1.Effect of Tongluo Juanbi Granules on Inflammatory Injury and Apoptosis of Osteoarthritis Based on TLR4/MyD88/NF-κB Signaling Pathway
Qi QI ; Liang OU ; Weichen HUANG ; Zehua CHEN ; Daoqing XU ; Weiwei HU ; Jingjing LI ; Jianjun KUANG
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(10):29-36
ObjectiveTo investigate the effects of Tongluo Juanbi granules on chondrocyte apoptosis and Toll-like receptor 4 (TLR4)/myeloid differentiation factor 88 (MyD88)/nuclear factor-κB (NF-κB) signaling pathway of rabbits with knee osteoarthritis (KOA) and study the mechanism of Tongluo Juanbi granules in the prevention and treatment of KOA. MethodThirty New Zealand rabbits were randomly assigned to the following five groups (n=6): sham group, model group, low-dose and high-dose groups of Tongluo Juanbi granules (4.1 and 8.2 g·kg-1·d-1), and celecoxib group (10.9 mg·kg-1·d-1). The KOA model was established by destabilization of the medial meniscus (DMM) for six weeks. Six weeks after the modeling, the drug was given once a day for eight weeks. The pathological changes of cartilago articularis were observed by hematoxylin-eosin (HE) staining and Safranin O-Fast Green staining. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was performed to detect chondrocyte apoptosis. Enzyme-linked immunosorbent assay (ELISA) was used to detect the contents of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in synovial fluid. The mRNA and protein expression levels of genes related to the TLR4/MyD88/NF-κB signaling pathway were detected by real-time fluorescence quantitative polymerase chain reaction (Real-time PCR) and Western blot, respectively. ResultCompared with the sham group, the cartilago articularis of the model group significantly degenerated. Mankin's score was increased (P<0.01), and the contents of IL-1β and TNF-α in synovial fluid were increased (P<0.01). The number of apoptosis of chondrocytes was increased (P<0.01). The mRNA and protein expressions of TLR4, MyD88, and NF-κB p65 in cartilage tissue were up-regulated (P<0.01), while the mRNA and protein expressions of Bcl-2 were down-regulated (P<0.01). Compared with the model group, chondrocyte degeneration in both low-dose and high-dose groups of Tongluo Juanbi granules was improved, and Mankin's score was decreased (P<0.01). The contents of IL-1β and TNF-α were decreased (P<0.01), and the number of apoptosis of chondrocytes was decreased (P<0.01). The mRNA and protein expressions of TLR4, MyD88, and NF-κB p65 in cartilage tissue were down-regulated (P<0.01), while the mRNA and protein expressions of Bcl-2 were up-regulated (P<0.01). In addition, in the above observation indicators, the high-dose group of Tongluo Juanbi granules was significantly superior to the low-dose group of Tongluo Juanbi granules. ConclusionTongluo Juanbi granules could inhibit chondrocyte apoptosis in rabbits with KOA and improve cartilage degeneration, which may be related to inhibiting inflammatory responses mediated by TLR4/MyD88/NF-κB signaling pathway.
