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Predictive value of enhanced magnetic resonance imaging for pathological classification and prognosis of conservative treatment in patients with lumbar disc herniation

Yifan TAO ; Fei LUO

Journal of Clinical Medicine in Practice.2024;28(24):1-5. doi:10.7619/jcmp.20242121

Objective To explore the predictive value of enhanced magnetic resonance imaging (MRI) for pathological classification and prognosis of conservative treatment in patients with lumbar disc herniation. Methods Clinical materials of 105 patients with conservative treatment for lumbar disc herniation in the hospital from September 2021 to September 2022 were retrospectively analyzed. All the patients underwent enhanced MRI at the time points of hospital admission and the final examination. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic efficacy of enhanced MRI parameters [maximal rim thickness (Tr), rim enhancement range (Er), and herniated volume] in the pathological classification of lumbar disc herniation. Patients were followed up for 8 months and divided into recurrence and non-recurrence groups based on recurrence after conservative treatment. The Oswestry Disability Index (ODI) score, the Visual Analogue Scale (VAS) score for low back pain, and levels of enhanced MRI parameters were compared between the two groups. ROC curve analysis was conducted to assess the predictive value of Tr, Er and herniated volume for the prognosis. Results The levels of Tr and Er in the extrusion patients were significantly higher than those in the sequestration patients (P < 0.05). The area under the curve (AUC) for the prediction of pathological classification of lumbar disc herniation by Tr combined with Er was 0.854, with a sensitivity of 84.21% and a specificity of 76.12%. After treatment, the ODI score and VAS score for low back pain in the non-recurrence group were significantly lower than those in the recurrence group, while Tr and Er were significantly higher in the non-recurrence group (P < 0.05).The AUC for the prediction of the prognosis of conservative treatment for lumbar disc herniation by Tr combined with Er was 0.802, with a sensitivity of 96.55% and a specificity of 53.95%. Conclusion Enhanced MRI has good value in assessing the pathological classification and prognosis of conservative treatment in patients with lumbar disc herniation.

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Effectiveness and safety of a new nerve block puncture needle in patients undergoing total knee arthroplasty

Lei FENG ; Hao ZHONG ; Yang XI ; Yan TAO ; Yan ZHOU

Journal of Clinical Medicine in Practice.2024;28(24):6-9. doi:10.7619/jcmp.20243408

Objective To investigate the effectiveness and safety of a new nerve block puncture needle for nerve block in patients undergoing total knee arthroplasty (TKA). Methods A total of 106 patients undergoing TKA were enrolled, and randomly divided into conventional group (n=53) and study group (n=53). Conventional nerve block puncture needle was used in the conventional group, and a new nerve block puncture needle was used in the study group. The needle insertion effects, block effects, pain [Visual Analogue Scale (VAS)], stress responses [heart rate (HR) and mean arterial pressure (MAP)] and safety were observed in both groups. Results The number of needle insertions, corrections and the duration of needle insertion were significantly lower or shorter in the study group compared with the conventional group (P < 0.05). The success rate of one-time puncture in the study group was 81.13%, which was significantly higher than 62.26% in the conventional group (P < 0.05). There were no statistically significant differences in the onset time, duration and success rate of block between the two groups (P>0.05). During needle insertion, the HR, MAP and VAS scores were significantly lower in the study group compared with the conventional group (P < 0.05). The overall incidence of adverse events related to nerve blockade was significantly lower in the study group than that in the conventional group (P < 0.05). Conclusion The application of the novel nerve block needle in patients undergoing TKA exhibits good effects and high effectiveness, which can reduce stress responses and the risk of adverse events related to needle insertion.

