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Objective:To investigate the correlation of the expressions of programmed death ligand 1 (PD-L1) and interleukin-10 (IL-10) with the prognosis in uterine cervical cancer tissues.Methods:A total of 82 patients with uterine cervical cancer hospitalized at Nantong Maternal and Child Health Hospital from January 2015 to December 2019 were retrospectively analyzed, and the clinicopathological data of all patients were collected and sorted out. Immunohistochemical method was used to detect the positive expression of PD-L1 protein in cancer tissues, and Western blot was used to detect the expression level of IL-10 protein in cancer tissues. The survival of all patients for 24-month follow-up was recorded and 82 patients were divided into the survival group and the death group. The clinicopathological characteristics and the expressions of PD-L1 and IL-10 in both groups were compared. Multivariate Cox proportional risk model was used to analyze the factors affecting the survival of patients with uterine cervical cancer. The value of PD-L1 and IL-10 expressions predicting the survival in uterine cervical cancer was evaluated by using receiver operating characteristic (ROC) curve. The best cut-off value of IL-10 relative expression in cancer tissues obtained from ROC curve analysis predicting 24-month survival of patients was used to group; ≥ the best cut-off value was treated as IL-10 high expression group, and < the best cut-off value was treated as IL-10 low expression group. Kaplan-Meier method was used to compare the survival of PD-L1 positive and negative groups, IL-10 high and low expression groups.Results:There was no loss of follow-up in 82 patients during 24-month follow-up, of which 11 cases (13.4%) died and 71 cases (86.6%) survived. The proportion of patients with Federation International of Gynecology and Obstetrics (FIGO) staging Ⅲ-Ⅳ, poor differentiation, tumor long diameter > 4 cm and lymph node metastasis in the death group was higher than that of those in the survival group (all P < 0.05). PD-L1 was positive in 9 of 11 patients in the death group and 11 of 71 patients in the survival group ( P < 0.001). The relative expression level of IL-10 protein in the death group was higher than that in the survival group (1.18±0.32 vs. 0.89±0.21, P < 0.001). Multivariate Cox regression analysis showed that FIGO staging, tissue differentiation degree, tumor long diameter, whether lymph node had metastasis or not, whether PD-L1 was positive and the relative expression level of IL-10 protein were independent factors affecting patients' 24-month survival (all P < 0.05). ROC curve analysis showed that the area under the curve (AUC) of PD-L1 and IL-10 single and the combination of both predicting 24-month survival in cancer tissues was 0.748 (95% CI 0.664-0.894), 0.710 (95% CI 0.655-0.884) and 0.839 (95% CI 0.742-0.951), respectively. There were 20 cases in PD-L1-positive group and 62 cases in PD-L1-negative group. The best cut-off value of relative expression level of IL-10 protein was 7.12. There were 19 cases in IL-10 high expression group and 63 cases in IL-10 low expression group. The overall survival of patients in PD-L1-positive group was worse than that in PD-L1-negative group (24-month overall survival rate: 55.0% vs. 96.8%, P = 0.001). The overall survival of patients in IL-10 high expression group was worse than that in IL-10 low expression group (24-month overall survival rate: 57.9% vs. 95.2%, P = 0.001). Conclusions:The prognosis of patients with positive PD-L1 and IL-10 high expressions in uterine cervical cancer tissues is poor. The combined detection of PD-L1 and IL-10 has a high predictive effect on the prognosis.
