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25 June 2020, Volume 19 Issue 03 Previous Issue    Next Issue

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The clinical investigation of two cases of cutaneous skeletal hypophosphatemia syndrome and review of literature LIU Li, WEI Zhe, LIN Xiaoyun, YUE Hua, ZHANG Zhenlin 2020, 19 (03):  232-237.  DOI: 10.16150/j.1671-2870.2020.03.006 Abstract ( 441 )   HTML ( 0 )   PDF (737KB) ( 65 )   Objective: To explore the clinical features, imaging manifestations, gene mutations and treatment response of 2 sporadic cases of cutaneous skeletal hypophosphatemia syndrome. Methods: The case history, clinical presentation and laboratory and imaging data were reviewed. The genomic DNA was extracted from peripheral blood and skin tissue of patients were sequenced by Sanger sequencing for detection of KRAS、NRAS and HRAS gene mutations. Results: Both patients had bone pain accompanied with progressive difficulty in movement, scoliosis, multiple fractures, and melanocytic nevi located in waist and hips. The laboratory investigation revealed decreased blood phosphorus level（0.44 mmol/L and 0.46 mmol/L） and elevated levels of alkaline phosphatase(ALP)（157 U/L and 277 U/L） and fibroblast growth factor 23(FGF-23)（57.0 ng/L and 118.5 ng/L）. The dual-energy X-ray absorption detector indicated a significant decrease in bone density. The symptoms were significantly improved after treatment with neutral phosphorus and vitamin D. No related gene mutation was identified. Conclusions: Cutaneous skeletal hypophosphatemia syndrome is a rare metabolic bone disease with unclear pathogenesis. Currently, the diagnosis still relies on characteristic clinical, laboratory and imaging manifestation. Identification of RAS gene mutations will help the establishment of the diagnosis. Figures and Tables | References | Related Articles | Metrics

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Three-dimensional imaging of articular cartilage and subchondral bone using synchrotron radiation X-ray microtomography in rabbit osteoarthritis model GENG Jia, XING Yue, HU Yangfan, SI Liping, ZHONG Jingyu, GUO Han, YAO Weiwu 2020, 19 (03):  238-242.  DOI: 10.16150/j.1671-2870.2020.03.007 Abstract ( 367 )   HTML ( 1 )   PDF (640KB) ( 65 )   Objective: To explore the value of synchrotron radiation X-ray microtomography (SR-μCT) in the imaging analysis of bone-cartilage unit in rabbit osteoarthritis(OA) model, and to determine the changes of cartilage and subchondral bone in the progress of OA. Methods: A total of 10 healthy male New Zeal and white rabbits aging 6-month were randomly divided into study and control group, 5 animals in each group. To establish OA model, the rabbit in the study group got surgery on the knees using modified Hulth method, while rabbits in the control group were only treated by opening the joint cavity. All the animals were sacrificed 12 weeks later. The samples of bone-cartilage unit collected in the load-bearing area of medial tibial plateau were fixed in formaldehyde solution and dehydrated by an ethanol gradient,and scanned with SR-μCT. All original images were processed by phase retrieval, slicere construction and three-dimensional reconstruction. The image of chondrocytes, the morphology and quantitative parameters of subchondral bone trabe-cula were analyzed. Results: The reconstructed images of SR-μCT could clearly display the chondrocytes, cartilage lacunae and their arrangement. The chondrocytes in the control group were arranged orderly and evenly, and the surface of cartilage was smooth, while chondrocytes in the study group were arranged disorderly and the deep fissures and the surface fibrillations appeared in the cartilage matrix. The subchondral bone trabecular in the control group was also distributedcompletely and evenly, and subchondral bone trabecular in the study group became thinner and locally exfoliated. The quantitative analysis of subchondral bone morphology showed that the bone volume fraction(BVF)(26.64%±1.64% vs 39.00%±2.28%) and trabecular thickness (Tb.Th)[(80.55±5.51) μm vs(102.12±8.02) μm] in the study group were lower than those in the control group(P<0.05). Conclusions: SR-μCT can be used for imaging analysis of bone-cartilage unitat cellular level. Both cartilage degeneration and subchondral bone remodeling play an important role in the development of OA. Figures and Tables | References | Related Articles | Metrics

