Table of Content

20 May 2022, Volume 25 Issue 15

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Hot Research: Irritable Bowel Syndrome

Research Status and Thoughts on the Comparative Effect of Traditional Chinese Medicine in the Treatment of IBS-D

Min CHEN, Xin XIE, Yunzhou SHI, Hui ZHENG, Qiaofeng WU, Haiyan ZHOU, Zhigang LI, Shuguang YU

2022, 25(15):  1795-1800,F01.  DOI: 10.12114/j.issn.1007-9572.2022.02.008

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Diarrhea irritable bowel syndrome (IBS-D) is a common clinical disease with high prevalence and recurrent episodes. Patients with IBS-D often suffer from anxiety and depression, which bring a huge medical burden to the society. There are many clinical treatment options for IBS-D, especially in the field of traditional Chinese medicine (TCM) . Which one is better among traditional Chinese medicine treatment methods has become a common concern of clinicians, patients and medical decision-makers. By reviewing the comparative effect research (CER) application of clinical effect assessment in the treatment of IBS-D with TCM, combined with the methodological innovations of comparative effect research in the past five years, this article discusses the current status of CER in the treatment of IBS-D with TCM, and then considers how to design, implement and evaluate the comparative effect of TCM in real-world clinical research.

Research Progress of Traditional Chinese and Western Medicine in the Treatment of Irritable Bowel Syndrome Based on 5-hydroxytryptamine

Pengning WU, Shuai XIONG, Xiaohan JIANG, Yi ZHANG, Chao LIANG, Min CHEN

2022, 25(15):  1800-1806.  DOI: 10.12114/j.issn.1007-9572.2022.0034

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Irritable bowel syndrome (IBS) is a gastrointestinal disorder with no structural damage and biochemical abnormality, and its pathogenic mechanism is still unclear. Variety of drugs, psychotherapy, diet regulation and other methods have been used by modern medicine to relieve symptoms, but the effect is not satisfactory. In recent years, TCM treatment of IBS has attracted widespread attention, especially for constipation type and diarrhea type. Among the many experiments, most of the traditional Chinese medicine experiments aimed at the 5-HT signaling pathway have achieved good results. Therefore, this paper summarizes the main mechanisms and results of traditional Chinese medicine based on 5-HT in the treatment of IBS, in order to provide a reference for subsequent research.

Review of Complementary and Alternative Medicine Therapies for Irritable Bowel Syndrome

Yunzhou SHI, Hui ZHENG, Min CHEN, Zhigang LI, Shuguang YU

2022, 25(15):  1807-1813.  DOI: 10.12114/j.issn.1007-9572.2022.02.011

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Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder frequently encountered clinically. Many IBS patients use complementary and alternative medicine (CAM) therapies for better treatment results when their conditions could not be improved by first-line drug treatment. However, due to limitations of quality and quantity of studies about CAM therapies, most of these therapies for IBS have not been recommended by relevant consensuses and guidelines. We overviewed common CAM therapies for IBS, detailed three types, namely, natural products, psychosomatic therapies, and Chinese medicine, aiming at increasing clinical workers and patients' understanding and application of these therapies.

Mechanism of Huangqi Jianzhong Decoction in Treating Diarrhea Predominant Irritable Bowel Syndrome Based on Network Pharmacology and Molecular Docking Technology

Kun YE, Min LEI, Xin XIE, Hui ZHENG, Min CHEN, Shuguang YU

2022, 25(15):  1814-1824.  DOI: 10.12114/j.issn.1007-9572.2022.02.014

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Background

Clinical treatment often achieves unsatisfactory effect for irritable bowel syndrome (IBS) , a common complex functional gastrointestinal disease. Huangqi Jianzhong Decoction is widely used for diarrhea IBS (IBS-D) , and its efficacy has been recognized, but the mechanism is unclear and relevant studies are rare.

Objective

To explore the potential mechanism of Huangqi Jianzhong Decoction in the treatment of IBS-D based on network pharmacology and molecular docking.

Methods

TCMSP database was adopted to acquire the active ingredients and corresponding targets of all herbals in Huangqi Jianzhong Decoction. And targets related to IBS-D were identified using GeneCards, OMIM, TTD, Drug Bank and PharmGKB databases. Then the intersection of herbal targets and IBS-D-related targets were selected to obtain the potential therapeutic targets of Huangqi Jianzhong Decoction for IBS-D. Cytoscape, String and Metascape were used to construct an "herbals-active ingredients-target" network map, draw the protein-protein interaction network (PPI) , and conduct genetic ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. AutoDock Vina and PyMOL were used for the visualization of molecular docking results.

Results

Finally, we obtained 123 active ingredients and 247 potential targets of Huangqi Jianzhong Decoction, 3 486 IBS-D related targets, and 180 intersected herbals targets and IBS-D-related targets. A total of 2 376 items of biological process, 194 items of molecular function and 115 items of cellular component were identified through GO enrichment analysis. Enrichment analysis of KEGG signaling pathway revealed MAPK, NF-κB, cAMP, estrogen and other related signal pathways. The molecular docking results showed that the main active ingredients of Huangqi Jianzhong Decoction in the treatment of IBS-D are quercetin, kaempferol, β-sitosterol, isorhamnetin, formononetin, stigmasterol, calycosin, 7-O-methylisomucronulatol, and they showed good binding to core proteins AKT1, TP53, TNF, IL-6, CASP3, IL-1B, EGFR and CTNNB1.

Conclusion

Therefore, we speculated that Huangqi Jianzhong Decoction may plays a role in the treatment of IBS-D by enhancing intestinal barrier function, reducing visceral hypersensitivity, reducing inflammatory response and regulating intestinal flora.

