Table of Content

20 October 2020, Volume 23 Issue 30

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Monographic Research

Prevalence and Influencing Factors of Fear of Hypoglycemia in Elderly Diabetic Patients　

BAO Di，YU Hangqing，CHENG Zhengnan，XU Hongmei，WANG Qinglong，XING Qiuling

2020, 23(30):  3775-3780.  DOI: 10.12114/j.issn.1007-9572.2020.00.484

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Background　Fear of hypoglycemia（FOH）is an important factor associated with reaching the glycemic control targets.Elderly diabetic patients are more prone to hypoglycemia due to decreased sensitivity and response to hypoglycemia.In China，most relevant studies have placed emphasis on the reasons and influencing factors of hypoglycemia in elderly diabetics，but few have studied FOH in this population.Objective　To explore the prevalence and influencing factors of FOH in elderly diabetic patients.Methods　A total of 720 elderly diabetic patients（≥60 years old）were selected from Tianjin Medical University Chu Hsien-I Memorial Hospital from March to September 2019 by using convenient sampling.A self-designed Socio-demographic Questionnaire，the Chinese version of CHFSII-WS，Gold's method and Summary of Diabetes Self-Care Activities（SDSCA）were used to carry out the questionnaire survey to collect relevant information.The prevalence of FOH and impaired awareness of hypoglycemia（IAH）was analyzed，respectively.Backward binary Logistic regression analysis was used to identify the influencing factors of FOH.Results　The survey received a response rate of 95.8%（690/720）.Of the 690 respondents，309（44.8%）had FOH，and 71（10.3%）had IAH.Backward binary Logistic regression analysis results showed that，FOH was significantly correlated with previous hypoglycemic types〔asymptomatic：OR=5.627，95%CI（1.133，27.949），P=0.035；suspicious symptomatic：OR=3.304，95%CI（1.245，7.394），P=0.015；symptomatic：OR=4.444，95%CI（1.793，11.017），P=0.001；severe hypoglycemia：OR=22.414，95%CI（4.099，122.554），P=0.001〕and hypoglycemic prevention education〔OR=2.203，95%CI（1.386，3.502），P=0.001〕.Conclusion　The prevalence of FOH is as high as 44.8% in elderly diabetic patients，which is associated with hypoglycemic types，hypoglycemic prevention education.In view of this，medical workers should pay more attention to the assessment of mental state and IAH during strengthening the hypoglycemia prevention education and improving the awareness of hypoglycemia risk，to reduce the incidence of hypoglycemia and FOH.


Relationship between BMI Changes and Hyperglycemia in Elderly Women　

LIU Xiu，ZHANG Aijun，KE Yu

2020, 23(30):  3781-3784.  DOI: 10.12114/j.issn.1007-9572.2020.00.395

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Background　Diabetes mellitus is a common clinical disease.Related studies have found that high body mass people often have elevated fasting blood glucose，but few studies have found that high body mass is related to hyperglycemia.Objective　To explore the relationship between BMI changes and hyperglycemia in elderly women.Methods　From January to December 2012，300 menopausal women aged 65-76 were selected from Department of Geriatrics，Wuhan Wuchang Hospital，and were divided into normal FBG group （FBG≤5.0 mmol/L，n=200） and predicted elevated FBG group （FBG > 5.0~<5.6 mmol/L，n=100） by FBG，receiving a 5-year follow-up （till January 2018） with an endpoint of hyperglycemia 〔hyperglycemia was defined as FBG ≥5.6 mmol/L or prediabetic glycated hemoglobin （HbA1c）≥6.0% in this study〕.Baseline and follow-up general data and laboratory test indicators were compared between the two groups.The influencing factors of hyperglycemia were explored in elderly women.Results　There were no significant differences in average age，family history of diabetes，baseline smoking rate，drinking rate，diastolic blood pressure，low-density lipoprotein，and high-density lipoprotein between the two groups （P>0.05）.Baseline average BMI，systolic blood pressure，FBG，and triacylglycerol were higher in predicted elevated FBG group than those in normal FBG group （P<0.05）.There were no significant differences between the two groups in terms of follow-up smoking rate and drinking rate，average follow-up low-density lipoprotein，high-density lipoprotein，and triacylglycerol （P>0.05）.The average follow-up BMI，systolic blood pressure，diastolic blood pressure，and FBG were higher in predicted elevated FBG group than those in normal FBG group （P<0.05）.At the end of follow-up，32 subjects had hyperglycemia.Maximum likelihood estimation showed that changed BMI，systolic blood pressure，diastolic blood pressure，FBG，and triacylglycerol were independent influencing factors of hyperglycemia in elderly women.Conclusion　Changed BMI is independently associated with lower risk of hyperglycemia in elderly women，and the risk may be reduced more significantly in those who are overweight or obese.


Different Evaluation Methods for Target Heart Rate for Aerobic Exercise-based Rehabilitation in Patients with Low-to-intermediate Risk of Coronary Heart Disease　

LI Ren，HUANG Haifen

2020, 23(30):  3785-3788.  DOI: 10.12114/j.issn.1007-9572.2020.00.391

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Backgroud　For safety's sake，exercise intensity should be set accurately and objectively for coronary heart disease（CHD） patients receiving aerobic exercise-based rehabilitation，a basis for cardiac rehabilitation.However，due to the complexity of the disease and variability in patients' tolerance to exercise intensity，it is difficult to accurately evaluate aerobic exercise intensity by different methods for determining the target heart rate.Objective　To perform a comparative analysis of different methods for determining the target heart rate for aerobic exercise-based rehabilitation in patients with low-to-intermediate risk of CHD.Methods　A retrospective analysis was conducted.52 patients with low-to-intermediate risk of CHD were chosen from Chenzhou First People's Hospital from January 2018 to March 2019.All of them performed cardiopulmonary exercise tests，and target heart rates for which determined based on anaerobic threshold，peak oxygen uptake，heart rate reserve，age，and resting heart rate plus 20 method were compared.The agreement between peak oxygen uptake and heart rate reserve and anaerobic threshold was analyzed，respectively.Results　The target heart rate determined by anaerobic threshold showed a substantial difference from that determined by age（P<0.05），but did not differ significantly from that determined by peak oxygen uptake，heart rate reserve，or resting heart rate plus 20 method（P>0.05）.The target heart rate determined by anaerobic threshold was positively correlated with that determined by peak oxygen uptake or heart rate reserve（r=0.89，0.83，P<0.05），but showed no linear correlation with that determined by age or resting heart rate plus 20 method（r=-0.15，P=0.57；r=0.41，P=0.19）.Bland-Altman plot for agreement analysis revealed that the average difference of target heart rate measured between anaerobic threshold and peak oxygen uptake，and between anaerobic threshold and heart rate reserve were 1.07，and 0.99，respectively，which were close to zero，with the maximum difference of 95% limits of agreement ranging from -5% to 5%，indicating that there was relatively good agreement between anaerobic threshold and peak oxygen uptake，and between anaerobic threshold and heart rate reserve（P<0.05）.Conclusion　Both heart rate reserve and peak oxygen uptake showed good agreement with anaerobic threshold in determining the target heart rate for aerobic exercise-based rehabilitation in patients with low-to-intermediate risk of CHD，which possess clinical application value.


