Objective To investigate the predictive value of new simplified insulin resistance (IR) assessment indexes in identifying subclinical left ventricular systolic function impairment in patients with type 2 diabetes mellitus (T2DM). Methods A total of 150 T2DM patients with preserved left ventricular ejection fraction (LVEF≥50%) who were admitted to Department of Endocrinology of the First Affiliated Hospital of Air Force Medical University from June 2021 to December 2021 were retrospectively analyzed. All patients underwent two-dimensional speckle tracking echocardiography to measure left ventricular global longitudinal strain (GLS). According to GLS value, the subjects were divided into the normal group (GLS≥18% group, n=80) and the impaired group (GLS<18% group, n=70). Some new simplified IR assessment indicators were calculated and compared between the two groups, including body mass index (BMI), TG/HDL‑C ratio, triglyceride-glucose (TyG) index, TyG‑BMI index, TyG‑WHR and metabolic score for IR (METS‑IR). Correlation between the GLS and the new simplified IR assessment indexes was analyzed. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of different simplified IR assessment indexes, with the area under the curve (AUC) calculated. Furthermore, according to whether the subjects were complicated with hypertension, binary logistics regression analysis was performed to explore the independent correlation between the simplified IR assessment index and GLS <18%. Results Total 150 were included with aged (54.5±13.7) years with 96 (64.0%) men and 54 (36.0%) women. Compared with the GLS≥18% group, the TG/HDL‑C ratio, TyG index, TyG‑BMI, and METS‑IR of subjects in the GLS<18% group were significantly increased (P<0.05). Pearson correlation analysis showed that TG/HDL‑C ratio, TyG index, TyG‑BMI, TyG‑WHR, and METS‑IR were negatively correlated with GLS (P<0.05). ROC analysis showed that TyG index had a certain predictive value for the evaluation of GLS<18% (AUC=0.678, 95%CI 0.591-0.765, P<0.001). Stratification based on hypertension and further adjusting for confounding factors, TyG index remains significantly associated with GLS<18% (OR=3.249, 95%CI 1.045-10.103, P=0.042). Conclusions The novel simplified insulin resistance evaluation indexes are closely associated with left ventricular subclinical systolic dysfunction in T2DM patients with preserved ejection fraction. TyG index is an effective index to identify left ventricular subclinical dysfunction in these populations.

Objective To investigate the clinical value of coronary computed tomography angiography (CCTA) based CT derived fractional flow reserve (CT-FFR) and ΔCT-FFR in improving the diagnostic efficiency for coronary abnormal hemodynamics in patients with severe calcification. Methods We retrospectively analyzed the clinical data of coronary artery disease (CAD) patients who underwent CCTA, CT-FFR, invasive coronary angiography (ICA) and FFR during hospitalization from January 2018 to June 2019 in Chinese PLA General Hospital. Severe calcification was defined as coronary artery calcium score (CACS) ≥100 on single vessel level. A total of 107 CAD patients with 149 coronary arteries were included in the present study. The enrolled coronary arteries were assigned to CACS≥100 group (n=56) and CACS<100 group (n=93). CT-FFR was performed on the deep FFR platform based on machine learning (ML) algorithms and ΔCT-FFR was defined as CT-FFR difference between proximal and distal to the coronary lesion. The correlation and consistency between CT-FFR and FFR values were analyzed by Pearson and Bland-Altman methods. We attempted to analyze the incremental value of ΔCT-FFR for coronary functional evaluation, especial for coronary arteries with severe calcification, regarding FFR≤0.8 as the diagnostic gold standard. Comparison of receiver operating characteristic curves (ROC) between different diagnostic methods was presented by Delong test. Results Pearson and Bland-Altman analyses showed appreciable correlation (CACS≥100 group, r=0.71, P<0.01; CACS<100 group, r=0.73, P<0.01) and consistency (CACS≥100 group, Mean=-0.01, P=0.25; CACS<100 group, Mean=0, P=0.96) between CT-FFR and FFR values in both groups. FFR (0.80±0.08 vs. 0.84±0.09, P=0.004) and CT-FFR (0.81±0.06 vs. 0.85±0.06, P<0.001) levels were significant lower in CACS≥100 group than those in CACS<100 group, while ΔCT-FFR (0.14±0.06 vs. 0.09±0.06, P<0.001) levels were significant higher in CACS≥100 group. Moreover, the diagnostic efficiency of CT-FFR in CACS≥100 group was inferior to that in CACS<100 group [AUC=0.792(95%CI 0.663-0.889) vs. AUC=0.929(95%CI 0.856-0.972), P=0.04], while it achieved significant improvement after ΔCT-FFR adjustment [AUC=0.876(95%CI 0.760-0.949) vs. AUC=0.792(95%CI 0.663-0.889), P=0.02] and was similar to that in CACS<100 group (P=0.37). Conclusion For coronary arteries with severe calcification, CT-FFR demonstrated significant incremental value in improving the diagnostic efficiency of coronary abnormal hemodynamics after ΔCT-FFR adjustment.