2.Hereditary pheochromocytoma/paraganglioma and associated syndromes:a clinical and genetic study
Peng TANG ; Weihua LAN ; Yao ZHANG ; Jun ZHANG ; Zehua SHU ; Ke LI ; Zaoming HUANG ; Yiqiang HUANG ; Qiuli LIU ; Jun JIANG
Journal of Army Medical University 2024;46(4):377-383
Objective To summarize and analyze the clinical phenotypes,hereditary features and treatment and follow-up strategies of different hereditary pheochromocytoma/paragangliomas(PCC/PGL)and related syndromes.Methods Forty-four clinically diagnosed PCC/PGL patients admitted in our hospital from January 2000 to August 2022 were enrolled,and the clinical data of them and their family members were collected.Second-generation sequencing was performed on 43 patients for genetic detection,and Sanger sequencing was applied to verify the mutation of the probands and family members.Results There were 15 patients diagnosed with hereditary PCC/PGL,including 7 cases of von Hippel-Lindau(VHL)syndrome,3 cases of multiple endocrine neoplasia type 2(MEN2),and 5 cases of familial paraganglioma syndrome.Seven VHL syndrome families were diagnosed as VHL2A(c.500G>A),VHL2B(c.239G>T and c.444_457del),and VHL2C(c.293A>G)according to their clinical manifestations.All probands received surgical treatment,and 2 cases of recurrent PCC and the patients with multiple renal cancer also received targeted therapy with sunitinib.Three MEN2 families carried c.1901G>C,c.1832G>A,and c.1901G>A missense mutations,respectively,and were diagnosed with MEN2A clinically.All of them underwent adrenalectomy and thyroidectomy,including one for preventive thyroidectomy.Among the 5 familial paraganglioma syndrome families,4 patients carried SDHB mutations(SDHB:c.343C>T,c.541-2A>G,c.575G>A,c.268C>T)and 1 patient carried an SDHD mutation(SDHD:c.337_340del).Sporadic retroperitoneal PGL were most common.Conclusion More than 1/3 of PCC/PGL patients carry germline gene mutations,showing obvious genotype-phenotype correlation.Genetic diagnosis technology plays an important guidance role for clinical precision treatment and follow-up,and genetic counseling.
3.Huangjing Jiannao Granules Improve Learning and Memory Abilities and Cerebral Blood Flow in Rat Model of Vascular Cognitive Impairment via PI3K/Akt Signaling Pathway
Rui YANG ; Yumu TIAN ; Yujing JIN ; Jianwen ZHAIWU ; Tong ZHANG ; Zehua ZHAO ; Shijing HUANG ; Juhua PAN
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(22):52-60
ObjectiveTo study the effects of Huangjing Jiannao granules on learning and memory abilities and cerebral blood flow in the rat model of vascular cognitive impairment (VCI) and to explore the mechanism of Huangjing Jiannao granules in the treatment of VCI. MethodSeventy-two SPF-grade male SD rats were randomly selected, with 12 rats as the sham operation group. The remaining rats were subjected to bilateral carotid artery ligation (2-VO) for the modeling of VCI. According to the randomized block design, the successfully modeled rats were grouped as follows: model, donepezil hydrochloride (0.50 mg·kg-1), and low-, medium-, and high-dose (2.36, 4.72, 9.44 g·kg-1, respectively) Huangjing Jiannao granules. After 6 weeks of treatment, Morris water maze test and new object recognition test were conducted to evaluate the learning and memory abilities of the rats. After continuous gavage for 8 weeks, the cerebral blood flow was recorded by a laser microcirculation blood flow imager, and the survival and injury of hippocampal neurons were observed by Nissl staining. The expression of neuronal nuclear antigen (NeuN) in the hippocampus was detected by immunohistochemistry (IHC). The levels of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in the serum were determined by enzyme-linked immunosorbent assay. The protein levels of phosphatidylinositol 3-kinase (PI3K), phosphorylated protein kinase B (p-Akt), nuclear factor-κB p65 (NF-κB p65), and nuclear factor-κB inhibitor α (IκBα) in the hippocampus were determined by Western blot. ResultCompared with the sham operation group, the model group showed weakened learning and memory abilities (P<0.01), reduced blood flow in the whole brain, forebrain, and hindbrain (P<0.01), damaged neurons and reduced survived neurons in the hippocampal CA1 region (P<0.01), down-regulated expression of NeuN (P<0.01), elevated levels of IL-1β and TNF-α in the serum (P<0.01), up-regulated protein levels of PI3K, p-Akt, and NF-κB p65 in the hippocampal tissue, and down-regulated protein level of IκBα (P<0.01). Compared with the model group, medium- and high-dose Huangjing Jiannao granules improved the learning and memory abilities (P<0.05,P<0.01). High-dose Huangjing Jiannao granules increased the blood flow in the whole brain, forebrain, and hindbrain (P<0.05,P<0.01), and medium-dose Huangjing Jiannao granules increased the blood flow in the whole brain (P<0.05). All the doses of Huangjing Jiannao granules increased the number of survived neurons (P<0.05,P<0.01) and up-regulated the protein level of NeuN (P<0.05,P<0.01). Medium and high-dose Huangjing Jiannao granules lowered the level of TNF-α (P<0.05,P<0.01), down-regulated the protein levels of PI3K, p-Akt, and NF-κB p65 (P<0.05,P<0.01), and up-regulated the protein level of IκBα (P<0.01). ConclusionHuangjing Jiannao granules can improve the learning and memory abilities and promote the recovery of cerebral blood flow in the rat model of VCI induced by 2-VO by regulating the expression of proteins involved in the PI3K/Akt signaling pathway, inhibiting inflammation, and reducing hippocampal neuron injury.
