Table of Content

15 July 2021, Volume 24 Issue 20

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Monographic Research

Effect of the Modified DASH Diet of Hypertension：Research Progress and Challenges　

GUO Ru，LIAO Xiaoyang，LI Zhichao，ZHAO Qian

2021, 24(20):  2508-2513.  DOI: 10.12114/j.issn.1007-9572.2021.00.521

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Hypertension is a primary risk factor for cardiovascular disease，which is the leading cause of premature death worldwide.However，few people with hypertension achieve effective BP control.DASH diet，as a first-line blood pressure control measure recommended guidelines of hypertension by the Global Hypertension Practice and many Countries，is difficult to follow and translate，so the effectiveness was reduced.The modified DASH diet improves the effect of BP reduction and culture suitableness and is conducive to improving diet promotion，treatment effect，and diet compliance.However，there are many ways to the modified DASH diet，and the current research shows that evidence on the effect of the modified DASH diet on BP reduction is inconsistent.In this review，we summarized the research progress of the modified DASH diet，the effect of the modified DASH diet，the current challenges of the modified DASH diet，offering a reference to the effectiveness of the modified DASH diet and future research.


Relationship between DASH Diet and Insomnia among Older People with Hypertension　

MAO Danhui，CHENG Jingmin

2021, 24(20):  2514-2519.  DOI: 10.12114/j.issn.1007-9572.2021.00.552

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Background　Insomnia is often found in older people with hypertension，which may be due to psychological，physiological or medication.，Hypertension patients are more prone to insomnia，which in turn aggravates hypertension.Increasing evidence shows that the patients with higher adherence to DASH diet have lower physical and mental health risk，so DASH diet may be an option for reducing the risk of insomnia in patients with hypertension.Objective　To assess the effectiveness of DASH diet on the risk of insomnia among older patients with hypertension.Methods　From April to July 2020，stratified，random sampling was used to select community-dwelling older adults（≥60 years） Taiyuan to attend a questionnaire survey，which consists of the flowing parts：general demographic characteristics（gender，age，marital status，hukou type），socioeconomic status（education duration，annual household income per capita），physiological characteristics（height，weight and hypertension stage），lifestyle characteristics〔smoking prevalence，alcohol consumption frequency，bedtime screen time and physical activity，evaluated by International Physical Activity Questionnaire-Short Form（IPAQ-S）〕，DASH diet（evaluated by the Chinese Revised DASH score scale），and insomnia〔evaluated by Taiwan version of Athens Insomnia Scale（AIS-T）〕.We divided patients into insomnia and non-insomnia groups according to insomnia prevalence.Binary logistic regression analysis and hierarchical linear regression analysis were used to explore the relationship between DASH diet and insomnia.Results　A total of 300 cases attended the survey，280 of them（93.3%） who handed in responsive questionnaires were finally included.Those with insomnia（n=116） had greater BMI ，alcohol consumption frequency and lower mean DASH diet score than those without（n=164）（P<0.05）.After controlling for age，alcohol consumption，bedtime screen time and BMI，Binary Logistic regression analysis demonstrated that insomnia was positively correlated with DASH diet score〔OR=0.86，95%CI（0.79，0.93）〕.After controlling for the covariates，the hierarchical linear regression with intergroup statistically significantly different variables incorporated revealed that the individual's DASH diet score was associated with the functioning during the day （in the AIS-T）（β=-0.41，P=0.04）.Conclusion　Insomnia may be associated with DASH diet among elderly patients with hypertension.


H-type Hypertension Severity and Cognitive Function in Middle-aged and Elderly Chinese People with Hypertension　

WEI Xinyuan，JIANG Yugang，HUANG Chengyu，YANG Lurui，SONG Yuqing，CHENG Daomei

2021, 24(20):  2520-2526.  DOI: 10.12114/j.issn.1007-9572.2021.00.558

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Background　H-type hypertension refers to hypertension accompanied by hyperhomocysteinemia（HHcy）.It accounts for about 75% of all the types of hypertension and is increasing in the large number of Chinese hypertension patients.Hypertension and HHcy are both risk factors for cognitive impairment.H-type hypertension may have more serious adverse effects on cognitive function and quality of life of patients.Objective　To investigate the prevalence of H-type hypertension，and the association of its severity with cognitive function in middle-aged and elderly hypertensive patients，providing evidence for related disease prevention and control.Methods　From March to November 2020，a total of 97 patients with hypertension who lived in 5 communities（Anle Village，Xianyang Road，Longxingli，Shangyouli，Rongqiandongli） and 2 nursing homes（Tianjin Nursing Home and Heping District Apartment for the Elderly） in Tianjin were selected from March 2007 to November 2008.A face-to-face interview was conducted to collect demographic characteristics，including gender，age，years of education，marital status，residence status，monthly income，lifestyle（drinking，smoking，coffee consumption，tea consumption，daily water intake，daily sleep time，daily exercise time，and vitamin intake.The Mini-Mental State Examination（MMSE） was used to initially assess the cognitive function，by using MMSE score <26 as a criterion for mild cognitive impairment（MCI）.The Basic Cognitive Aptitude Test（BCAT） was used for further evaluating the cognitive function.The patients were divided into three groups according to the level of serum total homocysteine （tHcy）：tHcy <10 μmol/L，10 μmol/L≤ tHcy ≤15 μmol/L，15 μmol/L< tHcy ≤30μmol/L and tHcy >30 μmol/L were considered as simple hypertension，mild，and moderate H-type hypertension，respectively.Multiple linear regression was used to analyse the relationship between H-type hypertension and cognitive function.Results　The prevalence of H-type hypertension was 86.60%（84/97）.Among the 97 subjects，13（13.40%） were found with simple hypertension，31（31.96%） with mild H-type hypertension，and 53（54.64%） with moderate H-type hypertension.The residence status of moderate H-type hypertension patients was significantly different from that of those with simple hypertension or mild H-type hypertension （P <0.05）.The overall prevalence of MCI was 17.53%（17/97）.And the prevalence of MCI in simple hypertension，mild and moderate H-type hypertension patients was 30.77%（4/13），12.90%（4/31），and 16.98%（9/53），respectively.Multiple linear regression analysis demonstrated that moderate H-type hypertension was correlated with mental arithmetic score（P =0.028）.Conclusion　The prevalence of H-type hypertension was relatively high in these middle-aged and elderly patients.And the risk of H-type hypertension was higher in elderly people living in the nursing home.Increased severity of H-type hypertension may be associated with poorer calculation ability.So it is suggested to pay more attention to the monitoring of Hcy level and cognitive function in hypertensive patients to prevent and control cognitive dysfunction as soon as possible.


