1.Effect of Fuzheng Huayu prescription on hepatocyte extinction and regeneration in a mouse model of liver cirrhosis
Tingting ZHU ; Jingshu QI ; Yanan GUO ; Hongliang LIU ; Yanyan TAO ; Zhimin ZHAO ; Zhengxin LI ; Chenghai LIU
Journal of Clinical Hepatology 2024;40(4):745-752
ObjectiveTo investigate the effect of Fuzheng Huayu prescription on hepatocyte extinction and regeneration in fibrotic liver and its mechanism of action in promoting hepatocyte regeneration. MethodsMice were given intraperitoneal injection of CCl4 for 6 weeks to establish a model of liver cirrhosis, and there were 10 mice in the model group, 10 in the sorafenib group, 10 in the Fuzheng Huayu prescription group, and 9 in the normal control group. Since week 4 of modeling, the mice in the Fuzheng Huayu prescription group and the sorafenib group were given the corresponding drug by gavage at a dose of 4.8 g/kg and 4 mg/kg, respectively, for three consecutive weeks, and those in the normal group and the model group were given an equal volume of sodium carboxymethyl cellulose. Serum liver function parameters were measured; the METAVIR scoring system was used to evaluate liver inflammation and fibrosis stage; Sirius Red staining and hydroxyproline (Hyp) content in liver tissue were used to evaluate collagen deposition; immunohistochemistry was used to measure the protein expression levels of type IV collagen, CD31, CD32b, Ki67, CyclinD1, glutamine synthetase, Wnt2, and HGF, and Western blot was used to measure the expression levels of Wnt2, LRP6, β-catenin, p-β-catenin, and CyclinD1 in liver tissue. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups. ResultsCompared with the model group, the Fuzheng Huayu prescription group and the sorafenib group showed the following changes: significant reductions in the serum levels of alanine aminotransferase and aspartate aminotransferase and the content of Hyp in liver tissue (all P<0.01); a significant reduction in METAVIR score; significant reductions in the expression levels of type Ⅳ collagen and CD31 (all P<0.05) and a significant increase in the expression level of CD32b (P<0.01); significant reductions in the number of parenchymal extinction lesions and significant increases in the expression levels of Ki67 and CyclinD1 in liver tissue (all P<0.01); significant increases in the protein expression levels of Wnt2, LRP6, β-catenin, and CyclinD1 and a significant reduction in the protein expression level of p-β-catenin (all P<0.05); significant increases in the number of cells stained positive for both CD32b and Wnt2. ConclusionFuzheng Huayu prescription can inhibit hepatic sinusoidal capillarization, improve the Wnt2 exocrine function of liver sinusoidal endothelial cells, activate the Wnt/β-catenin signaling pathway associated with hepatocyte regeneration, and finally reverse liver cirrhosis.
2.Evaluation of analgesic effect of nalbuphine in patients with non-mechanical ventilation in intensive care unit: a multi-center randomized controlled trail
Yi ZHOU ; Shaohua LIU ; Song QIN ; Guoxiu ZHANG ; Yibin LU ; Xiaoguang DUAN ; Haixu WANG ; Ruifang ZHANG ; Shuguang ZHANG ; Yonggang LUO ; Yu FANG ; Xiaoyun FU ; Tao CHEN ; Lening REN ; Tongwen SUN
Chinese Journal of Emergency Medicine 2024;33(1):59-64
Objective:To analyze the efficacy and safety of nalbuphine for analgesia in patients with non-mechanical ventilation in intensive care unit (ICU).Methods:From December 2018 to August 2021, a multicenter randomized controlled clinical study was conducted to select non-mechanical ventilation patients with analgesic needs admitted to ICU of four hospitals in Henan Province and Guizhou Province. Patients were randomly assigned to nalbuphine group and fentanyl group. The nalbuphine group was given continuous infusion of nalbuphine [0.05~0.20 mg/(kg·h)], and the fentanyl group was given continuous infusion of fentanyl [0.5~2.0 μg/(kg·h)]. The analgesic target was critical-care pain observation tool (CPOT) score<2. The observation time was 48 hours. The primary endpoint was CPOT score, the secondary endpoints were Richmond agitation-sedation score (RASS), ICU length of stay, adverse events, and proportion of mechanical ventilation. The quantitative data of the two groups were compared by t test or Mann-Whitney U test. The enumeration data were compared by chi square test or Fisher exact probability method. The data at different time points between groups were compared