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Establishment of pretibial myxedema severity and activity rating scale and validation with ultrasonic and laboratory measurements CHEN Xiaoying, ZHENG Jie 2020, 19 (03):  243-247.  DOI: 10.16150/j.1671-2870.2020.03.008 Abstract ( 571 )   HTML ( 2 )   PDF (738KB) ( 101 )   Objective: To establish a rating scale for assessing severity and activity of pretibial myxedema (PTM) and to validate its application value by ultrasonic measurement of skin thickness and detection of thyroid stimulating hormone receptor antibody(TRAb). Methods: The PTM severity and activity rating scale was established based on Vancouver scars scale and PTM skin lesion staging. A total of 40 PTM patients were enrolled during January 2015 to December 2018 and severity and activity of PTM referring to the clinical manifestation and skin lesion were assessed. The correlation of scale score with serum TRAb level and skin dermal thickness in the lesions measured by ultrasound were further analyzed. Results: Scores of PTM severity and activity rating scale ranged from 3 to 11, with an average of 7.2±1.9. The serum TRAb level in all patients were higher than normal (<1.75 IU/L): 31 cases (77.5%)> 40 IU/L, 7 cases (17.5%) between 30-40 IU/L, and 2 cases (5%) between 20-30 IU/L. The skin dermal thickness obtained by ultrasonic measurement ranged from 4.2 to 10.4 mm, with an average of (6.4±1.6) mm. Spearman analysis showed the rating scores had a positive correlation with serum TRAb level (P<0.05) and skin dermal thickness (P<0.05). Conclusions: The pretibial myxedema severity and activity rating scale is a valua-ble method to assess the degree of PTM severity and activity, and was also easy and helpful to describe the disease accurately. Figures and Tables | References | Related Articles | Metrics

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Identification of differentially expressed target genes in pediatric Burkitt lymphoma and its clinical application MENG Leijun, ZHANG Jing, WANG Xueli, LI Zhi, ZHANG Hong, ZENG Naiyan 2020, 19 (03):  248-257.  DOI: 10.16150/j.1671-2870.2020.03.009 Abstract ( 532 )   HTML ( 0 )   PDF (3018KB) ( 74 )   Objective: To identify the differentially expressed genes of phosphatidylinositide3-kinase(PI3K), nuclear factor kappa-B(NF-κB) and RAS/RAF signal pathways at mRNA and protein levels in pediatric Burkitt lymphoma（BL） for exploring the correlation of these genes with the development and progression of BL and determining the specific target genes for diagnosis and treatment monitoring. Methods: Tumor tissues from 18 cases of pediatric BL and tissues of normal lymphnodes of 20 pediatric cases were collected. The expression levels of mRNA of related target genes in the pathways were analyzed by real-time fluorescence quantitative reverse transcription polymerase chain reaction and the protein levels were determined by immunohistochemistry. Results: The expressions of MYC, TCF3, ID3, CCDN3, CDK6, CDK4, NRAS, RAF1 at mRNA and protein levels were up-expressed significantly in BL and some target genes and its protein of NF-κB pathway such as BCL2, CD44, C-FLIP, CCND2 and A20 were suppressed in BL when compared with normal tissues (P<0.05). Cases carrying c-MYC translocation and BCL2 expression (BCL2+) had higher serum LDH levels (P<0.05). Conclusions: Expressions of MYC, TCF3, CCND3, CDK6, NRAS and RAF1 genes are high,which might be used as molecular markers for the diagnosis and treatment monitoring of pediatric BL. c-MYC gene translocation accompanied with BCL2+ might be an important molecular indicator in BL, which is correlated with high serum LDH level, indicating advanced tumor staging, high tumor burden, and poor prognosis. Figures and Tables | References | Related Articles | Metrics