Serum Uric Acid Level and Mild Cognitive Impairment in Patients with H-type Hypertension　

LI Qian，ZHAO Jianhua，PENG Xue，MENG Lifang，LIU Hao，WANG Jin，LIU Junli，ZHAO Panpan，WANG Fan，LI Shaomin

2021, 24(20):  2527-2531.  DOI: 10.12114/j.issn.1007-9572.2021.00.554

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Background　H-type hypertension easily brings about the decline of cognitive，whose incidence in China is increasing with years.Elevated serum uric acid（SUA） levels in patients with H-type hypertension may be related to mild cognitive impairment（MCI）.Objective　The present study aimed at investigating the correlation between SUA level and MCI in patients with H-type hypertension to find early identification indicators of cognitive decline caused by H-type hypertension.Methods　Eighty-nine patients with H-type hypertension and 40 health examinees were selected from the First Affiliated Hospital of Xinxiang Medical University from January 2019 to September 2020.Clinical data of the participants were collected，including gender，age，years of education，height，weight，and body mass index，history of smoking，drinking，coronary heart disease，hyperlipidemia，and diabetes，systolic blood pressure（SBP），diastolic blood pressure（DBP），homocysteine（Hcy），SUA.The Mini-Mental State Examination（MMSE） and the Chinese version of the Montreal Cognitive Assessment（MoCA） were used to assess cognitive function in hypertension patients，and by the assessment results，the patients were divided into H-type hypertension with MCI subgroup（n=47），and H-type hypertension with normal cognitive function subgroup（n=42）.Multivariate Logistic regression analysis was carried out to identify the factors associated with H-type hypertension with MCI.The correlation between SUA level and MoCA score in H-type hypertension patients was analyzed by Pearson correlation analysis.Results　Compared to health examinees，H-type hypertension patients with MCI had lower mean height，and higher mean levels of SBP，DBP and Hcy（P<0.05），those with normal cognitive function had higher mean levels of SBP，DBP，Hcy and SUA（P<0.05）.In addition，H-type hypertension patients with normal cognitive function had higher mean SUA level than those with MCI（P<0.05）.Multivariate Logistic regression analysis found that elevated SUA was associated with decreased risk of MCI，while elevated SBP was associated with increased risk of MCI in H-type hypertension（P<0.05）.The level of SUA had a positive correlation with the MoCA score in patients with H-type hypertension（r=0.279，P=0.008）.Conclusion　SUA level may be related to MCI in patients with H-type hypertension，and may contribute to a decreased risk of MCI.


Association of Carotid Intima-media Thickening and Hypertension with New-onset Cardio-cerebrovascular Disease　

ZHANG Ying，DU Xin，LI Jie，MA Lin，ZHANG Shuhua，WU Shouling

2021, 24(20):  2532-2536.  DOI: 10.12114/j.issn.1007-9572.2021.00.555

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Background　Either carotid intima-media thickening（CIMT） or hypertension is closely related to the occurrence of cardio-cerebrovascular disease（CVD），yet large-scale studies exploring the combination of the two in relation to cardio-cerebrovascular disease are rare.Objective　To investigate the association of new-onset CVD with the combination of CIMT thickening and hypertension.Methods　In this prospective cohort study，5 440 middle-aged and elderly people（≥ 40 years old） who participated in the health examination of Kailuan Group from July 2006 to January 2017 and carotid ultrasound in 2010 were randomly selected.The content of epidemiological investigation，anthropometric indices，biochemical indices and the definition of living habits were described in the previous study of our group.Participants were grouped according to CIMT thickening and hypertension prevalence：group 1：normal CIMT（CIMT<1.0 mm） without hypertension；group 2：CIMT thickening without hypertension；group 3：normal CIMT（CIMT<1.0 mm） with hypertension；group 4：CIMT thickening with hypertension.The follow-up started since the completion of 2010 physical examination，and ended on 2017-12-31 with CVD（including stroke and myocardial infarction） as the endpoint event.The CVD cumulative incidence curves of the four groups were plotted by Kaplan-Meier method，and were compared by the Log-Rank test.Multivariate Cox regression analysis was used to explore the association of CIMT thickening and hypertension with new-onset CVD.Results　The mean follow-up period was（6.84±0.89） years.The cumulative incidence of CVD for groups 1，2，3，and 4 was 1.28%，2.96%，5.73% and 8.37%，respectively，with a statistically significant difference（χ2=96.10，P<0.001）.Multivariate Cox regression analysis showed that compared with group 1，the HR（95%CI） for new-onset CVD in groups 2，3 and 4 was 1.15（0.55，2.37），3.34（2.15，5.19） and 3.16（1.91，5.12），respectively.Sex-based analysis showed that compared to men in group 1，the HR（95%CI） for new-onset CVD in those in groups 2，3 and 4 was 1.35（0.62，2.94），3.46（2.04，5.89） and 3.29（1.84，5.90），respectively.Compared to women in group 1，the HR（95%CI） for new-onset CVD in those in groups 3，4 was 2.53（1.13，5.65） and 2.67（0.98，7.31），respectively.After eliminating the interference of antihypertensive drugs，the HR value of group 4 was significantly higher than that of group 3（P<0.05）.After excluding individuals taking lipid-lowering drugs，multivariate Cox regression analysis showed that compared with group 1，the HR（95%CI） of new-onset CVD in group 4 was 3.36（2.02，5.59）.After excluding those taking antihypertensive drugs，the HR（95%CI） of new-onset CVD in group 4 was 3.19（1.19，5.71） compared to group 1in the multivariate Cox regression.And after excluding those taking hypoglycemic drugs，the HR（95%CI） of new-onset CVD in group 4 was 3.59（2.06，6.25） compared to group 1showed by multivariate Cox regression analysis.Conclusion　CIMT thickening with hypertension may be strongly associated with new-onset CVD，which can provide help for clinical prevention of CVD.


