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RSS2024 Vol. 45, No. 9
2024, 45(9): 1-8.
doi: 10.12259/j.issn.2095-610X.S20240901
Abstract:
HSV-1 is an important pathogen that can be carried and transmitted in various populations and can cause diseases including herpes labialis, capsulatus, keratitis and viral encephalitis. Although there are several types of HSV-1 vaccines in various stages of development, there is still no commercially available vaccine on the market. The specific anti-HSV-1 drugs used in clinical practice, such as acyclovir, valaciclovir and peniclovir, are also facing the serious threat of resistance. The development of new specific anti-HSV-1 drugs is one of the main tasks currently faced. siRNA is a double-stranded RNA with a length of 20-25 nucleotides that plays an interfering role by silencing gene expression at the post-transcriptional level. As a new and potential antiviral drug, siRNA has attracted much attention and developed rapidly. In this paper, we review the recent progress of siRNA in anti-HSV-1 research, including the design, delivery and targeting strategies of siRNA targeting key HSV-1 genes and HSV-1 interacting host cell genes.
HSV-1 is an important pathogen that can be carried and transmitted in various populations and can cause diseases including herpes labialis, capsulatus, keratitis and viral encephalitis. Although there are several types of HSV-1 vaccines in various stages of development, there is still no commercially available vaccine on the market. The specific anti-HSV-1 drugs used in clinical practice, such as acyclovir, valaciclovir and peniclovir, are also facing the serious threat of resistance. The development of new specific anti-HSV-1 drugs is one of the main tasks currently faced. siRNA is a double-stranded RNA with a length of 20-25 nucleotides that plays an interfering role by silencing gene expression at the post-transcriptional level. As a new and potential antiviral drug, siRNA has attracted much attention and developed rapidly. In this paper, we review the recent progress of siRNA in anti-HSV-1 research, including the design, delivery and targeting strategies of siRNA targeting key HSV-1 genes and HSV-1 interacting host cell genes.
2024, 45(9): 9-16.
doi: 10.12259/j.issn.2095-610X.S20240902
Abstract:
Objective To investigate the effect of human papillomavirus E6 protein （HPV E6） on the proliferation, invasion and migration of Hela cells of cervical cancer and its potential molecular mechanism. Methods Illumina Hiseq 4000 transcriptome sequencing technology was employed to identify the gene expression profiles of 12 cases featuring various degrees of cervical lesions and to screen for HPV-related differential genes. The biological function enrichment of the differential genes was analyzed using GO and KEGG Pathway. Western blotting was utilized to detect the expression levels of Rap and Rap1GAP proteins in normal cervical epithelial cells HCerEpic and cervical cancer cells Hela. The capabilities of proliferation, invasion, and migration were examined by plate cloning, Transwell, and scratch tests. Intracellular HPV E6 expression was down-regulated through sh-E6 lentivirus transfection and classified into the control group （Hela cells）, the no-load group （sh-NON）, and the sh-E6 group （with low expression of HPV E6）. The expression of HPV E6 was diminished, and the proliferation ability and cell viability of each group were determined by plate cloning and CCK-8 assay. Transwell and scratch assays were adopted to detect cell invasion and migration. Western blotting was conducted to detect the expression levels of E6, Rap1, Rap1GAP, CyclinD1, E-cadherin, and N-cadherin in cells of each group. Rap1 was overexpressed based on the sh-E6 group, and the expression levels of the Rap1 pathway and related proteins were measured by Western blot. Cell proliferation, invasion, and migration were evaluated respectively by plate cloning, Transwell assay, and scratch assay. Results The sequencing results indicated that, in contrast to normal cervical HPV-negative tissues, 340, 864 and 1036 differentially upregulated genes were respectively present in HPV-positive normal cervix, CIN and cervical cancer tissues. A total of 24 differential genes were identified across the 3 datasets. GO|KEGG enrichment analysis of the 24 differentially expressed genes primarily focused on the RAP1-related signaling pathway. Compared with HCerEpic cells, Rap1 expression was elevated and Rap1GAP expression was reduced in Hela cells （P < 0.01）. The proliferation, invasion and migration of the cells were enhanced （P < 0.01）. After down-regulating the expression of HPV E6, the proliferation, colony formation, invasion and migration of sh-E6 cells were decreased compared with the Hela group （P < 0.001）. Western blotting showed that the protein expressions of Rap1, CyclinD1 and N-cadherin in sh-E6 group were lower than those in Hela group, and the protein expressions of Rap1GAP and E-cadherin were higher than those in hela group （sh-E6/OE Rap1） were restored （P < 0.001）, and the cell proliferation, invasion and migration were restored （P < 0.01）. Conclusion During the development of cervical cancer, HPV E6 promotes the proliferation, invasion and migration of cervical cancer cells by activating Rap1 signaling pathway.
2024, 45(9): 17-23.
doi: 10.12259/j.issn.2095-610X.S20240903
Abstract:
Objective To investigate the impact of inhibiting peroxisome proliferator-activated receptor γ （PPARγ） expression on osteogenic differentiation of BMSCs, so as to provide a theoretical basis for the treatment of primary osteoporosis （POP）. Methods BMSCs were extracted from patients with normal bone density and categorized into the normal control group（CON group）. BMSCs extracted from patients with primary osteoporosis were categorized into the primary osteoporosis group （POP group）. The cells from the POP group were treated with a PPARγ inhibitor and divided into the inhibitor group （INR group）. Following osteogenic differentiation, the expression of osteopontin （OPN）, osteocalcin （OCN）, Osterix, and runt-related transcription factor 2 （Runx2） was evaluated in the cells of each group.The alkaline phosphatase （ALP） staining was employed to assess the osteogenic differentiation of BMSCs in each group. Results The quantity of ALP-positive cells in the POP group was lower than that in the CON and INR groups （P < 0.05）. The expression of OCN, OPN, Osterix, and Runx2 was found to be decreased in the POP group when compared to the CON group, with statistically significant differences (P < 0.05）. Conversely, the expression of OCN, OPN, Osterix, and Runx2 was elevated in the INR group when compared to the POP group, with statistically significant differences (P < 0.05）. Conclusion Increased expression of osteogenic differentiation-specific genes （ALP, OCN, OPN, Osterix, Runx2） in BMSCs after inhibition of PPARγ expression.