Objective To investigate the effect of different doses of statins on the clinical efficacy and safety outcome of intravenous thrombolytic therapy of urokinase in patients with acute ischemic stroke (AIS). Methods Based on a large prospective, multicenter study, the Chinese Intravenous Thrombolysis Registry for AIS within 4.5 h of onset (INTRECIS) database, clinical data of 898 patients with urokinase intravenous thrombolysis for AIS were retrospectively analyzed. According to the amount of statin used during hospitalization, the patients were divided into 132 patients in no-statin group, 591 patients in conventional statin group and 175 patients in intensive statin group. Clinical outcome measures included 14-day improvement in the National Institutes of Health Stroke Scale (NIHSS) and 90-day excellent prognosis (improved Rankin score ≤1 point). Safety measures included recurrent stroke, bleeding events, and 90-day all-cause mortality. Results After adjusting for differences in baseline characteristics (age, coronary heart disease, diabetes, atrial fibrillation, systolic blood pressure, OTT, DNT, previous anti-plate use, blood glucose, and treatment in Class A hospitals), NIHSS scores improved at 14 days after admission and excellent prognosis at 90 days after admission in convention-dose and intensive statin groups were superior to those in no-statin group (P<0.05); Univariate and multivariate analysis of safety outcome indicators showed no statistically significant differences in stroke recurrence and bleeding events among the three groups (P>0.05); The 90-day all-cause mortality was significantly higher in no-statin group (10.6%) than in convention-dose statin group (2.0%) and intensive dose statin group (2.9%) (P<0.01). Conclusions In patients with AIS who were treated with intravenous urokinase thrombolytic therapy, intensive statin use was associated with improved 14-day NIHSS score and near-term prognosis without increasing the risk of stroke recurrence and bleeding events. Statin use is beneficial to reduce mortality.

Objective To analyze the correlation between irritable bowel syndrome (IBS) as well as its subtypes and gallbladder stone. Methods Collected the clinical data of 556 patients who were treated in Department of Gastroenterology of the Sixth Medical Center of Chinese PLA General Hospital from January 2019 to March 2023. The patients were divided into IBS group (n=161) and non-IBS group (n=395). The subjects were investigated by questionnaire, physical examination and blood examination, and the data of gender, age, height, weight, blood pressure and blood biochemical indexes were obtained and compared between two groups. The relation between gallbladder stone and IBS were evaluated by logistic regression analysis. Results There were 90 cases of gallbladder stone in the total population, accounting for 16.2%, including 37 cases of gallbladder stone in IBS group (23.0%) and 53 cases in non-IBS group (13.4%). The prevalence rate of gallbladder stone in IBS group was significantly higher than that in non-IBS group (P<0.05). There were 6 cases of gallbladder muddy stones (3.7%) in IBS group and 3 cases (0.8%) in non-IBS group. And the prevalence rate of gallbladder muddy stones in IBS group was also significantly higher than that in non-IBS group (P<0.05). Logistic regression analysis showed that the age, BMI, total bile acids (TBA), total cholesterol (TC) and combined IBS were independently related to the occurrence of gallbladder stone (P<0.05). In the 161 IBS patients, there were 114 cases of diarrhea-predominant IBS (IBS-D group), including 26 cases (22.8%) of gallbladder stone in IBS-diarrhea (IBS-D, n=114) group and 47 cases of constipation-predominant IBS (IBS-C group), including 11 cases (23.4%) of gallbladder stone. And there were 53 cases (13.4%) of gallbladder stone in the non-IBS group (n=395). Further analysis showed that the prevalence rate of gallbladder stone in IBS-D group was significantly higher than that in non-IBS group (P<0.05). There was no significant difference in gallbladder stone prevalence rate between IBS-C group and non-IBS group (P>0.05). Conclusions There is a correlation between IBS and gallbladder stones. In addition, among the two subtypes of IBS, IBS-D patients may have an increased risk of gallbladder stone compared with non-IBS patients.

