Table of Content

20 February 2021, Volume 24 Issue 6

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Monographic Research

Strengthening Primary Healthcare Workers' Identification，Diagnosis and Treatment of Dementia Is the Key to the Prevention and Control of Dementia in China　

WANG Wei1，TAN Shuhui2，ZHANG Bin3，GUO Dongmei1*

2021, 24(6):  637-642.  DOI: 10.12114/j.issn.1007-9572.2021.00.058

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With the aggravation of aging population，the number of dementia patients in China has shown a rapid growth trend in recent years.However，current available dementia care resources are mainly distributed in large-scale general hospitals in China，which is far from meeting the needs of the majority of dementia patients.And most dementia patients seeking care in primary care may not receive accurate diagnosis and treatment as primary healthcare workers can not distinguish dementia from normal aging due to lack of related experience，which may lead to dementia progression because of delayed diagnosis and treatment.To prevent and control dementia，it is necessary to improve primary healthcare workers' abilities in identifying，diagnosing and treating dementia，and to develop a specific mechanism to strength the cooperation（including bi-directional referrals and continued management of dementia）between primary healthcare workers and memory disorders outpatient healthcare workers in tertiary care.This paper mainly analyzes the epidemiological characteristics of dementia，status and difficulties in diagnosing and treating dementia，and effective measures to improve the standardized management of dementia in China.


Latest Developments in Community Screening and Diagnosis of Alzheimer's Disease　

MA Weiwei，ZHANG Xiaoling

2021, 24(6):  643-651.  DOI: 10.12114/j.issn.1007-9572.2020.00.512

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Alzheimer's disease is the most common type of dementia，whose incidence is increasing with the advent of an aging society.The development of community-based screening and diagnosis procedure of Alzheimer's disease is greatly essential to early detection，diagnosis and treatment of this disease，but there are no uniform criteria for the procedure.We reviewed the evaluation scales and tools，diagnostic criteria，screening and diagnosis procedure commonly used in community-based screening and diagnosis of Alzheimer's disease in recent years，with brief introduction to the strengths and limitations of the scales and tools，the application of diagnostic criteria，and the maneuverability of the screening and diagnosis procedure，to offer theoretical guidance for the development of a community-based screening and diagnosis procedure of Alzheimer's disease appropriate for domestic conditions.


Prevalence and Factors Associated with Grading of Cardiac Autonomic Neuropathy in Community-dwelling Patients with Type 2 Diabetes Mellitus　

FEI Xiuwen，DONG Aimei，GUO Xiaohui，WEN Bing，QI Xin，ZHANG Lina5，MENG Min5，GUO Yu5，HUANG Yucheng，KONG Yuxia，ZHANG Chen，HAN Lan，WANG Jingjing，ZHENG Jiatang

2021, 24(6):  652-657.  DOI: 10.12114/j.issn.1007-9572.2020.00.569

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Background　As one of serious complications of diabetes mellitus，cardiac autonomic neuropathy（CAN）may lead to painless myocardial infarction，malignant arrhythmias and even sudden cardiac death，and is strongly associated with approximately five-fold increased risk of cardiovascular mortality.However，there are no reports about prevalence of CAN in community-dwelling patients with type 2 diabetes mellitus（T2DM）in China so far.Objective　To investigate the prevalence and factors associated with grading of CAN in community-dwelling patients with T2DM.Methods　Random sampling method using Excel was used to extract 300 from 2 751 T2DM patients who underwent screening for diabetic foot and diabetic nephropathy from November 1 to December 31，2018 in six stations attached to Shichahai Community Health Center，Xicheng District，Beijing，including Aimin Street Station，Gulou Street Station，Baimi Station，Denei Station，Xisi Station，Liuyin Street Station.Face-to-face questionnaire survey，detailed medical history inquiry and physical examination were conducted to collect related clinical data.Ewing test was used to screen CAN.Multinomial and ordinal Logistic regression analyses were used to analyze the influencing factors of CAN grading in community-dwelling patients with T2DM.Results　A total of 136 cases were enrolled at last，including 15（11.0%）without CAN（grade 0），38（28.0%）with subclinical CAN（grade 1），57（41.9%）with clinical CAN（grade 2）and 26（19.1%）with severe CAN（grade 3）.Mean age，BMI，course of T2DM，supine systolic blood pressure，fasting plasma glucose，HbA1c，and HDL-C，prevalence of coronary heart disease and peripheral neuropathy，and percent of users of oral metformin varied significantly across the four groups stratified by CAN grade（P<0.05），while sex ratio，mean supine diastolic blood pressure and LDL-C，percents of ever and current smokers，and users of oral mecobalamin and B vitamins，prevalence of hypertension，cerebrovascular disease and chronic kidney disease did not（P>0.05）.Multinomial and ordinal Logistic regression analyses showed that，age〔OR=6.878，95%CI（3.003，15.753）〕，course of T2DM〔OR=4.422，95%CI（2.048，9.546）〕and peripheral neuropathy〔OR=2.830，95%CI（1.315，6.090）〕were associated with CAN grading in community-dwelling patients with T2DM （P<0.05）.Conclusion　The prevalence of CAN was relatively high（61.0%）in community-dwelling patients with T2DM，factors associated with CAN grading may be age，course of T2DM and peripheral neuropathy，which should be paid attention.