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Objective:To evaluate the correlation of serum vitamin D (VitD) and parathyroid hormone (PTH) with insulin resistance and islet β-cell function in patients with type 2 diabetes mellitus (T2DM), and to analyze the role of serum VitD and PTH in the progression of T2DM.Methods:A total of 376 T2DM patients hospitalized in endocrinology department from January 2018 to January 2021 were selected. The baseline data were collected and the biochemical indexes were determined. Patients were divided into 3 groups according to serum VitD level, including 220 cases in deficiency group [25-(OH)D ≤ 20 μg/L], 107 cases in insufficiency group [25-(OH)D>20 and ≤ 30 μg/L] and 49 cases in sufficiency group [25-(OH)D > 30 μg/L]. Meanwhile, 31 of the patients were classified into PTH decreased group (PTH < 25.16 ng/L), 137 into normal PTH group (PTH ≥ 25.16 and < 38.35 ng/L) and 208 into PTH elevated group ( PTH ≥ 38.35 ng/L). According to body mass index (BMI), patients were divided into normal weight group (18.5 kg/m 2 ≤ BMI ≤ 23.9 kg/m 2), overweight group (BMI ≥24 and ≤ 27.9 kg/m 2) and obese group (BMI ≥ 28 kg/m 2). Results:Among the three groups defined by serum VitD level, comparisons of glucose metabolism and calcium and phosphorus metabolism indicators showed no significant differences in BMI, fasting insulin (FINS), fasting plasma glucose (FPG), homeostasis model assessment of insulin resistance index (HOMA-IR), serum calcium and phosphorus (all P > 0.05). The levels of glycated hemoglobin (HbA1c) and PTH in vitamin D deficiency group and sufficiency group were significantly lower compared with vitamin D deficiency group (both P < 0.05). Among the three groups defined by PTH level, there were no significant differences in BMI, FINS, FPG, HbAlc, HOMA-IR, and serum calcium (all P > 0.05). Serum phosphorus in the PTH elevated group was significantly lower compared with PTH decreased and normal PTH group ( P = 0.000), and VitD in the PTH elevated group was significantly lower compared with PTH decreased group ( P = 0.002). There were significant differences in age and blood phosphorus among the three groups defined by BMI level (all P<0.05). According to the analysis of clinical indexes of different nationalities, the level of VitD in Mongolians was significantly higher than that in Han nationality patients ( P <0.034). Spearman correlation analysis showed that VitD was negatively correlated with PTH and HOMA-IR and positively correlated with serum calcium. PTH was negatively correlated with serum calcium and phosphorus, and positively correlated with HOMA-IR. There was a significant negative correlation between normal PTH and VitD. Multiple linear regression analysis showed that HOMA-IR and homeostasis model assessment of β-cell function (HOMA-β) were protective factors, and FPG and FINS were risk factors for HOMA-IR and HOMA- β. Conclusion:There is a negative correlation between VitD and insulin resistance, and a positive correlation between PTH and insulin resistance, suggesting that VitD and PTH are possibly two impacting factors for T2DM pathogenesis.
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Objective:To investigate the effects of anesthesia depth control on cognitive function and high mobility group protein B1 (HMGB-1) level in older adult patients with breast cancer.Methods:Eighty-six female older adult patients with breast cancer who received mastectomy between June 2019 and June 2020 in the First Hospital of China Medical University, China were included in this study. They were randomly assigned to undergo anesthesia with sodium phenobarbital and atropine at deep (bispectral index 30-45, deep anesthesia group, n = 43) or superficial level (bispectral index 45-60, superficial anesthesia group, n = 43). The mean arterial pressure, heart rate, HMGB-1 level, Mini-Mental State Examination (MMSE) score were assessed in each group. Results:There were no significant differences in mean arterial pressure and heart rate recorded during each time period between the deep anesthesia and superficial anesthesia groups (all P > 0.05). No significant difference in HMGB-1 level was found between the two groups before anesthesia induction and at the end of surgery (both P > 0.05). At 1 and 2 days after surgery, HMGB-1 level in the deep anesthesia group was (75.46 ± 3.33) pg/mL and (93.98 ± 4.32) pg/mL, respectively, which was significantly lower than that in the superficial anesthesia group [(87.89 ± 5.13) pg/mL and (121.01 ± 4.36) pg/mL, t = 13.327, 28.878, both P < 0.05)]. At 1 day before surgery, there was no significant difference in MMSE score between the two groups ( P > 0.05). In the deep anesthesia group, MMSE score was (26.73 ± 1.11) points, (28.16 ± 0.72) points, and (28.97 ± 0.88) points at 1, 3 and 6 days after surgery respectively, which was significantly higher than that in the superficial anesthesia group [(21.03 ± 1.46) points, (22.39 ± 1.24) points, and (24.69 ± 0.57) points, t = 20.380, 26.388, 26.768, all P < 0.05]. Conclusion:Deep anesthesia for mastectomy in older adult patients can reduce cognitive impairment and decrease HMGB-1 level after surgery, and plays a positive role in postoperative recovery.