Evidence for Optimization

Summary of the Best Evidence for Enteral Nutrition Support in Adults with Severe Brain Injury

Wenchao GUO, Hanzhi QIN, Jiao TENG, Kui JIN, Jian SUN, Zhongli WANG, Yan JIANG

2022, 25(15):  1825-1832.  DOI: 10.12114/j.issn.1007-9572.2022.0055

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Background

Enteral nutrition support can effectively improve the nutritional status of patients with severe brain injury, which is beneficial to the prognosis of patients. However, the relevant literature in China and abroad lacks a systematic nutritional management plan for such patients, and there is rare summary of the best evidence for enteral nutrition support.

Objective

To retrieve and summarize the best evidence of enteral nutrition support in adult patients with severe brain injury, and provide evidence-based evidence for the clinical nutrition management of such patients.

Methods

All evidence on enteral nutrition in adult patients with severe brain injury was retrieved from databases and websites including BMJ Best Practice, Up To Date, GIN, NICE, NGC, RNAO, Yimaitong, ESPEN, ASPEN, SCCM, ESICM, JBI Library, Cochrane Library, PubMed, EMBase, CINAHL, CBM, CNKI, Wanfang Data, VIP. The retrieved evidence included guidelines, evidence summaries, best practices, expert consensus, systematic reviews and meta-analysis. The retrieval period was from April 2011 to April 2021. Corresponding quality evaluation criteria were used to evaluate the quality of the included literature, and the evidence was described and summarized using the JBI Evidence-based Health Care Center Evidence Pre-grading System (2014 edition) and JBI Evidence Recommendation Rating System (2014 edition) .

Results

A total of 18 articles were included, including 5 clinical guidelines, 3 evidence summaries, 3 expert consensus, 2 systematic reviews, and 5 meta-analysis. Their methodological qualities were rated high overall. Finally 25 pieces of best evidence involving 8 aspects were nutrition screening, nutrition assessment, timing of initiating enteral nutrition, energy and protein requirements, enteral nutrition composition, feeding route, infusion method and complication management.

Conclusion

When giving enteral nutrition to adult patients with severe brain injury, medical staff need to implement it based on the best evidence. At the same time, an individualized enteral nutrition support program should be formulated in combination with the current medical status and specific treatment goals in China to improve the effect of nutritional support, thereby improving the clinical outcome of patients.

Article

Prevalence and Influencing Factors of Comprehensive Disability in Empty and Non-empty Nesters

Jiaojiao CHENG, Beibei LIU, Yun SU, Yangyang ZHANG, Shuhan WANG, Han ZHANG, Zongshang OUYANG, Qingfeng TIAN

2022, 25(15):  1833-1837,1844.  DOI: 10.12114/j.issn.1007-9572.2022.0048

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Background

Disability influences physical and mental health of older people, and causes a heavy burden on family and society. The increasing prevalence of empty-nested phenomenon has aroused wide concern for empty and non-empty nesters.

Objective

To investigate the prevalence and associated factors of comprehensive disability in empty and non-empty nesters in Henan, providing a scientific basis for the prevention and control of disability among these people.

Methods

By use of multistage stratified sampling, 5 570 older people aged ≥60 years were selected from Henan's 18 provincial cities from January to September 2019 for a questionnaire survey. The comprehensive ability of them was assessed by using the Ability Assessment for Older Adults Scale developed by the Ministry of Civil Affairs of the People's Republic of China. Binary Logistic stepwise regression analysis was used to identify the factors associated with comprehensive disability.

Results

The participants included 3 731 empty nesters and 1 839 non-empty nesters. The prevalence of intact comprehensive ability, and comprehensive disability in empty nesters was 51.97% (1 939/3 731) , and 48.03% 〔1 792 (1 417 mild, 217 moderate, and 104 severe) /3 731〕, respectively. The prevalence of intact comprehensive ability, and comprehensive disability in non-empty nesters was 44.64% (821/1 839) , and 55.36% 〔1 018 (820 mild, 123 moderate, and 75 severe) /1 839〕, respectively. Empty nesters had lower prevalence of comprehensive disability than did non-empty nesters (χ²=26.448, P<0.001) . Empty and non-empty nesters had significant differences in sex ratio, age distribution, marital status, education level, monthly income, financial support from children, prevalence of disability and accidents (P<0.05) . Stepwise binary Logistic regression analysis showed that age, prevalence of disability and accidents as well as number of chronic diseases were associated with comprehensive disability prevalence in both empty and non-empty nesters, and the specific corresponding data with values of OR and 95%CI were as follows: age 〔70-79 years, OR=1.590, 95%CI (1.373, 1.842) ; ≥80 years, OR=2.429, 95%CI (1.934, 3.050) 〕, disability 〔OR=3.803, 95%CI (2.924, 4.947) 〕, accidents 〔OR=2.747, 95%CI (2.101, 3.591) 〕, and number of chronic diseases 〔4-7, OR=6.549, 95%CI (3.736, 11.482) 〕were associated with comprehensive disability prevalence in empty nesters (P<0.05) . Age〔70-79 years, OR=1.357, 95%CI (1.084, 1.699) ; ≥80 years, OR=3.784, 95%CI (2.820, 5.076) 〕, disability〔OR=3.523, 95%CI (2.413, 5.145) 〕, accidents〔OR=2.789, 95%CI (1.962, 3.965) 〕 and number of chronic diseases 〔4-7, OR=2.997, 95%CI (1.460, 6.151) 〕 were associated with comprehensive disability prevalence in non-empty nesters (P<0.05) . In addition, comprehensive disability prevalence in empty nesters was also affected by education level 〔primary school: OR=0.748, 95%CI (0.629, 0.890) ; middle school: OR=0.776, 95%CI (0.634, 0.949) 〕, and financial support from children〔OR=1.318, 95%CI (1.146, 1.516) 〕 (P<0.05) . And comprehensive disability prevalence in non-empty nesters was also influenced by marital status 〔unmarried/divorced/widowed: OR=1.291, 95%CI (1.047, 1.592) 〕 and monthly income 〔1 001-2 000 yuan: OR=0.574, 95%CI (0.443, 0.743) 〕 (P<0.05) .