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The prognostic value of Beclin-1 and Bcl-2 and its relationship with pathological characteristics in patients with non-small cell lung cancer DU Hailei, CHEN Ling, LUO Fangxiu, LI Yong, CHENG Qijian, ZHU Lianggang, HANG Junbiao 2020, 19 (03):  258-263.  DOI: 10.16150/j.1671-2870.2020.03.010 Abstract ( 431 )   HTML ( 0 )   PDF (760KB) ( 75 )   Objective: To evaluate Beclin-1 and Bcl-2 in the prognosis of non-small cell lung cancer (NSCLC) by analyzing the expression of the two markers and clinical/pathological characteristics of patients. Methods: A total of 120 paired cancerous and paracancerous tissue samples from NSCLC patients were collected from surgical procedures and expressions of Belin-1 and Bcl-2 protein was determined with immunohistochemical analysis. The correlation between Belin-1 and Bcl-2 and the clinical/pathological characteristics of the patients was studied. Results: The high expression rate of Beclin-1 in the paracancerous tissues was significantly higher than that in the cancer tissues (49.2% vs 31.7%, P<0.01), while Bcl-2 in paracancerous tissues was significantly lower than that in cancer tissues (21.7% vs 45.8%, P<0.01). The lower expression of Beclin-1 in NSCLC was associated with poor differentiation, advanced pathological stage and lymph node metastasis(P<0.05). Higher Bcl-2 expression rate was correlated with poor differentiation and lymph node metastasis (P< 0.05). Neither Beclin-1 or Bcl-2 expression in lung cancer tissues was associated with age, gender, smoking, preope-rative serum CEA and tumor pathological type (P>0.05). Multivariate Cox regression analysis showed that advanced pathological stage, the lower the expression of Beclin-1,and poor differentiation were independent predictors of poor prognosis in patients with NSCLC (P<0.05, P<0.01, P<0.01). In patients with high expression of Bcl-2, high Beclin-1 expression was related to a better 5-year survival (P<0.01). Conclusions: The fuction of autophagy activity in NSCLC is decreased. Lower Beclin-1 expression and higher expression of Bcl-2 are found in NSCLC tissues, and both of them are associated with occurrence and progress of NSCLC. High Beclin-1 may serve as a favorable prognostic marker independently for NSCLC patients with high Bcl-2 expression. Figures and Tables | References | Related Articles | Metrics

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High frequency ultrasound in combination with dynamic tests in diagnosis of pharyngoesophageal diverticulum WANG Yan, ZHANG Jingwen, ZHAN Weiwei 2020, 19 (03):  264-268.  DOI: 10.16150/j.1671-2870.2020.03.011 Abstract ( 372 )   HTML ( 1 )   PDF (565KB) ( 107 )   Objective: To evaluate the performance of routine high frequency ultrasound in combination with dynamic tests in diagnosing pharyngoesophageal diverticulum(PD). Methods: A total of 42 cases of PD undergone routine high-frequency ultrasound (42 cases), with successive swallowing saliva test (28 cases), drinking water test (15 cases) or oral contrast-enhanced ultrasound agent (2 cases), were reviewed. The imaging features of ultrasound were compared with findings from esophagus barium swallow examination. Results: All lesions were located in the back of thyroid gland, with 39 cases (92.9%) in the left lobes and 3 cases(7.1%) in the right. Fourteen cases (33.3%) were diagnosed as PD according to the structure of hypoechogenicity wall and internal gas hyperechogenicity presented on the ultrasound imaging. Positive findings of dynamic tests included absence of liquid echogenicity, gas hyperechogenicity or contrast agent hyperechogeni-city entering into the lesions. Sequential execution of swallowing test, drinking water test and oral contrast agent test identified 11 cases (26.2%), 15 cases (35.7%) and 2 cases (4.8%), respectively, increasing the rate of diagnosis from 59.5%（25 cases）, 95.2%（40 cases） to 100% (42 cases). Two cases identified by oral contrast agent test had larger maximum diameter( 8.8 mm and 24.7 mm). Conclusions: For the mass behind the thyroid, high frequency ultrasound in combination with swallowing salivais should be routinely recommended. Drinking water or oral contrast-enhanced ultrasound may facilitate the diagnosis of PD with the diameter of mass greater than 7 mm. Figures and Tables | References | Related Articles | Metrics

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Sonographic findings of thyroid tuberculosis: Report of a case and review of literature FEI Yuanxin, KUANG Lijun, LU Caifeng, LI Weiwei, ZHOU Wei, ZHOU Qinghua 2020, 19 (03):  269-273.  DOI: 10.16150/j.1671-2870.2020.03.012 Abstract ( 453 )   HTML ( 3 )   PDF (749KB) ( 51 )   Objective: To investigate the sonographic appearance of thyroid tuberculosis on conventional ultrasound and contrast-enhanced ultrasound (CEUS), so as to improve the understanding and diagnosis of the disease. Methods: The features on conventional ultrasound and CEUS of one case with thyroid tuberculosis were analyzed and reviewed with relevant literature and pathological findings. Results: On conventional ultrasound,it appeared as two inhomogeneously hypoechoic, irregular and ill-defined nodules without calcifications and no changes in the posterior echo was found. CEUS showed heterogeneous and low enhancement with slow wash-in and fast wash-out. The nodules were finally confirmed as thyroid tuberculosis by cytological examination. Conclusions: The sonographic appearance of thyroid tuberculosis is not specific, similar to the features of papillary thyroid carcinoma. The final diagnosis depends on pathological examination. Figures and Tables | References | Related Articles | Metrics