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Objective:To investigate frailty status of the elderly patients with leukoaraiosis (LA) and to analyze the correlation between white matter hyperintensities and their frailty status.Methods:From June 2019 to September 2020, a total of 162 patients with leukoaraiosis over 65 years old were screened by cranial MRI.The Fried frailty phenotype was used to evaluate their frailty status.The Fazekas scale scoring method was used to independently assess the periventricular white matter hyperintense (PVH) and deep white matter hyperintense (DWMH) by the cranial MRI images.SPSS 22.0 software was used for statistical analysis.ANOVA test was used to compare normal distribution data between groups, and Kruskal-Wallis H test was used to compare non-normal distribution data between groups.Spearman rank correlation analysis was used to analyze the correlation between PVH and DWMH scores and Fried frailty phenotype score. Results:Among 162 elderly patients with leukoaraiosis, 46 patients (28.40%) were non-frailty, 76 patients (46.91%)were pre-frailty and 40 patients (24.69%) were frailty.There were statistically significant differences in age( F=9.382, P<0.01), number of chronic diseases( H=10.736, P<0.01), number of medication ( H=15.927, P<0.01) and mini-nutritional assessment short form (MNA-SF) scores( F=5.263, P<0.01) among older LA patients with different frailty phenotype.There was statistical difference in PVH scores in elderly LA patients with different frailty phenotype (χ 2=108.537, P<0.01), but no significant difference in DWMH scores (χ 2=4.239, P>0.05). Spearman correlation analysis showed significant positive correlation between PVH score and frailty phenotype score in elderly LA patients ( r=0.718, P<0.001). Conclusion:Elderly LA patients have a high incidence of frailty, which may be related to aging, multi-disease coexistence, multiple medication, nutritional risk and other factors.The occurrence of weakness in elderly LA patients is related to periventricular white matter lesions, and the more serious the white matter damage, the more obvious the degree of frailty.
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Objective:To analyze the gait and balance disorder and fall risk in patients with leukoaraiosis (LA) in different degrees and locations.Methods:Seventy-eight patients with LA (LA group) and thirty healthy controls (NC group) were selected.According to Fazekas grading scale, the LA group were subgroups of different degrees(LA1, LA2, LA3)and evaluated independent scores for periventricular white matter hypersignal (PVH) and deep white matter hypersignal (DWMH). All subjects were tested by Tinetti scale, and the gait test, balance test and fall risk assessment were carried out, and the correlation between gait test results and balance test results and PVH and DWMH scores were analyzed.Results:There were significant differences in gait test((11.47±0.51), (10.18±1.29)), balance test((15.63±0.49), (13.96±1.58)) and fall risk((27.10±0.76), (24.15±2.73)) between LA group and NC group ( t=5.310, 5.667, 5.799, all P< 0.01). There were no significant differences in gait test, balance test and fall risk between NC group and LA1 group (all P>0.05). There were significant differences in gait test, balance test and fall risk between NC group and LA2 group and LA3 group ( t=1.110, 1.562, 1.336; 2.592, 3.342, 2.985; all P<0.01). There were significant differences in gait test, balance test and fall risk between LA1 group((11.19±0.85), (15.38±0.75), (26.58±1.47)) and LA2 group((10.36±0.82), (14.07±1.09), (24.43±1.64)) and LA3 group((8.88±0.99), (12.23±1.08), (21.21±1.93)) ( t=0.835, 1.313, 1.039; 2.317, 3.093, 2.756; all P<0.01). There were significant differences in gait test, balance test and fall risk between LA2 group and LA3 group ( t=1.482, 1.780, 1.639, all P<0.01). The analysis showed that the gait test was negatively correlated with the PVH and DWMH scores ( r=-0.810, P<0.01; r=-0.452, P<0.01). The balance test was negatively correlated with the PVH and DWMH scores ( r=-0.502, P<0.01; r=-0.836, P<0.01). Conclusions:There are gait disorder and balance disorder in patients with moderate and severe LA.With the increase of the degree of LA , the damage of gait and balance function is significantly increased, and the risk of fall is also significantly increased.The gait disorder and the balance disorder of LA patients has different correlation with the high-signal score of the white matter in different parts.The correlation between gait disorder and PVH score is more obvious, and the correlation between balance disorder and DWMH score is more obvious.