2024, 45(9): 24-29.
doi: 10.12259/j.issn.2095-610X.S20240904
Abstract:
Objective To analyze the nutrition knowledge and attitudes and factors associated with dietary nutrition literacy of Ji Nuo, Jing Po, De Ang, A Chang, Bu Lang and Pu Mi ethnic minorities in Yunnan Province from January 2018 to August 2020. Methods The data were collected by multi-stage stratified cluster sampling in the six ethnic minorities areas of Yunnan Province. The total of 3 145 ethnic minorities aged ≥18 years were investigated the nutrition knowledge. The chi-square test and logistic analysis were done by SAS9.4 software. Results All the nutrition knowledge among the number of 3145 ethnic minorities aged 18 years and above in Yunnan province had a median score of 8.7. The percentage of 8.3% of them had adequate dietary nutrition literacy, which was significant among different ethnic groups (χ2 = 149.974, P < 0.0001) . The lowest percentage was 0.2% among Bu Lang people. Higher education levels were associated with higher literacy of dietary nutrition (OR = 1.992, OR = 3.073, P < 0.05, compared with primary school and below education level). Ji Nuo, De Ang, Bu Lang and Pu Mi people did not have adequate dietary nutrition literacy compared with A Chang people (OR = 0.105, OR = 0.366, OR = 0.010, OR = 0.341, P < 0.05). Conclusion The awareness of dietary nutrition knowledge and literacy were at a low level among six ethnic minorities aged 18 years and above in Yunnan province. The propaganda and education of dietary nutrition knowledge should be strengthened, especially the ethnic minorities with low education level so as to improve adequate literacy.
Analysis of Genetic Diagnosis Results for Thalassemia in Childbearing Age Population in Baoshan City
2024, 45(9): 30-34.
doi: 10.12259/j.issn.2095-610X.S20240905
Abstract:
Objective To investigate the gene-carrying rate of thalassemia in the population of Baoshan. Methods A total of 874 samples were α-thalassemia and β-thalassemia detected by NGS, and the ethnic characteristics of the population were statistically analyzed. Results There were 251 cases of positive thalassemia gene, accounting for 28.72%（251/874）. There were 140 α-thalassemia carriers, with a positive rate of 16.02% （140/874）. The most common gene mutation type was α α/-α3.7. There were 95 β-thalassemia carriers, with a positive rate of 10.87% （95/874）. The most common gene mutation type was CD26. There were 16 α- and β-thalassemia compound carriers, with a positive rate of 1.83% （16/874）; Comparison of the differences between Han and Ethnic populations in thalassemia carry （P < 0.01） was statistically significant. There were 13 α-globin gene triplet carriers, with a positive rate of 1.49% （13/874）. The most common gene mutation type was α α αanti3.7. Conclusions Baoshan region population has a high thalassemia carrier frequency. The most common gene mutation type was α α/-α3.7and CD26. This study provides theoretical support for thalassemia prevention and control as well as clinical genetic counseling in the Baoshan region.
2024, 45(9): 35-41.
doi: 10.12259/j.issn.2095-610X.S20240906
Abstract:
Objective To establish a nomogram model for tsutsugamushi disease complicated with sepsis based on Lasso regression, so as to provide a reference for the diagnosis and treatment of tsutsugamushi disease complicated with sepsis. Methods We selected patients with scrub typhus patients admitted to Kunming Third People’ s Hospital from June 2012 to December 2023 as the research subjects （n = 235）, with scrub typhus patients patients with sepsis as the experimental group （n = 138） and scrub typhus patients patients without sepsis as the control group （n = 97）, Lasso regression was used to screen the influencing factors of scrub typhus combined with sepsis, and a nomogram model was constructed through logistic regression. The effectiveness of the model was evaluated using receiver operating characteristic（ROC） curves and calibration curves, and clinical utility analysis was performed using decision curve analysis（DCA）. Results The results of multivariate analysis through logistic regression showed: that age （OR = 1.039, 95%CI: 1.017～1.061）, PLT （OR = 0.995, 95%CI: 0.990～1.000）, UA （OR = 1.004, 95%CI: 1.001～1.008） and IgA （OR = 0.680, 95%CI: 0.472～0.979） were independent influencing factors of scrub typhus combined with sepsis. The area under the ROC curve （AUC） was 0.721 （95%CI: 0.656～0.786, P < 0.001）, the sensitivity of the model was 69.1%, and the specificity was 63.1%. The calibration curve indicates that the model had good consistency, and the DCA indicated that the model had a high net benefit value. Conclusion Patients with scrub typhus are associated with increased age and UA levels and decreased PLT and IgA levels, and have a higher risk of secondary sepsis.
2024, 45(9): 42-48.
doi: 10.12259/j.issn.2095-610X.S20240907
Abstract:
Objective To analyze the prevalence of hypertension and its relationship with the clustering of risk factors of cardiovascular diseases（CVD） in the elderly of Han majority and Ha Ni ethnic minority in rural districts of Yunnan Province. Methods The multi-stage stratified random sampling method was used to select 1413 Han majority participants and 1402 Ha Ni ethnic minority participants aged ≥60 years from Mo Jiang Hani Autonomous County, respectively, and each participant received a questionnaire survey and physical examination. Results The prevalence of hypertension was 64.5% for Han majority and 63.4%for Ha Ni ethnic minority. Female Han older adults, Han older adults with higher annual income and good medical service accessibility had a higher prevalence of hypertension than Ha Ni ethnic minority counterparts （all P < 0.05）, while Han older adults with poor medical service accessibility had a lower prevalence of hypertension than Ha Ni ethnic minority counterparts （P < 0.05）. Prevalence of hypertension increased with age for both ethnicities （all P < 0.05）. The prevalence of clustering of CVD risk factors was 90.4% and 86.9%among Han majority and Ha Ni ethnic minority, respectively, which was higher in the Han majority than in the Ha Ni ethnic minority （P < 0.05）. Compared with the Ha Ni ethnic minority elderly. Female Han older adults, Han older adults with higher annual income and good medical service accessibility had a higher prevalence of clustering of CVD risk factors （all P < 0.01）. The result of multivariate logistic regression analysis showed that the clustering of CVD risk factors was a risk factor for hypertension in the elderly of Han majority （OR = 1.590, 95%CI: 1.101～2.296, P = 0.013）; In addition, for both Han majority and Ha Ni ethnic minority older adults, the individuals with 4（Han: P = 0.016, Ha Ni: P = 0.029） or ≥5 （Han: P < 0.001, Ha Ni: P < 0.001） CVD risk factors had higher prevalence of hypertension than those without clusters of cardiovascular disease risk factors. Conclusion The prevalence of hypertension and clustering of CVD risk factors are both at a high level in Han majority and Ha Ni ethnic minority elderly in rural Yunnan Province, the individuals with multiple risk factors should be targeted as a priority population for intervention reducing the number of clusters of CVD risk factors is helpful to decrease the risk of hypertension.