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Anti-transcriptional intermediary factor 1-γ antibody serves as a serum biomarker for dermatomyositis accompanied by malignancy diseases XIA Qunli, DIAO Licheng, WU Haixi, XUE Ke, WU Dan, DU Lianjun, ZHENG Jie, CAO Hua, LI Hao 2020, 19 (03):  274-278.  DOI: 10.16150/j.1671-2870.2020.03.013 Abstract ( 999 )   HTML ( 2 )   PDF (446KB) ( 79 )   Objective: To explore significance of anti-transcriptional intermediary factor 1-γ (TIF1-γ) antibody detection in diagnosing ermatomyositis (DM) malignancy or clinically amyopathic dermatomyositis (CADM) accompanied by malignancy diseases. Methods: A total of hospitalized 223 patients were enrolled at Department of Dermatology, Ruijin Hospital during Jan. 2016 to Dec. 2019, including 107 cases of adult DM, 102 cases of adult CADM, 5 cases of juvenile DM, and 9 cases of juvenile CADM. DM patients were divided into malignant DM group and non-malignant DM group, and so were the CADM patients. Enzyme-linked immunosorbent assay(ELISA) was used to detect serum anti-TIF1-γ antibodies in patients at first visit. The positive rates of anti-TIF1-γ antibody were compared between malignant DM group and non-malignant DM as well as between malignant CADM group and non-malignant CADM group. Results： It revealed that 35 adult DM and 7 adult CADM patients were diagnosed as having malignant neoplasia, and nasopharyngeal carcinoma, breast cancer and lung cancer were on the top three of cancer-associated myositis in our cohort, however, there was no malignancy detected in JDM and JCADM patients. Seventy-four (35.4%) adult patients had serum anti-TIF1-γ antibody detected, including 36 cased of DM (33.6%) and 38 cases of CADM (37.3%). Serum anti-TIF1-γ antibody was positive in 3 cases of JCADM (33.3%), but none in total of 5 cases of JDM. The positive rate of anti-TIF1-γ antibody in DM patients with malignant tumor was significantly higher than those without malignant tumor[26/35(74.3%) vs 10/72(13.9%), P<0.000 1]. The incidence of malignant tumor in patients with positive anti-TIF1-γ antibody was significantly higher than those with negative antibody[26/36(72.2%) vs 9/71(12.7%), P<0.000 1]. However there was no significant difference in the positive rate of anti-TIF1-γ antibody between patients with malignant tumor and without malignant tumor [4/7 vs 34/95(35.8%), P=0.420] in adult CADM. There was no statistically significant difference in the incidence of malignancy between anti-TIF1-γ antibody-positive and antibody-negative patients[4/38 (10.5%) vs 3/64(4.7%), P=0.420]. Conclusions： Serum anti-TIF1-γ antibody correlates with the occurrence of malignancy diseases in DM, but has no relationship with malignancy diseases in CADM. Thus, anti-TIF1-γ antibody might be the serum biomarker for DM associated with malignancy, and oncology screening should be intensified in adult DM patients with positive anti-TIF1-γ antibody. Figures and Tables | References | Related Articles | Metrics

