Table of Content

20 May 2021, Volume 24 Issue 15

Previous Issue    Next Issue

Monographic Research

Opportunistic Viral Infections in Patients with Inflammatory Bowel Disease：Clinical Features and Management Strategies　

WU Rong，WANG Yingde，MAO Jingwei

2021, 24(15):  1853-1860.  DOI: 10.12114/j.issn.1007-9572.2021.00.407

Asbtract ( )   HTML ( )   PDF (1361KB) ( )  

References | Related Articles | Metrics

Inflammatory bowel disease（IBD）is a term used to describe ulcerative colitis and Crohn's disease，manifested by chronic inflammation of the gastrointestinal tract.Although its pathogenesis remains unclear，it has been recognized as an autoimmune disease with abnormal immune response in the gastrointestinal tract.Current treatments mainly include drug therapies such as steroid，immune inhibitors and biological agents，and their effects mainly attribute to targeted intervention in different stages of immune response in the process of IBD.As the body's defense against pathogens is impaired due to declined nutritional and immune status as well as application of immunomodulatory，patients with IBD have a significant increase in the risk of opportunistic infection.This paper mainly reviewed the clinical features and management strategies of opportunistic viral infections in patients with IBD，hoping to provide a reference for clinical efficient management.


Emerging Adulthood Management in Inflammatory Bowel Disease：New Progress and Implications　

TU Wenjing，XU Guihua

2021, 24(15):  1861-1866.  DOI: 10.12114/j.issn.1007-9572.2021.00.426

Asbtract ( )   HTML ( )   PDF (1369KB) ( )  

References | Related Articles | Metrics

Inflammatory bowel disease（IBD），which is characterized by chronic course，high recurrence rate and canceration rate，has become a chronic disease affecting people's health that cannot be ignored.IBD patients during emerging adulthood have to face the dual challenges of disease management and social adaptation，but the emerging adulthood management is still a weak link in the health management of IBD in China.This paper reviewed the new progress in emerging adulthood management in IBD at home and abroad，with detailed analysis of the difficulties，key elements and projects of emerging adulthood management，and recommendations proposed for current and future development of emerging adulthood management in IBD in China，providing a reference for improving the management level.


Summary of the Best Available Evidence for the Prevention and Control of Influenza Outbreaks in Nursing Homes　

HUANG Yuyan，HUANG Houqiang，CHEN Peiyun，PENG Bo，CHEN Yingyi，ZHENG Silin

2021, 24(15):  1867-1873.  DOI: 10.12114/j.issn.1007-9572.2021.00.077

Asbtract ( )   HTML ( )   PDF (1052KB) ( )  

References | Related Articles | Metrics

Background　At present，the coverage rate of influenza vaccine in China is low，once outbreak，it will increase the medical pressure.Objective　To summarize the best available evidence of preventing and controlling influenza outbreaks in nursing homes，thus strengthening the attention of managers and workers of nursing homes to influenza.Methods　Evidence（including clinical guidelines，systematic reviews，expert consensuses，cohort studies，randomized controlled trials，and cross-sectional studies） regarding the containment of influenza outbreak in nursing homes，was searched according to Wanfang Data，VIP，CNKI and CBM，and the official website of Ministry of Civil Affairs of the People's Republic of China，Cochrane Library，PubMed，Medline，Joanna Briggs Institute（JBI） evidence-based health care research center library，Up to Date and Ovid，and the official website of Centers for Disease Control and Prevention，from inception to February 12，2020.Quality evaluation was performed according to the frame of AGREE Ⅱ，AMSTAR，2017 Joanna Briggs Institute Critical Appraisal Checklist for Text and Opinion Papers，2016 Joanna Briggs Institute Critical Appraisal Checklist for Cohort Studies，Jadad Scale，and 2017 Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross Sectional Studies.Finally，evidence was summarized，evaluated，and divided following the 2014 Joanna Briggs Institute Levels of Evidence and Grades of Recommendation.Results　A total of 17 articles were enrolled，including 5 clinical guidelines，2 systematic reviews，3 expert consensus，2 cohort studies，4 randomized control trials and 1 cross-sectional study.Out of the 5 clinical guidelines，3 had a ≥60% score across 6 areas，but all won the A recommendation level.All the systematic reviews and expert consensus were approved for inclusion.Both cohort studies showed a high level of quality，and were allowed to be included.All the randomized control trials were also allowed to be included.One cross-sectional study was evaluated to be high-quality and allowed to be included.We finally extracted 27 items of available best evidence，covering four aspects：environment，personnel management，preventive measures and influencing factors of vaccination.Conclusion　Our analysis and summary of the related literature suggested that，influenza vaccination is still the best method for influenza control.Managers and wokers of nursing homes should put their emphasis on influenza and optimize the management model of influenza prevention.


Clinical Characteristics，Severity of Illness and Its Influencing Factors in COVID-19 Patients with Diarrhea as the Initial Symptom　

ZU Ming，SHI Yanyan，NING Jing，LU Haoping，ZHAO Zhiling，CHENG Qin，SHEN Ning，GE Qinggang，DING Shigang

2021, 24(15):  1874-1882.  DOI: 10.12114/j.issn.1007-9572.2021.00.435

Asbtract ( )   HTML ( )   PDF (1092KB) ( )  

