artery contrast-enhanced ultrasound should be based on the patient's condition. 2021 Vol. 51 (11): 907-911,916 [Abstract] ( 543 ) HTML (1 KB)  PDF (1504 KB)  ( 703 ) 912 Stability difference of varied doses of polymethylmethacrylate reinforced anchor in osteoporotic bone module DONG Yilong, QIAN Yuenan, ZHANG Xia, LI Yimin, CAI Chunyuan, LIU Liangle DOI: 10.3969/j.issn.2095-9400.2021.11.010 Objective: To compare the anchor stability strengthened by polymethylmethacrylate (PMMA) with varied doses in osteoporotic bone modules and analyze the correlation between anchor stability and PMMA dose, and then, to find the optimal PMMA cement injection dose. Methods: Thirty-six osteoporotic bone modules were randomly divided into 6 experimental groups (A-F, n=6): group A (blank group), which was directly screwed into the anchor; group B-F, through injector push rod, were injected respectively with an accurate dose of 0.5, 1.0, 1.5, 2.0, and 2.5 mL PMMA bone cement into the screw channel. Then, X-ray examination was performed after the cement was hardened, followed by the observation of the bone cement distribution around the screw. Mechanical experiments were performed to measure the maximum axial pullout force (Fmax) and the destruction of the module observed. Results: The Fmax of group A-F was (145.50±23.82)N, (188.67±34.90)N,(234.00±21.14)N, (296.80±18.55)N, (445.00±33.72)N and (458.60±25.54)N, respectively, with significant statistical difference between the groups (F=143.020, P<0.001). There was positive correlation between Fmax and PMMA dose (0-2 mL, Pearson correlation coefficient (r=0.948, P<0.05). The modules in all groups were damaged to varying degrees after anchor pullout. The damage degree of the module from group A to group E was gradually aggravated, while the module’s damage for E and F was nearly the same. Conclusion: PMMA can significantly improve the anchor stability in osteoporotic bone modules, and the stability of anchors increases with the increase of PMMA dose among 0-2 mL. The recommended dose of PMMA in clinical practice is 2.0 mL. 2021 Vol. 51 (11): 912-916 [Abstract] ( 486 ) HTML (1 KB)  PDF (1727 KB)  ( 764 ) 917 Two methods of making cell wax blocks for bloody pleural effusion and their effect on the film-making results SHI Danfei, CUI Ge, LI Yong DOI: 10.3969/j.issn.2095-9400.2021.11.011 Objective: To compare the effect of traditional and modified cell wax methods on HE and immunohistochemistry in hemorrhagic pleural effusion. Methods: A total of 55 patients with exudative bloody pleural effusion admitted for clinical examination to the First Affiliated Hospital of Huzhou University from January 2018 to January 2021 were selected and prepared by the traditional and modified methods of cell wax block making respectively to compare the excellent rate of HE and immunohistochemical production. Results: The excellent rate of HE and immunohistochemistry by traditional method was 74.5% and 76.4% respectively, while it was 94.6% and 92.7% respectively by the modified method. The defect rate of HE and immunohistochemical in the modified method was significantly lower than that of the traditional method (χ2=8.419, P=0.004; χ2=5.636,P=0.018). Conclusion: The modified method has better effect on the preparation of cell wax blocks from hemorrhagic pleural effusion. 2021 Vol. 51 (11): 917-919 [Abstract] ( 554 ) HTML (1 KB)  PDF (1493 KB)  ( 830 ) 920 Early removal feasibility of hook plate for acromioclavicular joint dislocation XU Fangzao, WANG Gencun DOI: 10.3969/j.issn.2095-9400.2021.11.012 Objective: To explore the feasibility of early removal of the hook plate of the acromioclavicular joint and its therapeutic effect. Methods: Clinical data of 32 patients with acromioclavicular joint dislocation treated in our hospital from January 2017 to December 2019 were retrospectively analyzed. Results: Thirtytwo patients completed the initial internal fixation implantation, regular follow-ups and internal fixation removal in our hospital. The VAS pain score of the patients in the 6-month removal group was significantly higher than that in the over-6-month removal group (4.58±1.08 vs. 2.20±1.36, P<0.001). The shoulder function score of the patients in the 6-month removal group was 72.92±7.13, significantly lower than that of the patients in the over-6-month removal group (80.50±5.58, P=0.002). When the plate was removed, no significant difference was found in VAS pain score and shoulder function score between both groups. There was no significant difference in the widening distance of coracoclavicular joint space between the two groups after the removal of internal fixation[(1.70±1.19)mm vs. (2.20±2.02)mm, P=0.442]. Conclusion: Early removal of internal fixation after hook plate fixation of acromioclavicular joint dislocation can relieve the patients of pain, discomfort and functional limitation without increasing the re-dislocation risk of the acromioclavicular joint. 2021 Vol. 51 (11): 920-923 [Abstract] ( 547 ) HTML (1 KB)  PDF (1441 KB)  ( 880 ) 924 Endoscopic injection of methylene blue combined with curing agent in the treatment of ectopic rectal varicose hemorrhage WANG Lingling, GE Qing, HUANG Qin, YE Liping DOI: 10.3969/j.issn.2095-9400.2021.11.013 Objective: To seek a new endoscopic treatment for ectopic rectal varicose hemorrhage with methylene blue combined with curing agent. Methods: A retrospective analysis was performed on two cases of ectopic rectal varicose hemorrhage, focusing on the diagnosis, procedures of endoscopic injection of methylene blue combined with curing agent, the surgical precautions and the therapeutic effect. Results: The diagnosis of ectopic rectal varices mainly depends on abdominal CT, selective angiography and electronic colonoscopy.Methylene blue combined with curing agent could ensure the precise injection, a much clearer operation field,the co-assessment of the dosage of the curing agent, thus reducing the endoscopic complications. Methylene blue injection combined with curing agent under endoscope was used to successfully treat 2 patients with ectopic rectal varicose hemorrhage. Conclusion: Endoscopic treatment is usually the first choice for ectopic rectal varicose hemorrhage, which is rare and complicated with large amount of bleeding and critical condition.Methylene blue injection combined with curing agent under endoscope is safe and effective in the treatment of ectopic rectal varicose hemorrhage. 2021 Vol. 51 (11): 924-927,930 [Abstract] ( 571 ) HTML (1 KB)  PDF (1482 KB)  ( 729 )

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