2024, 45(9): 49-55.
doi: 10.12259/j.issn.2095-610X.S20240908
Abstract:
Objective To evaluate the effects of different sodium intake levels and serum inflammatory factors on the risk of urinary albumin （UA） in patients with type 2 diabetes mellitus （T2DM） by using 24 h UNa as an indicator of sodium intake. Methods 130 T2DM patients were included and divided into a UA-positive group （60 cases） and a UA-negative group （70 cases） according to urinary albumin/creatinine ratio （UACR）. Clinical data of patients were collected and inflammatory factors and 24-hour urine-related indexes were detected. spearman correlation analysis was used to analyze the correlation between clinical indicators and UACR in T2DM patients. The effect of clinical indicators on UA in T2DM patients was analyzed by binary Logistic regression. The effect of 24 h UNa and IL-18 correlation on UA was analyzed by binary regression method. Results 24 h UNa level （OR = 1.019, 95%CI 1.003～1.035, P = 0.017）and IL-18 （OR = 1.204, 95%CI1.060～1.368, P = 0.004）were independent risk factors for positive UA in T2DM patients. Conjoint analysis suggested a significantly increased risk of UA positive in the high-sodium and high-IL-18 groups （OR = 10.774, 95%CI 2.105～55.155, P = 0.004）compared with the low-sodium and low-IL-18 groups. Conclusion Increased levels of 24 h UNa and IL-18 are risk factors for UA in T2DM patients.
2024, 45(9): 56-61.
doi: 10.12259/j.issn.2095-610X.S20240909
Abstract:
Objective To explore the differences in laboratory test index characteristics among smear-negative pulmonary tuberculosis patients, smear-positive pulmonary tuberculosis patients and healthy people. Methods Fifty patients with initial treatment of pulmonary tuberculosis in our hospital from March 2023 to September 2023 were selected and divided into a smear-negative group and a smear-positive group according to the diagnosis. The general data of the subjects were collected, and the lymphocyte subsets and cytokines levels of the subjects were detected by flow cytometry. The lymphocyte subsets, cytokines, blood routine indexes and biochemical indexes were compared among the groups. Results The proportions of smoking history, drug-resistant tuberculosis, positive sputum culture, positive GeneXpert and pulmonary cavity in the smear-negative group were significantly lower than those in the smear-positive group （P < 0.05）. The counts of CD45+, CD3+T, CD4+T, CD8+T and NK cells in PTB patients with negative smears were significantly lower than those in healthy controls （P < 0.05）. The counts of CD45+, CD3+, CD4+, CD8+T and B cells were significantly higher than those of smear-positive PTB patients （P < 0.05）. The levels of IL-1β, IL-6, IL-8, IL-10, IL-17 and IFN-γ in the smear-negative PTB group were significantly higher than those in the healthy control group, while the levels of IL-12 and IFN-α were significantly lower than those in the healthy control group （P < 0.05）. The levels of IL-2, IL-5, IL-6, IL-12, IL-17 and IFN-γ in PTB patients in the smear-negative group were significantly lower than those in the smear-positive group （P < 0.05）. The neutrophil ratio, CRP and procalcitonin levels of PTB patients in the smear-negative group were significantly higher than those in the healthy control group （P < 0.05）, and the red blood cell, hemoglobin, total protein, albumin, white blood cell ratio and prealbumin levels were significantly lower than those in the healthy control group （P < 0.05）. The level and proportion of monocytes in PTB patients in the smear-negative group were significantly lower than those in the smear-positive group （P < 0.05）. Conclusion Pulmonary tuberculosis patients have impaired immune function. Compared with smear-negative pulmonary tuberculosis patients, the lymphocyte subsets of sputum smear-positive pulmonary tuberculosis patients are more severely damaged, the levels of cytokines are higher, and the degree of infection is more serious.
2024, 45(9): 62-69.
doi: 10.12259/j.issn.2095-610X.S20240910
Abstract:
Objective To compare the clinical efficacy and imaging results of unilateral biportal endoscopic discectomy （UBE） with traditional open surgery for the treatment of lumbar disc herniation. Methods We retrospectively analyzed 84 patients with single-segment lumbar disc herniation admitted to the First Affiliated Hospital of Kunming Medical University from January 2022 to March 2023, 44 cases in the UBE group and 40 cases in the open surgery group, and recorded the patients' age, gender, disc herniation site, operation segment, operation time, intraoperative bleeding, and hospitalization days, respectively. Visual analog scale （VAS） scores were performed preoperatively, 2 days postoperatively, and at follow-up at 1 month postoperatively. Efficacy was evaluated using the modified Macnab Treatment Effectiveness Evaluation Index at 1 month of surgery. The preoperative and postoperative articular process preservation rate and disc height changes were compared between the two groups. Results There were no statistically significant differences between the two groups of patients in terms of age, gender, operative segment and type of disc herniation （P > 0.05）. All patients completed the surgery. Compared with the open group, the UBE group had a shorter operation time, less bleeding, and a shorter postoperative hospitalization （P < 0.05）, and the perioperative complication rate was lower in the UBE group than in the open group （P < 0.05）. The VAS scores of patients in the two groups decreased significantly at preoperation and 2 days postoperation （P < 0.05）, but the difference between the two groups was not significant at 1 month postoperation （P > 0.05）; and the difference in VAS scores at preoperation, 2 days postoperation and 1 month postoperation within the groups was statistically significant （P < 0.05）. The results of the modified Macnab efficacy evaluation criteria in the UBE group were 40, 2, 2 and 0 cases in order of excellent, good, acceptable and poor at the last follow-up, and the overall excellent rate was as high as 95.4%. In the open surgery group, there were 29, 7, 4 and 0 cases of excellent, good, feasible and poor, with an overall excellent rate of 90%. The difference in disc height between the two groups was statistically significant when comparing preoperative and postoperative disc heights （P < 0.05）. For the UBE group, there was no statistically significant difference between the preoperative and postoperative disc heights within the group （P > 0.05）, while the postoperative disc height in the open group was significantly increased compared with that of the preoperative period, with a statistically significant difference （P < 0.05）.The preservation rate of the articular eminence in the UBE group was 63.6%, while the preservation rate of the articular eminence in the open surgery group was 10%. Conclusion UBE can directly reach the target point to release nerve compression, and is a new technique that is minimally invasive, flexible, less traumatic, has a gentle learning curve, has little effect on spinal mobility, and is conducive to postoperative rehabilitation, which can completely remove the protruding nucleus pulposus, and has an ideal clinical therapeutic effect.