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Objective To investigate the value of A2DS2 score in predicting stroke-associated pneumonia (SAP) in patients with anterior and posterior circulation ischemic stroke. Methods The clinical data of patients with acute ischemic stroke admitted to the Department of Neurology, Heze Municipal Hospital from June 2011 to March 2016 were analyzed retrospectively. The independent risk factors for SAP were determined by binary multivariate logistic regression analysis. The value of A2DS2 score in predicting SAP in patients with anterior and posterior circulation ischemic stroke was evaluated by the receiver operator characteristic (ROC) curve. Results A total of 530 patients with acute ischemic stroke were enrolled, 90 of them (16. 98％) had SAP. There was no significant difference in SAP incidence between the patients with anterior circulation stroke (n = 430) and posterior circulation stroke (n = 100)(17. 2％ vs. 16. 0％; χ2 = 0. 084, P = 0. 772). Binary multivariate logistic regression analysis showed that the A2DS2 score was an independent risk factor for SAP in patients with ischemic stroke (odds ratio [OR] 1. 644, 95％ confidence interval [CI] 1. 097-2. 426), anterior circulation stroke (OR 1. 593, 95％ CI 1. 086- 2. 387), and posterior circulation stroke (OR 1. 463, 95％ CI 1. 064-2. 174). The ROC curve showed that the area under the curve of the A2DS2 score predicting SAP in patients with ischemic stroke, anterior circulation and posterior circulation stroke were 0. 826 (95％ CI 0. 792-0. 869), 0. 821 (95％ CI 0. 783-0. 858), and 0. 832 (95％ CI 0. 781-0. 923), respectively. The best cut-off value was 5. There was no significant difference in the area under SAP curve of the A2DS2 score for predicting SAP between patients with acute anterior circulation and posterior circulation ischemic stroke (Z = 0. 259, P = 0. 394). Conclusion A2DS2 score could predict SAP in patients with anterior circulation and posterior circulation stroke without difference, both of the cut-off value was 5.
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Objective To evaluate the curative effect of traditional Chinese medicine fumigation combined with conventional therapy for the diabetic foot. Methods A total of 90 patients with type 2 diabetes who were treated in the hospital from March 2015 to August 2017 were enrolled in this study. On the basis of conventional treatment, the treatment group received the traditional Chinese medicine fumigation, while the control group received warm water fumigation. The total limb popliteal artery, femoral artery, posterior tibial artery and dorsalis pedis artery and a score of symptoms and signs were compared between two groups after 4 weeks. Results The total effective rate of the treatment group was 73.3% (33/45), while the control group was 53.3% (24/45), and the difference was statistically significant (χ2=3.876, P=0.049). After treatment, total limb femoral artery(58.38 ± 12.53 cm/s vs.51.94 ± 11.62 cm/s,t=2.528),popliteal artery(43.87 ± 9.46 cm/s vs.39.87 ± 8.28 cm/s,t=2.134),posterior tibial artery(35.72 ± 8.29 cm/s vs.30.89 ± 8.51 cm/s,t=2.725),dorsalis pedis artery (26.82 ± 8.10 cm/s vs.22.87 ± 7.39 cm/s,t=2.413)of the treatment group were significantly higher than those of the control group(P<0.05).The main symptom score(2.0 ± 1.5 vs.4.1 ± 2.1,t=5.419),sub syndrome score(3.1 ± 1.8 vs.5.1 ± 2.3,t=4.692),tongue and pulse condition score(1.8 ± 0.8 vs.2.4 ± 0.6,t=4.277)of the treatment group were significantly lower than those of the control group (P<0.01). Conclusions The traditional Chinese medicine fumigation combined with conventional therapy could improve the lower extremity blood flow status in diabetic foot patients and clinical symptoms.