Influencing Factors of Painful Diabetic Neuropathy in Type 2 Diabetes Mellitus　

WU Lanxue，WANG Sihu，HUANG Daxiang，HUANG Lijuan，HE Jiang，ZHANG Qiu

2021, 24(6):  658-662.  DOI: 10.12114/j.issn.1007-9572.2020.00.562

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Background　As a common complication of type 2 diabetes mellitus （T2DM），painful diabetic neuropathy（PDN） is often overlooked or misdiagnosed，particularly in physicians with lack of sufficient understanding of related risk factors，which may delay appropriate treatment.Objective　To explore the influencing factors of PDN in T2DM，providing countermeasures for early clinical intervention and active prevention of this disease.Methods　273 eligible T2DM patients who were hospitalized in Department of Endocrinology，Anqing Municipal Hospital were enrolled from January 2016 to December 2019，including 88 with PDN（PDN group），and 185 without（NPDN group）.The demographic information and laboratory test results were compared between the two groups.Multivariate unconditional Logistic regression analysis was used to explore the influencing factors of PDN.Results　PDN group showed greater average age，BMI，FPG，2 hPG，HbA1c，and longer average course of T2DM，higher prevalence of diabetic retinopathy and diabetic kidney disease，as well as lower average 1-hour and 2-hour postprandial C-peptide levels（P<0.05）.Multivariate unconditional Logistic regression analysis showed that the course of T2DM 〔OR=1.079，95%CI（1.003，1.160）〕，diabetic retinopathy〔OR=7.524，95%CI（1.363，41.541）〕，diabetic kidney disease〔OR=3.547，95%CI（1.134，11.095）〕，FPG 〔OR=1.831，95%CI（1.384，2.422）〕，and HbA1c〔OR=2.468，95%CI（1.694，3.596）〕were associated with PDN in T2DM （P<0.05）.Conclusion　The course of T2DM，diabetic retinopathy，diabetic kidney disease，FPG and HbA1c may be influencing factors of PDN in T2DM.Clinical attention should be paid to these factors in T2DM patients to early prevent PDN or deliver interventions.


Monocyte to High-density Lipoprotein Ratio and Lower Extremity Atherosclerosis Disease in Patients with Type 2 Diabetes Mellitus　

HAN Mengran，AO Na，WANG He，JIN Shi，YANG Jing，DU Jian

2021, 24(6):  663-668.  DOI: 10.12114/j.issn.1007-9572.2020.00.622

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Background　Lower extremity atherosclerosis disease（LEAD） is a common complications of type 2 diabetes mellitus （T2DM），which may be associated with increased risk of lower extremity gangrene and amputation，and may also has an association with cardiovascular and cerebrovascular diseases，seriously affecting the quality of life.Monocyte / high-density lipoprotein ratio （MHR） is a newly discovered inflammatory marker，which has close correlation with vascular diseases.Objective　To explore the correlation between MHR and LEAD in patients with T2DM.Methods　From September 2018 to September 2019，400 T2DM patients from Department of Endocrinology，the Fourth Affiliated Hospital of China Medical University were selected.Clinical and laboratory data as well as calculated MHR were collected.According to Color Doppler ultrasound-detected severity of lower extremity atherosclerosis（AS），participants were divided into four groups:T2DM+AS1 group （n=109，T2DM without LEAD），T2DM+AS2 group （n=97，T2DM with intimal thickening in lower limb arteries），T2DM+AS3 group （n=109，T2DM with plaques in lower limb arteries），T2DM+AS4 group （n=85，T2DM with stenosis of lower limb arteries）.Results　Gender ratio，mean age，course of T2DM，BMI，MHR，monocyte count，glycosylated hemoglobin，fasting plasma glucose，high-density lipoprotein，and creatinine，and prevalence of smoking history，hypertension history，and insulin treatment in the 4 groups were all significantly different （P<0.05）.Spearman rank correlation analysis showed that MHR increased with increasing degrees of BMI （rs=0.176，P<0.001），neutrophil count （rs=0.426，P<0.001），monocyte count （rs=0.739，P<0.001），lymphocyte count （rs=0.261，P<0.001），triacylglycerol （rs=0.215，P<0.001），uric acid （rs=0.203，P<0.001），and creatinine （rs=0.127，P=0.011），but decreased with increasing degrees of total cholesterol（rs=-0.200，P<0.001），high-density lipoprotein（rs=-0.630，P<0.001），and low-density lipoprotein（rs=-0.102，P=0.042）.Multivariate Logistic regression analysis showed that older age 〔OR=1.853，95%CI（1.398，2.456） 〕，longer course of T2DM 〔OR=1.323，95%CI（1.002，1.746）〕，smoking history 〔OR=2.854，95%CI（1.440，5.658）〕，hypertension history〔OR=2.116，95% CI（1.281，3.661）〕，and elevated MHR 〔OR=1.777，95%CI （1.190，2.653）〕 were associated with increased risk of lower extremity AS，while elevated BMI 〔OR=0.590，95%CI （0.422，0.824）〕 was associated with decreased risk of lower extremity AS （P<0.05）.Multivariate Logistic regression analysis fount that older age was a risk factor for 2-4 grade lower extremity AS（P<0.05）；smoking history，hypertension history and elevated MHR were risk factors for 3-4 grade lower extremity AS（P<0.05）；longer course of T2DM was a risk factor for 4 grade lower extremity AS（P<0.05）；elevated BMI was a protective factor for 2-4 grade lower extremity AS（P<0.05）.Conclusion　MHR may have a close correlation with LEAD and its severity in T2DM patients.Elevated MHR increased with increasing degrees of lower extremity AS，which was mainly manifested in T2DM patients with 3-4 grade lower extremity AS.


Diagnostic Value of Neutrophil/Lymphocyte Ratio and Procalcitonin for Diabetic Ketoacidosis with Bacterial Infection　