ST-elevation Myocardial Infarction Patients with Failed Thrombolysis with Recombinant Human Prourokinase: Clinical Characteristics and Influencing Factors of Thrombolysis Failure　

WANG Yanbo，DIAO Jingchao，ZHI Wei，WANG Qing，FU Yang，JIANG Yunfa，HAO Guozhen，FU Xianghua

2021, 24(20):  2537-2541.  DOI: 10.12114/j.issn.1007-9572.2021.00.538

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Background　Intravenous thrombolysis is still a major reperfusion therapy for ST-segment elevation myocardial infarction（STEMI）patients in China's rural primary care，but some patients have failed recanalization after using thrombolysis with recombinant human prourokinase（RHP）.Objective　To analyze the clinical characteristics of patients with STEMI with failed thrombolysis with RHP and influencing factors of thrombolysis failure.Methods　From January 2018 to October 2019，a total of 131 STEMI inpatients treated by early interventional therapy following thrombolysis with RHP were selected from No.5 Cardiovascular Department，the Second Hospital of Hebei Medical University，and divided into recanalization and non-recanalization groups by coronary angiographic findings in infarct-related arteries.The general clinical data，reperfusion parameters，as well as clinical events during hospitalization were recorded and compared between the two groups.Multivariate Logistic regression was used to analyze the related factors of failed thrombolysis.Results　Thirty-two cases had failed thrombolysis，accounting for 24.4%，the other 99 had successful thrombolysis.Compared with patients in recanalization group，those in non-recanalization group had younger age，larger average body mass index and body surface area，shorter average APTT and higher platelet aggregation rate after thrombolysis（P<0.05）.Moreover，non-recanalization group had higher rates of using thrombus aspiration and stents，higher average peak values of creatine kinase and creatine kinase isoenzyme and lower average left ventricular ejection fraction（P<0.05）.Multivariate Logistic regression analysis found that age，body surface area，levels of APTT were associated with failed thrombolysis with RHP（P<0.05）.Conclusion　The clinical characteristics of STEMI patients with failed thrombolysis with RHP were including being younger age，large body surface area，shorter APTT after thrombolysis，large myocardial infarction area and poor cardiac function.Younger age，larger body surface area and shorter APTT after thrombolysis may be risk factors for failed thrombolysis with RHP in STEMI patients.


Prevalence and Associated Factors of Binge Drinking in Freshmen and Sophomores: a Survey from Zhejiang Province

LIU Lingpei，CHEN Jianyong，CHEN Guangming，CHEN Yuehua

2021, 24(20):  2542-2546.  DOI: 10.12114/j.issn.1007-9572.2021.00.539

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Background　Binge drinking in college students is becoming a serious public health concern in China，which may be caused by peer drinking norms，low drinking refusal self-efficacy and impulsivity.However，research on influencing factors of binge drinking among freshmen and sophomores is rare.Objective　To investigate binge drinking prevalence，and its association with peer drinking norms，drinking refusal self-efficacy and impulsivity in freshmen and sophomores in Zhejiang province，to provide insights to deliver interventions for binge drinking in this population.Methods　From December 2018 to May 2019，freshmen and sophomores from four universities in Zhejiang Province were recruited via convenient sampling to attend a survey using a self-developed General Demographic Questionnaire，the Binge Drinking Questionnaire，Drinking Norms Rating Form，Drinking Refusal Self-efficacy Questionnaire，and Short Version of UPPS-P Impulsive Behavior Scale（consisting of negative urgency，lack of perseverance，sensation seeking，positive urgency and lack of premeditation subscales）.Spearman rank correlation analysis was employed to analyze the association of binge drinking with peer drinking norms，drinking refusal self-efficacy，and impulsivity.Multivariate Logistic regression analysis was used to identify the associated factors of binge drinking.Results　The survey achieved a response rate of 97.36%（1 216/1 249）.The prevalence of binge drinking was 42.68%（519/1 216）.Correlation analysis revealed that binge drinking frequency in the year prior to the survey was positively correlated with peer drinking norms，negative urgency，lack of perseverance，sensation seeking，positive urgency and lack of premeditation（rs=0.39，0.07，0.12，0.12，0.09，0.08，P<0.05）and negatively correlated with drinking refusal self-efficacy（rs=-0.28，P<0.05）.Multivariate Logistic regression analysis indicated that sex〔OR=2.261，95%CI（1.738，2.940）〕，peer drinking norms〔OR=3.331，95%CI（2.617，4.239）〕，drinking refusal self-efficacy〔OR=0.487，95%CI（0.396，0.598）〕，lack of perseverance〔OR=1.488，95%CI（1.142，1.941）〕 and sensation seeking〔OR=1.220，95%CI（1.005，1.481）〕 were associated with binge drinking（P<0.05）.Conclusion　The prevalence of binge drinking was high in freshmen and sophomores from Zhejiang.Male，higher prevalence of peer drinking，lower levels of drinking refusal self-efficacy and perseverance，and higher level of sensation seeking may be associated with increased risk of binge drinking.


Changes of Inhibitory Amino Acids in the Brain of Depression Model Rats before and after Escitalopram Treatment　

