Table of Content

30 November 2021, Volume 36 Issue 11

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Relationship between plasma APN,sRAGE and the prognosis of patients with ARDS

GUO Weidong, FU Yun, GAO Shanglan

2021, 36(11):  1097-1100.  DOI: 10.3969/j.issn.1673-8640.2021.11.001

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Objective To investigate the relationship between plasma adiponectin（APN）,soluble receptor for advanced glycation end product（sRAGE） and the prognosis of patients with acute respiratory distress syndrome（ARDS）. Methods A total of 120 ARDS patients treated in intensive care unit（ICU） were enrolled,which included 21 mild patients（mild group）,56 moderate patients（moderate group） and 43 severe patients（severe group）. Oxygenation index,acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） score,sequential organ failure assessment（SOFA） score and lung injury score（LIS） at 1 h after admission were recorded,and the plasma levels of APN and sRAGE were determined. All the patients were followed up for 12 months to calculate the mortality. Logistic regression analysis was used to evaluate the risk factors of death in patients with ARDS. Results The levels of APN in mild group,moderate group and severe group decreased in turn（P<0.05）,and the levels of sRAGE in plasma increased in turn（P<0.05）. Among the 120 ARDS patients,32（26.67%） died. The oxygenation index and plasma APN level of death group were lower than those of survival group（P<0.05）,and the APACHE Ⅱ score,SOFA score,LIS and plasma sRAGE level of death group were higher than those of survival group（P<0.05）. APACHE Ⅱ score,SOFA score,APN and sRAGE were the risk factors of death in ARDS patients [odds ratio（OR） were 1.723,1.652,0.754 and 1.391,95% confidence intervals（CI） were 1.206-2.461,1.110-2.459,0.624-0.912 and 1.117-1.732,respectively]. Conclusions APN and sRAGE are related to the severity and prognosis of ARDS,which can be used as the indicators to evaluate the severity and prognosis of ARDS.

Correlation between serum IL-33 level and its gene polymorphism and the clinical outcome of HBV infection

LIU Tingting, LIN Yuting, Mila , LI Xiaoqin

2021, 36(11):  1101-1105.  DOI: 10.3969/j.issn.1673-8640.2021.11.002

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Objective To investigate the correlation between the level of serum interleukin 33（IL-33）and its gene polymorphism and the clinical outcome of hepatitis B virus（HBV） infection. Methods Totally,341 patients with HBV infection were enrolled,including 93 patients with self limited HBV infection（self limited infection group）,91 asymptomatic chronic HBV carriers（HBV carrying group）,90 patients with chronic hepatitis B（CHB）（CHB group） and 67 patients with hepatitis B related cirrhosis（liver cirrhosis group）. The single nucleotide polymorphisms of alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,total bilirubin（TB）,IL-33,IL-33 gene rs10975519 and HBV DNA load were determined. Pearson correlation analysis was used to evaluate the correlation between IL-33 and ALT,AST and TB. Results The levels of ALT,AST,TB and IL-33 increased successively in self limited infection group,HBV carrying group,CHB group and liver cirrhosis group（P<0.05）. Pearson correlation analysis showed that the level of IL-33 was positively correlated with the levels of ALT,AST and TB（r values were 0.447,0.459 and 0.512,P<0.001,<0.001 and 0.018,respectively）. According to the upper limit of the reference interval of each index,CHB group and liver cirrhosis group were classified,and the levels of serum IL-33 were compared. In CHB group,the level of serum IL-33 in patients of HBV DNA>1×10⁵ was higher than that in patients of HBV DNA≤1×10⁵（P<0.05）. There was no statistical significance in serum IL-33 levels among ALT>40 and ≤40 U/L,AST>40 and ≤40 U/L,TB>20 and ≤20 μmol/L groups（P>0.05）. In liver cirrhosis group,the level of serum IL-33 in HBV DNA load>1×10⁵,ALT>40 U/L,AST>40 U/L and TB >20 μmol/L patients was higher than that of HBV DNA load≤1×10⁵,ALT≤40 U/L,AST≤40 U/L and TB≤20 μmol/L patients（P<0.05）. There was statistical significance in genotype and allele distribution frequency of rs10975519 of IL-33 gene in each group（P<0.05）. The distribution frequency of TT genotype was the highest in self limited infection group,and it was the lowest in liver cirrhosis group. The distribution frequencies of TC and CC genotypes were the lowest in self limited infection group,and they were the highest in liver cirrhosis group. Conclusions The level of IL-33 is related to the clinical outcome of HBV infection. The C allele at rs10975519 of IL-33 gene may increase the risk of CHB progression to liver cirrhosis.