LI Li，FENG Xiaoyu，WANG Minghua

2021, 24(6):  669-673.  DOI: 10.12114/j.issn.1007-9572.2020.00.558

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Background　Diabetic ketoacidosis（DKA） is a serious complication of diabetes that can lead to death.Many studies have shown that the most common inducement of DKA is bacterial infection.Objective　This study aims to assess the predictive value of neutrophil / lymphocyte ratio（NLR） and procalcitonin（PCT） in DKA with bacterial infection.Methods　Totally 127 cases of DKA admitted to Department of Endocrinology of Bazhong Central Hospital from January 2015 to January 2020 were retrospectively enrolled，including 64 with bacterial infection and 63 without.Results of bacterial culture and laboratory test were analyzed.NLR，PCT and the combination of the two in the diagnosis of DKA with bacterial infection were evaluated by receiver operating characteristic （ROC） curve analysis.Results　The bacterial culture test showed that the prevalence of Staphylococcus aureus infections，Escherichia coli infections，Klebsiella pneumoniae infections，Pseudomonas aeruginosa infections，Haemophilus influenzae infections，and other bacterial infection was 18.8%（12/64），15.6%（10/64），12.5%（8/64），4.7%（3/64），and 32.8%（21/64），respectively.Those with bacterial infection had higher average levels of fasting blood glucose，NLR and PCT but lower average levels of arterial blood pH and serum HCO3- than those without（P<0.05）.In predicting DKA with bacterial infection，the AUC of NLR was 0.707〔95%CI（0.617，0.797）〕when the optimal cutoff value was selected as 12.94 μg/L，with 59.4% sensitivity and 76.2% specificity.And that of PCT was 0.715〔95%CI（0.624，0.805）〕when the optimal cutoff value was selected as 2.57 μg/L，with 46.9% sensitivity and 93.7% specificity.The AUC of NLR with PCT developed based on the equation of binary logistic regression ｛PRE（P）：Ln〔P/（1-P）〕=-1.235+0.046×NLR+0.335×PCT｝was 0.761〔95%CI（0.680，0.843）〕 when the optimal cutoff value was selected as 0.458，with 60.9% sensitivity and 82.5% specificity.Conclusion　Either NLR or PCT can be used as a clinical predictor for DKA with bacterial infection，and the combination of the two is more valuable.


Recent Developments in the Association of Nutrition with Frailty　

WANG Wanwan，LI Yuanyuan，SHI Xiaotian，MA Qing

2021, 24(6):  673-677.  DOI: 10.12114/j.issn.1007-9572.2020.00.627

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Frailty is a geriatric syndrome commonly seen in clinical practice，which is associated with a series of adverse health events.Nutrition，as one of the changeable risk factors of frailty，has an important influence on the occurrence and development of frailty.We reviewed recent studies on nutrition and frailty，and found that malnutrition，overnutrition，inadequate intake of energy，protein，and trace elements may increase the risk of frailty，while healthy dietary patterns reduce.

Frailty-related Factors and Degree of Association of Frailty with Malnutrition in Elderly Inpatients　

WANG Wanwan，LI Yuanyuan，SHI Xiaotian，MA Qing

2021, 24(6):  678-684.  DOI: 10.12114/j.issn.1007-9572.2020.00.594

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Background　Frailty and malnutrition are common problems in the elderly people.Malnutrition has attracted more and more attention as a modifiable risk factor for frailty in recent years.Early identification of malnutrition and timely delivery of targeted interventions may delay or even reverse frailty.Objective　To explore the prevalence and associated factors of frailty，and the degree of association of frailty with malnutrition in elderly inpatients，to provide a reference for frailty intervention research.Methods　From September 2018 to May 2019，362 inpatients≥60 old years from Department of Gerontology and Geriatrics，Beijing Friendship Hospital，Capital Medical University were enrolled.The Comprehensive Geriatric Assessment （CGA），FRAIL scale，and Mini-Nutritional Assessment-Short Form （MNA-SF） were used by professionals to assess the prevalence of geriatric syndrome，frailty，and malnutrition，respectively.The number of patients with frailty was counted.Multivariate Logistic regression was used to identity the influencing factors of frailty.Spearman rank correlation analysis was used to analyze the degree of association of frailty and malnutrition.Results　Of the 362 cases，91（25.1%） were identified with frailty，172（47.5%） with prefrailty，99（27.4%） with robust health；27（7.5%） were identified with malnutrition，125（34.5%） with risk of malnutrition，210（58.0%） with normal nutrition.Multivariate Logistic regression analysis showed that diabetes〔OR=2.844，95%CI（1.309，6.178）〕，malnutrition〔OR=6.055，95%CI（1.580，23.200）〕，IADL score〔OR=0.603，95%CI（0.523，0.695）〕，hemoglobin〔OR=0.981，95%CI（0.964，0.998）〕and hs-CRP level〔OR=1.017，95%CI（1.004，1.030）〕 were influencing factors of frailty（P<0.05）.The FRAIL score decreased with the increase of BMI（rs=-0.244），MNA-SF score（rs=-0.585），hemoglobin（rs=-0.360），albumin（rs=-0.420），TC（rs=-0.164），TG（rs=-0.117），HDL-C（rs=-0.124） and LDL-C（rs=-0.151），but increased with the decrease of age（rs=0.537），blood urea nitrogen（rs=0.172） and creatinine（rs=0.168）（P<0.05）.Conclusion　In our study，the prefrail cases accounted for about half of all the cases，which deserves attention.Diabetes，malnutrition，activities of daily living，hemoglobin，and hs-CRP may be associated with frailty.In particular，nutritional status may be has a more significant association with frailty.In view of this，clinicians should pay attention to functional status assessment and comorbidity management in elderly hospitalized patients.


Recent Advances in Pathogenesis and Nutrition Interventions of Frailty in Chronic Obstructive Pulmonary Disease　

TAO Yang，GUO Honghua，ZHANG Caihong

2021, 24(6):  684-689.  DOI: 10.12114/j.issn.1007-9572.2020.00.614

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With the aging of the global population，frailty，as a geriatric syndrome，has attracted extensive attention from researchers in the field of geriatrics in recent years.Since chronic obstructive pulmonary disease （COPD） is one of the high risk factors of frailty，frailty in COPD has been a research focus.However，previous studies are mainly cross-sectional investigations on the incidence of frailty in COPD and their correlations，while comprehensive studies，especially reviews on the pathogenesis and nutrition interventions of frailty in COPD are relatively lacking.Considering the importance of pathogenesis and effective nutrition interventions of frailty in improving the long-term life quality of COPD patients，we reviewed relevant advances that have been recently achieved，aiming to provide a reference for the development of nutrition intervention programs targeting population with COPD with frailty.