Conclusion

The associated factors of comprehensive disability prevalence for Henan's empty and non-empty nesters were not completely the same. Age, prevalence of disability, and accidents as well as number of chronic diseases were associated with comprehensive disability in both of them. Other associated factors of comprehensive disability were education level and financial support from children for empty nesters, and were marital status and monthly income for non-empty-nesters. So targeted interventions delivered to these two groups should be different.

Impact of Average Daily Temperature on Stroke Mortality in Community: a Time-series Analysis

Yichen CHEN, Hua CHEN, Xiaobin QU, Lianghong SUN, Hanyi CHEN, Xiaopan LI, Li PENG, Wanghong XU, Yi ZHOU

2022, 25(15):  1838-1844.  DOI: 10.12114/j.issn.1007-9572.2022.02.017

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Background

With the increasing frequency of extreme weather events due to global climate change, the impact of air temperature on stroke deaths is gaining increasing attention.

Objective

This study aimed to evaluate the impact of average daily temperature on stroke mortality in Pudong New Area.

Methods

Data were collected from Pudong New Area from January 1, 2005 to December 31, 2019, including deaths due to stroke (hemorrhagic stroke and ischemic stroke) , meteorological information (air temperature, relative humidity, atmospheric pressure) , atmospheric pollutants 〔particulate matter 10 (PM₁₀) , sulfur dioxide (SO₂) and nitrogen dioxide (NO₂) 〕. We used a distributed lag non-linear model (DLNM) to evaluate the impact of average daily air temperature on stroke mortality, and assess the lagged and cumulative effects. Age- and education attainment-specific analyses were performed to identify the susceptible groups.

Results

During the period, a total number of 30 337 deaths from stroke were reported in Pudong New Area of Shanghai, and the deaths due to hemorrhagic stroke and ischemic stroke numbered 11 221 (36.99%) and 15 308 (50.46%) , respectively. The average daily deaths from stroke, hemorrhagic stroke and ischemic stroke were 5.54, 2.05 and 2.79, respectively. The average daily temperature, relative humidity and air pressure in Pudong New Area were 17.25 ℃, 73.75%, and 1 015.83 hPa, respectively. The average daily concentrations of PM₁₀, SO₂ and NO₂ were 68.87 μg/m³, 28.82 μg/m³, and 44.68 μg/m³, respectively. Using the average median daily temperature (P₅₀=18.2 ℃) as a reference, the strongest cumulative effects of low temperature (P₅=3.0℃) were observed within 0-14 days lagged (Lag 0-14) for stroke mortality〔RR=1.34, 95%CI (1.15, 1.56) 〕 and hemorrhagic stroke mortality〔RR=1.61, 95%CI (1.25, 2.08) 〕. The impact of low temperature on stroke mortality and hemorrhagic stroke mortality was significantly lagged and cumulated, but its impact on ischemic stroke mortality was not significant. The strongest cumulative effects of high temperature (P₉₅=30.1 ℃) on stroke mortality 〔RR=1.26, 95%CI (1.12, 1.41) 〕 and ischemic stroke 〔RR=1.64, 95%CI (1.39, 1.93) 〕 were observed within 0-1 day lagged (Lag 0-1) . High temperature imposed an acute effect on stroke mortality and ischemic stroke mortality, but produced insignificant effect on hemorrhagic stroke mortality. No significant impact of low temperature was observed on stroke mortality in population < 75 years old, but the impact on stroke mortality in population≥ 75 years old was strongest within Lag 0-14 d. The strongest impacts of low temperature on stroke mortality in population with primary education or below, and in population with secondary education or above were observed within Lag 0-21 d and Lag 0-14 d, respectively. No significant impact of high temperature was observed on stroke mortality in population < 75 years old and population with secondary education and above, but the impact was the strongest on stroke mortality in population ≥ 75 years old and the population with primary education or below within Lag 0-1 d. The impact of high temperature on stroke mortality in population with primary education or below was significantly higher than that in population with secondary education and above within Lag 0-3 d (P<0.05) .

Conclusion

Both low and high temperatures were associated with the stroke mortality risk in Pudong New Area. Low temperature increased the risk of death from hemorrhagic stroke, while high temperature increased the risk of death from ischemic stroke. People with primary education or below were more likely to die from strokes in hot environments.

Relationship of Triglyceride-glucose Index with Coronary and Carotid Atherosclerosis

Xin BAO, Changhong LU, Yuan ZHAO, Xiaoli GUAN, Qianwen NIE, Wenxia LIANG, Jing ZHANG, Zhengyi ZHANG

2022, 25(15):  1845-1849.  DOI: 10.12114/j.issn.1007-9572.2022.02.026

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Background

Triglyceride-glucose (TyG) index is a relatively good predictor of insulin resistance, an indicator that is associated with atherosclerosis. There are few studies on the correlation between TyG index and symptomatic coronary artery disease (CAD) . And there is no evidence definitely determining the relationship between TyG index and carotid atherosclerosis in the elderly.

Objective

To perform an analysis of the relationship of TyG index with coronary and carotid atherosclerosis, to assess its predictive value for large artery atherosclerosis.

Methods

A single-center retrospective design was used. Inpatients with suspected CAD in Lanzhou University Second Hospital were enrolled from January 2018 to January 2021. General clinical characteristics, carotid ultrasonography and coronary angiography results obtained from the electronic hospital information system, as well as calculated TyG index, Framingham Risk score, and Gensini score were collected.