Development and Prognostic Value of a Mortality Risk Prediction Model in Patients with Carbapenem-resistant Klebsiella Pneumoniae Infection　

LIU Xiaoting，YANG Huan，YAO Hong，REN Xiaochan，LUO Xuanjuan，WANG Xiaochuang

2020, 23(30):  3789-3797.  DOI: 10.12114/j.issn.1007-9572.2020.00.209

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Background　Klebsiella pneumoniae is a common nosocomial infection pathogen，and carbapenem antibiotics is "the last line of defense" to treat its infection.In recent years，hospital infections caused by carbapenem-resistant Klebsiella pneumoniae（CRKP） are increasing due to the overuse of antibiotics，especially carbapenems.The detection rate of CRKP is also growing each year with the progress of medical technology.After infection，there are only a few sensitive antibiotics that can be selected clinically，yielding unoptimistic anti-infection effects，which in turn leads to a rising mortality rate.Objective　To identify the risk factors of mortality in patients of CRKP infection，and use them to establish a mortality risk prediction model，then evaluate the model's prognostic value.Methods　Clinical data of 199 patients with CRKP infection were collected from January 2017 to April 2019 from the Second Affiliated Hospital of Xi'an Jiaotong University，including 138〔modeling group consisting of 104 survivals and 34 deaths（classified at discharge）〕 receiving inpatient treatment from January 2017 to December 2018，and 61（validating group） from January to April 2019.General data，prevalence of underlying diseases，pre-hospital treatment，complications during hospitalization，invasive treatment，biochemical indices and temperature after 3-day initial treatment，post-admission treatment，and other indices were compared between the survival and death subgroups.Multivariate Logistic regression models were applied to investigate the risk factors of mortality in patients with CRKP infection，and based on the derived related coefficients，a mortality risk prediction model for CRKP infection was established，and ROC curve of the model was drawn to predict the mortality in modeling and validating group.Results　The mortality rate was 24.6%（34/138） in the modeling group and 24.6%（15/61） in the validating group.Multivariate Logistic regression analysis showed that multiple organ dysfunction syndrome during hospitalization，APACHE Ⅱ score ≥14 points after initial treatment，and use of vasoactive drugs were closely related to the mortality after CRKP infection（P<0.05）.The regression equation was that multiple organ dysfunction syndrome during hospitalization ×2.4 + （APACHE Ⅱ score ≥14 points after initial treatment）×1.5 + use of vasoactive drugs × 2.0.The mortality risk prediction model in CRKP infection was applied in modeling group with the value of H-L test 0.866，in validating group with 0.807.The area under the curve（AUC）of the model in modeling group was 0.851〔95%CI（0.774，0.928）〕，with optimal cut-off value of 2.75，sensitivity of 84.4%，specificity of 76.0% and Youden index of 0.584，and the AUC of which in validating group was 0.966〔95%CI（0.894，1.000）〕，with optimal cut-off value of 2.95，sensitivity of 100.0%，specificity of 87.0% and Youden index of 0.870.Conclusion　Multiple organ dysfunction syndrome during hospitalization，APACHE Ⅱ score ≥14 after initial treatment and use of vasoactive drugs are independent risk factors of mortality in CRKP infected patients.The mortality risk prediction model in CRKP infection fitted out based on the above-mentioned indices has a good prognostic value.


Value of Preablation Stimulated Thyroglobulin，Stimulated Thyroglobulin，and Thyroglobulin Reduction Index in Predicting Long-term Remission Status in Differentiated Thyroid Cancer Patients Treated with Thyroid Remnant Ablation with 131I　

