Table of Content

30 November 2022, Volume 37 Issue 11

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Clinical value of thromboelastography and conventional coagulation tests in evaluating coagulation status of colon cancer and colon polyps

XIE Yuan, YI Wanwan, SHI Qiuyuan, LÜ Zhongwei, LIU Jin

2022, 37(11):  1007-1011.  DOI: 10.3969/j.issn.1673-8640.2022.011.001

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Objective To understand the pattern of coagulation function change in colon cancer patients and colon polyp patients，and to investigate the clinical application value of thromboelastography（TEG） and conventional coagulation tests（CCT） in evaluating coagulation function and predicting thrombosis in colon cancer patients. Methods Totally，128 patients with colon cancer，147 patients with colon polyps in Shanghai Tenth People's Hospital of Tongji University from May 2018 to May 2019 were enrolled. A total of 60 patients with healthy subjects were enrolled as control group. The determinations of TEG [coagulation reaction time（R），coagulation formation time（K），alpha angle（α-Angle），maximum amplitude（MA） and coagulation index（CI）]，CCT [prothrombin time（PT），fibrinogen（Fib），activated partial thromboplastin time（APTT），thrombin time（TT） and D-dimer（DD）] and platelet（PLT） count were performed，and the differences between the 2 groups were observed. Receiver operating characteristic（ROC） curve was used to evaluate the performance of each indicator for blood hypercoagulable state in colon cancer and colon polyp patients. Results The 67.19% of patients with colon cancer and 34.69% of patients with colon polyps had a blood hypercoagulable state. Compared with control group，R，K，PT，APTT，TT and PLT count were decreased（P<0.01），and α-Angle，MA，CI，Fib and DD were increased in colon cancer group（P<0.01）. Compared with colon polyp group，R，K，APTT，TT and PLT count in colon cancer group were decreased（P<0.05），and α-Angle，CI，Fib and DD were increased（P<0.05）. MA and CI were increased in colon polyp group compared with control group（P<0.05）. The evaluation performance for blood hypercoagulable state in colon cancer group was optimal with CCT，with an area under curve of 0.863，a sensitivity of 68.8% and a specificity of 92.3%. That for blood hypercoagulable state in colon polyp group was optimal with TEG，with an area under curve of 0.726，a sensitivity of 70.3% and a specificity of 61.5%. Conclusions TEG and CCT are complementary in the evaluation of coagulation function and can not be replaced by each other，which play roles in clinic.

Clinical value of MTHFR gene C677T polymorphism determination in patients with H-type hypertension

WANG Shan, XU Minyi, WANG Wei, JIANG Mingming, LU Pei, XIONG Zhongbo, WANG Lei

2022, 37(11):  1012-1016.  DOI: 10.3969/j.issn.1673-8640.2022.011.002

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Objective To investigate the clinical value of methylenetetrahydrofolate reductase（MTHFR） gene C677T polymorphism determination in H-type hypertension. Methods The MTHFR gene C677T polymorphism was determined by digital fluorescence molecular hybridization in 215 patients with hypertension and 113 healthy subjects，and the levels of serum homocysteine（Hcy） were determined. The patients with hypertension were classified into H-type group（143 cases） and non-H-type hypertension group（72 cases） according to Hcy levels. According to the severity of hypertension，they were classified into Grade Ⅰ，Ⅱ and Ⅲ groups（48，77 and 90 cases，respectively）. Serum Hcy levels were determined in patients with H-type hypertension before and after folic acid treatment for 6 months. Results Serum Hcy level in H-type hypertension group was higher than those in non-H-type hypertension group and healthy control group（P<0.01）. Serum Hcy level in Grade Ⅲ hypertension group was higher than those in Grade Ⅱ and Grade Ⅰ hypertension groups（P<0.05）. The frequencies of CC，TT genotype and C，T allele in H-type hypertension group were higher than those in non-H-type hypertension group and healthy control group（P<0.05）. The frequencies of TT genotype and T allele in Grade Ⅱ and Grade Ⅲ hypertension group were higher than those in Grade Ⅰ hypertension group（P<0.05）. In patients with H-type hypertension，serum Hcy level in TT genotype group was higher than those in CT genotype group and CC genotype group before and after folic acid treatment（P<0.01）. After folic acid treatment，serum Hcy levels of the 3 genotypes were lower than those before treatment（P<0.05）. Serum Hcy levels of TT genotype patients with H-type hypertension before and after folic acid treatment were higher than those of CT genotype patients and CC genotype patients（P<0.01）. Conclusions The MTHFR gene C677T polymorphism is related to the severity of hypertension，and its determination has clinical value for individualized treatment efficacy of H-type hypertension.