Results

A total of 1 232 cases were enrolled. Correlation analysis showed that the Framingham Risk score, risk of CAD, obstructive CAD, and Gensini score increased with the growth of TyG index value (P<0.01) either in high TyG index (mean value≥9.05, n=616) or low TyG index (mean value <9.05, n=616) group of patients, but had no association with carotid atherosclerosis, mean intimal media thickness (IMT) and carotid plaque score (cPS) (P>0.05) ; CAD and obstructive CAD were positively correlated with carotid atherosclerosis, mean IMT, cPS and Framingham risk score (P<0.001) . Binary Logistic regression analysis showed that high TyG index was associated with increased risk of CAD〔OR=1.385, 95%CI (1.123, 1.707) , P<0.01〕 and obstructive CAD〔OR=1.255, 95%CI (1.034, 1.523) , P<0.05〕.

Conclusion

TyG index was correlated with coronary atherosclerosis, and its increase was associated with enhanced risk of CAD and obstructive CAD, but had no correlation with carotid atherosclerosis. The relationship between TyG index and carotid atherosclerosis still needs to be confirmed by prospective studies.

Mediating Effect Analysis of Visceral Adiposity Index on Serum Uric Acid to Creatinine Ratio and Metabolic Syndrome in People with Normal Thyroid Function

Huanxin LIU, Cuiqiao MENG, Qian NIE, Chunhong YU, Yuling XING, Zhongli WANG, Chenghao LIU, Huijuan MA

2022, 25(15):  1850-1856.  DOI: 10.12114/j.issn.1007-9572.2022.02.028

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Background

The yearly prevalence of metabolic syndrome (MS) is increasing in China. Although the level of serum uric acid (SUA) is closely related to MS, due to the influence of renal function on SUA, standardized SUA 〔SUA/serum creatinine ratio (SUA/Scr) 〕 may be a better predictor for MS. Visceral adiposity index (VAI) , as an important indicator for estimating visceral fat accumulation, could be used to predict MS more directly. However, few studies have explored whether VAI mediates the association between SUA/Scr ratio and MS in euthyroid population.

Objective

To explore the mediating effect of VAI on SUA/Scr ratio and MS in people with normal thyroid function.

Methods

A total of 10 042 annual health examinees were selected from the Health Examination Center, Hebei General Hospital from January 2020 to June 2021. The basic demographic information, physical examination and biochemical parameters, as well as calculated SUA/Scr ratio and VAI were collected. MS was diagnosed according to the criteria recommended by Chinese Diabetes Society. The risk of MS was analyzed by quartiles of SUA/Scr ratio (Q1-Q4 quartiles) , and VAI (V1-V4 quartiles) , respectively. Pearson correlation analysis was used to explore the association between SUA/Scr ratio and VAI. Multivariate Logistic regression analysis was used to explore the association of SUA/Scr ratio and VAI with MS. Bootstrap was used to explore whether VAI mediated the association between SUA/Scr ratio and MS.

Results

Of the 10 042 participants, 1 833 (18.25%) had MS and 8 209 (81.75%) did not. Pearson correlation analysis showed that SUA/Scr ratio was positively associated with VAI (P<0.05) . Multivariate Logistic regression analysis indicated that compared with Q1 group, the risk of MS significantly increased in Q2 group〔OR=1.310, 95%CI (1.039, 1.651) 〕, Q3 group〔OR=1.372, 95%CI (1.089, 1.729) 〕, and Q4 group〔OR=1.744, 95%CI (1.381, 2.203) 〕 (P<0.05) . Compared with V1 group, the risk of MS notably increased in V3 group〔OR=6.721, 95%CI (4.600, 9.819) 〕 and V4 group〔OR=33.327, 95%CI (21.509, 51.640) 〕 (P<0.01) . Mediating effect analysis indicated that SUA/Scr ratio significantly, directly influenced MS prevalence〔β=0.154, 95%CI (0.104, 0.205) 〕, and VAI partly mediated the indirect effect of SUA/Scr ratio on MS prevalence〔β=0.183, 95%CI (0.156, 0.213) 〕, and the mediating effect accounted for 54.25% of the total effects.

Conclusion

Both SUA/Scr ratio and VAI were predictors of MS, and VAI partly mediated the indirect effect of SUA/Scr ratio on MS prevalence in population with normal thyroid function.

Effect of Modified Tai Chi on Gait Balance and Fall Performancein Hemiplegic Patients in Convalescent Period of Stroke

Qiang TANG, Xue WANG, Bingyao LI, Sha SHA, Luwen ZHU

2022, 25(15):  1857-1862.  DOI: 10.12114/j.issn.1007-9572.2022.0043

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Background

Hemiplegia patients in the convalescent period of stroke generally have gait, balance dysfunction and the risk of falling, which seriously affects their daily living ability and prognosis. Traditional exercise therapy such as Tai Chi can play its unique advantages as an intervention, but there are different practice routines and insufficient evidence of evidence-based medicine, which limit its clinical application.

Objective

To observe the effect of modified Tai Chi on the disorder of gait and balance and fall efficacy in patients with hemiparesis in convalescent stage of stroke.

Methods

A total of 68 patients with hemiplegia in the convalescent stage of stroke who were admitted to the Second Affiliated Hospital of Heilongjiang University of Chinese Medicine from June 2020 to July 2021 were selected and divided into an observation group (n=34) and a control group (n=34) by random number table method. On the basis of routine rehabilitation treatmentonboth groups, the control group received motor relearning program (MRP) , whereas the observation group received modified Tai Chi intervention, once a day, 30 min a time, and 5 days a week, for 8 weeks. The two groups were assessed before and after the intervention using Fugl-Meyer assessment of lower extremity (LE-FMA) , 6-min walking test (6MWT) , Berg Balance Scale (BBS) , timed up and go test (TUGT) , modified Barthel index (MBI) , step length, frequency and speed, and modified fall efficacy scale (MFES) .