References | Related Articles | Metrics

Background　There are gastrointestinal symptoms in some patients with COVID-19，but there are few reports about the clinical characteristics and prognosis in COVID-19 patients with diarrhea as the initial symptom.Objective　To analyze the clinical characteristics，severity of illness and its influencing factors in COVID-19 patients with diarrhea as the initial symptom.Methods　A total of 207 COVID-19 patients with positive RNA test results of nasopharyngeal swabs were taken over by Peking University Medical Team for Hubei from 2020-01-28 to 2020-02-28，who were hospitalized in isolated wards in Tongji Hospital Zhongfa New Town Branch Affiliated to Tongji Medical College，Huazhong University of Science and Technology，17 cases with diarrhea as the initial symptom charged by Medical Team of Peking University Third Hospital were selected as observation group，34 cases without diarrhea as the initial symptom were selected as control group.General information，clinical symptoms，blood routine test results，liver function index，blood lipid indices，creatinine，coagulation function indicators，inflammatory indicators，PCT，myocardial injury indicators，chest CT findings，clinical classification，maximum body temperature，therapeutic protocols，incidence of complications，survival status，duration from onset to treatment and hospital stays were compared between the two groups；univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of severity of illness in patients with COVID-19.Results　Incidence of expectoration，D-dimer，abnormal rate of PCT and proportion of patients with severe and critical clinical classification types in observation group were significantly lower than control group，incidence of debilitation and albumin in observation group were significantly higher than control group，prothrombin time and hospital stays in observation group were significantly shorter than control group（P<0.05）.Multivariate Logistic regression analysis results showed that，albumin〔OR=0.739，95%CI（0.569，0.960）〕was the protective factor of severity of illness in patients with COVID-19，but PCT〔OR=7.349，95%CI（1.213，44.513）〕was the risk factor（P<0.05）.Conclusion　In COVID-19 patients with diarrhea as the initial symptom，the respiratory symptom and severity of illness are relatively mild，incidence of debilitation is relatively high，clinical classification is mainly common type，and hospital stays is relatively short；albumin is the protective factor of severity of illness in patients with COVID-19，but PCT is the risk factor.


Relationship between Cardiometabolic Index and Risk of Nonalcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus　

LI Yanyan，ZHAO Li，DENG Xia，ZHU Zhuanzhuan，GUO Chang，XIA Hong，DAI Meiqing，YU Fan，YIN Wei，WANG Dong，YANG Ling，YUAN Guoyue

2021, 24(15):  1883-1888.  DOI: 10.12114/j.issn.1007-9572.2021.00.433

Asbtract ( )   HTML ( )   PDF (1079KB) ( )  

References | Related Articles | Metrics

Background　The increasing prevalence of type 2 diabetes mellitus （T2DM） and nonalcoholic fatty liver disease（NAFLD） has emerged as a critical public health problem.Recent guidelines recommend that more attention should be paid to the screening of NAFLD in T2DM patients，but it is difficult to perform the screening in clinical practice，especially in primary care.Objective　To investigate the relationship between cardiometabolic index （CMI） and risk of NAFLD in patients with T2DM.Methods　A total of 501 individuals with T2DM were recruited between May 2018 and March 2020 at the Affiliated Hospital of Jiangsu University and divided into NAFLD group（n=336） and non-NAFLD group（n=165） according to the result of ultrasound.The clinical data of the two groups were collected and analysed.NAFLD prevalence was compared across the tertile groups of CMI（CMI <0.765，0.765-1.375 and >1.375，167 cases in each tertile）.The correlation of CMI with other clinical indicators was analyzed to explore the influencing factors of NAFLD and the predictive value of CMI for NAFLD in patients with T2DM.Results　Compared with T2DM patients without NAFLD，those with NAFLD showed lower average age，shorter average T2DM duration，higher prevalence of hypertension，higher average levels of diastolic blood pressure，body mass index （BMI），visceral fat area（VFA），subcutaneous fat area（SFA），visceral-to-subcutaneous fat area ratio（VSR），alanine aminotransferase（ALT），aspartate transaminase（AST），triglyceride，total cholesterol（TC），gamma-glutamyl transpeptidase（GGT），uric acid，fasting C-peptide（FC-P），fasting insulin（FINS），homeostasis model assessment of insulin resistance（HOMA-IR） and CMI ，as well as lower average high-density lipoprotein cholesterol （P<0.05）.The low CMI tertile group had lower NAFLD prevalence than other two groups（P<0.05）.The medium CMI tertile group had lower NAFLD prevalence than top CMI tertile group（P<0.05）.CMI was positively correlated with diastolic blood pressure，BMI，VFA，SFA，VSR，ALT，AST，GGT，uric acid，TC，fasting plasma glucose，FINS，FC-P，and HOMA-IR （P<0.05），but negatively correlated with age and T2DM duration in correlation analysis（P<0.05）.The binary Logistic regression analysis showed that T2DM duration〔OR=0.996，95%CI（0.994，0.999）〕，BMI〔OR=1.400，95%CI（1.264，1.551）〕，FC-P〔OR=1.959，95%CI（1.442，2.661）〕and CMI〔OR=2.053，95%CI（1.422，2.964）〕were influencing factors for NAFLD in patients with T2DM （P<0.05）.The area under the ROC curve predicted by CMI for NAFLD was 0.738〔95%CI（0.691，0.784），P<0.01〕，and the optimal cut-off value was 0.692，with sensitivity and specificity of 83.6% and 51.5%，respectively.The binary Logistic regression analysis was used to fit the equation of CMI and BMI，where the fitting equation was Log（P）=-9.103+0.938×CMI+0.358×BMI，and the AUC of CMI with BMI was 0.816〔95%CI（0.776，0.856），P<0.01〕，with sensitivity and specificity of 84.2% and 64.8%，respectively.Conclusion　CMI was associated with NAFLD in patients with T2DM，and it with BMI may have good predictive value for NAFLD.CMI is expected to become a predictor for NAFLD in patients with T2DM.


Prevalence and Influential Factors of Hemodialysis-induced Hypoglycemia in Diabetes Mellitus Patients Undergoing Hemodialysis　

NIAN Sujuan，LI Huili，LI Er，YAN Mingxia

2021, 24(15):  1889-1896.  DOI: 10.12114/j.issn.1007-9572.2021.00.071

Asbtract ( )   HTML ( )   PDF (1111KB) ( )  