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Efficacy of red and blue lights combined with Yufa Shengfa solution and 5% minoxidil solution in treating type Ⅰ female androgenetic alopecia

Chenlei DAI ; Jun LIU ; Xiaoming SUN ; Jinghui YANG ; Jiang MA ; Yuxuan WANG ; Juping CHEN

Journal of Clinical Medicine in Practice.2024;28(24):10-14. doi:10.7619/jcmp.20243505

Objective To investigate the efficacy of red and blue lights combined with Yufa Shengfa solution and 5% minoxidil solution in treating Ludwig type Ⅰ female androgenetic alopecia. Methods A total of 160 patients with Ludwig type Ⅰ female androgenetic alopecia were randomly divided into group A (Yufa Shengfa solution combined with 5% minoxidil solution), group B (red and blue lights therapy combined with Yufa Shengfa solution), group C (red and blue lights therapy combined with 5% minoxidil solution) and group D (red and blue lights therapy combined with Yufa Shengfa solution and 5% minoxidil solution), with 40 cases in each group. All the patients orally took compound glycyrrhizin tablets and Centrum multivitamins, and the therapeutic period was 3 months. Differences in hair diameter, hair density, and the number of hair follicles with multiple hairs were compared before and after treatment. Results The hair density, hair diameter, and the number of hair follicles with multiple hairs improved significantly in 4 groups compared with those before treatment, and group D showed the best improvement in these parameters, with significant between-group differences (P < 0.001). There were no serious adverse events or side effects during treatment in all the patients. Conclusion Red and blue lights therapy combined with Yufa Shengfa solution and 5% minoxidil solution is an effective non-surgical treatment for Ludwig type Ⅰ female androgenetic alopecia.

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Construction and validation of a risk prediction model for device-related pressure injuries in critically ill patients

Wei LI ; Ying LIU ; Weiping TIAN ; Qiyan LIU

Journal of Clinical Medicine in Practice.2024;28(24):15-19. doi:10.7619/jcmp.20243040

Objective To explore the influencing factors of device-related pressure injuries (DRPI) in critically ill patients, construct a risk prediction model, and validate its effectiveness. Methods A retrospective analysis was conducted on the clinical data of 136 critically ill patients. Based on the occurrence of DRPIs, the patients were divided into occurrence group (32 patients) and non-occurrence group (104 patients). Univariate analysis and binary Logistic regression analysis were used to investigate the influencing factors of DRPIs, and a binary Logistic regression model was constructed. The Hosmer-Lemeshow test was used to assess the goodness of fit of the model, and the area (AUC) under the receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of the model.Additionally, the Bootstrap method was employed for internal validation of the model. Results Univariate analysis revealed statistically significant differences between the two groups in terms of age, diabetes, ICU stay duration, duration of non-invasive ventilation mask use, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, Braden scale score, use of vasoactive drugs, prone position ventilation, hemoglobin levels, and lactate levels (P < 0.05). Binary Logistic regression analysis indicated that age, diabetes, ICU stay duration, APACHE Ⅱ score, duration of non-invasive ventilation mask use, use of vasoactive drugs, prone position ventilation, lactate levels, Braden scale score, and hemoglobin levels were independent influencing factors for DRPIs in critically ill patients (P < 0.05). A binary Logistic regression model for predicting the risk of DRPIs in critically ill patients was constructed based on these independent factors. The overall prediction accuracy of the model was 99.26%. The Hosmer-Lemeshow goodness-of-fit test showed that the model had good fitness (χ² < 0.001, P>0.999). Internal validation using the Bootstrap method and ROC curve analysis showed that the AUC of the model for predicting DRPIs in critically ill patientswas 0.952, with a sensitivity of 87.5% and a specificity of 93.3%. Conclusion The risk prediction model for DRPIs in critically ill patients constructed in this study demonstrates good stability and predictive performance. It can assist clinical healthcare professionals in screening high-risk patients and formulating personalized intervention plans.