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Objective To observe the level of imprinting gene p57kip2 and p27kip1 expression in different hydatidiform moles.To investigate the value of combined detection of p57kip2 and p27kip1 in diagnosis and differential diagnosis of hydatidiform moles.Methods We examined the immunohistochemical staining of p57kip2 and p27kip1 in 30 cases of complete hydatidiform moles and 86 cases of partial hydatidiform moles and 30 cases normal placenta,and also analyze the differences and correlation between the two genes of p57kip2 and p27kip1 in two different patterns of hydatidiform moles.Results The rate of expression of p57kip2 and p27kip1 in complete hydatidiform moles was obviously lower than that in partial hydatidiform moles and nor-mal placenta.There were significant differences in the expression of p57kip2 and p27kip1 among complete hy-datidiform moles,partial hydatidiform moles and normal placenta(P<0.05).p57kip2 had positive correlation with p27kip1 in complete hydatidiform moles(r=0.750,P<0.01),meanwhile there was negative correlation between p57kip2 and p27kip1 in partial hydatidiform moles(r= -1.000,P<0.01).Conclusion The differen-tial expression of p57kip2 and p27kip1 in complete hydatidiform moles and partial hydatidiform moles can be of certain value in the differential diagnosis of hydatidiform moles.Meanwhile,the combined methed is useful to the identification and classification of hydatidiform moles.
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Objective To investigate the morphological regularity of the thoracic pedicle screw in 4 to 12 years old children by the digital technology,and to provide the theoreticl basis for thoracic pedicle screw fixation in children.Methods A total of 60 healthy children aged from 4 to 12 years old with computed tomography(CT) data of thoracic spine were divided into three groups by age,each group 20 cases.Then they were examined by MIMICS software and the parameters of pedicle width(PW),pedicle height(PH),the length of screw path(SL),e angle and f angle were measured.Results The pedicle width,pedicle height,the SL of the pedicle generally showed a rising trend with advancing age.There were significant differences in the PW,PH and LS between the three group(P0.05).E angle of the pedicle generally showed a decreasing trend with increasing vertebral order,and e angle of T11 to T12 showed negative angle.The f angle showed a wavy descending trend.Conclusion There was significant difference in correlation parameters of thoracic pedicle with increasing age in healthy children,which indicates that the pedicle screw fixation for the kind of children should be performed based on 'the Principle of individualization' to improve the success rate of surgery.
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Objective To explore the effects and safety of early urinary continence for elderly prostate cancer patients treated with laparoscopic radical prostatectomy with bladder neck preservation.Methods Retrospectively analyze the datas for 123 elderly prostate cancer patients treated with laparoscopic radical prostatectomy with bladder neck preservation,including operative time,blood lose,margin status and early continence status,etc from group A (56 cases) and group B(67 cases).Classify the urinary incontinence through Common Toxicity Criteria of National Cancer Institute while evaluate the postoperative urinary continence for patients by number of daily pads usage.Lastly, record the urinary continence at the very day, 7 days,1 and 3 months in detail.Results There were no significant differences in body mass index, prostate volume, preoperative serum PSA level and preoperative Gleason score between the two groups.2 cases of patients were postoperative 5 cases and 7 cases of surgical margin positive, and postoperative A, B two groups were 6 cases and 9 cases of leakage of urine.The number of urinary incontinence 0 and urinary incontinence were significantly different between the two groups (P<0.05).Conclusion Elderly prostate cancer patients treated with radical prostatectomy with bladder neck preservation,is useful for early urinary continence, which is available and safe to be generalized.