2024, 45(9): 70-75.
doi: 10.12259/j.issn.2095-610X.S20240911
Abstract:
Objective Logistic regression and decision tree model were used to analyze the influencing factors of adverse reactions of iodine contrast agents. Methods The adverse reaction group consisted of 129 patients who underwent CT examination using ICM and had adverse reactions from January 2019 to August 2023 in Fuwai Yunnan Hospital. The control group consisted of 135 patients who did not have adverse reactions during the same period using ICM. The variables with statistical significance in the univariate analysis were incorporated into multi-factor Logistic regression and decision tree model to extract and analyze the influencing factors causing adverse reactions. Results Logistic regression showed that BMI, allergic history, and renal insufficiency were the influencing factors of ICM （P < 0.05）. The prediction model was: Lggit （P） = 0.123×BMI+1.684×allergy history + 2.551×renal insufficiency −3.652. Decision tree analysis screened out three risk variables, including allergy history, renal insufficiency and ICM type, among which allergy history was the most important influencing factor. Conclusion Logistic regression and the decision tree model can predict the influencing factors of adverse reactions and transform the study into an active prediction to avoid adverse reactions, it has reference value for the safe drug use of patients.
2024, 45(9): 76-82.
doi: 10.12259/j.issn.2095-610X.S20240912
Abstract:
Objective To investigate the socioeconomic impact of self-management in patients with chronic heart failure（CHF） . Methods Convenient sampling method was used to investigated and analyzed the self-management of 1762 CHF patients aged 18~89 one month after discharge in Yunnan Province from September 2019 to May 2023. Principal component analysis method was used to construct comprehensive socioeconomic status （SES）, and binary Logistic regression analysis was used to investigate the socioeconomic impact of self-management in patients with CHF. Results The proportions of exercise management, monitoring symptom/weight, medication as prescribed, low sodium diet, fluid or water intake control and regular follow-up were 29.2%, 37.7%, 80.9%, 58.0%, 3.3% and 45.5% in patients with CHF, respectively. The proportion of exercise management and low sodium diet was different in different gender patients （P < 0.01）. Compared with young patients, older ones were more likely to follow prescribed medication, monitor symptoms or weight, and eat a low-sodium diet. Patients with higher education and income were also more likely to follow prescribed medication, exercise management, monitoring symptoms or weight, and regularly follow-up. Non-farmer patients had higher rates of prescribed medication, exercise management, monitoring of symptoms or weight, and regular follow-up than farmer patients. The binary logistic regression analysis results showed that a higher proportion of prescribed medication, monitoring of symptoms/weight, exercise management, and regular follow-up was found in the higher SES（P < 0.05）. Conclusion The self-management of CHF patients is generally low, and there are socioeconomic effects. Improving self-management in patients with CHF should focus on patients with low socioeconomic status.
2024, 45(9): 83-90.
doi: 10.12259/j.issn.2095-610X.S20240913
Abstract:
Objective To systematically evaluate the incidence and influencing factors of postoperative renal dysfunction in patients undergoing radical cystectomy. Methods The cohort studies and case-control studies related to postoperative renal function damage of patients undergoing radical cystectomy were retrieved from China HowNet, VIP, Wanfang, China Biomedical Literature Database, The Cochrane Library, PubMed, Web of Science and Embasedatabases. The retrieval time is from the establishment of the database to September 30, 2023. Two researchers independently conducted literature screening and article quality assessment based on predefined inclusion and exclusion criteria. Mata analysis was carried out on the literature with Stata14.0 software. Results A total of 11 articles were included. Meta-analysis showed that the heterogeneity of the included studies was large （I 2 = 92.5%, P < 0.001）. Based on the random effect model, the incidence of renal function damage after radical cystectomy was 32%[95%CI （0.25, 0.35）, P < 0.001], and subgroup analysis showed that the research duration was 5 years or more 30%[95%CI （0.24, 0.37）, P < 0.001], the study area was Asia35%[95%CI （0.28, 0.42） in Asia, P < 0.001] , the postoperative estimated glomerular filtration rate was < 45 mL/（min·1.73m2） as the evaluation standard of renal function damage 33%[95%CI （0.29, 0.36）, P < 0.001]and cohort studies 39%[95%CI （0.26, 0.52）, P < 0.001]is higher. The influencing factors of postoperative renal dysfunction were age[HR = 1.03, 95%CI （1.02, 1.04）], hypertension [HR = 2.14, 95%CI （1.32, 3.40）], hydronephrosis [HR = 1.89, 95%CI （1.50, 2.36）], urinary tract infection[HR = 1.35, 95%CI （1.13, 1.61）] and Anastomotic stenosis [HR = 2.53, 95%CI （1.77, 3.61）]. Conclusion The incidence of renal function damage after radical cystectomy is high, which is closely related to age, history of hypertension, postoperative hydronephrosis, urinary tract infection and anastomotic stenosis. Medical staff should strengthen the monitoring of postoperative renal function and formulate effective measures for related influencing factors to reduce the incidence of renal function damage.