by repeated measures analysis of variance. Results:A total of 210 patients were enrolled, including 105 patients in the nalbuphine group and 105 patients in the fentanyl group. There was no significant difference in baseline data between the two groups (all P>0.05). There was no significant difference in CPOT score between nalbuphine group and fentanyl group at each time point after medication ( P>0.05), the CPOT score of both groups at each time point after medication was significantly lower than that before medication, and the analgesic target could be achieved and maintained 2 hours after medication. There was no significant difference in RASS between the two groups at each time point after medication ( P>0.05), which was significantly lower than that before medication, and the target sedative effect was achieved 2 hours after medication. There was no significant difference in ICU length of stay between nalbuphine group and fentanyl group [5.0(4.0,7.5) d vs. 5.0(4.0,8.0) d, P=0.504]. The incidence of delirium, nausea and vomiting, abdominal distension, pruritus, vertigo and other adverse events in the nalbuphine group was lower than that in the fentanyl group (all P<0.05). There was no significant difference in the incidence of other adverse events such as deep sedation, hypotension and bradycardia between the two groups (all P>0.05). The incidence of respiratory depression in nalbuphine group was not significantly different from that in fentanyl group ( P>0.05), but the proportion of mechanical ventilation was significantly lower than that in the fentanyl group [1.9% (2/105) vs. 8.6%(9/105), P=0.030]. Conclusions:Nalbuphine could be used for analgesia in ICU patients with non-mechanical ventilation. The target analgesic effect could be achieved within 2 hours, and it had a certain sedative effect with a low incidence of adverse reactions.
3.Changes of video head impulse test before and after translabyrinthectomy in patients with acoustic neuroma
Wei LI ; Shuguang ZOU ; Tao YANG ; Anquan PENG ; Zhiwen ZHANG ; Qin WANG
Journal of Central South University(Medical Sciences) 2024;49(5):679-686
Objective:Acoustic neuroma(AN)is a benign tumor that usually affects a patient's hearing and balance function.For the screening and diagnosis of AN,the traditional approach mainly relies on audiological examination and magnetic resonance imaging(MRI),often ignoring the importance of vestibular function assessment in the affected area.As an emerging method of vestibular function detection,video head impulse test(vHIT)has been widely used in clinic,but research on its use in AN diagnosis is relatively limited.This study aims to explore the value of vHIT in the diagnosis of AN,vestibular dysfunction assessment,and postoperative compensation establishment in unilateral AN patients undergoing unilateral AN resection through labyrinthine approach. Methods:This retrospective study was conducted on 27 AN patients who underwent unilateral AN resection via labyrinthine approach from October 2020 to March 2022 in the Department of Otolaryngology-Head and Neck Surgery,the Second Xiangya Hospital,Central South University.vHIT was performed 1 week before surgery to assess vestibular function,pure tone audiometry(PTA)was used to assess hearing level,and ear MRI was used to assess tumor size.Follow-up vHIT was conducted at 1 week,1 month,6 months,and 1 year post-surgery.The correlation of vHIT with hearing and tumor size was analyzed. Results:Preoperative vHIT showed that the posterior semicircular canal on the affected side was the most common semicircular canal with reduced vestibulo-ocular reflex(VOR)gain.There was a correlation between the VOR gain of vHIT on the affected side and the hearing level(r=-0.47,P<0.05)or tumor size(r=-0.54,P<0.01).The results of vHIT on the affected side showed that the hearing level and mean VOR gain of the anterior semicircular canal increased slightly with time,and the amplitude and saccade percentage of the dominant saccades of the 3 semicircular canals increased,while the latency time decreased,with the most obvious changes occurring 1 week post-surgery. Conclusion:vHIT can effectively monitor the changes of vestibular function in AN patients before and after surgery and has application value in assisting the diagnosis of vestibular dysfunction in AN patients.
4.Tiaoqi Jieyu acupuncture for treatment-resistant depression: a randomized controlled trial.