References | Related Articles | Metrics

Background　Diabetes mellitus patients are prone to hypoglycemia during hemodialysis，especially asymptomatic hypoglycemia.However，there are few studies about the influential factors of hemodialysis-induced hypoglycemia in diabetes mellitus patients undergoing hemodialysis.Objective　To explore the prevalence and influential factors of hemodialysis-induced hypoglycemia in diabetes mellitus patients undergoing hemodialysis.Methods　A total of 86 diabetes mellitus patients undergoing hemodialysis from January 2017 to December 2019 were selected from Dialysis Center，Xixi Hospital of Hangzhou.All of them received conventional treatment and glycemic control therapy.Blood glucose during 12 times of hemodialysis（within 30 minutes after using the hemodialysis machine）in the first month following the initiation of the study were monitored，and hypoglycemia events as well as glucose variability were analyzed.Univariate analysis and multiple ordinal Logistic regression analysis were performed to identify the influential factors of hemodialysis-induced hypoglycemia in diabetes mellitus patients undergoing hemodialysis.Results　Of the 86 patients，40 had no hypoglycemia，24 had one hypoglycemia，and other 22 had at least two hypoglycemia，with an overall hypoglycemia prevalence of 53.5%（46/86）.The three groups showed significant differences in mean age，BMI，and number of children，distribution of educational level，medication compliance，and self-care ability，as well as mean blood glucose and mean coefficient of variability of blood glucose（P<0.05）.Multiple ordinal Logistic regression analysis results demonstrated that，older age〔OR=1.079，95%CI（1.000，1.160）〕，poor medication compliance〔OR=13.250，95%CI（2.300，76.250）〕，poor self-care ability〔OR=4.067，95%CI（1.090，15.300）〕and mean blood glucose less than 8.91 mmol/L〔OR=4.001，95%CI（1.250，12.850）〕were associated with higher risk of hemodialysis-induced hypoglycemia in diabetes mellitus patients undergoing hemodialysis，while elevated BMI〔OR=0.776，95%CI（0.640，0.950）〕and mean coefficient of variability of blood glucose less than 0.26〔OR=0.254，95%CI（0.080，0.790）〕were associated with decreased risk of hemodialysis-induced hypoglycemia（P<0.05）.Conclusion　The prevalence of hemodialysis-induced hypoglycemia is relativity high（which is 53.5%）in diabetes mellitus patients undergoing hemodialysis，whose risk may be increased with older age，poor medication compliance，poor self-care ability and mean blood glucose less than 8.91 mmol/L，and may be reduced with elevated BMI and mean coefficient of variability of blood glucose less than 0.26.


Early Detection of Post-stroke Cognitive Impairment by Stroop Color Word Test　

ZHANG Junfang，JIANG Shuai，ZHAO Xiaoling，WANG Lei，FANG Sheng，ZHU Xi，HE Liu，GU Rui，LI Li，LIU Yan

2021, 24(15):  1896-1902.  DOI: 10.12114/j.issn.1007-9572.2021.00.446

Asbtract ( )   HTML ( )   PDF (702KB) ( )  

References | Related Articles | Metrics

Background　Post-stroke cognitive impairment（PSCI） is one of the complications of acute cerebral infarction，which seriously affects the quality of life and increases the burden on patients' families and social economy.Current available scales used to assess the cognitive function of stroke patients have problems such as longer time consuming，limited sensitivity，and poor cooperation of patients.So there is a need to explore a more convenient and sensitive assessment tool.Objective　We aimed to explore the applicability of Stroop color word test（SCWT） on PSCI in the early stage.Methods　174 patients with acute cerebral infarction who were hospitalized in the Department of Neurology of the Third People's Hospital of Chengdu from October 2019 to June 2020 were selected.The Beijing version of the Montreal Cognitive Assessment （MoCA） was used to screen cognitive impairment.The SCWT was used to assess the executive function of patients with and without cognitive impairment.The correlation of the indictors of SCWT with the scale and each cognitive domain score of the MoCA was analyzed.The ROC curve of the indictors of SCWT in predicting PSCI was plotted and analyzed.Results　One hundred and thirty cases were found with PSCI，accounting for 74.7%（130/174），with an average scale score of MoCA of （18.2±4.2） points，other 44 without PSCI had an average scale score of MoCA of （25.3±2.2） points.PSCI group had a greater average age （P<0.05）.PSCI group used more time to finish card A，B，and C，had greater completion time of SIE（the difference between completion time for card C and that for card B），more correct response number of SIE，higher decline rate of correct response number，higher ratio of completion time for card A，B，or C to correct response number and less correct response numbers of cards B and C on average（P<0.05）.The completion time for card A，B or C，correct response number of SIE，decline rate of correct response number，ratio of completion time for card A，B or C to correct response number were negatively correlated with the scale score of MoCA and its domain scores of visuospatial and executive functioning，animal naming，attention，language，abstraction，delayed recall，and orientation （P<0.05），while the correct response number of card B or C was positively correlated with them （P<0.05）.The completion time of SIE was negatively correlated with the scale score of MoCA and its domain scores of visuospatial and executive functioning，language，delayed recall，and orientation （P<0.05）.In predicting PSCI，the sensitivity and specificity of the completion time for card C were 87.7% and 56.8%，with an AUC of 0.750〔95%CI（0.663，0.836），P<0.01〕when the optimal cut-off value was determined as 95.89 s and Youden's index of 0.445.The sensitivity and specificity of correct response number of SIE were 76.2% and 77.3%，with an AUC of 0.802〔95%CI（0.730，0.874），P<0.01〕when the optimal cut-off value was determined as 1.5 and Youden's index of 0.535.The sensitivity and specificity of decline rate of correct response number were 76.2% and 77.3%，with an AUC of 0.796〔95%CI（0.721，0.872），P<0.01〕when the optimal cut-off value was determined as 3.02% and Youden's index of 0.535.The sensitivity and specificity of ratio of completion time for card C to correct response number were 76.9% and 72.7%，with an AUC of 0.796〔95%CI（0.718，0.874），P<0.01〕when the optimal cut-off value was determined as 2.36 and Youden's index of 0.496.Conclusion　Patients at an early stage of acute cerebral infarction had high prevalence of cognitive impairment.PSCI patients had poor executive function，and their evaluation results by most items of the SCWT had correlation with the cognitive domain scores of MoCA，indicating that SCWT may have high sensitivity and specificity in rapidly diagnosing PSCI in early stage of acute cerebral infarction.