2024, 45(9): 91-96.
doi: 10.12259/j.issn.2095-610X.S20240914
Abstract:
Objective To explore the factors influencing the onset of vascular dementia （VD）, a nomogram model was constructed, incorporating both serological and clinical indicators. Methods In the Physical Examination Department of the First Affiliated Hospital of Kunming Medical University, 500 middle-aged and elderly people who participated in physical examinations from January 2019 to December 2023 were selected to statistically analyze the risk of VD. The single and multiple factors that affect the occurrence of VD were analyzed, and a nomogram model was drawn. The receiver operating characteristic curve （ROC）, area under the curve （AUC）, calibration curve, and decision curve （DCA） were used to analyze the diagnostic performance of the nomogram model. A risk stratification system was established based on the risk score of the nomogram. Results （1） The incidence of VD in middle-aged and elderly patients was 10.00%; （2） Hypertension, stroke, and serum KLK6, Klotho protein, and NRG-1 were factors affecting the occurrence of VD in middle-aged and elderly patients （P < 0.05）; （3） The diagnostic AUC of the nomogram model in the occurrence of VD in middle-aged and elderly patients was 0.851 （95%CI: 0.794-0.908）, and the diagnostic probability was consistent with the actual probability. When the threshold probability was between 0.00 and 0.78, the clinical net benefit of the nomogram model was maximized; （4） Using the nomogram model to diagnose individual VD risk scores based on the recursive segmentation method for risk classification, the incidence of VD in high-risk patients was 18.00%, which was higher than that in moderate-risk patients （10.00%） and low-risk patients （4.00%） （P < 0.05）. Conclusion The incidence of VD in middle-aged and elderly people in Kunming region is 10%, and its influencing factors involve hypertension, stroke, and serum KLK6, Klotho protein, NRG-1. Strengthening the monitoring and intervention of these factors is of great significance for reducing the incidence of VD.
2024, 45(9): 97-102.
doi: 10.12259/j.issn.2095-610X.S20240915
Abstract:
Objective To investigate the knowledge and awareness of physicians in Anning City regarding the diagnosis and treatment of gout, and explore the influencing factors. Methods From January to April 2024, a questionnaire survey was conducted among general practitioners and physicians in 3 sanatoriums and 3 tertiary hospitals in Anning City to assess their knowledge of gout. Personal information of the participants was also collected. Chi-square test and binary logistic regression analysis were used to explore the differences between participants in two medical institutions and the factors influencing their awareness of the standardized diagnosis and treatment of gout. Results In Anning City, participants in sanatoriums had lower educational backgrounds （χ2 = 49.093, P < 0.05） and professional titles （χ2 = 23.896, P < 0.05）, with a higher proportion of general practitioners （64.10% vs 35.90%, P < 0.05）. In addition, participants in sanatoriums had fewer annual cases of hyperuricemia （χ2 = 16.643, P < 0.05） and gout （χ2 = 18.479, P < 0.05）. Furthermore, participants in sanatoriums had lower overall awareness of the standardized diagnosis and treatment of gout （χ2 = 5.193, P < 0.05）, especially in the management of acute gout attacks and the selection of medications. Educational background （OR = 2.044, 95%CI = 1.055-3.960, P < 0.05） and the number of annual cases of hyperuricemia （OR = 3.706, 95%CI = 1.952-7.038, P < 0.05） were positively associated with the awareness of standardized diagnosis and treatment of gout among physicians in Anning City. Conclusions Physicians in Anning City have certain blind spots in their knowledge of gout management, especially in the management of acute gout attacks and the selection of urate-lowering medications for patients with complex comorbidities by physicians in sanatoriums. Improving the gout management capabilities of physicians in Anning City should not only focus on their educational backgrounds but also provide more opportunities for specialized clinical practice.
2024, 45(9): 103-109.
doi: 10.12259/j.issn.2095-610X.S20240916
Abstract:
Objective To investigate the etiology and influencing factors of female infertility. Methods A total of 776 infertile women who visited Kunming Maternal and Child Health Hospital from July 2021 to June 2023 were collected. Multiple Logistic regression model was used to explore the etiology of infertility. Results The prevalence of female infertility is higher in the age group of 26～35 years old, and the etiology is complex and mutually influential, among which fallopian tube factors, ovulation disorders, and low ovarian reserve are the main reasons, accounting for 48.32%, 19.20%, and 10.57% of infertility patients respectively. For primary and secondary infertility patients, the P-values for the above three causes are <0.001, <0.001, and 0.42 respectively. Results from a multivariate logistic regression model suggest that age （95%CI: 1.14～1.21）, pre-pregnancy body mass index （BMI） （95%CI: 0.74～10.83, 1.28～2.30）, smoking history （95%CI: 1.27～17.66）, menstrual irregularities （95%CI: 3.52～8.68）, history of induced abortion （95%CI: 1.08-2.19, 5.52～15.22）, history of genitourinary tract infections （95%CI: 3.74～6.42）, and history of gynecological surgeries （95%CI: 3.99～7.40） are major influencing factors on female fertility. The primary cause of female infertility is tubal obstruction, which is associated with a history of unsafe sexual practices, abortions, and pelvic surgeries; secondary causes include ovulatory disorders, which are linked to diminished ovarian reserve, endocrine disorders, and delayed childbearing. Conclusion The main influencing factors of female infertility include tubal factors, ovulatory disorders, and decreased ovarian reserve function. Additionally, factors such as age, pre-pregnancy body mass index （BMI）, place of residence, smoking history, menstrual cycle regularity, number of induced abortions, history of genitourinary infections, history of gynecological surgeries, and systemic disease history all impact fertility. It is necessary to target the causes and influencing factors for proactive prevention and treatment.