Results

One case dropped out in the observation group, and a total of 33 cases were included, while there was no dropout in the control group, and a total of 34 cases were included. There was no significant difference between the two groups on the results of LE-FMA, 6MWT, BBS, TUGT, MBI, step length, frequency and speed, and MFES before the treatment (P>0.05) . No significant difference was found in TUGT time and step length between the two groups after the treatment (P>0.05) . However, after the treatment, LE-FMA, BBS, MBI, MFES scores, step frequency and speed in the observation group were higher than those in the control group, and 6MWT walking distance was longer (P<0.05) . Furthermore, LE-FMA, BBS, MBI, MFES scores, step frequency and speed after treatment were higher than those before treatment, 6MWT walking distance was longer and TUGT time was shorter than that before treatment (P<0.05) .

Conclusion

Modified Tai Chi can effectively improve gait and balance disorder and fall efficacy in patients with hemiparesis in the convalescent stage of stroke.

Association of Cyclic RNAs with the Risk of Type 2 Diabetes Mellitus in Han Chinese

Jiehong KANG, Xiangyun CHANG, Yurong ZHU, Tao BA, Yuan SUN

2022, 25(15):  1863-1868.  DOI: 10.12114/j.issn.1007-9572.2022.02.013

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Background

The prevalence of diabetes is increasing year-on-year. However, current diagnostic methods have many deficiencies in early identification of type 2 diabetes mellitus (T2DM) . Epigenetic factors may be associated with the development and secretory function of pancreatic islet β cells, which reduces the sensitivity of the body to the effects of insulin, ultimately leading to the development of T2DM.

Objective

To identify differentially expressed hsa_circ_0005414, hsa_circ_0139634, hsa_circ_0032491 and hsa_circ_0002922 in the peripheral blood of Han Chinese patients with T2DM to assess the clinical significance, and to explore the relationship between candidate circRNAs and T2DM in Han Chinese.

Methods

From the Department of Endocrinology and Metabolism, the First Affiliated Hospital of Shihezi University School of Medicine between September 2020 and June 2021, 21 Han Chinese patients with T2DM were selected. 22 healthy examinees were also selected as controls. Glucose metabolism indices and expression levels (2^-ΔΔCT) of the four candidate circRNAs were measured. The relationship between expression levels of candidate circRNAs and glucose metabolism indices was explored using multiple linear regression analysis. Univariate Logistic regression analysis was used to explore the correlation of expression levels of candidate circRNAs with the risk of T2DM. Receiver operating characteristic (ROC) curve analysis was used to assess diagnostic values of these candidate circRNAs for T2DM.

Results

T2DM patients had higher relative expression levels of hsa_circ_0032491 and hsa_circ_0002922, and lower relative expression levels of hsa_circ_0005414 and hsa_circ_0139634 than did the controls (P<0.05) . Multiple linear regression analysis showed that fasting plasma glucose and Log₂-transformed fasting insulin were associated with the expression level of hsa_circ_0032491 in Chinese Han with T2DM (P<0.05) , with an R²=0.503. The areas under the ROC curves of hsa_circ_0005414, hsa_circ_0139634, hsa_circ_0032491, and hsa_circ_0002922 for the diagnosis of T2DM in Chinese Han were 0, 0.199, 0.968, and 0.844, respectively. Univariate Logistic regression analysis showed that elevated relative expression levels of hsa_circ_0139634 may be associated with reduced risk of T2DM 〔OR=0.092, 95%CI (0.016, 0.520) , P=0.007〕, while elevated relative expression levels of hsa_circ_0032491〔OR=3.607, 95%CI (1.625, 8.004) , P=0.002〕 and hsa_circ_0002922〔OR=5.105, 95%CI (1.683, 15.482) , P=0.004〕 may be associated with increased risk of T2DM.

Conclusion

hsa_circ_0032491 and hsa_circ_0002922 could be used as biomarkers for T2DM in Han Chinese. hsa_circ_0139634, hsa_circ_0032491 and hsa_circ_0002922 could be independent predictors of T2DM in Han Chinese population. An increase in the relative expression level of hsa_circ_0139634 decreased the risk of T2DM, while an increase in the relative expression levels of hsa_circ_0032491 and hsa_circ_0002922 increased the risk of T2DM, suggesting that these three candidate circRNAs may play an important role in the development of T2DM.

Ultrasonographic Analysis of Primary Thyroid Lymphoma

Xiangliu OUYANG, Bei GAO, Yanbin WANG, Liyun LIU, Cheng GU, Lichun ZHENG

2022, 25(15):  1869-1874.  DOI: 10.12114/j.issn.1007-9572.2022.02.004

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Background

Primary thyroid lymphoma (PTL) is a rare type of extranodal lymphoma, which is prone to misdiagnosis and missed diagnosis due to atypical clinical and ultrasonic features.

Objective

To summarize and analyze the features of 2-D ultrasonography and contrast-enhanced ultrasonography in PTL.

Methods

A retrospective, comparative analysis was conducted on ultrasonographic features of 16 patients with pathologically confirmed PTL (PTL group) and 16 thyroid cancer patients (thyroid cancer group) recruited from Tangshan Gongren Hospital during December 2012 to December 2020.

Results

Pathological results of PTL group: 10 cases were diffuse large B-cell lymphoma, 4 cases were mucous-associated lymphoid tissue extranodular marginal zone B-cell lymphoma, 1 case was follicular lymphoma, and 1 case was Burkitt lymphoma. Pathological results of thyroid cancer group: 11 cases were papillary carcinoma, 4 cases were follicular carcinoma and 1 case was medullary carcinoma. The rate of thyroid enlargement in PTL group was higher than that in thyroid cancer group (13/16 vs 5/16) (χ²=8.127, P<0.05) . PTL group also had higher rate of posterior echo enhancement (14/16 vs 3/16) (χ²=15.184, P<0.05) . Besides that, PTL group had lower calcification rate (0) than thyroid cancer group did (10/16) (χ²=14.545, P<0.05) . PTL and thyroid cancer groups had statistically differences in lesion morphology and margins (χ²=10.165, P<0.05) as 13 PTL cases had lesions with regular morphology and well-defined margins, and 12 thyroid cancer cases had lesions with irregular morphology and ill-defined margins. The rate of increased blood flow signals within the lesions showed no significant difference between PTL group and thyroid cancer group (7/16 vs 3/16) (χ²=3.327, P>0.05) . PTL and thyroid cancer groups also had no statistically significant difference in the rate of cervical lymph node metastases (8/16 vs 11/16) (χ²=1.166, P>0.05) . Contrast-enhanced ultrasonography showed high enhancement during arterial and venous phases in PTL, and low enhancement at arterial and venous phases in thyroid cancer.