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Flash extraction process of Huangyu Shenshu Granules based on Box-Behnken design-response surface methodology

Dan LI ; Li WAN ; Wei LI ; Sijie HE

Journal of Clinical Medicine in Practice.2024;28(24):20-25. doi:10.7619/jcmp.20242825

Objective To optimize the flash extraction process of Huangyu Shenshu Granules based on Box-Behnken design-response surface methodology. Methods The extraction yields of morroniside and loganin, as well as the yield of dry extract, were used as evaluation indices. The rotation speed, liquid-solid ratio, and extraction time were selected as the investigation factors. Based on preliminary experiments, combined with Box-Behnken design-response surface methodology, the flash extraction process of Huangyu Shenshu Granules was studied and optimized. Results The optimal condition for the flash extraction of Huangyu Shenshu Granules were taking water as the extraction solvent, with a rotation speed of 4, 560 r/min, a liquid-solid ratio of 23 mL/g, and an extraction time of 85 s. Conclusion The flash extraction process established based on Box-Behnken design-response surface methodology is rapid and efficient, and suitable for the subsequent industrialization development of Huangyu Shenshu Granules.

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Diagnostic efficacy of dynamic contrast-enhanced magnetic resonance imaging combined with diffusion-weighted imaging for prostate cancer

Yuanfei ZHANG

Journal of Clinical Medicine in Practice.2024;28(24):26-30. doi:10.7619/jcmp.20242599

Objective To analyze the diagnostic efficacy of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with diffusion-weighted imaging (DWI) in prostate cancer (PCa). Methods A total of 94 patients with prostate diseases were selected as study subjects, and divided into PCa group (n=41) and benign prostatic hyperplasia (BPH) group (n=53). The general information of the two groups was compared. The diagnostic efficacy of DCE-MRI and DWI examination parameters in PCa and their correlation with serum prostate-specific antigen (PSA) were analyzed. Results There were statistically significant differences in total prostate-specific antigen (tPSA), free prostate-specific antigen (fPSA)/tPSA, prostate volume (V), prostate-specific antigen density (PSAD), plasma volume fraction (V_p), reflux rate constant (K_ep), volume transfer constant (K^trans), extracellular extravascular volume fraction (V_e) and apparent diffusion coefficient (ADC) between the two groups (P < 0.05). The area under the curve for the combined prediction of PCa using DCE-MRI and DWI examination parameters was 0.924, which was greater than that for individual predictors or the combination of DCE-MRI examination parameters. K^trans, K_ep and V_e were positively correlated with tPSA and negatively correlated with fPSA/tPSA, while V_p and ADC were negatively correlated with tPSA and positively correlated with fPSA/tPSA (P < 0.05). Conclusion The combination of DCE-MRI and DWI has high diagnostic value for predicting PCa, and K^trans, K_ep, V_e, V_p and ADC have certain correlations with tPSA and fPSA/tPSA.

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Changes of interleukin-34 levels in serum and bronchoalveolar lavage fluid of patients with severe pneumonia and their prognostic value

Yuxin LIU ; Yongmin YAN ; Jianke REN ; Jianlei TANG ; Sheliang XUE ; Zhifang ZHUANG ; Run CAI ; Yanjuan ZHOU

Journal of Clinical Medicine in Practice.2024;28(24):31-36. doi:10.7619/jcmp.20243604

Objective To investigate the changes in interleukin-34 (IL-34)levels in serum and bronchoalveolar lavage fluid (BALF) of patients with severe pneumonia and their prognostic value. Methods A total of 66 patients with severe pneumonia (severe pneumonia group), 35 patients with non-severe pneumonia (non-severe pneumonia group), and 27 healthy adults (control group) were enrolled. The severe pneumonia group was further divided into survival group of 38 patients and non-survival group of 28 patients based on 28-day survival. Clinical data of all subjects were analyzed. Receiver operating characteristic (ROC) curves were plotted to assess the predictive power of serum IL-34 and relative IL-34 gene expression in BALF for 28-day mortality in patients with severe pneumonia, as well as the predictive power of serum IL-34 for severe pneumonia. Kaplan-Meier survival curves were plotted, and the Log-rank test was used to compare cumulative survival rates. Cox regression analysis was conducted to explore risk factors for 28-day mortality in patients with severe pneumonia. Pearson correlation analysis was used to assess the correlation between serum IL-34 levels and relative IL-34 gene expression in BALF of patients with severe pneumonia. Results Serum IL-34 levels were higher in the severe pneumonia group than those in the non-severe pneumonia group, and were higher in the non-severe pneumonia group than in the control group (P < 0.05). Serum IL-34 levels and relative IL-34 gene expression in BALF were higher in the non-survival group than in the survival group (P < 0.05). ROC curve analysis showed that the areas under the curve for predicting 28-day mortality in patients with severe pneumonia were 0.908 for serum IL-34 levels and 0.878 for relative IL-34 gene expression in BALF. The optimal cutoff value for serum IL-34 levels in predicting severe pneumonia was 129.9 pg/mL. Multivariate Cox regression analysis showed that increased serum IL-34 levels and increased relative IL-34 gene expression in BALF were independent risk factors for 28-day mortality in patients with severe pneumonia (P < 0.05). The Kaplan-Meier survival analysis results indicate that, with a cutoff value of 129.9 pg/mL, patients with severe pneumonia who had high serum levels of IL-34 exhibited a lower cumulative survival rate compared to those with low IL-34 level(Log-rank P < 0.001). Conclusion Serum IL-34 levels are significantly increased in patients with severe pneumonia, and relative IL-34 gene expression in BALF is positively correlated with serum IL-34 levels. Both can be used as indicators for predicting the prognosis of 28-day mortality in patients with severe pneumonia.