Predictive Value of Daily Fetal Movement Count Chart for the Fetal Safety of Fetus with Umbilical Cord around Neck　

YE Aimei，LI Zijun，AI Xiaoyu

2021, 24(6):  690-695.  DOI: 10.12114/j.issn.1007-9572.2021.00.007

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Background　Fetal movement is the only index that is assessed by pregnant women subjectively，but can objectively reflect the safety of fetus.How to quantify fetal movement and make it be a relatively objective evaluation index has been a research focus of obstetricians.Objective　To predict the fetal safety of fetus with umbilical cord around neck by using the daily fetal movement count chart （DFMC）.Methods　A retrospective design was used.Participants were 100 pregnant women who were hospitalized in Zhejiang Quhua Hospital for a full-term delivery from January 2010 to January 2016.Their babies had antepartum B-mode ultrasound suggested umbilical cord around neck，which was confirmed at birth.The DFMC of 24 hours before delivery was collected and used to predict the fetal safety （fetal safety and unsafety were defined as normal fetal movement，and abnormal，decreased or disappeared fetal movement，respectively）.Other clinical data were collected，including maternal age，gestational week，systolic-diastolic（S/D） ratio in the umbilical artery measured by Doppler ultrasound，amniotic fluid index，modified Fischer score of the results of non-stress test performed 24 hours before delivery，neonatal outcome after delivery（44 with safety and 56 without），delivery mode（vaginal，cesarean or forceps）.Stepwise multiple Logistic regression was used to analyze influencing risk factors of fetal safety of fetus with umbilical cord around neck.Results　There were significant differences in the S/D ratio，the gestational week at which umbilical cord to be found around the baby's neck，fetal movement，modified Fischer score and delivery mode between the two groups （P<0.05）.Stepwise multiple Logistic regression analysis showed that fetal movement and mode of delivery were independently associated with fetal safety of fetus with umbilical cord around neck（P<0.05）.The sensitivity，specificity and Youden's index of DFMC were 86.5%，90.0%，and 0.77，respectively in predicting the fetal safety of a baby vaginally born with umbilical cord around neck，and were 66.7%，94.6% and 0.61，respectively in predicting that of a baby cesarean delivered with umbilical cord around neck.Abnormal, decreased or disappeard fetal movement was accounting for 87.5% （35/40） of the cesarean delivered babies.Conclusion　DFMC may effectively predict the fetal satety of fetus with umbilical cord around neck，and may be used as a clinical indicator for the selection of an appropriate delivery mode in pregnant women with a fetus with umbilical cord around neck.


Chromosome Detection Results and Related Factors in Second-trimester Fetuses with Nasal Bone Abnormalities　

HOU Dongxia，HOU Liqing，WUYUNTANA，JI Yunpeng，WANG Xiaohua，JI Xiaoping

2021, 24(6):  696-700.  DOI: 10.12114/j.issn.1007-9572.2020.00.605

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Background　Fetal nasal bone development，an item assessed by routine prenatal ultrasound，is often used as a key ultrasound marker for assessing fetal chromosomal anomalies.With recent application of chromosomal microarray analysis（CMA），prenatal fetal chromosomal diseases have been detected in a wider range and with higher accuracy.So it is necessary to re-summarize the correlation between nasal bone abnormalities and chromosomal abnormalities，to provide evidence for clinical practice.Objective　To investigate the predictive value of fetal nasal bone abnormalities or its combination with other prenatal risk factors for chromosomal abnormalities，and to evaluate the application value of CMA in the genetic examination of fetal nasal bone abnormalities.Methods　92 pregnant women with fetuses with prenatal ultrasound-suggested nasal bone abnormalities were recruited from Inner Mongolia Maternal and Child Care Hospital from December 2016 to January 2020.Prenatal examination information，prenatal genetic test results（including karyotype analysis and CMA） and pregnancy outcomes were collected.Results　Karyotype analysis detected chromosome abnormalities in 19 cases （20.7%），all of which were trisomy 21.CMA detected chromosomal abnormalities in 25 cases （27.2%），including 19 cases of trisomy 21 and 6 cases of chromosomal microdeletions and microduplications.There was no statistical difference in the rate of chromosome abnormalities between fetuses with isolated and non-isolated nasal bone abnormalities （P>0.05）.Compared with fetuses with isolated nasal bone abnormalities，the incidence of chromosomal abnormalities in those with isolated nasal bone abnormalities with increased nuchal translucency thickness，isolated nasal bone abnormalities with high risk for chromosomal abnormalities suggested by maternal serum screening，isolated nasal bone abnormalities with high risk for chromosomal abnormalities suggested by non-invasive prenatal testing，or isolated nasal bone abnormalities with 2 or more high-risk factors for chromosomal abnormalities was increased（P<0.05）.Conclusion　The incidence of chromosomal abnormalities in fetuses with nasal bone absence or hypoplasia was higher，which was related to copy number variations.Karyotype analysis and CMA in combination with other prenatal examinations may effectively improve the detection rate of chromosomal abnormalities.The application of CMA technology provides more information on chromosome variation for prenatal diagnosis，and it is recommended that all fetuses with nasal bone absence or hypoplasia should be tested by karyotype analysis and CMA.