Correlation analysis of PBK/TOPK expression with treatment response and survival prognosis in elderly patients with acute myeloid leukemia

WU Wenping, XU Linjuan, WANG Jiaheng, ZHANG Nana

2022, 37(11):  1017-1022.  DOI: 10.3969/j.issn.1673-8640.2022.011.003

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Objective To evaluate the relationship of PBK/TOPK expression with treatment response and survival prognosis in elderly patients with acute myeloid leukemia（AML）. Methods From July 2016 to March 2017，80 elderly patients with AML in Quzhou People’s Hospital were enrolled，and 32 patients with non malignant blood diseases undergoing bone marrow biopsy were enrolled as control group. The general clinical data，cytogenetic and molecular biological data of AML group were collected. The relative expression of PBK/TOPK in bone marrow mononuclear cells was determined by real-time fluorescence quantitative polymerase chain reaction（RT-qPCR）. The AML group was treated with induction therapy，and the complete remission（CR） rate was calculated. The patients were followed up for 3 years. The survival curve was drawn by Kaplan-Meier method. The relationship between PBK/TOPK expression level and overall survival（OS） and event free survival（EFS） was analyzed. Results The results of RT-qPCR showed that the expression of PBK/TOPK in bone marrow mononuclear cells of elderly patients with AML was higher than that of control group. The expression level of PBK/TOPK was related to hemoglobin（Hb），platelet（PLT）count，chromosome karyotype and gene mutation. The high expression of PBK/TOPK had low CR rate（P<0.05）. The results of survival analysis showed that the 3-year survival rate of PBK/TOPK low expression group was higher than that of PBK/TOPK high expression group（P<0.05），and the EFS of patients with high PBK/TOPK expression was lower than that of patients with PBK/TOPK low expression（P<0.05）. Conclusions The expression of PBK/TOPK in elderly patients with AML is higher，and its high expression is related to the clinical characteristics of patients，which has a predictive value for the survival and prognosis of elderly patients with AML.

Distribution characteristics of neutrophil-to-lymphocyte ratio，platelet-to-lymphocyte ratio and lymphocyte-to-monocyte ratio of healthy adults in Xi’an

WANG Tian, ZHAO Ming, GUAN Jiahao, FU Yawen, DANG Xiaojun

2022, 37(11):  1023-1025.  DOI: 10.3969/j.issn.1673-8640.2022.011.004

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Objective To investigate the distribution characteristics of peripheral blood neutrophil-to-lymphocyte ratio（NLR），platelet-to-lymphocyte ratio（PLR） and lymphocyte-to-monocyte ratio（LMR） of healthy adults in Xi’an. Methods A total of 6 835 healthy adults were enrolled from Shaanxi Provincial People’s Hospital from January 2021 to December 2021，and routine blood test was performed. After excluding outliers，6 781 research subjects were enrolled. They were classified according to sex and ages [young（18-44-year-old），middle-aged（45-59-year-old） and elder（>59-year-old） groups]. The differences of NLR，PLR and LMR were evaluated. Results There was statistical significance of NLR，PLR and LMR for different age groups（P<0.05）. For males，there was statistical significance for NLR between young group and middle-aged，elder groups（P<0.05），there was statistical significance for PLR between elder group and young，middle-aged groups（P<0.05），and there was statistical significance for LMR among the 3 age groups（P<0.05）. For females，there was no statistical significance for NLR and LMR among the 3 age groups（P>0.05），and there was statistical significance for PLR among the 3 age groups（P<0.05）. Conclusions NLR，PLR and LMR are different in the population of different sex and age groups in Xi’an. The clinical diagnosis of related diseases should be based on the actual distribution characteristics of NLR，PLR and LMR.

Clinical application of maximum aggregation rate and thrombus maximum amplitude in children with Glanzmann thrombasthenia and Bernard-Soulier syndrome