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Study on regulation of human hypertrophic scar fibroblast behavior by miR-211-5p via the TGF-β/Smad2 signaling pathway

Zhaohui CHEN ; Jinyan YANG ; Lihua LI ; Lin LI

Journal of Clinical Medicine in Practice.2024;28(24):37-43. doi:10.7619/jcmp.20241963

Objective To investigate the mechanisms of microRNA-211-5p (miR-211-5p) in regulation of proliferation, apoptosis, migration, invasion, and collagen synthesis of human hypertrophic scar fibroblasts (HSFBs) via the transforming growth factor (TGF)-β1/Smad homolog 2 (Smad2) signaling pathway. Methods HSFBs were randomly divided into control, miR-NC, miR-211-5p mimic, anti-miR-211-5p, and miR-211-5p mimic + SB431542 (TGF-β1/Smad2 signaling pathway inhibitor) groups. After 72 hours of continuous culture, quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) was used to detect miR-211-5p expression, western blot was employed to assess TGF-β1 and Smad2 protein levels, methyl-thiazoldiphenyl-tetrazolium (MTT) assay was performed to measure cell proliferation, flow cytometry was utilized to analyze apoptosis rates, Transwell chambers were applied to evaluate cell invasion and migration, and western blot was again utilized to quantify type I collagen (Col-Ⅰ) and type Ⅲ collagen (Col-Ⅲ) protein expressions. An animal model of hypertrophic scars was established in rats using a constant temperature and pressure electric scalding apparatus. Following successful modeling, rats in each group received tail vein injections of miR-NC or miR-211-5p mimic. Scar healing was assessed, and histopathological changes in scar tissue were observed via hematoxylin and eosin (HE) staining. Results Compared with the control and miR-NC groups, the miR-211-5p mimic group exhibited increased miR-211-5p, TGF-β1, and Smad2 protein expressions, enhanced cell proliferation, reduced invasion and migration capabilities, decreased apoptosis rates, and elevated Col-Ⅰ and Col-Ⅲ protein expressions (P < 0.05). Conversely, the anti-miR-211-5p group displayed opposite trends, and significant differences were observed between the anti-miR-211-5p and miR-211-5p mimic groups for the aforementioned indicators (P < 0.05). Compared to the miR-NC group, the miR-211-5p mimic group had higher scar healing rates and fibroblast counts (P < 0.05). Compared to the miR-211-5p mimic group, the miR-211-5p mimic + SB431542 group showed reduced TGF-β1, Smad2 protein expressions, and weakened cell invasion and migration capabilities (P < 0.05). Conclusion MiR-211-5p may regulate proliferation, apoptosis, migration, invasion, and collagen synthesis of HSFBs by activating the TGF-β1/Smad2 signaling pathway.