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Objective To evaluate the incidence and epidemiologic characteristics of Kawasaki disease (KD)in Nanjing.Methods We reviewed the medical records and reports of all patients admitted to Nanjing Chil-dren′Hospital with KD diagnosed during 3 -year periods from 2012 to 2014.Results We studied 1 446 inpatients diagnosed with KD from 2012 to 2014.There were 1 135 cases(78.5%)with complete KD.The ratio of male to female was 1.7241.The disease occurred in all of the seasons,but the peak was from spring to summer.Age at onset ranged from 1 month to 14 years old,and the peak age group was 1 year old.Fever(99.45%)was the most common clinical symptom,followed by conjunctive congestion(93.15%),rash(73.32%),oral changes(51.76%), extremities desquamate(75.08%)and lymphadenopathy(45.89%).There were 131(9.05%)patients with coronary aneurysm,the ratio of male to female was 3.02 1.14 patients (0.97%)developed recurrent KD.Conclusion Patients with KD has become more and more in Nanjing,and clinical doctors should improve the understanding of KD. Early diagnosis and treatment is very important to reduce the sequelae and reduce the mortality of KD.
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Objective To study the effects of angiotensin Ⅱ (AngⅡ) on insulin signal transduction pathway in skeletal myoblast of L6 rats,and further to explore the possible mechanism of AngⅡ on glucose utilization.Methods Myoblast cells of L6 rats were cultured and induced to differentiate.They were divided into 4 groups according to different treatment by AngⅡ or JAK2-PKA inhibitor H89:normal control group ( NC group),insulin group,insulin + AngⅡ group and insulin + AngⅡ + H89 group.Expression of IRS1 and GLUT4 mRNA was detected by RT-PCR.Expression of IRS1,Ptyr-IRS1 and GLUT4 (total and membrane protein) were detected by Western blot.Results The difference of GLUT4 mRNA expression in the 4 groups detected by RT-PCR had no statistical significance(P ＞ 0.05).The difference of IRS1 mRNA expression among the latter 3 groups had no statistical significance(P ＞ 0.05),however,IRS1 expression in the latter 3 groups was higher than that in NC group(P ＜ 0.05).Western blot results showed expression of IRS1,Ptyr-IRS1 and GLUT4 (membrane protein)was higher in the latter 3 groups than in NC group(P ＜0.05).The difference of IRS1 expression among the latter 3 groups(P ＞ 0.05 ) and GLUT4 (total protein) expression among the 4 groups had no statistical significance (P ＞ 0.05).The expression of of ptyr-IRS1 and GLUT4 membrane protein in Ins + AngⅡ + H89 group was much higher than that in Ins + AngⅡ group,and lower than that in insulin group(P ＜0.05).Conclusion AngⅡ inhibits IRS1's tyrosine phosphorylation and GLUT4's transfer from cytoplasm to plasma membrane in skeletal muscle cells through JAK2-PKA signaling pathway,and therefore induces insulin resistance.
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Objective To investigate the toxicity of alpha terthienyl to the larvae of Aedes albopictus , its influencing factors and effect on the larva deve lopment. Methods Under experimental ultraviolet A (UVA),the number of dead,pupal or eclosive mosquito larvae was determined on the condition of different doses of alpha terthienyl and different disposal time in the dark;the number of dead larvae was also determined under sunlight on the condition of different doses of alpha terthienyl and different disposal time to water. Results The LC 50 of alpha terthienyl to Aedes albopictus larvae was 2.37 ?g/L under UVA. The best effect was shown when the larvae were incubated with alpha terthienyl 3 h in dark. Alpha terthienyl could significantly inhibit the larva deve lopment and the emergence of the pupae. Under strong sunlight, the larvae were quickly killed by high concentration alpha terthienyl. The 24 hours effect of alpha terthienyl was better when it was applied at 5 AM than that of at 10 AM and 1PM. Conclusion Alpha terthienyl is an effective, practicable larvicide which prohibits the growth and development of the larvae of Aedes albopictus .