MIAO Wenjia, GU Hao, LI Gang

2022, 37(11):  1026-1029.  DOI: 10.3969/j.issn.1673-8640.2022.011.005

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Objective To compare the difference between the maximum amplitude（MA） values of thromboelastography（TEG） and maximum aggregation rate（MAR） of different agglomerators in Glanzmann thrombasthenia（GT） and Bernard-Soulier syndrome（BSS）. Methods Totally，from July 2014 to June 2021，24 GT and 13 BSS patients were enrolled from Beijing Children’s Hospital of Capital Medical University，and another 20 patients with coagulation factor deficiency were enrolled as control group. Light transmittance aggregometry（LTA） and TEG were used to compare the differences in platelet aggregation function among the groups. Results The MA value and MAR induced by adenosine diphosphate（ADP），collagen（Col） and arachidonic acid（AA） of GT group were lower than those of BSS group and control group（P<0.01）. Ristocetin（Risto） induced MAR in GT group was lower than that in control group（P<0.01）. Risto induced MAR in BSS group was lower than those in GT group and control group（P<0.01）. Spearman correlation analysis showed that there was no correlation between MAR and MA values induced by the 4 agglomerators in GT，BSS and control group（P>0.05）. Conclusions The combined determination of MAR with multiple agglomerators can reflect the platelet function of children with congenital bleeding disorders better. Therefore，MAR is more sensitive than MA value in diagnosing and distinguishing GT and BSS. MA value can not be a diagnostic marker of BSS.

Virulence gene analysis of Enterococcus isolated from clinical blood and urine samples

KANG Yi, ZHU Hong, SHEN Han, ZHOU Wanqing

2022, 37(11):  1030-1033.  DOI: 10.3969/j.issn.1673-8640.2022.011.006

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Objective To analyze the carrying condition of virulence gene of Enterococcus isolated from clinical blood and urine samples. Methods Totally，93 isolates of Enterococcus faecalis and 103 isolates of Enterococcus faecium were collected in Nanjing Drum Tower Hospital of Clinical College of Nanjing Medical University from 2017 to 2019. Six virulence genes，including cylA，esp，asa1，hyl，gelE and agg，of Enterococcus were determined by polymerase chain reaction（PCR），and the differences of virulence genes in different isolates and from different sources were compared and analyzed. Results The 93 isolates of Enterococcus faecalis mainly carried asa1（76.3%），gelE（71.0%），cylA（64.5%），esp（60.2%） and agg（22.6%），and no hyl was determined. Enterococcus faecium mainly carried esp（68.9%） and hyl（31.1%），and cylA，asa1，gelE and agg were not determined. For blood samples，the determination rate of gelE was the highest（75.0%）. For urine samples，the determination rate of asa1 was the highest（85.7%）. The virulence genes of cylA and asa1 determined in Enterococcus faecalis isolated from urine samples were higher than those isolated from blood samples（P<0.05），and the virulence gene of esp determined in Enterococcus faecium isolated from urine samples was higher than that isolated from blood samples（P<0.05）. Conclusions Enterococcus faecalis carrys more virulence genes than Enterococcus faecium，and the distribution of virulence genes of Enterococcus is different from different sample sources.

Correlation analysis of Helicobacter pylori colonization level and metabolic syndrome in physical examination population in Shanghai

CHI Wenjing, DING Li, LIU Yixin, YANG Feng, LIU Tao, CONG Jianhua, GAO Zhenhui, ZHAO Hu, ZHANG Yanmei

2022, 37(11):  1034-1038.  DOI: 10.3969/j.issn.1673-8640.2022.011.007

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Objective To analyze the relationship between the level of Helicobacter pylori（Hp） colonization in the stomach and the metabolic syndrome（MS） based on female and male grouping，and to provide an epidemiological basis for clinically reducing the prevalence of MS. Methods The clinical data of 30 376 subjects in Huadong Hospital of Fudan University from October 2019 to September 2020 were collected and analyzed retrospectively，and the subjects were classified into MS group（3 300 cases） and non-MS group（27 076 cases）. The risk factors of MS were analyzed，and the correlation of the level of Hp colonization in the stomach with MS was evaluated. Results The prevalence of Hp was 24.1%，26.3% for males and 21.6% for females，and there was statistical significance between females and males（P<0.001）. The prevalence of MS was 10.9%，15.6% for males and 5.7% for females，and there was statistical significance between females and males（P<0.001）. In the different groups of MS scores，the prevalence of Hp in males was higher than that in females（P<0.05）. In the different groups of colonization values，the prevalence of MS in males was higher than that in females（P<0.05）. High colonization level of Hp was risk factor of MS in males. Conclusions In Shanghai physical examination population，there is a correlation between high colonization level of Hp and MS in males. It is recommended that males with Hp-positive and MS should receive Hp eradication treatment in time.