HE Yu，YANG Xi，YAN Hong，WANG Shuaiqi

2020, 23(30):  3798-3805.  DOI: 10.12114/j.issn.1007-9572.2020.00.204

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Background　Differentiated thyroid cancer（DTC）patients need long-term follow-up services due to post-treatment persistence and high risks of recurrence.So it is essential to explore effective parameters for estimating the outcome and frequency of follow-up for these patients.Preablation stimulated thyroglobulin（ps-Tg）is an important prognostic parameter for DTC.However，its prognostic value in DTC（especially locally advanced DTC）patients has not been reported in China.Objective　To evaluate the value of ps-Tg，stimulated thyroglobulin（s-Tg）and thyroglobulin reduction index（TRI）in predicting long-term remission status in DTC（including locally advanced DTC）patients treated with thyroid remnant ablation with 131I，to identify the responses of the patients to treatment，and based on this，to deliver personalized management，or to alleviate the frequency of follow-ups in those with good responses to decrease psychological and economic burdens caused by frequent follow-ups.Methods　 From the long-term follow-up database of 992 DTC patients developed by Department of Breast & Thyroid Surgery，Suining Central Hospital，An Affiliated Hospital of Chongqing Medical University，those receiving thyroid remnant ablation with 131I between January 2004 and January 2012 were selected between October 2018 and January 2019.General characteristics（including gender，age，diameter of DTC，T/N/M staging，DTC invasion，lymph node capsule rupture，ps-Tg，s-Tg and TRI）and prognosis of the patients were collected.Multivariate Cox regression analysis was used to analyze the prognostic factors of patients with DTC.ROC curve analysis was carried out to explore the value of ps-Tg，s-Tg and TRI in predicting the long-term remission status in patients with DTC，and locally advanced DTC（T3-T4/Nx-N1 staging）.Log-rank test was performed to compare the survival status between groups.Results　 N staging，ps-Tg，s-Tg and TRI were associated with the prognosis of DTC patients in multivariate Cox regression analysis（P<0.05）.T staging，N staging，distribution of ps-Tg，s-Tg and TRI were also associated with the prognosis in multivariate Cox regression analysis（P<0.05）.ROC analysis identified ps-Tg of 10.0 μg/L（AUC=0.831），s-Tg of 1.0 μg/L（AUC=0.846）and TRI of 60%（AUC=0.722）as sensitive predictors for long-term remission in DTC patients.The sensitivity of ps-Tg，s-Tg and TRI was 74.1%，76.9% and 77.7%，respectively，while the specificity was 73.4%，74.7% and 72.8%，respectively.In the sub-population with locally advanced DTC，ps-Tg of 10.0 μg/L（AUC=0.864），s-Tg of 1.0 μg/L（AUC=0.859）and TRI of 62.5%（AUC=0.764）were effective indicators for predicting long-term remission with the sensitivity of 96.1%，54.2% and 74.0%，respectively.The specificity of ps-Tg，s-Tg and TRI was 55.4%，97.3% and 63.8%，respectively.The rate of long-term remission was significantly reduced when ps-Tg≥10.0 μg/L and s-Tg≥1.0 μg/L（P<0.05）.The cutoffs were also applicable to locally advanced DTC.DTC patients with TRI>60.0% achieved higher rate of long-term remission than that of those with TRI≤60.0%（P<0.05），while in locally advanced tumors this cutoff became 62.5%（P<0.05）.Conclusion　This study identified ps-Tg<10.0 μg/L，sTg<1.0 μg/L，and TRI>60.0% as highly sensitive predictors for excellent response in patients with DTC.And ps-Tg<10.0 μg/L，sTg<1.0 μg/L，and TRI>62.5% may be used for those with locally advanced DTC（T3-T4/ Nx-N1 staging）.


Development of an Intra-pregnancy Pelvic Floor Muscle Training Program Using Mobile Health Technologies　

CHEN Xiaomin，HU Yingjie，CHEN Ling，ZHANG Yan，HUANG Shurong，CAI Wenzhi

2020, 23(30):  3806-3811.  DOI: 10.12114/j.issn.1007-9572.2020.00.137

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Background　At present，foreign research on pelvic floor muscle training based on mobile health technologies has achieved initial results，but most of its research objects are elderly female patients，there is no research target for pregnant women，and most existing application in the domestic market have not been verified.Therefore it is of clinical significance to construct a scientific application of pelvic floor muscle training based on mobile health technologies.Objective　To develop a pelvic floor muscle training program for pregnant women using mobile health technologies，to guide clinical nursing practice，and to provide a reliable basis for scientific management of such trainings.Methods　From November 2018 to April 2019，by use of literature review and brainstorming，a draft of intra-pregnancy pelvic floor muscle training program using mobile health technologies was developed by our research group，then its contents were discussed in an expert consultation，and were determined after being revised according to the consultation results.Results　 Of the 1 032 articles that were searched，10 eligible studies were referred.In the consultation，the authority degree of experts was 0.904，indicating the results were reliable.The intervention program consists of knowledge presentation，functional evaluation，pelvic floor muscle training，emotional support，and regular supervision，and can be accessible on the mobile APP in forms of text，pictures，videos，animation，or consulting online consultants.Conclusion　 The intra-pregnancy pelvic floor muscle training program developed based on scientific methods and mobile heath technologies is reliable，which may be used for or used as a reference for scientific management of intra-pregnancy pelvic floor healthcare，and for the evaluation of such care.


The Main Early Clinical Features of Kawasaki Disease Shock Syndrome and Septic Shock in Children：a Comparative Study　

XU Meixian，LIU Gang，CAO Lijing，SHI Xiaona，SUN Hui，LI June

2020, 23(30):  3812-3816.  DOI: 10.12114/j.issn.1007-9572.2020.00.250

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Background　Kawasaki disease shock syndrome （KDSS） is a rare disease that has similar clinical presentations in the early onset as sepsis shock，which confuses physicians often.Objective　To comparatively analyze the early clinical features of KDSS and septic shock in children，to provide a reference for pediatricians to effectively distinguish the two diseases.Methods　Eligible pediatric KDSS patients（n=15） and pediatric septic shock patients （n=21） were recruited from Hebei Children's Hospital Affiliated to Hebei Medical University during May 2015 to May 2018.Data of all of them were retrospectively collected and analyzed，including general information （gender，age，length of stay in the PICU，results of bacterial culture），laboratory indices 〔WBC，neutrophil fraction，hemoglobin，platelet count，albumin，CRP，PCT，ESR，ALT，AST，troponin I （TnI），CK-MB〕within 24 hours after admission，echocardiographic indices 〔left ventricular ejection fraction （LVEF），LVEF < 50%，mitral regurgitation，tricuspid regurgitation，coronary artery damage〕，ECG indices （sinus tachycardia，sinus bradycardia，supraventricular tachycardia，ventricular extrasystole，atrial extrasystole，atrioventricular block，ST-T change，PR interval prolongation） and prognosis（death at the end point of 28 days after the admission of PICU）.Results　There were no significant differences between the two groups in sex ratio，mean age，mean length of stay in the PICU，positive rate of bacterial culture and mortality（P>0.05）.There were also no significant differences in WBC，neutrophil fraction，albumin，CRP，PCT，ESR，ALT，AST，cTnI，and CK-MB between the two groups （P>0.05），but the mean value of hemoglobin was higher and that of platelet count was lower in the septic shock group （P<0.05）.There were no significant differences in LVEF，ratio of LVEF<50% and incidence of mitral regurgitation，sinus tachycardia，sinus bradycardia，supraventricular tachycardia，ventricular extrasystole，atrial extrasystole，atrioventricular block，ST-T change，prolonged PR interval between the two groups （P>0.05）.However，the incidence of tricuspid regurgitation and coronary artery damage in the KDSS group was higher than that in the septic shock group （P<0.05）.Conclusion　The specific manifestations of KDSS compared with septic shock include relatively higher hemoglobin，lower platelet count，and higher incidence of tricuspid regurgitation and coronary artery damage in children，which deserve clinical attention.


