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2022 Vol. 52, No. 4 Published: 2022-04-25   259 Feasibility of oral microecological intervention using vestibular sulcus: take probiotic cotton for example PAN Binhui, SHI Jiangmin, JI Xiawei, CHEN Huasen,XU Changlong DOI: 10.3969/j.issn.2095-9400.2022.04.001 Objective: To explore the effectiveness of oral microecological information extraction and intervention with the bacterial fluid obtained from oral vestibular sulcus. Methods: A total of 10 postgraduates from the Department of Gastroenterology, the Second Affiliated Hospital of Wenzhou Medical University were collected. Cotton was utilized as a carrier to extract bacterial fluid from oral vestibula, while probiotic cotton was taken for example to conduct oral microflora intervention. Bacterial composition and short-chain fatty acid content in saliva collected from cotton and saliva collector were detected and compared by 16S rDNA amplification sequencing and targeted metabolomics. R software was used to draw dilution curves, Rank abundance curves,and α diversity analysis, parametric test and non-parametric test. Results: Compared with the saliva from saliva collector, the bacteria liquid collected by cotton had higher species abundance and evenness, and short-chain fatty acid concentration was also higher, more markedly in acetic acid and propionic acid. Different from healthy volunteers, the cotton bacteria liquid in caries patients had obviously higher percentage of Streptococcus and lower percentage of Proteobacteria, and there was statistical difference in Prevotella between the two groups (P<0.05). After probiotic cotton intervention, Massilia and Arthrobacter were significantly increased in the healthy control group (P<0.05), while Lachnospiraceae_NK4A136_group were significantly decreased (P<0.05).However, in the caries group, the level of Pantoea and Capnocytophaga was significantly higher (P<0.05). Linear discriminant analysis further indicated that Proteobacteria and Gammaproteobacteria significantly increased while Firmicutes significantly decreased in the healthy control group after probiotic cotton intervention (P<0.05).An evident increase in Flavobacteriales was also discovered in the caries group (P<0.05). Conclusion: Oral vestibular sulcus could be available for oral microecology extraction and intervention, which has a wide application prospect in the study of oral and systemic diseases and oral health care. 2022 Vol. 52 (4): 259-265 [Abstract] ( 553 ) HTML (1 KB)  PDF (1933 KB)  ( 776 ) 266 Construction of intelligent regulation model of oxytocin in vaginal birth after cesarean HU Tingting,ZHANG Yichao, YUAN Zhenming, LI Jianhong, LU Zhongqiu, ZHU Xiaoling DOI: 10.3969/j.issn.2095-9400.2022.04.002 Objective: To construct an intelligent regulation model of oxytocin (OT) in vaginal trial delivery of (VBAC) after cesarean section and to further explore the intelligent and precise regulation and control scheme for the use of OT during delivery. Methods: A cross-sectional study design was used to collect the data of VBAC parturients who delivered in the obstetrics department of the First Affiliated Hospital of Wenzhou Medical University from January 2014 to May 2020 and used OT during the labor process. The multiple linear regression method was used to screen the modeling variables from the electronic medical records, and combined with the variables such as fetal heart rate and uterine contraction frequency extracted by fetal heart rate, the OT drip speed prediction model was established based on XGBoost algorithm. At the same time, compared with Logistic regression model and traditional decision tree, the data set was divided as training set and test set in a ratio of 8:2, and the prediction performance of the model was evaluated in terms of accuracy, precision, recall rate and F1 score. Results: A total of 1 005 OT regulation records were included in 124 parturients with VBAC. The performance of XGBoost model was the best, with the under -50% discount cross-validation, accuracy, precision,recall and F1 value of the model being 0.82, 0.84, 0.80 and 0.82. The order of variable importance showed that the duration of uterine contraction, uterine pressure, fetal heart rate, frequency of uterine contraction and interval time of previous cesarean section were variables with great contributions to modeling. Conclusion: In this study,an OT regulation model is constructed based on XGBoost. It has the advantages of fast training speed, high accuracy and strong extrapolation, so it is of positive significance to assist the midwifery in the decision-making of OT injection. 