Roles of Flt-3L，TF and 25（OH）D in iron deficiency anemia among infants and children

ZHAO Xiaomin, JIANG Xiaoyu, SHAN Kaili, SHAN Tieying, LIU Xiuzhen

2022, 37(11):  1039-1043.  DOI: 10.3969/j.issn.1673-8640.2022.011.008

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Objective To investigate the values of FMS-like tyrosine kinase 3 ligand（Flt-3L），transferrin（TF） and 25-hydroxyvitamin D [25（OH）D] in the auxiliary diagnosis of iron deficiency anemia among infants and children. Methods Totally，128 children with iron deficiency anemia（iron deficiency anemia group），68 children with non-iron deficiency anemia（non-iron deficiency anemia group） and 100 infants and children undergoing healthy physical examination（healthy control group） were enrolled. Hemoglobin（Hb），mean corpuscular volume（MCV），mean corpuscular hemoglobin（MCH），mean corpuscular hemoglobin concentration（MCHC），Flt-3L，TF，25（OH）D and serum iron（SI） levels were determined. The children with iron deficiency anemia were classified into mild anemia group（61 cases），moderate anemia group（55 cases） and severe anemia group（12 cases）. Risk factor analysis was performed using Logistic regression analysis，and receiver operating characteristic（ROC）curve was used to evaluate the efficiency of each index in the diagnosis of iron deficiency anemia in infants and children. Results Hb，MCV，MCH and MCHC were lower in iron deficiency anemia group and non-iron deficiency anemia group than those in healthy control group（P<0.05）. Serum Flt-3L and TF levels were higher in iron deficiency anemia group than those in healthy control and non-iron deficiency anemia groups（P<0.05），and SI and 25（OH）D levels were lower than those in healthy control and non-iron deficiency anemia groups（P<0.05）. Flt-3L and TF levels were increased with the severity of iron deficiency anemia（P<0.05）. Hb，MCV，MCH，MCHC，25（OH）D and SI levels were decreased with the severity of iron deficiency anemia（P<0.05）. Serum Flt-3L，TF and 25（OH）D were independent risk factors for iron deficiency anemia（P<0.05）. The area under curve（AUC） of the combination of Flt-3L，TF and 25（OH）D for the diagnosis of iron deficiency anemia was 0.983. The AUC for the differential diagnosis of iron deficiency anemia and non-iron deficiency anemia was 0.981. Conclusions Flt-3L，TF and 25（OH）D have diagnostic values in the auxiliary diagnosis of iron deficiency anemia in infants and children，and the diagnostic efficiency of the combined determination is better.

Relationship between the changes of Aβ1-42，Tau protein，Lp-PLA2 levels and electroencephalogram in patients with mild cognitive impairment

HU Jinya, MU Bin, MENG Xiang'an

2022, 37(11):  1044-1048.  DOI: 10.3969/j.issn.1673-8640.2022.011.009

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Objective To investigate the changes of serum amyloid β-protien（Aβ）1-42，Tau protein，lipoprotein-related phospholipase A2（Lp-PLA2） and electroencephalogram parameters in patients with mild cognitive impairment（MCI）. Methods Totally，80 elderly MCI patients，80 Alzheimer’s disease（AD） patients and 80 healthy subjects（healthy control group） were enrolled. The general data were collected，and serum Aβ1-42，Tau，Lp-PLA2 levels and electroencephalogram were determined and performed. The result difference was compared. The correlations between the indicators were assessed by Pearson correlation analysis. Results Serum Aβ1-42 levels were increased successively in AD，MCI and healthy control groups（P<0.05），and serum Tau and Lp-PLA2 levels were decreased successively（P<0.05）. The α1 waves，δ waves and θ waves in MCI and AD groups were higher than those in healthy control group（P<0.05）. The δ wave and θ wave in AD group were higher than those in MCI group（P<0.05）. The α2 wave，β1 wave and β2 wave had no statistical significance among the 3 groups（P>0.05）. Pearson correlation analysis showed that δ wave and θ wave were negatively correlated with Aβ1-42（r values were -0.447 and -0.482，P=0.001 and P<0.000 1，respectively），they were positively correlated with Tau（r values were 0.571 and 0.467，P<0.000 1，respectively），and there was no correlation with Lp-PLA2 levels（r values were 0.117 and 0.163，P>0.05，respectively）. Conclusions The Aβ1-42，Tau and Lp-PLA2 levels may change abnormally in elderly MCI patients，and it may affect the electroencephalogram parameters.