Yuan GAO ; Qiu-Yu TONG ; Wen MA ; Guan-Tao WANG ; Yi-Jing LI ; Wa CAI ; Kun ZHANG ; Ran LIU ; Wei-Dong SHEN
Chinese Acupuncture & Moxibustion 2023;43(4):417-421
OBJECTIVE:
To observe the effect of Tiaoqi Jieyu (regulating qi and relieving depression) acupuncture on the clinical symptoms of treatment-resistant depression (TRD), and to explore the relationship between the acupuncture pain sensitivity and symptom's improvement.
METHODS:
A total of 78 patients with TRD were randomly divided into an observation group (39 cases, 3 cases dropped off) and a control group (39 cases, 4 cases dropped off). The patients in the control group were treated with medications according to the treatment plan of psychiatrists (at least one medication was 5-hydroxytryptamine reuptake inhibitor). On the basis of the control group, the patients in the observation group were treated with Tiaoqi Jieyu acupuncture, and Baihui (GV 20), Yintang (GV 24+), Yanglingquan (GB 34), Taichong (LR 3), Hegu (LI 4), Neiguan (PC 6), Yinlingquan (SP 9) and Zusanli (ST 36), etc. were selected. The acupuncture was given three times a week. Both groups were treated for 8 weeks. After 8-week treatment, the response rate of Hamilton depression scale-24 (HAMD-24) score after was evaluated in the two groups. The scores of HAMD-24 and Hamilton anxiety scale (HAMA) were compared between the two groups before treatment, after 4, 8-week treatment and 12 weeks after treatment (follow-up). After the first treatment and 8-week treatment, the visual analogue scale (VAS) score in the observation group was evaluated, and the correlation between VAS score after the first treatment and HAMD-24 score before treatment, between VAS score after the first treatment and the course of disease in the observation group was analyzed, and the correlation between difference of VAS after 8-week treatment and after the first treatment and difference of HAMD-24 score before treatment and after 8-week treatment was analyzed.
RESULTS:
After 8-week treatment, the response rate of HAMD-24 score in the observation group was 52.8% (19/36), higher than 17.1% (6/35) in the control group (P<0.001). Compared before treatment, the scores of HAMD-24 and HAMA in the two groups were decreased after 4-week treatment, 8-week treatment and in follow-up (P<0.05), and those in the observation group were superior to the control group (P<0.05). After 8-week treatment, the acupuncture pain VAS score in the observation group was (5.28±2.13) points, which was higher than (3.33±1.62) points after the first treatment (P<0.001). There was a negative correlation between VAS score after the first treatment and HAMD-24 score before treatment in the observation group (r =-0.486, P=0.003); there was no correlation between acupuncture pain VAS score after the first treatment and the course of disease in the observation group (P>0.05). After 8-week treatment, there was a positive correlation between the difference of VAS score and the difference of HAMD-24 score in the observation group (r =0.514, P=0.001).
CONCLUSION
Tiaoqi Jieyu acupuncture could improve the depression and anxiety in patients with TRD, and the symptom's improvement is related to the recovery of acupuncture pain sensitivity.
Humans
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Depression/therapy*
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Treatment Outcome
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Acupuncture Therapy
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Acupuncture Points
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Pain
5.A Multicenter Clinical Trial of Pudilan Anti-inflammatory Oral Liquid of Different Doses in Treatment of Acute Pharyngitis/Tonsillitis Caused by Bacterial Infection in Adults
Dinglei LI ; Yinghai CUI ; Xuefeng YU ; Min PANG ; Wei ZHANG ; Zhanping MA ; Nianzhi ZHANG ; Tao HUANG ; Mingbo LIAO ; Yiqing QU ; Zhuying LI ; Xiu GU ; Liqi NI
Chinese Journal of Experimental Traditional Medical Formulae 2023;29(19):136-144
ObjectiveThrough a randomized, double-blind, double-simulation, positive-control, multicenter design, this study aimed to analyze the relationship between the dosage, efficacy, and safety of Pudilan anti-inflammatory oral liquid in treating acute pharyngitis/tonsillitis in adults caused by bacterial infection and validate the regulatory effect of Pudilan anti-inflammatory oral liquid on inflammatory markers such as serum amyloid A (SAA), C-reactive protein (CRP), white blood cells (WBC), neutrophil percentage (NE%), and erythrocyte sedimentation rate (ESR), thereby exploring the feasibility of using Pudilan anti-inflammatory oral liquid as a substitute for antibiotics in the treatment of infectious diseases and providing a basis for rational clinical medication. MethodUsing a stratified randomized, double-blind, double-simulation, positive-control, multicenter design, 220 participants were enrolled from nine centers. The participants were randomly divided into three groups at 1∶1∶1 — a Pudilan anti-inflammatory oral liquid 20 mL group (73 cases), a Pudilan