Relation between anti-gp210 antibody,anti-sp100 antibody and ALBI score in patients with primary biliary cholangitis

QIU Fang, ZHU Ping, JIANG Peng, WANG Chan

2021, 36(11):  1106-1109.  DOI: 10.3969/j.issn.1673-8640.2021.11.003

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Objective To investigate the relation of anti-gp210 antibody,anti-sp100 antibody and albumin-bilirubin（ALBI）score as prognostic risk predictors in primary biliary cholangitis（PBC）. Methods The clinical data of 374 patients with PBC were collected. The differences of biochemical indexes,ALBI score and grade were compared between PBC patients with positive and negative results of anti-gp210 antibody and anti-sp100 antibody. Results The levels of serum alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,gamma-glutamyltransferase（GGT）,alkaline phosphatase（ALP）,total bilirubin（TB）,direct bilirubin（DBil） and ALBI score in PBC patients with positive anti-gp210 antibody were higher than those in patients with negative anti-gp210 antibody（P<0.05）. The levels of serum AST,TB and DBil in patients with positive anti-sp100 antibody were higher than those in patients with negative anti-sp100 antibody（P<0.05）,and albumin（Alb） was lower（P<0.05）. The ALBI score of PBC patients with both or single positive anti-gp210 and anti-sp100 antibodies was lower than that of PBC patients with negative anti-gp210 and anti-sp100 antibodies,while the proportion of patients with ALBI grade 3 was higher than that of PBC patients with negative anti-gp210 and anti-sp100 antibodies（P<0.05）. Conclusions PBC patients with positive anti-gp210 antibody and anti-sp100 antibody have a high risk of poor prognosis,and anti-gp210 antibody and anti-sp100 antibody could be used as auxiliary indicators to predict the prognostic risk of PBC.

Clinical significance of plasma protein C and von Willebrand factor in patients with multiple myeloma

CHEN Xia, CHEN Xi

2021, 36(11):  1110-1113.  DOI: 10.3969/j.issn.1673-8640.2021.11.004

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Objective To investigate the clinical significance of plasma protein C（PC） activity and von Willebrand factor antigen（vWF：Ag） level in the treatment and prognosis of multiple myeloma（MM）. Methods Totally,81 patients who were diagnosed with MM were enrolled and classified into 3 groups according to international staging system（ISS）staging criteria（stage Ⅰ,Ⅱ and Ⅲ groups）. A total of 14 healthy subjects were enrolled as control group. PC activity and vWF：Ag level were determined and compared between MM and control groups. Results The levels of vWF：Ag in MM groups were higher than that in control group（P<0.05）. The level of vWF：Ag in males was higher than that in females（P<0.05）. The activities of PC in stage Ⅱ and stage Ⅲ were lower than that in control group（P<0.05）,and PC activity had a decreasing trend with disease progress. PC activity was decreased with ages（P<0.05）. The activity of PC was negatively correlated with ages in stage Ⅲ group（r=-0.361,P<0.05）. There was a positive correlation between PC activity and vWF：Ag level in stage Ⅲ group（r=0.363,P<0.05）. Conclusions PC and vWF：Ag would reflect the disease severity in some degree and are correlated,which play roles in the treatment and prognosis of patients with MM.

Preliminary analysis of differentially expressed circRNA of patients with Alzheimer's disease

LOU Xiaoyan, WANG Tao, GAO Qiong, LU Wei, LI Dan, LI Zhenhua, LIN Ping

2021, 36(11):  1114-1120.  DOI: 10.3969/j.issn.1673-8640.2021.11.005

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Objective To investigate expression profiles of circular RNA（circRNA） in peripheral blood of patients with Alzheimer's disease（AD）,and to predict its downstream microRNA（miRNA） targets and the biological function of host gene. Methods Expression profiles of circRNA in peripheral blood from 3 AD patients（AD group） and 3 healthy subjects（healthy control group） were analyzed by microarray assay. Differentially expressed circRNA between the 2 groups were identified,and bioinformatics prediction was performed. Two differentially expressed circRNA were further confirmed by real-time fluorescence quantitative polymerase chain reaction（RT-qPCR） in a validation cohort of 30 AD patients and 22 healthy subjects. Results A total of 144 circRNA（fold change>1.5,P<0.05） were identified to be differentially expressed in AD patients as compared to healthy subjects,which included 72 circRNA upregulated and 72 circRNA downregulated. Gene Ontology（GO）was performed to investigate biological functions of their host genes. Host genes may participate in various biological processes,such as reproductive process,regulation of mitogen-activated protein kinase cascade,regulation of T cell receptor signaling pathway and Toll-like receptor signaling pathway. Kyoto Encyclopedia of Genes and Genomes（KEGG） pathway analysis showed that some vital pathways could also be influenced by the differentially expressed circRNA,including inflammatory bowel disease,vascular endothelial growth factor（VEGF）,endocytosis,gamma receptor for the Fc region of immunoglobulin G（FcγR） mediated phagocytosis. Two differentially expressed circRNA were chosen for further validation,including one upregulated circRNA（hsa_circ_0018905） and one downregulated circRNA（hsa_circ_0024825）. The RT-qPCR results showed that compared to healthy control group the relative expression of hsa_circ_0018905 was upregulated in AD group（P<0.05）,and hsa_circ_0024825 was downregulated between AD group and healthy control group（P<0.01）,which were consistent with the microarray assay results. Conclusions This study identifys a few differentially expressed circRNA between AD patients and healthy subjects,which may exhibit a regulatory role in the occurrence and development of AD by the function as "miRNA sponge".