2024, 45(9): 110-115.
doi: 10.12259/j.issn.2095-610X.S20240917
Abstract:
Objective To explore the effects of PCV-VG ventilation mode combined with dexmedetomidine sedation on intraoperative respiratory mechanics and blood gas indicators in obese patients undergoing laparoscopic sleeve gastrectomy. Methods 132 patients who underwent laparoscopic sleeve gastrectomy at Kunming First People's Hospital from July 2022 to December 2023 were randomly divided into VCV mode group （Group V）, PCV-VG mode group （Group P）, VCV mode combined with dexmedetomidine pump group （Group D）, and PCV-VG mode combined with dexmedetomidine pump group （Group PD）, with 33 patients in each group. Then we compared the oxygen partial pressure （PaO2）, carbon dioxide partial pressure （PaCO2）, peak airway pressure （Ppeak）, mean airway pressure （Pmean）, and lung dynamic compliance （Cdyn） of four groups of patients 20 minutes before anesthesia induction （T0）, 10 minutes after tracheal intubation （T1）, 40 minutes after CO2 pneumoperitoneum establishment （T2）, and 10 minutes after deflation （T3）. Results （1） Blood gas indicators: At time points T2 and T3, the PaO2 levels in the P, D, and PD groups were higher than those in the V group, with P < 0.01, indicating a statistically significant difference, Among them, the PD group was higher than the other three groups, with P < 0.01, indicating a statistically significant difference; And PaCO2 was lower than that of Group V, P < 0.01, with statistically significant differences, Among them, the PD group was lower than the other three groups, P < 0.01, with statistically significant differences. （2） Respiratory mechanics indicators: At T1, there was no significant statistical difference in Ppeak among the four groups, with P > 0.05. The Ppeak of the PD group was lower than that of the V, P, and D groups at time points T2 and T3, with P < 0.01, and the difference was statistically significant; And Cdyn was higher than the other three groups, with P < 0.01, and the difference was statistically significant; At T1, T2, and T3, Pmean was lower in the PD group than in the P group, with P < 0.01, and the difference was statistically significant. Conclusion PCV-VG ventilation mode combined with intravenous infusion of dexmedetomidine can improve oxygen and function during laparoscopic sleeve gastrectomy in obese patients, reduce airway peak pressure, improve lung compliance, and reduce mechanical lung injury.
2024, 45(9): 116-121.
doi: 10.12259/j.issn.2095-610X.S20240918
Abstract:
Objective To investigate the effect of goal-directed fluid therapy combined with milrinone in achieving controlled low central venous pressure （CLCVP） in laparoscopic hepatic lobectomy. Methods Sixty patients undergoing laparoscopic hepatectomy at the First People’ s Hospital of Kunming City from August 2021 to November 2023 were selected as the study subjects. They were randomLy divided into two groups, with 30 cases in each group: the control group and the experimental group. The control group received strict fluid therapy （infusion of crystalloid at a ratio of 1∶1 at 3 mL/kg） and Nitroglycerin infusion to achieve CLCVP based on the patient’ s condition. The experimental group received fluid therapy targeting SVV 1%～9% （infusion of crystalloid at a ratio of 1∶1 at 20 mL/kg） and milrinone was used in combination to achieve CLCVP. Surgical field satisfaction, blood loss, blood pressure changes, urine output, central venous pressure, and length of hospital stay were recorded for both groups. Results The intraoperative surgical field satisfaction of the experimental group was higher than that of the control group, with statistically significant differences （P < 0.05）; the total intraoperative blood loss and average blood loss in the experimental group were lower than those in the control group, and the surgical time was shorter than that of the control group, with statistically significant differences （P < 0.05）. There was no statistically significant difference in preoperative mean arterial pressure between the two groups （P > 0.05）. The experimental group had higher mean arterial pressure both intraoperatively and postoperatively than the control group, with statistically significant differences （P < 0.05）. There was no statistically significant difference in urine output between the two groups intraoperatively （P > 0.05）, but postoperatively, the urine output in the experimental group was higher than that in the control group. The average CVP value was lower in the experimental group than in the control group, with statistically significant differences （P < 0.05）. The total length of hospital stay and average length of hospital stay were shorter in the experimental group than in the control group, with statistically significant differences （P < 0.05）. Conclusion In laparoscopic liver resection surgery, the use of goal-directed fluid therapy combined with milrinone to achieve controlled low central venous pressure （CLCVP） significantly reduces intraoperative bleeding, maintains hemodynamic stability, shortens surgical and hospital stay, and improves surgeon’ s satisfaction with surgical field compared to the traditional strict fluid control method.
2024, 45(9): 122-128.
doi: 10.12259/j.issn.2095-610X.S20240919
Abstract:
Objective To explore the test indicators closely related to the incidence and prognosis of acute traumatic head injury. Methods The data of 156 patients with head injuries admitted to the emergency department from October 2022 to June 2023 after the establishment of the trauma center of Yan'an Hospital of Kunming were collected. The gender, age, prognosis, and laboratory tests immediately after admission were statistically analyzed. Results The incidence rate of acute TBI patients was significantly higher in males than in females, with a ratio of 2.62∶1, and the incidence of moderate to severe and poor prognosis was significantly higher in males than females, and the difference was statistically significant P < 0.05. The main age of onset was 39～72 years old, and the age of patients with poor prognosis was significantly higher than that of patients with good prognosis, and the difference was statistically significant, P < 0.05. The tests immediately upon admission WBC, CRPH, AST, GLU, D-Dimers, S100βand IL-6 in the patients with craniocerebral injury were significantly higher than those in the normal control group, and the recombinant WBC, CRPH and AST were higher than those in the mild group. The levels of CRPH, AST and GLU in the poor prognosis group were higher than those in the good prognosis group, and the difference was statistically significant P < 0.05. Conclusion Immediate test markers, such as WBC, CRPH, AST, GU, etc., may be related to the severity or poor prognosis of acute traumatic head injury, and clinicians should pay attention to and timely targeted intervention and treatment to improve adverse outcomes.
2024, 45(9): 129-135.
doi: 10.12259/j.issn.2095-610X.S20240920
Abstract:
Objective To evaluate the effect of early enteral nutrition on the clinical outcomes of very low birth weight preterm infants. Methods The literature on the use of early enteral nutrition and clinical outcome measures in VLBW premature infants was searched by computer until 31 December 2023. The data were extracted for Meta-analysis with RevMan5.4 software. Results A total of 323 articles were selected, and 8 articles were selected, with a total sample size of 3451 cases, the results of the Meta-analysis showed that early enteral nutrition for hospitalization of very low birth weight preterm infants [MD = -17.26, 95%CI （-35.41, 0.89）, P = 0.06], incidence of NEC [RR = 0.98, 95%CI （0.75, 1.27）, P = 0.85] has no effect. But early enteral nutrition can reduce the duration of full enteral feeding in very low birth weight premature infants [MD = -3.44, 95%CI （-4.15, -2.73）, P < 0.00001 ], reducing the time of parenteral nutrition [MD = -5.90, 95%CI （-10.42, -1.38）, P = 0.01], incidence of feeding intolerance [RR = 0.70, 95%CI （0.63, 0.77）, P < 0.00001 ], Reduced incidence of infection [RR = 0.57, 95%CI （0.42, 0.76）, P = 0.0001 ]. Conclusion Early enteral nutrition can reduce the total duration of enteral nutrition, parenteral nutrition, incidence of feeding intolerance and infection.