anti-inflammatory oral liquid 10 mL group (73 cases), and a control group (amoxicillin group, 74 cases). The treatment course was 7 days. The study observed parameters including the total effective rate of sore throat, onset and disappearance time of sore throat, health status score, treatment time, and inflammation markers. Result①Dataset division: The 211 cases were included in the full analysis dataset (FAS), 208 cases were included in the per-protocol dataset (PPS), and 218 cases were included in the safety dataset (SS). ② Efficacy evaluation: There were statistically significant differences (P<0.05) in the comparison of the three groups regarding the total effective rate of sore throat, disappearance time of sore throat, and health status. Both the 20 mL and 10 mL groups were non-inferior to the control group, and there was a statistically significant difference between the 20 mL and 10 mL dosage groups (P<0.05). There was no statistically significant difference in the comparison of onset time of sore throat among the groups. CRP, WBC, and NE% of patients in all three groups significantly decreased on the 7th day of treatment compared with those before treatment (P<0.01). ③Safety evaluation: Adverse events mainly occurred in various examination indicators. There were no statistically significant differences in the comparison between groups, and no adverse reactions or serious adverse events occurred. ④Economic evaluation: The increased cost of the 10 mL and 20 mL dosage groups was entirely justified as compared with that in the control group. When comparing the 10 mL and 20 mL dosage groups, the 10 mL dosage group was deemed less advantageous. ConclusionPudilan anti-inflammatory oral liquid can be used alone as an alternative to antibiotics in the treatment of acute pharyngitis/tonsillitis caused by bacterial infection. It demonstrates good safety and can lower inflammation markers such as CRP, WBC, and NE%, suggesting its potential to reduce the body's inflammatory response. Its mechanism of action may be related to its multi-target regulatory mechanism.
6.Role of glutathione transferase in nonalcoholic fatty liver disease: An analysis based on gene expression profile
Tingting SHEN ; Gerui ZHU ; Fan WANG ; Xin SUN ; Kai HUANG ; Yuan PENG ; Yanyan TAO ; Chenghai LIU
Journal of Clinical Hepatology 2023;39(1):89-96
Objective To investigate the role of glutathione transferase in nonalcoholic fatty liver disease (NAFLD) induced by high-fat diet using the RNA-Seq technique in combination with gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses of differentially expressed genes. Methods A total of 14 male C57BL/6J mice were divided into control group with 6 mice and model group with 8 mice by random sampling. The mice in the control group were fed with normal diet, and those in the model group were fed with high-fat diet for 7 consecutive weeks to establish a model of NAFLD. Kits were used to measure the activities of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and the level of triglyceride (TG), and HE staining and oil red staining were used to observe liver pathology and deposition of lipid droplets. Liver tissue RNA was extracted for RNA-Seq, and genes with a fold change of ≥2.0 and a P value of < 0.05 were defined as differentially expressed genes; after differentially expressed genes were screened out between the control group and the model group, GO and KEGG enrichment analyses were performed, and qRT-PCR was used to validate the expression of the differentially expressed genes. The independent samples t -test was used for comparison of normally distributed continuous data between two groups. Results There were no significant differences between the two groups in body weight and the serum levels of ALT and AST (all P > 0.05). Compared with the control group, the model group had a significantly higher serum level of TG (2.02±0.50 mmol/L vs 1.00±0.29 mmol/L, t =-4.45, P =0.001). HE staining showed diffuse steatosis and ballooning degeneration in the model group, and oil red staining showed that the model group had a significant increase in orange-red lipid droplets in the cytoplasm of hepatocytes and a significantly higher grade of hepatocyte steatosis than the control group (1.88±0.64 vs 1.00±0.00, t =-3.86, P =0.006). RNA-seq results showed a total of 1367 differentially expressed genes between the two groups, among which there were 608 upregulated genes and 759 downregulated genes, and there were 17 differentially expressed GST genes between the two groups. The top 10 GST genes in terms of fold change were validated, and compared with the control group, the model group had downregulated expression of GSTa2, GSTa3, GSTa4, GSTm1, GSTm2, GSTm3, GSTm4, GSTp1, and GSTo1 and upregulated expression of GSTk1. The results of qRT-PCR were consistent with the results of sequencing. Conclusion GST affects lipid metabolism by participating in various biological processes such as steroid metabolism, fatty acid metabolism, and cholesterol metabolism and is closely associated with the pathogenesis of NAFLD.