4.Clinical value of TAM receptor tyrosine kinase and ligands in evaluating disease severity of acute pancreatitis
Xiuli ZHANG ; Xiaoyu GUO ; Zehua HUANG ; Yue ZENG ; Li WEN
Chinese Journal of Pancreatology 2024;24(1):58-62
Objective:To investigate the clinical value of Tyro3/Axl/Mertk (TAM) receptor tyrosine kinase and ligands in severity evaluation for acute pancreatitis (AP).Methods:The peripheral blood and clinical data of 27 patients with AP admitted in the Department of Gastroenterology of Shanghai General Hospital from February 2020 to July 2022 were prospectively selected. The patients were divided in to mild AP group (MAP, n=13), moderately severe AP (MSAP, n=10) and severe AP group (SAP, n=4) according to the 2012-revised Atlanta classification for AP. Another 10 healthy normal subjects were selected as the control group. The general information, biochemical indicators and blood cell analysis of the patients were recorded, and the levels of serum Gas6, protein S and soluble Axl (sAxl) were measured by ELISA. Linear regression equations were used to analyze the correlation of serum Gas6, protein S and sAxl levels with the white blood cell (WBC) counts, neutrophil percentages, lymphocyte percentages, and monocyte percentages of each group, and to assess the clinical value of Gas6, protein S and sAxl in predicting the severity of AP patients. Results:Compared with the control group, the serum Gas6 level [(31.3±13.0)ng/ml vs (21.2±2.6)ng/ml], protein S level [(24.4±11.3)μg/ml vs (17.7±3.4)μg/ml], and sAxl level [(9.0±4.4)ng/ml vs (6.6±1.3)ng/ml] were significantly higher in the AP group. The Gas6 level was significantly higher in the SAP group (54.1±13.7 ng/ml) than in the MAP group (31.0±9.4 ng/ml) and the MSAP group (25.2±8.9 ng/ml), and the differences were statistically significant (all P value <0.05). The Gas6 level was significantly positively correlated with the WBC count ( r=0.1733) and neutrophils percentage ( r=0.4424), and negatively correlated with lymphocyte percentage(r=-0.363), with statistically significant differences (all P value <0.05). The levels of protein S and sAXL were positively correlated WBC count and neutrophil percentage, and negatively correlated with monocyte percentage and lymphocyte percentage, but the differences were not statistically significant. Conclusions:The serum levels of Gas6 increase significantly with the severity grading of AP, which may serve as a relatively good predictor for the early severity assessment of AP.