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Sirt1 involved in sepsis-induced acute liver injury via regulating HNF-1α/FXR-1 pathway: The mechanism study in a rodent model WANG Qiuyun, CHEN Ying, ZHAO Bing, SUN Silei, YANG Zhitao, MAO Enqiang, CHEN Erzhen 2020, 19 (03):  279-285.  DOI: 10.16150/j.1671-2870.2020.03.014 Abstract ( 533 )   HTML ( 0 )   PDF (1424KB) ( 105 )   Objective: To investigate the role of Silent information regulator 1 (SIRT1) in sepsis-induced liver injury and the related mechanism in a mouse model. Methods: A mouse sepsis model was established by intraperitoneal injection (IP) of LPS, and the mice in control group were only given same volume sterilized 0.9% saline via IP. Sections of the liver from the mice in both groups were stained with hematoxylin-eosin and hepatic injury was examined, and quantitative real-time polymerase chain reaction (qrt-PCR) was performed to detect expression of Sirt1/HNF-1α/FXR-1 in hepatic tissue. The isolated primary mouse hepatic parenchymal cells were treated with different concentrations of LPS. Viabilityand proliferation of hepatic parenchymal cells were evaluated by CCK8 and EdU assay respectively. In addition, enzyme linked immunosorbent assay (ELISA) was conducted to measure interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) production in hepatic parenchymal cells treated with different concentration of LPS. Sirt1 overexpressing plasmids were constructed and transfected into hepatic cells in mediation of Lipofectamine 2000. After 48 hour, the Sirt1/HNF-1α/FXR-1 pathway expression was tested by qrt-PCR and the impact of overexpressing Sirt1 on the function of the cells was evaluated by CCK8, EdU and ELISA. Results: Compared with control, Sirt1/HNF-1α/FXR-1 pathway was down-regulated in LPS-induced sepsis mouse model. LPS lowered cell viability, inhibited proliferation and increased secretion of inflammatory factors IL-6 and TNF-α in hepatocytes. Over-expression of Sirt1 upregulated the expression of HNF-1α/FXR-1 pathway in parenchymal cells, alleviated LPS-induced inhibition of cell viability and proliferation, and decreased LPS-induced inflammatory factor secretion. Conclusions: The Sirt1/HNF-1α/FXR-1 pathway is involved in LPS-induced septic liver injury. Overexpression of Sirt1 is able to attenuate the toxic effects of LPS on parenchymal cells. Figures and Tables | References | Related Articles | Metrics

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Diagnostic value of fine needle aspiration biopsy combining with RJ-TIRADS in distinguishing benign and malignant thyroid nodules in elderly patients GUO Yan, GE Juanjuan, CHEN Chen, YIN Jiming, WANG Xiaolong, CHEN Jiageng, DU Yanwei, DUAN Yuanyuan, FAN Xuelin, ZHENG Lei, WANG Xiyong, ZHAN Weiwei, ZHANG Lu 2020, 19 (03):  286-291.  DOI: 10.16150/j.1671-2870.2020.03.015 Abstract ( 369 )   HTML ( 1 )   PDF (612KB) ( 67 )   Objective: To evaluate diagnostic value of Ruijin-thyroid imaging reporting and datasystem (RJ-TIRADS) combining with fine needle aspiration biopsy(FNAB) in thyroid nodules in elderly patients. Methods: From April 2017 to April 2020, a total of 117 patients (≥60 years old, 30 male and 87 female) with 129 thyroid nodules were enrolled from Department of Ultrasound,Suzhou Hospital Affiliated to Anhui Medical University and Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. All the patients were performed with ultrasound-guided FNAB and surgical treatment. Postoperative pathological diagnosis confirmed that 98 lesions were malignant and 31 were benign in all 129 thyroid nodules form patients. The data including size, internal structure, echo, morphology, margin and calcification of nodules on ultrasound imaging was collected and analyzed. Thyroid nodules were classified into three categories according to RJ-TIRADS classification as follows: Nodules without malignant characteristic(MC) were classified as category 3, nodules with one MC were classified as category 4A, nodules with 2 MC were classified as category 4B, nodules with 3-4 MC were classified as category 4C, nodules with 5 MC were classified as category 5. The diagnostic sensitivity,specificity, positive predictive value,negative predictive value and accuracy of RJ-TIRADS and FNAB alone or combination for malignant thyroid nodules in elderly patients were calculated regarding to the results of pathological biopsy. Results: There were significant differences between male and female patients with thyroid cancer in terms of solid (91.7% and 100%) lesions(P<0.05). The RJ-TIRADS classification results showed that cancer risk for patients with the category 4A-4C（59.3%, 88.4%, 100%） in elderly patients was higher than that in the general population（5.0%-20.0%, 21.0%-50.0%, 51.0%-90.0%）. The sensitivity, specificity and accuracy of FNAB in diagnosing thyroid nodules were 99.0%, 83.9% and 95.3%, higher respectively than ultrasound malignant characteristics, such as solid, low echo, aspect ratio of nodules >1, irregular margin, micro-calcification. Specificity and accuracy of FNAB in combination with RJ-TIRADS increased from 29%, 82.9% to 87.1%, 96.9% respectively. Conclusions: Solid nodules more often occur in the elderly female with thyroid cancer than male with thyroid cancer. Compared to the general population with RJ-TIRADS category 4, elderly patients classified as RJ-TIRADS category 4 have a higher risk of having thyroid cancer. FNAB combined with RJ-TIRADS may increase diagnosis value of thyroid nodules in the elderly. Figures and Tables | References | Related Articles | Metrics