7.Effect of traditional Chinese medicine on portal vein thrombosis in patients with liver cirrhosis and its medication characteristics
Yanan GUO ; Hongtu GU ; Changqing ZHAO ; Yongping MU ; Jili YUAN ; Feng XING ; Yanyan TAO ; Jing LYU ; Chenghai LIU
Journal of Clinical Hepatology 2023;39(2):345-351
Objective To investigate the therapeutic effect of traditional Chinese medicine (TCM) on portal vein thrombosis (PVT) in patients with liver cirrhosis and its medication characteristics. Methods A retrospective analysis was performed for 89 patients with liver cirrhosis and PVT who were hospitalized and treated in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, and according to whether TCM treatment was applied in combination, they were divided into TCM group with 59 patients and control group with 30 patients. Related data were collected for the two groups, including demographic data, laboratory examination, radiological examination, gastroscopy, history of surgery, portal hypertension-related complications, medication, and follow-up data. The independent samples t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. An ordinal polytomous Logistic regression analysis was used for multivariate analysis. TCM Inheritance Computing Platform (V3.0) was used to perform a drug effect cluster analysis of TCM prescriptions. Results The multivariate logistic regression analysis showed that esophageal and gastric varices (odds ratio [ OR ]=3.144, 95% confidence interval [ CI ]: 1.221-8.094), PVT involving the portal vein (PV) and the superior mesenteric vein (SMV) ( OR =51.667, 95% CI : 3.536-754.859), PVT involving PV+spleen vein (SV)+SMV ( OR =13.271, 95% CI : 2.290-76.928), cavernous transformation of the portal vein ( OR =11.896, 95% CI : 1.172-120.696), and TCM intervention ( OR =0.348, 95% CI : 0.129-0.938) were influencing factors for the outcome of PVT in liver cirrhosis. Follow-up results showed that compared with the control group, the TCM group had a significantly lower progression rate (16.95% vs 56.67%, P < 0.001) and a significantly lower incidence rate of variceal rupture and bleeding (8.47% vs 33.33%, P < 0.001). Effective TCM drugs with a relatively high frequency of use included deficiency-tonifying drugs (359 times, 34.6%), blood-activating and stasis-resolving drugs (202 times, 19.5%), and diuresis-inducing and dampness-draining drugs (180 times, 17.3%); the TCM drugs with a relatively high frequency of use included Astragalus membranaceus (57 times, 8.7%), Angelica sinensis (50 times, 7.6%), and leech (48 times, 7.3%); TCM drug combinations with a relatively high frequency of use included Astragalus membranaceus+Angelica sinensis, Astragalus membranaceus+leech, Angelica sinensis+leech, and Astragalus membranaceus+Angelica sinensis+leech. Conclusion Qi-tonifying, blood-activating, and stasis-breaking drugs, such as Astragalus membranaceus, Angelica sinensis, and leech, can promote the stabilization or recanalization of PVT in liver cirrhosis and reduce the incidence rate of bleeding events due to portal hypertension.