Clinical value of LDL-C determination in non-fasting blood samples

SHEN Ying, XU Xiaoping, ZHANG Lele, DU Yongping, MENG Chao

2022, 37(11):  1049-1056.  DOI: 10.3969/j.issn.1673-8640.2022.011.010

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Objective To analyze the consistency of 4 calculated low-density lipoprotein cholesterol（LDL-C） levels（Friedewald formula，Martine formula，Sampson formula and Vujovic formula） with the direct determination of LDL-C（D-LDL-C） in non-fasting serum，and to evaluate the clinical value of LDL-C determination in non-fasting serum lipids. Methods Totally，110 cardiovascular disease（CVD） patients were enrolled，and the changes of fasting and postprandial 2 h serum lipids were compared. In addition，291 patients with CVD and/or diabetes mellitus（DM） and 259 healthy subjects were enrolled. Non-fasting serum lipids（fasting time <4 h） were determined，which included total cholesterol（TC），triglyceride（TG），LDL-C，high-density lipoprotein cholesterol（HDL-C） and small and dense low-density lipoprotein cholesterol（sd-LDL-C），and non-high-density lipoprotein cholesterol（non-HDL-C） was calculated. Spearman correlation analysis was used for D-LDL-C with calculated LDL-C levels，and the consistency was evaluated by different LDL-C cut-off points. Results For CVD patients，the levels of TC，HDL-C，LDL-C and non-HDL-C were lower after 2 h of routine meal（P<0.05），and there was no statistical significance in sd-LDL-C and TG levels whether postprandial or fasting condition（P>0.05）. For males，postprandial TG was increased as 0.11 mmol/L on average（P<0.05），and LDL-C was decreased as 0.13 mmol/L（P<0.05）. For females，the levels of TC，LDL-C and non-HDL-C were decreased as 0.22，0.14 and 0.19 mmol/L，respectively（P<0.05），and the change of TG level was not obvious（P>0.05）. Spearman correlation analysis showed that the calculated LDL-C levels of Friedewald formula，Martine formula，Sampson formula and Vujovic formula were positively correlated with D-LDL-C（r=0.922，0.953，0.949 and 0.944，P<0.05）. When TG≤2.26 mmol/L，the mean absolute deviation（MAD） between calculated LDL-C by Friedewald formula and D-LDL-C was minimum，and when TG>2.26 mmol/L，the deviation showed calculated LDL-C by Martine formula was minimum. For atherosclerotic cardiovascular disease（ASCVD） low-risk cases，different LDL-C cut-off points（2.6，3.4 and 4.9 mmol/L） were selected and concerned. When non-fasting serum TG>2.3 mmol/L，the consistency rates of calculated LDL-C of Martine formula，Sampson formula and Vujovic formula with D-LDL-C for evaluating ASCVD risk were 83.8%，83.8% and 82.5%，respectively，which were better than that of Friedewald formula（72.5%）. For ASCVD high-risk cases，when TG<2.3 mmol/L，the clinical assessment results of 4 calculated LDL-C levels showed good consistency with D-LDL-C（≥95%）. When 2.3<TG<5.6 mmol/L，the calculated LDL-C level of Martine formula showed the highest consistency with D-LDL-C（88.8%）. When TG>5.6 mmol/L，all the calculated LDL-C levels had no consistency with D-LDL-C. Conclusions Compared with fasting serum lipids，the levels of non-fasting serum lipids are usually increased in TG level and decreased in TC and LDL-C levels，but there was difference for males and females between fasting and postprandial changes. Using non-fasting calculated LDL-C of Martine formula may do help for the precise estimation of LDL-C level by clinicians，especially when TG>4.52 mmol/L. Non-fasting condition for lipid determination is convenient and acceptable for hypertriglyceridemia and CVD and DM patients，which should choose fasting blood sampling for serum lipid determination.

Roles of serum ACTA，LXA4，Tau protein in prognostic evaluation of children with hypoxic-ischemic encephalopathy