Clinical Features and Risk Factors of Treatment-naive Systemic Sclerosis-associated Thrombocytopenia　

YUE Luyao，TAO Bei，XU Yuan，HE Chengsong

2020, 23(30):  3817-3822.  DOI: 10.12114/j.issn.1007-9572.2020.00.440

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Background　Treatment-naive patients are not affected by medication，thus their clinical features can better reflect the changing rules of the disease，which is helpful to more accurate understanding of the occurrence and development of disease.However，there are few research reports about treatment-naive patients with systemic sclerosis（SSc）-associated thrombocytopenia.Objective　To analyze the clinical features and risk factors of treatment-naive SSc-associated thrombocytopenia.Methods　From 2013 to 2018，a total of 124 treatment-naive inpatients with SSc were selected from Department of Rheumatology and Immunology，the Affiliated Hospital of Southwest Medical University，and were divided into groups thrombocytopenia（n=12）and non-thrombocytopenia（n=112）according to the prevalence of SSc-associated thrombocytopenia.General information，clinical manifestations and laboratory examination results were compared between the two groups.Binary Logistic regression analysis was used to analyze the risk factors of SSc-associated thrombocytopenia.Results　The prevalence of SSc-associated thrombocytopenia was 9.7%（12/124）.There were no significant differences in gender ratio，average height and weight，distribution of types of SSc，prevalence of Raynaud's phenomenon，fingertip ulcer，arthromyositis and interstitial lung disease，average hemoglobin，WBC，albumin，TC，TG，Cr，BUN，and uric acid，and prevalence of antinuclear antibody，anti-SSA antibody，anti-SSB antibody，anti-Ro52 antibody，anti-SCL-70 antibody，anti PM-SCL antibody，anti JO-1 antibody as well as anti-CENP-B antibody positivity between the two groups（P>0.05）.Compared with those in non-thrombocytopenia group，thrombocytopenia group showed younger age，longer disease course，and lower BMI on average（P<0.05）.Besides，thrombocytopenia group demonstrated higher prevalence of pulmonary arterial hypertension（PAH），electrocardiographic abnormality and anti-RNP antibody positivity，lower average levels of complement C3 and C4（P<0.01）.Binary Logistic regression analysis results showed that，anti-RNP antibody positivity was the independent risk factor of SSc-associated thrombocytopenia〔OR=19.56，95%CI（2.04，187.87），P<0.01〕.Conclusion　Compared with those without thrombocytopenia，treatment-naive inpatients with SSc-associated thrombocytopenia showed younger age，longer disease course，lower BMI，complement C3 and C4，higher prevalence of PAH and electrocardiographic abnormality，and anti-RNP antibody positivity.Moreover，anti-RNP antibody positivity is the independent risk factor of SSc-associated thrombocytopenia.So clinicians should be vigilant of SSc-associated thrombocytopenia in treatment-naive SSc patients when they are found with anti-RNP antibody positivity after blood system damage is excluded.


Association of Gene Polymorphisms in β1-adrenergic Receptor and Angiotension Ⅱ-1 Receptor with Hypertension in Alpine Areas　

WANG Jing，DONG Tianwei，WANG Shuang，ZHOU Meng，WU Chunli，HU Yanyao，YANG Jun

2020, 23(30):  3823-3828.  DOI: 10.12114/j.issn.1007-9572.2020.00.237

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Background　Hypertension is the most common chronic cardiovascular disease and the leading cause of the global disease burden.There are regional differences in the incidence of hypertension in China，and more patients with hypertension are found in alpine areas than in non-alpine areas，which is mainly determined by living environment and genetic factors.This article will study the pathogenesis of hypertension from the perspective of genetics.Objective　To explore the association of gene polymorphisms in β1-adrenergic receptor（ADRB1） and angiotensionⅡ-1 receptor（AGTR1） with hypertension in alpine areas.Methods　A total of 1 084 patients with hypertension who met the research criteria seeking medical advice and hospitalization in Department of Hypertension and Department of Cardiology in the First Affiliated Hospital of Jiamusi University from August of 2014 to February of 2017 were selected.Among them，546 cases were tested for ADRB1 genotypes（recorded as Group 1），and 702 cases were tested for AGTR1 genotypes（recorded as Group 2）.And 169 healthy volunteers without taking any medicine were selected as the control group during the same period.The fluorescence in situ hybridization method was used to detect ADRB1 genotypes and AGTR1 genotypes.The ADRB1 genotypes and frequency of alleles between Group 1 and control group were compared and the AGTR1 genotypes and frequency of alleles between Group 2 and control group were compared.The ADRB1 genotypes and allele frequency，and AGTR1 genotypes and allele frequency between patients with hypertension in alpine areas and non-alpine areas（Beijing，Hunan，and Fujian），and healthy people in alpine areas and patients with hypertension in non-alpine areas（Beijing，Hunan，and Fujian） were compared.Results　There was no significant difference in the ADRB1 genotypes between Group 1 and control group（P>0.05），while there was significant difference in the ADRB1 allele frequency between Group 1 and control group（P<0.05）.There was no significant difference in the AGTR1 genotypes and allele frequency between Group 2 and control group（P>0.05）.There was no significant difference in the ADRB1 genotypes and allele frequency between patients with hypertension in Group 1 and in Beijing，Hunan and Fujian（P>0.05）.There was no significant difference in the AGTR1 genotypes and allele frequency between patients with hypertension in Group 2 and in Beijing（P>0.05），while there was significant difference in the AGTR1 genotypes and allele frequency between patients with hypertension in Group 2 and in Hunan and Fujian（P<0.05）.There was significant difference in the ADRB1 genotypes between volunteers in control group and patients with hypertension in Beijing（P<0.05），while there was no significant difference in the ADRB1 allele frequency between volunteers in control group and patients with hypertension in Beijing（P>0.05）.There was no significant difference in the ADRB1 genotypes and allele frequency between volunteers in control group and patients with hypertension in Hunan and Fujian（P>0.05）.There was no significant difference in the AGTR1 genotypes and allele frequency between volunteers in control group and patients with hypertension in Beijing（P>0.05）.There was significant difference in the AGTR1 genotypes and allele frequency between volunteers in control group and patients with hypertension in Hunan and Fujian（P<0.05）.Conclusion　The C allele in ADRB1 gene is associated with the onset of hypertension in alpine areas，and there is no association between the AGTR1 gene polymorphisms and the incidence of hypertension in alpine areas.