2024, 45(9): 136-143.
doi: 10.12259/j.issn.2095-610X.S20240921
Abstract:
Objective To understand the emotional perception and general mental health status of medical students, and explore related influencing factors to promote mental health education for medical students. Methods An on-site questionnaire survey was conducted on 1037 medical students at Kunming Medical University to describe their overall psychological status. Factors influencing the positive/negative emotions and general mental health of medical students were analyzed through multiple linear regression and logistic regression analysis. Results The average score of positive emotions among medical students on campus was （26.31 ± 6.76）, while the average score of negative emotions was （21.50 ± 6.76）. The detection of mental health problems was relatively low （8.58%）. Whether only child, academic performance, and self-reported health status （P < 0.05） had an impact on positive emotional scores; Gender, self-reported health status, and sleep time had an impact on negative emotional scores （P < 0.05）. The prevalence of mental health problems among medical students was influenced by whether they were single child or self-reported health status （P < 0.05）. Conclusions Good academic performance can enhance positive emotions, and students with shorter sleep duration and poorer physical health are more likely to perceive negative emotions and experience mental health problems. Universities should pay attention to the psychological status of medical students and take corresponding measures to ensure their physical and mental health to promote medical education.
2024, 45(9): 144-150.
doi: 10.12259/j.issn.2095-610X.S20240922
Abstract:
Objective To compare the clinical therapeutic effects of Laparoscopic cholecystectomy （LC） + laparoscopic common bile duct exploration and primary suture （LBEPS） and LC + laparoscopic common bile duct exploration through cystic duct （LTCBDE）. Methods The clinical data of 64 patients with cholecystolithiasis complicated with choledocholithiasis treated by LC + LBEPS and LC + LTCBDE from January 2018 to June 2023 were analyzed retrospectively, including 35 patients with LC + LBEPS and 29 patients with LC + LTCBDE. Besides, the operation time, intraoperative bleeding, abdominal drainage time, operation success rate, total hospitalization time, total hospitalization expenses, surgical complications and stone recurrence rate between the two groups were compared. Results There was no significant difference in baseline data, surgical success rate and postoperative complication rate between these two groups （P > 0.05）. The operation time, blood loss, abdominal drainage time, total hospitalization time and total hospitalization cost in the LC + LBEPS group were significantly higher than those in LC + LTCBDE group （P < 0.05）. Conclusions LC + LBEPS and LC + LTCBDE are two effective treatment methods for cholecystolithiasis complicated with choledocholithiasis without T tube. However, LC + LTCBDE has lower operation time, intraoperative bleeding, abdominal drainage time, total hospitalization time and total hospitalization cost, as well as better clinical treatment effect, so that it can be preferred on the premise of meeting surgical indications.
2024, 45(9): 151-155.
doi: 10.12259/j.issn.2095-610X.S20240923
Abstract:
Objective To investigate the clinical effect of vacuum sealing drainage （VSD） combined with human epidermal growth factor in the treatment of diabetic foot ulcers. Methods A total of 62 patients diagnosed with diabetic foot ulcer （wagner grade 2～4） hospitalized in the first department of General Surgery and Vascular Surgery of Harbin 242 Hospital from January 2022 to January 2024 were selected as the study subjects. All patients were given standard systemic basic treatments such as controlling blood pressure, blood sugar, blood lipids, anti-infection, and thorough debridement of ulcer wounds. The patients were randomly divided into control group （n = 30） and experimental group （n = 32） by using random number table. The control group received a routine treatment plan of hydropathic compress and dressing change for ulcer wounds, while the experimental group accepted VSD combined with growth factors. Compared with the effective rate, wound area, duration of antibiotic use , wound healing time, and adverse reactions of foot ulcer wounds between two groups of patients after 6 weeks of treatment. Results The effective rate （χ2 = 4.26, P = 0.031） in the experimental group were significantly higher than that in the control group. The wound area in the experimental group was smaller than that in the control group after treatment（P < 0.05）, the duration of antibiotic use （t = 6.145, P < 0.001） and wound healing time （t = 9.486, P < 0.001） in the experimental group were significantly lower than these in control group. There were no obvious adverse reactions in two groups. Conclusion VSD combined with growth factor has a significant effect in the treatment of DFUs, which can enhance the treatment efficiency, reduce the duration of antibiotic use, shorten the wound healing time, safely and reliable as well.
2024, 45(9): 156-162.
doi: 10.12259/j.issn.2095-610X.S20240924
Abstract:
Objective To understand the status quo of social support of HIV patients in Yunnan Province and explore its influencing factors, so as to provide a reference for improving the social support status of this population in the future. Methods Multi-stage stratified cluster sampling was used to conduct a cross-sectional survey of HIV patients receiving treatment in designated hospitals in Yunnan province. The questionnaire included demographic characteristics, HIV infection-related information and social support rating scale （SSRS）, and the analysis was conducted by t-test, analysis of variance and multiple linear regression. Results The total score of social support in 631 HIV patients was （28.44±8.48）, the scores of objective support （6.14±2.56）, subjective support （16.54±5.69） and support utilization （5.76±2.26）, all of which were lower than the domestic norm （P < 0.001）. Being youth under 30 years old, living in rural areas, not living alone, being married, having an occupation, having a high level of education, having a high average annual household income, and participating in group activities with infected persons were favorable factors for social support （P < 0.05）. Conclusions The overall social support status of HIV-infected people in Yunnan Province is worse than that of the whole country. Humanistic care should be strengthened for elderly infected people who are older, living in cities, living alone, divorced/widowed/unmarried, unemployed, those with low average annual family income and those who do not participate in group activities for HIV-infected people, so as to improve their level of social support.