Objective To evaluate the characteristics of different antigen-specific T cell immune responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after inoculation with 2 doses of SARS-CoV-2 inactivated vaccine for 12 months. Methods Fifteen healthy adults were enrolled in this study and blood samples collected at 12 months after receiving two doses of SARS-CoV-2 inactivated vaccine. The level and phenotypic characteristics of SARS-CoV-2 antigen-specific T lymphocytes were detected by activation-induced markers (AIM) based on polychromatic flow cytometry. Results After 12 months of inoculation with 2 doses of SARS-CoV-2 inactivated vaccine, more than 90% of adults had detectable Spike and Non-spike antigen-specific CD4⁺ T cells immune responses (Spike: 14/15, P=0.0001; Non-spike: 15/15, P<0.0001). 80% of adults had detectable Spike and Non-spike antigen-specific CD8⁺ T cells immune responses (Spike: 12/15, P=0.0463; Non-spike: 12/15, P=0.0806). Antigen-specific CD4⁺ T cells induced by SARS-CoV-2 inactivated vaccination after 12 months were composed of predominantly central memory (CM) and effector memory 1 (EM1) cells. On the other hand, in terms of helper subsets, antigen-specific CD4⁺ T cells mainly showed T helper 1/17 (Th1/17) and T helper 2 (Th2) phenotypes. Conclusions SARS-CoV-2 inactivated vaccination generates durable and extensive antigen-specific CD4⁺ T cell memory responses, which may be the key factor for the low proportion of severe coronavirus disease 2019 (COVID-19) infection in China.

Objective To analyze the correlation between the ELL2 gene 1119 T>C polymorphism and the susceptibility to pleomorphic adenoma of the salivary gland. Methods The pedigree of the pleomorphic adenoma family of salivary gland was drawn. The exons of ELL2 gene in 5 members of salivary pleomorphic adenoma family were sequenced. A case-control study was conducted. One hundred and twelve patients with pleomorphic adenoma of the salivary gland who visited the Department of Oral and Maxillofacial Surgery of Shanxi Bethune Hospital from January 2016 to July 2020 were taken as case group, and 176 healthy examinees from January 2019 to January 2020 were taken as control group with age and sex as matching conditions. The 1119 T>C polymorphism of ELL2 genes in the two groups were detected with high resolution melting (HRM) curve. Chi-square test was adopted to analyze the correlation between gene polymorphism and the occurrence of pleomorphic adenoma of the salivary gland, stratified analysis was performed to evaluate the synergistic effect of smoking and genotype, and real time quantitative reverse transcription polymerase chain reaction (RT-PCR) was used to detect the expression level of ELL2 in individuals with different genotypes. Results The 1119 T>C polymorphism site existed in the exon 8 of ELL2 gene in a family with pleomorphic adenoma of salivary gland. The results of case-control study showed that the genotype frequency of homozygous CC was significantly higher in patients with pleomorphic adenoma of salivary gland than that in the controls (24.1% vs. 11.9%, P=0.002). Homozygous CC was associated with increased risk for developing pleomorphic adenoma of salivary gland (OR=3.059, 95%CI 1.494-6.263) in this cohort. Stratification analysis showed that smoking and 1119C allele cooperated to increase the risk of pleomorphic adenoma of salivary gland (OR=3.200, 95%CI 1.460-7.014). The expression level of ELL2 mRNA in CC genotype was significantly higher than that in individuals with CT or TT genotype (P<0.05). Conclusion The genetic variation of ELL2 may play an important role in the occurrence of pleomorphic adenoma of salivary gland, and smoking combined with the 1119C allele increased the risk of this disease.