DING Kaimo，LI Bingyue，ZHANG Mimi，LI Guohai，LI Suxia

2021, 24(20):  2547-2554.  DOI: 10.12114/j.issn.1007-9572.2021.00.469

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Background　Major depressive disorder（MDD）is a common chronic and recurrent illness，causing enormous global economic burden.Its pathogenesis remains unclear although relevant studies have been continuing for decades.Objective　To investigate the changes of inhibitory amino acids in the brain of depression-like rats model before and after escitalopram treatment.Methods　 This study was implemented from June 2016 to March 2017.Thirty-eight adult male SD rats were selected，and 18 of them were treated with chronic unpredictable stress（CUS）for 28 days（CUS group），other 20 were normally reared without CUS（control group）.Since the 15th day of intervention，21 rats〔9 in CUS group（CUS+escitalopram subgroup） and 12 in control group（control + escitalopram subgroup〕 were intraperitoneally injected with escitalopram，while other 17 rats〔9 in CUS group（CUS + vehicle subgroup） and 8 in control group（control + vehicle subgroup）〕 were intraperitoneally injected with 0.9% normal saline solution.Body weight gain，sucrose preference value measured by sucrose preference test（SPT），horizontal movement distance and time spent in the central area measured by the open field test（OFT），time used for exploring the open arms in the elevated plus-maze test（EPM），and time consumed in white box in the black box and white box testing（BWT）were used to assess the changes of depression-and anxiety-like behaviors.A high performance liquid chromatography-mass spectrometry（LC-MS）was used to investigate the changes of amino acid metabolism in the prefrontal cortex and hippocampus in rats.Results　Behavioral results：there was no interaction effect between CUS and escitalopram on the weight gain，sucrose preference percentage value，horizontal movement distance and time spent in the central area in OFT（P>0.05）.A significant main effect of CUS on the weight gain，sucrose preference value，and the horizontal movement distance in OFT was found（P<0.05），while no significant main effect of CUS on time spent in the central area in OFT was found（P>0.05）.A significant main effect of escitalopram on the sucrose preference value，and the horizontal movement distance in OFT was found（P<0.05），while no significant main effect of escitalopram on the weight gain，and time spent in the central area in OFT was found（P>0.05）.There was an interaction effect between CUS and escitalopram on the time spent on exploring open arms in EPM and on the time consumed in white box in BWT（P<0.05）.A significant main effect of CUS and escitalopram on the time consumed in white box in BWT was found（P<0.05），but no such effect was found on the time spent on exploring open arms in EPM（P>0.05）.The post hoc analysis showed that the mean time spent on exploring open arms in EPM and that consumed in white box in BWT in CUS group were both significantly decreased compared with control group（P<0.05）and escitalopram shortened the time spent on exploring open arms in EPM and that consumed in white box in BWT（P<0.05）.LC-MS results: there was an interaction effect between CUS and escitalopram on the concentration of γ-aminobutyric acid（GABA）and the ratio of glutamate（Glu）/GABA in the prefrontal cortex（P<0.05）.There was no significant main effect of CUS on the concentration of GABA and Glu / GABA（P>0.05）.A significant main effect of escitalopram on the concentration of GABA and Glu/GABA was found（P<0.05）.The post hoc analysis showed that the concentration of GABA was significantly decreased and Glu/GABA was significantly increased in the prefrontal cortex in CUS group compared with control group（P<0.05）and escitalopram rescued the concentration of GABA and Glu/GABA（P=0.005）.However，no changes in amino acid metabolism were found in the hippocampus.Conclusion　GABA in the prefrontal cortex may be involved in the occurrence of depression-like behaviors induced by CUS.escitalopram may significantly rescue depression-like and anxiety-like behaviors and improve the abnormal concentration of GABA in the prefrontal cortex induced by CUS.


Prognostic Value of Partial Ephrectomy in Patients with Localized Ⅰ Clear Cell Renal Cell Carcinoma　

CAI Menghui，LIU Feng，GE Tianyu，FENG Zihao，HUANG Kunping，GE Bo

2021, 24(20):  2555-2562.  DOI: 10.12114/j.issn.1007-9572.2021.00.428

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Background　At present，partial nephrectomy（PN）is preferred for patients with localized T1a clear cell renal cell carcinoma（ccRCC）.However，it remains controversial whether PN is the first-choice surgical procedure for patients with localized T1b ccRCC.Objective　To estimate the effects of PN on overall survival（OS）and cancer-specific survival（CSS）of patients with localized Ⅰ ccRCC.Methods　From April to May 2020，we downloaded the clinicopathological data of patients diagnosed with ccRCC pathologically from 1975 to 2016（year of diagnosis，age，sex，race，marital status，tumor laterality，pathological stage，T stage，surgical method）from SEER after getting permission to use the database.According to the use of surgical techniques，the patients were divided into PN group and radical nephrectomy（RN）group.Cox proportional hazards regression model was used to identify independent prognostic factors of CSS in patients with localized I ccRCC.Multivariate Logistic regression analysis was used to explore the the influencing factors of surgical methods in patients with ccRCC.Propensity score matching method was used to adjust samples.Kaplan-Meier curve and multivariate Cox proportional hazards regression model were used to estimate the effects of two surgical methods on the OS and CSS of patients before and after matching.Results　The results of univariate Cox proportional hazard regression model showed that age，marital status，pathological stage，T stage and surgical method were factors associated with CSS in patients with localized ⅠccRCC（P<0.05）.The results of multivariate Cox proportional hazard regression model showed that age，marital status，pathological stage，T stage and surgical method were all independent factors for CSS in patients with localizedⅠ ccRCC（P<0.05）.In terms of evaluating the prognostic value of surgical method by overall survival population and tumor specific survival population，localized T1b stage ccRCC with PN and those with RN had statistically significant differences in the year of diagnosis，age，tumor laterality and pathological stage（P<0.05）.Multivariate Logistic regression analysis revealed that year of diagnosis，age，tumor laterality and pathological stage were associated with the use of surgery method in patients with localized T1b stage ccRCC（P<0.05）.Kaplan-Meier survival analysis found that either before or after propensity score matching，PN significantly prolonged the OS（P<0.05），but showed similar effect on the CSS（P>0.05）of patients compared with RN.After propensity score matching，multivariate Cox regression analysis found that PN was independently associated with prolonged OS of patients（HR=0.695，P=0.009），but was not significantly associated with CSS（HR=0.804，P=0.301）.Conclusion　When surgery is feasible，PN is recommended as the first-choice surgical mode for patients with stage ⅠccRCC in light of long-term survival.


