Actively Managing Obesity to Reduce the Risk of Cardiovascular Disease
GUO Yuyang, ZENG Qingchun
Background Obesity and Cardiovascular Disease, a statement released by the American Heart Association on April 22, 2021, gives a summary of the impact of obesity on the diagnosis, clinical management and prognosis of atherosclerotic cardiovascular disease, heart failure, sudden cardiac death and atrial fibrillation.
What This Study Found In view of the present clinical management of cardiovascular diseases in China, this paper interprets the content of the statement in detail, aiming to provide guidance relevant to domestic cardiovascular management practices.
Implications This paper interprets the content of the statement in detail, aiming to provide guidance relevant to domestic cardiovascular management practices.
Summary of the Essentials for the Diagnosis and Treatment of Sexually Transmitted Proctitis，Proctocolitis and Enteritis from CDC's Sexually Transmitted Infections Treatment Guidelines，2021
https://www.chinagp.net/CN/10.12114/j.issn.1007-9572.2021.02.112
LENG Xinying，ZOU Huachun，FU Leiwen，KE Wujian
Background Sexually transmitted infections (STIs) may cause symptomatic proctitis, proctocolitis and enteritis. Given that there are still many questions in the management of proctitis, proctocolitis and enteritis caused by STIs.
What This Study Found On July 23, 2021, CDC released the latest guidelines on the diagnosis and treatment of STIs. Combining the latest literature and clinical experience, the article focused on the interpretation of the differences between the new version and the previous version.
Implications Assist clinicians in the management of proctitis, proctocolitis and enteritis caused by STIs.
Latent Profile Analysis of Benefit Finding in Patients with Inflammatory Bowel Diseases
https://www.chinagp.net/CN/10.12114/j.issn.1007-9572.2021.02.085
SUN Caiyun，LIN Zheng，ZHOU Meijing，GU Zijun，LUO Dan，WANG Mi，GU Junyi，ZHU Zhanhui
Background Patients with inflammatory bowel disease (IBD) are vulnerable to a variety of negative emotions due to recurrence of disease symptoms and prolonged unhealing. With the rise of positive psychology, scholars have discovered that in addition to the perceived negative emotions in the process of illness, individuals also conduct cognitive reappraisal on stressful events and explore the positive meaning brought by the disease, that is, benefit finding.
What This Study Found Patients with IBD had obvious differences in characteristics by benefit finding. Low benefit finding-coping disability group accounted for a relatively larger proportion (50.9%). The influencing factors involved positive emotion expression, negative emotion expression and perceived support.
Implications To improve benefit finding of these patients, medical workers should pay more attention to those with low benefit finding-coping disability, encourage them to express disease related feelings and promote their perception of social support.
Prevalence and Associated Factors of Kinds of Dietary Restrictions in Patients with Inflammatory Bowel Disease：a Multicenter Study
WANG Yu，TU Wenjing，ZHANG Ping，FANG Jian，SHI Yi，LIU Xiaowen，JIN Hongcheng
Background Diet has been proven to be an important factor affecting the occurrence, development and outcome of inflammatory bowel disease (IBD), but there are few studies in China on dietary restriction, a common diet management problem in patients with IBD.
What This Study Found The kinds of dietary restrictions differed significantly by gender, body mass index, living status (living alone or with others), economic burden, type of IBD, course of IBD, prevalence of surgical treatment, incidence of complications, prevalence of receiving dietary guidance, and receiving dietary guidance from dietitian or gastroenterologist in IBD patients. Multiple linear regression analysis results showed that, gender, body mass index, living status, and incidence of complications were associated with the kinds of dietary restrictions in IBD patients.
Implications Dietary restrictions are common and serious in IBD patients, whose kinds may be related to patients' gender, body mass index, living status and incidence of complications.
Risk Factors of Dysphagia in Parkinson's Disease
SHI Xiaoxue，ZHENG Jinhua，MA Jianjun，WANG Zhidong，SUN Wenhua，LI Mingjian，HUANG Shen，HU Shiyu，LI Dongshen
Dysphagia is a common non-motor symptom of Parkinson's disease (PD), which may cause Background pneumonia, malnutrition, and declined quality of life. However, risk factors of dysphagia in PD are still unclear.
What This Study Found There were significant difference in terms of age, Hoehn-Yahr classification, Unified Parkinson's Disease Rating Scale (UPDRS) Ⅰ, Ⅱ and Ⅲ scores, incidence of sialorrhea, the 14-item Hamilton Anxiety Scale (HAMA-14) score, the 24-item Hamilton Depression Scale (HAMD-24) score, Mini-mental State Examination (MMSE) score and uric acid between these two groups. Multivariate Logistic regression analysis showed that, UPDRSⅢ score≥35, sialorrhea, HAMA-14 score≥13 and uric acid <251 μmol/L were independent risk factors of dysphagia in PD. ROC curve analysis showed that, AUC of UPDRS Ⅲ score, sialorrhea, HAMA-14 score and uric acid was 0.750, 0.682, 0.638 and 0.670 in predicting dysphagia in PD, with sensitivity of 69.4%, 56.5%, 59.7% and 64.5%, specificity of 80.0%, 80.0%, 71.1% and 66.7%, Youden index of 0.494, 0.365, 0.308 and 0.312, respectively.