Correlation between Helicobacter Pylori Infection and Frailty in Hospitalized Elderly Patients with Hypertension　

SUN Zixu，GAO Yinfeng，GUO Hongju，LIU Da

2020, 23(30):  3829-3833.  DOI: 10.12114/j.issn.1007-9572.2020.00.447

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Background　Frailty is a common geriatric syndrome，which seriously affects the physical and mental health of the aged.Helicobacter pylori （H.pylori） infection has a high global incidence，which is associated with the occurrence and development of multiple extra-gastric diseases.However，the correlation between H.pylori infection and frailty is unclear.Objective　To investigate the correlation between H.pylori infection and frailty in hospitalized elderly patients with hypertension.Methods　206 consecutive hospitalized patients with hypertension aged ≥ 65 from Departments of Geriatrics and Cardiovascular Medicine，First Affiliated Hospital，School of Medicine，Shihezi University from October 2018 to June 2019 were included.H.pylori infection prevalence in gastric mucosal biopsy specimens was detected by pathological examination，and other clinical data were collected.The prevalence of frailty was assessed by the FRAIL scale.The effect of H.pylori infection on frailty was analyzed by multivariate Logistic regression analysis.Results　47 cases （22.8%） were assessed to be frail and other 159 （77.2%） were non-frail.The results of multivariate Logistic regression analysis showed that age〔OR=1.309，95%CI（1.136，1.508）〕，primary school education〔OR=0.107，95%CI（0.026，0.442）〕，junior high school education〔OR=0.127，95%CI（0.028，0.574）〕，senior high school education〔OR=0.013，95%CI（0.000，0.424）〕，leukocyte counts〔OR=4.260，95%CI（1.202，15.097）〕，lymphocyte percentage〔OR=0.793，95%CI（0.676，0.930）〕，neutrophil counts〔OR=0.139，95%CI（0.021，0.907）〕，fructosamine〔OR=13.099，95%CI（2.136，80.337）〕，polypharmacy〔OR=5.679，95%CI（1.486，21.709）〕，score of risk of fall/falling out of bed 〔OR=1.788，95%CI（1.236，2.586）〕 and H.pylori infection〔OR=2.912，95%CI（1.036，8.181）〕 were associated with higher risk of frailty in hospitalized patients with hypertension （P<0.05）.Analysis based on H.pylori infection prevalence in frail patients showed that，there was no significant difference in total protein，albumin，monocyte counts，leukocyte counts and neutrophil counts between H.pylori infected patients〔55.3%（26/47）〕 and H.pylori uninfected patients〔44.7%（21/47）〕（P>0.05）.Conclusion　H.pylori infection might be a risk factor leading to frailty in hospitalized elderly patients with hypertension.In view of this，clinicians should not only strengthen the assessment of frailty，but also attach great importance to the influence of H.pylori infection.

Frailty and Post-stroke Depression in Elderly Patients with Acute Ischemic Stroke　

SHANG Xiaofeng，ZHANG Ying，LI Hong，WANG Su，RAN Xiurong，WANG Tan

2020, 23(30):  3834-3838.  DOI: 10.12114/j.issn.1007-9572.2020.00.462

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Background　The prevalence of stoke is increasing yearly with the aggravation of population aging in China.Post-stroke depression（PSD） is one of the common complications of stroke，but there is still lacks meaningful predictive indicators for it.Objective　To evaluate the correlation between frailty and PSD in elderly patients with acute ischemic stroke，to provide evidence for evaluating PSD and delivering intervention timely.Methods　118 patients with acute ischemic stroke were selected from Department of General Medicine and Department of Neurology，the First People's Hospital of Shangqiu from June to December 2017.General information 〔gender，age，body mass index（BMI），smoking and drinking atatus，prevalence of hypertension，diabetes，hyperlipidemia and atrial fibrillation〕，and clinical data 〔prevalence of multicormodity（having ≥ 5 coexisting diseases），admission NIHSS score，modified Rankin scale（mRS ）score and TOAST typing 〕were collected.The frailty prevalence assessed within 24 hours of admission by the FRAIL〔33 with frailty（with FRAIL score equal to or greater than 3），and 85 without（with FRAIL score less than 3）〕，and PSD prevalence assessed within 6-12 months of follow-up by both the DSM-Ⅳand Hamilton Depression Rating Scale（HAMD）〔45 with PSD（with HAMD score equal to or greater than 7） and 73 without（with HAMD score less than 7）〕 were also collected.Multivariate Logistic regression analysis was used to identify the factors associated with frailty or PSD in elderly patients with acute ischemic stroke.Results　Multivariate Logistic regression analysis showed that age 〔OR=1.131，95%CI（1.055，1.211），P<0.001〕 and admission mRS score〔OR=4.626，95%CI（2.027，10.561），P<0.001〕were influencing factors of frailty，meanwhile age〔OR=1.060，95%CI（1.005，1.118），P=0.031〕and frailty〔OR=2.855，95%CI（1.144，7.126），P=0.025〕were influencing factors of PSD in elderly patients with acute ischemic stroke.Those with frailty had higher PSD prevalence than those without〔60.6%（20/33） vs 29.4%（25/85）〕（P=0.002）.The frailty prevalence showed no significant growth with the increase of the severity of PSD（P>0.05）.Conclusion　Age and frailty are closely related to PSD in elderly patients with acute ischemic stroke.The assessment of frailty can be evaluated in time to predict the risk of PSD.