5.Establishment of mouse pancreatic ductal organoids and exploration of its physiological functions
Zehua HUANG ; Nuoming YIN ; Li WEN ; Yue ZENG
Chinese Journal of Pancreatology 2023;23(1):38-44
Objective:To establish culture system for mouse pancreatic ductal organoids and investigate the morphology and physiological functions of the organoids.Methods:Pancreatic tissues were taken from C57BL/6 mice (6-8 weeks) and digested by collagenase Ⅳ. The pancreatic ducts were separated and collected and then the pancreatic organoids were cultured in the complete medium after Matrix gel embedding. Morphological evaluation of the organoids was performed after hematoxylin-eosin staining. The expression and localization of markers for organoids were identified by Western Blot and immunofluorescence staining; and the expression and localization of ion channels and antimicrobial peptides of the organoids were detected by agarose gel electrophoresis and immunofluorescence staining.Results:Mouse pancreatic organoids were successfully established, which could be stably passaged for 10 generations. The organoids grew spherically and formed a duct-like structure. The internal cavity corresponded to the lumen of pancreatic duct tissue. The pancreatic organoids stably expressed stem progenitor cell marker gene SOX9 and ductal epithelial cell-specific gene KRT19, which were both localized in the epithelium. The organoids did not express amylase. The organoids maintained stable expression of epithelial ion channels Clcn1, Kcnma1, CFTR, Slc12a5, Slc26a3, Slc26a6 and Scnn1a, low expression of Ano1 and no expression of Clcn3, Kcna1, Kcna2, Kcnd3, Kcnh1, Atp12a, Slc4a4, Slc9a1, Slc12a2 and Slc26a11; and CFTR highly expressed in epithelial cells. The organoids maintained high expression of antimicrobial peptides Reg3a, CRAMP and glycoprotein 2, low expression of Defb1, Defb2, and Defb3 and no expression of Defa1 and Defa4; and both CRAMP and Reg3a were expressed in the epithelial cells and secreted into the lumen of the organoids.Conclusions:Mouse pancreatic organoids are successfully established, which can be stably passaged. The organoids maintain the characteristics of ductal epithelial cells and can be used as an in vitro model to study the physiology of pancreatic ducts.
6.Effect of Lactobacillus plantarum WCFS1 on pancreatic and ileal injury in mice with acute necrotizing pancreatitis
Binqiang XU ; Wenfei QIN ; Yang FU ; Nuoming YIN ; Zehua HUANG ; Qixiang MEI ; Chunlan HUANG ; Yue ZENG
Chinese Journal of Pancreatology 2023;23(2):121-127
Objective:To explore the effect of probiotics Lactiplantibacillus plantarum(LP) WCFS1 by gavage on acute necrotizing pancreatitis (ANP) and associated ileum injury in mice. Methods:Twenty-four healthy male mice were gavaged with broad-spectrum antibiotics for 3 weeks to establish microbiota-depleted mice, and then randomly divided into control group (CON), ANP model group (ANP), LP gavage group (LP) and LP gavage and ANP induced group (LP+ ANP) , with 6 mice in each group. Mice in LP and LP+ ANP group were treated by gavage of LP (1×10 9 CFU/ml, 0.2 ml/day per mouse) for 1 week, while CON and ANP were gavaged with sterile phosphate buffered saline for 1 week instead. The ANP model was induced by intraperitoneal injection with caerulein (100 μg/kg) for 10 times with 1-hour interval between two injections and the 10th injection with lipopolysaccharide(LPS) 5 mg/kg intraperitoneally, and the mice were sacrificed 2 h later. Levels of LP in stool and ileal mucosa were detected by real-time PCR; the pancreas and ileum were collected for pathological examination to observe the extent of tissue inflammation and to score the pathology. Serum amylase activities were determined by enzymatic kinetic chemistry; serum inflammators levels and intestinal permeability were detected by ELISA; levels of inflammators in pancreatic and ileal tissues were detected by real-time PCR; ileal tight-junction proteins (occludin, claudin-1 and ZO-1) were measured by immunofluorescence staining. Results:LP levels in the stool and ileal mucosa of mice were significantly increased after LP gavage, and the differences were statistically significant (913.30±39.12 vs 2.39±1.39, 23.11±0.50 vs 1.38±0.28, all P value <0.05). The pathological scores of pancreatic tissue of CON, LP, ANP and LP+ ANP group were (0.26±0.41), (0.17±0.26), (8.55±0.46) and (6.30±0.45); the serum amylase activities were (219.70±19.73), (217.60±11.30), (2896.24±98.32) and (1837.13±131.60)U/L, IL-1β were (0.87±0.28), (1.4±0.85), (67.41±6.45) and (36.33±5.65)pg/ml, IL-6 were (0.74±0.27), (0.16±0.16), (280586.12±39163.92) and (107912.75±31283.47)pg/ml, IL-10 were (35.52±5.27), (50.99±15.34), (2008.45±184.83) and (3070.35±403.71)pg/ml; the expression level of pancreatic IL-1β mRNA was 1.42±0.39, 0.95±25, 20.53±0.50 and 10.69±1.01, IL-6 mRNA was 1.31±0.44, 0.93±0.023, 21.97±1.71 and 11.54±1.75, IL-10 mRNA was 0.93±0.14, 0.75±0.15, 0.99±0.21 and 1.76±0.19; there was no significant difference between LP and CON group, and pancreatic pathological scores, serum amylase、IL-1β and IL-6 levels, and the expression level of pancreatic IL-1β and IL-6 mRNA were significantly decreased in LP+ ANP group compared with those in ANP group, while serum IL-10 levels and the expression level of pancreatic IL-10 mRNA were significantly increased compared with ANP group, and all the differences were statistically significant (all P values <0.05). The pathological scores of ileal tissue of CON, LP, ANP and LP+ ANP group were 0, 0, (3.17±0.41) and (1.67±0.52); the levels of serum DAO of CON, LP, ANP and LP+ ANP group were (0.03±0.03), (0.02±0.02), (0.50±0.05) and (0.49±0.06)ng/ml; LPS levels were (2.75±0.35), (3.74±0.28), (7.19±0.92) and (5.88±0.38)ng/ml; the expression level of ileal IL-1β mRNA was 1.21±0.20, 1.17±0.09, 1.81±0.25 and 1.63±0.21; IL-6 mRNA was 1.01±0.29, 2.83±0.42, 54.45±8.50 and 16.87±4.42; IL-10 mRNA was 1.12±0.41, 6.09±2.51, 11.65±1.47 and 29.86±2.93. There was no significant difference between LP and CON group, except that the ileal IL-10 mRNA expression was significantly higher than that of CON group. Ileal pathological scores, serum LPS levels and the expression level of ileal IL-6 mRNA were significantly lower in LP+ ANP group than those in ANP group, while the expression level of ileal IL-10 mRNA was significantly higher than that of ANP group; the expression of ileal tight junction proteins (ocludin, claudin-1, ZO-1) was significantly higher than those in ANP group, and all the differences were statistically significant (all P values <0.05). Conclusions:LP WCFS1 gavage could ameliorate the injury of pancreatic and ileal barrier in caerulein-induced ANP mice.
7.High-risk human papillomavirus negative cervical lesions in the cervical cancer screening population
Jing ZHAO ; Jing CAI ; Si SUN ; Zaiju HUANG ; Zehua WANG ; Liying WU
Journal of Chinese Physician 2023;25(5):656-660
Objective:To investigate the incidence of high-risk human papillomavirus (hrHPV) negative cervical lesions in the screening population, and based on this, to preliminarily evaluate the potential harm (missed diagnosis) and benefits (reduced colposcopy referral) of HPV primary screening compared to combined screening so as to provide reference for the selection of cervical cancer primary screening methods.Methods:This study was a single center cross-sectional study. Women who underwent joint screening [hrHPV typing test combined with cervical liquid based cytology test (LCT)] at the Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from January 1, 2018 to December 31, 2019 were included in the cervical cancer screening. The proportion of hrHPV negative cytological abnormalities and cervical lesions in the population was analyzed and the theoretical colposcopy referral rate of the combined screening and HPV initial screening protocol was calculated. In the population with cervical pathological results, the number of colposcopy examinations required for the diagnosis of cervical intraepithelial neoplasia grade 2 and above (CIN2+ ) was calculated.Results:A total of 35 321 screened women were included. The overall incidence of hrHPV infection, LCT abnormalities and severe LCT abnormalities in the population was 17.13%(6 051/35 321), 18.07%(6 384/35 321), and 3.97%(1 402/35 321), respectively. The negative rate of hrHPV in women with severe cervical cytology abnormalities was as high as 51.28%(719/1 402), and in CIN2+ lesions diagnosed by cervical biopsy, hrHPV negative accounted for 7.15% (49/685). The theoretical colposcopy referral rates for combined screening and initial HPV screening were 11.28%(3 985/35 321) and 8.33%(2 943/35 321), respectively, with an average diagnosis of CIN2+ requiring 3.51 and 2.81 colposcopy examinations, respectively.Conclusions:In the opportunistic screening population, the proportion of hrHPV negative CIN2+ lesions cannot be ignored, and the HPV initial screening strategy may cause missed diagnosis of these lesions. However, compared to combined screening, HPV initial screening has the potential to improve the efficiency of colposcopy. These results suggest that we should carefully choose the HPV initial screening plan.