Effect of Antenatal Dexamethasone Administration for Fetal Lung Maturation on Blood Glucose in Pregnant Women with Threatened Preterm Birth　

FENG Jinping，HE Xuemei，ZHOU Zixing，WANG Lijuan，YU Dandan，CHEN Feina

2021, 24(6):  701-705.  DOI: 10.12114/j.issn.1007-9572.2021.00.050

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Background　Preterm birth is a serious and common pregnancy complication.Immature development of physical function in premature infants causes the low survival rate，whose rescue results in a heavy burden on the family and society.Antenatal glucocorticoids treatment is an international recognized standard regimen benefiting fetal lung maturation.However，dexamethasone has a certain adverse effect on maternal glucose，and the mechanism that maternal glucose varies by peak blood concentration of dexamethasone is not clear.Objective　To explore the effect of antenatal administration of dexamethasone on blood glucose in pregnant women with threatened preterm birth.Methods　From October 2018 to February 2020，63 eligible hospitalized pregnant women with threatened premature birth were recruited from Foshan Women and Children Hospital，and divided into  GDM（gestational diabetes mellitus） group and non-GDM group according to the results of 75-gram oral glucose tolerance test （OGTT） at 24-28 weeks' gestation.Both groups received the same protocol to promote fetal lung maturation after admission：dexamethasone was injected intramuscularly 6 mg every 12 hours，4 times in total.The blood glucose 1 hour before and 3 hours after each injection of dexamethasone，and blood glucose at 1 hour before and after the peak blood concentration of dexamethasone after each injection of dexamethasone measured by the Medtronic MINIMED continuous glucose monitoring system as well as the chart of the trend of blood glucose over time were compared between the two groups Results　Finally，55 cases completed the study，including 16 with GDM and 39 without.There were no significant differences in blood glucose measured 1 hour before and 3 hour after each dexamethasone injection in both groups （P>0.05）.The first measured blood glucose at 1 hour before dexamethasone injection was lower than each of the latter three measured in GDM group （P<0.05）.The blood glucose 3 hours after each injection of dexamethasone showed no significant changes in GDM group （P>0.05）.The first measured blood glucose at 1 hour before dexamethasone injection was lower than that measured at the second or third time in non-GDM group （P<0.05）.The first measured blood glucose 3 hours after injection of dexamethasone was lower than each of the latter three measured in non-GDM group （P<0.05）.The blood glucose at 1 hour before or after peak blood concentration of dexamethasone after dexamethasone administration did not differ significantly by the times of injection of dexamethasone in both GDM and non-GDM groups （P>0.05）.Within 3 hours of injection of dexamethasone，the blood glucose of women without GDM was within the reference range，and there was no discernible trends，but the blood glucose of women with GDM showed greater fluctuation，and increased gradually 2 hours after each injection of dexamethasone.Conclusion　The blood glucose of singleton pregnant women may not be affected by the peak blood concentration of dexamethasone within 2 hours after injection of dexamethasone.The blood glucose significantly increased at 3 hours after dexamethasone injection.However，four times injections of dexamethasone had no cumulative effect on the increase of blood glucose.Within 3 hours of injection of dexamethasone，the blood glucose of women without GDM was within the reference range，and there was no discernible trends，but the blood glucose of women with GDM showed greater fluctuation，and increased gradually 2 hours after each injection of dexamethasone.


Value of Cervical Length Combined with Placental alpha Microglobulin-1 in Cervical Secretions in Predicting Preterm Labor in Pregnant Women with Threatened Preterm Birth　

YE Yun，SHEN Qian，YAN Yanfen，SHEN Shuangshuang

2021, 24(6):  706-711.  DOI: 10.12114/j.issn.1007-9572.2021.00.065

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Background　Preventing premature birth is an important task in the perinatal period of modern medicine.It is also the key to reducing neonatal morbidity and mortality.Objective　To investigate the value of cervical length （CL） combined with PAMG-1 in cervical secretions in predicting preterm labor in women with threatened preterm labor.Methods　From Jinhua Maternal and Child Healthcare Hospital，252 pregnant women of appropriate reproductive age（20-32） with threatened preterm birth were enrolled from January 2017 to January 2020，and divided into three groups by gestational age and other research results：group 1（28-30 gestational weeks），group 2（31-33 gestational weeks） and group 3（34-36 gestational weeks）.CL was measured by transvaginal ultrasound and PAMG-1 in cervical secretions was detected.Clinical preterm birth was used as the gold standard for evaluating the predictive value of CL，PAMG-1 in cervical secretions or the combination of the two for preterm birth.The relationships of CL and PAMG-1 in cervical with preterm birth were analyzed in the three groups.The predictive values of CL，PAMG-1 in cervical and CL combined with PAMG-1 in cervical for preterm birth in each group were estimated.The quantitative relationships of CL and PAMG-1 in cervical with preterm birth was explored.Results　There were 67，95，and 90 cases in groups 1，2，and 3，respectively.Those with a CL<2.5 cm and PAMG-1（+） in cervical had higher risk of preterm birth in all groups（P<0.05）.The incidence of preterm birth predicted by CL with PAMG-1 in cervical differed across the groups（P<0.05）.In the prediction of preterm birth，in group 1，the sensitivity of CL<2.5 cm，PAMG-1（+）in cervical and CL<2.5 cm with PAMG-1（+） in cervical was 69%，63%，56%，respectively，and the specificity of the three was 67%，75%，and 78%，respectively.In group 2，the sensitivity of CL<2.5 cm，PAMG-1（+） in cervical and CL<2.5 cm with PAMG-1（+） in cervical was 74%，56%，and 53%，respectively，and the specificity of the three was 79%，66%，and 87%，respectively.In group 3，the sensitivity of CL<2.5 cm，PAMG-1（+） in cervical and CL<2.5 cm with PAMG-1（+） in cervical was 76%，83%，and 62%，respectively，and the specificity of the three was 56%，65%，and 71%，respectively.Multivariate Logistic regression analysis showed that CL〔OR=0.331，95%CI（0.182，0.601）〕 and PAMG-1 in cervical 〔OR=0.332，95%CI（0.182，0.605）〕 had a quantitative relationship with preterm birth （P<0.05）.Conclusion　CL and PAMG-1 in cervical may be used for the prediction of preterm birth occurring in different gestational weeks.The combination of the two may improve the predictive specificity，but slightly reduce the sensitivity，which is more suitable for the prediction of preterm birth during 31-33 gestational weeks.