Prevalence and Associated Factors of Preoperative Frailty in Elderly Patients with Knee Osteoarthritis Undergoing Surgery　

FANG Wen，WANG Xiuhong，WANG Junhua，JIANG Zhiyue，DONG Lianghong，LI Jing

2020, 23(30):  3839-3845.  DOI: 10.12114/j.issn.1007-9572.2020.00.126

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Background　The elderly patients，a special group of patients，have a high risk of surgery，poor postoperative recovery，and a high incidence of adverse postoperative outcomes.More and more clinical studies show that preoperative frailty is correlated with postoperative adverse outcomes.Objective　To investigate the prevalence of preoperative frailty and its influencing factors in elderly patients with knee osteoarthritis（KOA） who were hospitalized for surgery.Methods　By use of purposive sampling method，totally 230 elderly patients with KOA who were hospitalized for surgery were selected from the Affiliated Hospital of Guizhou Medical University，Guizhou Orthopedics Hospital and the Fourth People's Hospital of Guiyang during November 2018 to April 2019.All patients received an interviewer-administered questionnaire survey using self-designed General Data Questionnaire，FRAIL Scale，Faces Pain Scale-Revised（FPS-R），American Knee Society（AKS） score and measured preoperative knee flexion.Binary Logistic regression analysis was used to investigate the influencing factors of preoperative frailty in elderly.Results　A total of 230 questionnaires were issued，and 230 effective questionnaires were recovered，with an effective recovery rate 100%.156（67.8%） were found with frailty，and other 74（32.2%） without.Binary Logistic regression analysis showed that household monthly income per person〔≤2 000 yuan：OR=12.598，95%CI（2.771，57.272），P<0.05；>2 001 yuan：OR=5.972，95%CI（1.318，27.053），P<0.05〕，BMI〔abnormal：OR=3.007，95%CI（1.426，6.339），P<0.05〕，duration of knee pain〔6-10 years：OR=2.447，95%CI（1.016，5.895），P<0.05；11-14 years：OR=6.072，95%CI（2.257，16.340），P<0.05；>15 years：OR=7.638，95%CI（1.763，33.097），P<0.05〕，FPS-R score〔>6 points：OR=3.506，95%CI（1.672，7.354），P<0.05〕were the influencing factors of preoperative frailty patients with KOA undergoing surgery.Conclusion　The prevalence of preoperative frailty in preoperative frailty patients with KOA undergoing surgery was high（67.8%）.Healthcare workers should attach great importance to the elderly KOA patients with low income，abnormal BMI，long-term pain and severe pain，and timely screening preoperative frailty in them to develop a more scientific and rational diagnosis and treatment plan to prevent or delay the development of frailty.


Clinical Effect of Tongluo Digui Decoction in Patients with Stage 4 Type 2 Diabetic Kidney Disease　

PANG Xinxin，SHI Xiujie，ZHANG Yage，PENG Zining，XING Yufeng，HAN Jiarui

2020, 23(30):  3846-3850.  DOI: 10.12114/j.issn.1007-9572.2020.00.267

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Background　Diabetic kidney disease（DKD） is one of the major complications of diabetes，which endangers nearly one third of the diabetic patients in China，a country owning the largest number of diabetics.However，there is lack of effective interventions for DKD，and it is necessary to explore relevant treatments with Chinese medicine.Objective　To investigate the clinical effect of Tongluo Digui decoction in patients with stage 4 type 2 DKD.Methods　From June 2018 to February 2019，70 stage 4 type 2 DKD outpatients and inpatients with Yin deficiency and blood stasis syndrome from Departments of Nephrology and Endocrinology，Henan Province Hospital of TCM（the Second Affiliated Hospital of Henan University of Chinese Medicine） were enrolled，and randomized into the observation group（n=36） and control group（n=34）.Both groups received primary Western medicine treatments，the observation group additionally received 8-week oral administration of Tongluo Digui decoction.Pre- and post-treatment TCM Symptom Scale score，24-hour quantitative proteinuria，serum creatinine（Scr），blood urea nitrogen（BUN），estimated glomerular filtration rate（eGFR），HbA1c，fasting blood glucose，hemoglobin，albumin，serum uric acid，inflammatory cytokines in the serum and urine were compared between the two groups.The adverse reactions of the two groups were counted.Results　After treatment，the average levels of 24-hour quantitative proteinuria，Scr，BUN，HbA1c，fasting blood glucose and serum uric acid decreased and average levels of eGFR and albumin increased in both groups（P<0.05）.Intergroup comparisons revealed that there were no significant differences in post-treatment fasting blood glucose，hemoglobin，albumin and serum uric acid after treatment（P>0.05），however the observation group showed lower average levels of 24-hour quantitative proteinuria，Scr，BUN and HbA1c but higher eGFR than the control group（P<0.05）.The average each item of TCM Syndrome Scale score，serum IL-6 and TNF-α，and urine IL-1β and IL-18 showed a decrease after treatment in both groups（P<0.05），and they decreased more significantly in the observation group（P<0.05）.During the treatment，2 patients in the observation group had mild diarrhea.Conclusion　Tongluo Digui decoction helps to improve the clinical symptoms，renal functions and inflammation，and reduce the 24-hour quantitative proteinuria in stage 4 type 2 DKD patients with satisfactory safety.


Effect of Soaking and Fumigation Washing Therapy of Modified Guizhi Decoction on Patients with Hemiplegia in Acute Stage of Ischemic Stroke（Meridian Obstruction）　