2022 Vol. 52 (4): 266-271 [Abstract] ( 407 ) HTML (1 KB)  PDF (1546 KB)  ( 687 ) 272 The application value of serum β-Amyloid level in the occurrence and prognosis of knee osteoarthritis XU Yu, XIE Qipeng, CHEN Shaomin, YE Hantao, LI Feida, SHUI Xiaolong DOI: 10.3969/j.issn.2095-9400.2022.04.003 Objective: To investigate the correlation between the level of β-Amyloid in the serum of patients with knee osteoarthritis (KOA) and the severity, occurrence and prognosis of knee osteoarthritis.Methods: Fifty-six KOA patients who underwent arthroscopic or total knee arthroplasty were assignied as the experimental group and 25 routine patients as the control group. Patients in the experimental group were graded according to X-ray Kellgren-Lawrence (K-L) grading method; and serum samples were collected before and after operation, and serum β-Amyloid level was measured by double antibody sandwich ELISA. The correlation between serum β-Amyloid level and prognosis of KOA were evaluated by ROC curve. Spearman rank correlation was used to analyze the relationship between serum serum β-Amyloid level and the severity of KOA. Pearson correlation was used to analyze the relationship between the changes in serum β-Amyloid and the length of hospital stay. Results: The level of serum β-Amyloid in KOA patients was higher than that in control group (P<0.001).Logistic regression showed that β-Amyloid was a risk factor for KOA, and the OR value was 15.122. ROC curve analysis showed the β-Amyloid cut off was 0.770, the area under β-Amyloid curve 0.752, 95%CI 0.636-0.867, sensitivity 85.5% and specificity 60.0%. K-L2 patients had lower level of serum β-Amyloid than K-L3/4 patients (P=0.041), and Spearman rank correlation analysis showed that β-Amyloid expression was significantly positively correlated with KOA severity (r=0.332, P=0.013). The level of β-Amyloid in KOA patients before operation was higher than after operation (P=0.002), and Pearson correlation analysis showed that the changes of serum β-Amyloid had significantly negative correlation with the length of hospital stay in KOA patients (r=-0.949,P<0.001). Conclusion: β-Amyloid is a risk factor for KOA. The serum β-Amyloid level may become a potential biomarker for evaluating the occurrence and prognosis of KOA. 2022 Vol. 52 (4): 272-276 [Abstract] ( 463 ) HTML (1 KB)  PDF (1533 KB)  ( 837 ) 277 The development and validation of a risk prediction model for lower extremity deep venous thrombosis in elderly patients with intracerebral hemorrhage YAN Feifan, LI Yun, MA Pengyan, YIN Qiang, LU Zhongqiu DOI: 10.3969/j.issn.2095-9400.2022.04.004 Objective: To develop and verify the risk prediction model of lower extremity deep vein thrombosis (DVT) in elderly patients with intracerebral hemorrhage (ICH). Methods: The clinical data of 953 elderly ICH in-patients in the First Affiliated Hospital of Wenzhou Medical University from January 2016 to December 2020 were collected. DVT associated risk factors of these patients were screened according to univariate analysis and multivariate Logistic regression analysis, after which the risk prediction model was established and the nomogram was drawn. The area under the ROC curve was used to evaluate the predictive effect of the model,and the Bootstrap method was used to internally verify the prediction model. Results: The multivariate regression analysis showed that age, sex, season, disturbance of consciousness, left lower limb muscle strength and D-dimer concentration were independent risk factors of lower limb DVT in elderly patients with intracerebral hemorrhage.The area under ROC curve of the prediction model is 0.766, with the sensitivity 70.5%, specificity 71.4%, Youden index 0.418, and the internal validation C-index 0.758. Conclusion: This model can effectively predict the occurrence of lower limb DVT in elderly patients with intracerebral hemorrhage, and provide basis for clinical medical staff to identify high-risk patients and