Pilot Clinical Study of Methylene Blue-mediated Photodynamic Antibacterial Chemotherapy to Improve Diabetic Lower Extremity Ulcer Infection　

WANG Jiuxiang，CHENG Qingfeng，ZHU Shenyin，CHEN Huanhuan，DU Zhipeng，TANG Ziwei

2021, 24(15):  1903-1908.  DOI: 10.12114/j.issn.1007-9572.2021.00.432

Asbtract ( )   HTML ( )   PDF (1295KB) ( )  

References | Related Articles | Metrics

Background　Bacterial infection is the most important cause of diabetic lower extremity ulcer healing delay and amputation.The increasing resistance of bacteria to multiple antibiotics and inadequate lower extremity blood perfusion limit the efficacy of systemic antibiotic therapy.Photodynamic antimicrobial chemotherapy（PACT） is a promising approach for the treatment of chronic ulcer infections.Recently，available clinical evidence for methylene blue-mediated PACT （MB-PACT） for diabetic lower limb ulcer infection is limited.Objective　To investigate the efficacy and safety of MB-PACT for diabetic lower extremity ulcer infection using a pilot approach.Methods　The patients with diabetic lower extremity ulcer infection hospitalized in the Endocrinology Department of the First Affiliated Hospital of Chongqing Medical University from March 2019 to February 2020 were included and divided randomly into the experimental group（15 patients） and the control group（15 patients），using a computer generated pseudorandom permutation procedure.Besides standard treatment （hypoglycemic，antibacterial，lipid regulation，vascular circulation improvement，etc.），the experimental group was given MB-PACT，and the control group was given phototherapy for 7 days，respectively.The intensity of defined daily doses （DDDs） for antibacterial，pre- and post-treatment inflammation score and area of ulcer surface，routine blood test results and CRP level，bacterial load in the ulcer pre-treatment and immediately，and 4 and 7 days after treatment were compared between the two groups.Treatment-emergent adverse reactions were evaluated.Results　There was no statistically significant difference in DDDs for antibacterial between the two groups（P<0.05）.At 7 days post-treatment，in the experimental group，PEDIS grade decreased from grade 2 to grade 1 in 60% of patients（9/15），while that did not significantly decrease in the control group.However，ulcer size showed no significant improvement in each group（P>0.05）.And it was still similar across the two groups despite receiving treatment（P>0.05）.Serum CRP in the experiment group was similar to that of control group before treatment and 7 days after treatment，but decreased significantly after 7 days of treatment（P<0.05）.A decrease in the bacterial load in the ulcer was seen in the experimental group immediately，4 and 7 days after treatment and in the control group 4 and 7 days after treatment（P<0.05）.The experimental group was found with less bacterial load in the ulcer 4 and 7 days after treatment than the control group（P<0.05）.No adverse reactions，such as erythema，swelling，pain，pruritus，were observed during treatment in both groups.Conclusion　MB-PACT may improve the efficacy on ulcer infection by reducing the bacterial load and the inflammatory reaction in the ulcer surface with good safety for diabetic lower extremity ulcer infection patients，providing a basis for the development of new adjuvant treatment for diabetic lower extremity ulcer.


Effects of Remote Diet Record versus Paper-based Three-day Diet Record on Nutritional Management Compliance of Patients with CKD　

ZHANG Xianlong，LIU Xusheng，FU Lizhe，TANG Fang，ZHANG Dingjun，WANG Linglan，XIA Bingqing，DONG Chendi，WU Yifan

2021, 24(15):  1909-1914.  DOI: 10.12114/j.issn.1007-9572.2021.00.105

Asbtract ( )   HTML ( )   PDF (1039KB) ( )  

References | Related Articles | Metrics

Background　Chronic kidney disease（CKD） and its complications greatly affect patients with CKD.There is evidence that nutrition management is a good adjuvant treatment for CKD，but patients' compliance is the difficulty of management.Remote management may improve compliance，but its effect is not clear.Objective　To compare the effects of remote diet record and paper-based three-day diet record on the nutrition management compliance of CKD patients.Methods　From November 1，2017 to December 31，2018，91 cases of CKD stage 3-5 patients（n=91） without dialysis treatment were recruited from Guangdong Provincial Hospital of Chinese Medicine.According to the random number table，they were divided into remote group and paper group.Essential treatment and nutrition management were given to them，and the information about three-day diet of 43 cases was collected and recorded via using the remote follow-up system in the remote group，and that of other 48 cases was collected by face-to-face interviews and was noted down as paper records in the paper group.The observation time was 48 weeks，during which a total of 12 follow-ups（a follow-up once every 4 weeks） were conducted.The compliance indices of the two groups during intervention were compared，including diet protein intake calculated based on diet dairy（dietary task-DPI），diet protein intake calculated based on normalized protein equivalent of nitrogen appearance rate（nPNA-DPI），and daily energy intake calculated based on diet diary（dietary task-DEI）.Results　The analysis using the mixed linear model found that，the model with dietary task-DPI was influenced by grouping and follow-up time（Fgrouping=58.046，P<0.001；Ffollow-up=22.236，P<0.001），and so was the model with nPNA-DPI（Fgrouping=95.096，P<0.001；Ffollow-up=14.420，P<0.001）.And the grouping was the influencing factor of dietary task-DEI as well（Fgrouping=234.715，P<0.001）.Compared to paper group，the remote group showed significantly lower average nPNA-DPI at the 9th and 12th follow-ups（t=-2.142，-2.191；P=0.035，0.031）.Moreover，the remote group showed much higher qualified rate of dietary task-DPI at the 6th follow-up（χ2=5.099，P=0.024），and much higher qualified rate of nPNA-DPI at the 3rd，6th and 12th follow-ups（χ2=4.317，6.889，6.920；P=0.038，0.009，0.009）.There were no significant differences in estimated glomerular filtration rate，waist-to-hip ratio，total body moisture，fat-free body mass，upper arm circumference，upper arm muscle circumference，hemoglobin，albumin，total cholesterol and triglyceride between the two groups at the 12th follow-up（P>0.05）.Conclusion　The protein and calorie intake of CKD patients can be optimized by remote diet record or paper-based three-day diet diary.In some aspects，the method of remote follow-up may be better than the paper record and offline follow-up.This suggests the importance of chronic disease management combined with the current progress of mobile medicine.