8.A preliminary study on the peripheral seroimmunological characteristics of drug-induced liver injury
Yu WANG ; Qiong LUO ; Shu LI ; Xiaoping SHEN ; Shuang LI ; Yanyan TAO ; Chenghai LIU
Journal of Clinical Hepatology 2022;38(5):1097-1100
Objective To investigate the characteristic manifestation of the peripheral seroimmunological indicators such as cellular immunity and cytokines in drug-induced liver injury (DILI). Methods The medical records of 219 patients with DILI collected in Shuguang Hospital and Baoshan Branch from January 2019 to August 2021 were retrospectively analyzed, grouped according to the type of drug injury and the degree of injury, and their clinical characteristics, biochemical and peripheral serum immunological characteristics were analyzed. analyze.Twenty-nine cases were selected from the healthy subjects as the normal liver function group, and 42 cases of DILI cases who had undergone cytokine and cellular immune evaluation within 1 week before the acute onset treatment were confirmed as the DILI control group. The t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the Fisher test was used to compare the count data between groups. Results Among the 219 DILI patients, 122 (56%) were female and 97 (44 %) were male. 89 cases (40%) of injuries were caused by traditional Chinese medicines, proprietary Chinese medicines or health products, and 130 cases (60%) were caused by western medicines such as anti-tuberculosis and anti-tumor. Among them, 82 cases (37%) were classified as hepatocyte injury type, 17 cases (8%) of cholestatic type, and 120 cases (55%) of mixed injury type. The longest incubation period was 180 days, the shortest was 1 day, and the median was 15 days. Fatigue accounted for 49% of the main symptoms. There were statistically significant differences in cytotoxic T lymphocytes (%) and CD4/CD8 ratio between the traditional Chinese medicine, Chinese patent medicine or health product group and the western medicine group ( Z =2.55 and 3.08, P =0.011 and 0.002, ). From 219 DILI patients, it was confirmed that 42 patients who had detected peripheral immune indicators were compared with 29 patients with normal liver function physical examination. The statistical analysis showed that IL-6 and IL-10 were statistically significant in the peripheral immune serum distribution of DILI. Significance ( Z =3.828 and 2.695, P < 0.001 and 0.007). Conclusion Cytotoxic T lymphocytes may play different roles in the pathogenic mechanisms of Chinese herbal medicines, Chinese patent medicine preparations or health products and western medicines; drugs or drug-protein complexes may affect inflammatory and immune pathways and release related cytokines For example, IL-6 and IL-10 are involved in the pathogenesis of DILI.
9.Twelve-section ultrasonic screening diagnosis method for neonatal complex congenital heart disease in primary hospitals at county level
Xinjian HE ; Jiuru WEI ; Jiaoyang CHEN ; Lei LIU ; Jie YAO ; Shuguang TAO ; Shuai ZHANG ; Ning ZHAO ; Zhe REN ; Yun CUI
Chinese Journal of Perinatal Medicine 2022;25(8):582-591
Objective:To investigate the feasibility of "twelve-section ultrasonic screening diagnosis method" in screening for neonatal complex congenital heart disease (CHD) in primary hospitals.Methods:This is a prospective study. A total of 71 580 newborns were screened for CHD using the "twelve-section ultrasonic screening diagnosis method" from four pilot units in Hebei province, which were Bo'ai Hospital of Huanghua Development Zone, Traditional Chinese Medicine Hospital of Fengning County, Maternity & Child Healthcare Hospital of Tang Country, and Maternity & Child Healthcare Hospital of Rongcheng Country, from November 2015 to December 2019. Another 262 children with CHD were enrolled, including 39 with complex CHD. These cases received ultrasonography at four pilot units above and then were transferred to CHD Screening Diagnosis and Treatment Center of Hebei Children's Hospital (our center) prior to the implementation of "twelve-section ultrasonic screening diagnosis method" from June 2012 to June 2014, who were all confirmed by surgery. Set the diagnosis results of our center as the gold standard, the sensitivity, specificity, and diagnostic consistency rate in screening for complex CHD cases were calculated. Receiver operating characteristic (ROC) analysis and Chi-square test were used to compare and analyze the sensitivity for screening neonatal complex CHD before and after implementing the method. The screening results of complex CHD after implementing the method between the pilot units and our center as well as between the four pilot units were compared and analyzed using Chi-square test. Results:A total of 553 (0.77%) CHD cases were detected by the "twelve-section ultrasound screening diagnosis method", including 66 cases of complex CHD and 487 cases simple CHD. Among the cases screened using the method, there were three false negative cases (one case with total anomalous pulmonary venous drainage, one with abnormal coronary artery originating from pulmonary artery, and one with atresia of distal to the left subclavian artery, aortic arch and left aortic arch of double-arch), one false positive case (false echo loss of aortopulmonary septal that was misdiagnosed as aortopulmonary septal defect), five cases of misdiagnosis (one common pulmonary venous atresia case that was misdiagnosed as total anomalous pulmonary venous drainage, one persistent stenosis of the fifth aortic arch that was misdiagnosed as coarctation of aorta, one pulmonary artery sling that was misdiagnosed as absence of left pulmonary artery, one severe coarctation of aorta that was misdiagnosed as interruption of aortic arch, and one aortic isthmus atresia that was misdiagnosed as coarctation of aorta), and all were complex CHD cases. A total of 68 cases (12.3%) of complex CHD were confirmed by our center. The overall sensitivity, specificity, and diagnostic consistency rate of screening were 95.6% (65/68), 99.8% (484/485), and 86.8% (59/68), respectively and the area under ROC curve was 0.98. Before the implementation, the overall sensitivity, specificity, and diagnostic coincidence rates of ultrasonic screening for complex CHD were 69.2%(27/39), 95.5%(213/223), and 61.5% (24/39), respectively, and the area under ROC curve was 0.82. The sensitivity of complex CHD screening was significantly increased after implementing the method ( χ2=14.28, P<0.05). There was no significant statistical significance in the sensitivity for screening complex CHD after the implementation between the pilots and our center or between the four pilots (all P>0.05). Conclusions:"Twelve-section ultrasonic screening diagnosis method" is suitable for the screening of neonatal complex CHD in hospitals at the county level. However patients with some special types of complex CHD are recommended to be transferred for a more accurate diagnosis.