Analysis of the Current Situation of Frequent Visits and Influencing Factors of Hypertension Patients in Yuetan Community　

JI Yan，DING Jing，CHEN Xue，LIU Meixing

2021, 24(20):  2563-2567.  DOI: 10.12114/j.issn.1007-9572.2021.00.502

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Background　Frequent visits not only causes unreasonable application of community medical resources，but also increases the workload of general practitioners.Objective　To understand the current situation of frequent visits to patients with hypertension in Beijing Yuetan Community and to analyze related influencing factors.Methods　434 hypertensive patients with complete outpatient visit records in Yuetan Community Health Center，Fuxing Hospital，Capital Medical University from July 2017 to June 2018 were retrospectively selected as the research object and their basic information（gender，age，marital status，occupational status，education level，whether to contract a family doctor service agreement），disease atatus（body mass index，combination with other chronic diseases），status of visits（number of simple consultations，types of oral hypotensive drugs，times of blood pressure measurement）were analyzed.Results　434 patients with hypertension paying a total of 9 910 visits，among them，there were 160 patients（36.9%）in the frequent visits group（the annual visiting times >24），with a total of 5 694 visits（57.5%）；274 patients（73.1%）in the routine visits group（the annual visiting times ≤24），with a total of 4 216 visits（42.5%）.There were statistically significant differences in age composition，proportion of contracted family doctor services，body mass index，proportion of patients with coronary heart disease and stroke between the two groups（P<0.05）.Multivariate Logistic regression analysis showed that the contracted family doctor services〔OR=2.467，95%CI（1.536，3.964）〕 and combination with stroke〔OR=2.702，95%CI（0.449，1.106）〕 were risk factors for frequent visits.Conclusion　Frequent attenders in hypertension patients occupy a large amount of community medical resources，contracted family doctor services and combination with stroke are the are the risk factors of frequent visits.We should enhance the importance of frequent visits，screen and interven unnecessary medical visits，so as to help play better role of general practitioners and make full use of community medical resources.


Correlation between Ambulatory Arterial Stiffness Index and Severity of Heart Failure with Preserved Ejection Fraction in Patients with Hypertension　

ZHU Mingna，ZHANG Lihua，JIANG Youxu，MA Xiaoying，XIONG Haiyan，LI Yuan，ZHU Lina，HUANG Xin

2021, 24(20):  2568-2572.  DOI: 10.12114/j.issn.1007-9572.2021.00.429

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Background　The major pathophysiological mechanism of heart failure with preserved ejection fraction（HFpEF）refers to ventricular diastolic dysfunction caused by ventricular remodeling.Ambulatory arterial stiffness index（AASI）refers to a common clinical indicator，which is closely related to both arteriosclerosis and left ventricular remodeling.But less researches on AASI and HFpEF has appeared yet.Objective　To examine the changes of AASI in patients with hypertension and HFpEF，and explore the correlation of AASI with cardiac functional and ventricular structural indices.Methods　210 patients with hypertension〔including 112 with HFpEF（63 with NYHA class Ⅱ-Ⅲ and 49 with NYHA class Ⅲ-Ⅳ）and 98 without〕 who were admitted into the Cardiovascular Department，the Second Affiliated Hospital of Zhengzhou University from 2018 to 2019 were enrolled.Gender，age，admission systolic and diastolic blood pressures，and heart rate and medication history（use of ACEIs/ARBs，calcium channel blockers，digoxin，mineralocorticoid receptor antagonists，diuretic），serum indices〔serum creatinine（Scr），serum urea nitrogen（SUN），alanine aminotransferase，aspartate aminotransferase，total cholesterol，triglyceride，high- and low-density lipoprotein〕in the fasting venous blood sample taken after admission，and NT-proBNP and cardiac functional and structural indices，such as echocardiography measured left ventricular ejection fraction（LVEF），left ventricular end-diastolic diameter（LVDd），interventricular septal thickness，left ventricular posterior wall thickness，left atrial diameter，and calculated left ventricular mass，left ventricular mass index（LVMI）and AASI were recorded.Pearson correlation analysis was used to explore the correlation of AASI with cardiac function and ventricular structure indices.Results　Hypertensive patients with HFpEF had greater average age，higher average levels of Scr，SUN，NT-proBNP，LVMI，LVDd and AASI，as well as higher rate of using diuretics，but had lower average level of LVEF compared with those without（P<0.05）.Hypertensive patients with HFpEF of NYHA class Ⅰ-Ⅱ had lower average levels of NT-proBNP，LVDd，LVMI and AASI，and higher average level of LVEF than those of NYHA class Ⅲ-Ⅳ（P<0.05）.AASI was positively correlated with NT-proBNP（r=0.434，P<0.001），LVDd（r=0.470，P<0.001）and LVMI（r=0.417，P<0.001），and negatively correlated with LVEF（r=-0.410，P<0.001）in patients with HFpEF and hypertension.Conclusion　The AASI was higher，and was related to the changes of cardiac function and the degree of ventricular remodeling in hypertension patients with HFpEF，which may be caused by HFpEF.


Influence of Titrated Positive End-expiratory Pressure Using an Esophageal Pressure-guided Strategy on the Early Prognosis of Patients with Acute Respiratory Distress Syndrome：a Meta-analysis　

LIU Tian，DU Yuming，SUN Jianhao，WANG Xiaodi

2021, 24(20):  2573-2579.  DOI: 10.12114/j.issn.1007-9572.2021.00.556

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Background　Acute respiratory distress syndrome（ARDS） is a common cause of death in the ICU.The strategy used in mechanical ventilation，a major support for sustaining life，is closely related to the prognosis of patients.Currently，it is still a controversy regarding the strength of association of titrated positive end-expiratory pressure（PEEP） using an esophageal pressure-guided strategy with the early prognosis of ARDS patients.Objective　To evaluate the effect of titrated PEEP using an esophageal pressure-guided strategy compared with high PEEP on the early prognosis of ARDS patients.Methods　The PubMed，EMBase，The Cochrane Library，CNKI，Wanfang Data and VIP databases were searched from inception to 2020-06-18 for published randomized controlled trials（RCT） about ARDS patients treated with esophageal pressure-guided PEEP titration.The test group was treated with conventional treatment and peep titration guided by esophageal pressure，while the control group was treated with conventional treatment and high PEEP guided mechanical ventilation；outcome measures: main outcome measures （28 day mortality risk），secondary outcome measures （oxygenation index，peep，days of mechanical ventilation）.The RCTs were included according to the inclusion and exclusion criteria，and evaluated in terms of the quality of methodology，and their references were cited and indexed.Stata 16.0 and RevMan5.3 were used for data analysis.Results　A total of 13 RCTs were included，involving 800 cases，of which 12 were single-center，and one was multicenter；9 were published in Chinese，and 4 in English.The analysis revealed that compared to the control group，the test group had lower risk of 28-day mortality〔OR=0.55，95%CI（0.39，0.79），P=0.001〕，higher mean oxygenation index〔SMD=1.86，95%CI（1.65，2.08），P<0.000 01）〕，higher mean PEEP〔SMD=1.27，95%CI（1.04，1.51），P<0.000 01〕，and less mean number of days of mechanical ventilation〔SMD=-1.51，95%CI（-1.79，1.22），P<0.000 01〕.Conclusion　Esophageal pressure-guided PEEP titration could reduce the risk of 28-day mortality，and improve clinical symptoms in patients with ARDS，indicating that it may play a positive role in improving early prognosis，so it is recommended to use esophageal manometry in the management of mechanical ventilation in patients with ARDS.