ZHAO Qian, HU Hongxia

2022, 37(11):  1057-1061.  DOI: 10.3969/j.issn.1673-8640.2022.011.011

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Objective To investigate the relationship between the expressions of activin A（ACTA），AT-lipoxin A4（LXA4） and Tau protein in children with hypoxic-ischemic encephalopathy（HIE） with neonatal behavioral neurological assessment（NBNA） scores and inflammation，and to analyze the value of each index in predicting the risk of death in children. Methods Totally，145 children with HIE were enrolled and classified into survival group（118 cases） and death group（27 cases） according to the prognosis during hospitalization. The clinical data，serum levels of ACTA，LXA4，Tau protein，interleukin-6（IL-6），tumor necrosis factor-alpha（TNF-α） and high mobility group protein box 1（HMGB1） were compared between the 2 groups. Pearson correlation analysis was used. Logistic regression analysis was used to analyze the correlations of ACTA，LXA4，Tau protein with death. Receiver operating characteristic（ROC）curve was used to evaluate the efficiency of single determinations and combined determination for evaluating the prognosis of HIE. Results In death group，serum ACTA，Tau protein，IL-6，TNF-α，HMGB1 level were higher than those in survival group，and LXA4 was lower than that in survival group（P<0.05）. Serum ACTA and Tau protein were negatively correlated with NBNA scores（P<0.05），they were correlated positively with IL-6，TNF-α and HMGB1（P<0.05），serum LXA4 is positively correlated with NBNA scores（P<0.05），and it was negatively correlated with IL-6，TNF-α and HMGB1（P<0.05）. Serum ACTA，LXA4 and Tau protein were influencing factors for the prognosis of HIE [odds ratios（OR）were 6.133，0.547 and 8.260，95% confidence intervals（CI） were 4.126-9.115，0.347-0.862 and 4.803-14.206]（P<0.05）. The areas under curves（AUC） of serum ACTA，LXA4 and Tau protein single determinations and combined determination in predicting the prognosis of children with HIE were 0.774，0.778，0.840 and 0.871，respectively. Conclusions Serum levels of ACTA，Tau protein and LXA4 in children with HIE were related to NBNA scores and inflammation，and they have certain predictive value for the prognosis of children.

Changes of thyroid hormones in patients with COPD and infection and the correlation with low T₃ syndrome

ZHANG Ying, LIU Huiling

2022, 37(11):  1062-1065.  DOI: 10.3969/j.issn.1673-8640.2022.011.012

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Objective To investigate the changes of thyroid hormones in patients with chronic obstructive pulmonary disease（COPD） and infection and the correlation with low triiodothyronine（T₃） syndrome. Methods Totally，58 patients with COPD and infection were enrolled. The results of thyroid hormones，including thyroid-stimulating hormone（TSH），total triiodothyronine（TT₃），free triiodothyronine（FT₃），total thyroxine（TT₄） and free thyroxine（FT₄），were collected. The rate of low T₃ syndrome in patients with COPD and infection was evaluated based on the reference change value（RCV） and reference intervals. Results Compared with control group，COPD patients with infection showed lower TT₃ and FT₃ levels（P<0.05）. TT₃ and TSH after treatment were higher than those before treatment（P<0.05），which TT₃ was still lower than that in control group（P<0.05）. There was no statistical significance for TT₄ and FT₄ among the groups（P>0.05）. Based on the reference intervals，29 of 58 COPD patients with infection were diagnosed as low T₃ syndrome before infection （50.0%）. After infection control，21 cases had low T₃ syndrome （36.2%）. Based on the RCV，12 of 58 patients had low T₃ syndrome （20.8%）. The incidence rate of low T₃ syndrome based on the RCV was lower than that based on the reference intervals （P<0.05）. Conclusions The patients with COPD and infection has high low T₃ syndrome rate ，and the levels of thyroid hormones should be monitored. The results based on the RCV should be good choice for clinicians to recognize low T₃ syndrome cases.

Correlation between serum follistatin and clinicopathological characteristics and prognosis of patients with differentiated thyroid cancer

ZHENG Yu, CHEN Jin

2022, 37(11):  1066-1070.  DOI: 10.3969/j.issn.1673-8640.2022.011.013

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Objective To investigate the correlation between serum follistatin（FS） and clinicopathological characteristics and prognosis of patients with differentiated thyroid cancer. Methods Totally，78 patients with differentiated thyroid cancer（thyroid cancer group），including 68 cases of papillary thyroid carcinoma（PTC） and 10 cases of follicular thyroid carcinoma（FTC），41 cases of benign thyroid nodules（benign nodule group），and 35 healthy subjects（healthy control group） were enrolled. The patient clinical data were collected，and serum FS levels of patients before and 3 months after operation and healthy subjects were determined. Receiver operating characteristic（ROC） curve was used to evaluate the efficacy of FS in the differential diagnosis of thyroid cancer and cervical lymph node metastasis. Logistic regression analysis was used to evaluate the risk factors for recurrence and metastasis in patients with thyroid cancer. Results The preoperative FS level in thyroid cancer group was higher than those in benign nodule group and healthy control group（P<0.001）. The serum FS level in thyroid cancer group at 3 months after operation was lower than that before operation（P<0.01）. There was no statistical significance in serum FS levels between PTC and FTC patients（P>0.05）. The area under curve（AUC） of FS in the differential diagnosis of benign thyroid nodules and thyroid cancer was 0.78，with an optimal cut-off value of 2.90 ng/mL，the sensitivity of 70.5% and the specificity of 82.9%，respectively. The AUC for cervical lymph node metastasis from thyroid cancer was 0.69，with an optimal cut-off value，sensitivity and specificity of 3.71 ng/mL，58.1% and 77.1%，respectively. The number of cases with lymph node metastasis in high FS（≥2.90 ng/mL） group was larger than that in low FS（<2.90 ng/mL） group（P<0.05）. Multivariate Logistic analysis showed that TNM stage Ⅲ-Ⅳ and serum FS≥4.33 ng/mL were independent risk factors for persistent thyroid cancer [odds ratios（OR） were 8.97 and 7.77，95% confidence intervals（CI） were 2.12-18.33 and 4.54-15.98，respectively]. Conclusions Serum FS level has a certain clinical value in the identification of benign and malignant thyroid nodules and the judgment of cervical lymph node metastasis in thyroid cancer. A high level of FS is a risk factor for thyroid cancer recurrence and metastasis.