Conclusion

PTL has specific ultrasonic manifestations. A diagnosis of PTL could be made when a patient manifests as thyroid enlargement, diffuse hypoechoic, non-calcified, regular-shaped lesions with well-defined margins and posterior echo enhancement, and high enhancement at arterial and venous phases.

Medicinal Flavor of Fecal Microbiota and Efficacies of Its Transplantation in Mice with Different Types of Ulcerative Colitis

Xiaofei MA, Jiali HU, Manman CUI, Wei GE, Suqin YANG, Chenghua DING, Leichang ZHANG

2022, 25(15):  1875-1882.  DOI: 10.12114/j.issn.1007-9572.2022.02.025

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Background

As an intractable disease recognized by the WHO, current available treatments have limitations for ulcerative colitis (UC) . Although the effectiveness of fecal microbiota transplantation (FMT) has been confirmed, the reported efficacies are various.

Objective

To compare the effect of FMT between a mouse model of common UC and a mouse model of damp-heat UC, and the medicinal flavor of fecal microbiota (new jinzhi) .

Methods

This experiment was implemented from December 9th to 28th, 2019. Thirty-five male SPF C57BL/6 mice were equally divided into seven groups: normal control group (no intervention) , common UC model (CUCM) group (received interventions to be a CUCM according to the requirements) , CUCM+FMT group (received interventions to be a CUCM successfully, then received an enema of 0.2 ml prepared fecal microbiota solution) , CUCM+5-aminosalicylic acid (5-ASA) group (received interventions to be a CUCM successfully, then received an enema of 0.019 5 g/ml 5-ASA) , damp-heat UC model (DUCM) group (received interventions to be a DUCM according to the requirements) , DUCM+FMT group (received interventions to be a DUCM successfully, then received an enema of 0.2 ml prepared fecal microbiota solution) , and DUCM+5-ASA group (received interventions to be a DUCM successfully, then received an enema of 0.019 5 g/ml 5-ASA) . The intestinal tissues of each group of mice were taken out when the experiment ended, and were stained with H&E for observing the morphology, and ultrastructure of them was observed using transmission electron microscope, Th1 and Th2 cells in them were detected using flow cytometry, and microbial community in them were detected using high-throughput 16S rRNA gene sequencing. Routine blood test was conducted to measure the levels of white blood cell count (WBC) , red blood cell count (RBC) , platelet count (PLT) and hemoglobin (HGB) . Nimodipine method was used to evaluate the efficacy index before and after intervention.

Results

The mice in each group were successfully established. The morphology of intestinal tissues stained with H&E: the intestinal mucosal surface of CUCM group and DUCM group had different degrees of defect or shedding and necrosis, while the intestinal mucosa was basically intact in CUCM+FMT group, CUCM+5-ASA group, DUCM+FMT group and DUCM+5-ASA group. The DUCM+FMT group had more neatly arranged and compacted glands than did CUCM+FMT group. The ultrastructure of intestinal tissue observed using transmission electron microscope: the surface microvilli of epithelial cells in CUCM and DUCM groups were sparse with decreased goblet cells. The CUCM+FMT, CUCM+5-ASA, DUCM+FMT and DUCM+5-ASA groups had denser microvilli with more goblet cells. Compared with the CUCM+FMT group, the DUCM+FMT group had denser microvilli and more goblet cells. Th1 and Th2 cell contents: there were significant differences in Th1 and Th2 cell contents, WBC, RBC, PLT and HGB across all groups of mice (P<0.001) . Efficacy analysis: the efficacy index of CUCM+5-ASA group, DUCM+FMT group or DUCM+5-ASA group was better than that of CUCM+FMT group (P<0.05) . Microbial community analysis: the genus with significantly decreased abundance in CUCM and DUCM groups was Ruminococcus, and the increased abundance was Akkermansia. The CUCM+FMT and DUCM+FMT groups had a tendency of gradually increasing similarities to the control group, indicating that the intestinal flora of these two groups were improving.

Conclusion

FMT were effective for mice models of UC, especially for the mice model of damp-heat UC. The new jinzhi has a bitter and cold flavor, which may work by regulating the intestinal flora to improve the Th1/Th2 balance for therapeutic purposes.

Single Nucleotide Polymorphisms in the Mitochondrial Displacement Loop and Age at Onset of Gastric Cancer

Yingnan WANG, Chensi WU, Yue ZHAO, Fengbin ZHANG, Shaochen ZHANG, Zhanjun GUO, Ruixing ZHANG

2022, 25(15):  1883-1887.  DOI: 10.12114/j.issn.1007-9572.2022.02.003

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Background

It is very difficult to contain persistently high incidence and mortality rates of gastric cancer. Moreover, the age at onset of gastric cancer is becoming earlier. However, there are few studies on the prediction of the age at gastric cancer onset.

Objective

To investigate the relationship between single nucleotide polymorphisms (SNPs) in mitochondrial displacement loop (D-Loop) and age at gastric cancer onset.