Determination and quantitation of blood human papillomavirus DNA in healthy subjects

LIU Hongqian, SONG Chaohui, LIANG Qiaomi

2021, 36(11):  1121-1124.  DOI: 10.3969/j.issn.1673-8640.2021.11.006

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Objective To study blood human papillomavirus（HPV） DNA load of healthy subjects,and to evaluate its potential clinical significance. Methods The blood samples from 207 healthy subjects were collected,and genomic DNA was extracted. GP5+/GP6+ primers were used for quantitative polymerase chain reaction（PCR）. Simultaneously,140-150 bp specific fragment of HPV L1 gene was sequenced to classify genotypes. Results HPV DNA was determined in 14（6.8%） blood donors in the 207 healthy subjects. The 7 cases were single type HPV infection,and 7 cases were mixed infection. The viral load of all the positive samples was 12.4-39.3 copies/mL. Conclusions There is a low load of HPV DNA in the blood of some healthy subjects,and the blood may be a new way of HPV transmission. It is not excluded that some healthy blood donors have potential HPV infection in the reproductive tract or other parts,or have a history of HPV infection.

Characteristics of Salmonella isolate serotyping and molecular subtyping in Panzhihua,Sichuan

CHEN Yan, CUI Lin, HUANG Weifeng, FENG Zhengjuan, LIU Yue, XU Xuebin

2021, 36(11):  1125-1130.  DOI: 10.3969/j.issn.1673-8640.2021.11.007

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Objective To study the clinical characteristics of Salmonella infection cases and the serotyping,molecular subtyping and drug resistance of Salmonella isolates in Panzhihua,Sichuan. Methods A total of 90 Salmonella isolates from 4 sentinel hospitals in Panzhihua were collected from 2018 to 2019. According to the National Pathogen Identification Network,serotyping determination,drug resistance determination and pulsed field gel electrophoresis（PFGE）were carried out. Results The 90 Salmonella isolates from clinical cases including 79 intestinal diarrhea cases and 11 extra-intestinal invasion cases were confirmed into 15 serotypes. The most common serotype from intestinal diarrhea cases was Salmonella typhimurium（45 isolates）,followed by Salmonella enteritidis（18 isolates）,Salmonella london（3 isolates）,Salmonella stanley（3 isolates） and Salmonella weltevreden（3 isolates）,while the most common serotype from extra-intestinal invasion cases was Salmonella enteritidis（6 isolates）,followed by Salmonella paratyphi A（2 isolates）,Salmonella typhimurium（1 case）,Salmonella derby（1 case）and Salmonella uzaramo（1 case）. Children under 5-year-old and 20-59-year-old adults were the high risk groups. There were more cases in males than in females,and spring and summer were the common seasons of high incidence of diarrhea. Drug resistance results of Salmonella typhimurium and Salmonella enteritidis had statistical significance（P<0.05）. Salmonella typhimurium isolates were still sensitive to fluoroquinolones and third-generation cephalosporins,while Salmonella enteritidis isolates were highly resistant to fluoroquinolones（nalidixic acid and ciprofloxacin）,and cefotaxime resistance rate was >20%. PFGE showed that Salmonella isolates from diarrhea cases had 3 dominant clusters,2 of which were multiple-drug resistant（MDR）. Salmonella enteritidis,Salmonella london,Salmonella stanley and Salmonella weltevreden isolates only had one drug resistant or sensitive cluster. Conclusions The Salmonella isolates in Panzhihua illustrate serotype diversity and MDR molecular clone. Salmonella typhimurium,Salmonella enteritidis and Salmonella enteritidis,Salmonella paratypli A are the most common serotypes from intestinal diarrhea and extra-intestinal invasion cases,respectively. Improving regional surveillance and sharing the big data of the National Pathogen Identification Network should be strengthened,so that we can have accurate response and early warning of various Salmonella outbreaks.