take measures in time. 2022 Vol. 52 (4): 277-282 [Abstract] ( 504 ) HTML (1 KB)  PDF (1489 KB)  ( 720 ) 283 The value of emergency CT-based radiomics in predicting abdominal aortic syndrome LIN Wenxiao,SU Jiehui, GUO Yifan, CHEN Shaoqing, WU Aiqin, CHENG Jianmin DOI: 10.3969/j.issn.2095-9400.2022.04.005 Objective: To evaluate the value of radiomics based on emergency CT plain scan in the diagnosis of abdominal aortic syndrome (AS). Methods: A total of 145 emergency patients who underwent plain and enhanced abdominal CT scan in the Second Affiliated Hospital of Wenzhou Medical University from August 2012 to October 2020 were collected. According to abdominal AS, all subjects were stratified randomly into the training set and the validation set in a ratio of 7:3. The abdominal aorta on CT plain scan images was manually segmented layer by layer, from which the radiomic features were extracted. The radiomic signature was constructed based on the selected features, and the radiomics score (Rad-score) of each patient was calculated.Univariate and multivariate logistic regression analyses were used to identify the risk factors for predicting abdominal AS. Finally, a nomogram based on clinical risk factors and Rad-score was constructed by multivariate logistic regression. Receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of the model. Results: Univariate and multivariate Logistic regression showed that abdominal pain (OR=0.48, 95%CI=0.19-1.22, P=0.12) and displaced calcification (OR=8.76, 95%CI=3.27-23.45, P<0.001) were the clinical risk factors of abdominal AS. The area under the curve (AUC) of ROC curve of the clinical model in the test set was 0.79. Eight radiomic features were selected to construct radiomic signature with an AUC of 0.88 in the test set. The nomogram was obtained by combining the radiomic signature with the clinical model,and its AUC in the test set was 0.89. The clinical decision curve showed that the nomogram had the best clinical practicability. Conclusion: The nomogram based on radiomics of CT plain scan and clinical factors can well predict abdominal AS in emergency patients. 2022 Vol. 52 (4): 283-287,293 [Abstract] ( 556 ) HTML (1 KB)  PDF (1664 KB)  ( 733 ) 288 Analysis of lower gastrointestinal bleeding caused by FXI gene mutation WANG Huanhuan, LIU Meina,XIE Haixiao, JIA Kaiqi, ZENG Manlin, WANG Mingshan DOI: 10.3969/j.issn.2095-9400.2022.04.006 Objective: To analyze the pathogenesis of abnormal lower gastrointestinal bleeding after endoscopic rectal polypectomy in a patient with hereditary coagulation factor XI (FXI) deficiency, and to explore the relationship between the FXI mutation and lower gastrointestinal bleeding after treatment. Methods: Pedigree investigation (5 people of 3 generations in total) was made and relevant coagulation factor indexes of the patient and her family members were detected. Genomic DNA of peripheral blood was extracted for PCR amplification.All the exons, flanking sequences, 5’ and 3’ untranslated regions of FXI gene of the patient were analyzed by direct sequencing. And the corresponding mutation site was subjected to sequencing in other family members.The PyMol software was used to construct protein model before and after gene mutation. Results: The patient was admitted to hospital for abnormal lower gastrointestinal bleeding after endoscopic rectal polypectomy. The activated partial thromb oplastin time (APTT), FXI activity (FXI:C) and FXI antigen (FXI:Ag) of the patient was 50.9 s, 53% and 47.2%, respectively; The above three indicators for her father were 45.4 s, 44% and 43.1%,respectively. Gene sequencing revealed that the patient and her father had a heterozygous nonsense mutation c.841C>T (p.Gln281*) in exon 8 of the FXI gene. Protein model analysis demonstrated that the p.Gln281*mutation producing truncated protein. Conclusion: A heterozygous nonsense mutation c.841C>T (NM_000128) in exon 8 of the FXI gene is responsible for the low FXI level in this pedigree, which might be the main reason for abnormal lower gastrointestinal bleeding after endoscopic rectal polypectomy in this patient. 