Diagnostic Value of Plasma SEPT9 Methylation Test for Colorectal Cancer　

WU Xiufang，NAN Qiong，ZHANG Xiaohong，GENG Ting，CHEN Zihong

2021, 24(15):  1915-1919.  DOI: 10.12114/j.issn.1007-9572.2021.00.136

Asbtract ( )   HTML ( )   PDF (1072KB) ( )  

References | Related Articles | Metrics

Background　Colorectal cancer（CRC）is a common malignant tumor of the digestive system，its morbidity and mortality present a year-by-year ascending tendency.Early diagnosis and treatment are the key to CRC prevention and treatment.However，there is short of noninvasive，simple，convenient and effective detecting methods for clinical diagnosis of CRC.Objective　To probe into the diagnostic value of plasma SEPT9 methylation test（mSEPT9）for CRC，to provide evidence for the diagnosis of this disease.Methods　Two hundred and seventy-two（126 cases of CRC，146 cases of non-CRC）cases of patients who visited the gastroenterology，gastrointestinal surgery and oncology departments of First Affiliated Hospital of Kunming Medical University between December 2017 and December 2018 were enrolled.They were divided into control group（82 cases），colorectal adenoma group（64 cases），early CRC group（72 cases）and progressive CRC group（54 cases）according to colonoscopy and pathological examination results.The relationship between positive expression of plasma mSEPT9 and the clinical characteristics of CRC patients was analyzed.The diagnostic performance of plasma mSEPT9 and serum carcinoembryonic antigen（CEA），and the combination of the two for early and progressive CRC was compared，and the accuracy of these three tests were evaluated.Results　The positive rate of plasma mSEPT9 was not related to CRC patients' age，gender，tumor location or tumor diameter（P>0.05）.The positive rate of plasma mSEPT9 was significantly lower in early CRC patients than that of progressive CRC patients（P<0.001）.The positive rate of plasma mSEPT9 was significantly higher in CRC patients with lymph node metastasis than that of those without（P<0.001）.The positive rate of plasma mSEPT9，serum CEA and the combination of the two for CRC showed significant differences across the four groups（P<0.001）.The combination of plasma mSEPT9 and serum CEA for CRC diagnosing was superior to either plasma mSEPT9 or serum CEA in terms of sensitivity，accuracy，negative predictive values，and its Kappa value was 0.514，indicating a moderate level of agreement with the gold standard.Conclusion　In the diagnosing for early and progressive CRC，the plasma mSEPT9 showed higher accuracy than serum CEA，but the accuracy of the combination of these two may be higher（in terms of sensitivity，accuracy，negative predictive values，and level of agreement with the gold standard），which may be used as a new thought or method for the diagnosis of CRC.


Anti-diarrhea Activity of Ethanol Extract from Forsythia Suspensa Leaves and Its Effect on Spontaneous Contraction of the Isolated Rabbit Intestinal Smooth Muscle　

CHEN Guiyu，LI Chunchen，GU Chunxia，YANG Chen，JIANG Lan，LUO Tao，MEI Xue，ZHANG Jianwu

2021, 24(15):  1920-1926.  DOI: 10.12114/j.issn.1007-9572.2021.00.086

Asbtract ( )   HTML ( )   PDF (1445KB) ( )  

References | Related Articles | Metrics

Background　Traditional Chinese medicine has the advantages of rapid acting，less side effects and low cost in the treatment of diarrhea.Forsythia suspensa have the efficacy of clearing heat and detoxicating，reducing swelling and dispersing nodules.However，there are few reports on its effect on diarrhea at present.Objective　To observe the effect of ethanol extract from Forsythia suspensa leaves （FS ext） on castor oil-induced diarrhea in mice and to study its effect and mechanism on the contraction of isolated intestinal smooth muscle from rabbits.Methods　This study was implemented from June to December，2018.Forsythia suspensa leaves were collected and extracted in Nanchong City，Sichuan Province.The chemical components of FS ext were analyzed by high performance liquid chromatography （HPLC）.60 fasted mice（with free access to water） were randomly divided into 0.5 g/kg，1.0 g/kg，2.0 g/kg，4.0 g/kg，8.0 g/kg and 16.0 g/kg FS ext groups，and received gavage administration of 0.5 g/kg，1.0 g/kg，2.0 g/kg，4.0 g/kg，8.0 g/kg and 16.0 g/kg FS ext，respectively，for determining the safety of 6 doses of FS ext.The mortality and toxicity of FS ext within 14 days were recorded，and the corresponding dose-response curve was established to determine the median lethal dose （LD50） of FS ext.Additionally，50 mice were randomly divided into negative and positive groups，and 0.25 g/kg，0.50 g/kg and 1.00 g/kg FS ext test groups，treated by gavage administration of 0.9% sodium chloride solution （20 ml/kg），loperamide （4 mg/kg），0.25，0.50 and 1.00 g/kg FS ext，respectively.30 minutes later，0.4 ml castor oil was administered by gavage to each mouse，and the following indicators were observed within 4 hours：the defecating time of initial semi-solid feces，the number of solid，semi-solid and liquid feces.We used diarrhea index （EI） to evaluate the severity of diarrhea.Then 42 healthy rabbits were used to prepare isolated intestinal smooth muscle in order to carry out the following experiments.Firstly，the effect of FS ext on the spontaneous contraction of isolated intestinal smooth muscle was observed.Secondly，the isolated intestinal smooth muscle was preprocessed with acetylcholine （ACh，10 μmol/L） or potassium chloride （KCl，60 mmol/L），the effect of FS ext on the ACh/KCl-induced contraction of isolated intestinal smooth muscle was studied.Finally，the isolated intestinal smooth muscle was preprocessed with Ca2+-free high-K+ Tyrode solution containing FS ext or verapamil（1 μmol/L），then CaCl2 was accumulated to further study its mechanism.Results　The main chemical constituents of FS ext were Forsythin and Forsythoside A.After administration by gavage at different doses of FS ext，there were no signs of death or toxicity in the observation period.The defecating time of initial semi-solid feces of positive group was longer than that of negative group，0.25 g/kg and 0.50 g/kg FS ext groups（P<0.05）.The defecating time of initial semi-solid feces of 1.00 g/kg FS ext group was longer than that of negative group and 0.25 g/kg FS ext group（P<0.05）.The EI of negative group was higher than that of positive group and 1.00 g/kg FS ext group （P<0.05）.The EI of 0.25 g/kg or 0.50 g/kg FS ext group was higher than that of positive group（P<0.05）.Besides，FS ext（0.01-10.00 mg/ml） inhibited spontaneous contraction of rabbit isolated intestinal smooth muscle in a dose-dependent manner，and the jejunal contraction induced by Ach or KCl.At the same time，the FS ext also inhibited the contraction of jejunal smooth muscle induced by CaCl2 in a dose-dependent manner，and the CaCl2 dose-response curve was shifted to the lower right，similar to that of verapamil.Conclusion　FS ext may have a significant anti-castor oil diarrhea effect in mice，and could inhibit spontaneous contraction of rabbit isolated intestinal smooth muscle，as well as the jejunal contraction induced by ACh or KCl.The mechanism may be related to FS ext-induced blocking of M-receptor and inhibiting of L-type calcium channel.