Methods

A total of 150 patients with confirmed gastric cancer by pathologically examination of biopsy samples taken during gastroscopy were recruited from Department of Gastroenterology, the Fourth Hospital of Hebei Medical University between July 2007 and December 2008. PCR was used to amplify the targeted fragment of peripheral blood mitochondrial DNA, and the mitochondrial D-Loop region was sequenced. Survival curves for patients with different ages of onset of gastric cancer were plotted by the Kaplan-Meier method, and compared by the Log-rank test. Cox regression analysis was used to identify factors associated with age of onset of gastric cancer.

Results

The age of onset of patients with different degrees of education was statistically significant (P<0.05) . Log-rank test revealed that patients with 153G genotype had earlier age of onset of gastric cancer than did those with 153A genotype〔 (48.0±5.3) vs (60.1±0.8) 〕 (χ²=7.757, P=0.005) . Multivariate Cox regression analysis indicated that the 153A/G polymorphism in mitochondrial D-Loop was a predictor of age at onset of gastric cancer〔HR=0.323, 95%CI (0.140, 0.745) , P=0.008〕.

Conclusion

The 153A/G polymorphism in mitochondrial D-Loop may be used as a novel predictor of the age at onset of gastric cancer. Analyzing the SNPs in mitochondrial D-Loop may contribute to early identification of gastric cancer.

Evidence-based Medicine

Clinical Efficacy of Different Doses of Canagliflozin Combined with Metformin in the Treatment of Type 2 Diabetes Mellitus: a Meta-analysis

Yuying CHEN, Xiaodong LI, Yunzhao TANG, Daiqing LI

2022, 25(15):  1888-1896,1905.  DOI: 10.12114/j.issn.1007-9572.2022.0073

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Background

Canagliflozin (CANA) and metformin (MET) can both be used in the treatment of type 2 diabetes (T2DM) , but the clinical efficacy of combined use remains to be further clarified.

Objective

To elevate the efficacy and safety of CANA combined with MET in the treatment of T2DM, and to provide clinical reference for the treatment of T2DM.

Methods

A systematic review of published randomized controlled trials (RCTs) of 100 mg and/or 300 mg CANA combined with MET for T2DM performed in PubMed, Cochrane Library, EMBase, Clinical Trials.gov, CNKI Database, VIP Database, Wanfang Databases from inception to 18 April 2021 were retrieved by computer, and the included references were retrieved manually. After literature screening, data extraction and quality evaluation, meta-analysis was performed using RevMan 5.3 software.

Results

A total of 9 RCTs with 6 224 patients were included. Meta-analysis results showed that the levels of glycosylated hemoglobin (HbA_1c) , fasting blood glucose (FPG) , body weight, systolic blood pressure (SBP) , diastolic blood pressure (DBP) , and triacylglycerol (TG) in the 100 mg CANA combined with MET group and the 300 mg CANA combined with MET group were lower than placebo control group (P<0.05) . The levels of pancreatic β-cell function index (HOMA-β) , low-density lipoprotein cholesterol (LDL-C) , and high-density lipoprotein cholesterol (HDL-C) in the 100 mg CANA combined with MET group were higher than those in the placebo control group (P<0.05) . The levels of HbA_1c and SBP in the 300 mg CANA combined with MET group were lower than those in the active control group, and the level of HOMA-β was higher than that in the active control group (P<0.05) . The FPG, body weight, DBP and TG in the 100 mg CANA combined with MET group and 300 mg CANA combined with MET group were lower than those in the active control group, and the levels of LDL-C and HDL-C were higher than those in the active control group (P<0.05) . The incidence of reproductive system infection (female) in the 100 mg CANA combined with MET group was higher than that in the placebo control group (P<0.05) . The incidence of reproductive system infection (female) and osmotic diuresis-related adverse events in the 300 mg CANA combined with MET group was higher than that in the placebo control group (P<0.05) . The incidence of reproductive system infection (male) , reproductive system infection (female) , and osmotic diuresis in the 100 mg CANA combined with MET group and 300 mg CANA combined with MET group was higher than that in the active control group (P<0.05) .

Conclusion

100 mg and 300 mg of CANA combined with MET can effectively reduce HbA_1c and FPG levels, body weight, blood pressure and TG levels, and increase LDL-C and HDL-C levels in T2DM patients. For patients with T2DM poorly controlled by MET, it may be considered in combination with CANA, but attention should be paid to infection of the reproductive system. Therefore, high-quality large-sample trials are still needed to confirm the long-term safety of different doses of CANA combined with MET.

Influence of Physical Exercise Interventions during Pregnancy on Natural Childbirth: a Meta-analysis

Moufang JI, Ruobing LI, Kejing WEI, Fanhua ZENG

2022, 25(15):  1897-1905.  DOI: 10.12114/j.issn.1007-9572.2021.02.136

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Background

Natural childbirth is a normal physiological approach of human reproduction, while in China, the cesarean section rate has exceeded the upper limit recommended by the WHO by more than two times. As a nonpharmaceutical intervention facilitating natural childbirth, physical exercise should be valued by relevant departments.

Objective

To perform a meta-analysis of studies regarding effects of physical exercise interventions on promoting natural childbirth probability, and to attempt to recommend a better exercise scheme.

Methods

Randomized controlled trials (RCTs) about the effect of intrapregancy physical exercise versus routine care (health duration or irregular physical exercise) improving the probability of natural childbirth published between 1990 and 2021 were searched in databases of CNKI, SinoMed, CQVIP, PubMed, EMBase, Web of Science, and Cochrane Library. Meanwhile, the references of systematic reviews on relevant RCTs were also searched and reviewed. Data extraction and methodological quality assessment were conducted for the included studies. RevMan 5.2 was used for meta-analysis. GRADE was used to rate the quality of evidence concerning an outcome.