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Expression of ZNF692 gene in clear cell renal cell carcinoma and its relationship with prognosis XU Zhaoping, WANG Haofei 2020, 19 (03):  292-296.  DOI: 10.16150/j.1671-2870.2020.03.016 Abstract ( 476 )   HTML ( 1 )   PDF (711KB) ( 86 )   Objective: To analyze the expression and prognostic value of ZNF692 gene in clear cell renal cell carcinoma (ccRCC) and to explore the related regulation mechanism. Methods: The RNA-Seq and clinical data were extracted from The Cancer Genome Atlas (TCGA) database and the correlation of ZNF692 expression with prognosis in the 516 ccRCC patients obtained were assessed. Twenty paired cancerous and paracancerous tissue samples of ccRCC patients were collected at Ruijin Hospital, and quantitative RT-PCR was used to determine ZNF692 gene expression. Upstream regulation mechanism of ZNF692 gene was explored by analyzing gene expression level with DNA copy number, DNA methylation and histone modification. Cell proliferations in ccRCC cell lines 786-O and 769-P with ZNF692 gene knockdown were detected and the function of ZNF692 gene was analyzed. Results: TCGA data extraction and analysis of the clinical samples revealed that ZNF692 gene was highly expressed in ccRCC cancer tissue compared with paracancerous tissue, and the high level of ZNF692 gene expression predicted a poor prognosis. Patients with high ZNF692 gene expression had shorter overall survival and event-free survival than those with low ZNF692 gene expression. High expression of ZNF692 gene was correlated with activation of c-MYC transcription. In regulatory region of ZNF692 gene, H3K27ac was enriched and in a highly activated transcription state. Knockdown of ZNF692 gene inhibited cell proliferation in ccRCC. Conclusions: ZNF692 as a potential oncogene is involved in the development and progress of ccRCC, and high expression of ZNF692 in ccRCC predicts a poor prognosis Figures and Tables | References | Related Articles | Metrics

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Correlation of estimated glomerular filtration rate with incidence of in-stent restenosis in patients with drug-elu-ting stent LIU Shengjun, LIU Lili, ZHU Zhengbin, SUN Yi, ZHU Tianqi, FENG Shuo, CHEN Xin, QUAN Weiwei, ZHANG Ruiyan 2020, 19 (03):  297-302.  DOI: 10.16150/j.1671-2870.2020.03.017 Abstract ( 265 )   HTML ( 0 )   PDF (629KB) ( 138 )   Objective: To evaluate correlation of estimated glomerular filtration rate with occurrence of in-stent restenosis (ISR) in patients treated with drug-eluting stent(DES) implantation during follow-up period. Methods: Patients undergone DES implantation in the RIPPER study between January 2010 and July 2016 were enrolled, and coronary angiography was performed again to detect ISR after 12-24 months (with the average time of 13 months). Binary Logistics regression were used to assess the risk factors for in-stent restenosis (ISR), and evaluate the correlation of eGFR with ISR in patients. Results: A total of 1 790 patients meeting the inclusion criteria, with the average eGFR of 89.97 mL/(min·1.73 m2) during follow-up, were divided into ISR group (n=200) and No-ISR group (n=1 590). The eGFR in ISR group was significantly lower than No-ISR group [(86.50±25.69) mL/(min·1.73 m2) vs. (90.64±26.59) mL/(min·1.73 m2), P=0.038]. Binary Logistics regression showed that the risk factors for ISR were number of implanted stent[OR=1.478, 95% CI 1.177-1.855, P=0.001] and increased baseline C-reactive protein level [OR=1.006, 95%CI 1.002-1.011, P=0.007], while relatively elevated eGFR during follow-up was protective factor（OR=0.990, 95%CI 0.982-0.999, P=0.022.Conclusions: In patients with nearly normal eGFR after DES implantation, relatively lower eGFR is correlated with the incidence of ISR. Figures and Tables | References | Related Articles | Metrics