Implications UPDRSⅢ score≥35, HAMA-14 score≥13, sialorrhea and uric acid <251 μmol/L are independent risk factors of dysphagia in PD, and the above four risk factors has certain predictive value for dysphagia in PD.
A Predictive Nomogram for the Risk of Peripheral Neuropathy in Type 2 Diabetes
LI Yongsheng，ZHANG Xueliang，LI Cheng，FENG Zhiwei，WANG Kai
Background Effective treatment has not been worked out so far for diabetic peripheral neuropathy (DPN) in type 2 diabetes which is regarded as highly prevalent and quite harmful.
What This Study Found Among the 15 020 cases, 6 133 had DPN, and other 8 887 did not. The findings of Lasso regression with multivariate Logistic regression analyses showed that age, diabetic retinopathy, duration of diabetes, glycosylated hemoglobin and high-density lipoprotein were associated with DPN. The predictive nomogram was established by employing the above-mentioned variables. The AUC of the nomogram for identifying DPN in the training group was 0.858, and in the validation group was 0.852. The nomogram was found with a high goodness of fit by the Hosmer-Lemeshow test . DCA showed that when the threshold probability of patients was 0 to 0.9, using the nomogram resulted in higher net benefit of predicting the risk of DPN.
Implications We successfully established and verified a nomogram (with above-mentioned five variables included) with a high accuracy, which may be used as a tool facilitating the improvement in early identification or screening of DPN in high-risk type 2 diabetics.
Correlation of Visceral Fat with Bone Mineral Density and Osteoporotic Fracture Risk in Patients with Type 2 Diabetes
XIONG Dan，LIU Lijun，HE Peixiang，PENG Weixia，PENG Ke，ZHONG Yaqin，LI Juxiang，XU Xuehui，DING Ting
Background Obesity is strongly associated with type 2 diabetes mellitus (T2DM). But the relationship of obesity with bone mineral density (BMD) and osteoporotic fractures in T2DM patients is not very clear.
What This Study Found T2DM patients had higher weight, BMI and visceral fat area than those without diabetes. T2DM women had lower femoral neck BMD and hip BMD, and may be at higher risk of 10-year hip osteoporotic fracture. Visceral fat area was negatively correlated with femoral neck BMD and total hip BMD in T2DM women.
Implications The risk of 10-year hip osteoporotic fracture may increase as visceral fat area increases in postmenopausal women with or without T2DM.
Predictive Value of Age Shock Index for Adverse Outcomes in Patients with Acute Gastrointestinal Bleeding
GAN Junying，XU Heping*，WU Kaifang，CHEN Yunmei，YE Xiaojuan
Background Acute gastrointestinal bleeding (AGB) is one of the common emergencies for patients of emergency department. How to quickly and accurately stratify the risk of AGB is essential to improving the prognosis. Therefore, a simple, fast and easy-to-operate method is needed to early detect emergency patients at high-risk of AGB.
What This Study Found The average SI, ASI and MSI of patients with adverse outcomes were all higher than those without (P<0.05). SI, ASI and MSI were all of statistical significance in predicting the adverse outcomes. Specifically, ASI had a larger AUC than SI and MSI for predicting adverse outcomes in AGB, but the AUC of SI was similar to that of MSI. Both SI and ASI were of statistical significance in predicting theadmission to the ICU. SI, ASI and MSI were all of statistical significance in predicting the requirement for blood transfusion. SI was of statistical significance in predicting the requirement for E/C intervention. The cut-off point of ASI predicting adverse outcomes in AGB was 45.12. Spearman correlation analysis indicated that the number of adverse outcomes in AGB had a positive relation with SI (rs=0.255, P=0.002), ASI and MSI.
Implications ASI is easy to be calculated during the triage phase, and it may be superior to both SI and MSI in terms of predicting adverse outcomes in AGB.
Effects of Different Exercise Modalities on Metabolic Indices and Pregnancy Outcomes in Patients with Gestational Diabetes Mellitus
ZHONG Xin，HUANG Qiuhong，QIN Yin，ZENG Yachang，QIN Guirong，CHEN Qingyun，XU Ming，WEI Xiao，MA Cui，HUANG Yanfeng，DAI Xia
Background Gestational diabetes mellitus (GDM) is a common pregnancy disease, which can cause complications such as preterm delivery, macrosomia and cesarean section, seriously affecting maternal and infant health.
What This Study Found Significant decreases were found in average levels of FBG, 2 hPBG, SBP, and DBP in all groups at 1 and 3 months post-intervention (P<0.05). The average levels of 2 hPBG and HbA1c in RT+AT group were lower than those of other two groups at 3 months post-intervention. The average gestational age, incidence of preterm delivery and pregnancy-induced hypertension, number of insulin users, and average weight gain in late pregnancy showed no significant intergroup differences. The incidence of cesarean delivery in RT+AT group was lower than that of other two groups, the average amount of postpartum bleeding in RT and RT+AT groups were lower than that of AT group (P<0.05).The average neonatal birth weight and length, and 1-minute Apgar score had no significant intergroup differences. The incidence of macrosomia varied significantly accross the groups. In particular, RT+AT group had a lower incidence of macrosomia than AT group .