8.Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair (version 2023)
Junchao XING ; Long BI ; Li CHEN ; Shiwu DONG ; Liangbin GAO ; Tianyong HOU ; Zhiyong HOU ; Wei HUANG ; Huiyong JIN ; Yan LI ; Zhonghai LI ; Peng LIU ; Ximing LIU ; Fei LUO ; Feng MA ; Jie SHEN ; Jinlin SONG ; Peifu TANG ; Xinbao WU ; Baoshan XU ; Jianzhong XU ; Yongqing XU ; Bin YAN ; Peng YANG ; Qing YE ; Guoyong YIN ; Tengbo YU ; Jiancheng ZENG ; Changqing ZHANG ; Yingze ZHANG ; Zehua ZHANG ; Feng ZHAO ; Yue ZHOU ; Yun ZHU ; Jun ZOU
Chinese Journal of Trauma 2023;39(1):10-22
Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.
9.A Cohort Study of Invigorating Qi and Dissipating Depression Herbs on Depressive Disorders in the Clinical Efficacy
Zehua ZHAO ; Yusong YANG ; Xile YANG ; Shijing HUANG ; Juhua PAN ; Yuxia CHEN
World Science and Technology-Modernization of Traditional Chinese Medicine 2023;25(12):3843-3850
Objective To evaluate the dynamic efficacy of Invigorating Qi and Dissipating Depression Herbs in the treatment of depressive disorders and its effect on recurrence rate and suicidal thoughts.Methods The prospective cohort study was used to divide the patients into three cohorts according to the different exposure factors(treatment regimens):Western medicine group,integrated traditional Chinese and Western medicine group,and Invigorating Qi and Dissipating Depression Herbs group,and followed up for 2 years,and the treatment effects of each cohort at half a year,one year,one and a half years,and two years were observed respectively,and the evaluation indicators were Montgomery Depression Scale(MADRS),Hamilton Anxiety Scale(HAMA)and Social Deficit Screening Scale(SDSS)reduction rates,and endpoint events(relapse,suicidal ideation)incidence;By comparing the efficacy and endpoint event rate of the three cohorts,the effect of Invigorating Qi and Dissipating Depression Herbs on improving depressive disorders was evaluated.Results A total of 409 patients(67 in the Western medicine group,131 in the integrated traditional Chinese and Western medicine group,and 211 cases in the Invigorating Qi and Dissipating Depression Herbs group)were enrolled,and the rate of score reduction after treatment with MADRS,HAMA and SDSS increased compared with the pre-treatment treatment with the extension of the drug taking time.The difference between the MADRS and SDSS reduction rates in the Invigorating Qi and Dissipating Depression Herbs group on taking the drug for half a year and the SDSS reduction rate on one year of taking the drug were statistically significant compared with the Western medicine group,and there was no significant difference compared with the integrated Chinese and Western medicine group.On one and a half years and two years of medication,the integrated Chinese and Western medicine group had more advantages in MADRS reduction rate than the Invigorating Qi and Dissipating Depression Herbs group.The recurrence rates of depression in the three groups within 2 years were 20.9%,30.5%and 36.0%,and the difference was not statistically significant,and the length of taking medication was used as a protective factor by logistic regression analysis.The incidence rates of suicidal thoughts were 44.8%,19.1%and 17.5%,and the differences were statistically significant,and the exposure factors and income level were the protective factors by logistic regression analysis.Conclusion Invigorating Qi and Dissipating Depression Herbs can significantly improve the depressive state of patients,promote the recovery of social function,reduce the occurrence of long-term suicidal ideation,and appropriately extend the time of taking medicine can increase the long-term efficacy and reduce recurrence.