Diagnostic Value of Circulating Cell-free DNA to Prostate Cancer：a Meta-analysis　

LI Fan，XU Bin，XIANG Hui，CHEN Zejia，PANG Zisen，ZHANG Tianyu

2021, 24(20):  2580-2588.  DOI: 10.12114/j.issn.1007-9572.2021.00.559

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Background　Numerous studies have shown that circulating free DNA（cfDNA）has diagnostic value in prostate cancer，but there is no consensus on its accuracy.Objective　To evaluate the diagnostic value of cfDNA in prostate cancer by a Meta-analysis.Methods　Articles in Chinese and English regarding diagnosing prostate cancer using cfDNA were collected by searching databases of PubMed，EMBase，Web of Science，The Cochrane Library，CNKI，and WANFANG DATA from inception to February 2020，and were enrolled according to the inclusion and exclusion criteria.Data were extracted，including the first author's name，year of publication，country of publication，sample size，detection method and accuracy assessment indices（true-positive，false-positive，false-negative，true-negative）.Spearman correlation was used to assess whether there was a threshold effect.The SROC plot was used to examine whether the diagnostic performance curve of cfDNA presenting a “shoulder-arm” shape.The heterogeneity between the included studies was measured by the Cochran's Q test and I2 test and used for selecting an appropriate model for pooling data.Meta-analysis and Fagan's nomogram were used to estimate the diagnostic efficiency and probability of cfDNA，respectively.Results　 Twenty-two articles were included，involving 2 774 cases，1 936 of whom were diagnosed with prostatic cancer by cfDNA and 838 were not.The overall quality of the included literature was good.The pooled sensitivity，specificity，positive likelihood ratio，negative likelihood ratio，diagnostic odds ratio of cfDNA for prostate cancer diagnosis were 0.49〔95%CI（0.47，0.51）〕，0.91〔95%CI（0.89，0.92）〕，6.04〔95%CI（4.39，9.31）〕，0.52〔95%CI（0.45，0.60）〕，and 18.19〔95%CI（12.33，26.85）〕，respectively.The AUC of the SROC curve was 0.898 2.Subgroup analysis showed that the AUC value of cfDNA in the diagnosis of prostate cancer did not change significantly in each subgroup（P>0.05）.Fagan's nomogram demonstrated that using cfDNA to detect prostatic cancer increased the posttest probability to 88% from the pretest probability of 20%.Conclusion　cfDNA might be a diagnostic biomarker for prostate cancer.It may be used as a helper for prostate-specific antigen screening，but it still needed a large number of prospective stuides to support this.


Recent Developments in the Pathogenesis of COVID-19-associated Myocarditis　

LUO Fei，LI Shuren，HAO Xiao，BAI Yuhao，YUAN Kexin，XIE Yuetao

2021, 24(20):  2589-2593.  DOI: 10.12114/j.issn.1007-9572.2021.00.524

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Severe acute respiratory syndrome coronavirus-2（SARS-CoV-2）was initially thought to mainly affect the respiratory system.A growing body of research has found that SARS-CoV-2 infection can affect multiple human organ systems，and heart is a major target organ secondary to lung.COVID-19-associated cardiac injury is often seen clinically，about 1%-7% of which is myocarditis.COVID-19-associated myocarditis often has a poor outcome.However，the possible pathogenesis mechanisms of COVID-19-associated cardiac injury，and its progression to COVID-19-associated myocarditis，as well as related pathophysiological changes are still unknown.Available data analysis has revealed that the recognized mechanism of cardiac injury in COVID-19 is ACE2-mediated cardiac injury，and cytokine storm-mediated or immune-mediated cardiac injury is only suggestive currently.Due to limited use of cardiac MRI and endocardial biopsy as well as insufficient autopsy findings and other basic research data in patients with COVID-19-associated myocarditis，the diagnosis and treatment of COVID-19-associated myocarditis are challenges that still exist for clinicians.We reviewed the possible pathophysiological mechanisms of COVID-19-associated myocarditis，which will contribute to improving medical workers' understanding of this disease so that its related mortality may be reduced.