2022 Vol. 52 (4): 288-293 [Abstract] ( 474 ) HTML (1 KB)  PDF (1653 KB)  ( 611 ) 294 Clinical value of non-invasive prenatal testing in screening of fetal sex chrom osome aneuploidy XU Yunzhi,XU Xueqin, TANG Shaohua, ZHOU Lili, LI Huanzheng DOI: 10.3969/j.issn.2095-9400.2022.04.007 Objective: To investigate the application value of non-invasive prenatal testing (NIPT) in the screening of fetal sex chromosome aneuploidies (SCAs). Methods: A total of 27 116 singleton pregnant women who underwent usual NIPT (15 218) or NIPT PLUS (11 948) in Wenzhou Central Hospital from 2018 to 2019 were collected. The fetal free DNA from maternal plasma was extracted and was sequenced by high-throughput sequencing. For those with high risk of SCAs, invasive karyotype detection was performed after genetic counseling.Results: The results of usual NIPT showed that there were 125 cases of SCAs with a positive rate was 0.82% (125/15 218). Prenatal diagnosis of amniotic fluid confirmed positive in 17 cases out of 70, with the positive predictive value being 24.29% (17/70). The results of NIPT PLUS showed that there were 97 cases of SCAs with a positive rate was 0.81% (97/11 948), and 29 of 70 cases were confirmed positive by prenatal diagnosis of amniotic fluid, with the positive predictive value being 41.43% (29/70). Conclusion: With high clinical application value, NIPT can be used as a prenatal screening method for SCAs. Compared with usual NIPT, NIPT PLUS can significantly improve the prenatal screening efficiency for SCAs. Invasive prenatal diagnosis must be performed for pregnant women with NIPT or NIPT PLUS showing high SCAs risk, while patients with low risk should be alert to the possibility of missed diagnosis. 2022 Vol. 52 (4): 294-299 [Abstract] ( 535 ) HTML (1 KB)  PDF (2718 KB)  ( 828 ) 300 The value of contrast-enhanced ultrasound combined with immunohistochemical markers in the prognostic evaluation of breast cancer CHEN Xiaoqin, WENG Xijin, SUN Haiqin, CHEN Limin DOI: 10.3969/j.issn.2095-9400.2022.04.008 Objective: To investigate the characteristics of contrast-enhanced ultrasound (CEUS) related to the prognostic parameters of immunohistochemical markers in breast cancer, and to explore the value of CEUS in the prognosis evaluation of breast cancer. Methods: From January 2019 to December 2020, 150 patients with breast masses in Wenzhou Central Hospital were selected as subjects. All patients were examined by conventional ultrasound and contrast-enhanced ultrasound. The gold standard was the pathological diagnosis of surgical and/or puncture biopsy. The expressions of p53, Ki-67, estrogen receptor (ER) and progesterone receptor (PR) in patients with breast cancer and benign breast masses were detected by immunohistochemical staining. The correlation between the positive expression of p53, Ki-67, ER and PR and the characteristics of contrast enhanced ultrasound in breast cancer patients were analyzed. Results: The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of contrast-enhanced ultrasound in the diagnosis of breast cancer were significantly higher than those of conventional ultrasound (P<0.05). The peak intensity of breast cancer patients was higher than that of benign breast masses (P<0.05), the time of onset enhancement, the time to peak and the peak extinction time of breast cancer patients were shorter than those of benign breast tumor patients(P<0.05). Blood perfusion defect in contrast-enhanced ultrasound images of breast cancer patients was positively correlated with the positive expression of p53 and Ki-67 (r=0.814, 0.839, P<0.05), but negatively correlated with the positive expression of ER and PR (r=-0.780, -0.769, P<0.05). The tumor range after contrast was larger than that before, and it was positively correlated with the negative expression of p53 and Ki-67 (r=-0.820, -0.841,P<0.05), but positively correlated with the positive expression of ER and PR (r=0.803, 0.785, P<0.05). The high peak enhancement was positively correlated with the positive expression of p53 and Ki-67 (r=0.789, 0.773,P<0.05), and it was negatively correlated with the positive expression of ER and PR (r=-0.754, -0.781, P<0.05).Conclusion: Contrast-enhanced ultrasound can improve the preoperative diagnostic accuracy of breast cancer.Some characteristics of CEUS are closely correlated with immunohistochemical markers of breast, reflecting the biological characteristics of breast cancer, which can be used as a reference indicator for preoperative noninvasive evaluation of prognosis of breast cancer. 