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Predictive value of NT-proBNP for new-onset atrial fibrillation following acute myocardial infarction LUO Xiaoying, XU Yan, ZHANG Jiansheng, WU Liqun, QI Wenhang 2020, 19 (03):  303-307.  DOI: 10.16150/j.1671-2870.2020.03.018 Abstract ( 520 )   HTML ( 5 )   PDF (517KB) ( 70 )   Objective: To investigate relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) level and new-onset atrial fibrillation (AF) in patients with acute myocardial infarction (AMI). Methods: A total of 236 AMI patients admitted within 24 hours of onset were tested for NT-proBNP level upon admission, and 1day, 3 days, and 7 days after primary percutaneous coronary intervention (PCI). All patients were monitored continuously for new-onset AF for 7 days, and were later divided into AF group (n=51) and non-AF group (n=185). Clinical manifestations, echocardiographic and angiographic data were also reviewed in all patients. The impact of NT-proBNP level on new-onset AF following initial AMI was analyzed with multi-factor Cox regression analysis.The receiver operator characteristic curve (ROC curve) was used to determine the predictive cutoff value of NT-proBNP for the occurrence of new-onset atrial fibrillation following initial AMI. Results: AF occurred in 21.6% of patients. The univariate analysis showed that patients with new-onset AF had an older age, larger left atrial diameter (LAD), higher C reactive protein （CRP）level,higher percentage of the population with high blood pressure, anterior AMI, left-anterior-descending-artery lesion and 3-vessel lesion, and lower left ventricular ejection fraction （P<0.05）. Levels of NT-proBNP were higher in patients with AF than those in patients without at any point of test (P<0.05). Area under ROC (AUC) of NT-proBNP to predict new-onset AF was 0.74（95%CI 0.60-0.90, P<0.01）, with an optimal cut-off value of 1 403.6 pg/mL. Multivariate analysis showed that NT-proBNP level (>1 403.6 pg/mL)(OR=1.8, 95%CI 1.3-2.4), age(>69 years old)（OR=1.6, 95%CI 1.3-3.1） and LAD(>43.8 mm) (OR=1.3, 95%CI为1.1-1.9) were independent predictors of occurrence of new-onset AF. Conclusion: Serum NT-proBNP level is of certain value in early prediction of the new-onset AF following AMI. Figures and Tables | References | Related Articles | Metrics

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Survey on postoperative quality of life and influencing factors in patients treated with percutaneous coronary intervention CHEN Xin, LIU Lili, NI Jingwei, XU Gang, QUAN Weiwei, ZHANG Zhiruo 2020, 19 (03):  308-313.  DOI: 10.16150/j.1671-2870.2020.03.019 Abstract ( 407 )   HTML ( 0 )   PDF (575KB) ( 56 )   Objective: To investigate the impact of percutaneous coronary intervention (PCI) on quality of life (QOL) in patients with coronary heart disease (CHD). Methods: A total of 99 patients with CHD treated with PCI from April to December 2018 were enrolled. The Seattle Angina Questionnaire (SAQ) and the Patient Health Questionnaire-9 (PHQ-9) were performed to evaluate the quality of life (QOL) at 1 month and 6 months after PCI. QOL was assessed in respect to number of stents implanted (≤2 and >2), times of PCI (1 or >1) and SYNTAX score (light, medium and severe) using multi-factors and multi-levels of repeated measurements. Results: Both scores of SAQ and PHQ-9 were significantly improved at 6 months than those at 1 month after PCI. SAQ score was significantly lower at 1 month than that at 6 months (320.1±80.7 vs. 380.3 ±46.8, P<0.01), while PHQ-9 score was significantly higher at 1 month than that at 6 months (6.7±5.3 vs. 5.3±4.2, P<0.01). Furthermore, the interactive effects of number of stents implanted, times of PCI and SYNTAX score on the SAQ and PHA-9 scores were analyzed. The results showed that score of SAQ was not affected by the number of stents implanted, times of PCI and SYNTAX score 6 months after discharged from hospital. However, PHQ-9 score was affected by number of stents implanted and times of PCI. In patients with more than 2 stents implanted or multiple times of PCI, depression was not improved significantly at 6 months. Conclusions: The QOL is significantly improved at 6 months in patients treated with PCI. The improvement of SAQ score is not affected by number of stents implanted, times of PCI and SYNTAX score, while PHQ-9 is affected by number of stents implanted and times of PCI. In patients with multiple stents implanted or multiple times of PCI, the depression mood is not differed significantly between 1 month and 6 months after PCI. Figures and Tables | References | Related Articles | Metrics