Detection of Clostridium difficile toxin genes and diagnosis of multilocus sequence typing in patients with diarrhea in Hohhot

WANG Yanyan, WANG Junrui, ZHENG Wenqi, SHEN Huimin, LÜ Yingying, GUO Sufang

2021, 36(11):  1131-1134.  DOI: 10.3969/j.issn.1673-8640.2021.11.008

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Objective To understand the clinical toxin status of clinical isolates of Clostridium difficile in patients with acquired diarrhea in Hohhot and the status of multilocus sequence typing（MLST） of Clostridium difficile. Methods The 326 fecal specimens of adult diarrhea patients in the Affiliated Hospital of Inner Mongolia Medical University were collected from July 2018 to December 2019 for the cultivation and identification of Clostridium difficile. The toxin genes（tcdA and tcdB） and binary toxin genes（cdtA and cdtB） of cultivated Clostridium difficile were amplified by polymerase chain reaction（PCR）to determine producing toxin. The MLST of Clostridium difficile producing toxin was performed. Results Totally,46 isolates of Clostridium difficile were cultivated,of which 35 isolates were Clostridium difficile producing toxin,among them 3 isolates were toxin gene tcdA（-） and tcdB（+） type,and 32 isolates were tcdA（+） and tcdB（+） type. However,binary toxin genes were all negative. The producing toxin isolates came from 13 different ST types（ST2,3,14,33,35,39,42,48,52,54,55,109 and 512）,ST54 was the most common type（22.9%,8/35）,followed by ST2（14.3%,5/35） and ST55（14.3%,5/35）,and no high-yielding isolate of ribosome type 027 （ST1）and high-yielding isolate of ribosome type 078 （ST11）were determined. Conclusions The producing toxin Clostridium difficile with tcdA（+） and tcdB（+） mainly is isolated from adult diarrhea patients in Hohhot,and no high-yielding isolates producing binary toxin are determined. The genotypes of Clostridium difficile are relatively more（13 types）,and ST54,ST2 and ST55 are the top 3 types.

Respiratory tract virus surveillance and analysis of pneumonia inpatients from 2017 to 2020 in Yangzhou

HUANG Yao, ZHANG Xiuling, WANG Yan, KONG Guimei, XU Qin

2021, 36(11):  1135-1139.  DOI: 10.3969/j.issn.1673-8640.2021.11.009

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Objective To analyze the results of respiratory tract virus surveillance of pneumonia inpatients in Yangzhou,and to investigate the prevalence of respiratory tract viruses in Yangzhou. Methods From 2017 to 2020,the throat swab samples of pneumonia inpatients in Yangzhou were determined for 5 respiratory tract viruses by fluorescence quantitative polymerase chain reaction（PCR）,and the results were analyzed. Results In the 1 479 throat swab samples,195（13.18%） positive cases were determined. There were 7 cases（0.47%） of mixed 2-virus infection. The top 3 viruses with high determination rates were influenza virus（5.54%）,human respiratory syncytial virus（2.63%） and human enterovirus（1.89%）. The peak of positive determination rate of respiratory tract virus in pneumonia inpatients was mainly concentrated in March-May and November-December in 2017,in July and September in 2018,in January-March and December in 2019 and in September in 2020. In the positive cases of respiratory tract virus,the determination rate of females was higher than that of males（χ²=6.26,P<0.05）. Children of 0-6 years old had the highest positive determination rate（χ²=15.87,P<0.05）. There was no statistical significance in the composition of respiratory pathogen spectrum between males and females（χ²=7.68,P>0.05）. The composition of respiratory pathogen spectrum was different in different years and different ages （χ² values were 6.26 and 27.33,P<0.01）. Conclusions The epidemic season and respiratory pathogen spectrum in pneumonia inpatients in Yangzhou from 2017 to 2020 varied from year to year,but the main pathogens were influenza virus and respiratory syncytial virus. Children of 0-6 years old are the susceptible group,and females infected with respiratory tract virus are more likely to progress to pneumonia. Respiratory tract virus surveillance should be strengthened,and influenza virus and human respiratory syncytial virus should be taken as the focuses of the prevention and control of respiratory epidemic.

Clinical value of whole blood zinc in children and adolescents with neurally-mediated syncope