10.The value of urine DNA methylation in non-invasive diagnosis of upper urinary tract epithelial carcinoma
Xu CHEN ; Yucai WU ; Zehua CHEN ; Jian HUANG ; Xuesong LI ; Tianxin LIN
Chinese Journal of Urology 2023;44(10):725-730
Objective:To explore the performance and value of urine DNA methylation technology in non-invasive diagnosis of upper tract urothelial carcinoma (UTUC).Methods:A retrospective analysis was conducted on the of 107 patients with UTUC (UTUC group) and 121 patients with benign upper urinary tract diseases (control group) admitted to Sun Yat sen Memorial Hospital and Peking University First Hospital from August 2019 to March 2021. There were 64 males (59.8%) and 43 females (40.2%) in the UTUC group, with the age of (67 ± 10) years old.There were 50 cases (46.7%) of ureteral cancer, 42 cases (39.3%) of renal pelvis cancer, and 15 cases (14.0%) of renal pelvis cancer combined with ureteral cancer.45 cases (42.0%) of non muscular infiltrative UTUC, 51 cases (47.7%) of muscular infiltrative UTUC, and 11 cases (10.3%) of unclear stage.There were 14 cases (13.1%) with low tumor grade and 93 cases (86.9%) with high grade. There were 81 males (66.9%) and 40 females (33.1%) in the control group, with the age of (52 ± 14) years old.There were 104 cases (86.0%) of urinary stones, 13 cases (10.7%) of ureteral stenosis or polyps, and 4 cases (3.3%) of simple hydronephrosis. Sixty cases (56.1%) in the UTUC group and 11 cases (9.1%) in the control group underwent urine cytology examination. Seventy-two cases (67.3%) in the UTUC group and 9 cases (7.4%) in the control group underwent urine in situ fluorescence hybridization (FISH) examination. Quantitative PCR detection based on ONECUT2 and VIM gene methylation was performed on urine sediment samples from both groups. If ≥ 1 gene was positive, it was determined as positive, and if both genes were negative, it was determined as negative. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of urine cytology, FISH, and urine DNA methylation tests were evaluated based on pathological or clinical diagnosis criteria.Results:The overall sensitivity of urine DNA methylation test was 84.1%, specificity was 90.9%, accuracy was 87.7%, positive predictive value was 89.1%, and negative predictive value was 86.6%, respectively. It's sensitivity and accuracy were significantly higher than that of urine cytology (43.3%, P<0.05)(52.1%, P<0.05)and FISH (69.4%, P<0.05)(71.6%, P<0.05). The accuracy was significantly higher than that of urine cytology (52.1%, P<0.05) and FISH (71.6%, P<0.05); There was no statistically significant difference in specificity between urine cytology (100.0%) and FISH (88.9%) ( P>0.05). The results of subgroup analysis showed that the diagnostic sensitivity of urine DNA methylation test for tumors in different locations was 74.0% (37/50 cases) for ureteral cancer, 90.5% (38/42 cases) for renal pelvis cancer, and 100.0% (15/15 cases) for renal pelvis cancer combined with ureteral cancer.The diagnostic specificity for different benign diseases was 92.3% (96/104 cases) for urinary stones, 84.6% (11/13 cases) for ureteral stenosis and polyps, and 75.0% (3/4 cases) for simple hydronephrosis. The diagnostic sensitivity of urine DNA methylation test for low-grade UTUC was 64.3%, significantly higher than that of urine cytology (20.0%) and FISH(36.4%)( P<0.05). The diagnostic sensitivity for high-level UTUC was 87.1%, which was higher than that of urine cytology (48.0%) and FISH (75.4%)( P<0.05). The diagnostic sensitivity for non muscular invasive UTUC was 77.8%, which was significantly higher than that of urine cytology (29.2%) and FISH (64.5%)( P<0.05). The diagnostic sensitivity for myometrial infiltrative UTUC was 88.2%, which was superior to urine cytology (53.6%) and FISH (72.7%)( P<0.05). The sensitivity and specificity of urine DNA methylation test in Sun Yat-sen Memorial Hospital of Sun Yat-sen University were 83.0% and 92.0%, respectively.It’s sensitivity and specificity in Peking University First Hospital were 85.2% and 85.7%, respectively. Conclusions:The urine ONECUT2 and VIM gene methylation assay have high sensitivity and accuracy in upper urinary tract urothelial carcinoma, which are superior to urine cytology as well as FISH.

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