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A self-established scoring method for risk stratification of prostate cancer in subjects with gray zone PSA YU Yifei, WANG Zhiqian, LI Min, LIU Jun, ZHAN Weiwei 2020, 19 (03):  314-318.  DOI: 10.16150/j.1671-2870.2020.03.020 Abstract ( 300 )   HTML ( 1 )   PDF (544KB) ( 103 )   Objective: To establish a scoring method for assessing the risk of prostate cancer in subjects with prostate specific antigen（PSA） in gray zone, and evaluate its diagnostic value. Methods: A total of 412 cases with gray zone PSA (4~10 μg/L) were enrolled from April 2017 to November 2019, and all had transperineal prostate biopsy performed under ultrasound guidance. Patients were divided into benign and malignant groups based on biopsy. Differences in age, prostate volume, serological indicators, PSA density (PSAD) and transrectal ultrasonography （TRUS） imaging between benign and malignant groups were compared with U test and Chi-square test. Receiver operator characteristic (ROC) curve was used to screen for the valid parameters and determine the cutoff values. The risk scoring method using valid parameters was then established for differentiating benign from malignant lesions in patients with gray zone PSA. The capability of the risk scoring method was assessed by ROC curve. Results: The age, prostate volume, free/total PSA ratio（f/t PSA） and PSAD between benign and malignant groups were statistically different (P<0.05). The detection rates of suspicious -looking nodules by TRUS between benign and malignant groups were also statistically different (P<0.05). The above mentioned indice including age, prostate volume, f/t PSA, PSAD and TRUS imaging findings were accepted to establish the risk scoring method. As scores of the scoring method increased from 0 to 5, the malignancy rates of prostate lesions assessed were 3.12%, 9.57%, 18.02%, 30.48%, 53.45% and 100%, respectively. The area under the ROC curve of the risk scoring method(cut off value >2.5) for diagnosing prostate cancer was 0.759, and the sensitivity and specificity were 71.41%, 67.39%, respectively. The performance of the established risk scoring method was superior to any other single index. Conclusions: The self-established scoring method could be used to assess malignant risk of prostate cancer in patients with gray zone PSA, which might facilitate the diagnosis of prostate cancer. Figures and Tables | References | Related Articles | Metrics

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Cloud-based solution assisted blood pressure management in outpatient setting HUANG Yongyan, YANG Lina, CAO Jiumei, WANG Wei 2020, 19 (03):  319-324.  DOI: 10.16150/j.1671-2870.2020.03.021 Abstract ( 532 )   HTML ( 2 )   PDF (706KB) ( 229 )   Objective: To implement a cloud-based solution for hypertension management in an outpatient setting and to assess the efficacy of cloud-based solution on control of blood pressure (BP). Methods: A cloud-based solution was developed, consisting of a Bluetooth-enabled BP monitor, a physician-end App, a cloud engine with knowledge database offering personalized lifestyle management and medication adherence contents. During Jan 1st 2018 and Dec 31st 2018, a total of 7 933 hypertensive patients were recruited into this study at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. The patients were divided into six different groups according to the intervention duration (2 months, 3 months, 4 months, 5 months, 6 months and more than 6 months). Changes in SBP, DBP, and final BP measurement distribution and hypertension staging as well as the time-effectiveness of the solution were studied. Results: The study population showed an average reduction in SBP by 8.88 mmHg (95%CI: 8.79-8.98, P<0.001), and DBP by 5.25 mmHg (95%CI: 5.23-5.27, P<0.001), respectively, in the before-after analysis. Hypertension staging distribution in the patients was improved, and the distribution at baseline vs last follow-up were normal BP, 0% vs 39%; stage-1, 69% vs 39%; stage-2, 23% vs 17%; and stage-3, 8% vs 5% (P<0.001). Further study revealed that BP reduction occurred after the first intervention and the reduction remained stably over time. Conclusions: The cloud-based solution might serve as an important tool for assisting BP management in outpatient clinic. Figures and Tables | References | Related Articles | Metrics