Objective To evaluate the clinical effect of total optic nerve canal decompression in the treatment of traumatic optic neuropathy (TON) without photoreceptor. Methods The clinical data of 67 patients with no photoreceptor TON admitted to Department of Neurosurgery of the Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine from January 2015 to December 2021 were selected for retrospective analysis, in which 37 cases in observation group received total optic nerve canal decompression surgery and 30 cases in control group received non-total optic nerve canal decompression surgery. Both groups received high-dose glucocorticoid therapy and oral administration of methylcobalamin before surgery. The visual acuity changes and complications after admission and treatment were examined and recorded in both groups. The effective rate, unblinding rate and complications after treatment were compared between the two groups. Results There were no statistically significant differences between observation group and control group in terms of age, gender, time from injury to surgery, preoperative GCS score, operative time, and intraoperative bleeding volume (P>0.05). After treatment, the effective rate of observation group was 54.1% and the unblinding rate was 35.1%, while the effective rate of control group was 46.7% and the unblinding rate was 33.3%; there was no statistically significant difference between the effective rate and unblinding rate of the two groups (P>0.05). No serious complications such as cerebrospinal fluid leakage, epilepsy, and intracranial infection occurred in both groups after surgery. In observation group, the effective rate after treatment was significantly lower in those with optic nerve canal fractures than that in those without optic nerve canal fractures (P<0.05); the effective rate was significantly higher in patients with injury-to-operation time ≤7 d than that in patients with injury-to-operation time >7 d (P<0.05). Conclusion Total optic nerve canal decompression can improve the visual acuity of patients without photoreceptor TON and reduce the blinding rate, which is an effective surgical treatment method.

Objective To explore the advantages of modified Paine point puncture for intraventricular intracranial pressure (ICP) monitoring probe implantation during decompressive craniectomy (DC) for severe traumatic brain injury. Methods The clinical data of 48 patients with severe traumatic brain injury admitted from April 2020 to April 2022 in Jiaxing Second Hospital were retrospectively collected. All patients underwent DC combined with ICP monitoring probe implantation. According to different ICP monitoring methods, they were divided into observation group (23 cases) and control group (25 cases). The observation group underwent the implantation of the intracerebroventricular ICP monitoring probe by puncture at the modified Paine point in the DC incision, while the control group underwent implantation of intracerebroventricular ICP monitoring probe by drilling of the skull through contralateral incision of DC at the Kocher point. The preoperative general data, operation time, postoperative mannitol dose and duration, ICP monitoring duration, postoperative rebleeding rate, intracranial infection rate and Glasgow outcome score (GOS) at 3 months after the operation were compared between the two groups. Results There was no statistical difference between the two groups in general data, mannitol dosage, mannitol duration and ICP monitoring duration (P>0.05). The operation time, postoperative rebleeding rate and intracranial infection rate in observation group were lower than those in control group (P<0.05). In the GOS score at 3 months after the operation, there was no statistical difference between the two groups (P>0.05). Conclusions Compared with the traditional implantation of intraventricular ICP monitoring probe through Kocher point through skull drilling with contralateral incision of DC, the implantation of intraventricular ICP monitoring probe through modified Paine point in the DC incision for severe traumatic brain injury can shorten the operation time and lower the postoperative rebleeding rate and intracranial infection rate.