Implications All of AT, RT and RT plus AT could improve the metabolic indices of GDM patients, but RT plus AT may be more effective. Furthermore, RT plus AT may also be more effective in improving maternal and infant outcomes of GDM patients.
Value of Multimodal Ultrasound for the Quantitative Assessment of Early Postpartum Pelvic Floor Structure and Function Changes as Well as Stress Urinary Incontinence in Parturients of Advanced Maternal Age
LI Ning，KAN Yanmin*，WANG Yihua，LI Jie，SHI Chaohui，ZHANG Man，ZHANG Shuhua
Background China is seeing an increase in the ratio of parturients of advanced maternal age, a population at high risk of stress urinary incontinence (SUI) .
What This Study Found Compared to parturients of proper maternal age, those of advanced maternal age had higher h1BL, h2BL, ΔhBL, PVUA1, and LHA2, and lower bilateral E1, E2, and ΔE ). For parturients of advanced maternal age, the analysis of the receiver operating characteristic curve of multimodal ultrasound parameters predicting early postpartum SUI revealed that the AUC for h1BL, h2BL, ΔhBL, PVUA1, PVUA2, LHA1, LHA2, bilateral E2, or bilateral ΔE was greater than 0.700. In particular, the AUC was greater than 0.850 for h1BL (-2.28 cm optimal cutoff, 82.4% sensitivity, 90.2% specificity), h2BL (-0.50 cm optimal cutoff, 83.3% sensitivity, 85.2% specificity), LHA1 (16.79 cm2 optimal cutoff, 94.1% sensitivity, 90.2% specificity), or bilateral ΔE (16.85 kPa optimal cutoff, 88.9% sensitivity, 87.0% specificity).
Implications Multimodal ultrasound can quantitatively evaluate the changes of early postpartum pelvic floor structure and function in parturients of advanced maternal age. h1BL, h2BL, LHA1, bilateral ΔE or the combination of h2BL, LHA1 and bilateral ΔE could be used as an ultrasonic predictor of early postpartum SUI in this group, and the latter has higher diagnostic value.
Overall and Sex-specific Associations between Ratio of Monocyte to High-density Lipoprotein Cholesterol and Hyperuricemia Prevalence
WANG Yanping，WU Meihua，YANG Sheng，CHEN Zhong
Background Hyperuricemia (HUA) is a common metabolic disease, which may cause damage to multiple target organs. Studies have showed that HUA is strongly related to inflammatory markers. It is of great importance to study the relationship of HUA with monocyte to high-density lipoprotein cholesterol ratio (MHR), a new inflammatory marker that could be obtained easily in the community, for community-based prevention and treatment of HUA.
What This Study Found Monocyte〔male, OR=2.010, 95%CI (1.265, 3.194) ; emale, OR=5.427, 95%CI (3.059, 9.627) 〕 and MHR〔male, OR=1.918, 95%CI (1.111, 3.313) ; female, OR=6.073, 95%CI (2.984, 12.358) 〕 were independently associated with HUA in both men and women.
Implications MHR was independently associated with HUA in men and women, and the association was stronger in women.
Non-comatose Hyperglycemic Crisis：Low-dose Insulin Therapy by Two Routes
LAI Weihua，LUO Sichan，CHEN Guangshu，HAN Dunzheng，TANG Muhan
Background Hyperglycemic crisis is a critical emergency related to uncontrolled diabetes, and the treatment of which is individualized. Studies have showed that low-dose subcutaneous and insulin infusion with a pump have similar hypoglycemic effects in hyperglycemic crisis, but the former is simpler and more convenient.
What This Study Found The speed of blood glucose reduction, time to reach the glycemic targets, average blood glucose and frequency of hypoglycemia demonstrated no significant differences in both groups (P>0.05). These four indicators also showed no notable differences in DKA patients in both groups (P>0.05). Furthermore, theyhad no obvious differences in HHS patients in both groups (P>0.05) .
Implications In patients with non-comatose hyperglycemic crisis, eitherlow-dose subcutaneous or insulin infusion with a pump could effectively lower the blood glucose, and the former could be used as an alternative for hyperglycemic crisis.
Clinical Analysis of Peptic Ulcer Bleeding in Tibet
XU Ying1，Cirenyangjin
Background Tibet is located on the plateau with a high incidence of peptic ulcer bleeding, but there are few reports about the clinical characteristics of peptic ulcer bleeding, as well as the risk factors of bleeding and rebleeding associated with peptic ulcer in Tibet.
What This Study Found The incidence of peptic ulcer bleeding in men was higher than women, and the incidence of peptic ulcer bleeding of gastric ulcer was higher than duodenal ulcer in Tibet.
Implications HGB and BUN level at admission were the independent influencing factors of high-risk peptic ulcer bleeding. PLT and ALB level at admission might be the risk factors of high-risk peptic ulcer rebleeding.