Efficacy and Safety of Vonoprazan versus PPIs in Treating Reflux Esophagitis：a Meta-analysis　

LI Mianli，ZHANG Weijian，GUO Linglong，HUANG Yanzi，GUO Shaoju，LI Haiwen，XU Yifei，JIANG Xiaoyan，LI Jingwei，KANG Jianyuan，CHEN Qiting，HUANG Bin

2021, 24(6):  712-717.  DOI: 10.12114/j.issn.1007-9572.2020.00.621

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Background　The acid secretion inhibition method typically adopted to treat reflux esophagitis （RE） aims to relieve symptoms and prevent complications.Vonoprazan is a novel potassium-competitive acid blocker characterised by rapid and potent acid inhibition，which has been used to treat RE recently.Objective　To systematically evaluate the efficacy and safety of vonoprazan in the treatment of RE compared with proton-pump inhibitor（PPI）.Methods　Databases of CNKI，VIP，Wanfang Data，PubMed，EMBase and the Cochrane Library were searched to collect randomized controlled trials （RCTs） of vonoprazan （treatment group） compared with PPI （control group） in the treatment of RE published from January 2015 to April 2020.Date extraction and quality evaluation of RCTs meeting the inclusion criteria were performed，and meta-analysis was conducted by using RevMan 5.3.Results　A total of 5 RCTs were included，all in English，with a total of 1 414 patients.Two groups showed no significant differences in the response rate at the 4th week of treatment 〔RR=1.03，95%CI（0.99，1.06），P=0.18〕and in the complete response rate at the 8th week of treatment 〔RR=1.02，95%CI（0.99，1.04），P=0.15〕.However，the response rate of treatment group was significantly higher at the 2nd week of treatment〔RR=1.09，95%CI （1.03，1.15），P=0.002〕.In addition，no significant difference was found in the complete response rate between those with Los Angeles grade A/B RE in both groups at the 2nd，4th and 8th weeks of treatment〔RR=1.04，95%CI （0.98，1.10），P=0.21 ；RR=0.98，95%CI （0.95，1.02），P=0.33；RR=1.00，95%CI （0.97，1.02），P=0.74〕.On the contrary，the complete response rate was numerically higher in those with Los Angeles grade C/D RE in the treatment group compared to that of those in the control group at the 2nd，4th and 8th weeks of treatment〔 RR=1.26，95%CI （1.11，1.42），P=0.000 3；RR=1.15，95%CI （1.05，1.25），P=0.003；RR=1.09，95%CI （1.02，1.16），P=0.01〕.Meta-analysis of safety demonstrated that there were no significant differences in treatment-emergent adverse events 〔RR=1.04，95%CI （0.89，1.22），P=0.59〕 and serious adverse events〔RR=0.82，95%CI （0.29，2.35），P=0.71〕between the two groups.Conclusion　The efficay and safety of vonoprazan are similar to PPIs in RE mucosa healing stage，but vonoprazan is more efficacy and acts quicker than PPI in a short-term treatment.What's more，vonoprazan brings more clinical benefits to those with severe RE.Due to insufficient quantity of RCTs，our conclusion still needs to be verified by more multi-center large-sample RCTs.


Traditional Chinese Medicine for the Prevention and Treatment of Bone Marrow Suppression after Chemotherapy Based on AMSTAR 2 and GRADE：an Overview of Systematic Reviews and Meta-Analyses　

XUE Mengting，YANG Min，PAN Yalan，TAN Jiani，HUANG Anle，BU Zihan，WANG Qing，XU Guihua

2021, 24(6):  718-726.  DOI: 10.12114/j.issn.1007-9572.2020.00.568

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Background　Bone marrow suppression is one of the common dose-limiting toxic and side effects of chemotherapy.There have been many systematic reviews and Meta-analyses about traditional Chinese medicine（TCM）for preventing and treating bone marrow suppression after chemotherapy，but their quality is uneven，with a lack of systematic evaluation.Objective　To evaluate the methodological quality and outcome indicators quality of systematic reviews and Meta-analyses about TCM in preventing and treating post-chemotherapy bone marrow suppression by AMSTAR 2 and GRADE.Methods　The databases such as the Cochrane Library，PubMed，Web of Science，OVID，EBSCO，CBM，CNKI，Wanfang Data and VIP were searched for systematic reviews and Meta-analyses on the topic of TCM in preventing and treating bone marrow suppression after chemotherapy from inception to February，2020.AMSTAR 2 was used to assess the methodological quality，and the evidence quality of the outcome indicators was graded according to the GRADE system.Results　A total of 23 systematic reviews and Meta-analyses were enrolled，AMSTAR 2 evaluation results showed that，1 had moderate reliability，2 had low reliability，and the other 20 had extremely low reliability.The GRADE evaluation results showed that，among the totaled 62 outcome indicators from meta-analyses，2 were high-quality，11 were intermediate-quality，13 were low-quality and 36 were critically low-quality，with the main degradation factors of limitation，followed by inconsistency，imprecision and publication bias.Conclusion　Methodological quality and quality of evidence of outcome indicators of available systematic reviews and Meta-analyses about TCM in preventing and treating post-chemotherapy bone marrow suppression are both low，with general reliability of relevant conclusions，thus it is uncertain that TCM can effectively prevent and treat bone marrow suppression after chemotherapy.And more high-quality systematic reviews and Meta-analyses with rigorous design are needed in the future.