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Application effect of fiberoptic bronchoscopy and alveolar lavage therapy in diagnosis and treatment of recurrent wheezing disorders in children

Shuang HONG ; Hongzhi LU ; Dawei TIAN ; Haixin YU ; Zhaochuan YANG

Journal of Clinical Medicine in Practice.2024;28(24):44-47. doi:10.7619/jcmp.20244288

Objective To investigate the application effect of fiberoptic bronchoscopy and alveolar lavage therapy in the diagnosis and treatment of recurrent wheezing diseases in children. Methods A total of 151 children with recurrent wheezing diseases were enrolled, and divided into control group (n=84) and study group (n=67) based on different diagnostic and therapeutic methods. The control group received conventional diagnosis and treatment, while the study group underwent fiberoptic bronchoscopy combined with alveolar lavage therapy. The time to resolution of symptoms and length of hospital stay were compared between the two groups. Additionally, lung function [forced expiratory volume in 1 second (FEV₁), FEV₁/forced vital capacity (FEV₁/FVC) and peak expiratory flow (PEF)], exhaled nitric oxide (FeNO), serum inflammatory mediator levels [C-reactive protein (CRP), procalcitonin (PCT) and white blood cell (WBC) count] and clinical efficacy were compared. Results The absence time of wheezing and pulmonary rales and hospital stay in the study group were significantly shorter than those in the control group (P < 0.05). After treatment, FEV₁, FEV₁/FVC and PEF in two groups were significantly higher than before treatment, and the study group was significantly higher than the control group (P < 0.05). After treatment, FeNO, CRP, PCT and WBC in two groups were significantly lower than before treatment, and the study group was significantly lower than the control group (P < 0.05). The total effective rate of the study group was 94.03%, which was significantly higher than 77.38% of the control group (P < 0.05). Conclusion Fiberoptic bronchoscopy and alveolar lavage are effective in the diagnosis and treatment of recurrent asthmatic diseases in children, which can effectively relieve symptoms, shorten hospital stay, and improve lung function, FeNO and serum inflammatory mediators.

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Characteristics of bone marrow megakaryocytes in patients with idiopathic thrombocytopenic purpura complicated with positive antinuclear antibody

Yunhao CHEN ; Liubing LI ; Zhenhai ZHOU

Journal of Clinical Medicine in Practice.2024;28(24):48-52. doi:10.7619/jcmp.20244956

Objective To investigate the characteristics of bone marrow megakaryocytes in patients with idiopathic thrombocytopenic purpura (ITP) complicated with positive for antinuclear antibody (ANA) but cannot be diagnosed as rheumatic immune diseases. Methods Newly diagnosed ITP patients in the First Hospital Affiliated to Sun Yat-sen University were retrospectively selected and divided into ITP1 group (ITP patients with positive ANA) and ITP2 group (ITP patients with negative rheumatic indicators). Degree of thrombocytopenia, the total number of bone marrow megakaryocytes, and the ratios of various types of megakaryocytes at the initial diagnosis were compared between the two groups. Results A total of 42 newly diagnosed ITP patients were included, with 20 cases in the ITP1 group and 22 cases in the ITP2 group. There were no significant differences in general information such as gender and age between the two groups (P>0.05). The platelet (PLT) count was (7.55±0.96)×10⁹/L in the ITP1 group, which was lower than (10.23±1.21)×10⁹/L in the ITP2 group, but there was no significant between-group difference (t=1.697, P=0.097). Compared with the ITP2 group, the total number of megakaryocytes in the ITP1 group was significantly decreased (t=3.071, P < 0.01), and the ratio of granular megakaryocytes was significantly increased while the ratio of naked nuclear megakaryocytes was significantly decreased (P < 0.05); there were no significant differences in the ratios of immature and platelet-producing megakaryocytes between the two groups (P>0.05). Conclusion Patients with ITP and positive ANA have a tendency of decreased PLT, and a more significant maturation disorder of bone marrow megakaryocytes, with a lower degree of megakaryocyte proliferation compared to patients without positive ANA. ANA may exacerbate the severity of ITP by aggravating the developmental disorder of bone marrow megakaryocytes.

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