Prognostic Indicators for Severity in COVID-19 Patients：a Meta-analysis　

WANG Jiting，LI Jun，TIAN Yuan，LI Yaling

2021, 24(20):  2594-2600.  DOI: 10.12114/j.issn.1007-9572.2021.00.548

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Background　The COVID-19 has become a global pandemic declared by the WHO，and the severity of which affects the prognosis of patients.Objective　To explore the prognostic indicators for severity and their predictive values in COVID-19 patients，providing a reference for clinical prediction of patients'outcome and prognosis.Methods　Eight databases （the Cochrane Library，Embase，PubMed，Web of Science，SinoMed，CNKI，Wanfang Data Knowledge Service Platform，VIP）were searched from inception to 2020-09-03 for randomized controlled trials（RCTs）about severe versus non-severe COVID-19 patients or deceased versus survived COVID-19 patients with prognostic indicators［including procalcitonin （PCT），C-reactive protein （CRP），lymphocyte count （LYM），interleukin-6 （IL-6），D-dimer）studied.The modified Jaded Scale was used to assess the methodological quality.Stata 12.0 was used for meta-analysis.Results　Fifteen RCTs were included，involving 1 476 cases，all were assessed with high methodological quality（modified Jadad Scale score ranging from 4 to 5 points）.Meta-analysis found that severe COVID-19 patients had higher mean values of PCT〔SMD=-2.28，95%CI （-3.60，
-0.98），P<0.001〕，CRP〔SMD=-2.23，95%CI （-3.38，-1.07），P<0.001〕，IL-6〔SMD=-2.97，95%CI （-4.94，-1.00），P<0.001〕，and D-dimer〔SMD=-1.22，95%CI （-2.66，0.21），P=0.008〕than non-severe COVID-19 patients.Severe COVID-19 patients had lower mean LYM〔SMD=1.41，95%CI （0.34，2.48），P<0.001〕.The deceased COVID-19 patients had higher mean values of PCT〔SMD=-4.11，95%CI （-9.98，1.76），P=0.007〕，CRP〔SMD=-2.73，95%CI （-4.21，-1.25），P<0.001〕，IL-6〔SMD=-3.79，95%CI （-4.90，-2.67），P<0.001〕，and D-dimer〔SMD=-0.68，95%CI （-1.46，0.09），P=0.009〕 than the survived.The deceased COVID-19 patients had lower mean LYM 〔SMD=2.08，95%CI （0.93，3.22），P<0.001〕.Conclusion　Increased PCT，CRP，IL-6 and D-dimer and decreased LYM were found in severe or deceased COVID-19 patients，indicating that the former three may be positively correlated with severity，while the latter may be negatively correlated with severity.These five indicators may be used as prognostic indicators for severity，too high PCT，CRP，IL-6 and D-dimer，and too low LYM may suggest a poor prognosis.


Predictive Value of Fat Fraction Quantification of Lumbar Spine for Newly Diagnosed Multiple Myeloma　

PEI Xiaojiao，PAN Zhenyu，LIAN Yufei，SHEN Man，JIANG Tao，HUANG Zhongxia

2021, 24(20):  2601-2606.  DOI: 10.12114/j.issn.1007-9572.2021.00.557

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Background　Multiple myeloma（MM） is a malignant proliferative hematological disease with abnormal accumulation of monoclonal plasma cells.Bone damage is one of its clinically defined presentations，thus making it particularly important to evaluate the degree of bone damage.Given the fact that fatty tissue is an important component of bone marrow and abnormal bone marrow microenvironment plays an important role in the pathogenesis of MM，more and more attention has been paid to the role of bone marrow fat content in the pathogenesis of MM.So far，Dixon imaging has been employed to measure the change in fat fraction of vertebral bone marrow，which plays a key role in the development of MM and newly diagnosed MM（NDMM）.Objective　We aimed to explore the value of the fat fraction acquired by T1-weighted two-point Dixon technique in the diagnosis of NDMM.Methods　Thirty inpatients with a definite diagnosis of MM〔including 25 with NDMM，and 5 with monoclonal gammopathy of undetermined significance（MGUS）〕 and 20 health examinees were recruited from Beijing Chao-yang Hospital（West Branch） from July 2016 to December 2019.The average fat fraction of each vertebral body（L1-5） and the average vertebral fat fraction of NDMM and MGUS patients and healthy controls were obtained by T1-weighted two-point Dixon technique at 3.0T MRI（Siemens Germany）.ROC curve analysis was utilized to evaluate the diagnostic efficacy of fat fraction for NDMM.Results　Compared to MGUS patients and healthy controls，NDMM patients had less average fat fraction of each vertebral body（L1-5）（P<0.05）.They also had less average vertebral fat fraction（P<0.05）.ROC curve analysis showed that the area under the curve of fat fraction for the diagnosis of NDMM was 0.946〔95%CI（0.917，0.976）〕，with the optimal cut-off value of 59.35%，and 87.20% sensitivity and 96.00% specificity.Conclusion　The fat fraction of vertebral bone marrow measured by T1-weighted two-point Dixon technique at 3.0T MRI was significantly lower in NDMM patients，which may has a certain value for diagnosing NDMM.


The Value of Simplified Calculation of CT Enhanced Washout Rate in Distinguishing Adrenal Metastasis and Adrenal Adenoma Less Than 4 cm　