Results

A total of 30 studies with 3 910 subjects were included. Meta-analysis found that physical exercise interventions were superior to routine care in improving the natural childbirth rate〔RR=1.34, 95%CI (1.28, 1.40) , P<0.000 01〕. Subgroup analyses revealed that natural childbirth rate was improved the most by physical exercise intervention started later than 24 weeks of gestation, followed by that started at 13-24 weeks of gestation, and 12 or less than 12 weeks of gestation. With respect to the type of physical exercise, the natural childbirth rate was improved the most by pelvic floor muscle training, general sports lessons, gymnastics, aerobic exercise, birthing ball movement, and yoga. As for the frequency of physical exercise, the natural childbirth rate was improved the most by at least 12 times per week, followed by 3-5 times per week, 6-8 times per week, and 9-11 times per week. In terms of the intensity of physical exercise, the natural childbirth rate was improved the most by moderate intensity of physical exercise. With regard to the duration of physical exercise, the natural childbirth rate was improved the most by physical exercise lasting for 30-<50 minutes per time, followed by less than 30 minutes per time, and at least 50 minutes per time. In respect to the number of weeks of conducting physical exercise, the natural childbirth rate was improved the most by physical exercise lasting for 8 or less than 8 consecutive weeks, followed by l7-24 weeks, 9-16 weeks, and 25-34 weeks. Funnel plot assessing publication bias of the studies was basically symmetrical in shape, indicating that the publication bias was generally weak. The overall quality of evidence concerning improvements in natural childbirth rate by physical exercise interventions in the studies was rated moderate.

Conclusion

The results show that proper physical exercise during pregnancy favorably affects the probability of natural childbirth. The natural childbirth probability could be positively influenced by some types of moderate-intensity physical exercise interventions, such as pelvic floor muscle training, general sports lessons, gymnastics, aerobic exercise, birthing ball movement, and yoga, if they are performed at least 12 times per week (30-<50 minutes each time) within 8 consecutive weeks after 24 weeks of gestation.

Research of Typical Cases

Pyoderma Gangrenosum with Crohn's Disease Presenting as a Giant Foot Ulcer: a Case Report and Literature Review

Hongyu HUANG, Tiantian LEI, Hongsheng MA, Renwei HU, Jinlin YANG

2022, 25(15):  1906-1909.  DOI: 10.12114/j.issn.1007-9572.2022.02.019

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Foot ulcers can be caused by a variety of causes, and identifying the causes is essential for treatment and prognosis. Pyoderma gangrenosum is an uncommon neutrophilic dermatosis that often accompanied by systemic diseases. The initial lesions of pyoderma gangrenosum is inflammatory papules or pustules, which rapidly progress to painful ulcers. Pyoderma gangrenosum are easily confused with local infectious diseases and diabetic feet, but the treatment options are completely different. Therefore, early and rapid diagnosis is crucial. This article reported on the diagnosis and treatment of a patient with pyoderma gangrenosum in association with Crohn's disease presenting as a giant foot ulcer, and reviewed the literature to improve clinicians' understanding of the disease and reduce misdiagnosis and mistreatment.

Rebound Hyperkalemia in Patients with Thyrotoxic Periodic Paralysis: Three Cases Reports and Literature Review

Haixia YUAN, Chunyan HE, Jing ZHANG, Feng ZHOU

2022, 25(15):  1910-1913.  DOI: 10.12114/j.issn.1007-9572.2022.0037

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Thyrotoxic periodic paralysis (TPP) is an endocrine emergency caused by thyrotoxicosis, mainly manifesting as periodic muscle weakness and hypokalemia, which seriously threatens the health of patients. The level of hypokalemia is closely related to the severity of muscle weakness in patients with TPP, and potassium supplementation can quickly alleviate the symptom of muscle weakness and hypokalemia. However, excessive potassium supplementation can lead to acute rebound hyperkalemia in patients with TPP, which also threatens the health of patients. This article reported 3 cases of TPP patients with acute rebound hyperkalemia caused by excessive potassium supplementation, and analyzed the risk factors for rebound hyperkalemia, in order to provide more information for the clinical treatment of TPP patients.

Review

Advances in Diagnosis and Management of Acute Kidney Injury Induced by Crush Syndrome

Jinxiang WANG, Yuxin DONG, Yibo ZHAO, Xianglong MENG, Yanfen CHAI, Heng JIN

2022, 25(15):  1914-1918.  DOI: 10.12114/j.issn.1007-9572.2021.02.132

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Crush syndrome (CS) often occurs in victims of natural disasters, trauma and traffic accidents, which mainly manifests as hypovolemic shock, acute kidney injury (AKI) , hyperkalemia, and acidosis, among which AKI is a major cause of the continuing high mortality of CS. Current treatments for AKI induced by CS include early rehydration, symptomatic treatment and renal replacement therapy, but the effects are not satisfactory. There are no standard treatment options for CS-related AKI, so identifying the pathogenesis of this disease and formulating an effective treatment regimen may be problems need to be solved urgently. This article reviews the latest advances in pathogenesis and treatment strategies of CS-related AKI.

New Developments in the Role of Lactobacillus Reuteri in Regulating Intestinal Barrier Function

Qiuyu CEN, Rizhao PANG, Xiaomin HU, Yanru CUI, Anren ZHANG

2022, 25(15):  1918-1922.  DOI: 10.12114/j.issn.1007-9572.2021.02.123

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The intestinal barrier plays a role in maintaining the stability of the intestinal environment, which relies on the dynamic regulation of the intestinal microbiota. Lactobacillusreuteri (L.reuteri) is a lactic acid bacterium reported to be naturally present in the intestines of almost all vertebrates and mammals, and has been shown to affect the function of the intestinal barrier and safeguard the health of body through various pathways. This paper reviews the role and possible mechanisms of action of L.reuteri in regulating intestinal physical, chemical, immune and microbial barrier functions, with the aim of providing a theoretical basis and new ideas for the clinical application of L.reuteri in treating related diseases.