YANG Dan, HAN Lu, LONG Shuai, XU Jin, TIAN Hong

2021, 36(11):  1140-1145.  DOI: 10.3969/j.issn.1673-8640.2021.11.010

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Objective To investigate the clinical value of whole blood zinc in children and adolescents with neurally-mediated syncope（NMS）. Methods Totally,102 NMS children（NMS group） who underwent head-up tilt test（HUTT） and tested trace elements and vitamins（Vit） were enrolled. According to the results of HUTT,83 cases were classified into HUTT positive group,and 19 cases were classified into HUTT negative group. The HUTT positive group included 32 cases of vasovagal syncope（VVS） and 53 cases of postural orthostatic tachycardia syndrome（POTS）. Two patients were diagnosed with both VVS and POTS. A total of 100 healthy age-matched children who tested trace elements and 100 healthy age-matched children who tested Vit were enrolled as control group A and control group B,respectively. The levels of zinc,calcium,copper,magnesium and iron in whole blood and the levels of Vit A,Vit B₁,Vit B₂,Vit B₆,Vit B₉,Vit C,Vit D and Vit E in serum were determined. Binary Logistic regression analysis was used to assess risk factors of NMS. Receiver operating characteristic（ROC） curve was used to evaluate the predictive value in diagnosing NMS and the predictive value in differentiating VVS and POTS. Results Compared with control group A,the differences of zinc,calcium and iron had statistical significance in NMS group（P<0.05）. There was no statistical significance in the other items between NMS group and control groups（P>0.05）. The levels of zinc,calcium and iron in HUTT positive group were lower than those in control group A（P<0.05）. There was no statistical significance in trace element levels between HUTT negative group and HUTT positive group,control group A（P>0.05）. The level of zinc in VVS group was lower than that in control group A（P<0.05）. The levels of zinc,calcium,magnesium and iron in POTS group were lower than those in control group A（P<0.05）. The level of magnesium in VVS group was higher than that in POTS group（P<0.05）. Binary Logistic regression analysis showed that the decrease of zinc [odds ratio（OR）=0.726,95% confidence interval（CI） 0.652-0.807] increased the risk of NMS,and the decrease of calcium（OR=1.772,95%CI 0.639-4.909） and iron（OR=0.472,95%CI 0.090-2.476） had no statistical significance on the occurrence of NMS. When the cut-off value of zinc was 80.09 μmol/L,the area under curve（AUC）was 0.800,and the sensitivity and specificity for the diagnosis of NMS were 74.5% and 80.0%,respectively. When the cut-off value of magnesium was 1.33 mmol/L,the AUC was 0.631,and the sensitivity and specificity for the differential diagnosis between VVS and POTS were 67.9% and 59.4%,respectively. Conclusions Zinc deficiency may be related to children and adolescents with NMS. Magnesium may have a clinical value in the differential diagnosis of VVS and POTS.

Interference effects of hemoglobin,bilirubin and chyle on the measurement of plasma ammonia by dry chemistry method and enzymatic assay method

OU Yuanzhu, GONG Jingkai, LIN Feiran, TANG Liping, ZHU Yuqing, LIU Jia, WANG Hualiang

2021, 36(11):  1146-1150.  DOI: 10.3969/j.issn.1673-8640.2021.11.011

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Objective To study the interference effects of endogenous substances [hemoglobin（Hb）,bilirubin（Bil） and chyle granules] on the measurement of plasma ammonia by enzymatic assay method [glutamic dehydrogenase（GLDH）method] and dry chemistry method. Methods According to the Clinical and Laboratory Standards Institute（CLSI） EP7-A2 guideline,clinical plasma samples were collected,and basic samples with high and low concentrations were prepared. GLDH method and dry chemistry method were used to measure plasma ammonia respectively,and the relative deviation（high value samples） and absolute deviation（low value samples） of plasma ammonia determination results between interference samples and basic samples were calculated. The allowable deviation standard of the Royal College of Pathologists of Australasia（RCPA）（±3 μmol/L for plasma ammonia ≤30 μmol/L,±10% for plasma ammonia >30 μmol/L） was used as the clinical acceptable standard. Results Different concentrations of Hb did not interfere with the high and low value samples of plasma ammonia determined by dry chemistry method,and all the deviations were within the allowable deviation range. Hb had negative interference on the high and low value samples of plasma ammonia determined by GLDH method,and the degree of interference increased with the increasing of Hb concentrations. Bil had positive interference on the low value samples of plasma ammonia determined by dry chemistry method,when Bil≥184.4 μmol/L,it had exceeded the allowable deviation range. There was no interference on the high value samples. Different concentrations of Bil had negative interference on the low value samples of plasma ammonia determined by GLDH method. For the high value samples of plasma ammonia,when Bil≥246.2 μmol/L,it had negative interference on GLDH method. Chyle had no interference on the high value samples of plasma ammonia determined by dry chemistry method. There was positive interference in the chyle concentration of 612 FTU,and there was negative interference in the chyle concentration of 1 534 FTU. Different concentrations of chyle had negative interference on the samples with low value samples of plasma ammonia determined by GLDH method. For the high value samples of plasma ammonia,except the chyle concentration of 306 FTU,the other chyle concentrations had negative interference. Conclusions The anti-interference ability of dry chemistry method to Hb,Bil and chyle is better than that of GLDH method,but these interfering substances will affect the repeatability of the 2 methods.