DAI Guojiao，ZHENG Hailan，ZHENG Yongfei，HUANG Danjiang

2021, 24(20):  2607-2613.  DOI: 10.12114/j.issn.1007-9572.2021.00.571

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Background　Among incidental adrenal tumors，adrenal metastases need to be distinguished from the most common benign adrenal tumors （adrenal adenomas）.It is recommended to delay the scan for 15 minutes to calculate the absolute percentage washout and relative percentage washout，but the scanning time is too long.Objective　To explore the value of simplified calculation of CT enhanced washout rate in distinguishing adrenal metastases and adrenal adenomas less than 4 cm.Methods　78 patients with adrenal metastasis and 50 patients with adrenal adenoma who were confirmed by clinical follow-up or suspected to be diagnosed as non-adrenal adenoma lesions followed by surgical pathology and enhanced CT scanning in Taizhou First People's Hospital from January 2014 to December 2019 were selected.According to the inclusion and exclusion criteria，37 patients with adrenal metastasis（adrenal metastasis group） and 47 patients with adrenal adenoma （adrenal adenoma group） were finally included in this study；among them，patients with adrenal metastases included 16 patients with lung cancer as the primary tumor and 21 patients with other tumors as the primary tumor （4 patients with liver cancer，14 patients with gastrointestinal cancer，1 patient with pancreatic cancer，1 patient with bladder cancer，1 patient with salivary gland cancer），and patients with adrenal adenomas included 15 patients with lipid-poor adrenal adenoma and 32 patients with lipid-rich adrenal adenoma.The age，sex，occurrence of hypertension，lesion location （left/right） and tumor size of patients were collected and CT attenuation value of plain scan，arterial phase and portal venous phases were measured to calculate simplified absolute percentage washout and relative percentage washout.Receiver operating characteristic curves （ROC） were used to assess the efficacy of statistically significant variables between groups including adrenal metastasis and adrenal adenoma groups，adrenal metastasis and lipid-poor adrenal adenoma groups，adrenal metastasis and lipid-rich adrenal adenoma groups，adrenal metastasis of lung cancer and lipid-poor adrenal adenoma groups respectively.Results　There were no statistical differences in age，gender，occurrence of hypertension，and the location and size of lesions between groups including adrenal metastasis and adrenal adenoma groups，adrenal metastasis and lipid-poor adrenal adenoma groups，adrenal metastasis and lipid-rich adrenal adenoma groups，adrenal metastasis of lung cancer and lipid-poor adrenal adenoma groups（P>0.05）.The plain CT value of patients in the adrenal metastasis group was higher than the adrenal adenoma group （P<0.001）.The plain CT value of patients in the adrenal metastasis group was higher than the lipid-poor adrenal adenoma group and the absolute percentage washout and relative percentage washout of patients in the adrenal metastasis group was lower than the lipid-poor adrenal adenoma group （P<0.05）.The plain CT value and relative percentage washout of patients in the adrenal metastasis group were higher than the lipid-rich adrenal adenoma group（P<0.05） and there was no significant difference in the absolute percentage washout between the adrenal metastasis group and the lipid-rich adrenal adenoma group （P>0.05）.The plain CT value of patients in the lung cancer adrenal metastasis group was higher than the lipid-poor adrenal adenoma group，and the absolute percentage washout and relative percentage washout of patients in lung cancer adrenal metastasis group were lower than the lipid-poor adrenal adenoma group （P<0.05）.In the ROC curve analysis of adrenal metastasis and adrenal adenoma，the cut-off value of plain CT value was 21.00 HU，and the AUC，sensitivity，and specificity were 0.894，81.1%，and 89.4%，respectively.In the ROC curve analysis of adrenal metastasis and lipid-poor adrenal adenoma，the cut-off value of plain CT value was 28.50 HU，and the AUC，sensitivity，and specificity were 0.746，64.9%，and 86.7%，respectively.The cut-off value of the absolute percentage washout was -21.54%，and the AUC，sensitivity，and specificity were 0.733，80.0%，and 83.8%，respectively.The cut-off value for the relative percentage washout was -9.65%，and the AUC，sensitivity，and specificity were 0.760，73.3%，and 89.2%，respectively.In the ROC curve analysis of adrenal metastasis and lipid-rich adrenal adenoma，the cut-off value of plain CT value was 11.50 HU，and the AUC，sensitivity and specificity were 0.964，91.9% and 100.0%，respectively.The cut-off value of the relative percentage washout was -64.10%，and the AUC，sensitivity and specificity were 0.677，89.2% and 53.1%，respectively.In the ROC curve analysis of lung cancer adrenal metastasis and lipid-poor adrenal adenoma，the cut-off value of plain CT value was 29.50 HU，and the AUC，sensitivity，and specificity were 0.881，81.3%，and 93.3%，respectively.The cut-off value of the absolute percentage washout was -24.89%，the AUC，sensitivity，and specificity were 0.721，80.0%，and 81.3%，respectively.The cut-off value for relative percentage washout was -10.58%，the AUC，sensitivity，and specificity were 0.733，73.3%，and 87.5%，respectively.Conclusion　 Simplified calculation of CT enhanced absolute percentage washout and relative percentage washout is of great value in distinguishing adrenal metastases and adrenal adenomas less than 4 cm.


Novel Advances in Gpnmb with Obesity and Obesity-related Diseases　

WU Xunan，ZHAO Li，YUAN Guoyue

2021, 24(20):  2614-2618.  DOI: 10.12114/j.issn.1007-9572.2021.00.520

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Glycoprotein non-metastatic melanoma protein B（Gpnmb） is a type I transmembrane glycoprotein first identified in melanoma cell lines with low metastatic potential.Recent research has shown that obesity promotes expression and secretion of Gpnmb in adipose tissue.Additionally，Gpnmb could contribute to obesity and obesity-related diseases by increasing weight，promoting lipid synthesis and aggregating insulin resistance.Therefore，Gpnmb may be a promising target for predicting and treating obesity and obesity-related diseases.This article reviews recent advances in the association of Gpnmb with obesity and obesity-related diseases.


Research Progress on Prognosis of Children with Autoimmune Epilepsy Encephalopathy　

ZHANG Kai，LU Hongru，SUN Suzhen

2021, 24(20):  2619-2623.  DOI: 10.12114/j.issn.1007-9572.2021.00.485

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Autoimmune epileptic encephalopathy（AEE） is a potentially treatable neurological disease.It usually refers to acute or subacute seizures that occur in the presence of encephalopathy.The neuronal targets of autoimmune epilepsy encephalopathy related to children mainly include NMDA receptor，GABA receptor，LGI1 receptor，AMPA receptor，glycine receptor，MOG and so on.At present，the main prognosis of children's AEE is through the modified Rankin Scale（mRS） and Pediatric Cerebral Performance Category（PCPC）.According to the scale evaluation，85% of the children have a good prognosis，but some studies have shown that some children have sequelae such as decreased learning ability，cognitive impairment，and social impairment，but there is no obvious manifestation in the scale.This article will review the latest research progress in children's AEE prognosis，aiming to provide a theoretical basis for clinicians' early follow-up，identification and prevention.


Research Progress of Sputum Biomarkers in the Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease　

MA Qingsong，LIU Ling，ZHAO Zhihuan

2021, 24(20):  2624-2628.  DOI: 10.12114/j.issn.1007-9572.2021.00.497

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Sputum is mainly derived from the central airway，which contains inflammatory cells and inflammatory mediators in these parts.The assessment of airway inflammation through sputum cytology classification and detection of related inflammatory mediators has been clinically confirmed.In recent years，sputum biomarkers have made some progress in the study of chronic obstructive pulmonary disease （COPD）.This article reviews the progress of various biomarkers in the diagnosis and treatment of COPD.It is found that the detection of inflammatory cells and inflammatory factors in sputum and the application of cluster analysis to propose more specific subgroup classification methods can better distinguish COPD and asthma，which is conducive to the study of the mechanism of the overlap between the two.Analyze the correlation among sputum biomarkers，various clinical indicators and scoring scales further to propose new disease evaluation indicators.Exploring the biomarkers that mediate the frequent acute attacks of COPD and the increased susceptibility of bacteria and viruses is expected to identify patients with frequent acute exacerbation phenotypes and provide a theoretical basis for the new diagnostic markers and therapeutic targets.