2022 Vol. 52 (4): 300-304 [Abstract] ( 493 ) HTML (1 KB)  PDF (2718 KB)  ( 831 ) 305 The effect of eIF3b on proliferation and invasion of triple-negative breast cancer CHEN Yanmei, ZHOU Suying, YANG Xiaomin, ZHENG Xiang, ZHANG Xueke DOI: 10.3969/j.issn.2095-9400.2022.04.009 Objective: To explore the effect of eukaryotic translation initiation factor 3 subunit b (eIF3b) on proliferation and invasion of triple-negative breast cancer (TNBC). Methods: Immunohistochemistry was used to detect the expression of eIF3b in 50 cases of TNBC. RNA interference (RNAi) was accomplished by transfecting eIF3b-siRNA into the cell line MDA-MB-231. The mRNA expression level of eIF3b was detected using RTqPCR.The proliferation and invasion of cells was detected using the cells proliferation rate detected by CCK-8, cell clone formation, the cell scratch test and Transwell invasion assay. The expression of β-Catenin and Cmyc was detected by Western blot. Results: The high expression rate of eIF3b in 50 cases of TNBC was 74%,significantly higher than adjacent normal tissues (P<0.01). eIF3b expression was significantly related to Ki-67 expression and lymphatic metastasis (P<0.05), but not related to age, tumor size, type of histopathology (P>0.05).The mRNA expression of eIF3b and the potential for cell proliferation, migration and invasion were significantly lower in siRNA transfected cells than that in non-transfected cells (P<0.05). The results of Western blot showed significantly decreased (P<0.05) expression of β-Catenin and C-myc. Conclusion: eIF3b is highly expressed in TNBC. Downregulation of eIF3b expression could inhibit cell proliferation, migration and invasion, which may be attributed to disordered cell cycles by blocking Wnt/β-Catenin signal pathway. 2022 Vol. 52 (4): 305-309 [Abstract] ( 551 ) HTML (1 KB)  PDF (1807 KB)  ( 697 ) 310 3D re-constructional DSA for evaluating the severity of iliac vein compression WANG Qiang, DING Qi,LIANG Siyuan DOI: 10.3969/j.issn.2095-9400.2022.04.010 Objective: To explore the significance of three-dimensional reconstructional DSA used for evaluating the severity of iliac vein compression. Methods: Anterograde venography of lower extremity screened 72 patients as iliac vein compression, who were accepted in the author’s hospital from June 2019 to August 2021.Having further received three-dimensional reconstructional DSA and two-dimensional DSA, they were divided into three subgroups based on the degree of iliac vein compression (<50%, 50%-70% and >70%). Then the effect was compared between the two kinds of angiography on the visualization of iliac vein compression. Results: The proportion of lateral branch development and iliac vein impression was both rising with the severity of iliac vein compression under three-dimensional reconstructional DSA. Logistic regression analysis of ordinal categorical variables showed the severity of iliac vein compression reflected by contralateral iliac vein development was 16.66 times higher than that without development (P=0.003) and reflected by external iliac vein development was 19.13 times higher than that without development (P<0.001). The patients’ iliac vein compression was more severe when associated with contralateral iliac vein and external iliac vein development. Conclusion: Threedimensional reconstructional DSA can better reflect the information of iliac vein compression, especially lateral branch development and iliac vein impression trace can effectively assess the severity of iliac vein compression,which is worthy of further clinical study. 2022 Vol. 52 (4): 310-314 [Abstract] ( 618 ) HTML (1 KB)  PDF (1523 KB)  ( 1061 ) 315 The relationship between perceived stress and professional commitment of nursing undergraduates:the chain mediation effect of career adaptability and psychological resilience ZHANG Jingjing, ZHAO Chengjia, LI Feiyue, YANG Yeqin, ZHANG Guohua DOI: 10.3969/j.issn.2095-9400.2022.04.011 Objective: To explore the intermediary effect of career adaptability and psychological resilience between perceived stress and professional commitment of nursing college students. Methods: A total of 850 undergraduate intern nursing students of Year 2018 from School of Nursing and Renji College, Wenzhou Medical University were