WANG Jiayan，XU Yujiao，LIN Xiaowei，CHEN Qi，ZHANG Guanzhuang，HUANG Hongmin

2020, 23(30):  3851-3855.  DOI: 10.12114/j.issn.1007-9572.2020.00.115

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Background　In order to reduce the degree of disability caused by stroke，comprehensive rehabilitation in the acute stage has received more and more attention.Soaking and fumigation washing therapy of Traditional Chinese Medicine has been clinically affirmed to improve the sequela symptoms of stroke，but there are few studies about its effect in the acute stage of stroke.Objective　To investigate the effect of  soaking and fumigation washing therapy of modified Guizhi decoction on patients with hemiplegia in acute stage of ischemic stroke（meridian obstruction）.Methods　A total of 116 patients with hemiplegia in acute stage of ischemic stroke（meridian obstruction）were selected and  randomly divided into control group（n=55） and observation group（n=58）in the Traditional Chinese Medicine Hospital of Hainan Province from March 2017 to May 2018.Patients in the both groups received standard treatment of acute cerebral infarction，while patient in  observation group was extraly treated with soaking and fumigation washing therapy of modified Guizhi decoction for 14 days.Incidence of limb swelling was observed within 90 days of treatment，National Institutes of Health Stroke Scale（NIHSS）score was compared between the two groups before treatment，14 and 90 days after treatment，so was levels of interleukin-4（IL-4），interleukin-6（IL-6） and high-sensitivity C-reactive protein（hs-CRP） before treatment and 90 days after treatment.Results　Incidence of limb swelling was 14.5% in control group within 90 days of treatment，which was  statistically significantly higher than that in observation goup of 1.7%（P<0.05）.There was no statistically significant difference in NIHSS score between the two groups before treatment（P<0.05）.After 14 days and 90 days of treatment，NIHSS score in the two groups was statistically significantly lower than that before treatment，respectively，meanwhile NIHSS score in observation group was statistically significantly lower than that in control group，respectively（P<0.05）.There was no statistically significant difference in levels of IL-4，IL-6 and hs-CRP between the two groups before treatment（P>0.05）.After 90 days of treatment，levels of IL-4，IL-6 and hs-CRP in the two groups were statistically significantly lower than those before treatment（P<0.05），meanwhile levels of IL-4，IL-6 and hs-CRP in observation group were statistically significantly lower compared with those in control group（P<0.05）. Conclusion　Soaking and fumigation washing therapy of modified Guizhi decoction can effectively promote the recovery of neurological function in patients with hemiplegia in acute stage of ischemic stroke（meridian obstruction），reduce the levels of inflammatory cytokines（such as IL-4，IL-6 and hs-CRP）and risk of limb swelling，with relatively high safety.


Vitamin D Effectively Controls Gelastic Seizure of Non-epileptic：Report of One Case and Review of Literature　

ZHANG Xiangmin，HAN Qian，LIU Zongyuan，XU Falin

2020, 23(30):  3856-3858.  DOI: 10.12114/j.issn.1007-9572.2020.00.358

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Clinical seizure events can be divided into epileptic seizure and non-epileptic seizure by whether epileptiform discharges appearing in VEEG or not at the same time of seizure，but non-epileptic seizures are easy to be misdiagnosed as epilepsy，leading to appropriate treatment.We reported a case of gelastic seizure of non-epileptic controlled by supplementing vitamin D，in which the patient's clinical features，treatment and prognosis were retrospectively analyzed and summarized，aiming to enhance the early diagnostic accuracy for this disease to reduce the possibilities of misdiagnosis and mistreatment by improving clinicians' recognition.We also suggest that clinicians should review the VEEG timely to further clarify the diagnosis when the clinical treatment effect of epilepsy is poor，by which serious mental burdens caused by inappropriate treatment on patients and their relatives may be avoided.


Activated PI3K Delta Syndrome Caused by PIK3CD Gene Mutation：Clinical and Genetic Variation Analyses of One Case　

HE Bo，CUI Qingyang，LU Jun

2020, 23(30):  3859-3863.  DOI: 10.12114/j.issn.1007-9572.2020.00.275

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This paper reports a case of activated PI3K delta syndrome caused by PIK3CD gene mutation，who mainly presented with recurrent respiratory tract infection for more than 17 years and was diagnosed by detection of exon gene mutations in his pedigree.Activated PI3K delta syndrome is a rare primary combined immunodeficiency disease，which is characterized by recurrent respiratory tract infection，hepato-splenic lymph node enlargement，and cytomegalovirus and/or EB viremia，and timely gene detection can be used for early diagnosis.


Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leucoencephalopathy：a Case Report and Literature Review　

ZHANG Chunyan，LIU Qingxin，CAO Xiaoyu，LIU Hui，LIU Rui

2020, 23(30):  3864-3869.  DOI: 10.12114/j.issn.1007-9572.2020.00.184

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Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy（CADASIL） is a monogenic autosomal dominant cerebral small-vessel disorder，mainly manifesting as migraine，subcortical ischemic events，cognitive impairment，and mental symptoms （mood disorders） and so on.The disease aggravates progressively，eventually leading to severe disability and dementia.At present，no therapies have been found to be effective in halting or delaying the disease progression and only empiric treatments can be employed to relieve the main symptoms.This article reports a case of CADASIL with a clear diagnosis，in which the clinical characteristics and management methods are analyzed and summarized，aiming to provide a reference for clinicians to manage the disease.


Value of Chest Ultrasound in Predicting the Outcome of Weaning from Mechanical Ventilation in Patients with Sepsis　

JIANG Mingming，ZHANG Xuejia，CHEN Zhixin，SUN Bo，ZHANG Tianqing，HU Xuezhong，SUN Qin，XU Yulu，FANG Qiang

2020, 23(30):  3870-3877.  DOI: 10.12114/j.issn.1007-9572.2020.00.252

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Background　Weaning from mechanical ventilation is associated with a high failure rate in sepsis patients.Although in recent years，ultrasound has been widely used in the management of critically ill patients before weaning from mechanical ventilation，such as evaluating the cardiac function，chest ultrasound is rarely used in the process of weaning from mechanical ventilation in patients with sepsis.Objective　To investigate the value of chest ultrasound in predicting the outcome of weaning from mechanical ventilation in patients with sepsis.Methods　A prospective study was conducted.Sixty-five patients with sepsis who underwent continuous mechanical ventilation for more than 48 hours in the ICU，Cixi Hospital Affiliated to WenZhou Medical University from June 2017 to December 2018 were enrolled.For those meeting the screening criteria of weaning from mechanical ventilation，spontaneous breathing trial（SBT） was performed using low level pressure support ventilation，and chest ultrasound was implemented before and 30 minutes after SBT，and parameters including lung ultrasound score（LUS），diaphragmatic excursion，diaphragmatic thickness at end-inspiration and diaphragmatic thickness at end-expiration as well as calculated rapid shallow breathing index（RSBI），diaphragmatic rapid shallow breathing index（D-RSBI） and diaphragmatic thickening fraction（DTF） were collected.Weaning from mechanical ventilation was performed in the eligible cases，and the aforementioned parameters were compared between those with successful and failed weaning（good weaning outcome was defined as successful weaning）.ROC curve analysis was conducted to evaluate the values of chest ultrasound parameters in predicting the outcome of weaning from mechanical ventilation.Results　Fifty cases were finally enrolled，including 35 with successful weaning，and 15 with failed weaning.There were significant differences in mean levels of post-SBT LUS，pre-SBT DTF，post-SBT DTF as well as post-SBT D-RBSI between the two groups（P<0.05）.The mean LUS level increased significantly after SBT than before in those with failed weaning（P<0.05）.The mean DTF level showed an obvious increase after SBT before in both groups（P<0.05）.In predicting the outcome of weaning from mechanical ventilation，the AUC of post-SBT LUS was 0.819，and a good outcome may be estimated when the cutoff point was determined as less than 15.5 scores with a sensitivity of 0.730 and a specificity of 0.800.The AUC of post-SBT D-RSBI was 0.895，and a good outcome may be estimated when the cutoff point was determined as less than 1.41 times?min-1?mm-1 with a sensitivity of 0.867 and a specificity of 0.829.The AUC of pre-SBT DTF was 0.738，and a good outcome may be estimated when the cutoff point was determined as greater than 22.9% with a sensitivity of 0.866 and a specificity of 0.667.The AUC of post-SBT DTF was 0.891，and a good outcome may be estimated when the cutoff point was determined as greater than 33.2% with a sensitivity of 0.886 and a specificity of 0.867.Conclusion　Chest ultrasound has predictive value for the result of weaning in patients with sepsis.Post-SBT LUS<15.5 scores in combination with post-SBT D-RSBI<1.41?min-1?mm-1 and post-SBT DTF>33.2% predicts high rate of successful weaning.