Application of Intervention Mapping in the Development of Chronic Disease Health Promotion Programs：a Literature Review and Enlightenments　

LIN Beilei，ZHANG Zhenxiang，MEI Yongxia，WU Kai，ZHANG Yaqin，PENG Rui，GUO Lulu，ZHANG Yan，LIU Lamei

2021, 24(15):  1927-1931.  DOI: 10.12114/j.issn.1007-9572.2021.00.091

Asbtract ( )   HTML ( )   PDF (1215KB) ( )  

References | Related Articles | Metrics

The intervention mapping（IM） provides a systematic and rigorous framework for the development of intervention plans，which includes six steps:needs assessment，change and preference objectives，program design，program production，program implementation plan，and evaluation plan.This approach emphasizes the application of theory and evidence，while requiring a precise strategy for the practice transformation of intervention plans.It has been widely used in health care，especially in the development and optimization of health promotion or education programs for people with chronic diseases，serving as important guidance for chronic disease management.The aim of this paper is to comprehensively review the application status of IM in developing chronic disease health promotion programs，with detailed analysis of the target population，application process，benefits and limitations，providing a normative，systematic，scientific and rigorous framework for the development of chronic disease health promotion projects in China.


Discussion on Community Rehabilitation Management Mode and Technology of Stroke　

TANG Long，ZHENG Zheng，RAO Amin，YAO Liqing

2021, 24(15):  1932-1937.  DOI: 10.12114/j.issn.1007-9572.2021.00.459

Asbtract ( )   HTML ( )   PDF (1070KB) ( )  

References | Related Articles | Metrics

Stroke is the main cause of threaten to the health of middle-aged and elderly people in China.Its high morbidity，mortality and disability rate has brought heavy economic burden to families and society.In recent years，evidence-based medicine has proved that community rehabilitation is an effective method to reduce the disability rate of stroke.However，the community-level rehabilitation technology in China is outdated and the management mode is chaotic now.Therefore，how to improve the community rehabilitation technology of stroke in China has gradually become a research hotspot.This paper briefly introduces the status of the management mode and the technology of community rehabilitation for stroke at home and abroad，puts forward some countermeasures for the development of community rehabilitation in China，so as to provide new ideas for the model of community rehabilitation for stroke in China.


Hospital-community-home Integrated Management Path for Patients with Osteoporosis：Exploratory Analysis and Insights to Primary Care　

CAI Yaoting，FANG Ronghua

2021, 24(15):  1938-1942.  DOI: 10.12114/j.issn.1007-9572.2021.00.431

Asbtract ( )   HTML ( )   PDF (1066KB) ( )  

References | Related Articles | Metrics

Osteoporosis prevalence is increasing with rapid acceleration of aging，which is the fifth major common chronic disease，easily leading to serious outcomes，such as brittle fracture，disability，and even death.The prevalence rate of osteoporosis in Chinese people aged over 60 is 36%.It is predicted that by 2050，the numbers of Chinese people suffering from osteoporosis and osteoporotic fractures will be 202 million，and 6 million，respectively，which will impose a serious burden on society and families.So it is essential to carry out effective systematic management of osteoporosis.We introduced the definition of hospital-community-home integrated management，and explained the necessity of using it in osteoporosis management，and interpreted the development of path of hospital-community-home integrated osteoporosis management，which is composed of five aspects：building a multidisciplinary management team for osteoporosis，constructing an online osteoporosis health management platform，modifying the management of osteoporosis patients' health records，strengthening osteoporosis-related trainings for general practitioner teams，and strengthening osteoporosis-related health education for osteoporosis patients and their families.We consider this path to be feasible for osteoporosis management，and for the building of an efficient and standardized osteoporosis management mode，to cope with the rapid growth of osteoporosis prevalence in China.


Effect of Tongluo Digui Decoction on Non-dipper Blood Pressure，Urinary Sodium Excretion，and Renin-angiotensin-aldosterone System in Patients with Stage Ⅳ Diabetic Kidney Disease　

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

2021, 24(15):  1943-1950.  DOI: 10.12114/j.issn.1007-9572.2021.00.079

Asbtract ( )   HTML ( )   PDF (1108KB) ( )  

References | Related Articles | Metrics

Background　Diabetic kidney disease（DKD）has become the leading cause of end-stage renal disease worldwide，whose development is independently associated with non-dipper blood pressure，but there is a lack of curative treatments.Traditional Chinese medicine treatment is considered to have potentials to treat DKD and non-dipper blood pressure.Objective　To explore the effect of Tongluo Digui decoction on non-dipper blood pressure，urinary sodium excretion，and renin-angiotensin-aldosterone system（RAAS）in patients with stage Ⅳ DKD.Methods　From January 2019 to March 2020，a total of 80 outpatients and inpatients with stage Ⅳ DKD were selected from the Departments of Nephrology and Endocrinology，Henan Province Hospital of TCM /The Second Affiliated Hospital of Henan University of Chinese Medicine，and were equally randomized into control group and observation group by random number table，receiving conventional Western treatment，and conventional Western treatment with Tongluo Digui decoction for 8 weeks，respectively.Pre- and post-treatment indicators of renal function（including Scr，BUN，24-hour urine protein quantification and eGRF），HbA1c，24-hour ambulatory blood pressure，blood pressure variability，percentage of non-dipper blood pressure，24-hour urinary sodium，and plasma levels of renin，angiotensin Ⅱ receptor and aldosterone as well as calculated reverse rate of non-dipper blood pressure were compared between the two groups.The incidence of adverse reactions during treatment was recorded.Results　There were no dropouts，all cases completed the follow-up.Compared to baseline，mean levels of post-treatment Scr，BUN，24-hour urine protein quantification，HbA1c，24 hSBP，dSBP，dSBPCV and nSBPCV significantly lowered but eGFR increased in the two groups，moreover mean levels of post-treatment nSBP，nDBP，24 hSBPCV and nDBPCV significantly lowered in observation group（P<0.05）.The mean levels of post-treatment Scr，24-hour urine protein quantification，24 hDBP，nSBP，nDBP，nSBPCV and nDBPCV lowered more significantly and mean post-treatment eGFR level increased more notably in observation group than those in control group（P<0.05）.The observation group showed a lowered percentage of non-dipper blood pressure after treatment（P<0.05）.The post-treatment percentage of non-dipper blood pressure in observation group was lower than that in control group，so did the reverse rate of non-dipper blood pressure（P<0.05）.Plasma aldosterone level decreased significantly in both groups after treatment（P<0.05）.The post-treatment 24-hour urinary sodium showed a significant increase in observation group（P<0.05）.No one in the two groups occurred any obvious adverse reactions during treatment.Conclusion　In patients with stage Ⅳ DKD，Tongluo Digui decoction based on conventional Western treatment is more helpful to improve the renal function，reduce the nocturnal blood pressure and blood pressure variability，as well as percentage of non-dipper blood pressure，improve the reverse rate of dipper blood pressure and 24 urinary sodium excretion，with relatively high safety and without significant effect on RAAS.