selected for questionnaire via www.wjx.com. The Perceived Stress Scale, Career Adaptability Scale, Chinese version of Connor and Davidson’s Resilience Scale, and Professional Commitment Scale were used to measure and analyze the results. Results: Correlation analyses revealed significantly positive correlations between perceived stress, dimensions of career adaptability, dimensions of psychological resilience, and dimensions of professional commitment (r=0.162 0.865, P<0.001), except for the correlation between perceived stress and the career control dimension of career adaptability, which was not significant. Mediating effect analysis indicated that career adaptability and psychological resilience played a chain mediating role between perceived stress and professional commitment, with a chain mediating effect of 0.070, 95%CI=0.038-0.108 and an effect size of 36.24%. Conclusion: The perception of stress could promote the professional commitment of nursing college students to a certain extent. Improving career adaptability and resilience can enhance their professional commitment. 2022 Vol. 52 (4): 315-319 [Abstract] ( 1100 ) HTML (1 KB)  PDF (1546 KB)  ( 1374 ) 337 The role of the Balint group in the practice of standardized training resident master JIN Xiaofeng,ZHENG Manman. DOI: 10.3969/j.issn.2095-9400.2022.04.017 Objective: To explore the effect of Balint group activities on the resident masters in the practice of standardized training. Methods: A total of 60 master students were enrolled in this study, who were divided as the experimental group and the control group with 30 in each. SEGUE scale was used to compare the differences in the doctor-patient communication ability between the two groups, and a questionnaire survey was made in the experimental group to analyze their satisfaction with the Balint group activities and perception of gain. Results:The doctor-patient communication ability of the experimental group was significantly higher than that of the control group (P<0.05); the experimental group were satisfied with the activities of the Balint group in that the Balint group can improve communication skills, gain understanding and support. Conclusion: The Balint group can effectively improve the doctor-patient communication ability, release pressure, reduce occupational burnout,and harmonize doctor-patient relationship. 2022 Vol. 52 (4): 337-340,封三 [Abstract] ( 501 ) HTML (1 KB)  PDF (1428 KB)  ( 627 ) 341 The training of general medical practitioners for rural grassroots: a university-local collaborative model based on the construction practice of Wenzhou Medical University LIN Jin, LI Zhangping, WANG Shize DOI: 10.3969/j.issn.2095-9400.2022.04.018 Accelerating the cultivation of high-quality grassroots-oriented general practitioners is one of the important tasks of the current medical education reform. It has become the core task to promoting collegelocal collaborative cooperation and optimize the cultivation mode of primary-level practitioners. In the process of training primary care medical talents, problems exist at present, including deviation of education mode from the goal, disconnection of training standard from the demand and lack of guarantee policy due to poor linkage mechanism, which lead to the separation of cultivation and service. The “College-Local Collaboration” model can encourage the general medical practitioners to “settle down, play the role and stay long” in the grassroots,thus building strong connections between the supplier (school) and the demander (local). Wenzhou Medical University has built a “government-college-local” tripartite collaborative education mechanism with 69 county (urban) governments or local employers in Zhejiang Province, which aims at the sustainable development of preserviceand in-service training. In this way, the competency-oriented talent training reform, a guarantee mechanism for talents’ career development and a cooperative education platform for the training process were jointly promoted and synergistically constructed, gradually forming a full-cycle cultivation model that integrates training and employment of general medical practitioners. 2022 Vol. 52 (4): 341-344,封三 [Abstract] ( 1060 ) HTML (1 KB)  PDF (1462 KB)  ( 1543 )

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