2024, 45(9): 163-167.
doi: 10.12259/j.issn.2095-610X.S20240925
Abstract:
Objective To investigate the efficacy of 48 weeks of rapid initiation of HIV antiviral therapy in Kunming, and analyze the influencing factors of Non-rapid initiation. Methods Data of patients initially receiving HIV antiviral treatment in The Third People's Hospital of Kunming from January 2018 to December 2022 were retrospectively collected. The time interval between diagnosis and treatment initiation was ≤7 days in the rapid ART group, and > 7 days in the non-rapid ART group. Chi-square test and T-test were used to compare the baseline demographic and clinical characteristics between the two groups and logistic regression analysis was used to analyze the influence factors. The chi-square test was used to compare the difference of CD4 count, viral inhibition rate, cohort retention rate and mortality between the two groups after 48 weeks of treatment. Results The Rapid ART rate was 32.70%, the Non-rapid ART group has higher loss rate in 48 week（χ2 = 11.169, P = 0.001）, higher mortality（χ2 = 3.924, P = 0.048）. The risk of Non-rapid initiation was 1.212 times higher in patients without a spouse（P = 0.040）. The risk of Non-rapid initiation in patients transmitted by intravenous drug use was 2.987 times that of heterosexual transmission（P < 0.001）. Patients with baseline CD4/CD8<0.5 had a 1.423 times greater risk of Non-rapid initiation than patients with CD4/CD8≥0.5（P = 0.001）, patients with CD4 counts≤350/μL were at higher risk for Non-rapid initiation（P = 0.047）. After 48 weeks of treatment, the virus inhibition rate in the Rapid ART group was higher than that in theNon-rapid ART group（P = 0.031）, the proportion of patients with CD4/CD8≥0.5 was higher in theRapid ART group（P < 0.001）. Conclusion Rapid initiation of antiviral therapy is beneficial to improve viral inhibition rate and cohort retention rate, and reduce mortality. For patients without spouses, with intravenous transmission and CD4/CD8<0.5, more interventions should be given to help patients receive antiviral therapy as soon as possible.
2024, 45(9): 168-173.
doi: 10.12259/j.issn.2095-610X.S20240926
Abstract:
Stem cells from apical papilla （SCAP） have a strong multi-line differentiation potential, in which osteogenic differentiation can be applied to bone tissue regeneration, providing a new idea for the treatment of oral jaw defects. Osteogenic differentiation is a complex network regulation process, and endogenous substances such as various cytokines, epigenetic material, various signaling molecules and signaling pathways can have different degrees of influence. The interaction of these factors can promote the proliferation, migration and osteogenic differentiation of SCAP, but the specific mechanisms and internal links in different processes of osteogenic differentiation of SCAP are different. In this paper, the factors that promote osteogenic differentiation of SCAP and their possible regulatory mechanisms were reviewed to provide new information for further application research.
Stem cells from apical papilla （SCAP） have a strong multi-line differentiation potential, in which osteogenic differentiation can be applied to bone tissue regeneration, providing a new idea for the treatment of oral jaw defects. Osteogenic differentiation is a complex network regulation process, and endogenous substances such as various cytokines, epigenetic material, various signaling molecules and signaling pathways can have different degrees of influence. The interaction of these factors can promote the proliferation, migration and osteogenic differentiation of SCAP, but the specific mechanisms and internal links in different processes of osteogenic differentiation of SCAP are different. In this paper, the factors that promote osteogenic differentiation of SCAP and their possible regulatory mechanisms were reviewed to provide new information for further application research.
Application of Flipped Classroom Mixed Teaching Mode in Standardized Training of Radiology Residents
2024, 45(9): 174-179.
doi: 10.12259/j.issn.2095-610X.S20240927
Abstract:
Objective To evaluate the application effect of the blended flipped classroom teaching mode on the academic performance, critical thinking ability, and teaching satisfaction of radiology residents. Methods Sixty radiology residents trained in our department from September 2017 to September 2019 were randomly selected and divided into an experimental group （n = 30, using the blended flipped classroom teaching method） and a control group （n = 30, using traditional teaching methods）. After training, the two groups were compared and evaluated in terms of exam scores, teaching satisfaction, and critical thinking ability. Results There was a significant difference in critical thinking scores between students in the flipped classroom and those in the traditional classroom （P < 0.05）; there was also a significant improvement in chapter tests, end-of-month tests, and end-of-rotation assessments （P < 0.05）. In the final subjective evaluation, students in the flipped classroom scored higher than those in the traditional mode in terms of improving independent learning ability, enhancing analytical problem-solving skills, increasing awareness of teamwork, and overall teaching effectiveness （P < 0.05）. Conclusion This study suggests that the blended flipped classroom can effectively enhance the professional performance, critical thinking ability, and teaching satisfaction of radiology residents. It is recommended to use this teaching mode for standardized training of residents.
2024, 45(9): 180-188.
doi: 10.12259/j.issn.2095-610X.S20240928
Abstract:
Objective To assess the efficacy of three disinfectants in disinfecting the ultrasonic scaling unit waterline. Methods Twelve periodontal ultrasonic scalers were randomly divided into four groups based on the disinfection protocol: distilled water （A group）, 3% hydrogen peroxide （B group）, 500 mg/L chlorine disinfectant （C group） and 5% povidone-iodine （D group）. Each scaler was used for daily periodontal treatment and worked effectively for 6 hours per day. Water samples were collected at baseline, after disinfection, and 1-7 days post-disinfection. Scanning electron microscopy （SEM） was used to observe biofilm formation. Culturable bacteria were counted, isolated and purified, then identified through 16S rRNA gene sequencing. Sequences of 16S rRNA gene amplicons were clustered by operational taxonomic units （OTUs）. Results Baseline colony counts exceeded 100 CFU/mL in all groups. However, after disinfection, the colony counts decreased significantly in all groups （P < 0.05）. The colony counts remained below 100 CFU/mL within 3 d after disinfection with 3% H2O2, within 6 days after disinfection with 500 mg/L chlorine-containing disinfectant, and within 4 d after disinfection with 5% povidone-iodine （P < 0.05）.Pathogens such as Stenotrophomonas maltophilia were detected in the ultrasonic scaler unit water circuit. SEM showed thinner biofilm thickness in the 3% H2O2 and 5% povidone-iodine groups compared to the control group （P < 0.05）. Conclusions Bacterial contamination is present in the ultrasonic scaling unit waterline, posing a potential infection risk to periodontal staff and patients. In the context of increasingly severe nosocomial infections, appropriate disinfection protocols should be developed based on clinical realities.