10.Application of endoscopic ultrasound in tumor staging of adenocarcinoma of the esophagogastric junction after neoadjuvant therapy
Tao PENG ; Huibin GAO ; Zhan LOU ; Shuguang LI ; Xiaoyong ZHAI
Cancer Research and Clinic 2022;34(11):826-830
Objective:To investigate the application value of endoscopic ultrasound (EUS) in tumor staging of adenocarcinoma of the esophagogastric junction (AEG) after neoadjuvant concurrent chemoradiotherapy.Methods:The clinical data of 40 patients diagnosed with stage Ⅲ AEG and treated with neoadjuvant concurrent chemoradiotherapy from January 2016 to December 2021 in the First Affiliated Hospital of Hebei North University were retrospectively analyzed. EUS was used to perform preoperative tumor staging after neoadjuvant concurrent chemoradiotherapy to evaluate the therapeutic effect, and the consistency between EUS and postoperative pathological staging was analyzed.Results:In 40 AEG patients after neoadjuvant chemoradiotherapy, the EUS staging was stage yp-uT 2 in 12 cases, stage yp-uT 3 in 18 cases, and stage yp-uT 4 in 10 cases. The postoperative pathological staging was stage pT 1 in 2 cases, stage pT 2 in 14 cases, stage pT 3 in 12 cases, and stage pT 4 in 12 cases. Taking postoperative pathological results as the gold standard, the accuracy of EUS for T staging after neoadjuvant chemoradiotherapy was 62.5%, and the accuracy, sensitivity and specificity for stage T 2 were 58.3%, 50.0% and 80.8%, respectively. The accuracy, sensitivity and specificity for stage T 3 were 61.1%, 91.7% and 75.0%, respectively. The accuracy, sensitivity and specificity for stage T 4 were 70.0%, 58.3% and 89.3%, respectively. The Kappa value of the consistency test between yp-uT staging and pT staging was 0.453. The EUS staging of lymph nodes was stage yp-uN 0 in 15 cases, stage yp-uN 1 in 10 cases, stage yp-uN 2 in 10 cases, and stage yp-uN 3 in 5 cases. The postoperative pathological staging was stage pN 0 in 18 cases, stage pN 1 in 7 cases, stage pN 2 in 7 cases, and stage pN 3 in 8 cases. Taking postoperative pathological results as the gold standard, the accuracy rate of EUS for N staging after neoadjuvant chemoradiotherapy was 57.5%, and the accuracy, sensitivity and specificity of EUS for stage N 0 were 73.3%, 61.1% and 81.8%, respectively. The accuracy, sensitivity and specificity for stage N 1 were 50.0%, 71.4% and 84.8%, respectively. The accuracy, sensitivity and specificity for stage N 2 were 40.0%, 57.1% and 81.8%, respectively. The accuracy, sensitivity and specificity for stage N 3 were 60.0%, 37.5% and 93.8%, respectively. The Kappa value of the consistency test between yp-uN staging and pN staging was 0.409. Conclusions:EUS is not accurate for T staging in patients with stage Ⅲ AEG after neoadjuvant therapy, but has high sensitivity for stage T 3 and high specificity for stage T 4. EUS has low sensitivity for N staging in patients with stage Ⅲ AEG after neoadjuvant therapy, but has high specificity for stage N 3.

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