Relationship between preoperative SII and postoperative infection in patients with open fracture after internal fixation

ZHANG Yinwang, LIU Jinyu, SONG Yunxiao, GE Wen, ZHANG Linlin, YUAN Wenhua, ZHAO Zhiyun

2022, 37(11):  1071-1074.  DOI: 10.3969/j.issn.1673-8640.2022.011.014

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Objective To investigate the relationship between preoperative systemic inflammatory indexes [systemic immune inflammation index（SII），platelet/lymphocyte ratio（PLR），neutrophil/lymphocyte ratio（NLR），lymphocyte/monocyte ratio（LMR）] and infection after internal fixation in patients with open fracture. Methods A total of 398 patients with open fracture treated with internal fixation were enrolled. The general clinical data were collected，and blood routine tests were performed within 24 h before operation. SII，PLR，NLR and LMR were calculated. The patients were followed up for 10 weeks after operation，and they were classified into infection group and non-infection group according to the presence or absence of infection. Kaplan-Meier survival curve was used to analyze the incidence of infection in patients with open fracture. Cox regression analysis was used to evaluate the risk factors of postoperative infection in patients with open fracture. Results In 398 patients with open fracture，41 cases developed postoperative infection. The SII in infection group was higher than that in non-infection group（P=0.002），and there was no statistical significance in PLR，NLR and LMR between the 2 groups（P>0.05）. All the patients were classified into SII≥777 group and SII<777 group according to the median level of SII at baseline. Kaplan-Meier survival curve analysis showed that the postoperative infection rate of SII≥777 group（14.93%） was higher than that of SII<777 group（5.58%）（Log-rankχ²=10.50，P=0.001 2）. After the adjustment for age，sex，body mass index（BMI），diabetes mellitus and hypertension，baseline SII≥777 was an independent risk factor for postoperative infection in open fracture patients [hazard ratio（HR）=3.320，95% confidence interval（CI） 1.450-7.599]. Conclusions Open fracture patients with elevated preoperative SII have a risk of postoperative infection. Preoperative SII has predictive value for postoperative infection in patients with open fracture.

Application of long-chain alcohols and oils as washing solution in DNA and RNA coextraction based on magnetic bead method

WANG Ding, LI Fugang, LUO Wang, CHEN Huajian, ZHANG Ke, XIE Guoming

2022, 37(11):  1079-1083.  DOI: 10.3969/j.issn.1673-8640.2022.011.016

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Objective To investigate the application value of long-chain alcohols and oils as washing solution in nucleic acid extraction based on magnetic bead method. Methods Totally，10²-10⁵ copies/μL DNA and RNA mixtures were extracted by magnetic bead method，and 5 kinds of long-chain alcohols，including undecanol，decanol，octanol，1-nonanol and 2-dodecanol，and 3 kinds of oils，including dimethicone，FC-40 and paraffin oil，were determined as washing solution，with the traditional 70% ethanol as control. The extracted nucleic acids were amplified using polymerase chain reaction（PCR） or reverse transcription-polymerase chain reaction（RT-PCR），and the nucleic acid extraction efficiency of different washing solutions was evaluated by cycle threshold（Ct）. The nucleic acid extraction performance under different reagent status（dry reagents and wet reagents） and different mixing modes（vortex mixing，pipette mixing and inversion mixing） was compared using oils as washing solution，and the performance for extracting genomic nucleic acid from clinical pathogen samples was evaluated as well. Results The nucleic acid extraction performance of dimethicone and FC-40 among the 8 kinds of washing solutions was basically the same as that of traditional 70% ethanol. The 10²-10⁵ copies/μL DNA or RNA could be effectively extracted without inhibiting PCR and RT-PCR. When using 70% ethanol as control and dimethicone or FC-40 as washing solution，no statistical significance was found in Ct values of 10³ copies/μL DNA and RNA amplification，regardless of the combination of reagent status or mixing mode（P>0.05）. There was no statistical significance in Ct value of DNA extracted from Mycoplasma pneumoniae simulated clinical samples（P>0.05），and it was basically consistent with commercial nucleic acid extraction kits. Conclusions Dimethicone and FC-40 can be used as washing solutions for nucleic acid extraction by magnetic bead method and can be used for the development of microfluidic products.