Expression of programmed cell death 5 in breast cancer and its clinical value

LIU Xiufen, AO Hongfeng, AO Jinping

2021, 36(11):  1151-1158.  DOI: 10.3969/j.issn.1673-8640.2021.11.012

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Objective To investigate the relationship between the expression of programmed cell death 5（PDCD5） protein and axillary lymph node metastasis in breast cancer. Methods The expressions of PDCD5,cyclin（Cyclin） D1,Ki-67,chemokine receptor 4（CXCR4） and E-cadherin（E-cad） were determined by immunohistochemical method. The clinicopathologic characteristics of all the patients were collected,and they were followed up for 5 years. The progression-free survival（PFS）and overall survival（OS） were calculated. Spearman correlation analysis was used to evaluate the correlation between projects. Kaplan-Meier survival curve was used to analyze the survival rate of patients with breast cancer. Cox regression proportional hazard model was used to analyze the prognostic factors of patients with breast cancer. Results The positive expression rate of PDCD5 protein in breast cancer tissues was 25.0%（40/160）,which was lower than that in adjacent normal tissues [60.0%（96/160）] （P=0.000）. The expression of PDCD5 protein had statistical significance among different TNM stages,histological differentiation,lymph node metastasis,myometrial invasion,vascular invasion and different expression states of estrogen receptor（ER）,progesterone receptor（PR） and human epidermal growth factor receptor 2（HER-2）（P<0.05）. There was no relation among different ages,menstrual states,tumor diameters and molecular types of breast cancer（P>0.05）. The results of Spearman correlation analysis showed that the expression of PDCD5 protein was positively correlated with the number of axillary lymph node metastasis（r=0.428,P=0.000）,it was negatively correlated with the expression of Cyclin D1,Ki-67 and CXCR4（r=-0.217,-0.220 and -0.271,respectively,P<0.05）,and it was positively correlated with the expression of E-cad（r=0.464,P=0.000）. The results of Cox regression proportional hazard model showed that TNM stage Ⅲ-Ⅳ,low tissue differentiation,myometrial invasion,vascular invasion,PDCD5 positive,ER negative,PR negative and HER-2 positive were the risk factors of axillary lymph node metastasis in breast cancer. Conclusions The low expression of PDCD5 in breast cancer may promote the occurrence of axillary lymph node metastasis by regulating exercise-related protein Cyclin D1,Ki-67,CXCR4 and E-cad.

Association between serum IL-2R,IL-6 and IL-8 before treatment and postoperative 30 d prognosis of hip joint fracture in elderly patients

HONG Weixiang, SONG Yunxiao, JIA Jiude, ZHANG Wentong, SHEN Wenhui, HUANG Jinwang, ZHANG Lei, SARI Jiang Yassen, ZHANG Yinwang

2021, 36(11):  1159-1163.  DOI: 10.3969/j.issn.1673-8640.2021.11.013

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Objective To investigate the correlation between the level of interleukin 2 receptor（IL-2R）,interleukin（IL）-6,IL-8 and IL-10 before treatment and the postoperative 30 d prognosis after hip joint fracture in elderly patients. Methods A total of 179 elderly patients with hip joint fracture were enrolled,and the preoperative levels of serum IL-2R,IL-6,IL-8 and IL-10 were determined and followed up for 30 d. Kaplan-Meier curve and Log-rank test were used to analyze the survival rate of elderly patients with hip joint fracture at postoperative 30 d. Cox regression analysis was used to evaluate the risk factors of death for 30 d after hip joint fracture. Results Among the 179 elderly patients with hip joint fracture,18 died during the 30 d after operation,the mortality rate was 10.06%. The levels of IL-2R,IL-6 and IL-8 in death group were higher than those in survival group（P<0.05）. There was no statistical significance in IL-10 level between the 2 groups（P>0.05）. Multivariate Cox regression analysis showed that the increase of IL-2R,IL-6 and IL-8 before operation were risk factors for 30 d death in elderly patients with hip joint fracture [odds ratios（OR） were 1.020,1.008 and 1.004,95% confidence intervals（CI） were 1.010-1.031,1.002-1.015 and 1.000-1.007,respectively,P<0.001]. According to the medians of preoperative serum IL-2R,IL-6 and IL-8 levels of elderly patients with hip joint fracture,Kaplan-Meier survival curve analysis results showed that the 30 d survival rates of high IL-2R,high IL-6 and high IL-8 groups were lower than those of low IL-2R,low IL-6 and low IL-8 groups（Log-rank χ²=7.54,6.03 and 8.22,P<0.05）. Conclusions The levels of IL-2R,IL-6 and IL-8 before operation can be used as indicators of postoperative evaluation,and the prognosis of elderly hip joint fracture patients with high preoperative levels of IL-2R,IL-6 and IL-8 is poor.