Correlation between Stigma and Post-stroke Depression in Initally Diagnosed Stroke Patients　

HU Ruidan，ZHOU Hongzhen，LIU Zhihong，HOU Jiakun，LIU Yangyang，BAI Xuejie，LI Muling

2021, 24(6):  727-731.  DOI: 10.12114/j.issn.1007-9572.2020.00.616

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Background　Psychosocial and scoial factors are important participators in the pathogenesis of post-stroke depression（PSD）.However，the fact that cognitive，emotional and behavioral changes brought by stigma may be closely related to PSD has received little attention.Objective　To explore the correlation between stigma and PSD in initally diagnosed stroke patients.Methods　In this cross-sectional study，by use of convenience sampling，initially diagnosed stroke patients（n=299） were recruited from Neurology and Neurosurgery Departments of Nanfang Hospital，Southern Medical University and Guangdong 999 Brain Hospital from July to December 2019.Socio-demograpchics and stroke-related history were collected.The stigma，depression and severity of disability at the end of 1-month follow-up were evaluated using the Stroke Stigma Scale（SSS），Patient Health Questionnaire-9 （PHQ-9） and modified Rankin Scale （mRS），respectively.Results　78 cases were excluded due to loss to follow-up，other 221 cases who completed the follow-up were included for final analysis.By PHQ-9 score，65（29.4%） and 156（70.6%） were evaluated with and without PSD，respectively.PSD patients experienced higher score of physical impairment，social isolation，discrimination experience，internalized stigma，and scores of SSS，PHQ-9，and mRS than non-PSD patients（P<0.05）.Correlation analysis revealed that PHQ-9 score was positively correlated with score of SSS，physical impairment，social isolation，discrimination experience，internalized stigma，and mRS，respectively（rs=0.606，0.319，0.441，0.369，0.616，0.389，P<0.05）.Multivariate Logistic regression analysis illustrated that score of SSS was an independent associated factor of PSD in initally diagnosed stroke patients〔OR=1.263，95%CI（1.158，1.379），P<0.05〕.Conclusion　Stigma manifested in the early stage of stroke may be used as a predictor of PSD in initally diagnosed stroke patients.So medical workers and family members of the stroke patient should be on fully alert for PSD.


Related Factors of Post-stroke Cognitive Impairment with Insomnia　

ZHU Mingjin，SUI Shuyan，LUO Fang，LI Bo，CAO Yulin，ZHANG Yonghua

2021, 24(6):  732-739.  DOI: 10.12114/j.issn.1007-9572.2020.00.611

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Background　Cognitive impairment and insomnia are common post-stroke complications.They often coexist and influence each other，affecting the recovery and increasing the length of hospital stay in stroke patients.Post-stroke changes in hormone level and cerebral blood flow may be related to post-stroke complications.Objective　To explore the related factors of post-stroke cognitive impairment with insomnia by analyzing the clinical data of such patients.Methods　55 outpatients and inpatients with stroke from Tongde Hospital of Zhejiang Province were enrolled from August 2018 to February 2020，of them those with and without post-stroke cognitive impairment and insomnia were assigned to a observation group （n=40）and a control group（n=15），respectively.General demographic data，clinical scale scores，serum hypothalamic-pituitary-adrenal （HPA） axis hormones 〔adrenocorticotropic hormone （ACTH），cortisol〕，and hypothalamus-pituitary-thyroid （HPT） axis hormones 〔thyroid-stimulating hormone （TSH），free triiodothyronine （FT3），free tetraiodothyronine （FT4）〕，homocysteine and neuron-specific enolase （NSE） levels were recorded.Cerebral blood flow was measured by arterial spin labeling，and the specific region of interest was analyzed.Results　The observation group and control group had significant difference in the distribution of education level （P<0.05）.The observation group had lower mean scores of Montreal Cognitive Assessment （MoCA） and Barthel Index and higher mean scores of National Institutes of Health Stroke Scale （NIHSS），Pittsburgh Sleep Quality Index （PSQI），Hamilton Depression Rating Scale （HAMD） and Hamilton Anxiety Rating Scale （HAMA） than the control group（P<0.05）.Mean serum levels of TSH，FT3 and FT4 showed no significant intergroup difference（P>0.05）.Mean serum levels of ACTH and cortisol in the observation group were much higher （P<0.05）.There was no significant difference in serum homocysteine level between the two groups （P>0.05）.Serum NSE level in the observation group was much higher （P<0.05）.The cerebral blood flow of left frontal lobe in the observation group was significantly lower （P<0.05）.Spearman rank correlation analysis showed that MOCA score was negatively correlated with age，NIHSS score and serum NSE level （rs=-0.321，P=0.043；rs=-0.478，P=0.002；rs=-0.433，P=0.005），and positively correlated with Barthel Index，cerebral blood flow of right parietal lobe，left parietal lobe，right frontal lobe，right temporal lobe，right occipital lobe，left occipital lobe and right thalamus （rs=0.486，P=0.001；rs=0.639，P=0.003；rs=0.285，P=0.003；rs=0.723，P<0.001；rs=0.530，P=0.020；rs=0.688，P=0.001；rs=0.705，P=0.009；rs=0.582，P=0.009；rs=0.576，P=0.010）；PSQI score was positively correlated with HAMD score，HAMA score，serum cortisol level and cerebral blood flow of right occipital lobe in observation group （rs=0.603，P<0.001；rs=0.591，P<0.001；rs=0.635，P<0.001；rs=0.593，P=0.007）.Conclusion　The patients with post-stroke cognitive impairment and insomnia had increased severity of depression and anxiety，increased activity of the HPA axis，and elevated serum NSE level.Correlation analysis showed that the degree of insomnia was positively correlated with serum cortisol level，HAMD and HAMA scores，and the cerebral blood flow in right occipital lobe；cognitive function was negatively correlated with age，NIHSS score and serum NSE level，and positively correlated with Barthel Index and cerebral blood flow in most lobes.