Performance evaluation of 2 mass spectrometry systems in clinical microbial identification

LIU Congcong, LI Jiaping, ZHOU Hongwei

2022, 37(11):  1084-1088.  DOI: 10.3969/j.issn.1673-8640.2022.011.017

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Objective To evaluate the performance of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry（MALDI-TOF MS） ASTA MicroIDSys with CoreDB database（MicroIDSys system） and Bruker Biotyper MS with DB2969 database（Biotyper system） in clinical microbial identification. Methods A total of 934 microorganisms and 5 standard isolates of 28 genera，70 species or species complexes were included from 2012 to 2020 in the Second Affiliated Hospital of Zhejiang University School of Medicine. The control method for microbial identification was performed with a direct smear method，and measured spectra were analyzed using respective software. Polymerase chain reaction（PCR） and sequencing were used as reference methods if either MALDI-TOF MS system could not identify the isolates or had discrepant results. The result accuracy was evaluated. Results Five standard isolates were accurately identified in species level by the 2 MALDI-TOF MS systems. Of 934 clinical isolates，898 isolates（96.1%） were identified correctly by MicroIDSys system，11 isolates had no identification results，and 25 isolates were misidentified（identified as the other species in genus level）. The Biotyper system identified correctly 918 isolates（98.3%），6 isolates identified in genus level，2 isolates of Chromobacterium haemolyticum showed “no identification”，and 6 isolates were misidentified. Conclusions The performance of MicroIDSys system was comparable to that of Biotyper system for the identification of clinical microorganisms. However，rare and easily confused bacterial species are challenging.

Patient medians and exponentially weighted moving average in comparing peripheral blood RBC count results of different instruments

WANG Huiru, WANG Shenghua, HUANG Shanshan, WU Hao, YU Wenjing, GUO Yinghui

2022, 37(11):  1093-1097.  DOI: 10.3969/j.issn.1673-8640.2022.011.019

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Objective To compare the application of patient medians and exponentially weighted moving average（EWMA） in in-laboratory comparison of peripheral blood red blood cell（RBC） count results by different instruments. Methods From July 1st 2020 to December 31st 2020，based on AI-MA patient datum quality control intelligent monitoring platform，EWMA method and median method were used to compare and analyze the monthly and daily deviations of 3 cut-off concentrations obtained between 3 comparison instruments（A2，A3 and A4） and reference instrument（A1）. Results When month was taken as statistical cycle，the monthly deviation obtained by EWMA method was within the allowable range，and the monthly deviation obtained by median method was inconsistent with the L1 concentration of one instrument. When taking day as statistical cycle，the daily deviation of L2 concentration obtained by the 2 methods was within the allowable range，and there were many nonconformities in the daily deviation of L1 and L3 concentrations. Conclusions The monitoring efficiency of EWMA method and median method for continuous real-time comparison of peripheral blood results between instruments in the laboratory is basically the same. It is an economic and practical comparison method.

Performance of antigen test for SARS-CoV-2 and related research progress

FANG Huiling, CHEN Ziqi, ZHU Yuqing

2022, 37(11):  1098-1103.  DOI: 10.3969/j.issn.1673-8640.2022.011.020

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Nucleic acid amplification test is the gold standard for the diagnosis of corona virus disease 2019（COVID-19）. However，it is inherently difficult to scale up with the reason that it is equipment dependent，technician dependent and time consuming. Recently，relevant departments issued the guidance on severe acute respiratory syndrome virus 2（SARS-CoV-2）antigen test providing guidance for carrying out SARS-CoV-2 antigen test in specific populations，representing a valuable resource in effort to halt the current pandemic. This review aims to briefly summarize the performance of SARS-CoV-2 antigen test.