Correlation between serum nucleic acid oxidative damage products and antioxidant substance in patients with Alzheimer's disease

LI Wenzheng, YU Songlin, YIN Yicong, YU Jialei, WANG Danchen, ZOU Yutong, QU Ling

2021, 36(11):  1164-1168.  DOI: 10.3969/j.issn.1673-8640.2021.11.014

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Objective To investigate the relationship between serum nucleic acid oxidative damage products [DNA related substance 8-oxo-7,8-dihydro-deoxyguanosine（8-oxo-dGsn） and RNA related substance 8-oxo-7,8-dihydroguanosin（8-oxo-Gsn）] and antioxidant substance selenium,vitamin（Vit） A and Vit E in patients with Alzheimer's disease（AD）. Methods A total of 55 patients with AD and 64 apparently healthy subjects were enrolled. Liquid chromatography tandem mass spectrometry（LC-MS/MS）was used to determine the levels of 8-oxo-dGsn,8-oxo-Gsn,Vit A and Vit E in serum,and the level of selenium in serum was determined by inductively coupled plasma mass spectrometry（ICP-MS）. All the subjects were classified into 4 groups according to ages：<60 years old,60-69 years old,70-79 years old and ≥80 years old groups. Spearman correlation analysis was used to evaluate the correlation between these substances. Results The levels of selenium and Vit A in AD group were lower than those in healthy control group（P<0.01）,and the level of 8-oxo-dGsn was higher than that in healthy control group（P<0.01）. The levels of Vit E and 8-oxo-dGsn had no statistical significance between the 2 groups（P>0.05）. The selenium level in healthy control group was higher than that in AD group（P<0.01）. The level of Vit A in <60 years old and 60-69 years old groups were higher than those in AD group（P<0.01）,and the levels of 8-oxo-dGsn were lower than those in AD group（P<0.05）. There was no statistical significance in Vit A and 8-oxo-dGsn levels between 70-79 years old and ≥80 years old groups（P>0.05）. There was no statistical significance in serum Vit E and 8-oxo-Gsn levels between healthy control group and AD group（P>0.05）. 8-Oxo-dGsn and 8-oxo-Gsn levels were positively correlated with age（r=0.443 and 0.782,P<0.01）,selenium levels were positively correlated with serum Vit A and Vit E（r=0.330 and 0.401,P<0.01）,and 8-oxo-dGsn levels were positively correlated with 8-oxo-Gsn levels（r=0.644,P<0.01）. There was no correlation between the other items（P>0.05）. Conclusions Sera from patients with AD contains high levels of DNA oxidative damage product 8-oxo-dGsn and low levels of antioxidant substance selenium.

Effect of vulva cleaning operation to the determination results of urinary biochemical indexes

WANG Jinduo, CUI Yunqing, ZHANG Hui, Yanhua, LI Yinghua

2021, 36(11):  1169-1171.  DOI: 10.3969/j.issn.1673-8640.2021.11.015

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Objective To investigate the effect of vulva cleaning operation to the determination results of urinary biochemical indexes. Methods A total of 35 volunteers were enrolled. The morning urine samples collected when the volunteers did not clean the vulva were used as uncleaning group,and the morning urine samples collected after cleaning the vulva with 0.9% NaCl solution on the 2nd and 3rd days were used as cleaning group. Urinary microalbumin（mAlb）,chloridion（Cl^-）,creatinine（Cr）,kalium ion（K⁺）,sodion（Na⁺）,total protein（TP）,alpha₁-microglobulin（α₁-MG）,beta₂-microglobulin（β₂-MG）,IgG,transferrin（TF）,calcium（Ca）,phosphorus（P） and glucose（Glu） levels were determined,and colony count determination and bacterial species identification were performed. Results There was statistical significance in total urinary colony count between males and females in uncleaning group（P<0.05）,but urinary mAlb,Cr,IgG,Glu,Ca,P,α₁-MG and TF had no statistical significance（P>0.05）. Between males and females in cleaning group,the total urinary colony count,α₁-MG,IgG,TF,Cl^- and Na⁺ had statistical significance（P<0.05）,and there was no statistical significance in urinary mAlb,Cr,Glu,Ca and P（P>0.05）. There was statistical significance in urinary IgG in males between cleaning group and uncleaning group（P<0.05）,but there was no statistical significance in total urinary colony count,mAlb,Cr,IgG,Glu,Ca,P,α₁-MG and TF（P>0.05）. There was no statistical significance for the urinary biochemical indexes between cleaning group and uncleaning group in females（P>0.05）. Conclusions The vulva cleaning operation has an impact on the determination results of male urinary biochemical indexes,but there is no impact on the determination results of female. Therefore,the female vulva cleaning operation needs to be further optimized.