Multimodal Ultrasound Characteristics Associated with Molecular Subtypes of Breast Cancer　

WU Fang，CHENG Jing，CAO Chunli，MA Ting，TONG Caixia，CAO Yuwen

2020, 23(30):  3878-3883.  DOI: 10.12114/j.issn.1007-9572.2020.00.321

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Background　 High heterogeneity in breast cancer distinguishes individual biological behavior，prognosis and treatment.Individualized molecular subtype-specific therapy has been widely used clinically.Studies have shown that some ultrasound features are associated with molecular subtyping，but it is difficult to screen relevant predictors out of various ultrasound parameters.Objective　To identify the multimodal ultrasound characteristics associated with molecular subtypes of breast cancer.Methods　 This prospective study was conducted in 91 women with pathology-confirmed breast cancer from the First Affiliated Hospital，School of Medicine，Shihezi University during January 2017 to February 2019.Postoperative immunohistochemical results，including Luminal（Luminal A and Luminal B subtypes） and non-Luminal（HER2-enriched and triple-negative subtypes） breast cancer，were collected and compared in terms of multimodal ultrasound characteristics〔including findings of two-dimensional ultrasound，virtual touch tissue imaging quantification（VTIQ） and contrast-enhanced ultrasonography〕．Univariate and multivariate Logistic regression were used to identify the ultrasound characteristics associated with molecular subtypes of breast cancer.Results　 The Luminal A，Luminal B，HER2-enriched and triple-negative subtypes numbered 11，49，18，and 13，respectively.Luminal and non-Luminal breast cancer patients showed significant differences in two-dimensional ultrasonic border（degree of clearness） and marginal features（spiculated or lobulated），contrast-enhanced ultrasonic margin，range and peripheral radial enhancement，and VTIQ-generated shear-wave elastographic features（P<0.05）.Multivariate Logistic regression analysis showed that two-dimensional ultrasonic spiculated or lobulated border and margin，contrast-enhanced ultrasonic peripheral radial enhancement，and increased VTIQ-measured shear-wave elastographic value of the marginal zone were independently associated with luminal breast cancer（P<0.05）.Conclusion　Different molecular subtypes of breast cancer have different ultrasound morphological，blood supply and elastographic characteristics.The two-dimensional ultrasonic spiculated or lobulated margin，contrast-enhanced ultrasonic peripheral radial enhancement，and increased VTIQ-measured shear-wave elastographic value of the marginal zone are closely associated with luminal breast cancer，which may be used as auxiliary indicators in diagnosing，prognosis evaluating and developing individualized treatment regimen.


Progress in the Application of Transmural Healing as an Indicator to Evaluate the Remission of Crohn's Disease　

ZHANG Ming，JIANG Chonghui

2020, 23(30):  3884-3887.  DOI: 10.12114/j.issn.1007-9572.2020.00.061

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Crohn's Disease （CD） is a chronic nonspecific inflammatory disease involving the entire digestive tract.There has always been controversy in the academic circle about the therapeutic target of CD.The remission of clinical symptoms and endoscopic mucosal healing of the intestinal tract were all used as the therapeutic target of CD.With the popularization of enterography （CTE），magnetic resonance enterography （MRE），intestinal ultrasound （IUS） and other related imaging technologies in the diagnosis and treatment of CD，transmural healing has received increasing attention.As an indicator to evaluate the alleviation of inflammation of full-thickness intestinal wall by means of imaging examination，transmural healing is expected to become one of the new therapeutic targets for CD.This paper reviewed the imaging features of CD and the definition and scoring criteria related to transmural healing，analyzed the role of transmural healing in the evaluation of curative effect in patients with CD，and proposed the existing problems in the evaluation of CD treatment with transmural healing，in order to provide more information for clinicians.


Novel Advances in Regulatory Mechanism of Microglia Autophagy，Inflammation and Their Interaction in Intracerebral Hemorrhage　

YAO LIN，MU Qiong

2020, 23(30):  3888-3894.  DOI: 10.12114/j.issn.1007-9572.2020.00.467

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Intracerebral hemorrhage has a higher incidence in middle-aged and elderly people，and has posed a major health threat to this population.Second only to cerebral infraction in morbidity，intracerebral hemorrhage is the second most common type of stroke，and its proportion in stroke is significantly higher in China than that in developed western countries.Intracerebral hemorrhage has placed a heavy burden on Chinese society，which has been in population aging，as well as on patients' families.To date，few therapeutic approaches with established efficacy for intracerebral hemorrhage have been available clinically.As the primary phagocytes in the brain，microglias play important roles in post-intracerebral hemorrhage brain injury，e.g.，protecting the central nervous system and alleviating brain injury through autophagy and modulating the inflammatory process.This paper reviews the roles of microglia autophagy and inflammation as well as their interactions in regulating intracerebral hemorrhage，expects to provide reference for the diagnosis and treatment of intracerebral hemorrhage，the identification of new therapeutic targets，as well as the improvement of prognosis.