Objective To report a case of synovial sarcoma of the liver and review the literature for improving the understanding of the disease. Methods The clinical data of a patient with liver synovial sarcoma admitted to the First Affiliated Hospital of Henan University were analyzed retrospectively. The imaging, pathological features, treatment and prognosis of this disease were summarized by searching the database (CNKI, Wanfang Data, PubMed, untill July 2022) and the literature results analyzed comprehensively. Results The patient was a 71-year-old female who was admitted to the hospital due to abdominal pain. Computed tomography (CT) scan showed a mass with mixed density in the right lobe and caudate lobe of the liver. The large cross section size was about 115 mm×87 mm and the mass showed continuous heterogeneous enhancement, being considered as malignant hepatic tumors with multiple metastasis of the liver and lung. Ultrasound-guided needle biopsy was performed, and microscopy showed the tumor cells were obvious atypical, and some were spindle-shaped. Immunohistochemistry showed that the patient was positive for vimentin (VIM), epithelial membrane antigen (EMA), methylation of histone at lysine 27 (H3K27Me3), and negative for pan cytokeratin (CK-pan) and S-100, and pathological diagnosis of synovial sarcoma was made. The patient did not undergo subsequent treatment and was lost to follow-up after discharge. A total of 12 cases of hepatic synovial sarcoma were reported after searching the database. The clinical manifestations were abdominal pain or distention. The lesions were mostly located in the right lobe of the liver, usually large, heterogeneous density, and heterogeneous enhancement on enhanced CT or magnetic resonance imaging (MRI). Spindle-shaped cells were found at histopathologic examination. Immunohistochemistry showed the patient was positive for VIM, EMA, H3K27Me, B-cell leukemia/lymphoma-2 (BCL-2) and transducer-like enhancer of split 1 (TLE1). SS18-SSX fusion gene or SS18 gene isolation were detected. Eleven patients received surgical treatment, 5 received adjuvant chemotherapy, and 4 had recurrence or metastasis during the follow-up period. Conclusions Synovial sarcoma of the liver is a rare malignant tumor of the liver. The clinical and imaging features are not specific. The diagnosis depends on pathology. At present, the main treatment is surgery, and comprehensive treatment such as adjuvant chemotherapy can be performed. The prognosis of the patient is poor.

Objective To explore the role and possible molecular mechanism of Isocitrate dehydrogenase 1(IDH1) gene in proliferation and migration of intrahepatic cholangiocarcinoma (iCCA) cell HuCCT1. Methods HuCCT1 cells with IDH1 gene knockout (HuCCT1^IDH1-/-) were constructed by CRISPR/Cas9 gene editing technology. To investigate the capacities of proliferation, migration and invasion of HuCCT1^WT (HuCCT1 cells with wild-type IDH1 gene) and HuCCT1^IDH1-/- cells, assays of CCK-8, clone formation, scratch and transwell were performed. Western blotting was used to detect the expression levels of epithelial-mesenchymal transition(EMT) associated proteins E-cadherin, N-cadherin, Vimentin, MMP-9, Wnt3a and β-catenin in two groups of cells. The transcriptome sequencing data of HuCCT1^WT and HuCCT1^IDH1-/-cells were analyzed by bioinformatics methods, Western blotting was used to verify the expression of signaling pathway-related proteins. Results Compared with HuCCT1^WT cells, HuCCT1^IDH1-/- cells showed the number of proliferation and clone formation significantly reduced (P<0.05), the proportion of cells blocked in G₂/M phase was significantly increased (P<0.01), the rate of scratch healing was significantly decreased (P<0.01), and the number of migrated cells (P<0.001) and invaded cells (P<0.05) was significantly reduced. qRT- PCR assay showed that the expression levels of IDH1, Vimentin, MMP-9 and genes related to the regulation of G₂/M cycle proliferation, Cyclin A2, Cyclin B1 and CDK1 mRNA were down-regulated in HuCCT1^IDH1-/- cells (P<0.05), and the expression of CDH1 mRNA encoding E-cadherin was up-regulated (P<0.01); Western blotting assay showed that the expression level of E-cadherin in HuCCT1^IDH1-/- cells was significantly increased (P<0.05), and the expression level of N-cadherin, Vimentin and MMP-9 protein was significantly decreased (P<0.05) than that in HuCCT1^WT cells. Data of transcriptome sequencing revealed 1476 differentially expressed genes (DEGs) between two groups of HuCCT1 cells. Go enrichment analysis showed the DEGs were significantly enriched in cell biological processes associated with inflammatory response, cell signaling and cell metabolism. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis suggested that the DEGs may be involved in some signaling pathways such as Wnt,MAPK, Rap1, Hippo and TNF, which are closely related to the regulation of proliferation and invasion of tumor cells. Western blotting verification results showed that compared with HuCCT1^WT cells, the relative expression of Wnt3a and β‑catenin proteins of HuCCT1^IDH1-/- cells was significantly decreased (P<0.05). Conclusions IDH1 gene may participate in the control of biological functions of HuCCT1 cells, including cell proliferation, migration, invasion and epithelial mesenchymal transition.The mechanism may be related to the activation of the Wnt/β-catenin signaling pathway.