Gene Mutation Analysis and Prenatal Diagnosis for Chinese People from a Pedigree with X-linked Hypohidrotic Ectodermal Dysplasia　

JIN Yuxia，LI Suping，LI Jing，TANG Ping

2021, 24(6):  740-743.  DOI: 10.12114/j.issn.1007-9572.2020.00.606

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Background　X-linked hypohidrotic ectodermal dysplasia（XL-HED）is a rare genetic disease，often accompanied with severe abnormal sweat gland secretion，without currently available effective clinical treatments. Thus，genetic counseling and accurate prenatal diagnosis are effective measures to prevent or reduce the birth of such neonates.Objective　To perform a gene mutation analysis of a pedigree with XL-HED，offering a reference for the accurate etiological diagnosis of XL-HED，genetic counseling and prenatal diagnosis in people from such a pedigree.Methods　Peripheral venous blood samples were collected from the proband and his blood relatives，and target gene chip capture high-throughput sequencing was carried out for gene detection and the mutant gene was confirmed by Sanger sequencing. Prenatal diagnosis was performed on amniocytes of the proband's elder sister（a pregnant woman）after confirmation of mutant gene locus.Results　A hemizygotic missense mutation c.467G>A（p.Arg156His）of EDA gene was discovered in the proband，which was a previously known pathogenic mutation.The proband's elder sister was found to be a heterozygous carrier. Prenatal diagnosis has detected no mutation in the fetus，so she continued pregnancy.Conclusion　Hemizygotic mutation of EDA gene of proband is the pathogenic mutation of XL-HED，thus we should pay attention to gene mutation analysis and prenatal diagnosis of proband's family members to reduce or avoid the birth of such neonates.


Diagnostic Value of Next-generation Sequencing of Cerebrospinal Fluid for Viral Encephalitis：Report of 3 Cases　

LI Guangxu，LI Yuanlong，LU Jun，SUN Weiwei

2021, 24(6):  744-747.  DOI: 10.12114/j.issn.1007-9572.2020.00.547

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Viral encephalitis is a central nervous system inflammatory disease involving the meninges and brain parenchyma，the common symptoms of which include fever，motor tics，and headache.Considering its lack of specific symptoms in early stage combined with high risks of mortality and disability，early diagnosis is of vital importance.This report examines three cases of pediatric herpes simplex encephalitis （HSE） who were diagnosed at an early stage using metagenomics next-generation sequencing （mNGS）. Compared with conventional approaches to diagnosis of viral encephalitis，next-generation sequencing of cerebrospinal fluid enabled earlier etiological diagnosis，which may have important implications for early diagnostic and therapeutic guidelines.


Recent Developments in Percutaneous Coronary Intervention via Distal Radial Artery Access　

LI Feng，XIAO Jianqiang，CAI Gaojun

2021, 24(6):  748-752.  DOI: 10.12114/j.issn.1007-9572.2020.00.523

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Distal radial artery access is a new approach to percutaneous coronary intervention（PCI）used in the past several years，which may be used as an alternative approach for PCI because of its merits of less local complications and higher comfort level.We reviewed recent developments in PCI using distal radial artery access，with detailed summary of the effectiveness，safety，strengths and limits of the treatment，aiming to improve the understanding and performance of PCI in cardiac interventionalists to benefit PCI patients.


Novel Developments in Sodium-glucose Co-transporter 2 Inhibitor for Adjuvant Therapy for Adult Type 1 Diabetics　

ZHANG Yu，LIAO Xiaoyang，ZHAO Qian，LI Zhichao，WANG Weiwen

2021, 24(6):  753-758.  DOI: 10.12114/j.issn.1007-9572.2020.00.595

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Type 1 diabetes mellitus （T1DM） seriously endangers people's health and life.On the whole，insulin hypoglycemic therapy achieves low rate of meeting the target glucose level，and long-term use of insulin may lead to frequent hypoglycemia，increased body weight，and elevated blood pressure，further increasing the risk of cardiovascular events.Studies have shown that sodium-glucose co-transporter 2（SGLT2） inhibitor，a novel glucose-lowering drug，can be used as an adjuvant therapy for adult T1DM diabetics，which may reduce insulin dosage and blood glucose without increasing the risk of severe hypoglycemia.However，it has also been reported that SGLT2 inhibitors can increase the risk of diabetic ketoacidosis（DKA）.Therefore，finding out the balance between the benefits and risks of SGLT2 inhibitors for T1DM adults is the key to clinical research.This paper summarized recently achieved important research results regarding SGLT2 inhibitors for adult T1DM，with a detailed review of benefits and risks of SGLT2 inhibitors，offering a reference to related clinical application and research.


Post-stroke Cognitive Impairment-related Studies in 2010—2019：a Visualization Review　

HAO Wenxue，LI Ruiqing，HU Yanchao，SU Kaiqi，HUANG Jin，LI Jieying，ZHAO Wei，FENG Xiaodong

2021, 24(6):  759-764.  DOI: 10.12114/j.issn.1007-9572.2020.00.549

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Background　Post-stroke cognitive impairment seriously affects the recovery of various functions after stroke，and can lead to a series of adverse results，such as decreased quality of life and reduced survival time.Therefore，it has become a focus of stroke-related research and intervention.Objective　To explore the status of studies about post-stroke cognitive impairment published from 2010 to 2019 with a deep analysis of the covered hot topics.Methods　The studies about post-stroke cognitive impairment published during 2009—2019 were searched from databases on the kernel database of Web of Science platform.The data extracted from the eligible studies，such as author's country/region and institution，high-output authors，publication journals and burst keywords，were analysed with CiteSpace.Results　A total of 3 603 articles were included.The overall trend of the number of publications showed a continuous growth.The United States ranked first in terms of the number of articles （1 107） and centrality （0.25）.The University of Toronto was the institution with the highest number of articles （83）.And Harvard University was the institution with the highest centrality （0.15）.BLACK from the University of Toronto in Canada，DICHGANS from the University of Munich in Germany，and DECARLI from the University of California in the United States ranked among the top 5 in terms of the number of articles and centrality.In addition，they had more cooperations with other authors and had high authority.Stroke，Neurology and Journal of Neurology Neurosurgery and Psychiatry are the three most influential journals in the field of post-stroke cognitive impairment.Transient ischemic attack，predictors，Meta-analysis，white matter hyperintensity，and oxidative stress may be the frontiers of post-stroke cognitive impairment in the future.Conclusion　Post-stroke cognitive impairment is a subject of growing attention.A more recent emerging trend has focused on its mechanism.The keywords "transient ischemic attack" "predictors" "Meta analysis" "white matter hyperintensity" and "oxidative stress" may be the latest research frontiers meriting close attention.