Effect of Tongluoqingnao Powder Injection on Protecting the Brain and Expression of Neuronic Autophagy-related Proteins in a Rat Model of Cerebral Ischemia-reperfusion Injury　

CHEN Yanyan，ZHANG Yehao，XU Li，YAO Mingjiang，WANG Guangrui，SONG Wenting

2021, 24(15):  1951-1958.  DOI: 10.12114/j.issn.1007-9572.2021.00.075

Asbtract ( )   HTML ( )   PDF (1902KB) ( )  

References | Related Articles | Metrics

Background　Neuronal apoptosis caused by cellular autophagy is an important link of nerve injury after cerebral ischemia.Tongluoqingnao powder injection，a representative therapy of TCM treatment for clearing heat and detoxifying and clearing collaterals，has been proved effective for cerebral ischemia in rats even without syndrome differentiation，indicating that the mechanism of cerebral protective effect of this therapy may be correlated with inhibition of cellular autophagy.Objective　To investigate the effect of tongluoqingnao powder injection on protecting the brain and expression of neuronic autophagy-related proteins in a rat model of cerebral ischemia-reperfusion injury.Methods　This experiment was conduct from January 2019 to March 2020.We selected 36 adult male specific pathogen free SD rats，and equally randomized them into sham-operated group，model group and tongluoqingnao group after coding.Suture-occluded method，namely middle cerebral artery occlusion，was used to prepare rat models of cerebral ischemia-reperfusion injury：rats in sham-operated group only received angiodiastasis，and those in tongluoqingnao group received tongluoqingnao solution 3.2 ml/kg（with a concentration of 18.75 mg/ml）injected slowly via the caudal vein，while those in other two groups received isopyknic 0.9% sodium chloride solution.Neurological functional score and proportion of cerebral infarction volume 24 hours after modeling，as well as neuron injury in hippocampus，formation of autophagosomes in hippocampus and cortex and neuronic autophagy-related proteins（including p-NF-κB，Beclin1 and LC3）in hippocampus 24 hours after reperfusion were compared among the three groups.Results　The neurological functional score and proportion of cerebral infarction volume 24 hours after modeling in sham-operated group，tongluoqingnao group，and model group increased successively（P<0.05）.Twenty-four hours after reperfusion，the sham-operated group showed no obvious neuronal necrosis in hippocampus，but with occasional autophagosomes in hippocampus and cortex，the model group demonstrated serious structural damage and a lot of loss of neurons in the ischemic region of hippocampus，with bilayer autophagosomes in hippocampus and cortex.In contrast to the model group，tongluoqingnao group had obviously shrinked range of neuronal necrosis，obviously relieved neuron damage，with obviously reduced number of autophagosomes.At 24 hours after reperfusion，the sham-operated group had less relative expression quantities of p-NF-κB，and LC3 in hippocampus than tongluoqingnao group（P<0.01），and this group also showed less relative expression quantities of p-NF-κB，Beclin1 and LC3 in hippocampus than the model group（P<0.01）.The relative expression quantities of p-NF-κB，Beclin1 and LC3 in hippocampus in tongluoqingnao group were significantly lower than those in model group（P<0.01）.Conclusion　In rat models of cerebral ischemia-reperfusion injury，tongluoqingnao powder injection may effectively improve the neurological function，relieve the degree of cerebral infarction and neuron injury，reduce the formation of autophagosomes and neuronal apoptosis，inhibit the expression of neuronic autophagy-related proteins such as p-NF-κB，Beclin1 and LC3，and its mechanism of cerebral protective effect may be correlated with the inhibition of neuronic excessive autophagy.


The Value of Ultrasound Elastography and Molybdenum Target X-ray in the Diagnosis of Breast Invasive Ductal Carcinoma　

FANG Kaifeng，DING Guanbao，HAN Lu

2021, 24(15):  1959-1961.  DOI: 10.12114/j.issn.1007-9572.2021.00.467

Asbtract ( )   HTML ( )   PDF (1659KB) ( )  

References | Related Articles | Metrics

Background　Breast cancer is one of the most common malignant tumors in women，so it is extremely important to find an effective method for early diagnosis of breast cancer.Objective　To investigate the value of ultrasonic elastography and molybdenum target X-ray in the diagnosis of breast invasive ductal carcinoma.Methods　From October 2017 to December 2019，102 female patients with suspected breast invasive ductal carcinoma treated in the Wanbei Coal Electricity Group General Hospital were selected as research objects.Ultrasonic elastography and molybdenum target X-ray examination were performed before operation or biopsy，with pathological diagnosis as the gold standard.The correlation between histological grade and ultrasonic elasticity score of breast invasive ductal carcinoma was analyzed.The ROC curves of ultrasound elastography and molybdenum target X-ray in the diagnosis of breast invasive ductal carcinoma were drawn.Results　98 cases of invasive ductal carcinoma of breast were confirmed by the gold standard.The histological grade of breast invasive ductal carcinoma was positively correlated with ultrasonic elasticity score（rs= 0.452，P=0.003）.When the optimal cutoff value of ultrasound elastography was 4，the sensitivity，specificity and AUC in diagnosis of breast invasive ductal carcinoma were 88.1%，92.1% and 0.953〔95%CI（0.912，0.995）〕；when the optimal cutoff value of molybdenum target X-raywas 4b，the sensitivity，specificity and AUC in diagnosis of breast invasive ductal carcinoma were 72.4%，83.3% and 0.855〔95%CI（0.805，0.893）〕.AUC of ultrasound elastography in the diagnosis of breast invasive ductal carcinoma was higher than that of molybdenum target X-ray（Z=3.337，P<0.05）.Conclusion　The diagnostic value of ultrasound elastography is higher than molybdenum target X-ray in the diagnosis of breast invasive ductal carcinoma，and ultrasound elastography is positively correlated with the histological grade of breast invasive ductal carcinoma，which is greatly significant in the evaluation of maligant degree of clinical diagnosis of breast invasive ductal carcinoma.