Influence and mechanism of hepatitis B virus on the expression of HOXA10

SONG Hui, YANG Lan, XU Limin, SHEN Zhenhua, LIU Qianqian, LIU Xinghui

2021, 36(11):  1172-1176.  DOI: 10.3969/j.issn.1673-8640.2021.11.016

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Objective To investigate the influence of hepatitis B virus（HBV） on the expression of homeobox protein A10（HOXA10） and its mechanism. Methods Totally,20 patients with chronic hepatitis B（CHB）（CHB group） and 23 healthy subjects（healthy control group） were enrolled,and peripheral blood mononuclear cells（PBMC） were isolated. Real-time fluorescence quantitative polymerase chain reaction（RT-qPCR）and western blotting were used to determine the expression of HOXA10 mRNA and protein in HepG2.2.15 cells,CHB group PBMC and healthy control group PBMC. The expression plasmids of HBV single gene（pCMV-S,pCMV-E,pCMV-C,pCMV-X and pCMV-P） were co-transfected with pGL3-HOXA10（a luciferase reporter gene which harbored HOXA10 gene promoter） into HepG2 cells,respectively,and the changes in luciferase activity were determined. Results The expression levels of HOXA10 mRNA and protein in HepG2.2.15 cells were higher than those in HepG2 cells（P=0.001）. The expression of HOXA10 mRNA in the PBMC of HBV patients was higher than that of healthy control group（P=0.001）. The luciferase activity of HepG2 cells transfected with pCMV-X was higher than that of HepG2 cells transfected with control vector pCMV-tag2B（P=0.001）. There was no statistical significance in luciferase activity between HepG2 cells transfected with other plasmids（P>0.05）. The expression levels of HOXA10 mRNA and protein in HepG2 cells transfected with pCMV-X were higher than those in HepG2 cells transfected with control vector pCMV-tag2B（P=0.001）. Conclusions HBV might up-regulate the expression of HOXA10 through its X gene.

Application of six sigma management in shortening outpatient coagulation test's turn-around time in clinical laboratory

ZHENG Xin, HU Jun, ZHANG Xueqing, ZHANG Jun, YAO Dongting, HU Xiaobo

2021, 36(11):  1177-1180.  DOI: 10.3969/j.issn.1673-8640.2021.11.017

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Objective To investigate the effect of six sigma（6σ） management on shortening outpatient coagulation test's turn-around time（TAT） in clinical laboratory. Methods Through the 5 steps（define,measure,analyze,improve and control）,the main causes of outpatient coagulation test's TAT in clinical laboratory delaying were investigated and analyzed,with following pointed improvement measures formulated and implemented. The difference between before and after improvement was compared. Results After improvement,the outpatient coagulation test's TAT in clinical laboratory was shortened from 127.5 min to 66.0 min in median,the qualified rate was increased from 47.0% to 93.9%,and defects per million opportunity（DPMO） was reduced from 53.003 5% to 6.100 2%. Both differences in TAT and TAT compliance rates between before and after improvement had statistical significance（P<0.05）. Conclusions The application of 6σ management shortens the outpatient coagulation test's TAT in clinical laboratory and could help with optimizing the inspection process with the value of promotion in clinical laboratory management.

Research progress on hypervirulent Klebsiella pneumonia

HUANG Yun, LI Congrong

2021, 36(11):  1181-1185.  DOI: 10.3969/j.issn.1673-8640.2021.11.018

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Recently,hypervirulent Klebsiella pneumoniae has emerged as a concerning pathogen. In contrast to nosocomial infections in immuno-compromised patients with classic Klebsiella pneumoniae,hypervirulent Klebsiella pneumoniae usually causes community acquired infections in healthy individuals and is prone to metastasize to distant sites,including most commonly the eye,lung and central nervous system,and often requiring source control. The genetic determinants of hypervirulent Klebsiella pneumoniae are often found on large virulence plasmids as well as chromosomal mobile genetic elements which can be used as biomarkers to distinguish hypervirulent Klebsiella pneumoniae from common Klebsiella pneumoniae clinical isolates. These distinct virulence determinants of hypervirulent Klebsiella pneumoniae include up to 4 siderophore systems for iron acquisition,increased capsule production,K1 and K2 capsule types and colibactin toxin. Alarmingly,multidrug-resistant hypervirulent isolates have emerged,creating a new challenge in combating this already dangerous pathogen. In order to better understand hypervirulent Klebsiella pneumoniae,the characteristics,epidemiology,virulence related factors and drug resistance with hypervirulent Klebsiella pneumoniae will be introduced in detail.

Application progress of heparin-binding protein in infectious diseases

ZHANG Wanqian, WANG Xiangfu, REN Youliang, ZHENG Huihui

2021, 36(11):  1186-1189.  DOI: 10.3969/j.issn.1673-8640.2021.11.019

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The clinically commonly used auxiliary diagnostic indicators for infectious diseases include white blood cell（WBC） count,neutrophil,C-reactive protein（CRP）,procalcitonin（PCT）,erythrocyte sedimentation rate（ESR） and interleukin 6（IL-6）. However,these indicators all have the defects of low accuracy,insufficient sensitivity and poor specificity to various degrees. In the prevention and treatment of infectious diseases,how to take reasonable response measures as soon as possible is the key to successful treatment. In the recent years,with the continuous in-depth study of heparin-binding protein（HBP）,its role in the early diagnosis of infectious diseases has gradually been revealed. This review focuses on the clinical value of HBP in infectious diseases.