Autoimmune Pancreatitis with Diabetic Ketoacidosis and Abdominal Pain as the Initial Presentations：One Case Report and Literature Review　

ZHANG Da，HU Ruihai

2021, 24(15):  1962-1966.  DOI: 10.12114/j.issn.1007-9572.2021.00.008

Asbtract ( )   HTML ( )   PDF (1389KB) ( )  

References | Related Articles | Metrics

This study reported a case of autoimmune pancreatitis who initially presented with diabetic ketosis and abdominal pain.Interventions were first given to him to improve DKA symptoms，but his abdominal pain remained after the relief of DKA，complicated with elevation of pancreatic enzymes，inflammatory indicators，and tumor marker CA19-9.Imaging examination confirmed the diagnosis of autoimmune pancreatitis.His pancreas swelling was reduced after glucocorticoid treatment，along with pancreatic enzymes，inflammatory indicators，and CA19-9 returned to normal level，and improvement of blood sugar.This suggests that the concern of classification diagnosis of diabetes should be strengthened，in particularly for patients with persistent abdominal pain symptoms and continuous elevation of liver or pancreatic enzymes，whose cause of elevated plasma glucose needs to be further clarified.Imaging examination favors autoimmune pancreatitis diagnosis.Early diagnosis and corticosteroids administration help to improve the prognosis of patients suffering autoimmune pancreatitis complicated with diabetes.


Recurrent Cerebral Infarction in Young Adults with Hyperthyroidism：a Case Report and Literature Review　

YANG Hongyan，ZHANG Ying，CHEN Panpan，LI Min，FU Xiaofeng，WANG Xuezhen

2021, 24(15):  1967-1971.  DOI: 10.12114/j.issn.1007-9572.2020.00.593

Asbtract ( )   HTML ( )   PDF (1664KB) ( )  

References | Related Articles | Metrics

Research reports about cerebral infarction in young adults with hyperthyroidism are few so far，and related pathogenesis is not clear.This paper reported the diagnosis and treatment of a young female patient with hyperthyroidism who had three times of cerebral infarction with progressive intracranial artery stenosis and occlusion within 4 years，and reviewed relevant literatures to summarize the clinical features and pathogenesis of this disease.Since active control of hyperthyroidism can effectively improve the accompanied symptoms of neurological deficits and reduce the risk of cerebral infarction recurrence，it is recommended that young patients with cerebral infarction should actively participate in hyperthyroidism screen，and if hyperthyroidism is found，further cranial magnetic resonance imaging or cerebrovascular imaging examination should be conducted，trying to achieve early detection and treatment as much as possible.


Recent Developments in Assessment Tools for Discharge Planning for Elderly Patients　

FENG Xiaoyu，LYU Siman，NI Cuiping，MA Mengning，TANG Wen，LIU Jialin，LIU Yu

2021, 24(15):  1972-1977.  DOI: 10.12114/j.issn.1007-9572.2021.00.040

Asbtract ( )   HTML ( )   PDF (1045KB) ( )  

References | Related Articles | Metrics

The post-discharge readmission rate of elderly patients is high，therefore making a discharge plan based on comprehensive pre-discharged evaluation is the guarantee for these patients receiving high-quality continuous care after the discharge.Some researchers have reviewed discharge planning assessment tools used abroad，but there is still a lack of reviews targeting at elderly inpatients，a population with special characteristics.We reviewed discharge planning assessment tools for elderly patients used at home and abroad，mainly focusing on discharge risk assessment tools and comprehensive assessment tools，hoping to help healthcare workers make an appropriate choice of discharge planning assessment tools.


New Advances in Clinical Diagnosis and Management of Gastroparesis　

JIANG Ya，LIN Lin

2021, 24(15):  1978-1983.  DOI: 10.12114/j.issn.1007-9572.2021.00.437

Asbtract ( )   HTML ( )   PDF (1040KB) ( )  

References | Related Articles | Metrics

Gastroparesis is a rare gastrointestinal motility disorder，which can be caused by many reasons，but the causative mechanism is still unclear.Gastroparesis has two main subtypes，idiopathic gastroparesis（primary）and diabetic gastroparesis（secondary），and an essential symptom of delayed gastric emptying.Diet modification and prokinetic drugs are initial treatments for gastroparesis，but how to significantly improve it is still a difficult problem.The recently emerged technologies have shed light on its diagnosis and treatment.This paper mainly summarized and analyzed new advances in clinical diagnosis and management of gastroparesis，aiming to provide a reference for clinical diagnosis and management of this disease.


Possible Mechanism of Chronic Constipation Improvement via Exercise-induced Changes in Gut Microbiota Composition and Metabolites　

HU Xiaomin，YE Jiamei，WANG Liqun，PANG Rizhao，WANG Wenchun，ZHANG Anren

2021, 24(15):  1984-1988.  DOI: 10.12114/j.issn.1007-9572.2021.00.044

Asbtract ( )   HTML ( )   PDF (1371KB) ( )  

References | Related Articles | Metrics

As a common health problem and an inducing factor for many diseases with high mortality rate，chronic constipation seriously affects human health and quality of life，bringing heavy mental and economic burden on families and society.However，due to limited efficacy of available treatments for chronic constipation，it is necessary to find a new，convenient，inexpensive and effective treatment.Exercise plays an important role in the prevention and treatment of chronic constipation.In addition，exercise can regulate the composition of gut microbiota，and some studies have shown that gut microbiota disorder after constipation reduces the content of gut microbiota metabolites（such as SCFA and 5-HT），inhibits intestinal movement and accelerates the development of chronic constipation，so there must be a close relationship between exercise，gut flora and constipation.This paper reviews the regulatory effect of exercise on constipation，the mechanism of gut microbiota in regulating constipation and the influence of exercise on gut microbiota，so as to explore the possibility of improving chronic constipation by exercise-induced changes in gut microbiota composition，and to further improve the mechanism of exercise in the remission of constipation.